----- Original Message -----
Sent: Thursday, October 05, 2006 7:24
PM
Subject: [ozmidwifery] No
Contractions
Hi Wise women,
Just want to throw this out there for
comments/suggestions. Had a birth the other night that was a bit worrying at
the time. Good outcome lovely 4200g baby girl. Mum (primip) had SROM at
clinic visit at 830 am then went home and established at about 1630, came in
contracting moderately at 1900hrs was 4-5cm , I took over her care at 2000hrs.
Lovely very motivated mum, well read and attended classes, well supported by
partner and mum and mum in law and sister. Ctx hotted up to 3-4 minutely and
stronger, was drinking well but had a few small vomits, and next UA showed
small ketones and SG 1.030, but was still drinking well and ctx remained
strong and regular so didnt want to put in a cannula. VE at 1130 showed an
anterior lip, still a bit thick. Wasnt able to wee again after that but head
was well down.
Was actively pushing with some ctx at 0100 with
signs of full dilatation (nice purple line!) Contractions really started to
drop off, became about 4minutely and only about 20secs of good strength. Mum
getting quite tired at this stage but more focussed and excited than earlier.
At this point I did put up some fluids as I thought with the ctx dropping off
combined with her fatigue she might need some hydration. She pushed babe up to
on view (birth stool) but made little more progress over next 20mins or so.
Fluids running in flat out but no sign of increased ctx. Babes HR started to
drop to around 80 which at first had good recovery , so I wasn't too worried
but after a while were staying there for a minute or so each time before
climbing back to 100. At this point with encouragement she managed to push bub
up to almost crowning and that was the last of the contractions!!! Obviously
not easy to get FH at this stage but was quite low and staying there. She had
not much strength left as she had done much of the work without help of ctx.
With a few position changes she got a little more
head out but then seemed to only move millimeter by millimeter....colour was
ok.... eventually after what seemed like 10 minutes I managed to push the peri
back to get a chin...then nothing no ctx...mum managed to push a little and I
got her to move from kneeling to standing then one leg up on bed....still
nothing... went onto bed and there was some movement with maternal effort (the
last of it!) the body birthed over almost three minutes, it was a pretty tight
fit with the shoulders coming in the lateral position, when a shoulder
appeared I gave it a push with two fingers to the anterior it moved just a
little into the oblique but then was finally out far enough for me to get a
little finger under the arm and finally managed to get her out! Apgars 7
and 10. but as it was so slow and there were no ctx to assist with her being a
big bub too, It was a bit hairy for a little while. Lucky she didnt have big
enough ears or they might have ended up a little stretched!! LOL. Second
stage was only 1hr 45min but I felt it was just way too slow birthing that
head and those shoulders! Perhaps I should have been more trusting?? I
hesitated in calling the Doc after an hour of pushing cause was on view at
this stage and I thought he would have been too late by the time he came in.
Probably would have been better to have him on standby just in case, I
suppose. I just felt quite helpless and know that things ended up quite
stressful for everyone in the room. I think I would have prefered to deal with
a shoulder dystocia at least then I would have had a practiced sequence of
events to go through!!
Thought she might get away without a tear as
birthed sooo slowly but peri went with the shoulders, 2nd degree peri tear (no
too big) and a anterior labial that wasnt too bad either.(thank goodness, was
after 3am by then, that time of night where you see double!) Did have
synto at birth but needed to get her to squat to get placenta and had a
constant trickle and (surprise surprise) a relaxed uterus, which was fine
after another shot of Syntometrine (450 loss).
My feelings are I probably should have been a
little more pro active in getting the fluids up, maybe I erred on the non
intervention side a little too long. Any other suggestions, how do you get a
bub out with no Ctx and a tired mum? She did try nipple stimulation with
little effect too.
Cheers
Di
