[ozmidwifery] No Contractions - ketone reference
Hi, An excellent article that explains the whole ketone story: Anderson, Tricia. Is ketosis in labour pathological? The Practising Midwife, Sept 1998 Vol 1 No 9. See also: Odent, Michel. Labouring women are not marathon runners. The Practising Midwife, September 1998, Vol 1 No 9 There is probably some useful references on Sarah Wickham's website - www.withwoman.co.uk Hope this helps Andrea At 04:15 PM 6/10/2006, you wrote: No Mary wasn't directing this at you or anyone in general really...just feel for Di...as think she did a great job as some hospital midwives would have thrown it in the too hard basket and called the doc for the vaccumm waay before; what with the fetal distress and all (tongue in cheek). And yep beating up on ourselves is a real midwife trait isn't it! Especially when you have rotton doctors and others putting their 2 cents worth in about you decsions! Can anyone think of the reference for the ketone thingy?.. LisaX -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] No Contractions
yes she also can see the funny side of it now. She thought I was nuts when I asked her where she wanted to have the baby because she was convinced she had hours to go because of her previous experiences The whole thing is so much fun sometimes Andrea On 07/10/2006, at 2:08 PM, Judy Chapman wrote: Fantastic story Andrea. As I am just starting in home birth I love hearing these variations from hospital stuff. Cheers Judy PS, bet she was pleased after the fact that you had not immediately jumped to ring an ambulance. --- Andrea Quanchi [EMAIL PROTECTED] wrote: Sometimes at home the women get just as despondent but the difference is that no one is going to walk through the door and under mine me and 'save' her. Last week I was with a women who was birthing at home after three very different and for a variety of reasons not so great labours.. She had done a hypno birthing course and used the tools beautifully and was so relaxed that I was not convinced that she was labouring despite her telling me that the contractions were getting stronger they were irregular and short.. She asked me to do a VE which showed her Cx to be 75% effaced but 2 cm and quite tight. This really annoyed her and when I suggested she rest she was opposed to this and so I suggested the alternative was to get up and get active and send her uterus the message that she wanted it to get into gear rather than the message that it was obviously getting from all her relaxation tapes, breathing etc. Almost immediately she started rocking and rotating her hips quite dramatically during contractions, she was in the kitchen with the lights on as opposed to being in the bedroom in the dark where she had been before. The response was dramatic and the contractions became co ordinated and strong and within 10 min she asked her partner to run the bath. She got in there and then became passive again lying on her back and struggling with quite strong contractions. It was quite funny actually as after about half an hour she opened one eye and told me I needed to call an ambulance as she couldn't do this any more and needed to go to the hospital. ( For those of you who haven;t been at a home birth women at home often ask to go to the hospital in exactly the same way as women in hospital often ask to go home). She made no move to get out of the bath and so at first I just ignored her but she became more insistent with each contraction so eventually I pointed out to her that she couldn't go anywhere while she remained lying in the bath and that if she wanted to go to the hospital she needed to get out of the bath and into the car as ambulances were for emergencies and this was not an emergency. She did stand up then and get out of the bath, leaned against me for two contractions as I helped her dry herself and then I asked her did she want to have the baby in the bedroom or in front of the fire in the lounge. She just looked at me and said the lounge. So we moved there, she leaned over the ball and had the baby. All this on 90 min since the VE. Andrea Quanchi On 07/10/2006, at 12:02 AM, Lisa Barrett wrote: Hi Sue, Thanks for sharing the information. Your right it is almost impossible to avoid active intervention when birthing in the system even with great midwives like yourself supporting. Part of the problem appears to be the lack of belief that waiting and doing nothing is going to work. Some multips don't have full on labour until transition. It is possible that when the head sits firmly on the cervix the contractions will pick up. I have not ever had to wait 12/15 mins from birth of a head to birth of a body. Physiology tells us that the uterus clamps down immediately after birth. I don't think you'd wait another 12/15 mins for the uterus to contract after the birth and that's if you don't do an active third stage. It is not so hard to do other things when sytno drip isn't an option and you have no-one but yourself and the woman to trust in ( no idiot specialist in complications when your the specialist in the normal I mean). I think I have the easy job when it comes to midwifery because I know I'm the specialist in normal and I don't answer to anyone on that score. Politics with birthing as far out of the system as I do is another thing altogether but in the birth space with women it isn't an issue. I chose to work like this because it's less waring than having to say F**k off to drs all the time. Lisa Barrett On Yahoo!7 Photos: Unlimited free storage – keep all your photos in one place! http://au.photos.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] No Contractions
Why only hanging around the door. I have had them come in and push me out to then tell the mother how to push and ''look I ''saved'' them! Barb -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lisa Gierke Sent: Friday, 6 October 2006 3:57 PM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] No Contractions In defence of Di...she obviously works in a hospital with registrar potentially hanging around the door..Sometimes 'best practice' may need to be modified to prevent the women from ending up with an instrumental birth..or synto...or an epidural ..or even a CS The lesser of two evils. The docs are not going to tolerate a 'rest be thankful' stage going on for hours espeically with decels in the fh!! (Yep even hospital midwives know about rest be thankful)So lets give her a break ...and walk in her shoes for abit heh! Does anyone think the contrations may have dropped of simply because she had a big baby and she was tired? Sounds like a more likely scenario to me than theories about overloading. Lisa Hi Di, Just a point on fluids in labour - if a woman is overloaded with fluid (via a drip) her system, vasopressin (antidiuretic hormone) will kick in to stop her body being flooded with fluid. This hormone is produced from the same source as oxytocin (posterior putuitary glad). Perhaps this was why the contractions dropped off. Why not let the woman herself dictate what she was drinking? As a rough guide, about 1 cup of fluid per hour is often suggested. The ketones in her urine (unless they are alarmingly high) are a sign that her body is working well and mobilising her fat stores to give her energy etc for labour. I agree that the rest and be thankful stage is often misunderstood - if a woman is lucky enough to get a break, especially in a strong labour, then she should not be robbed of it! I deliberately put this stage on the new Birth Day panels that I developed for teaching about second stage, because it is often glossed over in classes and women don't know about it. It is fantastic that you are seeking answers to these questions - that's the best way to learn - from experience! Warm regards, Andrea -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] No Contractions
Title: Message No Mary wasn't directing this at you or anyone in general really...just feel for Di...as think she did a great job assome hospital midwives would have thrown it in the too hard basket and called the doc for the vaccumm waay before; what with the fetal distress and all (tongue in cheek). And yep beating up on ourselves is a real midwife trait isn't it! Especially when you have rotton doctors and others putting their 2 cents worth in about you decsions! Can anyone think of the reference for the ketone thingy?.. LisaX -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Mary MurphySent: Friday, 6 October 2006 3:52 PMTo: ozmidwifery@acegraphics.com.auSubject: RE: [ozmidwifery] No Contractions Hi Lisa, there was definitely no intent of implied criticism when I said no should haves. Just a reminder that we beat up on ourselves all the time . OH maybe I should have, shouldnt have. etc. We each have to respond to the best of our clinical judgment, in the way we see it, at the time. It is hard to say I would do this when because there is no hard and fast rule, just that rush of adrenalin and a sense of alarm that makes us act. Sorry I cant elaborate further. I agree about the fluids. In fact quite a while ago I read some articles about the presence of keytones being normal in labour. sorry cant remember where. MM From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Lisa BarrettSent: Friday, 6 October 2006 1:19 PMTo: ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] No Contractions Sorry Mary If my language inferred "should have" but when would you get a woman to push without a contraction?. Exception maybe breech out to nape of neck with worries about the baby's condition. IV fluids doesn't constitute any part of normal physiological labour unless I've missed something vital. When asked for opinion in future I will refrain from giving any unless my language is less confrontational. Lisa Barrett - Original Message - From: Mary Murphy To: ozmidwifery@acegraphics.com.au Sent: Friday, October 06, 2006 8:17 AM Subject: RE: [ozmidwifery] No Contractions Di, It sounds as tho you managed a difficult situation in the best way you knew, and that is all one can do. You are now seeking to learn from it and we will obviously give you tips based on our experiences. Dont feel that you should have etc. Many midwifery authors in all kinds of natural birthing magazines like Midwifery Today etc, have spoken about the rest and recovery stage where the body needs to gather its strength for the final stage. It usually happens at the end of a demanding first stage and the woman showing signs of tiredness. I am old enough to remember doctors saying turn her on her side and give her a rest, Sis, in a time when IV fluids, synto drip and epidurals were available but not used so aggressively. At the transition between the first and second stage in a primip, the urge to push with each contraction needs to be resisted for a little while and breathed through, so that there is no pushing on a cervix that is not completely out of the way. We often cant reach that little bit at the back, but it is still there. We talk of an anterior lip, but there can be a posterior one too. The urge to push is triggered by the baby putting pressure on the nerves, even tho there is still a lip etc. Pushing without contractions is not usually the most productive thing, but as I said, you handled it the best way you knew how.remeber the discussion onundirected pushing? I am sure you will get lots of tips which will help us all in our practice no matter where we are. Cheers, MM
Re: [ozmidwifery] No Contractions
Title: Message
Thanks All, for your thoughts,
Not so sure it was rest and be thankful stage as
she had already had involuntary pushing happening for a while with the first bit
of second stage contractions that were only very short, and she had brought baby
down to on view at that stage, it was then they dropped right off and when bub
was almost crowning that they stopped. I didnt feel comfortable to have her sit
there with low FH and head 1/4 out!
Dont think there was a psychological block as she
had even stated earlier " i cant wait to feel that burning, stretching then I
know it is almost here"
We dont have on site doctors but have strict
criteria for transfer or to call in the consultant. We dont put up synto, that
would require transfer. I even thought about yelling BOO to scare her and get a
fetus ejection reflex!! : )
She had been self regulating her fluid intake, but
it could have been helpful to get some carbs, and usually I would do this but
she had been vomiting a reasonable amount and felt it best to stick with fluids,
perhaps some cordial could have helped.
Would love some good references on the Ketones too,
we get hounded badly about hydration.
Cheers,
Di
- Original Message -
From:
Lisa
Gierke
To: ozmidwifery@acegraphics.com.au
Sent: Friday, October 06, 2006 4:15
PM
Subject: RE: [ozmidwifery] No
Contractions
No
Mary wasn't directing this at you or anyone in general really...just feel for
Di...as think she did a great job assome hospital midwives would have
thrown it in the too hard basket and called the doc for the vaccumm waay
before; what with the fetal distress and all (tongue in cheek). And yep
beating up on ourselves is a real midwife trait isn't it! Especially
when you have rotton doctors and others putting their 2 cents worth in about
you decsions!
Can
anyone think of the reference for the ketone thingy?..
LisaX
-Original Message-From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Mary
MurphySent: Friday, 6 October 2006 3:52 PMTo:
ozmidwifery@acegraphics.com.auSubject: RE: [ozmidwifery] No
Contractions
Hi Lisa, there was
definitely no intent of implied criticism when I said no should
haves. Just a reminder that we beat up on ourselves all the time
. OH maybe I should have, shouldnt have. etc. We each have to
respond to the best of our clinical judgment, in the way we see it, at the
time. It is hard to say I would do this when because there is no
hard and fast rule, just that rush of adrenalin and a sense of alarm that
makes us act. Sorry I cant elaborate further. I agree
about the fluids. In fact quite a while ago I read some articles about
the presence of keytones being normal in labour. sorry cant remember
where. MM
From:
owner-ozmidwifery@acegraphics.com.au
[mailto:owner-ozmidwifery@acegraphics.com.au]
On Behalf Of Lisa
BarrettSent: Friday, 6
October 2006 1:19 PMTo:
ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] No
Contractions
Sorry Mary If my language
inferred "should have" but when would you get a woman to push without a
contraction?. Exception maybe breech out to nape of neck with worries about
the baby's condition.
IV fluids doesn't constitute any
part of normal physiological labour unless I've missed something
vital.
When asked for opinion in future
I will refrain from giving any unless my language is less
confrontational.
Lisa
Barrett
- Original Message -
From: Mary
Murphy
To: ozmidwifery@acegraphics.com.au
Sent:
Friday, October 06, 2006 8:17 AM
Subject: RE:
[ozmidwifery] No Contractions
Di, It sounds as
tho you managed a difficult situation in the best way you knew, and that
is all one can do. You are now seeking to learn from it and we will
obviously give you tips based on our experiences. Dont feel that
you should have etc. Many midwifery authors in all kinds of
natural birthing magazines like Midwifery Today etc, have spoken about the
rest and recovery stage where the body needs to gather its strength for
the final stage. It usually happens at the end of a demanding first
stage and the woman showing signs of tiredness. I am old enough to
remember doctors saying turn her on her side and give her a rest, Sis,
in a time when IV fluids, synto drip and epidurals were available but not
used so aggressively. At the transition between the first and second
stage in a primip, the urge to push with each contraction needs to
be resiste
RE: [ozmidwifery] No Contractions
That's right Barb...it's sometimes tempting to lock the bloody door! I too love the old 'cut an episiotomy' order as they are standing at the end of the bed (whilst directing the woman to push so much more effectively than you a mere midwife could)...serious dirty look often works with this one...or coming down with sudden onset of complete and total deafness! And this is what I mean...terrible midwife making woman suffer when the reg could have come in and dragged babe into the world with ventouse hours before...disgusting That's one good thing about nights as hopefully the said reg is somewhere sleeping like they should be and leaving the normal to us! -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of B G Sent: Friday, 6 October 2006 4:14 PM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] No Contractions Why only hanging around the door. I have had them come in and push me out to then tell the mother how to push and ''look I ''saved'' them! Barb -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lisa Gierke Sent: Friday, 6 October 2006 3:57 PM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] No Contractions In defence of Di...she obviously works in a hospital with registrar potentially hanging around the door..Sometimes 'best practice' may need to be modified to prevent the women from ending up with an instrumental birth..or synto...or an epidural ..or even a CS The lesser of two evils. The docs are not going to tolerate a 'rest be thankful' stage going on for hours espeically with decels in the fh!! (Yep even hospital midwives know about rest be thankful)So lets give her a break ...and walk in her shoes for abit heh! Does anyone think the contrations may have dropped of simply because she had a big baby and she was tired? Sounds like a more likely scenario to me than theories about overloading. Lisa Hi Di, Just a point on fluids in labour - if a woman is overloaded with fluid (via a drip) her system, vasopressin (antidiuretic hormone) will kick in to stop her body being flooded with fluid. This hormone is produced from the same source as oxytocin (posterior putuitary glad). Perhaps this was why the contractions dropped off. Why not let the woman herself dictate what she was drinking? As a rough guide, about 1 cup of fluid per hour is often suggested. The ketones in her urine (unless they are alarmingly high) are a sign that her body is working well and mobilising her fat stores to give her energy etc for labour. I agree that the rest and be thankful stage is often misunderstood - if a woman is lucky enough to get a break, especially in a strong labour, then she should not be robbed of it! I deliberately put this stage on the new Birth Day panels that I developed for teaching about second stage, because it is often glossed over in classes and women don't know about it. It is fantastic that you are seeking answers to these questions - that's the best way to learn - from experience! Warm regards, Andrea -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] No Contractions
Along the theme of slow labours: I just had a labouring mum with very slow contractions today. She came in in the night thinking she'd SROM'd but hadnot - was niggling all night with backache. This morning I reassessed and found intact forewaters and a posterior cervix which was a really stretchy multips os which could open easily to 6-7 cms. I encouraged food and walking/shower etc and she very reluctantly walked a bit but wanted to lie down instead despite the chronic backache. Explained that bub was OP and she needed good contractions to bring the head down but she was very half-hearted about it. Even gave her an enema!! (her choice) After a few hours I re-examined and did an ARM as she just wanted to get on with it - plus the OB would have come along and done that soon if I had not! Cx now up to 8cms and better applied, still OP. 3 hours later and still only contracting +-12minutely, we discussed synto as she was by now really 'over it' and refusing to get active. 30 minutes of synto at very low dose and we had a 9lb baby who rotated toOAin the final few minutes. She was drinking and eating as desired but was not keen to take much of either. I am not comfortable with weak, infrequent or no contractionsas it heightens the risk of uterine inertia post birth, shoulder dystocia and a compromised baby - The docs maintain that the fetal Ph drops (I think) 0.5 per minute sitting at crowning, which they learned at the obstetric emergencies seminar, so i also know that any of our obs will get very edgy if there is prolonged crowning. Sometimes you have to compromise what would be normal physiology with what you know would happen if obs took over. I wondered how I would have managed this in a home situaion, probably encouraged her to rest until things were established, and left alone - but we were not at home! So I agree with the points raised about hospital midwifery care and empathise with all who work withing similar restrictions. How would a homebirth midwife support this sort of labour? Sue -- Original Message - From: Michelle Windsor To: ozmidwifery@acegraphics.com.au Sent: Friday, October 06, 2006 10:10 AM Subject: Re: [ozmidwifery] No Contractions Hi Di, This reminds me of scenario that a cousin of mine had with her second bub. Her contractions basically stopped I think when she was fully and she did end up having some synto to get them going again. But what had happened was that the midwife (who said she could have bitten her tongue as soon as she said it!) said to her that she would probably have to work hard as she had a good size baby on board. My cousin said that she became really frightened and the contractions just died. I wonder if there was anything holding your woman back? Although you said she seemed excited and focussed. As far as her pushing without contractions, I think if you have a fetal bradycardia and possibly a compromised bub then it becomes priority to get the baby out. It might just be head compression, but it might not. Cheers Michelle diane [EMAIL PROTECTED] wrote: 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
Re: [ozmidwifery] No Contractions
Hi Sue, Without any malicious intent I'm again going to attempt an opinion. I don't routinely VE anybody and niggling backache alone with looking at the women would probably indicate to me that labour wasn't established. I would encourage her to carry on her normal routine but rest lots. I know it's hard and once woman present at the hospital they sometime feel it's labour and they should get on with it. I am always kind but say I think your body is preparing but not ready yet and you'll know when it is. The next VE you did you said stretchy multips os 6-7cm. Multips os suggests she's not in established labour so when her waters were broken ( know it was her choice so it's not a criticism of your practice at all) you tied her into an induction which is essentially what she ended up with. Weak infrequent contractions with nothing else wrong just means her body was taking time getting ready. After the ARM that's a different ball game. Shoulder dystocia isn't caused by weak contractions it's the bony shoulder against the bony pelvis so the shoulders are unable to move and maybe rotate into the optimal position for birth. Nothing heightens uterine inertia after birth like an unnecessary ARM and pushing her body with IV Syntocinon. Possibly the best way to handle the situation would have been to send the woman home after the first examination so she was safely out of any medical intervention. Lisa Barrett - Original Message - From: Susan Cudlipp To: ozmidwifery@acegraphics.com.au Sent: Friday, October 06, 2006 6:16 PM Subject: Re: [ozmidwifery] No Contractions Along the theme of slow labours: I just had a labouring mum with very slow contractions today. She came in in the night thinking she'd SROM'd but hadnot - was niggling all night with backache. This morning I reassessed and found intact forewaters and a posterior cervix which was a really stretchy multips os which could open easily to 6-7 cms. I encouraged food and walking/shower etc and she very reluctantly walked a bit but wanted to lie down instead despite the chronic backache. Explained that bub was OP and she needed good contractions to bring the head down but she was very half-hearted about it. Even gave her an enema!! (her choice) After a few hours I re-examined and did an ARM as she just wanted to get on with it - plus the OB would have come along and done that soon if I had not! Cx now up to 8cms and better applied, still OP. 3 hours later and still only contracting +-12minutely, we discussed synto as she was by now really 'over it' and refusing to get active. 30 minutes of synto at very low dose and we had a 9lb baby who rotated toOAin the final few minutes. She was drinking and eating as desired but was not keen to take much of either. I am not comfortable with weak, infrequent or no contractionsas it heightens the risk of uterine inertia post birth, shoulder dystocia and a compromised baby - The docs maintain that the fetal Ph drops (I think) 0.5 per minute sitting at crowning, which they learned at the obstetric emergencies seminar, so i also know that any of our obs will get very edgy if there is prolonged crowning. Sometimes you have to compromise what would be normal physiology with what you know would happen if obs took over. I wondered how I would have managed this in a home situaion, probably encouraged her to rest until things were established, and left alone - but we were not at home! So I agree with the points raised about hospital midwifery care and empathise with all who work withing similar restrictions. How would a homebirth midwife support this sort of labour? Sue -- Original Message - From: Michelle Windsor To: ozmidwifery@acegraphics.com.au Sent: Friday, October 06, 2006 10:10 AM Subject: Re: [ozmidwifery] No Contractions Hi Di, This reminds me of scenario that a cousin of mine had with her second bub. Her contractions basically stopped I think when she was fully and she did end up having some synto to get them going again. But what had happened was that the midwife (who said she could have bitten her tongue as soon as she said it!) said to her that she would probably have to work hard as she had a good size baby on board. My cousin said that she became really frightened and the contractions just died. I wonder if there was anything holding your woman back? Although you said she seemed excited and focussed. As far as her pushing without contractions, I think if you have a fetal bradycardia and possibly a compromised bub then it becomes priority to get the baby out. It might just be head compression, but it might not. Cheers Michelle diane [EMAIL PROTECTED] wrote: Hi Wise women
Re: [ozmidwifery] No Contractions
I have given tired women a spoonful of honey around this stage, sometimes when things just seem to be going off the boil and tiredness is kicking in. It seems to work magically, and one of the Obs Reg at my work now lets me give that a go before mentioning the synto.He has seen it work a few timesnow.Maybe it is one of those experiences of having been a RN as well as a midwife that has helped. In remote areas we have to work with what we have got. Cath - Original Message - From: diane To: ozmidwifery@acegraphics.com.au 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 millimetercolour 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 bedstill 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
RE: [ozmidwifery] No Contractions
I had a Sudanese client a while back whose other support person (another Sudanese woman) gave the client hot water with about 10 sugars in it. Traditionally they use a slightly different hot mixture she said, but boy did it pick up her contractions. This was her 3rd baby and third labour for this baby in 2 weeks. Fear played a big part in two labours stopping on presentation to hospital. Anyway I was in awe at this simple effective strategy for bringing things on. I wanted to respond also about how sad I feel as a consumer that the hospital midwives must do the lesser of two evils. Sad for the midwives who have to practice this way as it must be so hard. Also sad for the families that use this system that they often dont get evidence based care or an expectant management approach because they dont have enough information to say actually I am not going to have either option, I want something different. If only they knew to ask is that really necessary? Why? Another reason to have a professional support person I suppose or a private midwife. What a terrible state of affairs we are in. I truly feel for all who are involved in this type of scenario as no-one gets to experience that birth in the way it was meant to be. With respect and admiration, Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of cath nolan Sent: Friday, 6 October 2006 8:37 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] No Contractions I have given tired women a spoonful of honey around this stage, sometimes when things just seem to be going off the boil and tiredness is kicking in. It seems to work magically, and one of the Obs Reg at my work now lets me give that a go before mentioning the synto.He has seen it work a few timesnow.Maybe it is one of those experiences of having been a RN as well as a midwife that has helped. In remote areas we have to work with what we have got. Cath - Original Message - From: diane To: ozmidwifery@acegraphics.com.au 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 millimetercolour 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 bedstill 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
Re: [ozmidwifery] No Contractions
I entirely agree Lisa and no offense taken :-) Had I NOT been in the hospital situation and knowing the personality of the particular ob for the day my choice would have been to send her home, I wish she had not spent the night in hosp at all but by the time I took over, she had been there 7 hours and was tired and wanting it to be the real thing.It didn't helpthat she was wrongly diagnosed as having SROM'd. Had I seen her earlier in the piece I would have wantedher to go home, but I don't know that she would have wanted to do that. I agree that the ARM was committing her to delivery, but having told the ob that she was 6-7 cms, - even though I stressed that this was a true multips os- he was then of the opinion that she needed to get on with her labour and it took some tact to 'allow' several hours of non-interference while I tried to get her motivated. She wasdefinitely not committed to her birth and unwilling to take control of her own labour, so my path was a compromise of doing what was least intrusive for this woman (i.e. better that I do the ARM and take things gently than she jump on the medical machine) and providing her with as good a birth experience as I was able. I also knew that she would deliver easily and hoped that the ARM would kick-start her conts and avoid any other interference, I knew that all she needed was a few really strong conts to get the baby born, she was 8cm by this time and had made some progress with descent and effacement so it was more an 'augmentation' than an induction. She was asking for an epiduraleven though only conts 12-15 minutes apart and mild/mod. I would not have donethe initialVE had I been in a home situation, but knew that it was required by the medical model in which I work - sometimes you can get a better deal with the ob of the day, and sometimes you can't! It was a true OP early labour situation but I was also aware that this woman, while not truly established, was not completely stopping either and she had had enough. Shoulder dystocia is not - as you rightly state - caused by weak contractions, but with a big baby (as I knew this was) weak or non-existent contractions can certainly delay shoulder rotation and descent, given that most obs are very uncomfortable with delay between head and body, this can lead to the 'ER' mentality taking over and merely 'tight' shoulders being defined as dystocia with the full emergency drill ensuing. As to utering inertia - well, if I have had a long, slow labour with contractions far apart, I have found that there can be a lack of good contraction post birth which can lead to excessive blood loss, if the conts have ceased for 2nd stage or are far apart I feel synto is not such a bad thing to have going - she literally only had about 6 synto contractions over 30 minutes to get her to crowning,but as she was going this would have taken another 2 hours at least and the head/body delay would have been LOOONG, ditto the shoulder rotation, I think most midwives would be uneasy with12 minutes eachbetween head/shoulders/body.I would also have been concerned about PPH with conts only every 12-15 mins. After a discussion of the options she asked to have the synto drip as she just wanted her baby to be born by that stage, and I agreed that it would probably be a good idea. As I said, this is a typical scenario of the difference between physiological midwifery care and the medical model in which most of us work: trying to maintain the best care we can for our women while working within the system - in which the 'boys' hold the power cards. Thanks for your thoughts, I like it when this forum is used for open, honest discussion and comparison of opinions/styles/experience. We can all learn so much from each other, and it's good to support each other - we are all 'with women' in each of our settings. Cheers, sue - Original Message - From: Lisa Barrett To: ozmidwifery@acegraphics.com.au Sent: Friday, October 06, 2006 5:23 PM Subject: Re: [ozmidwifery] No Contractions Hi Sue, Without any malicious intent I'm again going to attempt an opinion. I don't routinely VE anybody and niggling backache alone with looking at the women would probably indicate to me that labour wasn't established. I would encourage her to carry on her normal routine but rest lots. I know it's hard and once woman present at the hospital they sometime feel it's labour and they should get on with it. I am always kind but say I think your body is preparing but not ready yet and you'll know when it is. The next VE you did you said stretchy multips os 6-7cm. Multips os suggests she's not in established labour so when her waters were broken ( know it was her choice so it's not a criticism of your practice at all) you tied her into an induction which is essentially what she ended up with. Weak infrequent contractions
Re: [ozmidwifery] No Contractions
I wanted to respond also about how sad I feel as a consumer that the hospital midwives must do the lesser of two evils. Sad for the midwives who have to practice this way as it must be so hard. Also sad for the families that use this system that they often dont get evidence based care or an expectant management approach because they dont have enough information to say actually I am not going to have either option, I want something different. If only they knew to ask is that really necessary? Why? Another reason to have a professional support person I suppose or a private midwife. What a terrible state of affairs we are in. I truly feel for all who are involved in this type of scenario as no-one gets to experience that birth in the way it was meant to be. Absolutely Philippa - this is the truth of the matter, women don't know that there IS another option, and we are caught between the rock and the hard place in trying to care for them. Sue PS - will try both the sugar water and the honey next time I have a slow labour :-) - Original Message - From: Philippa Scott To: ozmidwifery@acegraphics.com.au Sent: Friday, October 06, 2006 8:52 PM Subject: RE: [ozmidwifery] No Contractions I had a Sudanese client a while back whose other support person (another Sudanese woman) gave the client hot water with about 10 sugars in it. Traditionally they use a slightly different hot mixture she said, but boy did it pick up her contractions. This was her 3rd baby and third labour for this baby in 2 weeks. Fear played a big part in two labours stopping on presentation to hospital. Anyway I was in awe at this simple effective strategy for bringing things on. I wanted to respond also about how sad I feel as a consumer that the hospital midwives must do the lesser of two evils. Sad for the midwives who have to practice this way as it must be so hard. Also sad for the families that use this system that they often dont get evidence based care or an expectant management approach because they dont have enough information to say actually I am not going to have either option, I want something different. If only they knew to ask is that really necessary? Why? Another reason to have a professional support person I suppose or a private midwife. What a terrible state of affairs we are in. I truly feel for all who are involved in this type of scenario as no-one gets to experience that birth in the way it was meant to be. With respect and admiration, Philippa ScottBirth Buddies - DoulaAssisting women and their families in the preparation towards childbirth and labour.President of Friends of the Birth Centre Townsville From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of cath nolanSent: Friday, 6 October 2006 8:37 PMTo: ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] No Contractions I have given tired women a spoonful of honey around this stage, sometimes when things just seem to be going off the boil and tiredness is kicking in. It seems to work magically, and one of the Obs Reg at my work now lets me give that a go before mentioning the synto.He has seen it work a few timesnow.Maybe it is one of those experiences of having been a RN as well as a midwife that has helped. In remote areas we have to work with what we have got. Cath - Original Message - From: diane To: ozmidwifery@acegraphics.com.au 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
Re: [ozmidwifery] No Contractions
Hi Sue, Thanks for sharing the information. Your right it is almost impossible to avoid active intervention when birthing in the system even with great midwives like yourself supporting. Part of the problem appears to be the lack of belief that waiting and doing nothing is going to work. Some multips don't have full on labour until transition. It is possible that when the head sits firmly on the cervix the contractions will pick up. I have not ever had to wait 12/15 mins from birth of a head to birth of a body. Physiology tells us that the uterus clamps down immediately after birth. I don't think you'd wait another 12/15 mins for the uterus to contract after the birth and that's if you don't do an active third stage. It is not so hard to do other things when sytno drip isn't an option and you have no-one but yourself and the woman to trust in ( no idiot specialist in complications when your the specialist in the normal I mean). I think I have the easy job when it comes to midwifery because I know I'm the specialist in normal and I don't answer to anyone on that score. Politics with birthing as far out of the system as I do is another thing altogether but in the birth space with women it isn't an issue. I chose to work like this because it's less waring than having to say F**k off to drs all the time. Lisa Barrett
[ozmidwifery] No Contractions
This is one for the MIPPs...you here the occasional story of a woman at full dilatation during homebirth having a prolonged period of no contractions and going to sleep...How long would you wait? And when would you get concerned? These stories are in such contrast to what goes on in hospitals as someone has said...I'm sure there are some who believe that all will die if the synto isn't put up and flogged In response to the commetns about ARM...women know too that ARM will often speed things up and it is a common request..of course doesn't mean that it is done...sometimes we find that the women we care for aren't interested in the normality of stuff and just what it over and done with.Many women would choose synto over waiting! Lisa -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] No Contractions
I've known more than one woman who has waited many hours, even overnight. I know a woman who fully dilated, went to bed and slept all night then got up in the morning and pushed her baby out. It's interesting how wide the variation of normal is when birth is relatively undisturbed. I'd have paid money for a Rest and be Thankful in my recent marathon labour! J - Original Message - From: Lisa Gierke [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, October 07, 2006 7:07 AM Subject: [ozmidwifery] No Contractions This is one for the MIPPs...you here the occasional story of a woman at full dilatation during homebirth having a prolonged period of no contractions and going to sleep...How long would you wait? And when would you get concerned? These stories are in such contrast to what goes on in hospitals as someone has said...I'm sure there are some who believe that all will die if the synto isn't put up and flogged In response to the commetns about ARM...women know too that ARM will often speed things up and it is a common request..of course doesn't mean that it is done...sometimes we find that the women we care for aren't interested in the normality of stuff and just what it over and done with.Many women would choose synto over waiting! Lisa -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] No Contractions
Sometimes at home the women get just as despondent but the difference is that no one is going to walk through the door and under mine me and 'save' her.Last week I was with a women who was birthing at home after three very different and for a variety of reasons not so great labours.. She had done a hypno birthing course and used the tools beautifully and was so relaxed that I was not convinced that she was labouring despite her telling me that the contractions were getting stronger they were irregular and short.. She asked me to do a VE which showed her Cx to be 75% effaced but 2 cm and quite tight. This really annoyed her and when I suggested she rest she was opposed to this and so I suggested the alternative was to get up and get active and send her uterus the message that she wanted it to get into gear rather than the message that it was obviously getting from all her relaxation tapes, breathing etc.Almost immediately she started rocking and rotating her hips quite dramatically during contractions, she was in the kitchen with the lights on as opposed to being in the bedroom in the dark where she had been before. The response was dramatic and the contractions became co ordinated and strong and within 10 min she asked her partner to run the bath. She got in there and then became passive again lying on her back and struggling with quite strong contractions. It was quite funny actually as after about half an hour she opened one eye and told me I needed to call an ambulance as she couldn't do this any more and needed to go to the hospital. ( For those of you who haven;t been at a home birth women at home often ask to go to the hospital in exactly the same way as women in hospital often ask to go home). She made no move to get out of the bath and so at first I just ignored her but she became more insistent with each contraction so eventually I pointed out to her that she couldn't go anywhere while she remained lying in the bath and that if she wanted to go to the hospital she needed to get out of the bath and into the car as ambulances were for emergencies and this was not an emergency. She did stand up then and get out of the bath, leaned against me for two contractions as I helped her dry herself and then I asked her did she want to have the baby in the bedroom or in front of the fire in the lounge. She just looked at me and said the lounge. So we moved there, she leaned over the ball and had the baby. All this on 90 min since the VE.Andrea QuanchiOn 07/10/2006, at 12:02 AM, Lisa Barrett wrote:Hi Sue, Thanks for sharing the information. Your right it is almost impossible to avoid active intervention when birthing in the system even with great midwives like yourself supporting. Part of the problem appears to be the lack of belief that waiting and doing nothing is going to work. Some multips don't have full on labour until transition. It is possible that when the head sits firmly on the cervix the contractions will pick up. I have not ever had to wait 12/15 mins from birth of a head to birth of a body.Physiology tells us that the uterus clamps down immediately after birth. I don't think you'd wait another 12/15 mins for the uterus to contract after the birth and that's if you don't do an active third stage. It is not so hard to do other things when sytno drip isn't an option and you have no-one but yourself and the woman to trust in ( no idiot specialist in complications when your the specialist in the normal I mean).I think I have the easy job when it comes to midwifery because I know I'm the specialist in normal and I don't answer to anyone on that score. Politics with birthing as far out of the system as I do is another thing altogether but in the birth space with women it isn't an issue. I chose to work like this because it's less waring than having to say F**k off to drs all the time. Lisa Barrett
Re: [ozmidwifery] No Contractions
Andrea This is a beautiful story and yes you are so right about women asking to go home/hospital/ - Original Message - From: Andrea Quanchi To: ozmidwifery@acegraphics.com.au Sent: Saturday, October 07, 2006 10:41 AM Subject: Re: [ozmidwifery] No Contractions Sometimes at home the women get just as despondent but the difference is that no one is going to walk through the door and under mine me and 'save' her. Last week I was with a women who was birthing at home after three very different and for a variety of reasons not so great labours.. She had done a hypno birthing course and used the tools beautifully and was so relaxed that I was not convinced that she was labouring despite her telling me that the contractions were getting stronger they were irregular and short.. She asked me to do a VE which showed her Cx to be 75% effaced but 2 cm and quite tight. This really annoyed her and when I suggested she rest she was opposed to this and so I suggested the alternative was to get up and get active and send her uterus the message that she wanted it to get into gear rather than the message that it was obviously getting from all her relaxation tapes, breathing etc. Almost immediately she started rocking and rotating her hips quite dramatically during contractions, she was in the kitchen with the lights on as opposed to being in the bedroom in the dark where she had been before. The response was dramatic and the contractions became co ordinated and strong and within 10 min she asked her partner to run the bath. She got in there and then became passive again lying on her back and struggling with quite strong contractions. It was quite funny actually as after about half an hour she opened one eye and told me I needed to call an ambulance as she couldn't do this any more and needed to go to the hospital. ( For those of you who haven;t been at a home birth women at home often ask to go to the hospital in exactly the same way as women in hospital often ask to go home). She made no move to get out of the bath and so at first I just ignored her but she became more insistent with each contraction so eventually I pointed out to her that she couldn't go anywhere while she remained lying in the bath and that if she wanted to go to the hospital she needed to get out of the bath and into the car as ambulances were for emergencies and this was not an emergency. She did stand up then and get out of the bath, leaned against me for two contractions as I helped her dry herself and then I asked her did she want to have the baby in the bedroom or in front of the fire in the lounge. She just looked at me and said the lounge. So we moved there, she leaned over the ball and had the baby. All this on 90 min since the VE. Andrea Quanchi On 07/10/2006, at 12:02 AM, Lisa Barrett wrote: Hi Sue, Thanks for sharing the information. Your right it is almost impossible to avoid active intervention when birthing in the system even with great midwives like yourself supporting. Part of the problem appears to be the lack of belief that waiting and doing nothing is going to work. Some multips don't have full on labour until transition. It is possible that when the head sits firmly on the cervix the contractions will pick up. I have not ever had to wait 12/15 mins from birth of a head to birth of a body. Physiology tells us that the uterus clamps down immediately after birth. I don't think you'd wait another 12/15 mins for the uterus to contract after the birth and that's if you don't do an active third stage. It is not so hard to do other things when sytno drip isn't an option and you have no-one but yourself and the woman to trust in ( no idiot specialist in complications when your the specialist in the normal I mean). I think I have the easy job when it comes to midwifery because I know I'm the specialist in normal and I don't answer to anyone on that score. Politics with birthing as far out of the system as I do is another thing altogether but in the birth space with women it isn't an issue. I chose to work like this because it's less waring than having to say F**k off to drs all the time. Lisa Barrett No virus found in this incoming message.Checked by AVG Free Edition.Version: 7.1.407 / Virus Database: 268.13.0/465 - Release Date: 10/6/2006
Re: [ozmidwifery] No Contractions
Hi all, I've just gotten home from work and I feel jinxed! I was caring for a very motivated primip who presented before I arrived at 1930hrs. She previously had phoned and presented earlier in the morning in early labour. When she came she was examined by the midwife and was contracting 4-5/60, palp LOP and 1/5 above brim. VE 6 cm and at spines. I arrived at 2130hrs and the obstetrician came to see her before he went to bed and he palped her and agreed and wanted a ARM. Anyway all was going well and she wanted Pethidine at 2330hrs(he told her you'd be stupid not to have pethidine as a first timer and the baby needs it as well because his head gets squashed! so the idea was firmly implanted) I examined her on the birth stool where she was labouring quietly and she was 7 cm, well applied, station +1, no moulding. We discussed ARM as ordered and she consented to it after the pethidine had taken effect. At 2400hrs contractions had slowed to 6-7/60 and she wanted the ARM at that time. ARM at 0030hrs. Her contractions became weak to moderate 6-7mins, and she was enjoying the rest so I let her be for 3hrs. At 0330hrs no pick up of contractions so I discussed with the doctor ?synto and he said no and her contractions will pick up eventually. I was thinking maybe but the longer she goes the higher the chances the following obstetrician at 0700 will do a C/S plus a few other warning signs! She was happy to following my suggestions and mobilise but she could only do it for short periods due to sheer exhaustion. When standing/ stool she had strong contractions with involuntary pushing, anal pouting etc, but back on the bed they virtually stopped. Due to the recent thread on this list I watched her fluid intake very carefully. At 0400hrs she had a total of 1800mls of H2O and lemonade. I even gave her a spoonful of honey! She was voiding well and no palpable bladder. Pushing became uncontrollable, show, anal dilation etc. I decided to recheck her cervix and she was still 8cm at 0500hrs, LOP and station +2-+3. I was faced with the dilemma of leaving her on the stool where she was having strong contractions but uncontrollable pushing or back for a lie down where the contractions would virtually stop. Anyway she was desperate for a rest and wanted to lie down. At this stage she was totally spent, physically and emotionally. Dr still wouldn't come to see her. New doc came on and examined her and said that the vertex was +3 but it was only moulding and the actual head was still5/5 abovebrim!! With a anterior lip no less (I don't know how with everyone independently agreeing that it was 1/5above in early labour) Down the corridor she went for a C/S for 'CPD and always to be a C/S' I feel strongly that she would have birthed beautifully with good contractions if something had been done earlier in the shift,when she had the strength, energy and motivation.I could find no cause for her stop/start labour and there were no signs of obstruction, no moulding etc. Sorry its so long but any thoughts? Melissa - Original Message - From: Susan Cudlipp To: ozmidwifery@acegraphics.com.au Sent: Friday, October 06, 2006 9:30 PM Subject: Re: [ozmidwifery] No Contractions I wanted to respond also about how sad I feel as a consumer that the hospital midwives must do the lesser of two evils. Sad for the midwives who have to practice this way as it must be so hard. Also sad for the families that use this system that they often dont get evidence based care or an expectant management approach because they dont have enough information to say actually I am not going to have either option, I want something different. If only they knew to ask is that really necessary? Why? Another reason to have a professional support person I suppose or a private midwife. What a terrible state of affairs we are in. I truly feel for all who are involved in this type of scenario as no-one gets to experience that birth in the way it was meant to be. Absolutely Philippa - this is the truth of the matter, women don't know that there IS another option, and we are caught between the rock and the hard place in trying to care for them. Sue PS - will try both the sugar water and the honey next time I have a slow labour :-) - Original Message - From: Philippa Scott To: ozmidwifery@acegraphics.com.au Sent: Friday, October 06, 2006 8:52 PM Subject: RE: [ozmidwifery] No Contractions I had a Sudanese client a while back whose other support person (another Sudanese woman) gave the client hot water with about 10 sugars in it. Traditionally they use a slightly different hot mixture she said, but boy did it pick up her contractions. This was her 3rd baby and third labour for this baby in 2 weeks. Fear played a big part in two labours
Re: [ozmidwifery] No Contractions
Lisa, I am sure you have said what many of us think. I have worked like that for years and one gets sick of the tightrope all of the time. I am so glad that I am now working without drs, it is just protocols now. Cheers Judy --- Lisa Barrett [EMAIL PROTECTED] wrote: Hi Sue, Thanks for sharing the information. Your right it is almost impossible to avoid active intervention when birthing in the system even with great midwives like yourself supporting. Part of the problem appears to be the lack of belief that waiting and doing nothing is going to work. Some multips don't have full on labour until transition. It is possible that when the head sits firmly on the cervix the contractions will pick up. I have not ever had to wait 12/15 mins from birth of a head to birth of a body. Physiology tells us that the uterus clamps down immediately after birth. I don't think you'd wait another 12/15 mins for the uterus to contract after the birth and that's if you don't do an active third stage. It is not so hard to do other things when sytno drip isn't an option and you have no-one but yourself and the woman to trust in ( no idiot specialist in complications when your the specialist in the normal I mean). I think I have the easy job when it comes to midwifery because I know I'm the specialist in normal and I don't answer to anyone on that score. Politics with birthing as far out of the system as I do is another thing altogether but in the birth space with women it isn't an issue. I chose to work like this because it's less waring than having to say F**k off to drs all the time. Lisa Barrett On Yahoo!7 Photos: Unlimited free storage keep all your photos in one place! http://au.photos.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] No Contractions
Fantastic story Andrea. As I am just starting in home birth I love hearing these variations from hospital stuff. Cheers Judy PS, bet she was pleased after the fact that you had not immediately jumped to ring an ambulance. --- Andrea Quanchi [EMAIL PROTECTED] wrote: Sometimes at home the women get just as despondent but the difference is that no one is going to walk through the door and under mine me and 'save' her. Last week I was with a women who was birthing at home after three very different and for a variety of reasons not so great labours.. She had done a hypno birthing course and used the tools beautifully and was so relaxed that I was not convinced that she was labouring despite her telling me that the contractions were getting stronger they were irregular and short.. She asked me to do a VE which showed her Cx to be 75% effaced but 2 cm and quite tight. This really annoyed her and when I suggested she rest she was opposed to this and so I suggested the alternative was to get up and get active and send her uterus the message that she wanted it to get into gear rather than the message that it was obviously getting from all her relaxation tapes, breathing etc. Almost immediately she started rocking and rotating her hips quite dramatically during contractions, she was in the kitchen with the lights on as opposed to being in the bedroom in the dark where she had been before. The response was dramatic and the contractions became co ordinated and strong and within 10 min she asked her partner to run the bath. She got in there and then became passive again lying on her back and struggling with quite strong contractions. It was quite funny actually as after about half an hour she opened one eye and told me I needed to call an ambulance as she couldn't do this any more and needed to go to the hospital. ( For those of you who haven;t been at a home birth women at home often ask to go to the hospital in exactly the same way as women in hospital often ask to go home). She made no move to get out of the bath and so at first I just ignored her but she became more insistent with each contraction so eventually I pointed out to her that she couldn't go anywhere while she remained lying in the bath and that if she wanted to go to the hospital she needed to get out of the bath and into the car as ambulances were for emergencies and this was not an emergency. She did stand up then and get out of the bath, leaned against me for two contractions as I helped her dry herself and then I asked her did she want to have the baby in the bedroom or in front of the fire in the lounge. She just looked at me and said the lounge. So we moved there, she leaned over the ball and had the baby. All this on 90 min since the VE. Andrea Quanchi On 07/10/2006, at 12:02 AM, Lisa Barrett wrote: Hi Sue, Thanks for sharing the information. Your right it is almost impossible to avoid active intervention when birthing in the system even with great midwives like yourself supporting. Part of the problem appears to be the lack of belief that waiting and doing nothing is going to work. Some multips don't have full on labour until transition. It is possible that when the head sits firmly on the cervix the contractions will pick up. I have not ever had to wait 12/15 mins from birth of a head to birth of a body. Physiology tells us that the uterus clamps down immediately after birth. I don't think you'd wait another 12/15 mins for the uterus to contract after the birth and that's if you don't do an active third stage. It is not so hard to do other things when sytno drip isn't an option and you have no-one but yourself and the woman to trust in ( no idiot specialist in complications when your the specialist in the normal I mean). I think I have the easy job when it comes to midwifery because I know I'm the specialist in normal and I don't answer to anyone on that score. Politics with birthing as far out of the system as I do is another thing altogether but in the birth space with women it isn't an issue. I chose to work like this because it's less waring than having to say F**k off to drs all the time. Lisa Barrett On Yahoo!7 Photos: Unlimited free storage keep all your photos in one place! http://au.photos.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[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 millimetercolour 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 bedstill 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
Re: [ozmidwifery] No Contractions
Sounds to me like this woman needed rest and carbohydrates when she had a rim. Her body was telling you she needed a rest before she could get this baby moving. This may have prevented any stress on her or her baby. You said:: !!! 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. She shouldn't have had to push without any contrations. Lisa Barrett
RE: [ozmidwifery] No Contractions
Di, It sounds as tho you managed a difficult situation in the best way you knew, and that is all one can do. You are now seeking to learn from it and we will obviously give you tips based on our experiences. Dont feel that you should have etc. Many midwifery authors in all kinds of natural birthing magazines like Midwifery Today etc, have spoken about the rest and recovery stage where the body needs to gather its strength for the final stage. It usually happens at the end of a demanding first stage and the woman showing signs of tiredness. I am old enough to remember doctors saying turn her on her side and give her a rest, Sis, in a time when IV fluids, synto drip and epidurals were available but not used so aggressively. At the transition between the first and second stage in a primip, the urge to push with each contraction needs to be resisted for a little while and breathed through, so that there is no pushing on a cervix that is not completely out of the way. We often cant reach that little bit at the back, but it is still there. We talk of an anterior lip, but there can be a posterior one too. The urge to push is triggered by the baby putting pressure on the nerves, even tho there is still a lip etc. Pushing without contractions is not usually the most productive thing, but as I said, you handled it the best way you knew how.remeber the discussion onundirected pushing? I am sure you will get lots of tips which will help us all in our practice no matter where we are. Cheers, MM
RE: [ozmidwifery] No Contractions
Mary M said: I am old enough to remember doctors saying turn her on her side and give her a rest, Sis, in a time when IV fluids, synto drip and epidurals were available but not used so aggressively. Wow, doctors actually said that...you must be joshing us Mary!! In our place the synto would be waved around -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] No Contractions
I'm not that old ! early 40something but when I did midi we called it the "rest and be thankful stage". It seemed to go out of fashion! with "quick get the synto up". Now women ( if they're not private and have a doctor hovering) againhave that littlerest and then get on with it. Louise rural NSW [EMAIL PROTECTED] ---Original Message--- From: ozmidwifery@acegraphics.com.au Date: 10/06/06 09:02:53 To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] No Contractions Mary M said: "I am old enough to remember doctors saying "turn her on her side and give her a rest, Sis", in a time when IV fluids, synto drip and epidurals were available but not used so aggressively." Wow, doctors actually said that...you must be joshing us Mary!! In our place the synto would be waved around -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] No Contractions
Hi Di, Just a point on fluids in labour - if a woman is overloaded with fluid (via a drip) her system, vasopressin (antidiuretic hormone) will kick in to stop her body being flooded with fluid. This hormone is produced from the same source as oxytocin (posterior putuitary glad). Perhaps this was why the contractions dropped off. Why not let the woman herself dictate what she was drinking? As a rough guide, about 1 cup of fluid per hour is often suggested. The ketones in her urine (unless they are alarmingly high) are a sign that her body is working well and mobilising her fat stores to give her energy etc for labour. I agree that the rest and be thankful stage is often misunderstood - if a woman is lucky enough to get a break, especially in a strong labour, then she should not be robbed of it! I deliberately put this stage on the new Birth Day panels that I developed for teaching about second stage, because it is often glossed over in classes and women don't know about it. It is fantastic that you are seeking answers to these questions - that's the best way to learn - from experience! Warm regards, Andrea At 07:24 PM 5/10/2006, you wrote: 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 millimetercolour 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 bedstill 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
Re: [ozmidwifery] No Contractions
Hi Di,This reminds me of scenario that a cousin of mine had with her second bub. Her contractions basically stopped I think when she was fully and she did end up having some synto to get them going again. But what had happened was that the midwife (who said she could have bitten her tongue as soon as she said it!) said to her that she would probably have to work hard as she had a good size baby on board. My cousin said that she became really frightened and the contractions just died. I wonder if there was anything holding your woman back? Although you said she seemed excited and focussed.As far as her pushing without contractions, I think if you have a fetal bradycardia and possibly a compromised bub then it becomes priority to get the baby out. It might just be head compression, but it might not. Cheers Michelle diane [EMAIL PROTECTED] wrote: 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 millimetercolour 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 bedstill 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,
RE: [ozmidwifery] No Contractions
Hi, Thanks for that point Andrea because I had the opposite where I had really encouraged oral fluids and dietary intake. I had a young primip T+3 who experienced spurious labour for 2 days, visiting BS each day 'just in case', on the beginning of her 3rd presentation she was admitted given Pethidine and temazepam to settle at 2030 primarily because she was tired on her feet and I suppose people felt sorry. Anyway I have a phone call at home 0100 she was up in BS labouring. On arrival- 2:10 mild/mod very excited and very awake with very heavy eyelids. I reassessed settled her again encouraging sleep etc but what really got me was the foetal heart. The rate was already sitting on 154 baseline. Thinking needing rehydration gave her a full jug of water and encouraged her to maintain her fluids, was given breakfast, an another jug after breakfast was given for her -no change in contractions pattern. Took her case to team review and I am sorry to say but I am the firm believer 3rd presentation to BS is a warning 'time for baby out', listening to that message with her permission a decision was made to augment and get her going. I again mentioned to the consultant the foetal heart baseline being high for post dates- why? To cut a long story short after these -ARM, epidural, IV fluids, synto, foetal HR now with baseline 162 and Cx 5 cm when I left for my fellow Team Midwife following me after 12 hours with her. She required Vaccum 3 1/2 hours later as the FH at rocketed up to 180 - 200 and she was fully. Indication Foetal Distress with a summation for the foetal tachy being she was dehydrated! I too am a believer that the women 'know' when to drink and eat and I really encourage this. Any suggestion why to this scenario? Barb -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Andrea Robertson Sent: Friday, 6 October 2006 11:56 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] No Contractions Hi Di, Just a point on fluids in labour - if a woman is overloaded with fluid (via a drip) her system, vasopressin (antidiuretic hormone) will kick in to stop her body being flooded with fluid. This hormone is produced from the same source as oxytocin (posterior putuitary glad). Perhaps this was why the contractions dropped off. Why not let the woman herself dictate what she was drinking? As a rough guide, about 1 cup of fluid per hour is often suggested. The ketones in her urine (unless they are alarmingly high) are a sign that her body is working well and mobilising her fat stores to give her energy etc for labour. I agree that the rest and be thankful stage is often misunderstood - if a woman is lucky enough to get a break, especially in a strong labour, then she should not be robbed of it! I deliberately put this stage on the new Birth Day panels that I developed for teaching about second stage, because it is often glossed over in classes and women don't know about it. It is fantastic that you are seeking answers to these questions - that's the best way to learn - from experience! Warm regards, Andrea At 07:24 PM 5/10/2006, you wrote: 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
Re: [ozmidwifery] No Contractions
Sorry Mary If my language inferred "should have" but when would you get a woman to push without a contraction?. Exception maybe breech out to nape of neck with worries about the baby's condition. IV fluids doesn't constitute any part of normal physiological labour unless I've missed something vital. When asked for opinion in future I will refrain from giving any unless my language is less confrontational. Lisa Barrett - Original Message - From: Mary Murphy To: ozmidwifery@acegraphics.com.au Sent: Friday, October 06, 2006 8:17 AM Subject: RE: [ozmidwifery] No Contractions Di, It sounds as tho you managed a difficult situation in the best way you knew, and that is all one can do. You are now seeking to learn from it and we will obviously give you tips based on our experiences. Dont feel that you should have etc. Many midwifery authors in all kinds of natural birthing magazines like Midwifery Today etc, have spoken about the rest and recovery stage where the body needs to gather its strength for the final stage. It usually happens at the end of a demanding first stage and the woman showing signs of tiredness. I am old enough to remember doctors saying turn her on her side and give her a rest, Sis, in a time when IV fluids, synto drip and epidurals were available but not used so aggressively. At the transition between the first and second stage in a primip, the urge to push with each contraction needs to be resisted for a little while and breathed through, so that there is no pushing on a cervix that is not completely out of the way. We often cant reach that little bit at the back, but it is still there. We talk of an anterior lip, but there can be a posterior one too. The urge to push is triggered by the baby putting pressure on the nerves, even tho there is still a lip etc. Pushing without contractions is not usually the most productive thing, but as I said, you handled it the best way you knew how.remeber the discussion onundirected pushing? I am sure you will get lots of tips which will help us all in our practice no matter where we are. Cheers, MM
RE: [ozmidwifery] No Contractions
In defence of Di...she obviously works in a hospital with registrar potentially hanging around the door..Sometimes 'best practice' may need to be modified to prevent the women from ending up with an instrumental birth..or synto...or an epidural ..or even a CS The lesser of two evils. The docs are not going to tolerate a 'rest be thankful' stage going on for hours espeically with decels in the fh!! (Yep even hospital midwives know about rest be thankful)So lets give her a break ...and walk in her shoes for abit heh! Does anyone think the contrations may have dropped of simply because she had a big baby and she was tired? Sounds like a more likely scenario to me than theories about overloading. Lisa Hi Di, Just a point on fluids in labour - if a woman is overloaded with fluid (via a drip) her system, vasopressin (antidiuretic hormone) will kick in to stop her body being flooded with fluid. This hormone is produced from the same source as oxytocin (posterior putuitary glad). Perhaps this was why the contractions dropped off. Why not let the woman herself dictate what she was drinking? As a rough guide, about 1 cup of fluid per hour is often suggested. The ketones in her urine (unless they are alarmingly high) are a sign that her body is working well and mobilising her fat stores to give her energy etc for labour. I agree that the rest and be thankful stage is often misunderstood - if a woman is lucky enough to get a break, especially in a strong labour, then she should not be robbed of it! I deliberately put this stage on the new Birth Day panels that I developed for teaching about second stage, because it is often glossed over in classes and women don't know about it. It is fantastic that you are seeking answers to these questions - that's the best way to learn - from experience! Warm regards, Andrea -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] No Contractions
Hi Lisa, there was definitely no intent of implied criticism when I said no should haves. Just a reminder that we beat up on ourselves all the time . OH maybe I should have, shouldnt have. etc. We each have to respond to the best of our clinical judgment, in the way we see it, at the time. It is hard to say I would do this when because there is no hard and fast rule, just that rush of adrenalin and a sense of alarm that makes us act. Sorry I cant elaborate further. I agree about the fluids. In fact quite a while ago I read some articles about the presence of keytones being normal in labour. sorry cant remember where. MM From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Lisa Barrett Sent: Friday, 6 October 2006 1:19 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] No Contractions Sorry Mary If my language inferred should have but when would you get a woman to push without a contraction?. Exception maybe breech out to nape of neck with worries about the baby's condition. IV fluids doesn't constitute any part of normal physiological labour unless I've missed something vital. When asked for opinion in future I will refrain from giving any unless my language is less confrontational. Lisa Barrett - Original Message - From: Mary Murphy To: ozmidwifery@acegraphics.com.au Sent: Friday, October 06, 2006 8:17 AM Subject: RE: [ozmidwifery] No Contractions Di, It sounds as tho you managed a difficult situation in the best way you knew, and that is all one can do. You are now seeking to learn from it and we will obviously give you tips based on our experiences. Dont feel that you should have etc. Many midwifery authors in all kinds of natural birthing magazines like Midwifery Today etc, have spoken about the rest and recovery stage where the body needs to gather its strength for the final stage. It usually happens at the end of a demanding first stage and the woman showing signs of tiredness. I am old enough to remember doctors saying turn her on her side and give her a rest, Sis, in a time when IV fluids, synto drip and epidurals were available but not used so aggressively. At the transition between the first and second stage in a primip, the urge to push with each contraction needs to be resisted for a little while and breathed through, so that there is no pushing on a cervix that is not completely out of the way. We often cant reach that little bit at the back, but it is still there. We talk of an anterior lip, but there can be a posterior one too. The urge to push is triggered by the baby putting pressure on the nerves, even tho there is still a lip etc. Pushing without contractions is not usually the most productive thing, but as I said, you handled it the best way you knew how.remeber the discussion onundirected pushing? I am sure you will get lots of tips which will help us all in our practice no matter where we are. Cheers, MM
