These archives contain extracts from discussions held on the UK Midwives and Consumers email list, a discussion group for people interested in midwifery in the UK. Open to midwives, students, mothers, and anyone interested in improving maternity services in UK. Posts in these archives express the views of the individual authors, and not those of the Association of Radical Midwives.
I was at an interesting birth this morning and would like some comments. This
was a home water birth. Second baby, first one a water birth in hospital, short,
straight forward, baby about 6 1/2 lbs. We knew the mother had a large pelvis
as I had checked the pelvic measurements and we anticipated a baby about the
same size as her first. Another short labour and the one internal found the
cervix to be 5 cms. dilated with the head well down, and sutures felt. Not long
after this exam, about 25 minutes (I don't have the notes in front of me) she
felt like pushing and being in the pool, I couldn't see what was happening.
I asked her to feel with her hands and she said the head was out. I felt the
head, which was almost out and then it was born. By feel, the head was hyper-extended,
which obviously felt odd. Then nothing much happenend. 2 contractions came and
went with no rotation. She was on her knees leaning into the side, so I got
her to lift one foot and place it flat on the ground as high up (close to the
level of her shoulders) as she could take it. With that the shoulders rotated
and the body was born. I gently lifted the baby through the water up to the
surface. No cord around the neck but the face was blue, congested and puffy.
The baby took a breath, had a good heart rate, but then stopped breathing. I
got the mother to turn over, take the baby while I clamped and cut the cord
so I could bring the baby out to ventilate him. It took a few minutes but he
was fine and came around easily. The head continued to be congested
and blue and the face puffy. He went to the breast, fixed and fed well and his
behaviour and examination were normal.
My speculation is this: between my internal and the birth of the head, did the presentation change to a face presentation? If that sounds ludicrous, does anyone want to forward another idea explaining the situation? I've had 2 face presentations and both times the babies head looked like this guy. Anyway, all is well and this may make for some interesting discussion.
I have a lady on my caseload who is 38 weeks pregnant and a Gravida 4 Para
2.
Her first baby was born vaginally 14 years ago, her partogram states that this
baby was brow presentation. She's spoken to health professionals since who say
that is impossible and was probably a face presentation (mum says that her baby
had a bruised and swollen forehead rather than face-not sure if relevant?)
Her second baby was born 4 years ago by emergency c-section at full dilatation
as he was found to be a brow presentation.
After a growth scan today she has decided to try for a vaginal delivery although
she is very anxious about the same scenario happening again.
Has anybody got any words of wisdom for the management of this lady? I'm presuming
that this womans pelvis shap predisposes her to brow presentations? Is there
any good literature written about them?
Claire
(student midwife)
p.s I'm absolutely loving having a caseload of women - I love it, I love it,
I love it!!!! My confidence when speaking to doctors (etc..)
about my women has grown so much, I'm beginning to realise what being a woman's
advocate actually means and I can't stop smiling.
I have seen the congested head a number of times- always after a rapid second stage. I think the baby was a little shocked from the fast journey
LW updated June 4, 2005