Yes, Denise: I wonder if an hour in the tub would have helped?? There was no synto augmentation involved 4cm to fully in 4 hrs seemed like a lovely active birth was about to happen. Yes also: those Midwifery Today suggestions are great to try in a homebirth situation/independent practice but please tell me if there are any of you out there who would push a baby gently out of the pelvis and try to rotate and flex the head in a hospital birth suite? Also once I called in the consultant it became her call, however to be honest I kind of felt if I had said I was prepared to try to use my fingers to deflex the head she just might have let me(in the OT of course). I must admit I am a tad intimidated in the hospital but also I have never encountered a brow presentation before: it has all been academic. So, I await your wise counsel.
marilyn ----- Original Message ----- From: "Denise Hynd" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Monday, December 15, 2003 6:13 PM Subject: Re: [ozmidwifery] Brow presentations > Dear Marilyn > Thank you for sharing your reflections and cogitations. > > This is my beleif, experience that midwives do reflect on all that inputs > into a labour and the possible interplay rather than jumpimg to blame, > denouncement of specific action of another or the woman and baby like an > edict of an all knowing being !! > > In this particular insistance or similar I also wonder about the ramming (?) > effect of ARM and maybe other things that may have startled the mother or > baby in the hospital?? > > I take it there was no synto also pushing the hole along? > . > I understand and have seen floating in tubs to help unstick some asynclitic > babies I wonder if it would help relax a non rigid brow back to a face or > vertex?? > > Also Midwifery Today & other midwifery texts talk of pushing stuck babies > back and other maneovers trying to unstick them but that would be easier > with intact membranes? > > Denise > ----- Original Message ----- > From: "Marilyn Kleidon" <[EMAIL PROTECTED]> > To: <[EMAIL PROTECTED]> > Sent: Tuesday, December 16, 2003 11:37 PM > Subject: [ozmidwifery] Brow presentations > > > > What do you all know about brow presentations? I was with a lovely woman > > yesterday who wanted a natural birth and so i spent the morning with her > and > > her partner on the floor, in the shower and she dilated to fully within 4 > > hrs, just lovely and I am sure (so sure) I palped a posterior fontanelle > > such that baby was direct OA, but almost military poition; I was trying so > > hard to follow her through a physiological 2nd stage but after an hour and > a > > half with no sign of baby's head I did another VE and she had pushed down > a > > small anterior lip, which obligingly slipped back but now there was a > > central anterior fontanelle with caput just inferior to the fontanelle, so > > consultant called in and an emergency c/s due to brow presentation(not > > emergent emergent, baby was just fine and mum was exhausted but not > > physiologically compromised). Baby had great apgars, which is good as I > had > > not identified any fetal distress, I just want to know if there is > anything > > we could have done differently. Mum spent most of her labour and 2nd stage > > on all fours on the floor over a bean bag, with regular partner dancing, > > pelvic rocking ie very active and effective first stage after 4cm. She had > > had a prolonged early first stage with a significant hind leak and > > intermittent contractions for almost 24 hrs before presenting to to birth > > suite yesterday for IOL and antibiotics. She was then 4cm dilated and ARM > of > > forwaters to induce baby ROL at this time (this happened before my shift > > thankfully as I have a hard time supporting ARM and just hate that > > compromised feeling). Anyway she moved rapidly into an effective active > > first stage as described above. > > > > I am wondering if anyone thinks preserving those forewaters might had > > avoided the malpresentation. Also should I have re-examined her earlier? > Do > > you think I mistook the posterior fontanelle for the anterior one on my > > first 2nd stage VE? I was so convinced, I mean it felt like a text book > > palp.I just hate to think I encouraged this woman to work so hard for one > > and half hours when I could have saved her that exhaustion. And I don't > mean > > "saved" in any metaphysical sense, just can't think of a better word. I > know > > hindsight is often 20/20 and am not beating myself up, just trying to > > understand. There was some veiled criticism from the ob regarding not > having > > "effective analgesia" on board: however it was realised when the woman > > elected to have a GA that having an epidural or narcotics was never part > of > > her plan. > > > > I have looked up all of my texts and am pretty satisfied that a c/s for > > brow presentation is the best alternative, but would welcome other ideas. > > > > thanks > > marilyn > > > > > > -- > > 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.