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 strength left as she >had done much of the work without help of ctx. > >With a few position changes she got a little more head out but then >seemed to only move millimeter by millimeter....colour was ok.... >eventually after what seemed like 10 minutes I managed to push the >peri back to get a chin...then nothing no ctx...mum managed to push >a little and I got her to move from kneeling to standing then one >leg up on bed....still nothing... went onto bed and there was some >movement with maternal effort (the last of it!) the body birthed >over almost three minutes, it was a pretty tight fit with the >shoulders coming in the lateral position, when a shoulder appeared I >gave it a push with two fingers to the anterior it moved just a >little into the oblique but then was finally out far enough for me >to get a little finger under the arm and finally managed to get her >out! Apgars 7 and 10. but as it was so slow and there were no ctx >to assist with her being a big bub too, It was a bit hairy for a >little while. Lucky she didnt have big enough ears or they might >have ended up a little stretched!! LOL. Second stage was only 1hr >45min but I felt it was just way too slow birthing that head and >those shoulders! Perhaps I should have been more trusting?? I >hesitated in calling the Doc after an hour of pushing cause was on >view at this stage and I thought he would have been too late by the >time he came in. Probably would have been better to have him on >standby just in case, I suppose. I just felt quite helpless and know >that things ended up quite stressful for everyone in the room. I >think I would have prefered to deal with a shoulder dystocia at >least then I would have had a practiced sequence of events to go through!! > >Thought she might get away without a tear as birthed sooo slowly but >peri went with the shoulders, 2nd degree peri tear (no too big) and >a anterior labial that wasnt too bad either.(thank goodness, was >after 3am by then, that time of night where you see double!) Did >have synto at birth but needed to get her to squat to get placenta >and had a constant trickle and (surprise surprise) a relaxed uterus, >which was fine after another shot of Syntometrine (450 loss). > >My feelings are I probably should have been a little more pro active >in getting the fluids up, maybe I erred on the non intervention side >a little too long. Any other suggestions, how do you get a bub out >with no Ctx and a tired mum? She did try nipple stimulation with >little effect too. >Cheers >Di -- This mailing list is sponsored by ACE Graphics. 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