Re: [ozmidwifery] No Contractions

Fri, 06 Oct 2006 19:46:20 -0700

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 still 5/5 above brim!!!!!!  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 -----
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 don’t get evidence based care or an expectant management approach because they don’t 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 -----
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 don’t get evidence based care or an expectant management approach because they don’t 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 times now. 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

Sent: Thursday, October 05, 2006 7:24 PM

Subject: [ozmidwifery] No Contractions

 

Hi Wise women,

Just want to throw this out there for comments/suggestions. Had a birth the other night that was a bit worrying at the time. Good outcome lovely 4200g baby girl. Mum (primip) had SROM at clinic visit at 830 am then went home and established at about 1630, came in contracting moderately at 1900hrs was 4-5cm , I took over her care at 2000hrs. Lovely very motivated mum, well read and attended classes, well supported by partner and mum and mum in law and sister. Ctx hotted up to 3-4 minutely and stronger, was drinking well but had a few small vomits, and next UA showed small ketones and SG 1.030, but was still drinking well and ctx remained strong and regular so didnt want to put in a cannula. VE at 1130 showed an anterior lip, still a bit thick. Wasnt able to wee again after that but head was well down.

 

Was actively pushing with some ctx at 0100 with signs of full dilatation (nice purple line!) Contractions really started to drop off, became about 4minutely and only about 20secs of good strength. Mum getting quite tired at this stage but more focussed and excited than earlier. At this point I did put up some fluids as I thought with the ctx dropping off combined with her fatigue she might need some hydration. She pushed babe up to on view (birth stool) but made little more progress over next 20mins or so. Fluids running in flat out but no sign of increased ctx. Babes HR started to drop to around 80 which at first had good recovery , so I wasn't too worried but after a while were staying there for a minute or so each time before climbing back to 100. At this point with encouragement she managed to push bub up to almost crowning and that was the last of the contractions!!! Obviously not easy to get FH at this stage but was quite low and staying there. She had not much strength left as she had done much of the work without help of ctx.

 

With a few position changes she got a little more head out but then seemed to only move millimeter by millimeter....colour was ok.... eventually after what seemed like 10 minutes I managed to push the peri back to get a chin...then nothing no ctx...mum managed to push a little and I got her to move from kneeling to standing then one leg up on bed....still nothing... went onto bed and there was some movement with maternal effort (the last of it!) the body birthed over almost three minutes, it was a pretty tight fit with the shoulders coming in the lateral position, when a shoulder appeared I gave it a push with two fingers to the anterior it moved just a little into the oblique but then was finally out far enough for me to get a little finger under the arm and finally managed to get her out!  Apgars 7 and 10. but as it was so slow and there were no ctx to assist with her being a big bub too, It was a bit hairy for a little while. Lucky she didnt have big enough ears or they might have ended up a little stretched!! LOL.  Second stage was only 1hr 45min but I felt it was just way too slow birthing that head and those shoulders! Perhaps I should have been more trusting?? I hesitated in calling the Doc after an hour of pushing cause was on view at this stage and I thought he would have been too late by the time he came in. Probably would  have been better to have him on standby just in case, I suppose. I just felt quite helpless and know that things ended up quite stressful for everyone in the room. I think I would have prefered to deal with a shoulder dystocia at least then I would have had a practiced sequence of events to go through!!

 

Thought she might get away without a tear as birthed sooo slowly but peri went with the shoulders, 2nd degree peri tear (no too big) and a anterior labial that wasnt too bad either.(thank goodness, was after 3am by then, that time of night where you see double!) Did have synto at birth but needed to get her to squat to get placenta and had a constant trickle and (surprise surprise) a relaxed uterus, which was fine after another shot of Syntometrine (450 loss).

 

My feelings are I probably should have been a little more pro active in getting the fluids up, maybe I erred on the non intervention side a little too long. Any other suggestions, how do you get a bub out with no Ctx and a tired mum? She did try nipple stimulation with little effect too.

Cheers

Di

No virus found in this incoming message.
Checked by AVG Free Edition.
Version: 7.1.407 / Virus Database: 268.13.0/464 - Release Date: 5/10/2006

Reply via email to