Re: [ozmidwifery] No Contractions

[Andrea Quanchi]

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













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Re: [ozmidwifery] No Contractions

[Judy Chapman]

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
> >
> >
> >
> >
> 
> 




 
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Re: [ozmidwifery] No Contractions

[Judy Chapman]

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
> 
>  
> 




 
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Re: [ozmidwifery] No Contractions

[Melissa Singer]

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 - 
  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 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 - 
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 t

Re: [ozmidwifery] No Contractions

[[EMAIL PROTECTED]]

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

[Andrea Quanchi]

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

[Janet Fraser]

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: 
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


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Re: [ozmidwifery] No Contractions

[Lisa Barrett]

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

[Susan Cudlipp]

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 - 
  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 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 
  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 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 


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

Re: [ozmidwifery] No Contractions

[Susan Cudlipp]

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 help that she was wrongly diagnosed 
as having SROM'd. Had I seen her earlier in the piece I would have 
wanted her 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 was definitely 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 
epidural even though only conts 12-15 minutes apart and 
mild/mod.
 
I would not have done the initial VE 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 with 12 
minutes each between 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 cr

RE: [ozmidwifery] No Contractions

[Philippa Scott]

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 





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 ou

Re: [ozmidwifery] No Contractions

[cath nolan]

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 
  
  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 lit

Re: [ozmidwifery] No Contractions

[Lisa Barrett]

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 
  had not - 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 to OA in 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 
  contractions as 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.  
 

Re: [ozmidwifery] No Contractions

[Susan Cudlipp]

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 
had not - 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 to OA in 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 
contractions as 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 
m

RE: [ozmidwifery] No Contractions

[Lisa Gierke]

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


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Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
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Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.


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Re: [ozmidwifery] No Contractions

[diane]

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 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
  

-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, shouldn’t 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 can’t 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 can’t 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.  Don’t 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 

RE: [ozmidwifery] No Contractions

[Lisa Gierke]

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 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

  
  -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, shouldn’t 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 can’t 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 can’t 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.  Don’t 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 can’t 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 on”undirected 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

[B & G]

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

[Mary Murphy]

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,
shouldn’t 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 can’t
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 can’t
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.  Don’t 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 can’t 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
on”undirected 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

[Lisa Gierke]

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  to subscribe or unsubscribe.

Re: [ozmidwifery] No Contractions

[Lisa Barrett]

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.  Don’t 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 can’t 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 on”undirected 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

[B & G]

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 

Re: [ozmidwifery] No Contractions

[Michelle Windsor]

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

Re: [ozmidwifery] No Contractions

[Andrea Robertson]

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

[Grant and Louise McLeod]

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) again have that little rest 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
 
 
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RE: [ozmidwifery] No Contractions

[Lisa Gierke]

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 


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RE: [ozmidwifery] No Contractions

[Mary Murphy]

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.  Don’t 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 can’t 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 on”undirected 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

[Lisa Barrett]

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