Saturday, October 23, 2010

Shoulder Dystocia ~

Madelina came in to deliver her baby at the same time as all my prenatal patients. When this happens... I always feel guilty sending them away. But I just can’t deliver a baby with 20 women waving their prenatal books at me impatiently. Right now I’m the only one doing them. (Anyone want to come help a sista out?)

So when I noticed contraction on top of contraction, I knew it wouldn’t be long but I still tried to get the prenatal women to come another day. No one wanted to leave. I knew I wouldn’t get to all the women out on the porch. But I didn’t care. Labors come first.

Madelina labored well, preferring to stay left-side lying. All was going well until her baby’s heart rate started dropping. She was only 8 cm but the babies heart was in the 80s, 90s. I moved her in various positions and wished to myself I had oxygen to give her but nothing changed.

I told the Clinical Officer on duty, Caleb, that I might have to resuscitate the baby and might call him in for assistance. He was just across the particle wood wall. He was ready.

But when I got back to Madelina she was fighting not to push and the fetal heart tones kept dipping and stayed low. I decided to try to help her dilate by massaging her cervix. It worked.

About 10 minutes later, she pushed out this whomper of a head. I saw him rotate somewhat but then shrink back in. (Turtle sign?)

I turned him this way. Nothing. I turned him that way. Nothing. He wouldn’t budge. My assistant (his first birth and with a jumpy personality to start) was trying to get her to sit up for some reason. (This is the OPPOSITE of what I needed but he was too high strung to hear me direct him.) Fortunately, Caleb walked in just at that time and got her in the lithotomy position. I did a bit of supra pubic pressure and climbed on the birth bed.

I’m guessing a minute passed at this point - maybe more. The baby’s head was tinged a bit blue but I’ve seen worse. I prayed and pulled and rotated. Finally something gave way and out squeaked rolls upon rolls of cubby!

Breathing, cubby, gooked covered loveliness weighing in at 4150 grams! Yeah!