Thursday, February 24, 2011

Sticky Shoulders!

Ayor was carried in to the clinic by two friends. It was late, but I was already there caring for another patient. She smelled of alcohol and urine, and most of her body was covered in dirt. Obviously exhausted, she lay on the bed and explained her labor had been very difficult.

During her pregnancy, she’d come for several prenatals where I taught not to push for too long. Fortunately, she listened. Apparently, her labor started two days before, but it only got bad that morning. Pushing at home for over four hours caused her labia and the baby’s head to swell. Not good.

Since this was her 6th child, I suspected some kind of malposition or cephalo-pelvic disproportion (CPD), so I did a vaginal exam. The head was large, but her pelvis seemed adequate. The problem was she wasn’t fully yet, but it wouldn’t be long.

Massaging the cervix away while she pushed (uncontrollably), it wasn’t long before the head crowned. It crowned for easily two to three pushes without any progress. Not normal for a P6 (aka: 6th time delivering). Did I have a shoulder dystocia on my hands?

I pushed the labia back over the head, but the body didn’t restitute; he was stuck. Just then, Dennis walked in and I asked him to do suprapubic pressure. Reaching in to manually rotate the shoulders wasn’t hard and the next push he was out -- to the relief of everyone one in the room!

Ayor was so glad to finally deliver. I was so glad she came. Praise God for babies that come out and breathe! I have to say... I love my job!