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!

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!