The woman I was supporting for a hospital birth as blogged about in the midwifery group practice post has had her baby.
She initially planned a birth through the MGP and when she ask me for support as well the group made her leave. Her second birth had been a severe shoulder dystocia, lots of strangers rushing in, cutting an episiotomy the birth then resulting in a fracture of the clavicle and humerus and the baby being taken to the resus with an apgar of one and then off to the nursery . There was months of trauma and feelings of depression.
This time she thought that more support would help her get through it if a similar thing happened. However the group had different ideas so we were going through the regular labour ward where they were happy to do their best.
So at 38 weeks…
Her waters went but no labour, I decided to go and be close as the same thing happened last time and her labour went along fairly quickly afterwards.I actually went to see them first all was ok a few niggles only. They were going to bed after a while so I just said I’d stay on the sofa and see how it went. After an hour I could hear her contracting really well. I looked through the door and she was just doing her own thing. She had earlier been pretty sure that she would know when she wanted to go to the hospital, to me she sounded fairly advanced in her contraction but I didn’t bother her. I watched for a while and went back to lay down, she didn’t see me. Just a few contractions later she sounded pushy to me so I got up. She called me at the same moment. Her husband was up too and I said I thought she was advanced in labour and leaving would only be an option if I had heard wrongly.
Next contraction she is pushing and we can see the head. There is no way we are moving I asked for a towel to put on the floor and she starts birthing the baby. Baby comes very quickly to eyes and then each contraction only brings a little more baby, few more and baby’s mouth is half in half out, she’s on all 4fours so we are just waiting. chin is barely out just waiting, no contraction for a number of mins so I don’t touch but ask her to change position, touching before any sign impacts the shoulder, she changes position baby does a bit of a turtle neck thing but tries to swallow. Another 5 mins on peri and I ask them to call an ambulance but all is very calm, I’m well aware of their last experience so we keep chatting.
I felt shoulder abdominally and just tried to put them in the AP and I asked her to turn back onto all fours. Still nothing baby is looking a little off colour so with next contraction about 5 mins on, I put in my hand and with some difficulty, ( lots actually) I move the posterior shoulder and as it’s birthing I hear it snap. Fuck! However the arm came through and I was able to pull the baby out. I am so over this!! Baby had great cord pulse apgar is 1. I mouth to mouth baby and after 2/3 mins feel a few resps under my mouth. Ambos arrive at 5 mins, still just breathing into baby but colour is much better and resps more regular, ambos were great, took their time to get the 02 out but I just kept on breathing into the baby, by the time their stuff was attached baby didn’t need it. We just put some clean warm wraps around baby and then the placenta birthed. Ambos would have left, except I knew I’d broken the baby’s arm. They waited for my client to shower and feed the baby get the babysitters over and then we went to the hospital for an X-ray.
I had fracture the baby’s arm. This was a pretty traumatic experience for me, I had no equipment due to the fact she really had planned a hospital birth. Homebirth hadn’t even been a consideration, for me either. I have “stuff” surrounding shoulder dystocia and was more than happy that we would be at the hospital.
For them it was great. Having had the experience at home and at hospital then she would chose home any day, she doesn’t feel the anxiety and trauma of last time. The baby was never taken away after the birth. She was amazing calm throught the birth and is a true birth goddess and I am glad that she feels this birth was much better than her last.
She needed no stiches and the baby is doing very well at home. I don’t normally write a birth story on behalf of a woman as it’s not mine to tell and i’m sure she will give her own story when she can. I asked her for permission to write as I had a few bitchy comments on the group practice post and wanted the story here for everyone to see.
Addendum
Another post from the mad blogger. This time she failed to mention that the woman’s hospital birth had a baby with a broken humerus and clavicle and intensive nursery care. Postnatal depression from the trauma. Wonder why that wasn’t part of the discussion? But of course that’s ok Obs always do their best. If there is a complication they can’t help it. If they have fear they avoid it by cutting the woman open to manage their own fear and risk. The woman isn’t really involved is she?
It’s a sad reflection that these people rule.
- Do you
Homebirth? Share this post with your friends - Recommend on Facebook
- Buzz it up
- Share with Stumblers
- Tweet about it
Related posts:
Phew! What a wild ride for all of you. I hope the baby heals quickly.
As a recently retired homebirth midwife, I have a couple of things to offer here: First: every labor has a birth built in! Always go prepared to attend the birth, even if that isn’t the “plan”. We all know that babies come when they want, not when we want. Especially with a multip! Second, and this is more sensitive material: if you have “stuff” around SD; please work it out before you agree to attend another woman with a positive history. I was taught by a very savvy senior midwife that SD needs to be positively identified at the “yellow light” stage and acted upon ie. change position, corkscrew, extract nuchal arm etc. But ACT. A baby who is on the perineum and ‘turtling’ isn’t going to come out on its own! We ignore the baby’s communication to us at our, and most importantly, the baby’s, peril! If you have a lot of fear and anxiety about SD, you are going to tend to have some “denial” about the issue when it happens ie. to wait to long, hoping it will just “fix”–it won’t. When we, as Midwives, have a lot of fear around particular complications; we need to engage it, get some help and extra training so that we develop a comfort level, and confidence, about dealing with it. The fact that you took on a woman with a history that you have “stuff” around indicates that you need to address the issues; the next time, everyone may not be so lucky!
Ooh, crikey Lisa, a quick birth is a quick birth.
It would have been worse in a car hon. I’m so glad you kept calm and they feel it was good, but oh boy, I bet your heart was in your mouth.
It must have seemed like forever, I hate it when baby’s face darkens with an SD and you can’t get in yet to do internal maneuvres. The starters position is the only extra thing i would have done, it will sometimes help to free it up from all fours.
Commiserations, and I’m so glad and relieved the baby came good with your E.A.R. It would have been an ugly rerun, instead of a calm rerun.
A fast unexpected homebirth is just that, and thank heavens you were there for resus.
i am glad for the woman that she chose to birth the way that she wanted to. I am glad to hear that the baby is also doing well at home. thankyou for the story on her behalf i enjoy reading what you have to write keep up the good work
Thanks for your comments Kneeling midwife. I am a midwife with over 20 years experience and I would love to know what “stuff” would have made it any difference.
Plus, we had planned a hospital birth and the woman only asked me early so we could all go in together. I did all the changes required and I think if you were to read another birth story that is on this blog you wouldn’t be quite so judgemental, plus I had asked her when I got there about transferring immediately and she didn’t want to, she had never done this before and was sure of herself. I respect that. There was no denial on my part but I am never going to move a woman who is fully without an ambulance, who kindly arrived promptly. My admission of fear I feel that you have mis interpreted. the actions as you are well entitled to.
I was certainly confident of my actions and would honestly think that anyone without a healthy reverence of the potential complications one should NEVER practice.
This post seems to reflect some of your own fear surrounding birth which you often talk about on your own blog. How sad for you.
cant help but get caught up in this one. have had my two bobs worth over on mad amys website even though i KNOW its futile. i cant imagine the stress on a professional in these situations, have seen it and appreciate the skill involved and as the birthing mother of a SD no 3, with 2 previous uncomplicated home births, its one of those situations that just is. its .02% of births. RARE. but they happen and you dont want to practice invasive obs just to mitigate the rare. Having faced the bare truth of a SD, id still want to do it how i did it, at home, but definitely not freebirthing, you need an experienced practitioner to assist. No amount of modern tech is gonna help when a head has been birthed.
Great job, to mama, baby, and youself! SD is terrifying, no matter how many times you handle it, or how well trained you are to resolve it.
Hi Lisa,
I was wondering: if SD only occurs .02% (is that correct? seems to be what someone here mentioned), what are the risks of a vaginal birth compared to an elective c-section?
It seems that regular OB thinking would put a woman with prior SD in the elective c-section category. Does this indeed reflect the alleged risks of a repeat SD?
Not sure if I am asking this correctly LOL Having a hard time getting into words what I want to know but maybe you know what I mean.
Thanks!
maria.
LIsa; I don’t think I”ve ever talked about “fear” of birth on my blog–fear of the current cultural/legal situation around birth; yes, absolutely. I really wasn’t being ‘Judgmental” and I’m sorry you heard it that way. I too, practiced Midwifery for over 20 years and I’ve handled several SD’s successfully in that time. I’ve also been at peer reviews for baby deaths and all but one were mismanaged or miscalculated SD’s. It is surprising to me that there is often a fairly “casual” attitude towards this particular complication. In my State, we had a Midwife end up in court over two SD”s that simply were not acted upon in time–both babies died. I too, believe in respecting the mother but I also think that perhaps there was more conversation/dialogue that needed to happen between you and the mother given her history. The “stuff” I was referring to is what you described as your issues around this particular complication. We all go through periods when certain things just “worry” us and I’ve found, throughout my time attending births, that it was truly helpful and increased both my skill level and confidence; to work with my ‘worry’, get more training or even some good counseling……I wasn’t being critical of the fact that you have issues with SD. My only criticism, if it can be called that, would be to attend any birth without all your equipment, or with the assumption that you are only there as a “support” person. As Midwives, we have a responsibility to assume that our skills and knowledge may have to be used in ways we hadn’t anticipated.
As an aside: I find it interesting, but disturbing, that whenever a Midwife illustrates a cautionary tale, meant to be helpful; it is often projected back as some kind of “fear of birth” issue. I can honestly say that I was never afraid of birth. I began attending them in my early 20′s and the only “fear” I ever experienced was when Midwifery decided that it was no longer interested in being “with women” but preferred to work towards being ‘with health care system”….now that scared me–right out of the Profession!
Stuff doesn’t mean fear either. Healthy respect for birth is necessary as I said.
I have certainly handled more than one SD. I am not advocating that this woman should have planned a homebirth but being honest on the internet is open to being pull apart constantly. Believe me in this State of Australia at a birth in the hospital you are no more than a support person or a friend. I mentioned my equpiment for no other reason than to highlight my honesty over NOT planning to be at home. Neither I or the woman thought it the best idea. There is not a lot of equipment that would change much about birth and nothing that would change a shoulder dystocia. I was never casual about the birth and I certainly did a good job of managing it.
I constantly work with myself get regular counselling and update. This is a healthy way to live you life regardless. You made unfounded judgements in your first comment. Surely you can leave that to the Obstetric blogger who will be no doubt sued for slander in the future.
Mmm, wonder why my comment/questions were not posted?
Did I say something offensive?
maria@unassistedchildbirth.com
Maria, of course your comments weren’t offensive. I wanted to publish then answer and then I forgot. Thanks for the reminder.
The risk of surgery is higher than the risk of repeat shoulder dystocia, simply because only 0.2% of babies will die from SD. The surgeon prefers the odds of a section as SD isn’t a risk they can control but they feel that c/s is.
It’s about weighing up the risk you want to take as a woman and as a practitioner over the risk you want to hand over to an OB. They are not god and regardless to common belief they do not come risk free
No problem, Lisa!
“The risk of surgery is higher than the risk of repeat shoulder dystocia, simply because only 0.2% of babies will die from SD.”
So, you are saying that the risk of a fatal c-section is higher than 0.2%? Tried finding that online but was not successful.
Thanks,
maria.
copied from Wikki
Statistics from the 1990s suggest that less than one woman in 2,500 who has a Caesarean section will die, compared to a rate of one in 10,000 for a vaginal delivery.[9] However the mortality rate for both continues to drop steadily. The UK National Health Service gives the risk of death for the mother as three times that of a vaginal birth.[10] However, it is misleading to directly compare the mortality rates of vaginal and caesarean deliveries. Women with severe medical disease often require a caesarean section which can distort the mortality figures.
A study published in the 13 February 2007 issue of the Canadian Medical Association Journal found that women that have planned Caesareans had an overall rate of severe morbidity of 27.3 per 1000 deliveries compared to an overall rate of severe morbidity of 9.0 per 1000 planned vaginal deliveries. The planned Caesarean group had increased risks of cardiac arrest, wound haematoma, hysterectomy (alt PPH – Post Pregnancy Hysterectomy), major puerperal infection, anaesthetic complications, venous thromboembolism, and haemorrhage requiring hysterectomy over those suffered by the planned vaginal delivery group.
A study published in the February 2007 issue of the journal Obstetrics and Gynecology found that women who had just one previous caesarean section were more likely to have problems with their second birth. Women who delivered their first child by Caesarean delivery had increased risks for malpresentation, placenta previa, antepartum hemorrhage, placenta accreta, prolonged labor, uterine rupture, preterm birth, low birth weight, and stillbirth in their second delivery.
The risk to the baby of contracting diabetes is increased significantly by being delivered by Caesarean section. The risk of developing diabetes is 20% greater for children born by Caesarean section compared to those born naturally.
Nov 2007 BMJ study of 94,000 women. In the study, seven women out of more than 62,000 (0.01 per cent) died following a natural birth, five out of 13,000 (0.04 per cent) died after a caesarean section and 11 out of 18,000 (0.06 per cent) died following a planned caesarean section that was carried out after labour had started.
Out of more than 62,000 natural births, 1,125 women died or suffered complications (1.8 per cent), compared with 723 women out of 13,000 (5.5 per cent) having a planned caesarean section.
Out of 18,000 women who had a caesarean section after labour had begun, 742, or (4 per cent) died or suffered a complication
Thanks!
Didn’t check Wikki! LOL