As a midwife I use many external signs when making judgements weather a mum-to-be is reaching full dilation/2nd stage labour, here are some of them:
Transition (sudden behaviour change; sleepy, talkative, had enough, want to go home, want a c-section or epidural, aggressive, hungry, etc)
Pressure in bottom (can be deceiving with a first-timer)
Urges to push/involutary pushes (again deceiving in primips)
Vomitting (can happen anytime, but often once 2nd stage is reached)
If using gas & air; either sucking harder at it or stop using it
Purple line visible high (harder to see on darker skin colour)
Cold lower legs (just started comparing with dilation noted, seems hit and miss to me at present)
Stretching of perineum
Presto…here comes the baby!
Any addition to the list welcome!
So many thoughts going round in my head about the last labour and birth I attended but the main one is that I’m happy about the outcome. Happy that it went so smoothly even though some help was needed to progress the labour. The mum-to-be needed care in the high-risk unit due to her pregnancy-induced condition. Continuious fetal monitoring and certain maternal monitoring were part of the care plan according to the guidelines.On arrival to the hospital she was 7 cm dilated and coping very well.
The mum-to-be appeared to be making quick progress from the external signs but alas when next examined she was again 7 cm. Curiously she had a couple of times wanted more pain as she wanted the labour progress to go faster. She was very anxious about how long it was going to take. I wonder what kind of birth stories she had heard. She hadn’t had any antenatal education but instinctively she mobilised and rocked during contractions and later when sleepy, she rested in between contractions but sat upright during them. She had a birthpartner who rubbed her back and was very supportive but I wonder also if the same birthpartner was putting ideas into her head, they spoke a foreign language so it’s hard to know.
As her waters had already broken during the time she had laboured in the unit, the next step to help labour progress is to give the mum-to-be an oxytocin infusion. As this would increase her contraction pains and frequency, we discussed pain relief options with her and she opted for an opiate injection.
2 hours after the oxytocin infusion had started she had now progressed to full dilation and was having those involutary urges to push that often is a external sign of the same, but not always (the thoughts I have on this I’m sure to pen down in the future and have mentioned previously too). Being that this is her first baby, we let her get on with her own pushing without direction or encouragement to allow for decent of baby’s head. Should she after an hour not show progress, further active pushing is encouraged and directed.
As the contractions after an hour was now shorter and not as powerful, the oxytocin infusion rate was increased. Some direction and encouragenment was given on how to push and within a short time effective pushing was noted, and very quickly baby’s head was visible and then baby was delivered by our new mum!
Part of why I am so happy about this birthstory is that I have been in similar situations where progress has been slow, and fetal distress has been noted and the deliveries have had to be assisted by a cut, or instruments or a c-section. The last woman who did not progress whom I cared for had all three and baby was very bruised from the instruments. The same woman had laboured so well in water and had pushed like a champion but baby just did not come, allthough appeared to be in an ideal position. I know these are quite different cases but one wonders if it is the care that I provide, however how I can even think that when I attend day-in and day-out in so many non-intervention labour and births.
Quote for all maternity units tea-room’s:
“You are a midwife. You are helping at someone else’s birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening. If you must lead, lead so the woman is helped, yet still free and in charge. When the baby is born, the women will rightly say, ‘we did it ourselves.’” –from The Tao Te Ching
Check out the following trailer and promo documentary on childbirth!
Labouring is hard work, that is why it is called labour. So often we just want to lay back and hope it’ll go away but by embracing the hard work that lays in front of us, it usually is over quickly. This I have witnessed many times, let me tell you of the most recent.
A labouring young woman came into our care being in the early throes of established labour very distressed. Her contractions were long and doubling up. The doubling up of contractions means that presenting part is not in an ideal position, it’s a little kinked. This can make for a long labour. Being distressed can also make for a long and hard labour. To remedy this an active standing position was advised including a rocking movement so that the presenting part could rotate into a more favourable position and relax her, hence making the journey easier and shorter. The young woman listened, followed the advise and calmed down. Her contractions became more regular and progress was noted after 90 minutes by the woman experiencing pressure in her bottom.
At this stage she was getting distressed again, the pressure can be quite frightening and at this stage women either want to push or resist. Pushing to early can be damaging but at the same time it is what our body is telling us, so why not go for it? My take on this is; yes our body is telling us to do it but it is how we do it. Don’t force it! Our bodies need to relax at this stage. A good way to relax in labour is getting into water. Again a way to make the labour journey easier and shorter.
Getting in to the water made the young woman relax, I imagine the pressure in her bottom was more manageable because the water counterbalanced the pressure. Any urges to push were gone until shortly before she delivered her baby. She had a couple of involuntary pushing and then the baby’s head was visible. A few more involutary pushes and her baby was there in her arms.
She progressed from 5 cm dilation to delivering her baby in 3 hours. Now some of you are probably thinking she has done labour before but in fact, this was her first baby. Amazing, right!
Hearing from other and reading the textbooks on active positions and water births and their benefits is one thing, but to keep seeing it again and again for yourself is simply awesome.
A beautifully written ode, published on my mother’s birthday (very fitting I think); http://motherrevolution.wordpress.com/2012/03/12/before-i-was-a-mother-revolution/
What to write? I figured the other day that it probably be easier to write as a Midwife on my midwife days and to write as a Single Woman on my free days. But that does not seem to have gotten my juices going. The only thing that pops into my mind now is how Midwife has become a nervous-giggling-teenage-girl.
This Midwife turns into this nervous-giggling-teenage-girl when a certain Mr Cute walks through my department, he is totally delicious to look at from top to bottom. Those eyes, that smile, the chest and literally his bottom, basically the whole packaging. He not only walked through the department once but several times. He actually does not need to walk through our department but does. Is he coming through to say hi to me? or is he checking out another colleague? but it seems it’s me he wants to say hi to? those old uncertainties, why would he think me attractive? I’m old, I’m overweight, I’m this, I’m that…..and the list goes on. But then why wouldn’t he? I’m friendly, smiley, charming (I’m told), lovely eyes, a nose that friends would chose if they could, and I’m not really that old (I feel younger than I have felt for years!).
What does it matter anyhow what really is going on, what matters is that I’m feeling these wonderful butterflies. Now to the question at hand. Do I just enjoy or do I try to flirt?