Got a call Wednesday night around 11 that our primip at 38 + 4 had called to say her water broke. Got another call around 1:30 a.m. that contractions had picked up, were 4 min apart, and they were ready for us to come. When we arrived, she was already at 5 cm; she and her husband labored peacefully for the next couple hours while we read, occasionally checked in on them, and got everything ready for the birth.
At 5 a.m. she was completely dilated and started pushing...and kept pushing for the next 3.5 hours! This primip birthed her 6 lb 14 oz baby boy in a posterior, acynclitic presentation! She did hemorrhage pretty badly following the birth of the placenta; I administered a dose of pitocin, and the bleeding stopped.
My lessons learned? Some moms really do find flat-on-back, legs pushed up to ears the single most comfortable position for pushing. Mom's intuition on pushing position is keen - this happens to be a great position for getting a posterior baby past the pubic bone! A simple labor does not mean a simple birth. Some births really do need a little extra assistance (hands-on) from a provider...I am sure in a hospital setting, this young mama would have been taken for a C-section after about an hour of pushing, without any progress. Despite my personal preference for hands-off, do-it-yourself-style birth, some well-timed help made a huge difference in this pushing phase. What else...oh, administering IM pit isn't nearly as bad when you've seen the blood gushing...I thought jamming that long needle in a thigh would freak me out a little. First, I should have known better - I have no problem with poking people with needles (EMT leftover); second, knowing what you are doing will literally save a transfer, some major problems, and maybe a life makes that quick jab very very easy!
So one down, two to go...soon! Our mamas are currently at 40 + 6 and 40 + 4, so I'm expecting a call any time now...
9 comments:
What else.. Oh Yeah, I love Michelle B and I owe her big time...
Especially since she tagged me:
http://loomweaver224.blogspot.com/2008/09/book-tag.html
It's true that you can't be too dogmatic about how birth *should* happen. I think you can learn valuable things from many styles of midwifery and, when you are on your own, you can decide what to keep and what to let go.
Thank you so much for the report! Great birth story.
I'm so glad you could be of help :)
It's really interesting to hear your thoughts on the needle jab. Of course, you are EMT trained though. Forgive me if I'm getting way ahead of myself here but I'm curious to hear about the experience of your first perineal suturing -- that was always the thought that made me wince whenever I thought of apprenticeship. (Obviously I'll never personally know. Well, never say never, but you'll know much sooner that I might.)
I most likely will not ever do suturing when working with this midwife - she uses dermabond instead, as suturing is actually causing more trauma to the tissue...
This mama's perineum looked amazingly like new after some well-placed dermabond. Thing is, any worse of a tear, and it would be a transport for surgical fix, not suturing...I really like this approach. It makes sense - especially thinking back to my tearing with C - I wish they had *not* used stitches, as that's what caused me so much discomfort for weeks after the birth. Yup, super glue is better :)
Wow! I'm so glad I asked. She sounds excellent.
Yahoo for you. Sounds like it was an exceptional experience for you in lots of ways, some you'll only realize in the coming days. And I'm very excited about the dermabond. Something I can pass on to my expectant mamas.
So I'd like to hear more about how she applied the Dermabond. From what I understand, you hold the tissues together, get them nice and dry, and then apply the glue over the exterior skin surfaces so that all of the tissues are held in place. I'd love to hear a blow-by-blow of how your midwife did it, if you were watching. I definitely would like to skip stitches if I tear next time, but I don't know if I'm entirely okay leaving it all hanging open (and with a busy toddler, I won't have the luxury of lying in bed for weeks like I did last time).
Yup, that was pretty much it! It works best when the tissues automatically want to close back on their own, as this mom's did. S basically blotted with 4x4s, applied to the surface, held for maybe 10 seconds (?) and voila! I guess it is really pricey stuff (like $80 pricey), but I was really impressed with how well it worked, how fast it was, and how NOT stitches it was LOL
Hopefully you won't need it at all this time...I had bilateral periurethral AND a 2nd degree perineal tear with C, and never a mark since...
Can you use Dermabond with a 3rd degree tear?
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