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Archive for October 29th, 2007

Yesterday I wrote about the arrangements for on-calls locally, quite appropriate as I was on a 24 O/C. Well, at 10.30pm the 1st phoned me and told me not to go to bed as she would be calling me fairly shortly. At 11.45 the call came so I returned to the couple I had visited earlier. Everything appeared quite positive for a short ‘outing’, how wrong I was. At 10.20pm the other midwife had examined D and found her cervix to be 4 cms dilated, very thin and stretchy. She was contracting 3-4:10, strong so she had believed that good progress was happening. When I visited in the afternoon I had felt that this was early labour, and had noted that the baby was slightly posterior. Certainly, by just observing the appearance of D’s abdomen it still indicated a posterior position, and from the amount of back-ache D was experiencing I felt that this situation had not changed. D was coping well though. There was a double mattress piled high with cushions and pillows on the floor in the sitting-room and D was on all-fours with her birth support massaging her back during the contractions. From 1am D was finding the contractions harder to deal with, plus her knees were becoming sore, so I encouraged her to go into the bathroom, see if she could pass urine and then spend some time sitting on the loo, a position many women in labour find more comfortable. I believe that it also helps the labour hormones work better as the woman has privacy in there, she is away from prying eyes! I have copied here an extract from Andrea Robertson’s ‘The pain of  labour’ as it gives a good suggestion as to why.

“Whenever adrenalin begins to flow, a number of clinical signs will appear:

  • Panic behaviours.
  • Raised blood pressure.
  • Slowing of contractions due to the effect of adrenalin on oxytocin production.
  • Increased pain caused by reduced flow of oxygenated blood to the uterine muscle.
  • A pause in dilatation as the circular uterine muscle fibres contract and counteract the action of the other muscle layers.

When the true role of adrenalin in labour is understood, that is to prevent an untimely birth, remedies that will reduce its necessity and enhance productive labour become apparent. The following suggestions are in no particular order and will need to be tried in light of the individual circumstances:

  • Identify the source of fear or disturbance and remove it.
  • Use basic panic control measures.
  • Provide privacy.
  • Avoid unnecessary procedures.
  • Change the environment.
  • Dim lights, provide warmth and quiet.
  • Reduce attendants, beginning with unnecessary staff.
  • Provide continuity of empathetic caregivers.
  • Remove anyone who is showing signs of anxiety.
  • Allow time for adrenalin to decrease and endorphins and oxytocin and endorphins to reappear — at least an hour in the new conditions.
  • Whisper, avoid eye contact and conversation. “

This did help, in the short term, but by 2am D was becoming distressed again and wished a vaginal examination to see what progress had been made. Bad move. Cervix had only dilated 1 cm in 4 hours even with strong, regular contractions. It was now hard work supporting D through the contractions. Following the examination I encouraged D to lie on her side for a while so that she may rest between contractions, and also as an aid to allowing baby to turn into a more favourable position. After a cup of coffee and a chocolate digestive, for us tiring midwives, I went and ran a deep bath and found a candle to have burning in the bathroom whilst D spent some time in the water. Once she was in the bath I pulled the shower curtain across so that even with the door ajar she still had some privacy. We left her alone, only going in to listen in to the baby every 15 minutes. Her partner lay down on the sofa, and immediately fell asleep and her friend went into a bedroom to have a sleep. By 4am D was requesting that we transfer her into hospital as she didn’t feel that she could cope any longer. Her contractions had decreased in frequency and so we helped her out of the bath. She was really quite vocal now about how she couldn’t cope, grasping us fiercely with each contraction. I pulled the mattress over to the sofa and encouraged D to kneel and use the sofa to support her upper body. With every contraction  I used counterpressure on the sacrum, it helps with back pain and may also cause just enough movement of the pelvis to allow more freedom for a baby’s head to rotate. It did seem to be helping D to cope as she had calmed down and was coping well again. After about 20 minutes D apologised for passing urine uncontrollably. My spirits lifted, baby might of turned causing pressure on the bladder. With the next contraction the waters broke, I hurriedly woke the two slumbering birth supports, baby was coming. Three contractions later and D allowed baby’s head to slowly appear, a couple of blinks and a frown and the shoulders turned slowly, D gave a beautifully controlled push and her new son entered the world at 4.30am.

We left at 5.45am. D was showered, baby had gone to the breast at birth, fed well and was now back there, suckling happily.

I went back to the office, dropped off the on-call equipment, I had no intention of going out again, and arrived home at 6.30. I flopped on the bed in a spare room, after setting the alarm for 9.00, and feel asleep.

Up at 9. Off to a booking appointment. Home for an hour, another booking, and then I shall take up residence on the sofa.

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