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Archive for March 3rd, 2009

That well known purveyor of non-sensational news stories, The Daily Mail, has an attention drawing headline today ‘Babies crippled as midwives bungle births’, I started reading with a sense of dread, what is my profession being blamed for now?

The article is about an obstetric emergency, shoulder dystocia, and how it has affected 3 babies. A true shoulder dystocia is an absolutely horrific occurrence, which can lead to the death of a baby. Early on in my midwifery training I met a woman who had just experienced the death of her baby due to shoulder dystocia, I had never heard of this before and I asked the midwife I was working with what it was, her answer chilled me, ‘Every midwife’s nightmare’, she then went on to explain what happens. Basically, the baby’s head is born, but that’s as far as it gets. There is no further progress as the shoulders, generally the anterior, become stuck above the brim of the pelvis. I was terrified, I wanted to find out everything I could about it, why, how, is there anything you can do to avoid it and, most importantly, what can you do if it does happen. I read a huge amount of literature, I found out about the maneuvers recommended, the factors which may lead a midwife to believe a woman may have a large baby and the signs during birth which may indicate that a baby may be having problems sliding it’s shoulders through the pelvic brim.  The video below shows anatomically what happens when shoulder dystocia occurs, and the damage it may wreak on the baby. 

3D Medical Animation: Shoulder Dystocia Birth Injury

There are drills we have to practice on the sequence of events which should happen if we are caring for a women who has a shoulder dystocia, the first element is ‘call for help’. That ‘help’ is not solely another midwife, it is also an obstetric registrar. What happens in practice is, that when the emergency buzzer is pressed, every senior member of staff responds. Did the midwife ‘bungle’ as The Mail says, or did the team fail to respond appropriately? I think the latter, as the article says that the woman had been told that she needed a caesarean section, but that never happened. Instead,  ‘Penelope was at the mercy of an overstretched obstetric team which did not seem to have the skills to deliver the baby without injury’. Whatever happened the woman went through an horrific experience, and her child is left with  a possibly permanent disability, Erb’s palsy.

Back in 1955 W.I.C Morris wrote a description of shoulder dystocia. I read it as a student midwife, and have never forgotten it, the extract below starts from when the baby’s head has been delivered 

‘Time passes. The child’s face becomes suffused. It endeavors unsuccessfully to breathe. Abdominal efforts by the mother and by her attendants produce no advance.

Gentle head traction is equally unavailing. Usually equanimity forsakes the attendants — they push, they pull.

Alarm increases. Eventually, “by greater strength of muscle or by some infernal juggle,” the difficulty appears to be overcome, and the shoulder and trunk of a goodly child are delivered. The pallor of its body contrasts with the plum-colored cyanosis of the face, and the small quantity of freshly expelled meconium about the buttocks.

It dawns upon the attendants that their anxiety was not ill founded, the baby lies limp and voiceless, and only too often remains so despite all efforts at resuscitation.’

 

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