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Posts Tagged ‘shoulder dystocia’

I would like everyone who reads this to remember that on two seperate occasions I  have expressed my concerns to the doctors about the size of the baby and DIL’s ability to give birth to a baby bigger than Evie.

DIL’s waters broke at 16.45. They bought Evie around to us at 17.30 and, since there were only tightenings, they went off to the hospital whilst I stayed at home and gave Evie her dinner. At 18.20 son phoned and said that I should get over there soon as the contractions had started. Off I flew and, of course, encountered every super-cautious driver ( the ones who need an all clear from 2 miles away before they will pull out at a junction) I got to the hospital just before 19.00 hours.

I walked in to hear the midwife encouraging DIL to push, whilst the labouring Mum was inhaling deeply on the entonox. Gosh that was fast, nothing to pushing in an hour! Baby was moving down slowly, very slowly. The midwife and I exchanged glances. Baby’s head started to appear, and then stopped. Much encouragement and his head was born, just. Another contraction and baby didn’t advance at all. The midwife pulled him, he didn’t shift. Whilst the midwives lifted DIL legs back (McRoberts) I dropped the back of the bed and pulled the emergency buzzer, we had a shoulder dystocia.

Within 20 seconds the room had filled with midwives, obstetricians and paediatricians. After a tense few minutes, felt like 10, was really only 3, out came my new grandson, very shocked but after a minute he opened his mouth and let us know that he was fine. DIL didn’t seem to realise anything much untoward had happened, son was quite stunned.

Labour ward was full to bursting, 18 rooms of women in labour or who had recently given birth. Both the on-call community midwives had been called in but even so staffing was not covering the influx so I got on with weighing baby, 8lbs 9ozs, and measuring his head circumference, 37 cms. When DIL started bleeding rather more than we would wish I was left to observe and react. The bleeding slowed down to normal levels by 22.30, DIL was fine and baby had breastfed almost constantly since he was born. I bid them all farewell and returned home.

At 23.30 son texted to let us know that our grandson now had a name, William Joseph, and that Mother and son were doing well.

Evie had gone off to sleep well for grandad and didn’t wake until 5.45am. Unfortunately I had not gone to sleep well, my brain was churning over the evenings events, alternately thanking god for a positive outcome and plotting retribution on the doctors who had dismissed my concerns, so I had managed about 2 hours sleep before Evie woke me from my slumbers.

It is Thursday, so round came the boys to join Evie in the chaos of my sleep-deprived home. Son came and collected his first born at 11 so they could introduce her to her brother, who was now called Joshua William. Unfortunately I had spent the previous 5 hours teaching her to say ‘William,’ so there is definitely going to be some confusion there! The staff had advised DIL that she would not be able to leave until Joshua had been thoroughly checked by the paediatricians to ensure that there was no nerve damage or fractures resulting from his dramatic birth but they were hoping to be home by mid-afternoon.

At 16.30 son phoned to say that the docs had checked baby and he had not suffered any damage, but he does have a heart murmur so they can’t go home. I contacted Hubby who abandoned the golf course in favour of visiting his new grandson, I was stuck at home with the boys and Amy, tired and weepy, me not them!

At 18.30 Hubby arrived home, with Evie, her Mummy and Daddy were waiting for Joshua to be reviewed again. Thankfully I had been blessed with a second wind so we had a lovely time, dinner, bath and much chatting. Then the phone rang, it was son saying that the paediatricians had reviewed baby and……..he was fine so they would be leaving the hospital imminently and would pick Evie up on the way home.

That’s it then, the birth and first 24 hours in the life of my seventh grandchild. DIL appears well and oblivious to how much of a scare she and Joshua gave us. Her coccyx has been displaced again so sitting is painful and it’s very early, pre-baby blues days but presently she regards this labour as a better experience and ‘less traumatic’ than Evie’s labour and birth!

Joshua William, born at 19.19 hours on 23.06.2010

Joshua William – born at 19.19 hours on 23.06.2010

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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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