Wednesday, October 01, 2008

Oops! Repeat shoulder dystocia, fractured arm, Apgar 1

The midwife who writes Homebirth: A midwife Mutiny had an "oops" homebirth. Really, they were planning to go to the hospital to have this baby. She had a history of a severe shoulder dystocia with the previous baby. And yes she was in active labor when the midwife got there to be her "support" person, but, no doubt, they were planning to go to the hospital all along, but then (who could have forseen it?) the mother was pushing, the baby was crowning and it was just too late.

Guess what? Another shoulder dystocia. What a coincidence.
Baby comes very quickly to eyes and then each contraction only brings a little more baby,few more and baby's mouth is half in half out, she's on all fours so we are just waiting. chin is barely out just waiting, no contraction for a number of mins so I don't touch but ask her to change position, touching before any sign impacts the shoulder, she changes position baby does a bit of a turtle neck thing but tries to swallow. another 5 mins on peri and I ask them to call an ambulance but all is very calm, I'm well aware of their last experience so we keep chatting. I felt shoulder abdominally and just tried to put them in the AP and I asked her to turn back onto all fours, Still nothing baby is looking a little off colour so with next contraction about 5 mins on, I put in my hand and with some difficulty, (lots actually) I move the posterior shoulder and as it's birthing I hear it snap. FUck, However the arm came through and I was able to pull the baby out. I am so over this!! baby had great cord pulse apgar is 1. I mouth to mouth baby and after 2/3 mins feel a few resps under my mouth ...
It's only a matter of luck that the baby is not dead. Hopefully, the only lasting effect is a broken arm and not permanent nerve damage. Of course, it will be a while before they can determine whether the prolonged interval without oxygen caused permanent brain damage. Good thing all this is no one's fault, because really they were planning on transferring to the hospital, they were, but who could have predicted that a multip labor would proceed so fast?

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