Sunday, June 8, 2014

WhenTime Stands Still

I met “Sha-sha” at the beginning of my shift. She was happily expecting her 3rd child- which they believed to be a little girl. “Sha-sha” was very responsive to help and readily tried a number of suggested positions which greatly helped her cope through the strong and regular contractions. Though she was only 5 cm at 6am, labor was strong. However, she was stronger. “Sha-sha” focused well. She breathed through each contraction and pressed into her bana for support.

I should note here that her bana was also amazing. He brought her food, milo (a chocolate type drink), and water. He breathed with her, whispered to her softly, and gently massaged her back. When her hands and feet started to cramp, he massaged them and talked quietly with her. He was so kind and gently yet a strong support for her! I wish I saw this more often!

Around 8am, intensity increased. “Sha-sha” had a more difficult time breathing, but still could. When I asked how she was doing, at this point she told me “Not so good now Ma'am”. Further evaluation showed she was doing wonderfully! She just needed a little encouragement and she and her bana labored on.

9 am came and I could see that “Sha-sha” wanted to bear down with each contraction. I tried to help her breathe or blow through each contraction, but it was not effective. I suggested a hands and knees position. It helped for about 15 minutes, but with each contraction it became more and more difficult for “Sha-sha” to not push with force. A short time later I discovered that she had almost reached full dilation. With the next contraction or two she was fully dilated and the baby's head descended into view.

I alerted the supervising midwife and she quickly appeared. Ate picked up the chart as Emi assisted me. As the baby's head began to emerge, I saw that Violet had entered the cubicle for backup. I was glad. My instincts told me something was not quite right. The head slowly became more visible with a contraction then disappeared without one. This repeated itself with the next contraction. My alert sense heightened. I turned to Emi and told her this was called the Turtle sign and could indicate a nuchal cord or impending dystocia. As she checked the baby's heart tones, they came loud and clear. I prepared myself for what I expected to come and as I looked up I saw Violet thought the same thing. She had called for Brittany to be on “stand by”. 

Violet moved closer as the baby's head emerge from the perineum. Ever so slowly it came out and retreated. Finally the head was born. A nuchal cord was immediately ruled out. The anterior shoulder was not coming as it should. Immediate action was needed. Time stood still as the team sprang into action. The next moments happened quickly, yet felt as if time had stopped.

The anterior shoulder was not coming so Violet and Brittany performed McRobert's maneuver (straightening and then hyperflexing the legs. This movement rocks the pelvis and often is enough to dislodge a “stuck” shoulder). It did not help. We called for the “edge of the bed” as I saw the baby's face turn a deep purple. I knew we had to act quickly. If this baby did not come quickly, brain damage or death were real possibilities.

While still inside searching for the shoulder, we grabbed “Sha-sha” and turned her to the edge of the bed. With the sacrum off the bed in this position, it can help to open the pelvis and give baby more room. Still no shoulder. McRoberts was swiftly repeated. Nothing. We tried it a second time. As Brittany and Violet moved her legs into hyperflex, there was movement. My heart lept for joy! The shoulder was coming!!!

Seconds later, baby Jasmine's body followed and we all praised the Lord! Time seemed to resume at a normal pace. As I looked up, I saw the bana standing in the corner sobbing. My heart went out to him! He was terrified. “Sha-sha” was thankful to hold her precious daughter and slowly, her bana moved in for a closer look. We gave Jasmine a little oxygen to help her “pink up”. She was born at 9:57am and her APGAR scores were 7 and 9. 

A little while later (after things were cleaned up some and both mother and baby were stable), I sat down with “Sha-sha” and her bana while I explained what had happened. I told them how the baby's shoulder had become stuck behind the pubic bone and how each of the positions helped baby to be born. They both understood. My mind wonders what the alternative outcome would have been if no trained attendant was present.

I am always surprised how time seems to slow when you are in the midst of an intense birth like this one. The should dystocia “only” lasted 1 minute and 20 seconds, yet it seemed like time stood still. I am thankful that the Lord allows this to happen at times. The Lord helped everyone remain calm, controlled and focused. Some say that with a shoulder dystocia one has 3-5 minutes before brain damage occurs. I am thankful the Lord helped the baby come quickly!

Despite the “difficulty”, it was an amazingly beautiful birth. I loved the experience of teamwork in the midst of a complicated birth. I loved watching the parents interaction before and after. I saw once again the true beauty of midwifery! I also have an even greater appreciation for the training I have received. God is so very good!

Proud Parents who are thankful for their 7lb. 3oz Miracle

The Amazing Team! From Left to Right: Ate Ermie, Sarah, Violet, Emi, Brittany, and Rio

I am wicked blessed! **All photos and names used with permission!

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