Pushed the baby back in, what's normal/acceptable?

[bcblondie]

So, this is really late in coming. My DS is 2.5 But I've been pondering my birth since I'm pregnant again.

I had a lovely homebirth with DS. I dilated very very quickly, but the pushing was hard. We had some decels during contactions that didn't always rebound. I think I had a low placenta though it was never confirmed to me. They were in the 80's for quite a while and in the 60's a time or two. I was really worried becuase I didn't know how long that could go on before the baby risked brain damagae, etc. She did call for EMS backup.

At one point my midwife pushed the baby back in. I can't see why she might have done this, perhaps to lessen pressure on the cord or placenta temporarily? Seems redundant becuase the baby is just going to have to go past there again.

After 1.25 hours of pushing she gave me a episiotomy, and I think after that the baby came pretty quick. I was 100% in favour of this cut (I yelled DO IT! lol.) But of course it was painful healing with 7 stitches and I wonder if it was 100 percent necessary.

What is the acceptable range of heart decels... do you think an episiotomy was necessary? Was the pushing the baby back in rediculous?

I want to note that I was very happy with my birth in general. My midwife was very calm through it all, and very respectful of all my wishes. She has moved away so I have a new midwife this time around.  Hoping for another homebirth with less cutting, better pushing. :)

[NANandAUBIE]

Had you been in a hospital they would have been calling a C section (GROSS, I know) It sounds as though she may have saved your birth experience. Maybe someone else will have a different opinion. But as a HUGE HB Advocate it sounds like your midwife rocked. Im glad your experience went well overall... Congrats on your lil bundle!

[bcblondie]

This crossed my mind too! A completely unmedicated, unaltered labour, and we had decels. What chance would he have had in stressful hospital transfer, possibly pumped full of meds, poked and prodded, put on IV's, unable to move around and sit where I want? His less than favourable reaction would have been twice as bad, and my less than caring OB would have cut me wide open without hesitation. :( And I felt like if a midwife says I need an episiotomy I can trust it. I don't trust OBs.  I'm so so glad, the choice I made to stay at home. Really hoping for the same again. :)

[NANandAUBIE]

Im a nursing student and Doula and in my maternity rotation and the things that went on were HORRID. Sectioning women so we (students) could witness surgical births, purposely failing women's inductions so they could go home and avoid the weekend. The busiest day in L and D was THURSDAY! Alot of inductions. Hmmmm coincidence. NOPE.

Sometimes if you push the baby back in it takes the pressure off of the cord long enough for the heart rate to recover and the baby to get much needed oxygen. Also it make move the position of the cord too.

HBMW's just ROCK. LIKE SERIOUSLY ROCK! :)

[bcblondie]

Thank you! That's good to know she did the best thing. :)

I could never work in L and D. I get angry just watching a Baby Story!! lol! It makes me so angry that the peak times for C sections are right before dinner and right before bed time. That's why I avoid being there at all costs.

[Kanna]

Originally Posted by bcblondie 

So, this is really late in coming. My DS is 2.5 But I've been pondering my birth since I'm pregnant again.

I had a lovely homebirth with DS. I dilated very very quickly, but the pushing was hard. We had some decels during contactions that didn't always rebound. I think I had a low placenta though it was never confirmed to me. They were in the 80's for quite a while and in the 60's a time or two. I was really worried becuase I didn't know how long that could go on before the baby risked brain damagae, etc. She did call for EMS backup.

At one point my midwife pushed the baby back in. I can't see why she might have done this, perhaps to lessen pressure on the cord or placenta temporarily? Seems redundant becuase the baby is just going to have to go past there again.

After 1.25 hours of pushing she gave me a episiotomy, and I think after that the baby came pretty quick. I was 100% in favour of this cut (I yelled DO IT! lol.) But of course it was painful healing with 7 stitches and I wonder if it was 100 percent necessary.

What is the acceptable range of heart decels... do you think an episiotomy was necessary? Was the pushing the baby back in rediculous?

I want to note that I was very happy with my birth in general. My midwife was very calm through it all, and very respectful of all my wishes. She has moved away so I have a new midwife this time around.  Hoping for another homebirth with less cutting, better pushing. :)

Here's the information you were looking for:

http://www.aafp.org/afp/990501ap/2487.html

You can read up on the details at your leisure, but I think the relevant passage is the one under the heading "Fetal Bradycardia":

Fetal bradycardia is defined as a baseline heart rate less than 120 bpm. Bradycardia in the range of 100 to 120 bpm with normal variability is not associated with fetal acidosis......

....Moderate bradycardia of 80 to 100 bpm is a nonreassuring pattern. Severe prolonged bradycardia of less than 80 bpm that lasts for three minutes or longer is an ominous finding indicating severe hypoxia and is often a terminal event."

Granted, often does not equal always, but I think that, going by your description, THAT was a really close one, and it's a good thing your midwife pushed the kid back (probably to relieve pressure on the cord) called the EMTs and went for the scissors. Quick thinking and the right thing to do on her part.

[bcblondie]

Eesh. Yeah that might explain why I was scared at the time. I'm glad my midwife did know what she was doing. She was so calm throughout as well. And at one point she said "I think this baby is going to be born here" and I don't know why but that just made me realize my pushing was doing something and gave me the encouragement I needed. Oh I'm so glad I had her. I really would have been cut open through my tummy at a hospital, hey? :(

[34me]

My now 17 yo dd was pushed back in at a hospital.  I did have a gp not an ob though.  I honestly can't tell you whether she had de cels or not (although her younger brother had major ones) her was also about position.  She was really struggling coming down the birth canal with her cord wrapped around her neck twice - so yeah she probably did have decels....

I'm glad we both had good outcomes and you can be more at peace with the other ladies reassurance.

[bcblondie]

I'm glad it turned out well for you! Props to doctors and midwives who really know what they're doing and take the baby's and mother's best interest to heart.

[JamieCatheryn]

Sounds like all went well to me. Better than when they pushed my brother back in just because the OB had a hangover and was slow to arrive!

[Kanna]

Originally Posted by bcblondie 

Eesh. Yeah that might explain why I was scared at the time. I'm glad my midwife did know what she was doing. She was so calm throughout as well. And at one point she said "I think this baby is going to be born here" and I don't know why but that just made me realize my pushing was doing something and gave me the encouragement I needed. Oh I'm so glad I had her. I really would have been cut open through my tummy at a hospital, hey? :(

Not so sure about the "cut open through the tummy bit". If you were as advanced as you describe and pushing to boot (and your midwife hadn't done the episiotomy yet), I think they might have tried for an episiotomy first too, since that's quicker than doing a c-section. But they would have been prepped for a c-section too, and I think that, if it had come to that, and if it had been in time to save your daughter's life, it'd have been totally worth it.  ^_~

[Kanna]

Originally Posted by JamieCatheryn 

Sounds like all went well to me. Better than when they pushed my brother back in just because the OB had a hangover and was slow to arrive!

Wow. That sounds like some serious bad quality of care there! Geez.

[bcblondie]

Originally Posted by Kanna 

Not so sure about the "cut open through the tummy bit". If you were as advanced as you describe and pushing to boot (and your midwife hadn't done the episiotomy yet), I think they might have tried for an episiotomy first too, since that's quicker than doing a c-section. But they would have been prepped for a c-section too, and I think that, if it had come to that, and if it had been in time to save your daughter's life, it'd have been totally worth it.  ^_~

That's true of course. (my son though, not daughter lol.) But the paramedics were standing in my living room ready to transfer me if this kid wasn't out in 2 more minutes lol. How long does the O.R. take to prep for csection? Because it would take less than 9 mins for me to get to the ER. I know that in this situation though, 9 mins can mean life or death. I do take a risk by being home, but I feel that avoiding the stress of transfer and the pressure of meds from docs, that in the end baby and I have a better outcome.
 

[Kanna]

Originally Posted by bcblondie 

That's true of course. (my son though, not daughter lol.) But the paramedics were standing in my living room ready to transfer me if this kid wasn't out in 2 more minutes lol. How long does the O.R. take to prep for csection? Because it would take less than 9 mins for me to get to the ER. I know that in this situation though, 9 mins can mean life or death. I do take a risk by being home, but I feel that avoiding the stress of transfer and the pressure of meds from docs, that in the end baby and I have a better outcome.
 

How fast the hospital could have been prepped depends on the hospital and, I guess on how your midwife arranged the transfer. Hospitals in the States are supposed to have a decision-to-incision of 30 minutes and for hospitals here in Germany, it's 20 minutes (This is called an emergency or a crash c-section and it carries higher risks for mom and kid than a regular c-section.)

If a hospital can actually uphold that 30 / 20 minute standard depends on their organizational set-up and if they practice in trial runs and such.

The other thing would be if the midwife (or rather her assistant) called the hospital the same time she called the paramedics (which would give the hospital more time to get ready) or later and if she had your medical info / your chart given to the hospital before the birth, so they don't have to spend time clearing up such questions like "Do you have allergies to such and such medications which we'd like to give you? Do you have any known pre-existing conditions that might negatively affect the procedure?" (Like e.g. clotting problems) when you get there.

I certainly feel that if a mom is low-risk and if there are good transfer arrangements in case of emergency, then a vaginal homebirth can be a very good thing for the mom.

I had a vaginal birth at a hospital, because I felt safer there than I would have at home (I'm a bit paranoid in that regard, it's not necessarily something someone else should base their decision on)......plus, I didn't want to have to worry about the carpeting and the clean-up  ^_~

Given the circumstances (and given that your midwife probably had a good, prior transfer arrangement with the hospital), I think you and your son were probably not at all or at least only marginally more in danger than you would be at home. (Only think, because I'm no OB, not in the States, not familiar with the hospital or the midwife...can't really make a judgement call on that without knowing all the details.)

Anyway, congrats on a healthy baby boy! My DD is 2 years and a couple of months old right now, so they're pretty close in age 

[Alenushka]

All it takes is one accident, and the ambulance is stuck on the road for 10-20-30-60 minutes. Sometime ambulances are in the accidents themselves. Many people live in rural areas where the ride to the hospital under the best of conditions is 30-60 minutes.

[JamieCatheryn]

Those who live so far from the hospital factor that in to their decision of course, sometimes they home birth at a friend or relative's house in the city.

[bcblondie]

Yeah I'm just ignoring the fear mongering. I could crash on my drive to the hospital in the intention of a normal hospital birth as well. Fact is, they can do csections in an ambulance, too. So let's not be rediculous. If I had a hospital birth my baby could be subject to say... menengitis (as my friend's baby did, and died at only 5 days old.) If you're so against homebirth, stay out of this forum.

Thanks Jamie and Kanna, for being the voice of reason. :)

[Kanna]

Just for the sake of medical accuracy: neonatal meningitis is most likely to be caused by Group B Strep, E.coli and Listeria monocytogenes, all three germs that are most likely to be found in or around the mothers birth canal, so there is quite a likelihood of the kid being infected during a homebirth too.

Where I would say "shame on them" is if at the hospital, they didn't catch the infection early enough, but I don't know enough about the case to actually do that.

Germs that are special to a hospital setting are e.g. MRSA and VRE (so called noscomial infections)....and maybe, if they have an outbreak of something like Noro-Virus, which you can get in any setting where there are a lot of people in one place. I don't have any idea though, what the likelihood of contracting something like that would be for a neonate in the L&D ward.

[bcblondie]

Ohh yeah. Mrsa. Staph infections right? are more common in hospitals. Anyways what I meant was that being at a hospital is not without it's own risks. I think the ambulance crashing was a rediculous/condiscending/uneducated/paranoid comment. Perhaps a mod could remove it? Mods have removed rediculous posts at my request before.

[Kanna]

Originally Posted by bcblondie 

Ohh yeah. Mrsa. Staph infections right? are more common in hospitals. Anyways what I meant was that being at a hospital is not without it's own risks. I think the ambulance crashing was a rediculous/condiscending/uneducated/paranoid comment. Perhaps a mod could remove it? Mods have removed rediculous posts at my request before.

*clears throat*

Actually, my mom died on the way to the hospital because of an accident. I was 2. I don't remember her. All I have is pictures. It was wintery and the roads were slippery. The hospital they were taking her to is about a 20 minute drive away usually. It wasn't even a bad accident.

And I've worked as the equivalent of an EMT and at least here in Germany, there's the occasional clueless person / douchebag who WILL obstruct an ambulance, regardless of flashing blue lights and blaring horns.

Yes, it IS possible to get into an accident on the way to the hospital for a normal birth...but at that point, time is not as essential as it is in an emergency.

While calculating the risks of a transfer, one should also take a good hard look at the route: Usual amount of traffic? Anything that will obstruct traffic around the due date? (Around here, during carnival or big soccer games, some of the roads can get pretty much blocked). Road conditions? Corners that are accident prone?

And yes, at the hospital, things can happen too that will cause delays, e.g. getting stuck in an elevator.