Pushed the baby back in, what's normal/acceptable? - Page 3

[Kanna]

Originally Posted by Mama2Kayla 

I was shocked that anyone would consider a c-section by an EMT as an option. I had no idea anyone would think that was possible.

As someone who works in the medical profession: if you're a lay person, you often tend to over / underestimated what can be done.

....and now to come to think of it, I've had conversations with lawyer friends about stuff, and THEY get that too.

I guess it's normal for people who are unaware of the specifics (which they don't need to be, because that's what the professionals are FOR) to extrapolate: if X can be done, why shouldn't Y be possible too?

[starrlamia]

Chances are if you were in the hospital and they needed to deliver fast while pushing they would have gone for kiwi or forcep delivery over a c-section.

Glad everything turned out ok :)

[Kanna]

*g*

My daughter's head was BIG, and she was slightly stuck, so they had to do an episiotomy and use a suction cup. Not an emergency situation though.

They pulled VERY gently, together with the contractions, and out she came! (Nearly 12 hours after the contractions started).

[bcblondie]

I was scared to come check out this thread again but I'm glad it's back on track. Thank you.

Kanna I'm glad they were able to get her out vaginally. I hear the "too big" line so often as a push to an unnecessarian. I love to see people fighting for vaginal if at all possible.

Thanks Starrlamia :)

I was talking to friend today about my decellerations. I said:

They were in the 80's for, I'm not sure how long.. more than a few minutes, and not rebonding, and they hit the 60s a time or 2. Is that normal?

and she said:
When they are right in the birth canal, yes it is normal. I learned that when I took a Holistic Midwifery course a few years back. :)

What do you guys think of that? I just like to be prepared. I don't want to be scared and rushed over something that's normal that close to delivery. But obviously I DO want intervention asap if something's wrong.

[starrlamia]

decels during the pushing phase are normal, however the heart rate should bounce back between contractions, it is also often hard to get an accurate reading when the baby is in the pelvis. At least that is what I have already read.

this site has pretty good discriptions!

http://www.childbirths.com/cypress/fetalmonitoringetc.htm

[bcblondie]

Thank you. Mine weren't always rebounding from what we could find. I had an anterior placenta, does that affect it? I'm reading your link. :)

[Kanna]

Originally Posted by bcblondie 

I was scared to come check out this thread again but I'm glad it's back on track. Thank you.

Kanna I'm glad they were able to get her out vaginally. I hear the "too big" line so often as a push to an unnecessarian. I love to see people fighting for vaginal if at all possible.

My OB knew she was big, but at that gestational age, it's hard to tell via ultrasound exactly how big. Turns out they underestimated her weight by more than a pound. Still, I'm tall myself and as it turned out, the internal diameter of my pelvis is quite big too. It's not just a question of the size of the baby. It's also about the anatomy of the mom (and no, wide hips does not necessarily equate with a large internal diameter of the pelvis).

Actually though, I didn't have to fight my OB for it or anything. Since she was aware that I was a "med-person" too, we knew we'd go for a c-section if it became necessary...but as long as things went well, why bother?

Thanks Starrlamia :)

I was talking to friend today about my decellerations. I said:

They were in the 80's for, I'm not sure how long.. more than a few minutes, and not rebonding, and they hit the 60s a time or 2. Is that normal?

and she said:
When they are right in the birth canal, yes it is normal. I learned that when I took a Holistic Midwifery course a few years back. :)

What do you guys think of that?

Hmmm....all the data and studies I have access to indicate otherwise. Physiologically, it doesn't make any sense either, since low heart-rate = low cardiac output = low rate of oxygen delivery to the body (most of all the brain and heart). Outside of the mom, you start ventilating the baby at a HR at lower than 100 and you start chest compressions at anything below 60.

Before accepting what your friend learned at the Holistic Midwifery course, I'd really like a close look at the data / studies they've based that bit about decels in the birth canal being normal on.

I just like to be prepared. I don't want to be scared and rushed over something that's normal that close to delivery. But obviously I DO want intervention asap if something's wrong.

I completely understand the bit about not wanting to be scared and rushed. It was exactly the same for me.

But since I've worked in hospitals and also spent my fair share of time in an OR (mostly holding hooks) and also seen a few cesareans (once translating for the mom while it was being done....the lady was from a foreign country and spoke french and I was the one with the best grasp on that particular language in the OR), I feel fairly comfortable inside of a hospital. I know all the machines, what they do and how to interprete the numbers. I speak medical lingo. So it's not even remotely as scary for me as it would be for someone else.

It might lower your anxiety if you check out the L&D department at your hospital. The ones here offer regular tours for expectant moms. That way, if you DO end up needing a transfer (which is not THAT common, really....most homebirths are done without much fuss at home from start to end), you wouldn't be as scared, because you already know the place and got to ask questions beforehand (e.g. what their criteria for a c-section are, what kind of monitoring they have, pediatricians on call, rate of noskomial infections in the L&D department, how they handle informing the patient before procedures, etc.)

Just a possibility of covering all your bases.

[Kanna]

Originally Posted by starrlamia 

decels during the pushing phase are normal, however the heart rate should bounce back between contractions, it is also often hard to get an accurate reading when the baby is in the pelvis. At least that is what I have already read.

this site has pretty good discriptions!

http://www.childbirths.com/cypress/fetalmonitoringetc.htm

Early Decels are normal....but the site doesn't mention just how far they can decrease and still be considered normal. On the site you linked, even the early decels are (according to the strip) at about 100. The only strip with decels in the 60s range is the one with the variable decels and those are bad.

Do you have, by any chance, another source that says just how far down decels can go and still be considered normal?

[bcblondie]

Ok thank you. You would still check out your hospital if you were intent on homebirthing? Yes my clinic does have a low transfer rate, I think 5%? And about 90% of transfers are for pain relief, not emergencies. At least that's what I'm remembering from being pregnant 3 years ago! (but anyways. That's partly why I got upset at the derailment of complications DURING the complication of having to tranfer for an emergency. It's like worst case scenario on top of worst case scenario. I REALLY don't want to look at my birth that way, you know? I definitely want to be educated on risks but I also don't want to go into labour with fear at the forefront of my mind. That's never good for progressing... I want to be confident in my body, but I want someone there with medical knowledge who knows when to say, we need to go to the hospital...  But I also want to be educated myself on as much as possible, because last time the decels did scare me. So yes if anyone has more links of what are acceptable decels during pushing that would be great. Thanks. :)

[Kanna]

Originally Posted by bcblondie 

Ok thank you. You would still check out your hospital if you were intent on homebirthing?

Sure. If a transfer should ever become necessary, at least I'll know my way around the place I'm being taken to.

No idea about the procedures in the US, but if possible, I'd also let them have a copy of my medical records and info about how the pregnancy went (BP, blood-sugar, etc.), so in case of an emergency, everything will be on hand. (Wasn't the motto of the boy scouts something along the lines of "be prepared"?)

I like being thorough in my preparations (though I'm a bit on the paranoid side too on top of that).

And just 'cause I'm lookin' don't mean I'm buying, does it?

Yes my clinic does have a low transfer rate, I think 5%? And about 90% of transfers are for pain relief, not emergencies. At least that's what I'm remembering from being pregnant 3 years ago! (but anyways. That's partly why I got upset at the derailment of complications DURING the complication of having to tranfer for an emergency. It's like worst case scenario on top of worst case scenario. I REALLY don't want to look at my birth that way, you know?)

I definitely want to be educated on risks but I also don't want to go into labour with fear at the forefront of my mind. That's never good for progressing...

I understand completely. Birth and pregnancies should be joyous, relaxed times and shouldn't be ruined by being fearful and worried all the time.On the other hand, being a bit nervous is kinda part and parcel of the package.

Thing is, different people deal with worry differently. I usually research the hell out of a topic and know everything possible.The more I know, the safer I feel.  Other people opt for a bit of information and let the professionals handle the rest. And I'm sure there are many more ways to deal with it all. There is no "right" way to do it. Just a way that will suit your personality and your preferences and goals best.

I want to be confident in my body, but I want someone there with medical knowledge who knows when to say, we need to go to the hospital...  But I also want to be educated myself on as much as possible, because last time the decels did scare me. So yes if anyone has more links of what are acceptable decels during pushing that would be great. Thanks. :)

LOL. That sounds like a solid and reasonable combination for someone who wants a homebirth.

If you have some more questions you'd like to ask your midwife about how she'd handle an emergency, I think this is a good thread to find some questions to drill her with:

http://www.mothering.com/community/forum/thread/1305840/what-make-a-hb-midwife-not-safe-to-you

[kathrineg]

Just to clarify, the doctors in the Emergency Room will NOT do a c-section if the mother is alive. They will wait for an OB to get there. They are not trained to do c-sections and it would be too risky to the mother. So if it takes 9 minutes to get to the ER, that does not mean it will take 9 minutes to get a c-section started. It will take longer. How much longer is up to luck and the personnel/hospital involved.

[Honey693]

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.
 

Here a C-section prep is quoted as 20 minutes (both by midwives and doctors), but part of me wonders if they can do it faster if it's super scary emergency.

[Honey693]

Originally Posted by 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.

I just have to say I came home from the hospital with my first with an infection.  I forget what it was called, but I was rashy and had to get antibiotics all b/c I used the stupid bath tub.  My doctor said people pick it up from hot tubs or hospitals and told me it was probably the Jacuzzi tub at the hospital that did it.  Thankfully my baby was fine.
 

[starrlamia]

not offhand but i will ask my midwife buddies.
 

Originally Posted by Kanna 

Early Decels are normal....but the site doesn't mention just how far they can decrease and still be considered normal. On the site you linked, even the early decels are (according to the strip) at about 100. The only strip with decels in the 60s range is the one with the variable decels and those are bad.

Do you have, by any chance, another source that says just how far down decels can go and still be considered normal?

[starrlamia]

i asked and they stated it depends on the individual, it depends on base heart rates and how much the decel is for how long.

 

Originally Posted by starrlamia 

not offhand but i will ask my midwife buddies.
 

[holly6737]

Are you sure she wasn't "pushing the baby back in" so she could safely cut the epis? You have to get a finger in between the perineum and the baby's head so you don't hurt the baby with the scissors. Now, I've never had to cut an epis myself, but that's the way I was taught to do it. 

In the hospital, if the baby was that low, they likely would NOT have called a c-section. At that point, if you section someone, it's difficult to get the baby's head out of the pelvis. It can be quite trying, sometimes with someone having to push the baby's head up per the vagina while the OB pulls from the abdomen. You want to avoid that situation unless it's really necessary. When this happens with decels that don't recover, the goal is a quick delivery. Many times, the quickest way to delivery is to use forceps or a vacuum, which is likely what would have happened in your case. I just wanted to clear that up. Otherwise, I've never heard of a baby being pushed back in except in the Zavanelli maneuver with shoulder dystocia, and if you're at the point of doing the Zavanelli, it's basically a lost cause.