Silent dilation and I caught (with a big assist)

[homewithtwinsmama]

I had a client with SROM +9 hours. She had no contractions. Wanted to avoid pitocin induction and antiobiotics. I go over to do the Hibiclens protocol vaginal wash for GBS and she had just taken castor oil a couple hours before. We decided to wait for the diarrhea and then go in to her midwives once we had contractions. She had no contractions, she had no diarrhea, time is passing, still nothing. She is saying to me "I have never wanted to feel pain or poop so much in my life". Then for about two minutes the energy just shifted (no contractions, I just felt a shift), then she just began to push uncontrollably. I quick get her on the bed to check (want to make sure its not premature urge to push and do we have time to get to her midwives) her and the cervix is GONE! Baby is on its way down. No time for the drive to Baltimore. Call a midwife I know who lives nearby and ask her to come (I am a doula and birth asst. but don't carry oxygen, pit, etc. because I am never trying to catch, just get couple to their caregiver). Meantime mama is pushing, midwife shows up but just hangs out getting things ready and I am catching. Head comes out beautifully, then ---shoulder dystocia. I get her on hands and knees and feel inside and get arm/elbow all wrapped around neck. At this point I ask midwife to help me out since I know she has done many and complicated SD and why muck around with the midwife wannabee when she is so highly skilled. She gets the arm unwrapped and the anterior shoulder and then lets go and lets me do the rest of the baby and get baby up to mama. So I caught with assistance at an unplanned homebirth. Baby needed a bit of a help to start breathing after that so I was glad I had called her in with the oxygen and experience to back me(I do stay certified in neonatal resuscitation). Not even a very big baby (38 weeks). The couple were surprised but really feel good about it now. It was a very exciting night!

[DreamsInDigital]

No way! That's totally awesome!

[natural_mama89]

That is a great birth story!!!!! i am glad things turned out so well for the baby and mama!!!

[cfiddlinmama]

Great story! I'm glad you trusted your intuition about calling the mw. Congratulations!

[Contented73]

WOW. I've never heard of such a thing. Did she ever have any pain at all? Any contractions at all? What number baby was it?

[homewithtwinsmama]

Originally Posted by Contented73

WOW. I've never heard of such a thing. Did she ever have any pain at all? Any contractions at all? What number baby was it?

No pain until pushing, no contractions until pushing began. First baby.

[Midwife Kris]

Originally Posted by homewithtwinsmama

(I am a doula and birth asst. but don't carry oxygen, pit, etc. because I am never trying to catch, just get couple to their caregiver).

Definitely sounds exciting, but I am curious as to why you would put your midwife friend in a situation like this? Does she work with or know well the midwives who were wondering where their client was? Why not call for EMS for this clearly unplanned, unprepared home birth?

[courtenay_e]

*shrug* probably what I would have done if it had been a normal, healthy pregnancy. I trust my midwife friends, whose "work" I've seen in emergent situations with my client's lives more than I do EMS, who may or may NOT know what to do with SD. And, if the midwife didn't want to come, she could have said no...and if my friends didn't feel comfortable attending, they would have suggested a transport via ambulance, to either the nearest or their "safest" hospital.

[homewithtwinsmama]

Originally Posted by Midwife Kris

Definitely sounds exciting, but I am curious as to why you would put your midwife friend in a situation like this? Does she work with or know well the midwives who were wondering where their client was? Why not call for EMS for this clearly unplanned, unprepared home birth?

My midwife will help anyone who wants her help. She always tells me to feel free to call for advice or help if needed. She even scrambled to an unassisted planning couple of mine a couple years ago who got into a stalled situation at home and called her for advice. They asked her to check mama, break waters, check FHTs and then leave. She did as they asked, baby came 20 minutes later and they are forever grateful for her willingness to help out but not take over. She will serve couples where they are. This couple did not want this baby to get the 3 day NICU nightmare having missed the required 2 doses of antiobiotics would have led to and this baby was coming fast. Because this mama had attended her brother's homebirth and had said she would likely do so herself for the next baby for sure, though she was a little nervous about actually planning one for her first baby. Why not call EMS? Because the 19 year old EMTs that might show up are far less trained and experienced than even I am to handle a birth (I have caught precip. births before). I have a doula friend for whom they did call EMS and EMS totally FU the birth and were so freaked out that they wouldn't go near the mama to handle the placenta, so the doula ended up doing 3rd stage herself anyway. Because a highway birth with shoulder dystocia and an EMT with four hours of OB training is far more dangerous than a birth at home with a midwife trained in emergency techniques with meds and oxygen at the ready. Because they lived too far from the hosp. their midwives were in and the ambulance would have taken them to a hospital where they would have been attended by some on call OB they had never met. Because a hopped up on adrenaline, run in the door with the baby hanging out hospital birth is traumatic to the parents and depending on how the staff responds could even be more dangerous. Because after doing this for the last 8 years I go with my gut and my experience when things take an unexpected turn.

[Midwife Kris]

Originally Posted by homewithtwinsmama

Because a highway birth with shoulder dystocia and an EMT with four hours of OB training is far more dangerous than a birth at home with a midwife trained in emergency techniques with meds and oxygen at the ready.

When your midwife was willing to attend the birth and admittedly you are not a midwife, why didn't she assume the role of midwife completely? I feel the adrenaline rush you are speaking of in your response and wonder how the situation may have been improved had she stepped in rather than wait to resolve shoulder dystocia.

Because after doing this for the last 8 years I go with my gut and my experience when things take an unexpected turn.

Certainly "silent dilation" is a surprise, but with the woman inducing herself with castor oil one should expect the unexpected. I'm sorry for putting you on the defensive, but had you not had a friend to call this outcome might have been disastrous instead.

[jul511riv]

I think you did an AWESOME job and should be VERY proud of yourself and YOUR skill set in this situation. Way to go mama!

[homewithtwinsmama]

Originally Posted by Midwife Kris

When your midwife was willing to attend the birth and admittedly you are not a midwife, why didn't she assume the role of midwife completely? I feel the adrenaline rush you are speaking of in your response and wonder how the situation may have been improved had she stepped in rather than wait to resolve shoulder dystocia.

What was to improve? The baby came out in very good shape with apgars of 7 at 1 minute and 9 at 5 minutes. I handed it off as soon as I realized that it wasn't a completely straightforward birth. Why didn't the midwife shove me out of the way? Well, because this couple had never met her. They had a very good relationship with me and all was going beautifully up until that moment.

Certainly "silent dilation" is a surprise, but with the woman inducing herself with castor oil one should expect the unexpected. I'm sorry for putting you on the defensive, but had you not had a friend to call this outcome might have been disastrous instead.

Well the castor oil decision was made between her and the hospital CNMs to avoid a pitocin induction. They had her do it without bringing her in to see whether or not she was dilated or in labor at all. That was not my decision. The CNM had told the couple to come in as soon as the diarrhea had passed. Well it never came. I have seen castor oil not cause labor and only diarrhea, I have seen it bring labor with or soon after the diarrhea, but I have never seen it not cause the woman to poop for 9 hours or bring any contractions/cramping at all either.

I am not defensive. I actually don't believe that it would have been a disaster if the midwife hadn't shown up. I wouldn't have just given up on doing the SD and hoped for the best. I have done two training workshops with doll and pelvic models and am familiar with the techniques for releasing a SD. I just haven't had a lot of opportunity to do it in a live birth situation. And I believe that I would most likely have had more training for the situation than the EMTs who would have shown up. I think this would have been a lot more dangerous on the Baltimore Beltway with or without any help. I just wasn't going to mess around when I had a midwife of 18 years standing at my side who had done many SDs and all good outcomes.

In the end baby did great and avoided an unnecessary NICU stay, I learned a huge amount from this birth, and the couple is thrilled.

[Midwife Kris]

Congratulations on a good catch and I hope you will always have this angel of a midwife willing to help doulas in your community in unexpected home birth situations they are not prepared to handle.

[Defenestrator]

I think that you did great.

Any doula who supports women laboring at home has to expect to have an unintended homebirth at some point. I haven't yet, but I have had a baby born in the car within sight of the hospital. Most of these will go off without a hitch, but getting the best support you can is important. If you had called EMS, I believe that they would not have been equipped to handle a shoulder dystocia. I have trained EMS workers and most of the crews I have trained have protocols that say that they are not allowed to go up into the vagina to assist a baby's birth. So, if you were in my area, you would lose your ability to care for the mom once they showed up (they take over the care) and they would probably have resorted to pulling on the baby's head, possibly causing Erb's Palsy or worse.

My phone rings day and night with weird situations that the women in my community and my fellow birth workers encounter. I sometimes say no when people ask me for help, but I would almost never say no when one of my fellow midwives or doulas was in a pinch. I certainly feel that I take responsibility for my own actions, though, and if I didn't want to be part of a sketchy situation, it is my responsibility to draw the line.