Nuchal foot?!?! What did I miss?!?!

[~Mamaterra~]

I just got back from a birth that I attended early yesterday and into early this morning and am still shaking my head....

The presentation was vertex with a nuchal foot....never heard of it...well neither had I until there it was!!!

At first we thought that it was a nuchal hand and I had the mama change positions as she was having a DIFFICULT time of things (now I know why) but then the foot popped out.

My first thought was a footling breech, crap, immediate transfer to the hospital for a c-section. As I was waiting on the news of the birth, I went over things in my mind again and again thinking, what did I miss? How did I miss a breech?!?

I palpated her and she was definitely vertex as I could feel one foot underneath her ribs and the head (although no longer firmly engaged) in her pelvis. In listening to the fetal heart rate, it was exactly where it should've been with no significant changes.

The ONLY thing that should've tipped me off was when she was pushing for two hours(for the first time) she was in excruiating pain and wasn't progressing at all (still at
-1). I felt something on her cervix, but thought (and still do) that it was a lip that was swollen. Also, it seemed that baby shifted to posterior as I could still hear her heartbeat but it took some searching.

So I got her to change positions to compensate for that and then she started making progress, however very, very slowly as she pushed every 4th contraction. This carried on for 7 more hours (poor mama) and she was getting incredible perineum pressure but very little labial pressure, so I figured posterior for sure.

But when the OB went in for the c/s, the baby had somehow positioned her foot at her ear and had the other leg properly presenting vertex. The babe was in the splits in the birth canal!!! I don't know if the mama would have still been able to birth that presentation even if we did know without tearing from here to kingdom come!!!

What did I miss?!?! Can you spot it?!?!

[CarolynnMarilynn]

Can I clarify?

She was pushing without progress for 2 hours in excruciating pain?

Then she pushed for seven hours with very slow progress (slow enough that she didn't birth the baby vaginally)?

Was she at home in the second stage, or at the hospital?

When did the foot become visible?

An ususual presentation for sure! And poor baby - that must have been painful!

[~Mamaterra~]

Originally Posted by CarolynnMarilynn

Can I clarify?

She was pushing without progress for 2 hours in excruciating pain?

Then she pushed for seven hours with very slow progress (slow enough that she didn't birth the baby vaginally)?

Was she at home in the second stage, or at the hospital?

When did the foot become visible?

An ususual presentation for sure! And poor baby - that must have been painful!

She pushed for two hours the first time but they were very non-productive pushes, with a contraction every 4 minutes and little grunting. It was at the end of the 2 hours that she was saying that she couldn't do it anymore.

As they were very low intervention, I wasn't performing internals however when she got to the point that she was ready to be done with it, an internal was requested where I found that she wasn't progressing.

I discussed their options, transfer to the hospital included, however the mama and daddy decided to try the change of positions and continue labouring at home.

The next 7 hours were contractions with every fourth one being a pushing contraction (but again, not a real pushing, grunting push) and the mama was dozing inbetween contractions. It built up to strong pushing for the last hour.

Babys' heartrate was checked regularly with no changes so the parents decided that although the progress was slow and the baby wasn't distressed, they would continue to stay at home.

As I was attending to an unassisted birth, the mama and daddy were the ones that initially felt the foot (thinking it was a hand) up about a half inch. It was when the foot popped out and was visible, that I confirmed that it was a foot and 911 was called.

Just FYI, the baby scored 8, 9 and 10 apgar, has no visible hip issues and is nursing like a pro.

[babycatcher01]

Really intrusting birth, what did the baby weigh?

[scifimom]

I caught one six months ago actually. I have looked around for other stories and haven't found much. It was a third baby and she was having a much harder time pushing then I was expecting and after a bit over an hour of hard pushing i got her stood up, she was in the pool, and a few very hard pushes later out came a foot and a head lol. It was very surprising. The cord was around the nck once then around the leg and neck tying the leg to the head kinda. No tears for mom and no hip problems or anything for the babe who was a bit over 8 pounds I think, can't remember off hand lol. And of course the video camera was on the non foot side of the head so we didn't get a good shot of it. The placenta released as she was being born and allowed for baby to come out even so tangled and a shortish cord, but there was very very minimal bleeding even so. It was a great birth for really getting an example of how the body takes care of itself the majority of time when things are left alone.