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#1 of 15 Old 03-25-2004, 08:50 PM - Thread Starter
 
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scenario:

A near-term pregnant mama with a 2 1/2 year old chooses an elective induction of labor for convienence. Induction begins with AROM and then Pit, and at 7 cm baby is discovered to be breech, a c/sec is perfored, and a 7 1/2 lb baby is born. This second baby weighs over 1 lb less than the first child, who was born vaginally.

Thoughts?
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#2 of 15 Old 03-25-2004, 08:54 PM
 
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Ack. Sounds like a homebirth I had not too long ago....

Mom was two weeks over due date, after cervical stretches, nothing worked. (I NEVER felt like baby was breech - it definitely felt like a hard, firm head down there with heart tones down low!)

Induction on 42 week mark (mom said next day was an induction in the hospital, she didn't want to wait at home any longer) with castor oil and AROM.

Pushing, we noticed fresh-from-the-butt meconium. Felt up inside and there was a butt.

Still didn't feel the scrotum (which I had thought was an anterior lip, since the mom had an u/s that said YES it was a GIRL), but it was a boy.

She wanted to transport for a c-sec and we did.
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#3 of 15 Old 03-25-2004, 09:02 PM
 
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What is the point of questioning any of it? It's done, it happened, you can't go back and change any of it now.

I think the important word here is that the woman "chose" induction. Whether she was fully informed or not, it was her choice to make and now she has to live with the memory of what happened as a result of those decisions. She may or may not be traumatized by it all. What she needs now is compassion and support, not to be told she did anything wrong or made the wrong decision.

Just as I don't want to be told I cannot choose vbac if I get pregnant again, I don't want to tell any other women they cannot choose what they feel is best for their particular situations.
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#4 of 15 Old 03-25-2004, 09:25 PM
 
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pam... would you have caught the baby at home if Mom wanted that?
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#5 of 15 Old 03-25-2004, 10:03 PM
 
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She has a healthy baby of a normal weight. Unless she's consumed with guilt or feels really traumatized by this birth, I don't think she should be worried that she is somehow at fault or did something wrong. (I'm trying to be respectful of her feelings, which you don't explicitly go into, without placing unnecessary blame.)

I wouldn't induce under those circumstances myself (which I am - 39 weeks with a 3 year old), BUT - I don't think induction can make a baby breach, y'know? If she was near term, within a couple of weeks, the chances the baby staying breach and of a c-section with your typical ob setup is pretty high.

Sometimes complications are the result of lots of intervention, but sometimes complications happen for other reasons.

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#6 of 15 Old 03-25-2004, 10:39 PM
 
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Kama'aina mama, I would have.
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#7 of 15 Old 03-25-2004, 11:43 PM
 
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Tinyshoes, I'd like to know your thoughts.
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#8 of 15 Old 03-26-2004, 02:18 AM
 
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not sure what your asking for.......

why the problems? probably because it was early.

do I agree with induction in that circumstance? no.
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#9 of 15 Old 03-26-2004, 12:37 PM - Thread Starter
 
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Well, mamas, when I heard about this recent outcome for a mama I know IRL, I had a very emotional reaction to the news. First I felt grief, and then some anger, most of it directed toward the World of Obstetrical Birthing.

I felt grief because this mama didn't want a c-sec; she scheduled a vaginal induction, not a c-section.

I am angry, because I think the huberis of obstetrics is out of this world.....to me, this smaller, breech baby sounds like it could be a bit premature. Iagtrogenic prematurity, THE risk of inducted labors.

I wanted to ask my initial question without sharing my powerful bias because I wanted some reactions that aren't as emotionally charged as mine....I chose an elective induction with my first baby, and at the time I joked with my OB that I was "calling his bluff" and that I didn't want to end up w/ a c-section. I think I'm bringing a little extra drama to my reaction for that reason; I'm seeing my first birth with a different ending.

I thought my fellow IRL mama might run into a little "failure to progress" and then a c-sec, but I didn't imagine that breech could happen. It just didn't occur to me, so I am feeing very SHOCKED.

I spoke to some mamas IRL and their first thoughts were like mine, oh jeez, that baby must've been early, since it was breech and much lighter than the first baby. I wanted to ask the open-ended question here, to see if other mamas thought that could be a reason for the breech presentation, and to hear some other reasons or reactions.

I am not interested in judging if what my friend did was wrong or right...because I think she did make the best and safest decision she could. She feels comfortable and happy with a caregiver that offers elective induction, who has the arrogance to know better than nature and decide when baby is ready to be plucked, and then gets the "ohmygoodness baby was breech, thank GOD for the doctor!" laurels to rest upon. She just another American woman choosing the 'safest' and best way of birth in our culture...I understand her motivations for making the choices she made. I am just sad that in my eyes, she was hornswaggled and her baby was put at risk, because maybe her baby was interested in a longer stay in mama, who knows.

Pam says in her situation, "I NEVER felt like baby was breech - it definitely felt like a hard, firm head down there with heart tones down low!" Gee, that's the same humble, human, respectable attitude I keep hearing from midwives, that I'm not hearing from OBs that rely on the u/s scan done by the radiology tech and don't bother to learn the "primitive" skills of human touch.

The LDR buzz before wheeling into the OR was "this baby had fooled us," which I overreact to and charachterize as another way of docs faulting the woman and her fetus for things "going wrong," rather than entertaining the notion that, yeah, it IS hard to tell what's what in the belly sometimes, and yeah, mistakes BY the caregiver can be made. Let's just use our best judgement and use evidence to make the best guess (i.e., low heart tones) rather than basing it all on arrogance (heck, I'll just schmear this Doptone around the belly at this 37 week appt.) And I know mama had a vaginal exam in the office...can't ya have one hand in mom and the other on the belly to get an idea of what's presenting?

Whatever. The prevaling attitude is: we are doctors, we will induce you, you'd better dialate 1 cm/hr, your kid better be presenting normal, otherwise it's a DISASTER because your female body is a FREAK SHOW and now we gotta prep the OR.

When I talked to this mama on the phone, twice, before the birth, she asked me about *my* elective induction, and both times I characterized it as "successful" because my baby was born vaginally (the goal of an induction is a vaginal birth) and I did tell her that my primary worry about all modes of scheduled births is iatrogenic prematurity, "but you're pretty sure of your dates, right?" I said....

....and now I have learned that of course mama can be sure of her dates, but it's still possible that baby wanted LONGER than math might suggest. (I do not doubt this mama's datekeeping, and I assume her OB believes her dates, and she had u/s to confirm it, I'm sure.)

Thanks for your thoughts about this scenario...I just want to think all my reactions through, knowing that this birth scenario is a learning oppertunity, as it is a scenario I hadn't imagined, and it's not all that outlandish!

So now that ya'll know my motives...

and Pam, this breech babe was reported to have had her feet up by her ears...isn't that a frank breech, the 'preferred' breech presentaion? (Not that this mama's OB would deliver a breech vaginally! :LOL Just that there might be other caregivers and other situations when this would be concidered a pretty do-able delivery.)


(edited to add above caveat about breech birth)
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#10 of 15 Old 03-26-2004, 02:27 PM
 
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Well, babies do sometimes turn pretty late in the game. So the baby may have went head-down if she'd just waited to go into labor normally. Or not. It's impossible to say.

All kinds of things could have been done differently with a different outcome. But hornswaggled? That's implying that the doctor knew better than she did. Frankly, I don't see much evidence that most doctors have much common sense or are in any sense practicing and gaining information according to scientific method. It's like the blind leading the blind.
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#11 of 15 Old 03-26-2004, 02:30 PM - Thread Starter
 
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oops...I guess I did not know the definition of hornswaggle!!

I did not mean this doc knew better than this mama...I meant the doc "tricked" the mama, saying, "trush me, I'm an OB, your baby's ready to be born" when it is possible that was not the case.
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#12 of 15 Old 03-26-2004, 05:16 PM
 
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I dunno. Sounded like a hornswaggle to me.

---
Slightly o/t, but your posts made me laugh, Tinyshoes. Not because of the situation (which of course was no laughing matter) but because of the difference between the bare facts version and your, um, editorially enhanced version. It sounds like something I do in real life. Most of the time, I'm pretty good at keeping a lid on it, but there are just some times where I gotta let out a little : to stay (moderately) sane.
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#13 of 15 Old 03-26-2004, 05:50 PM
 
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Yeah, the thing with frank breeches (with the feet up by the head) is the position makes the babies lower in the pelvis, and it makes the bottom feel totally firm. Also, you're getting feet above and off to the side, like you would with a head down baby.

All in all, it's easy to ASSUME that a baby is head down and lead yourself to believe it.

When we transported for the c-sec for my client, both docs said that they had NUMEROUS times where they missed a breech. However, I also know that they don't have their hands on bellies as much as midwives do, so I'd expect it more from docs!

Still, it didn't make me feel any better about the situation as a whole. I felt horrible about it. Here I was inducing a BREECH baby at home without being aware of it! This baby ended up being 9lbs 10oz, so she was WAY more dilated than 10cm when we transported. Ugh! This mama says she wants to plan a VBAC soon with me, but asked if I'd mind if she did a last month ultrasound. LOL! I told her, "Go right ahead!"
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#14 of 15 Old 03-26-2004, 06:53 PM
 
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Quote:
Originally posted by tinyshoes
oops...I guess I did not know the definition of hornswaggle!!

I did not mean this doc knew better than this mama...I meant the doc "tricked" the mama, saying, "trush me, I'm an OB, your baby's ready to be born" when it is possible that was not the case.
No, no, we're working from the same definition. What I meant was: to say that he tricked her is to imply that he knew something about the situation that she didn't (that the baby wasn't ready to be born) and was trying to keep it from her. I just personally find it hard to believe that most doctors are that evil -- I prefer to give them the benefit of the doubt and just assume that they are stupid.
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#15 of 15 Old 03-28-2004, 07:06 PM
 
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Quote:
Originally posted by tinyshoes
scenario:

A near-term pregnant mama with a 2 1/2 year old chooses an elective induction of labor for convienence. Induction begins with AROM and then Pit, and at 7 cm baby is discovered to be breech, a c/sec is perfored, and a 7 1/2 lb baby is born. This second baby weighs over 1 lb less than the first child, who was born vaginally.

Thoughts?

My uneducated guess would go along the lines of...



This is obviously a hospital setting. My 1st guess would be that the OB didn't bother to palpatate, but I do know from slight experience, it's not easy to tell what your feeling (except, arms/legs vs back) and I will assume that the last ultrasound was too early to go off of.

There for.....during vaginal exams they weren't looking for fontanels (sp?) or perhaps the baby was too high to feel, but I know the nurse could feel ds's head when I was 6 cm and he was -2.

Also, the fact that this is an induction of convenice worries me. I can't imagine being able to do that. I have a 2.5 yr old, if I were near term, I would just have to wait....

anyway....perhaps she was further from term than first calculated, but then I would expect breathing problems, or lots of vernix to have been mentioned....just if that was a possibility the baby would have more room to turn, and flip.

My QUESTION : why, if this mother has given birth before, was it determined that she needed a c-section for the breech birth. I know they are hard to do, but God forbid if my 2nd baby is found to be breech when I start pushing (homebirth being planned) and for whatever reason my midwife decides it will be easier to trasport and I end up with a c-section I'll be PISSED!


That's my....no so $.02...uneducated guess.

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