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Discussion Starter · #1 ·
I attended the birth of a friend recently where things did not go as smoothly as she planned. She was doing fine but stalled at 9cm for 2 hours and labor was slowing down considerably. Her midwife kept asking to break the bag of waters but my friend said no, and finally gave in after they said they would have to transfer her to the hospital since labor was slowing down so much. My friend did try walking, squatting, all that stuff first but labor got slower and slower.<br><br>
When midwife broke the water finally, big chunks of meconium came out so they had to transfer her anyway. She wanted to know if it was necessary to break the bag of waters or not. She really wanted it to break spontaneously and felt pressured to have it broken by the midwife, because of the threat to transfer to the hospital from the birth center. I think it was part of their policy as far as stalled labor. The baby had a steady heartbeat throughout labor.<br><br>
Then, after 2 hours of pushing a face up baby who crowned along with one of her hands, the 9 pound 14 oz. baby was finally born. My friend and her dh pleaded with them not to cut the cord right away, it was very important to them. But the midwife and the neonatologist both said it was necessary. The baby's cord was cut but the baby remained right on the delivery table for several minutes while they suctioned her, then they moved her to the warming table and finished suctioning her, then gave her to my friend finally. They gave her a clean bill of health. She wanted to know if it was necessary that they cut the cord right away since she is really regretting it.<br><br>
Thanks!<br><br>
Darshani<br>
(who hopes to be certified as a doula someday)
 

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It is always difficult to judge another person without having been there.<br><br>
We have people at our birth center stall out at 9 or 10 cm (we recently had a mom who was complete for over 12 hours before her babe was born). After two hours, it is our policy that we have to confer with our physician. Every two hours after that, our physician has to be notified of progress; if little progress is being made, or if the CNM has an uncomfortable feeling, then the doc comes in to assess the situation.<br><br>
I can say that we do not break the bag of waters, unless the mom requests it. Even then, we often don't, or we put it off. If mom is close to pushing, we are usually okay with breaking the bag; but we usually caution against it and try to talk the mom out of it.<br><br>
We probably would not have transported for thick meconium if the heart tones were good, though we definately would have suctioned at teh perineum with a suction machine, and then required the parents and child to stay at least 4-6 hours after the birth. Our recent experience has been that the babies don't always have respiratory distress right away as a result of the meconeum; it seems (recently, anyhow) to happen about 3-4 hours after birth. So we want to make sure the babe really, truly is off to a good start.<br><br>
We would not cut the cord, unless we were in a position in which the cord was hampering resuscitation efforts (like, once we had a mom in the tub, and when babe came out, she was limp and not making any effort to breathe. We cut the cord after initial attempts at stimulation did not work, as the cord was too short; mom had had to stay crouched right next to her in the tub while the mw stimulated the babe. When it became apparent that we needed to use the bag and O2, we had to cut the cord so that we could lay the baby flat on a surface, under the heat lamp). Even with a resuscitation, we usually keep the cord intact; however, we are set up to do that. We have a big double bed on which many moms birth; or they birth on the stool or on the floor next to the bed. Our equipment is small and portable for the most part, and we are a staff of two (the nurse and the mw), so a resuscitation in a small space is not a problem. In a hospital, many more people are involved, and there isn't a set up for a resusciation at the bedside. And a guarantee they were thinking resuscitation (as we would have been, too, with thick mec). Their standard resuscitation, I am sure, is to take the baby over to the warmer where the o2 and the equipment is, and where everyone can work. That involves immediately cutting the cord.<br><br>
So, yes, the cord had to be cut, but because of the environment; not because a cut cord is immediately after birth, or for a resuscitation. If the babe needed to be resuscitated, the hospital was not set up to do that at the bedside with the cord intact, like, for example, we are. Also, many facilities (not ours, though) have the policy that with thick meconeum, you must deep suction, which involved brief intubation, which is very difficult to do if a babe isn't in a warmer. If your o2 and equipment are in the warmer, intubation and deep suction are impossible to do at the bedside with the cord intact.<br><br>
I hope this helps.<br><br>
I would advise you to help the mom go over the events. She needs to compose her thoughts, and she needs her mws to address her questions. Why was she transferred (policy? mw's discomfort?). Give the mw a chance to explain herself. For example, I was recently at a birth that was going slowly, but well. Over the course of a coupel of hours, I started to get this sense of forboding. Everything was fine, heart tones, mom, everything. But I was *so* uncomfortable. Then, after a while, I caught a very long decel on the doppler. Slowly the babe recovered, and no more decels for about half an hour. Then another. Mom was at 6-7 centimeters with a fairly thick cervix and contractions about 5 minutes apart, BOW intact. The decision was made to transport. Later that evening, while laboring in the hospital, the babe went into distress and an emergency section was performed. Apgars were 3, 7, 9.<br><br>
I share that story because maybe the mw just felt that something was wrong, andthe thick mec put her in the midset that the mom must be transported. I dont' know. I think the mw should have the opportunity to explain herself and her actions. She should also know the effect the transport and subsequent birth had on the mom. It is all a learning experience, after all.<br><br>
Well, I could probably say more, but this is getting rather long. I hope that the mom recovers well and can work through her birth to a positive place. I hope that lots of good things happened as well during her birth, and that she can remember those aspects, too.<br><br>
Lori
 

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Okay, I might be a little dense....I missed the part where you said that the baby was on the delivery table for several minutes before being moved.<br><br>
I have no idea why they would want or need to cut the cord, especially if the parents were objecting to it. I would definately bring this up with the mw. She needs to know, and to provide an explanation, if there is one.<br><br>
Lori
 

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Discussion Starter · #4 ·
Thanks Lori, I will pass this onto her. Mostlly she's just very, very happy and in love with her baby. She's glad that no one ever pressured her to have the epidural, too.<br><br>
Darshani
 
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