[Climbergirl]

So, I got every thing out of my records. Well, I was supposed to. At $0.25 a page, I spent over $115 to get this thing. And, it seemed like a huge waste of paper.

There were no records of the contraction tapes. No records of the FHR, other than what the nurse noted in her records. A lot of repetitive stuff like, "counseled patient on use of intercom" and "side rails up" sort of crap.

I am a little irritated. There was no mention of why pit was being recommended. There was definite mention that I *refused* it. Well, yes, the dang nurse said, you need pit. I ask why. She says because your labor is taking too long. And I asked if baby is ok and I am ok. The answer was yes. Well, then no, I don't want pit. And I refused the IUPC. Same converstation, really. THAT got mentioned too. Which is fine, but where is all the "you have to have a c/s" conversations that were popping up all over the place when according to the records, everyone was doing fine.

AND, it looked like the dr that delivered was not my doctor the whole time! Her notes indicate that she was not involved until I was 7-8cm (which she was under the impression that I CAME in at 7-8cm, not 4cm). I think that would have greatly influenced her thoughts. 7-8cm for 12 hours is not the same as going from 4-9 cm within 12 hours. That irritated me as well.

I did find out my son was posterior (there was another word, but I did not bring the notes to work). Also, he had "mild" shoulder dystocia and significant molding of the head. It also took over 4 minutes to get him out of my pelvis (that part I remember). How far down was he to be that far into my pelvis?

The reason for the c-section was officially CPD. What does that mean for wanting a VBAC next time?

He was apparently having decels during the contractions but I did not see any indication that he was "in the 170s for hours" like the nurse said. And no one ever mentioned this or explained these things to me.

The effacement note had "rim" on there. I was at 9cm with a rim. What does that mean?

How do I read these decel notes to see if he really was having problems?

Honestly, I feel lied to. I feel so mad that they were not upfront with me. I want to write a letter to the evil nurse and tell her what pain she has caused.

I really want to have nothing to do with the hospital next time!

 

[wombjuice]

I am so sorry you are hurt by your birth experience.

I hope you find some answers soon.

 

[nashvillemidwife]

Quote:

Originally Posted by Climbergirl There were no records of the contraction tapes. No records of the FHR, other than what the nurse noted in her records. A lot of repetitive stuff like, "counseled patient on use of intercom" and "side rails up" sort of crap.

That's common. That's what I would expect to see. The FHR tracings generate a lot of paper, you can expect to have paid twice what it has already cost you. The hospital does not consider that to be a part of your records; they only keep it around in case they need it to defend themselves in a law suit. Many hospitals shred the paper tracings and just back up the computer records.

Quote:

I did find out my son was posterior (there was another word, but I did not bring the notes to work). Also, he had "mild" shoulder dystocia and significant molding of the head. It also took over 4 minutes to get him out of my pelvis (that part I remember). How far down was he to be that far into my pelvis?

I'm not sure I understand your question. His head was born, then it took 4 minutes for the rest of the body to be born. He had already descended through your pelvis, it just took 4 minutes to pull him on out. Also, there's no such thing as "mild shoulder dystocia". Either the shoulders are stuck or they're not. If it didn't take significant effort to get him out, it wasn't a shoulder dystocia.

Quote:

The reason for the c-section was officially CPD. What does that mean for wanting a VBAC next time?

In general terms, expect a midwife to tell you that your inability to birth the baby had more to do with positioning than the baby's size. Expect a doctor to tell you that you will need a c-section unless your next baby is significantly smaller.

Quote:

The effacement note had "rim" on there. I was at 9cm with a rim. What does that mean?

You were almost, but not completely effaced. Think about the rim or the "lip" on the top of a paper cup.

Quote:

How do I read these decel notes to see if he really was having problems?

What do the notes say? You said they did not give you the FHR tracings? So there's nothing to interpret, only read on the paper? If you want someone to tell you what the terminology means you will have to share them.

 

[AcuMom]

I'm so sorry to hear your story, I hope you are able to begin healing from the trauma you have experienced.

Nashvillemidwife, I think she means it took 4 minutes for them to get him out via c/s. I don't know how the time relates to depth into the pelvis, but I imagine it might also vary some from OB to OB. depending on experience and baby's position, not only depth (I'm only a childbirth educator, so don't have 1st hand experience with c/s), hopefully Nashvillemidwife or one of the other birth professionals will have a better answer for that.

Having a rim or lip is not uncommon with posterior babies, but can often be overcome by repositioning mom.

As for the CPD, was baby's head or shoulder girth very large? It is more commonly due to position within the pelvis (larger diameter of head presenting), especially for a posterior baby, rather than a true CPD, but this will often be refered to as CPD also. In regards to future VBAC's, you will need to research and carefully interview your next Dr's or look for a midwife who will work with VBAC's. If you opt to interview OB's (though it sounds like you plan to not go this route next time!), ask for names of previous VBAC or attempted VBAC patients that you may contact to ask questions of to see how they felt about the OB support of their decision to VBAC. There are also lots of resources out there to help you when you are at that point.

If you're concerned about the decels but don't have records of them, could you schedule an appointment with the nurse or OB to go over them with you? The timing of the decels is critical in distinguishing between normal and possibly concerning.

I hope you are able to get some of the blanks filled in.
Take care!

 

[clovergirl33]

How can you have a shoulder dystocia in a c-section? That makes no sense to me. I also read the 4 minutes thing to mean that it took four minutes to get the head out of the pelvis during the section (probably partially the result of it being so well engaged in the pelvis, evidenced by the fact that it was already molding). I don't get the shoulder dystocia part though...unless the shoulders were stuck in the incision? Never heard of that though.

 

[fairydoula]

Quote:

Originally Posted by clovergirl33 How can you have a shoulder dystocia in a c-section? That makes no sense to me. I also read the 4 minutes thing to mean that it took four minutes to get the head out of the pelvis during the section (probably partially the result of it being so well engaged in the pelvis, evidenced by the fact that it was already molding). I don't get the shoulder dystocia part though...unless the shoulders were stuck in the incision? Never heard of that though.

Suspected "mild" shoulder dystocia in the notes sounds like a defensible reason for a Dr. to claim he/she "HAD" to do a C-section.
Did mom ever push?
When were the decels occuring? If they're during a ctx, it can be normal, if they're after a ctx it can indicate the baby is not tolerating the ctx well and having trouble "coming back up" after the ctx is over.
These are called "late decels" and are more of a cause for concern than early decels or just decels.

The "rim" as has been mentioned is the last little bit of cervix that still needs to melt away for baby to decend. It often is helped by mom getting into different positions before pushing and during pushing too.

I'm sorry you don't seem to have all the answers you want and I am sorry you seem frustrated! I'd be frustrated too if I couldn't quite figure out WHY I needed a c-section.
Can you give us more info to help you work it out?
- Jen

 

[MsBlack]

ITA with all that fairydoula posted--she said it very well.

"mild shoulder dystocia" indeed, imagine you can hear my BIG snort of derision over that. SO n/a to a csec--just a lame defense.

 

[dancindoula]

Quote:

Originally Posted by MsBlack ITA with all that fairydoula posted--she said it very well. "mild shoulder dystocia" indeed, imagine you can hear my BIG snort of derision over that. SO n/a to a csec--just a lame defense.

Yep, if your monitor just seemed to suck in on itself for a second that's because of the collective snort of disbelief from all of us reading your post. Shoulder dystocia, my foot! There is simply no possible way to predict a s/d is just about to happen - by the time it actually does happen baby's head is already out and little eyes are squinting against the bright new world.

 

[nashvillemidwife]

What exact do the records say about the shoulder dystocia. A shoulder dystocia is when the head is delvered, but the shoulders do not follow because they are impacted behind the pelvic bone. For this to happen in a c-section, the head would have had to already been born, then pushed the head back inside and pulled him out through the abdomen. This is called the Zavenelli Maneuver; it is an emergency procedure used as a last ditch effort to get the baby out alive. Outcomes are usually death of the baby or severe brain damage.

 

[GoBecGo]

Was the "other word with posterior "asyclintic"?

To be honest it sounds to me like failure to wait (on the Ob's part). At 9cm with a lip and significant moulding your baby's head was well descended in the pelvis and your second stage was either imminent or happening already - did you have the urge to push? Did you push?

True CPD is usually positional (i have a friend who had CPD-due-to-malposition - her #1 was a brow presentation and couldn't get into the pelvis at all) and usually manifests as a mother being fully dilated for several hours without descent or progression of pushing urge (because the head remains too high to cause one). Delivery (by c-section) reveals an unmoulded head. Except in cases of polio or past pelvic fracture in general if the baby's head fits IN to the pelvis it fits THROUGH and out again too.

There is no way to predict shoulder dystocia until the head is born, and nothing for the shoulders to get stuck ON before the head is through the pelvis.

I'm so sorry you had such a traumatic experience. I am positive that you will be able to find an experienced, supportive midwife who will assist you to VBAC next time.

 

[nashvillemidwife]

Quote:

Originally Posted by nashvillemidwife This is called the Zavenelli Maneuver; it is an emergency procedure used as a last ditch effort to get the baby out alive. Outcomes are usually death of the baby or severe brain damage.

I found a source on the internet that said the Zavenelli Maneuver actually has good outcomes. That's not what I've been told by doctors who've done it or seen it done, though.

 

[Autumn Breeze]

Quote:

Originally Posted by GoBecGo Was the "other word with posterior "asyclintic"?.

or occiput ?

 

[cileag]

Not to hijack the thread, but I'm surprised about the "mild shoulder dystocia" comments. Do you really not differentiate between a baby that smoothly delivers and one that has "sticky shoulders"? Or do you just not call it a true dystocia?

 

[MsBlack]

For me, Shoulder Dystocia is truly stuck shoulders that need some kind of maneuvering to unstick--be that mom's movements, HCP's maneuvers, or both. I've only seen this once, myself.

If shoulders are merely 'tight' or 'sticky', then that's what I call it--sticky shoulders or tight shoulder delivery. I've seen a fair amount of this. Patience, positioning and not rushing in too soon to 'help' seems important there.

Besides, back to Original Topic--there is simply NO WAY for a doc to determine that SD or even SS (sticky shoulders) 'would' happen, from the view through a csec incision--and IMO, ESPECIALLY when the baby hasn't even finished rotating/maneuvering through the pelvis. So yes, we are all snorting over that bit of 'defensive reporting'.

 

[Climbergirl]

Wow! I am sorry I did not have all the details

I wanted to do that last night but Aiden did not agree with my plan for the evening! I will try to get that together tonight because the input so far is awesome!

To answer some of the questions:

Quote:

I'm not sure I understand your question. His head was born, then it took 4 minutes.....

Based on my memory, it took 4 minutes to get his head out of the pelvis in order for him to be born. I remember the doctor's talking about placing hands in different positions and trying this or that (and I could feel the tugging and pulling). It was enough that I looked at my husband and said, "he does not want to be born this way either! I don't want to know what plan C is". I was scared they were going to have to literally cut me completely open (that thought actually crossed my mind).

Quote:

When were the decels occuring?

Not sure. I will get the exact notes but they looked something like this (format): 1 x 110-130

Quote:

What exact do the records say about the shoulder dystocia.

I'll get the exact wording tonight, but there was not much other than baby had "mild" shoulder dystocia. It seemed weird because I figured that I probably had pretty much birthed him at that point?

Quote:

did you have the urge to push? Did you push?

Did I have the urge? YES!!!! Yes, the nice nurse (note sarcasm) notes indicated they "counseled" me on the importance of not pushing. Ok, seriously, I had no choice. My body was pushing and they checked and said, nope, don't do it! My poor doula was doing accupressure to help and they came in with Fentanyl to knock me out for 45 minutes to keep me from pushing "because you don't want to deal with that" (basically, I could injury myself and apparently that kind of injury was "bad" - there was no real explanation). When I woke up, I think it had for the most part stopped or was not nearly as strong as before.

They did not let me actually push.

I will copy the whole thing down and update tonight. This is helping me a lot.

As a midwife, would you be willing to review records and discuss them and how much would that cost? How would I ask a midwife to do that?

Thanks so much for all your insight.

 

[nashvillemidwife]

Quote:

Originally Posted by Climbergirl Based on my memory, it took 4 minutes to get his head out of the pelvis in order for him to be born. I remember the doctor's talking about placing hands in different positions and trying this or that (and I could feel the tugging and pulling).

It is possible for babies to get so far into the pelvis (usually after you've pushed him that far) that opening the abdomen causes sort of a vacuum and it becomes really hard to pull the baby back out. So that's a valid report.

 

[fairydoula]

Quote:

Originally Posted by MsBlack For me, Shoulder Dystocia is truly stuck shoulders that need some kind of maneuvering to unstick--be that mom's movements, HCP's maneuvers, or both. I've only seen this once, myself. If shoulders are merely 'tight' or 'sticky', then that's what I call it--sticky shoulders or tight shoulder delivery. I've seen a fair amount of this. Patience, positioning and not rushing in too soon to 'help' seems important there. Besides, back to Original Topic--there is simply NO WAY for a doc to determine that SD or even SS (sticky shoulders) 'would' happen, from the view through a csec incision--and IMO, ESPECIALLY when the baby hasn't even finished rotating/maneuvering through the pelvis. So yes, we are all snorting over that bit of 'defensive reporting'.

yep and yep.
True SD is a life threatening complication.
There is no such thing as "mild" shoulder dystocia. They're either stuck or not.
Big babies and babies in less than optimal positions can be sticky... as in... it freaks us out a little cause they take longer to come out and they might need help, like a finger looped under an armpit or the much less preferrable pulling downward on the head, stretching out the poor baby's neck to pop the top shoulder out.. gawd, I HATE watching that when I'm with an OB.... anyway... I digress. The biggest baby I've seen born was at home to a non-diabetic mother, and the babe was 12lbs 6oz!!! And NO SD, although that baby was a SUPER tight fit!!!
But SD is not dependent on size as much as position of both the baby and mother.
Unfortunately, because most OB and hospital birthing CNM's see most of their patients on their backs for hours and hours, they probably do have a justifiably greater fear of SD because their "lie in bed till the baby comes out" policies cause more positional SD.

OP, I would encourage you to keep reviewing, talk with a midwife, ask her how much she might charge to review them with you, keep talking things out and take charge of your experience. I don't imagine most midwives would charge much, but do keep in mind most should charge something. Their time is valuable too!

I think it will probably help you a lot to continue to explore this until YOU feel satisfied that you KNOW what happened and WHY, to the best of your knowledge. I wish wish wish I could somehow bottle these experiences and give them to new moms who have this denial/fantasy that even though they're going to the most UNfriendly hospital I know, they'll be just fine. That even though the hospital has a 95% epidural rate and a 35% c-sect rate and a horrible rep for iatrogenic mistakes and harm, that THEY'll be ok. Cause they have me... a doula. I make it really clear to my doula clients that THEY are responsible for their birth and their baby at all times, before, during and after the birth. I make it clear that they are in charge and that I'm only there to support and offer information and encouragement. That, basically, walking into a lion's den... well, you can't help but get bit by a lion sometimes....
I much prefer my role as a midwife albeit only an apprentice right now. It's much more comfortable for me to be in a client's home waiting on birth. Honestly, I'd rather be at a homebirth for twice as long for 1/2 the pay than at a hospital birth for 1/2 as long and twice the pay!
It's just THAT difficult to see this and hear this and read this over and over and over. Moms being bossed, damaged, cut, coerced into doing things that are NOT in their or their baby's best interest. It can really cause major burnout for doulas.
Anyway, I'm rambling.
- Jen

 

[Climbergirl]

Thanks everyone! Here is the nitty gritty details. I apologize for the amount and length, I did not know what was important or not. And I understand you can't really analyze, I need to speak to someone (midwife/OB) with ALL the records in order to do that. I will gladly pay a midwife to review and as soon as my doula friend is back from Mexico, I am going to ask her for some recommendations. I did find it striking that my contractions seems to become irregular with the nurse change (I did not like her one bit from the moment I met her). Interesting......

Sorry for the spelling and I think I mistyped his position in my original post.

Thanks, you guys are truly the best! I can not tell you how much this means to me.....

Newborn
4065 grams
20.25"

Obstetric History and Physical Form
History: (unknown word) UC's 2300; SRM @ 8:30, 9cm no progress x4º, pitocin started @12 noon, IUPC placed @1240.

Plan: If ucs are adequate, will need to proceed with 1º C/S

Signed by Dr. Duncan at 12:50

Procedure Report - by Dr. Duncan

Pre-Op Diagnosis:
1.Intrauterine Pregnancy, term
2.Failure to Progress despite Pitocin

Post-Op Diagnosis:
3.Intrauterine Pregnancy, term
4.Failure to Progress despite Pitocin

Operation Performed: Primary cesarean section

Indications:
This is a 30 year old female, Gravida 1, Para 0, a patient of Dr. NK who was admitted in active labor, was 7 to 8 cm on admission. At 8:30 this morning she spontaneously ruptured at 9cm. The patient was extremely reluctant to allow interventions, although she did allow placement of an epidural catheter. Inadequate uterine forces were suspected, but again the patient was reluctant to allow intervention, so the intrauterine pressure catheter was not placed until after noon, nor did she allow Pitocin to be started until noon. The patient remained at 9 cm, and when adequate lavor was diagnosed after placement of the catheter and addition of Pitocin, once the failure to progress passed 9cm she finally consented to a cesarean section.

Intraoperative Findings:
Viable made infant, Apgars 7 and 9, weight 8 pounds, 15 ounces, length 201/4 inches, delivered from the right occiput anterior position. Posterior corpus placenta. Normal uterus, tubes, and ovaries.

Description of Procedure:
The patient was placed on the OR table in the supine position with left lateral tilt and prepped and draped in a sterile fashion. Placement of a Foley catheter had been done prior to arrival in the OR. After testing for efficacy the Pfannenstiel incision was made with a knife and a combination of blunt and cautery dissection was used to expose the fascia transversely. The fascia was incised transversely and then separated from the underlying rectus muscles with a combination of blunt and sharp dissection in a vertical fashion. The peritoneal cavity was entered sharply in the midline and the Alexis retractor was inserted and secured, being sure not to entrap any bowel within it. The vesicouterine peritoneum was incised transversely and blunt dissection was used to carry the bladder flap caudally. The lower segment of the uterus was incised with a knife and extended with the bandage scissors. Light meconium was noted. Because the baby's head was wedged into the pelvis, it took approximately 4 minutes to be able to extricate the head. Significant molding was noted. A viable male infant was delivered from the right occiput anterior position with mild shoulder dystocia. The cord was doubly clamped and severed. The moth and nares were suctioned at the time fo the delivery of the head with no recovery of meconium. The baby was handed off to the awaiting NICU staff without difficulty. Cord blood was obtained and a segment of cord has been previously removed and set aside. The placenta was extracted form the posterior corpus position and the uterus was curettaged with a wet laparotomy sponge. Allis-Adairs were placed on the edges of the uterine incision and the uterus was closed with two layer of 0 Vicryl. The first was a running locked stitch and the second was an imbricating stitch of Lembert. Excellent hemostatis was noted after two addition figure of eight stitches of 0 Vicryl. The Alexis retractor was then removed and the peritoneum was closed using 3-0 Vicryl in a running stitch. The fascia was closed using 0 Biosyn and the Accufuser cannula was then placed on top of the fascia. Vicryl, 3-0, was used to close the subcuticular fat in interrupted stitches and the skin wa then closed using 4-0 Monocryl and sealed using Indermil.

Nurse's Notes
(I left out all the position changing, etc.)

0307 - pt arrived to l/d in spontaneous labor. Uc's since 2300 last night. No srom or bleeding.
0312 - 4cm, 90%, -2, bulging membranes
0317 - call placed to dr martinez, report on sve, uc's. order obtained for admission.
0320 - IV Bolus started
0330 - FHR 140, LTV moderate, accelerations 15x15, decelerations early, contraction q2-3min, duration 60-90 sec, quality moderate, resting tone/toco soft
0400 - FHR 145, LTV moderate, accelerations 15x15, decelerations early, contraction q2-3min, duration 60-90 sec, quality moderate, resting tone/toco soft
0430 - FHR 140, LTV moderate, accelerations 10x10, decelerations late, contraction q2-3min, duration 60-90 sec, quality moderate, resting tone/toco soft
0448 - 6cm, 90%, -2
0500 - FHR 145, LTV moderate, accelerations 10x10, decelerations variable;late, intervention for decels position change IV bolus, contraction q2-3min, duration 60-90 sec, quality strong, resting tone/toco soft
0501 - call to (anesthesiologist) re: bps, variables, orders to give 7.5mg ephedrine at this time.
0530 - FHR 150, LTV moderate, accelerations 15x15, decelerations early, contraction q2-3min, duration 60-90 sec, quality moderate, resting tone/toco soft
0552 - intervention for decals oxygen,BP
0555 - 7cm, 90%, -1
0600 - FHR 150, LTV moderate, accelerations 15x15, decelerations variable;late, intervention for decels position change/oxygen/BP, contraction other @1.5-3, duration 60-90 sec, quality strong, resting tone/toco soft
0631 - FHR 150, LTV moderate (annotation: minimal to moderate), accelerations 10x10, decelerations variable, intervention for decels position change/oxygen/BP, contraction other @ Annotation: 1.5-3, duration 60-90 sec, quality strong, resting tone/toco soft
0700 - FHR 150, LTV moderate, accelerations 15x15, decelerations variable, intervention for decels oxygen, contraction other @1.5-5, duration 60-90 sec, quality strong, resting tone/toco soft
0714 - nurse change
0722 - 8cm, 100%, -1, bulging membranes
0724 - pronounced shivering with ucs
0730 - FHR 150, LTV moderate, accelerations 15x15, decelerations none, contraction Irreg, duration 60 sec, quality strong, resting tone/toco soft
0743 - no oxygen
0800 - FHR 145, LTV minimal, accelerations 15x15, decelerations variable, intervention for decels position change, FHR note to 140 x 50 sec x 2, contraction Irreg, duration 60 sec, quality strong, resting tone/toco soft
0830 - FHR 145, LTV minimal, accelerations 15x15, decelerations none, contraction Irreg, duration 60 sec, quality strong, resting tone/toco soft
0834 - ruptured membranes - SROM (my note: happened during internal exam), clear color, small fluid amount, normal odor
0835 - 9cm, 100%, -1
0837 - Foley dc'd at pt request pt feels pressure - no pain. Does not want to push pcea.
0900 - FHR 150, LTV moderate, accelerations 15x15, decelerations variable, FHR note to 140 x 30-40 sec, contraction Irreg, duration 60 sec, quality strong, resting tone/toco soft
0930 - FHR 140, LTV moderate, accelerations 10x10, decelerations variable, FHR note to 110-130 x 30-40 sec with and after uc's, contraction Irreg, duration 60 sec, quality strong, resting tone/toco soft
0934 - 9cm, 95%, -1 discussed no pushing to patient
1000 - FHR 140, LTV moderate, accelerations 10x10, decelerations variable, intervention for decels position change, FHR note x 1 to 110 x 2 min/other variables to 130s x 20-30 sec, contraction Irreg, duration 60 sec, quality strong, resting tone/toco soft
1019 - rim, station 0
1030 - FHR 135, LTV moderate, accelerations 15x15, decelerations variable, FHR note x 1 to 110 x 80 sec after 2 consecutive uc's, contraction Irreg, duration 60 sec, quality strong, resting tone/toco soft
1100 - FHR 135, LTV moderate, accelerations 15x15, decelerations variable, FHR note x 1 to 120 x 40 sec, contraction Irreg, duration 60 sec, quality strong, resting tone/toco soft
1130 - FHR 135, LTV moderate, accelerations 15x15, decelerations none, contraction Irreg, duration 60 sec, quality strong, resting tone/toco soft
1152 - discussed IUPC and pit augmentation. Pt wishes to discuss this with doula and spouse. Did discuss iupc and pit augmentation x2 earlier this morning. Pt has refused thus far. Dilation: rim
1200 - FHR 140, LTV minimal, accelerations 15x15, decelerations variable, FHR note x 2 to 120-130x 30 sec, contraction Irreg, duration 60 sec, quality strong, resting tone/toco soft
1203 - pt decided to take pit but not IUPC.
1221 - adjusted toco. Pt refuses IUPC
1230 - FHR 140, LTV moderate, accelerations 15x15, decelerations none, contraction Irreg, duration 60 sec, quality strong, resting tone/toco soft
1239 - dr Duncan at bedside
1242 - 9cm, 100%, -1 (by Dr. Duncan)
1243 - Dr. Duncan discussing IUPC with PT vs C/S
1247 - IUPC placed
1314 - IV Bolus started for temp
1320 - FHR 170, LTV moderate, accelerations 10x10, decelerations variable, contraction q2-4 min, duration 50 sec, quality moderate, resting tone/toco soft
1400 - FHR 165, LTV moderate, accelerations 10x10, decelerations variable, FHR note to 150-160 x 20-30 sec with uc's, contraction irreg, duration 60 sec, quality strong, resting tone/toco soft
1409 - vaginal exam by Dr. Duncan (no record)
1411 - (anesthesiologist) at BS for C/S dose in epidural.
1417 - to OR via guerney; FHR 150, LTV moderate, accelerations 10x10, decelerations variable, FHR note to 140 x 30 sec, contraction irreg, duration 60 sec, quality strong, resting tone/toco soft

 

[GoBecGo]

Wow, what a mammoth job you did typing all that in!

Ok, from pure numbers you do seem "stalled" for a long time at 9cm BUT your son is clearly moving lower and lower so i doubt an experienced midwife would have read that as a stall, more just a long (which is normal for posterior positioned babies) labour. I would also have hoped that after several hours at 9cm when they found a lip they might have attempted to help you push the baby past it or massagd it out of the way but these skills seem to be lost arts in hospital even when they are appropriate.

Premature pushing urge is very common with posterior babies because their occiput digs into your sacrum and stimulates the nerves that make you want to push (which in an anterior labour are caused by the brow, when the baby is already through the cervix). I had premature pushing urge that was so strong that when my baby turned anterior at full-dilation i continued fighting the urge to push until she was born - it is incredibly hard to resist! I sympathise!

From reading your notes i do think vaginal birth was a possibility, but to be honest i doubt you could have gotten it in hospital. I know very very few woman who were close to or at full dilation for more than 2 hours in a hospital without being sectioned - they do not wait well. Your son was in a non-standard position which would very possibly have made the second stage long and difficult, and hospitals get twitchy about that when they can section you and avoid it.

I'm not an ob and don't know much about decels but the labours i have seen when the baby had dangerous decelerations he heartrate went dwn to 80, not 110. At my SIL's labour for example they considered 110 to be a variable of the nomal rate and not a significant decel. Perhaps someone with more experience will be able to comment.

It would be very worthwhile you employing a midwife to go through these notes and debrief with you!

 

[dewi]

Decided to send as a private PM