Wednesday, May 2, 2012

Backwards baby

I have been hoping that I would be able to catch a breech baby while I am here. Georgia is ok with doing breech births here at the clinic as long as it isn't the woman's first baby; and in fact, since I have been here we've done four breech births. I observed for one breech birth back in November and it was beautiful!! And again in March I assisted for a breech birth that didn't go so well. So, I'd seen a great on and a not so great one. Talk about extremes!! 
Last week we had a woman come in for her first prenatal. By her dates she was 34 weeks and 5 days with the baby in a suspected breech position. They sent her for an ultrasound which she brought in two days later confirming that the baby was indeed breech, and with a gestational age of 38 weeks and 4 days. Georgia said because this was her fourth baby that she would be allowed to deliver here at the clinic. I was secretly hoping that I would get to be the one, but because I was about 3rd down on the rotation I had my doubts. Each time the clinic phone would ring I'd pray that it wouldn't be the breech patient, and each time it wasn't. Finally, I was second up, but there was already a labor who was 8cm and I began to change my prayers..."please let my labor be the breech. I really want the experience while I am here, with people more experienced than me to help should the need arise." 
I went to bed that night and slept very well. A little before 7am Chel came and said my labor was here..."and it's the breech." REALLY?!?! I quickly changed into my scrubs and ran downstairs. I noted that she was having good contractions as I checked all her vitals. When I did an IE she was 6cm dilated, intact bag of waters and with the bum indeed presenting. 
She labored very well, laying down for most of her labor. At 10:30 she was getting rather active and was bearing down a little bit with contractions. I did another IE to check her progress, and she was 8cm. Because the bum was well applied, we had get up and exercise a bit, sitting on the birth ball. However, she was having a very difficult time breathing through her contractions, and was bearing down quite a bit. 
Now, let take a moment and explain a bit about breech births. When the baby is coming backwards it is important that the mother not push until she is completely dilated and the baby is born until the umbilicus. This is because the body of the baby is more moldable than the head and could be born before the cervix is completely dilated thus causing the head to become trapped behind the cervix. This is a VERY dangerous situation and should NEVER happen!! 
Now, on with the story...I had her lay down on the bed again to take the pressure of the baby off her cervix, thus allowing her to breath through her contractions. At 11:30 my supervisor had me do another IE. She was still about the same as before with her bag of waters (BOW) REALLY bulging. We discussed breaking her BOW with her to ensure that the cervix didn't begin to close again after SROM (spontaneous rupture of membranes), and she decided yes, this would be ok. So, I broke the BOW and the bum came further down the birth canal. We had her continue to breath for as long as possible. With each contraction I could see the baby's bum just inside and he began to poop. This is quite normal for a breech baby due to the fact that they are really getting squeezed. The other thing we noticed was that his little boy parts were being quite smashed. We all kind of chuckled, but felt sorry for the little guy.
She continued breathing for about 45 minutes at which point the bum was about 4 cm visible so we moved her to the edge of the bed, so that the baby's body would hang as it came out, helping the head to flex for a *hopefully* easy birth. She continued breathing well, with bearing down only at the height of a contraction. As he began to emerge from his mother, I wrapped a towel around and began to support him a little, but still allowing him to hang a bit so as to keep his head flexed while Georgia did supra pubic pressure with the same intention. I slipped my hand under his face (which was facing his mama's back) and helped to guide his head out, after which we placed him on his mama's tummy, rubbed him down and he began to cry almost immediately. We were all ready to resuscitate if needed, and everyone was happy that it wasn't needed. :) 
It was such a BEAUTIFUL breech birth and I felt so honored to have caught a healthy little boy. I know that not all breech births go as smoothly (like I said, I've seen one that was pretty traumatic), and am very thankful that this one went so well. And to top it off, the mama asked me to name her son. I gave her a few suggestions that started with A (she wanted an A name because the baby was born in April), one of which was Alvin, the name of my grandpa. She ended up deciding upon the name Alvin James. He's a super cute little guy with a perfectly round head!! :) He weighed 3.09 kilos (6lbs 8 oz) and had Apgar scores of 9 and 10!!

He looks like he's trying to eat the little duck on his shirt. :)
He looks a bit worried in this picture...but he's still SUPER cute!! :)
Tianne caught a little boy that same day. Oh! We do love our job!! :)

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