Comments on: “…No But I’ll Do It Anyway…”

By: Serene

Serene — Mon, 01 Nov 2010 07:24:50 +0000

*THIS* Is why I love working with Male Midwives. They are brilliant people, with a sense of awe for their patients, and a sense of responsibility for them. Every one I have met and the 3 I have worked with all treated their “ladies” (I loved that!) as though they were their own wife or daughter. Not that intimately, but definitely with that level of respect. I have NEVER met a female midwife or an obstetrician AT ALL who treats their patients that way.

By: Andy

Andy — Wed, 30 Dec 2009 01:02:20 +0000

Yes, meconium is when the baby opens its bowels. It is actually the generic term for what the baby passes for the first 3 or 4 days (the black tarry stuff). If it is in the liquor, then the baby has opened its bowels in the uterus. This can be innocuous, the baby just did it for some reason. You often see this in postdates babies. However, it can be a sign of compromise (when we are short of oxygen, as a reflex our bowels open). Since you can’t ask the baby how it is feeling, the presence of meconium is taken as a sign of distress. When i said a natural birth is out of the window, I mean a mobilising, intermittent monitoring, as few people in the room as possible, stay in the pool or at home birth. Mec. means you need to continuously monitor the baby, have a second midwife in the room, and a paediatrician to check the baby. It doesn’t rule out a vaginal birth. And if the CTG is working well, you can mobilise too. It just means it will be a bit more medicalised.
Andy

By: heidi

heidi — Thu, 24 Dec 2009 01:06:38 +0000

andy, meconium is a bm in the amniotic fluids correct? if that is so then it doesn’t necessarily rule out a natural birth… at least 27 years ago it didnt, i guess it might nowadays… as embarassing as it is i had that in my fluids when i was born and my mom still had me 100% natural… though i dont know if the docs had much choice in the matter she came in 3 hours into a 4 hour labor and they had different parts of the ward for labor and delivery back then, so by the time they got her checked in and found this out i was already ready to come out…

By: Andy

Andy — Wed, 23 Dec 2009 21:27:18 +0000

There isn’t a ‘wrong’ time. Membranes are ruptured as part of the induction process, so it may happen at 2cm, if appropriate. Routine amniotomy isn’t a good idea, but ARM for induction is done under controlled conditions. Babies have fluid on their lungs naturally when in the womb. As part of the birth process, some gets absorbed at the start of labour, and most of the rest is squeezed out when they are born. When they breathe, the baby coughs up any other mucus and swallows it. Sometimes there is an excess they don’t cough up, or maybe it’s not passed naturally during birth. When that happens, the baby needs a bit of help because the fluid remains in the lungs. Obviously, I wasn’t there at the time, but I don’t think breaking the waters was the cause. The baby just had fluid because it did. It is very difficult in this job when things go wrong, because we always want somebody to be at fault. When we can’t find someone to blame, we blame ourselves. The only comfort you can offer is that it’s nothing the woman did. It was just in their stars. It was their turn.

By: Dusti

Dusti — Sun, 06 Dec 2009 20:07:48 +0000

Andy, not to change the subject..but on the subject of rupturing membranes.. At wat time is it ok 2 break the water? I ask this bc I had a friend that had her water broken @ 3 cm and her son was born w fluid on his lungs. Was this wrong on the hospitals part? Or is it un related? Wat r u thoughts?

By: Andy

Andy — Mon, 30 Nov 2009 09:58:26 +0000

A common one I saw as a student was, during a VE:
‘Pass me the amnihook, Andy….There! I’ve just broken your waters. Things will speed up now!’

I have never done that, and would give one of my students hell for trying it. Rupturing membranes (ARM as we call it here) is a surgical procedure, not to be done lightly. What if you break the waters with a high head, and a big loop of cord comes down? The woman, baby and, less importantly the midwife, are all in the poo. What if there is meconium? Bang goes the natural birth. Admittedly the natural birth idea would be out the window as soon as the waters went and mec was seen, but she would have had that little big longer to mobilise before the continuous monitoring commenced. The thing is, you had better have a darn good reason for doing these things, because if you do an unnecessary procedure and things go wrong, the first question you’d be asked in court is ‘why did you do it?’ If you can’t give a good answer you are in trouble.

By: Andy

Andy — Mon, 30 Nov 2009 09:49:04 +0000

Of course! Be my guest.
Andy

By: Amy

Amy — Mon, 30 Nov 2009 05:46:29 +0000

Brilliant, Andy! I would love to pass this insight along, if I may?

By: Kat

Kat — Sun, 29 Nov 2009 21:18:15 +0000

Well said Andy! I am with you on that one all the way!

By: Andy

Andy — Sun, 29 Nov 2009 20:48:06 +0000

Sorry to keep on, but the way I see maternity care is this:
As an ex-engineer, engineering works at three levels:
The engineer, who designs the system in the first place;
The technician who keeps it running smoothly;
The mechanic, who fixes it when it breaks.
Now, in my mind, whichever supreme being you believe in is the engineer. The midwife is the technician. The doctor is the mechanic, who we call when the system breaks.
Things went wrong when the doctors started thinking they were the engineers. When they relearn their place, things will start to improve.
Andy