home birth

bizby40 wrote:
"Cathy Weeks" wrote in message
ups.com...
48 minutes does seem scary though - Would you be able to get to the
hospital in time? Or would your midwives arrive in time? As much as
I'm a supporter of home birth, I'm not terribly comfortable with the
idea of an unattended birth. So I can see why it would be
panic-inducing!

I was overdue, and they broke my water, and then the labor started
within minutes. There was no gradual build-up, it was straight to
non-stop intense contractions. I wasn't even able to (sorry for the
TMI people) void my bowels, because I could not sit on the toilet long
enough -- no more than a few seconds. We were in the hospital already
of course, so that's not why I was panicked, it's just that everything
was happening so fast, and my body was completely out of control, and
it seemed like everybody in the room was yelling at me -- yelling
supportive things, but yelling nonetheless. Finally a nurse took my
hands and locked onto my eyes and started talking to me in a soft
voice. She helped me calm down and start to tune everyone else out.
Thank God for nurses!

Oh yeah, in the pushing stage in hospital, the room was full of nurses
yelling. Yes, encouraging things, but there was a point when I wanted
to scream "STFU AND LET ME FOCUS!" I knew they were trying to be
helpful, but it seemed to make things suddenly seem emergency-like.
Having gone from my quiet home with 2 midwives and DH to what seemed
like a Spurs game, I was out of whack. Fortunately, between my DH,
midwife, and the OB, all of whom were at my side saying calm words in
quiet voices I could focus on them and not the 6+ nurses in the room
shouting.

48 minutes does seem scary though - Would you be able to get to the
hospital in time? Or would your midwives arrive in time? As much as
I'm a supporter of home birth, I'm not terribly comfortable with the
idea of an unattended birth. So I can see why it would be
panic-inducing!

well exactly, I went into labour in the hospital with my 2nd, though it had
been a planned homebirth, but because I jumped to the 3rd emotional signpost
(bradley), I was in denial that I was actually in labour, if I'd have been
home alone, it would have been half an hour before I'd have even called my
husband, and I'd definitely have been fully dilated before a midwife
arrived, she was malpositioned, so things stalled then, so it would have
been unlikely to have been unassisted, but after that you can see why if I
have a 3rd and decide to go the vaginal route, I'll be making plans for
unassisted!

Anne

cjra wrote:
Oh yeah, in the pushing stage in hospital, the room was full of nurses
yelling.

Ha ha. Our posts crossed. Why do people who should know better yell
at us!? It is *so* not helpful.

Anne, the meconium question came up for me in September, as my MFM
didn't want me to go postdates because of the increased risk of
meconium passage in utero. So I searched PubMed etc. for that topic
too. What I gathered was that if meconium passage is suspected or
known (eg there is meconium stained amniotic fluid), then prompt
delivery is desirable. The objective is to deliver the baby before
meconium is aspirated as far as the lungs. That objective can be met
via vaginal delivery, and vaginal delivery in some cases would be
faster than an urgent C-section.

did they make any distinction about the type of meconium? or any other
observations? because if you actually practice urgent delivery simply for
meconium stained liquor you end up with an awful lot of c-sections and it
doesn't seem that this is what is being practiced, at the hospital I
delivered at, the only default was that if mec was seen, a pediatrican and
resus equipment would be in the room at delivery, I would presume it would
be routine to also check with a doctor at that time, though that didn't
happen when I was delivering. My question was more along the lines of what
is happening after distress occurs and meconium has been passed what is then
going on, and I'm not sure anyone really knows, urgent c-section doesn't
seem to solve the problem, I had a friend not long ago have a crash
c-section for this and the baby was in similar condition to cjra's and
almost didn't make it, it appears though that for this baby there was
ongoing distress, hence the crash c-section.

In part, in the end, it comes down to how may c-sections do you have to do
to save one baby and for this, it's likely to be far too many, particularly
when c-section doesn't even solve the problem some of the time. C-section is
definitely going to be a tool in management and prevention of MAS, but some
babies are going to emerge from c-section with every bit of their lungs
touched by meconium.

This is a good page www.homebirth.org.uk/meconium.htm, it's interesting that
50% of 42 week deliveries have meconium present, which would be an awful lot
of c-sections if you actually practiced urgent delivery. Meconium
aspirations is defined as mec present below the vocal cords and the exact
percentage varies from study to study, rough average of 35% of cases when
mec is present, but even that is not the whole story, meconium aspiration
syndrome is the problematic on, not just meconium aspiration and that's a
small 5-10% of those with mec below the vocal cords, so max 3.5% of those
with mec present. The page then goes on to explain that the primary cause is
actually foetal hypoxia or asphyxia, compounded rather than caused by the
mec, looking at those facts and cjras case, is then making me wonder how on
earth A continued to have a good heart rate through the rest of labour and
that perhaps the medics should actually be studying her case.

Cheers

Anne

Anne Rogers wrote:
And yes, the likelihood anyone would have known anything was wrong was
slim. As it was the OB made the decision to continue vaginal birth as
all was stable at that point.

I was wanting to ask about that actually, I'm trying to improve my
understanding of meconium aspiration, but you may not be able to answer
these questions, or maybe even the medical profession in general couldn't
answer them, I don't know what level they come in at!

I'm no expert on it, I know only what limited research I did after DD
was born to help understand. My first exposure to it was when my niece
was born in 1993 with it, and died. But she had a number of other
defects. That experience though, had me freaked out enough. One nephew
also aspirated meconium, but very mild and I didn't even know that's
what was wrong til my brother told me after DD was born (he had just
said the baby was in NICU when bornbut was out in a few days).


Passing meconium can be a sign of distress, so I'm guessing that the wonky
heart beat the midwife heard was whatever event caused the distress and that
was when A passed meconium.

Maybe. Maybe not. A was moving around a lot during the latter stages of
labor. She flipped positions, and labored stalled a bit at 8 cm.
Heartbeat sounded fine then however and it wasn't til just as I was
pushing that she detected distress. There's no way to know when she
passed meconium. My midwife recently said she saw it, but not til I was
pushing at the hospital (I thought before she'd seen it earlier, but
misunderstood). So they were prepared for it during delivery. But as
you know passing meconium isn't necessarily a problem - and indeed my
midwife has delivered a few meconium babies.

But actually getting the meconium into the lungs, that requires the baby to
gasp, or breath deeply, something that usually doesn't happen until after
they are born, but with babies that have MAS, it happens before they are
born (I'm not sure if this is all the time though, what happens when a baby
takes it's first breath on the outside, but there is meconium in it's
mouth..). I've come across some suggestions that these breaths that cause
the meconium to be aspirated, would be very shortly before birth, as if the
baby thought it was out, but then that would mean you'd never get meconium
aspiration in c-sections happening before full dilation, which is false, so
that gives a window for those breathes to be any time and one would guess in
a larger time window that they would be early on, during or shortly after
whatever the distress causing happening was.

Yes, my niece was born at 36 weeks via c-section, having already
aspirated meconium (and the doc decided to do the emergency C at that
point due to a poor heartbeat).

Do you know if I'm right there? And, on that basis, I'd guess that what
happened to A, all happened in one event, that the midwife luckily heard,
then she continued to hold up well to labour because she wasn't actually
needing to use those lungs whilst she was still inside, but was then a big
problem once she was born, and so a c-section would have made no difference
at all.

My midwife thinks she aspirated at the very end, but that the weird
heartbeat was maybe due to bumping the cord while she was moving around
during contractions. So she thinks a c-section *may* have prevented it.
The OB on call and the neonatologist both said it was a very acute
event, likely didn't happen early (based on how she recovered - it was
intense, and her lungs were totally full, but she recovered much
quicker than most meconium babies, even tho she was sicker to start).
That would have suggested it was a late event, esp as her heart rate
sounded fine once we started continual monitoring at hospital. All that
leads to a c-section perhaps have preventing this. However, all have
said that's really speculation. There's no way to tell when ithappened,
and if a C-section would have made a difference. the OB second guessed
herself a lot after this, but IMO, she made the right call. I was
willing to have a C-section if necessary, but by all accounts, at that
time, it didn't appear necessary.

She likely passed the meconium soon after i got to the hospital (2+ hrs
before she was finally born), but as for when she aspirated, no
telling, really. Also, as i said elsewhere, the atmosphere at the
hospital was very panicked and stressed. Not the OB, but due to the
nurses - in fact the OB told some of them to leave! I had been super
calm all day, if a little frustrated when I stalled at 8cm, but once i
got to the hospital - tho I still was not worried about any real
problem - the screaming and shouting and intensity of the nurses really
changed the situation and I found myself getting more and more
frustrated. I'm not blaming them - most were helpful and kind - but the
hospital environment was very stressful, and I think partly responsible
for that delay at the end. She was well into the birth canal and making
her way out when she seemed to get 'stuck' there, no doubt causing
distress.

This is what I tried to explain to my sister, who was ranting about how
I was in a 'stressful situation birthing at home' and had i been in a
less stressful environment - ie the hospital - this wouldn't have
happened. I could not convince her it was 100% the opposite.


Or, is that something there is just no way of knowing and answer to, that
when the actions that drew the mec into her lungs took place is unknowable,
and if that is the case, would it be fair to say that continuing with VB was
wise on the part of the OB, on the basis that she was holding up find and if
you did a c-section on every women who's baby had had a brief heartrate
alteration (do you know what was actually heard?) and had meconium present,
that you'd be doing far to many c-sections for the benefit gained and that
you just happened to be the worst case scenario?

I think I answered this above. IMO, yes - unknowable. I know my OB was
feeling pretty awful afterwards,and of all people praying for my baby's
life, I think she was praying the most, worried that her decisions
caused this. But I truly think she made the right call, with the
situation as it was at that time. Her heartrate was fine, and when I
entered the hospital, no evidence of meconium yet. Once there was, that
still isn't a huge problem (since only a small % of those who pass
meconium aspirate it), and they prepared for it with all the suctioning
equipment.

Sorry if this is all too much, feel free to just say you don't know, I'm
just trying to get my head round some stuff.

And with that, honestly I don't know ;-). The neonatalogist who has
treated many meconium aspiration babies said the same. He had some
ideas (as stated above), but said it's really not possible to tell.

And yes, I felt like we were worst case scenario. But as DH says, we
were really lucky in our bad luck, in many ways. DD is a happy healthy
5 month old now

btw- DD was 39w6d (according to my charting of day of conception and
multiple ultrasounds), so not post-term in any way.

Pologirl wrote:
cjra wrote:
Oh yeah, in the pushing stage in hospital, the room was full of nurses
yelling.

Ha ha. Our posts crossed. Why do people who should know better yell
at us!? It is *so* not helpful.

Oh, they were yelling things like "COME ON! YOU CAN DO IT!" so trying
to be helpful. But what they didn't get is that it was
counterproductive. I didn't need a room full of people shouting
encouragement, esp. as I had come from laboring at home in a very
peaceful, relaxed environment. I needed to get into my zone and focus!

Cathy Weeks wrote:
[snip]
LOL Well, Martha Sears, who had fast labors, was pretty tart about
things when people envied her fast labors - they aren't a bed of roses
by any means.

My labours were 3 hours, 4.5 hours and 1.75 hours.

The difficulty with fast labours is that you don't get a chance to
be mentally prepared. When the first contractions you time are
four minutes apart, you never have a chance to get your head round
what is about to happen.

My labours weren't physically difficult, but that still doesn't mean
that they were 'easy'.

--
Penny Gaines
UK mum to three

Anne Rogers wrote:
did they make any distinction about the type of meconium? or any other
observations?

Articles indexed on PubMed? Some articles distinguish between thick
and thin meconium. Some consider MAS to be a consequence, not a cause,
of some sort of respiratory difficulty. Some look at the issue of what
to do when meconium is detected: intervene (how?) or use expectant
management (wait and see). There is considerable variety of practice.

Annecdotally, detection of meconium does appear to be a common reason
for intervention, at least in the US. There is general agreement that
the presence of meconium can be but is not necessarily a sign of fetal
distress, yet some caregivers apparently take it as proof of fetal
distress. Or perhaps they simply consider intervening when in doubt to
be an instance of "better safe than sorry", as if the interventions
themselves were without risk.

Penny Gaines wrote:
Cathy Weeks wrote:
[snip]
LOL Well, Martha Sears, who had fast labors, was pretty tart about
things when people envied her fast labors - they aren't a bed of roses
by any means.

My labours were 3 hours, 4.5 hours and 1.75 hours.

The difficulty with fast labours is that you don't get a chance to
be mentally prepared. When the first contractions you time are
four minutes apart, you never have a chance to get your head round
what is about to happen.

Does it normally progress very fast once you hit 4 mins apart?

The first ones I timed were 5 mins apart/1 min long (that is what clued
me in to the fact that this was indeed labor, and not food poisoning).
But that was at ~5-6am and I was only 1cm dilated around 8:30am when
my midwife arrived, and by then we stopped timing because they were
coming very fast. DD arrived just before 10pm.

"cjra" wrote in message
ups.com...

Penny Gaines wrote:
Cathy Weeks wrote:
[snip]
LOL Well, Martha Sears, who had fast labors, was pretty tart
about
things when people envied her fast labors - they aren't a bed of
roses
by any means.

My labours were 3 hours, 4.5 hours and 1.75 hours.

The difficulty with fast labours is that you don't get a chance to
be mentally prepared. When the first contractions you time are
four minutes apart, you never have a chance to get your head round
what is about to happen.

Does it normally progress very fast once you hit 4 mins apart?

The first ones I timed were 5 mins apart/1 min long (that is what
clued
me in to the fact that this was indeed labor, and not food
poisoning).
But that was at ~5-6am and I was only 1cm dilated around 8:30am when
my midwife arrived, and by then we stopped timing because they were
coming very fast. DD arrived just before 10pm.