Shoulder Dystocia

Here in the Philippines, the biggest fear among the doctors, midwives, and mothers during pregnancy is growing a big baby. As some of you who are reading this might know after 20 weeks gestation the fundal height(measurement of the baby in the uterus) is supposed to match up with how many weeks the mom is pregnant, so if she is 28 weeks pregnant her fundal height should be 28cm. Well, it is different here in the Philippines. The mothers fundal height needs to be 2 cm less than her weeks gestation or else the baby is considered too big, meaning if she is 28 weeks pregnant her fundal height should be 26cm. And at the time of birth if her fundal height is more than 34cm everyone is worried about the baby being too big and there being a shoulder dystocia at birth. (this is supposed to be a very rare occurrence of when the head of the baby is born but the shoulders are stuck, it is a true obstetric emergency and the baby can become brain dead or die after only a few minutes). I have always believed that God created a woman’s body to give birth, and he created the baby inside of her, therefore the baby is usually the perfect size it needs to be to fit through its moms pelvis, I really didn’t believe in baby’s being "too big" to be vaginally delivered until maybe now... just 3 hours ago we delivered a baby girl who’s head was out for 12 minutes before her body was finally born. When the baby's head was coming, it took a long time, it was like the head was stuck as well, but when the head was finally born, and the baby's shoulders did not rotate and come out with the mothers next contraction, we knew right away that this was a shoulder dystocia. We got the mom on her hands and knees while I called the other staff midwife to come help who lives just right across the street, I asked Gerlene to go in and reach for the baby’s posterior shoulder/arm to manuever out, when that didn’t work we flipped the mom on her back putting pressure on her pubic bone to try to get the babies shoulder unstuck, then again on her hands and knees ect...apparently the baby had her arm twisted behind her back as well... finally we got the babies posterior arm born, but the baby was still stuck for 2 more minutes until with 2 midwives hands maneuvering and pulling that this baby girl was born. At birth she was totally flat, no heart beat, no respirations after stimulating, I immediately gave the mother an injection of pitocin to prevent hemorrhage and initiated neonatal resuscitation, I was giving breaths while the other midwife gave chest compressions, 1-2-3- breathe, 1-2-3 breathe... was the only words being spoken, other than the prayers that were being whispered throughout the room. For 3 minutes this little baby girl didn’t breathe, cry, or move...but miracousely she slowly started coming around, she would gasp every once in a while, her heart tones started coming up to the normal range, and she finally started breathing on her own, but it was only once she cried for the first time 15 minutes after birth that us midwives let out a deep breath and knew she would be okay. As crazy as this sounds this is the 2^nd shoulder dystocia we have had during the 2 weeks I have been here, the first one was a little baby boy who’s head was out for 9 minutes before his body. During a shoulder dystocia, you really only have 3-5 minutes to get that baby born, any longer than that, and there is a high chance of the baby having damage to the brain from lack of oxygen, and after 10 minutes it is a known fact the baby can die. We only have God to thank that these babies are okay, with no signs of damage to the brain, or body. Its after births like these when sitting in the silence of my room that I wonder, now why am I choosing to be a midwife again? But with birth the good much outweighs the bad, and even in the bad times just one look at that mom and new baby I know its meant to be...

We are made to do this work and its not easy...I would say that pain is part of the glory, or the tremendous mystery of life. And that if anything, it's a kind of privilege to stand so close to such an incredible miracle.
~Simone in Klasson 2001

You gain strength, courage and confidence by every experience in which you really stop to look fear in the face.
~Eleanor Roosevelt

There she is, all 8.6 lbs of her, which is considered huge here in the Philippines,
I thank God that she is okay!

And 2 hrs later I wake up to another woman at the door in labor, she had her baby 15 minutes after she got

here, and the baby just slid right out, I think it was just God reassuring me, in most cases birth is normal, and that I 

can do this :-) oh the life of being a midwife!