Wednesday, August 3, 2011

A Disappointing Day

I had a hard day at my hospital clinicals yesterday.

We had a patient that wanted a natural, unmedicated birth.  With her previous birth, she was induced with pitocin, had a very difficult labor, and subsequently has a very negative image ingrained in her memory about her birth experience.  This time she wanted to have a simple, serene birth - the one we all dream of.  She presented to the hospital already dilated to a 7 as a G2P1.  My midwife and I thought that this would be perfect for her, and that she'd easily give birth in the next few hours.

After 5 hours of hands and knees, walking, birth ball, rocking, squatting, in and out of the bath tub, lighting candles, and listening to soothing music there was relatively little change in her cervical dilation, and yet she was experiencing increasingly worse contraction pain.  She was beginning to give up; thinking she would not be able to carry on with her plan.  We were not checking her, so I was encouraging her to continue - telling her soothingly that she was almost there, that she could surely make it.  At the 6 hour point, we finally checked her to see if she was close.


She was the same.

Upon further inspection, her baby's posterior fontanel was extremely posterior, which is not typical, and we could not 100% decipher what the presenting part was.  It felt like a face.  We had the attending come and confirm for us, and she said it was definitely a face presentation with mentum transverse (MT).

MA or mentum anterior is the only one able to delivered vaginally.  It is done by placing a finger in the woman's rectum and flexing (or tucking) the head forward so the baby can still go through the cardinal movements of delivery.  Unfortunately, this is not possible for MT or MP (mentum posterior) presentation.

Oh sigh.  It was a such a heart wrenching moment to tell her she was not going to be able to physically birth from below.

When I came to get her husband to bring him back for the cesarean section, I asked him if he wanted to bring his camera and he said quietly, "No, I think we'd rather not remember this part."  My eyes welled up with tears and I had to look away.  How absolutely crushing.

Thankfully the baby was born easily and did not need any resuscitation efforts.  Both of the baby's eyes were swollen shut, but there was only minimal bruising over the right brow.  The mom, dad and baby spent the rest of the surgery time trying to bond with their new baby in the OR.  The mother was shaking uncontrollably (due to the spinal anesthesia) and despondent.  The father was quite sad.  It was a bittersweet moment for them.

The attending ensured a triple layer closure so that should they decide to have another baby they could attempt again to have the birth they so desperately desired.  She made sure they knew this, but I am not sure how much comfort it provided in the moment.

I am sure the healing both physically and emotionally will take some time, but my hope for today is that they are enjoying their baby much more and are able to let go of their negative perception of this birth bit by bit over time.

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