I'm a midwife assistant to a CPM. Last night we had a slightly interesting birth and I want to see some of your interpretations.
Mom is a primip at 40 weeks with 2 full days of light ctrx. She is cool and confident and v. relaxed. Well rested, healthy, and hydrated, too. (Don't we want all of our clients like this) Her baby is average in size and has been in a ROA position for about 4 weeks.
In early labor she is checked at 3 cm with 80% effacement. The senior midwife "roughs her up" and mom quickly begins harder ctrx and has a SROM about an hour later. She goes fast to transition (<4 hrs) and is pushy but is still vomiting/gagging during some squatting/pushing. She supported squats pushes for about 50 minutes. Then we go to side lying. I assume she still has some dilating to do (from the vomiting reflex) and she is checked to be complete with a left cervical lip. She does some lying and breathing through a few ctrx. Then the sr MW decides to push the cervix back while mom purple pushes (this was hard to watch) and finally baby is crowning. The rest was pretty predictable. Baby head born with no restitution, though. Baby is born fully OA with transverse shoulders. No tears due to a great catching apprentice, IMO.
So, can anyone tell me more about how or IF a ROA position can lead to a shoulder issue like that? Is this related or coincidental?
I have never heard of it, but I am not experienced with that type of thing....
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Ashley Motzenbecker, CD (CBI), RP, PED
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Most of the time when I have seen babies not rotate like that, it has been a cord entanglement issue. I would guess that the transverse shoulders were coincidental to the ROA position.
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Hmmm there is something about babies turning clockwise. I think that the birth was so fast that the baby didn't have time to complete his turn and got stuck during the process. Neither of my babies wanted to rotate their shoulders. With my first, I tore from here to there and beyond. With my second, it is a bit cool because I have it on video.
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Baby head born with no restitution, though. Baby is born fully OA with transverse shoulders. No tears due to a great catching apprentice, IMO.
So, can anyone tell me more about how or IF a ROA position can lead to a shoulder issue like that? Is this related or coincidental?
Thanks!
In a first time mom, I can see OA and transverse shoulders being related to an ROA position. Actually, that's exactly what happened to me with my first birth. My son had been ROA during labor, was born fully OA, had transverse 17 inch shoulders, and I ended up with some minor labial tears that did not require stitches.
However, in my second two births, both babies were ROA and were born easily with proper restitution and no tears.
I guess I would theorize it has to do with mom's pelvis never really having gone through the birth process before.
Analyze this birth
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Lindsay
