Interesting births

I have had some interesting births recently. The weekend was not as busy as I thought it might be but some interesting stuff did happen.

I had one baby who delivered OP after twelve minutes of bradycardia - yikes! When I looked back and realized it had only been twelve minutes I was shocked. It seemed like a lot more time had passed!!!! I had to cut an episiotomy unfortunately. There's a skill I utilize very little and only in this particular situation. The patient was totally ok with that, had an epidural, and could hear the slow thunk...thunk...thunk...of the baby's heartbeat. The cord was long and skimpy with a true knot (maybe the second or third I have ever seen) as well as wrapped around the baby's neck. The true knot and nuchal cord may have been responsible for some earlier EFM strip changes but I believe the true culprit for the bradycardia was she was abrupting at the end! She had a low platelet count so not terribly surprising in hindsight. Abruption is when the placenta tears away from the uterine wall prematurely (meaning the baby is still using it!). You can often tell because the baby is followed by a bunch of clots and blood, which was the case here. Baby came out absolutely fine, great blood gases, apgars, etc. I then went and changed my pants. Thank whoever these types of situations are not real common!

I had another lady come in having her 7th baby. With the face presenting first. This was a first for me!!!!!! With a face presentation, the chin must be facing anterior (or up) to be able to manuever the birth canal and deliver successfully. If the chin is posterior (facing momma's back) then it's very unlikely the baby can deliver vaginally. Fortunately this baby was chin up...and momma's pelvis was more than adequate. When she started to push the baby spontaneously (momma was doin' the natural thing), I could feel something nobby and thought the hand was coming down with the head! When she was almost ready to crown, I spread the labia and couls see an eye and the nose (not a hand) peaking out at me! It was a little surreal! The nurse, who had never seen a face presentation either, was looking at me like 'what now?'. I just told her that the baby was coming and we would just wing it! The baby converted to OP as the head was delivering and came out fine...well, the poor kid was molded and swollen in places she shouldn't have been due to the presentation issue, but otherwise fine. She had to go to the nursery for observation as she was having a little trouble with her breathing (also not uncommon in a face presentation due to the swollen nose!). Oh, and the baby was big...8-12! When I rounded on the momma and babe the next day, the baby looked beautiful! All the molding and edema was gone :)