The significance of the baby being at a-2 station means that the cervix is not changing in size on its own and even Cervadil or other agents cannot help ripen the cervix before induction. In such as case, contractions are rarely felt until later on during labor. If the cervix is not changing but remains dilated 2-3 cm, the doctor may decide to break the waters. It is at this point that contractions will be felt and epidural will start (Goer, 2009). When a baby is at a-2 station, it is recommended that the lady be induced early enough when the cervix is still ready. If the woman is past her due date and her cervix does not seem favorable, the situation calls for the need of an agent such as Cervadil to assist in softening up the cervix before Pitocin can be employed.
The body of a woman prepares in a number of ways before birth, with most of the preparations taking place in the last few weeks. There are hormones which start to soften the cervix forming the neck of the uterus. Throughout pregnancy, the cervix remains closed, holding the baby inside the uterus (Goer, 2009). What labor does is opening the cervix to create passage for the baby. In some cases, the cervix starts to soften and open before labor. Some women have their cervixes closed until labor begins while others have pre-labor contractions dilating their cervix to about three to four centimeters before labor begins. This is what happened to Carla
Following these conditions, FHT 150s, no accelerations, minimal variability, no decelerations, and baby is moving during rest periods between contractions, the baby is likely to contract bacteria. This meant that Carla had to be given antibiotics during her labor. A mother in this state is said to be colonized, hence she is given IV antibiotics in her labor. The antibiotics do not affect the mother but prevent the baby from coming into contact with the bacteria during birth. Such contact puts the baby at risk of contracting Group B Strep disease (Enkin, 2009). One out of five of babies who are infected end up dying. Babies who survive end up struggling with medical problems like vision loss or hearing, learning or physical disabilities and cerebral palsy.
Most women wish to have a natural child birth at home. Advocates for natural childbirth are not mistaken in stating that that lack of having control or supportive care contribute to PTSD and birth trauma (Enkin, 2009). However, such advocates are considering the downstream impacts of the real problem which is pain. The support needed is ways of coping up with the pain and the feeling that women have of not being in control is as a result of the pain.
Giving birth at home is likely to promote childbirth psychological complications. The notion that relieving pain is a moral weakness as well as a danger to the unborn baby encourages most women to forgo the excruciating pain relief and increase the risk of developing long term psychological complications like PTSD and depression (Enkin, 2009).
In such a case, epidurals serves as the most effective pain reliever, giving women control over the manner in which they behave during child birth and control over their babies. Such control allws expecting mother to represent themselves in a manner that they wish to be seen, instead of being push into a space that is not rational.
The excruciating labor pain is traumatic and not just because of the agony but because being in that state of pain makes almost impossible for women to advocate on their own, have full control of their care and make important decisions. This is the reason why Carl desired NCD at home but had to request for an epidural.
When the head of the baby turtles during childbirth, it means that the woman is experiencing shoulder dystocia. In this case, during childbirth, the child’s anterior shoulder cannot pass below or needs significant manipulation for it to pass below the public symphysis. Shoulder dystociais is regarded as an obstetric emergency, and fetal demise is likely to take place if the baby is not delivered, due to umbilical cord compression in the birth canal. One characteristics of shoulder dystocia minority is the turtle sign that involves the retraction and appearance of the fatal head.
Shoulder dystocia is caused by mechanical reasons; during the fetal cardinal head movements of flexion, descent, and internal rotation in the bony pelvis, the shoulders go down to the pelvic inlet. During the subsequent extension of the head, external rotation and delivery before the final expulsion, the shoulders are supposed to rotate in the bony pelvis in a winding gesture to arrive in the most accommodating pelvis dimension, its oblique diameter (Gherman, 2009).
In case either of the dimensions of the fetal shoulder is too large or the maternal pelvis happens to be too narrow to allow the shoulder to rotate to the diameter of the oblique pelvic, the fetal shoulders’ persistent anteroposterior orientation may cause the anterior shoulder to be obstructed by the symphyispubis, impending delivery and resulting to shoulder dystocia.
There are a number of labor positions that are sequentially performed in an effort to facilitate delivery and they include; the McRoberts maneuver which involves hyperflexing the legs of the mother tightly close to her abdomen (Gherman, 2009). This position widens the pelvis of the mother, and flattens her spine in the lumbar spine. If this position does not work, pressure should be applied on the lower abdomen, and the head is pulled gently. The other position is the Gaskin maneuver, which involves positioning the mother in all fours position with her back arched. This position widens the pelvic outlet.
There is little difference between suprapubic and fundal pressure, but when it comes to shoulder dystocia, the little difference becomes very significant. Suprapubic pressure is normally applied directly over the pubic bone of the mother and this move helps push the shoulder of the baby downward and permits it to free itself from the pubic bone of the mother, thus allowing the baby to come out through the birth canal (Gherman, 2009).
On the other hand, fundal pressure is applied on the upper portion of the abdomen of the mother. It can be applied in any routine delivery to assist the baby downward the birth canal, or incase the baby has to be delivered quickly in distress cases. Incase fundal pressure is applied during shoulder dystocia, the shoulder of the baby will be further impacted against the pubic bone of the mother making the brachial plexus to stretch further, and this may damage the nerves and result in serious injury (Gherman, 2009).
Most of the babies born after shoulder dystocia happen to be absolutely fine. However, the baby may need to be watched closely by the nurse for a while. If the birth process was very difficult, the baby might be forced to spend some time in the special care unit in hospital. After delivery, the nurse should remain alert to the postpartum haemorrhage possibility and perineal tears of third and fourth degree (Gherman, 2005). In the case of BPI, the care of the baby has to include a multidisciplinary approach that includes pediatric neurology, pediatrics, physical therapy, and if need be, referral to a center for brachial pleuxus.
Sholder dystocia may damage the bundle of nerves in the shoulders of the baby and arm. This damage is as a result of the nerves being stretched too much during birth (Gherman, 2005). The arm of the baby may also be paralyzed and numb. On rare occasions do the shoulder or arm of the baby break during birth but incase this happens, the nurses should provide pain relievers and the bone should quickly heal. There are extreme cases where the child can suffocate to death due to lack of oxygen.
Shoulder dystocia may also result in health problems to Carl. There in increased risk of postpartum haemorrhage that is characterized by severe bleeding. There is also a higher risk of tears in the mothers’ vagina or back passage. In addition, the mothers tend to have a lot of emotions to deal with. This is as a result of a lot of anxiety during birth on how the baby will be. Some of the women feel guilty, shocked, angry, depressed after a difficult birth.
Gherman R., (2009). “Shoulder Dystocia: An Evidencebased Evaluation Of The Obstetric Nightmare.” Clin Obstet Gynecol. 45:345–62.
Gherman, R. (2005). “Shoulder Dystocia: Prevention and Management.” Obstet Gynecol Clin North. 32:297–305
Goer, H., (2009). The Thinking Woman’s Guide to a Better Birth. New York: The Berkley Publishing Group
Enkin, K., et al (2009). A Guide To Effective Care In Pregnancy And Childbirth. Oxford: Oxford University Press