Elly Copp
“I had taken over the care of a mum having her first baby at 07.30. Previously at 04.00 she was 1cm dilated and similar at 05.00 so she was started with a syntocinon infusion - an artificial hormone to induce her labour (part of the induction process for post maturity and a spontaneous rupture of membranes.)
At 06.50 the woman was fully dilated with no urge to push. By 07.30 when I went In I observed how the woman was stressed and, due to that, to me appeared disconnected with her baby and body. I say this without judgment and perceive it would be an obvious reaction to the process of induction.
She was using Entonox for all her contractions. She had been fully dilated for almost an hour already so I was aware of the short time frame left for her to birth her baby and I suggested she move about.
We did some rebozo work including sifting and shaking the apple tree. This was possible as she had a fetal scalp electrode attached to her baby’s head. At 08.15 she started sounding expulsive during the sifting work with the rebozo. At 08.30 the baby’s head was visible while she was sitting on the birthing stool, but she wasn’t yet pushing. Through each contraction her heart rate was going up, to the level of the baby’s. I assumed this was a likely consequence following much Entonox, and the speed of which she had laboured. I didn’t want her to feel unwell/ collapse while she was on the stool with such a high heart rate, so I suggested lithotomy positon due to time and physical limitations. I didn’t want to be asking for anyone else’s input unnecessarily as I could see that birth was imminent. I did some counter pressure on her sitz bones. The head was coming slowly and I could see that it was descending in right occiput transverse (facing the right rather than in an optimal position facing towards the woman’s back).
At 09.19 she pushed her daughter’s head out and then had no contractions for three to four minutes. With the next contraction the baby came out easily.
Without the position changes and rebozo work, I felt the woman would have needed a ventouse to assist the baby’s delivery or perhaps had a much longer second stage of labour with more stress and bleeding.
I have found the biomechanics training has beneficially improved my practice. I can now consider the individual situation and offer solutions thereby enabling births without interventions. Although lithotomy is not my preference, on balance I gauged it would assist her to birth her baby herself whilst reassuring me (I was alert to her body’s physical response to stress and took action to minimise effort).
I wholeheartedly believe that if this was the first approach by birth workers babies would be emerging spontaneously more often. I have learned the result may not be revealed instantly, but for the most part after using rebozo, for example, most mothers will go on to birth spontaneously.
These days I recommend to nearly every mother I care for in labour that we make some positional “tweaks” to enable the baby to emerge, and through careful and astute observation of the mother and the baby choose which techniques seem ideal.