DON'T SCROLL DOWN!!
Yeah, I know. You weren't thinking about scrolling down until I mentioned it. It's just that I want to tell you about the pictures before you see them. The first one looks a little disturbing, but it's a happy story, it really is.
When the nurse called me (precisely 30 minutes after I got into bed, as is almost always the case) said that it was a footling breech, and that it was the young woman's first delivery. I groaned inwardly. At least I'm pretty sure that I didn't groan out loud. I was too groggy to be sure. You see, this combination of circumstances dictates that I must to do a cesarean section. I told the nurse to call the OR crew, and that I'd come right in.
A breech presentation (for those of you who don't already know, but are still interested) is when the baby's bottom is leading the way, rather than the head. In most breech deliveries, the buttocks come first, with the legs laid flat along the body. When the feet come out first, we call it a "footling breech." For a mom who has had previous babies, we will go ahead and deliver the baby vaginally, but for a first delivery, we always do a c-section. Usually our nurses are quite accurate in diagnosing breech presentations.
Bleary-eyed, I staggered into the delivery ward, found some sterile gloves and checked the patient. It certainly wasn't the baby's head I was feeling, and it sure wasn't feet or buttocks. There was a hard lump, then a hole, then a soft lump. Gradually, the truth dawned on me. I was feeling a chin, a mouth and then a nose. This was a face presentation!
My previous experience with face deliveries totals exactly 1. Oh, and read about it in a book once. The books say that most can deliver safely. It worked out OK the other time I had seen it.
This mom had already been pushing for a while, and was tired. I coached her to push harder. I can usually get better pushes out of the patients than the nurses can. She was having hard contractions, and was giving it a good effort. Still, things didn't seem to be progressing. I contemplated doing a c-section, but then whole head was now well down into the birth canal, and I didn't think I could get it out the other way! So I tried to be patient.
As time stretched out, push after seemingly futile push, I began to occasionally see slight progress. Then I'd get discouraged again. I thought about other options. I had already made a large episiotomy, but there are various other things that one can cut (you don't really want the details, do you?) to make things open up better. I had even scrubbed the skin and injected local anesthetic to do something called a symphysiotomy, when I noted a bit more progress.
As the little face became more visible, I could see the effects of the pressure. The face can't take the pressure, and the pounding of contractions and pushing the way the top of the head can. The soft tissues of the face become swollen and purple. Several times I asked the nurse to listen for the baby's heart beat, to assure myself that it was still alive. It was.
Finally, after what seemed like an eternity, or at least like a long time, the head slipped out, and the rest of the body followed easily. The baby made no effort to breath. There was no movement. It looked far worse than the picture that you are slowly scrolling down to. (I didn't have my trusty camera on my belt, so I didn't get the picture until the next morning.) I gave it a few breaths with a breathing bag, and it took, first a feeble breath, then a stronger one. There was a little tiny cry. The ugly white body turned a beautiful pink. The face was still purple, and not a shade that went nicely with the pink. But he was alive, and breathing on his own.
I then spent the next hour sewing up his mom. It was close to 4 a.m. when I crawled into bed, happy with the good outcome of my night's work.
The first photo was taken in the nursery the next morning. I had left him there on oxygen, but by morning he didn't need any extra help, beyond what babies commonly need.
Wednesday morning
Friday morning. Big improvement, huh?
Our star with his happy mom.
And of course, I couldn't resist including one with the happy doctor.
Love the pictures and the stories. It is great to stay informed about what is going on in PNG so we can pray for you better.
ReplyDeleteOne of the first deliveries I witnessed when I was training to be a L&D nurse was a face presentation. The healthy baby delivered after much time pushing at 6 pounds +-, however, my first impression was that it looked like E.T. The head was elongated and the face was flat. The mom looked at it and said, "aah, a face only a mother could love", and snuggled her close. The next day you could hardly see any sign of the trauma accept the bruising. It was quite a memorable experience. Absolutely amazing! -Lois
ReplyDeleteGreat work Doc! I always enjoy hearing about the deliveries in PNG.
ReplyDelete