Friday, October 30, 2009
In a way, every birth is full of "firsts" because no two births are ever exactly alike. There are certain "bigger", though not more important, firsts: my first water birth, my first transfer, etc. Last week, as I mentioned, seemed to be full of more these kinds of firsts that usual- trial by fire. But, this is how we learn and I feel more competent and confident than I did previous to this group of births. I also, more fully know now, how to expect the unexpected.
One instance that I did not expect was a retained placenta. It was a particular long, hard labor...it seemed like hours of transition, talking the mom through each contraction. Once the baby was out, we waited for the placenta. And waited. And nipple stimulated. And waited. And squatted. And waited. And gave some pitocin. And waited. And catheterized. And waited. The placenta clearly was not coming. One of the unique things about the birth center is that one of our doctors lives upstairs. As you can imagine, this is very convenient and can save us from a hospital transfer. In this case, she performed a manual removal.
I'm not sure why the placenta did not fully separate from the wall of this particular uterus. It is possible that, due to the long labor, the uterus was just not contracting well. A manual removal is exactly what it sounds like: Once pain medication is administered (a removal can be very uncomfortable), the attending doctor places her hand in the uterus and peels back the remaining stubborn membranes. One midwife said the analogy used in school was like "turning the pages of a book". The placenta came out in-tact and all was well!
I tried to find a YouTube video or instructional animation that could show me what this procedure looked like from the inside but, couldn't. The diagram from Moon Dragon's Retained Placenta Guidelines at the top of this post should give you some idea.
What are some of your more memorable "firsts"?
Posted by Kate Klein at 7:12 AM