SOP for Child Birth

[usafmedic45]

Yeah you hope, try Gravida=8, Para=8, all vaginal. That little guy came out like he was on a water slide.

The last baby I delivered (the one I delivered while smelling like deer piss on my birthday, the kid the parents named after me) was out in under 30 minutes from water breaking to when he was squirming in my hands.

 

[CAOX3]

The last baby I delivered (the one I delivered while smelling like deer piss on my birthday, the kid the parents named after me) was out in under 30 minutes from water breaking to when he was squirming in my hands.

Well to say I delivered it would be over estimation, I slid in position to catch him. I should have got an ESPY for it.

 

[usafmedic45]

Yeah, that's how most vaginal deliveries are. The mother does all the work and the doc/EMT/midwife tries to take all the credit. :lol:

 

[Veneficus]

Yeah, that's how most vaginal deliveries are. The mother does all the work and the doc/EMT/midwife tries to take all the credit. :lol:

sounds like most jobs actually.

 

[abckidsmom]

The need for the above described procedure in my experience is usually identified and performed after a normal vaginal delivery.

And rare. Normal births are just that: normal.

You've got to know that damn near vertical (high fowler's) is not close to physiologically similar to actual vertical.

Applying a load to the posterior pelvis while trying to fit a human through the pelvic girdle is counterintuitive. If there is a load applied (ie, not a water birth), it should be in a squatting position, or a hands-and-knees position. The better to maximize the diameter of the opening, and lower the stress on the vasculature supplying the uterus and placenta, decrease pain and blood pressure, and so on.

Every intervention has a response, and, I've found, just stepping into the hospital starts the intervention cascade.

I'm no hippie, tree worshipping homebirth midwife, but the way we do birth in our culture is wrong, start to finish.

 

[usafmedic45]

it should be in a squatting position

That's pretty much what I was trying to describe. It looked a lot like the ready position in sumo wrestling, only seated on a bed.

but the way we do birth in our culture is wrong, start to finish.

You know, except for good pain control, a good (low) rate of complications and low rate of morbidity and mortality among mothers. The ones who do die do so most frequently out of their own blatant stupidity in terms of failure to seek proper medical care before, during and after delivery or due to their engaging in activities that increase the risk of pregnancy and delivery exponentially (drug use, unattended or poorly attended birth, etc) or a combination of the two. I honestly can't see any reason why emulating countries (African nations for example) with higher rates of maternal morbidity and mortality is a good idea. Perhaps there is a bit of bias in your assessment of the situation?

 

[Veneficus]

And rare. Normal births are just that: normal..

I think we just see this all from a different perspective. For sure most births are normal. For sure they do not require a doctor. But I didn't see "most normal births" I saw most of the ones that go wrong, because my training institution has a very respectable midwifery program and the focus of my interest is not OB.

You've got to know that damn near vertical (high fowler's) is not close to physiologically similar to actual vertical..

For certain, you will find no argument from me on this.

Applying a load to the posterior pelvis while trying to fit a human through the pelvic girdle is counterintuitive. If there is a load applied (ie, not a water birth), it should be in a squatting position, or a hands-and-knees position. The better to maximize the diameter of the opening, and lower the stress on the vasculature supplying the uterus and placenta, decrease pain and blood pressure, and so on...

Again, I am not disagreeing with you.

Every intervention has a response, and, I've found, just stepping into the hospital starts the intervention cascade....

why else would you go to a hospital? (Kidding) Really though, not all hospitals are equal. Not all doctors are equal. There are good ones to go to for whatever your problem and not so good ones.

Any respectable surgeon I have ever met will tell you that cutting somebody should be the last resort not the first. Having said that, many surgical diseases are time sensitive so when they appear require aggresive treatment early. (like an inflamed or ruptured appendix, you don't wait until after peritonitis to decide you need to take it out)

I fully support the position there are too many c-sections performed in the US (and a number of other places). But there are many factors that have caused that, not just a bunch of lazy or broke doctors.

I'm no hippie, tree worshipping homebirth midwife, but the way we do birth in our culture is wrong, start to finish.

I agree with you without condition.

 

[jjesusfreak01]

Which is why it is a good idea to fork out the $100 or so a year premium for malpractice insurance.

Good advice there. If it's that cheap (and I just looked it up, it is ), then I see no reason not to go for it.

 

[MrBrown]

Childbirth has been a natural event for thousands of years and it is hardly the time for modern medicine to come along and poke its beek in, unless something goes wrong.

So with that in mind, call somebody else coz my three hours of OBGYN education is just not cutting it here.....

The only children I wish to somehow participate in the delivery of are my own!

 

[lightsandsirens5]

Yeah you hope, try Gravida=8, Para=8, all vaginal. That little guy came out like he was on a water slide. h34r:

It seems to be more common now. It used to be when you went out on an OB call you knew you had an hour at least. Now their having them in the toilet.

What means this? I'm sure I sound stupid asking that, but for the life of me I can't figure it out.

 

[jjesusfreak01]

What means this? I'm sure I sound stupid asking that, but for the life of me I can't figure it out.

Its one of those terminology things that they taught us in class and then I told them it sounded stupid and I thought no one actually used it.

Gravida (pregnancies), Para (births). A mother who is gravida 8, para 8 before the current pregnancy has been pregnant 8 times and given birth 8 times. The average speed of the birth increases with each birth, hence after 8 pregnancies the babies pop out like on a water slide (ref http://www.youtube.com/watch?v=uvN0PAdnwQU).

Toilet births happen when the mother thinks she is having a bowel movement and the baby comes out instead. Usually first time mothers have long deliveries, but occasionally toilet births can happen with new mothers.

 

[lightsandsirens5]

Its one of those terminology things that they taught us in class and then I told them it sounded stupid and I thought no one actually used it.

Gravida (pregnancies), Para (births). A mother who is gravida 8, para 8 before the current pregnancy has been pregnant 8 times and given birth 8 times. The average speed of the birth increases with each birth, hence after 8 pregnancies the babies pop out like on a water slide (ref http://www.youtube.com/watch?v=uvN0PAdnwQU).

Toilet births happen when the mother thinks she is having a bowel movement and the baby comes out instead. Usually first time mothers have long deliveries, but occasionally toilet births can happen with new mothers.

Gotcha. Thanks! But if she was prgnant and actually having the kid then, wouldn't she be Gravida=9, Para=8?

 

[jjesusfreak01]

Gotcha. Thanks! But if she was prgnant and actually having the kid then, wouldn't she be Gravida=9, Para=8?

Yeah, gravida 9, para 8.5 if they were halfway out (I kid...)

 

[LucidResq]

It is also appropriate to break down the information further in to specifics if it's relevant and you have the time. The doctors have some system where you'll hear them spit out "she's a g6p2,1,0,3" whatever but I honestly haven't cared enough to learn it and prefer plain English.

As mentioned your gravida number includes the current pregnancy. So for a woman with her first pregnancy, she is a g1 p0.

NSVD = normal spontaneous vaginal delivery.

I usually just write out c-sect., but I've seen CS used.

I also usually write out ectopic.

SAB = spontaneous abortion / miscarriage

TAB = therapeutic abortion / termination

 

[DaniGrrl]

Or the rushed resident doesn't give the mother a chance to deliver on her own, dumps a ton of pitocin to "hurry things along", which causes abnormally rapid contractions and therefore stress to the baby, and since they're already paying more attention to the fetal monitor rather than the patient... they decide an emergency section is needed.

The c-section rate in this country is ridiculous, and it's not a good thing. Vaginal deliveries are much safer and less costly when possible.

I'm all for birthing centers and home births monitored by well-educated and trained Certified Nurse Midwives. They know when a pregnancy is too high-risk for them to manage and refer them out, and in the case of unforeseen circumstances during labor, are totally capable of taking crucial initial measures to control to situation and get the patient to the help they need. They are usually equipped with monitoring and resus. equipment.

When I decide to have children, this is the route I plan to take as long as my pregnancy is normal. Sorry, I don't want to be confined to a hospital bed, delivering against gravity and having a high risk of being incised by an overeager surgeon. This is coming from someone who works with such surgeons, who are great doctors who do a great job. But even one of the MDs I work with spent a day at a birthing center and her experience there totally changed her perspective on out-of-hospital birth - she said that she would rather deliver there than a hospital herself.

I'll get off my soap box now.

I just want to say "kudos to you" for this post. I wish I had thought this much about birth before I had my first. By the third, I had it figured out and went to a birth center.

 

[MrBrown]

Or the rushed resident doesn't give the mother a chance to deliver on her own, dumps a ton of pitocin to "hurry things along", which causes abnormally rapid contractions and therefore stress to the baby, and since they're already paying more attention to the fetal monitor rather than the patient... they decide an emergency section is needed.

The c-section rate in this country is ridiculous, and it's not a good thing. Vaginal deliveries are much safer and less costly when possible.

I'm all for birthing centers and home births monitored by well-educated and trained Certified Nurse Midwives. They know when a pregnancy is too high-risk for them to manage and refer them out, and in the case of unforeseen circumstances during labor, are totally capable of taking crucial initial measures to control to situation and get the patient to the help they need. They are usually equipped with monitoring and resus. equipment.

When I decide to have children, this is the route I plan to take as long as my pregnancy is normal. Sorry, I don't want to be confined to a hospital bed, delivering against gravity and having a high risk of being incised by an overeager surgeon. This is coming from someone who works with such surgeons, who are great doctors who do a great job. But even one of the MDs I work with spent a day at a birthing center and her experience there totally changed her perspective on out-of-hospital birth - she said that she would rather deliver there than a hospital herself.

I'll get off my soap box now.

I think you are onto something here. Women have been giving birth naturally for millions of years without a hospital so what makes us think now all of a sudden we need to go to one to drop a kid?

And as for those pesky surgeons I think they just like to cut things open because thats what they are trained to do!

Then there are those of us who like to roll round in an orange jumpsuit with "DOCTOR" written on the back, swann in out the sky in a big red and yellow helicopter, give people drugs and stick a tube down thier throat

.... not that there is anything wrong with that h34r:

Now that reminds me, you know what there is something wrong with? Nasotracheal intubation ... I don't care how awesome the drugs were that I got man my whole head and throat hurt for a week, bloody anaesthetist, I think he told me who he was but the drugs he gave me made me not remember so good .... bugger, now I can't sue him

 

[LucidResq]

I just want to say "kudos to you" for this post. I wish I had thought this much about birth before I had my first. By the third, I had it figured out and went to a birth center.

Thank you. Yours is a sentiment I hear pretty often.

 

[DaniGrrl]

Thank you. Yours is a sentiment I hear pretty often.

Not to go completely OT, but I think that's due to the medicalization of birth. Most of the women I know who don't have any birth regret were exposed to the idea of natural labor and birth when they were young - whether by being present at a birth or soon after or because they had a very open relationship with the women in their lives.

 

[jjesusfreak01]

So if you are transporting a pregnant woman by helicopter, do you have to pull over if she goes into labor?

 

[Focallength]

If your off duty,what are you going to do? In ca. a EMT has to be trained to deliver children. But off duty unless you have an OB kit what are you going to do? Do you have all the PPE with you? Child birth is messy and their is a very high risk of contamination. Its the same reason I dont stop and render aid off duty, the main factor is BSI I dont carry anything with me off duty so what can I do? hold c-spine at best and even then with no PPE Im not touching you. its best to get the ricky rescue mentality out of your head. It will end up biting you in the back side. This isnt holly wood, birth is probablly one of the most disgusting things you will ever encounter. Are you going to keep the mother covered with your jacket? How are you going to keep the baby warm? What are you going to cut the umbilical with and where are you going to keep the placentia? How are you going to feel when your covered in every bodily fluid the human body produces and your not protected? And thats if there are no complications.