MRS. BLACK FOX (PART 2)
As Sylvia pushed, the water bag began to emerge, and then it suddenly ruptured. The clear fluid looked completely normal. Then the head began to come into view. Looks kinda big, I thought—not realizing this would be the first sign of the disaster to come.
As more and more of the head appeared, I realized, This is going to be one big baby!
Gently I reached out, as was my routine, to help the head remain flexed. If the baby’s neck extends during this stage of the delivery, a larger diameter of the skull presents and can damage the woman’s sensitive tissues. Helping it remain flexed prevents tears and also the need for the birth attendant to make a cut—known as an episiotomy.
Just then the head slipped out. At this moment, I reached for the suction bulb, so as to clean the nose and mouth of secretions just prior to delivering the baby. However, to my horror, no sooner had the head slipped out than the baby was sucked back in, pulling the head tight against the perineum. Shoulder dystocia! I thought.
Shoulder dystocia can lead to an emergency in the birthing process. We can see it at the delivery of very large babies. The head will come out, but one of the shoulders hangs up just behind the pubic bone—giving the appearance of someone inside the woman pulling the baby back inside.
Although I had cared for shoulder dystocia many times in my training, it was always frightening to see it. Nevertheless, I’d been well trained in managing this problem—so, despite my initial concern, I began to walk through the step-by-step management.
The first step was to let the nurses know what was going on— and I always did this by talking to the patient. “Sylvia, the baby is very large, and its shoulder is wedged behind your pelvic bone. I’m going to ask Maxine and Louise to help me.”
Many doctors will instinctively start pulling down on the baby’s head to attempt to dislodge it, but this can be very dangerous, as it can stretch, damage, or even tear the nerves in the neck that go to the arm and leave the baby with a broken collarbone or even a nerve palsy—not something I wanted for this baby. I felt the first beads of sweat breaking out on my brow.
I quickly filled a syringe with lidocaine and rapidly numbed Sylvia’s perineum. I then took a pair of scissors and cut a generous episiotomy—hoping it would give me much more room to work and to deliver this child. Then I inserted and quickly removed a small catheter to be sure Sylvia’s bladder was empty. It was.
By the time I had finished these procedures, Maxine was at Sylvia’s right side, and I directed Louise to her left. As Louise was getting in position, Mrs. Black Fox commented, “Cherokee midwives don’t have this problem because they don’t let the woman get in bed.”
Years later, studies would actually provide proof for Mrs. Black Fox’s observation—nevertheless, I did have the problem, whether Sylvia was in bed or not.
“Ladies, with the next contraction, I want you to pull Sylvia’s thighs up toward her chest and out.” This movement, called the McRobert’s maneuver, helped open up the diameter of the pelvic outlet and would often work all by itself to allow the baby to be delivered. We tried this procedure through several contractions, with no success at all. Thankfully, the baby’s heartbeat indicated that there was no distress—yet.
Then I tried to rotate the baby’s shoulders to a position that was not directly behind the pubic bone. First I tried one way and then the other. Several attempts failed. I was beginning to feel panicked.
The baby’s head was getting more purple, and the sweat on my brow fell into my left eye. I dabbed it with my shoulder as Mrs. Black Fox commented, calmly and almost coldly, “Are you going to kill my great-great-grandchild?”
I looked at her. She was now standing behind Louise and appeared coolly composed. I was not so calm—I was feeling deeply afraid—and I did not answer her as I gently placed my right hand behind the baby’s head and tried once again to rotate the baby’s shoulders one way and then the other. There was no movement at all. This baby is really stuck! I thought to myself.
“Maxine, get the fetal monitor. Now! Louise, let’s get Sylvia to roll over and get on her hands and knees.”
“All fours?” Louise asked.
“Like a dog?” asked Mrs. Black Fox. “No midwife would do that!”
I didn’t have time to explain—but in actuality, midwives had taught me this age-old trick. Many times having a woman push while in this position would dislodge the baby’s shoulder and allow a safe and rapid delivery.
As Louise and I helped Sylvia get in position, Maxine returned with the fetal monitor. I attached a small clip to the baby’s purplish head. Maxine turned it on, and I felt sick. The baby’s pulse was less than seventy beats per minute, indicating that the baby was now distressed.
Mrs. Black Fox was standing near Sylvia’s head. She almost growled. “Doctor, the baby is not breathing.”
“That’s okay, Mrs. Black Fox. The baby is getting oxygen from the placenta via the umbilical cord. But I need to work quickly to get this little one out.”
To my chagrin and mounting terror, the change in position made no difference.
“Louise, let’s get Sylvia on her left side.” My training by midwives in England, when I had been a Queen’s Fellow in Nottingham, gave me one more technique to try. But if this failed, I’d need surgical help, and I’d need it fast.
“Maxine, call the surgeon on call, and let’s get ready for a stat C-section.”
She looked at me as if I had two heads—after all, the baby’s head was already out. “Move it!” I commanded.
“Dr. Mitchell’s on call. I’ll page him.” She immediately left.
As Sylvia was getting on her left side, I could hear the fetal heart tones slowing.
“Getting close to sixty per minute!” Louise commented.
I knew this heart rate was getting dangerously low. “Louise, hold her upper leg for me.”
I moved behind the patient. “Sylvia,” I told the patient, “I’m going to try again to rotate your baby. While I’m doing this, please don’t push. Okay?”
She nodded as I looked into the eyes of Mrs. Black Fox. I could see in her eyes what I was feeling in my heart— the fear of an impending death. She slowly raised her head, closed her eyes, and began an ancient chant.
As she chanted, I inserted my hand behind the baby’s head and tried one last desperate time to rotate the baby.
As I did so, Mrs. Black Fox chanted, and I prayed.
TO BE CONTINUED
PAST STORIES FROM BRYSON CITY SEASONS
- Dead Man Standing (Part 1), (Part 2), (Part 3)
- Eyes Wide Open (Part 1), (Part 2)
- Auspicious Accidents (Part 1), (Part 2)
- Answered Prayers (Part 1), (Part 2), (Part 3), (Part 4)
- Rotary Luncheon
- Death by Emotion (Part 1), (Part 2), (Part 3), (Part 4)
- The Invitation (Part 1), (Part 2)
- Barbecue and Bacon (Part 1), (Part 2)
- A Touchy Subject
- Family Time (Part 1), (Part 2)
- Chicken Pops(Part 1), (Part 2)
- Swain County Football (Part 1), (Part 2)
- Hospital Politics (Part 1), (Part 2), (Part 3)
- The Bobcat Attacks (Part 1), (Part 2)
- Dungeons and Apples
- A Tale of Two Surgeons (Part 1), (Part 2), (Part 3)
- Tanned Feets (Part 1), (Part 2), (Part 3)
- Wise Counsel (Part 1), (Part 2)
- An Anniversary to Remember (Part 1), (Part 2)
- Mrs. Black Fox (Part 1), (Part 2)
PAST STORIES FROM BRYSON CITY TALES
- The Murder (Part 1); (Part 2); (Part 3)
- The Arrival (Part 1); (Part 2)
- The Hemlock Inn (Part 1); (Part 2)
- The Grand Tour (Part 1); (Part 2)
- The Interview (Part 1); (Part 2); (Part 3)
- Settling In (Part 1); (Part 2)
- First-Day Jitters (Part 1); (Part 2)
- Emergency (Part 1); (Part 2)
- The Delivery (Part 1); (Part 2)
- The “Expert” (Part 1); (Part 2)
- The Trial (Part 1); (Part 2)
- Shiitake Sam (Part 1); (Part 2)
- Wet Behind the Ears (Part 1); (Part 2); (Part 3)
- Lessons in Daily Practice (Part 1) — Anal Angina; (Part 2); (Part 3); (Part 4)
- White Lies
- The Epiphany (Part 1); (Part 2)
- Becoming Part of the Team (Part 1); (Part 2)
- Monuments (Part 1); (Part 2)
- My First Home Victory (Part 1); (Part 2)
- Fisher of Men (Part 1); (Part 2)
- Fly-Fishing (Part 1); (Part 2)
- Something Fishy (Part 1); (Part 2)
- A Good Day at the Office
- An Evening to Remember
- Another New Doc Comes to Town
- ‘Twas the Night Before Christmas (Part 1); (Part 2)
- A Surprising Gift
- The New Year (Part 1); (Part 2)
- The Home Birth (Part1); (Part 2); (Part 3)
- The Showdown (Part1); (Part 2); (Part 3)
- The Initiation (Part 1); (Part 2); (Part 3)
- Home at Last (Part 1); (Part 2); (Part 3)
© Copyright WLL, INC. 2017. This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.