posterior and breech births

Hospital shifts and classes are over! Yesterday we celebrated with a 12-hour Changing Woman ceremony at a gorgeous retreat center in the hills above the city. I am finally caught up on sleep and that means my brain is quasi-functional to blog once more.

These births actually occurred 2 weeks ago: the posterior presentation birth on Saturday and the breech birth on Sunday night. Taken together, the pair makes an interesting contrast.

I could tell by palpation in the dilation/labor room that Carmen's baby was lying directly posterior. Verified this by taking heart tones with my fetoscope: the heartbeat was clearest right around Carmen's navel. This position did not seem to concern any of the hospital personnel. Of course C. was laboring almost flat on her back, providing little impetus for her baby to rotate.

Once determined to be completely dilated, Carmen made the 20 foot trek to the Sala de Parto. She exhaustedly purple-pushed for about 45 minutes. The Obstetra placed his forearm across her fundus and began some steady pressure. Nada.

Meanwhile, as soon as the baby's head was beginning to show, an Intern cut a generous episiotomy through Carmen's perineum, ensuing a minor torrent of blood and rendering her yoni a pulpy wreck.

The Obstetra inserted his fingers and pressed them against the baby's head, attempting to assist rotation from posterior to anterior.

Maria and I simultaneously pressed inwards on Carmen's hips to open her pelvic outlet a bit wider. The Obstetra climbed atop a stepstool and leaned his full weight onto Carmen's fundus, jabbing rhythmically as though administering CPR chest compressions. And slowly, finally, the baby made his entrance.

Questions:
1. What would have happened if Carmen had not been laboring flat on her back?
2. What if she had not been exhorted to push once declared "complete"?
3. What if she had been able to push her baby out in a position other than lithotomy?
4. How horrifed do you think I was?


Next night:
Jessica is brought into the Sala de Parto on a gurney, accompanied by two doctors. I am washing up from a prior birth. Jessica is completely dilated and her baby is presenting breech. "Parto vaginale?" I inquire dumbfoundedly. "Si!"

Cool.

As soon as Jessica is positioned up on the table of torture, a window of glossy white shows between her legs. The doctors are joking around and gowning up, arranging instruments, and preparing to break her membranes. Suddently the next contraction blossoms and Jessica's membranes balloon fantastically from her yoni. SPLASH! All over the doctor, the floor, the wall.

And two pinkish purple legs wiggle between two chestnut legs.

The doctor grabs the baby's legs, gently tugs for a minute, then picks up the episiotomy scissors. Even though Jessica has birthed before, apparently the doctor thinks she needs extra room this time. He is still chatty and not quite paying attention. Before he can actually do anything, the baby girl's body births up to her neck.

Now the adrenaline in the room is palpable. The Obstetra on for the night has realized the situation and gowned up. She and the doctor both grasp the baby and begin to hoist her upwards to deliver the head.

Except there is this crazy gringa volunteer standing against the wall jibbering at them in English: "Wait for the nape of the neck! You can't see the nape of the neck!"

Too late. Head flexes and sweeps across the perineum. 6 lb. baby girl is born to a triumphant mother. Double footling breech. Sweet.