Wednesday, June 15, 2005

Feelin' Like a Doula Again

It's been quiet for several months on the doula front. But now I have a client due this Sunday and am starting to meet with another client due in early August. Both are first-time moms. Both think they'll deliver early. Funny, I have yet to have a client who says, "I just know I'm going to go two weeks past my due date! I can tell." But the optimists abound.

Both women are planning to deliver at the Cathloic hospital in town. I haven't had a birth there in nearly a year and that birth happened precipitously, five minutes after I arrived. It was my first time in the newly built birth center. What I'm trying to say is that I'm completely unfamiliar with the facility.

This isn't a big deal, really. I just like knowing where everything is -- bathrooms, "nourishment" rooms, places to catch a nap -- at the U Hospital. It can save a little time and keep me from getting in the nurses' way with my questions and wanderings.

I believe I have finally learned why shoulder dystocia is such a big deal. I thought it might have something to do with impaired gas exchange. But that never made sense. If the baby's head has been delivered, shouldn't it be able to start breathing? I've heard babies cry one their head is out but their body is still in. Though if the body is still in the birth canal it's probably too squeezed for the lungs to expand much.

That still leaves the umbillical cord. Can't gas exchange continue to occur through the cord for some time after the head is out? Or does the conversion from placental gas exchange to lung has exchange occur instantaneously upon the baby's drawin the first breath? If not, then there seems to be little different between a head that's crowning slowly and gently, minute after minute, and a head that's come all the way out. My attempts to find illustrations of dystocia(such as here and here) don't show the cord in a compromised position.

I asked a local midwife who said it's pressure in the circulatory system that is of such a concern. Blood can't return from the baby's head because the pressure is too great. This midwifery site summarizes the situation better than I can.

So it's a circulatory system issue, not a respiratory system one.

I have also learned the correct way to spell cemetery, thanks to my spouse. Apologies for those who were offended by my persistent misspelling of it two posts ago. Spelling is not my forte. Indeed, I had to look up "persistent" and "misspell" just to write this paragraph. But I like to work on it, so please point out other errors if you catch them.


Blogger Dynamic Doula said...

Doulicia, I have an incredible photo of a shoulder dystocia that I have been released to share as I wish- email me if you'd like to see it. This woman gave birth 3/04 and is due with her second baby 12/05- my first repeat client!

Have you seen

Blessings to you!

5:34 PM  
Anonymous Stella said...

Thank you Doulicia for the info on shoulder dystocia, it was really helpful.

11:57 AM  
Blogger doulicia said...

I haven't seen but will check it out.

Stella, you're welcome! Let me know if you learn anything in addition to this.

1:23 PM  

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