Re: Alana's Surprise stillbirth
From: art fougner, md (evsono@pipeline.com)
Sat Oct 28 07:36:51 2000
appears this case fulfills the criteria for High Risk. concerning the
heart rate, auscultation will most certainly not detect the prolonged
fixed baseline with absent variability - a truly ominous pattern.
art
At Fri, 27 Oct 2000, Garry Siegel wrote:
>
>>I knew that I would eventually encounter death, but I did not know it would
>>be so early on in my career. I hope to find that birth to be one of the
>>most shocking and unbelievable things I ever have to witness. I pray to
>>never see anything like it again. It still hurts to think about but I will
>>share briefly. I was in attendance for 24 hours, she was 40 +2days. She
>>was a single woman, G2 and this was a VBAC. She was examined and found to
>>be in normal health both before and after the birth. Second stage was 3
>>1/2 hours FHR was checked frequently w/ a dopplar and was WNL, it was in
>>the 160's during crowning and the scalp was pink. Perineum stretched for
>>approx. 2 minutes after last FHR check. Fluid was clear throughout labor
>>until after the head was delivered when there was fresh mec. Birth of the
>>head was followed by shoulders without delay. The baby had no heart beat
>>and never attempted to take a breath after birth. NNR began in less than
>>90 seconds. Cord was around the body once and if I remember right,
>>appeared flat at birth. It is not certain but is thought that the cord may
>>have been across the baby's arm/shoulder/back and compressed, the baby's
>>lungs sounded fluid filled. I keep contemplating, how can a baby go from
>>ok to that bad in 2 minutes or less and we can't resuscitate her? I
>>believe we did everything within our abilities and in retrospect I would
>>not change the management of this labor. The unfortunate experience will
>>enhance my attention to detail and the seriousness with which I approach my
>>work but will not change where I choose to attend well informed, low risk
>>women.
>>Try not to slay me with your responses.
>>
>>Alana Millman
>>Wife to J.P.
>>Mom to Victoria (transport and c/s 12/95)
>>Mom to Elizabeth (home VBAC 09/98)
>>and mom to four in heaven
>>Apprentice midwife
>>Las Vegas, Nevada
>
>Alana:
>
>Sorry about the stillbirth, for the patient (yep) and for the midwife.
>Here are some rather incongruous things in your post--
>
>Home VBAC
>Apprentice midwife
>3 1/2 hour second stage
>well informed, low risk women--home VBAC doesn't qualify for this one!
>
>These are red flags to those of us who are experienced obstetricians; I
>suspect they don't sit too well with most midwives (certified, graduate,
>whatever flavor you wish). Perhaps your labor management was flawless,
>but should you have even labored this woman at home? Is a 3 1/2 hour
>second stage normal for a first vaginal birth? Methinks not.
>
>How could heart tones be good and then the baby be dead? Here's
>how--recurrent late decelerations over hours of labor that are not
>picked up by intermittent auscultation. This leads to metabolic
>acidosis, so that events during birth *that a metabolically normal fetus
>could tolerate* were intolerable.
>
>Maybe 2 minutes on the perineum wasn't such a good idea. Let's worry
>less about the perineum and more about the passenger!
>
>At the risk of being sacreligious, prayer isn't a factor here; how about
>medical knowledge, skill and experience?
>
>Immediate NNR--meaning intubation, epinephine down the tube, fluids/UAC
>line? A pH on the cord would be telling!
>
>I am not trying to bash you, and I've made huge mistakes in judgement in
>the past, and will do so in the future. Perhaps this tradgedy will
>allow you to reflect and learn. I hope that it does not lead to any
>harm to you professionally, and that you and the patient and her family
>recover quickly.
>
>Garry
>
>--
>Garry E. Siegel, M.D., F.A.C.O.G.
>Roswell, GA
>Private Practice
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
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