(above image from http://inexplicableways.com/tag/birth-bar-squat-bar/ )
I've had some seriously awesome births at work this week. It feels so great when I can work with a couple to help bring their new baby into this world. I've had several providers thank me for being so proactive in helping the women achieve a vaginal birth (lots of posterior and asynclitic babies lately).
It takes a lot of work and time to patiently help a posterior or asynclitic baby to turn into a better position for birth. Many of the women I care for have epidurals - sometimes very dense, heavy epidurals - and it makes it even harder to move the mom. (If you can't physically move the baby, you move the mom = the baby moves.)
I've become fairly astute and being able to detect when a baby is posterior or asynclitic. Labor is prolonged, cervical progress is slow, and often times there specific patterns in the contractions (coupling or tripling) in addition to back pain/rectal pressure felt by the mom, or an involuntary early urge to push. Also, if it's difficult for my to trace the FHR on the monitor (because of the baby lying posterior -- we listen over the fetal back -- easy to do when the baby is in an anterior position, difficult when posterior). On exam, if I can accurately feel the sutures and fontanelles, I can also tell how the baby is lying in relation to the mom's pelvis.
Anyhow, the secret to moving a poorly aligned/malpositioned baby? Move the mom. And keep moving her until the baby rotates and descends (usually fairly rapidly once the baby is in an optimal anterior position!). Far left lateral x 15 minutes, far right lateral X 15 minutes. Sitting up in a modified squat (adjusting the bed and using tons of pillows for maternal support), birth bar positions (there are several positions one can use with this!), deep squats, knee chest (cannot do this with a heavy epidural), playing tug of war with a sheet wrapped around the birth bar (I get my upper body workout this way!). Here is a birth story, with pictures of the tug of war being used, from a mom's blog. In short: changing the mom's position to help increase the pelvic diameters and encourage the baby to ROTATE!!
All of this physical work is active labor and delivery nursing care. You may not see this too often, depending upon how "active" the nurse is, or how many patients the nurse has. By this point (transition to 2nd stage labor) nursing care really should be 1:1 with the laboring woman. And yes, there are some nurses who have no clue about position changes helping to rotate a baby, or perhaps they are just too damn lazy to give a hoot about changing the mom's position.
Guess what? My goal for each mom and baby is a healthy birth, as well as a positive birth experience: no matter if it's a vaginal birth or a cesarean section birth.
This a very physically demanding aspect of this "job" as a L&D nurse. Constantly moving, rearranging, using pillows, adjusting, teaching, emotionally supportive, coaching through each and every contraction. It is physically draining, especially if it takes 2-3 hours during the 2nd stage (pushing) to encourage a baby to rotate and descend for a successful vaginal birth. I am worn out after that long of a 2nd stage! But it is all worth it when mom is holding her newborn in her arms. When she successfully gets her new baby to latch on to her breast and nurse in that first golden hour after the birth. When she looks as me, with tears in her eyes, and says "I did it!!!!"
Yep, that is why I am in this "job".
