The fetal head: To palpate it, face the mother's feet. Place your hands on either
side of the lower abdomen, fingertips pointing downward just above the pubic bone.
Press inward gently but firmly. If this proves difficult, have the mother take
a deep breath in; begin pressing as she exhales. Now alternate pressure with your
hands against the mass in the pelvis to bounce (ballot) it back and forth. Attempt
to outline what is in the pelvis by moving your hands around its borders. The
head is harder and rounder than the buttocks. If neither the head nor the breech
is found in the lower portion of the uterus, the baby may be lying either transverse
or oblique and further palpation of the lower uterus will not be very informative.
Feel to either side of midline to find an oblique or transverse lie.
For the next maneuver, some like to remain facing the mother's feet and some prefer to palpate while facing the mother's side, with their dominant arm nearest her feet. Form a "C" shape with the thumb and index/middle fingers of your dominant hand. Grasp the portion of the lower abdomen directly over the largest diameter of the fetal pole in the lower uterus. Gently but firmly press into the abdomen in order to feel the presenting part beneath your hand, between your thumb and fingers. Keeping your entire hand rigid in the C shape, move your hand back and forth in order to ballot the fetal pole between your fingers. If the part in the pelvis is not engaged it will move back and forth freely; if it is the head it will do so more easily. You may form the other hand into a C shape and, in the same fashion, simultaneously use it to palpate the pole in the fundus. Using both hands together can help you differentiate the head from the breech. If the fetus is breech, the buttocks will feel less firm than a head and will not ballot independently of the trunk.
If you are still unsure if the head or the breech is in the pelvis, go back and attempt to locate the fetal shoulder again. Although the breech may feel like a head, there will not be a shoulder just above it with the distinct drop-off characteristic of the junction between the shoulder and the fetal neck. Turn yourself around and, using the same shoulder-finding techniques, check for a shoulder in the upper portion of the uterus.
- Anne Frye, Holistic Midwifery Vol. 1, Care During Pregnancy, Labrys Press 1995
Editor's note: Anne Frye's book includes 14 pages under the heading "The Fine Art of Palpation." The book includes nearly 80 pages of text and illustrations detailing palpation, assessing fetal size, amniotic volume, etc.
Student or beginning midwives who are not yet able to accurately interpret what they are feeling during palpation may enhance their mental imagery by using a water-soluble marking pen to trace the shapes of fetal parts they are feeling onto the mother's abdomen. This gives a visual as well as tactile picture of size and position of the baby. Of course, make sure the mother feels comfortable with this procedure.
- Tricks of the Trade Volumes I & II.
Please Support Our Advertisers
Why OB STARE? In Latin, it means "to be by the side." We are beside the mother, the father, and of course beside the baby. OB STARE is a magazine about Motherhood and Childhood. It is aimed at midwives, parents and institutions. All ideas are welcome. OB STARE is a Spanish language journal.
Subscribe or learn more
Check It Out!
A Web Site Update for E-News Readers
SUBSCRIBE TO BOTH Midwifery Today
magazine and The Birthkit newsletter
and save $3.00!
THINKING ABOUT BECOMING A MIDWIFE? Invest in Midwifery Today's popular Beginning Midwives' Pack. Four Midwifery Today conference audio tapes, the Midwifery Today book "Paths to Becoming a Midwife: Getting an Education," and a one-year subscription to Midwifery Today magazine.
"AS THE RELATIONSHIP BETWEEN MIDWIFE AND MOTHER DEVELOPS during the course of prenatal care, a mutual trust between the caregiver and the cared-for brings a sense of safety and security." Read Valerie El Halta's article, "Normal Birth: Do We Believe? Can We Remember?"
Please Support Our Advertisers
International Cesarean Awareness Network (ICAN)
International Cesarean Awareness Network (ICAN) presents its 2001 conference: Celebrating the Gift of Birth: Empowering, Embracing, Acknowledging
April 20-22, 2001
Radisson Hotel Cleveland Southwest
A phenomenal lineup of speakers includes Ruth Ancheta, Nicette Jukelevics, Marsden Wagner, MD, Nancy Wainer, and others. For more information, see www.ican-online.org or contact Anita Woods at firstname.lastname@example.org or call (816) 505-0116. See you in Cleveland!
Midwifery Today's Online Forum
Do hospital staff take time to actually read over the birth plan and discuss it with the mother? How much consideration is generally given to it by an OB? What if there is all-new staff at the delivery? How is it handled when you have an on-call OB and/or the nurses shift changes?
TO SHARE YOUR THOUGHTS AND EXPERIENCE ON THIS TOPIC, go to Midwifery Today's Forums
: Click on "Doula/CBE Chat" and "Birth Plans."
PLEASE DO NOT SEND YOUR RESPONSES TO E-NEWS!
Please Support Our Advertisers
Yvonne Cryns Legal Defense Fund
Yvonne Cryns (CPM) was indicted by an Illinois grand jury on two counts of involuntary manslaughter. Each count carries a potential sentence of 2 to 5 years in prison. Legal fees are mounting. Please contact Jan Caliendo at email@example.com to help Yvonne and her family with a donation or contact Yvonne Cryns Legal Defense Fund, 5703 Hillcrest, Richmond, IL 60071.
Read "What to do when your midwife has been charged" for more information on what you can do to help your midwife and others in the same situation.
Question of the Week
Q: I am a lay midwife and doula. I recently took on a doula client with a rectal prolapse subsequent to her last delivery which was a Pitocin induction, epidural, forceps to turn an asynclitic head followed by vacuum extraction and shoulder dystocia. The McRoberts maneuver was used to deliver the baby's shoulders. She was given an episiotomy. I'm not sure how deep it went, but she doesn't believe it extended. I have searched for information on rectal prolapse in my textbooks, but can find none. Does anyone know of remedies (besides surgery), possible complications (she plans to labor at home,) or any other information?
SEND YOUR RESPONSES to firstname.lastname@example.org with "Question of the Week" in the subject line.
Send your responses to:
Question of the Week Responses
Q: I would like to hear how midwives deal with long,
long prodromal labors. In a recent birth the woman began prodroming on a Saturday
evening and didn't sleep for four nights. She finally went active on Tuesday evening
and got to complete on Wednesday morning. But by the time she got to complete
she had no energy left to push and no urge to push. Fetal position was favorable.
Now that research is saying that morphine use in labor leads to increased incidence
of drug addiction for the child later in life, I don't even feel comfortable recommending
hospitalization for sleeping the mother. Alcohol was out because she began having
trouble with nausea/vomiting on Monday evening, and homeopathy didn't resolve
- Karen, CPM, LM
A: I find massage after a warm bath with lavender oil helps settle women with long pre-labours. Before the massage or during the massage and bath, I also listen to their fears and anxieties and support them as they express these feelings. I am quite firm about "putting them to bed," and am clear with them that while it is exciting to be coming into labour, a rested mother and baby will handle labour well, and that there is nothing you can do to make it happen. I have always found this works, and particularly with VBAC women. The fear issue cannot be underestimated in these women. So use plenty of opportunity to express this and maintain a reassuring presence, but also affirm the partner's role. I do not stay with them beyond the above interventions because I feel this gives a clear message that it is not time yet.
- Emma Canberra, Australia
A: Although I am not yet a midwife, I can share my personal story: I was in labor with my second child for 2 1/2 days, only dilated to four cm., yet unable to rest at all and getting really tired, as were my midwife and husband! Finally, at 3:00 a.m., I told my midwife that I was getting really tired, and she suggested breaking the waters because the baby's head was completely engaged. My husband and I agreed, and lo and behold, 14 minutes later my son was born (four centimeters to birth in fourteen minutes--you can imagine that the contractions were quite intense-my cervix even tore a bit!). Now that I understand more about the psychological impact on birthing, I realize that I was afraid of having another baby. My first son was a very fussy baby, and was not quite three years old at the time of my second birth. My fear was that I would not be able to care for an active toddler and a fussy baby. I was sure that the second baby would be as fussy as my first and that I would never sleep again. I was also concerned that my first son would be neglected when I cared for the new baby. In addition, I didn't think it was possible to love anyone as much as my first child, and therefore was afraid that I would not give my new baby as much love as he deserved. All of these fears came into play during labor, but I wasn't aware of it until years later.
I recommend reading Dr. Gayle Peterson's books, "Birthing Normally" and "An Easier Childbirth." Dr. Peterson is a psychologist whose specialty is prenatal therapy. Her work addresses this particular issue at length and also issues such as postpartum hemorrhage and other complications.
In the meantime, I would suggest asking the laboring mother if there is something that is worrying her, some reason she is not quite ready to let this baby come out. I think you'll find that just bringing fears out into the open and talking about them will help the process along considerably.
- Cheryl Messer
Please Support Our Advertisers
WHEN MANA AND MIDWIFERY TODAY JOIN FORCES, SOMETHING AMAZING WILL HAPPEN. WE JUST DON'T KNOW WHAT!
Spend an afternoon with ALICE WALKER, explore a pueblo, soak in a natural spa...oh yeah, and earn your CEUs at the 2001 MANA conference.
September 21 to 23 in Albuquerque, NM. Watch this site for further info.
Know a strong woman? Helping empower one? If you haven't already done so, please
forward this issue of Midwifery Today E-News to one or two of your friends or
business associates. Thanks so much!
In response to Aiyana Gregori, student of midwifery in Chile [Issue 3:14]:
I agree entirely that good nutrition is vital in pregnancy and relates closely to favourable outcomes. The question these days is "how do I know it's good food"? This topic is too big to be covered here and the differences between the United States (the most overfed nation on earth) and the Third World are very great both in terms of quantity and quality of food. In fact it may be that a small quantity of "whole" food in the Third World may be better than large amounts of processed western food. I'm sure there'll be lots of feedback here. I don't see my role as a nutritionist, as the risk of [poor nutrition] in my practice is very small.
- Phil Watters
International birth practitioners, please direct your questions, comments, and needs to "International Connections." We're here to help you! For more information on international midwifery, join the International Alliance of Midwives (IAM).
What are the side effects on the baby when taking lysine vitamins and/or acyclovir during the last weeks of pregnancy to avoid an outbreak?
I would like to know if anyone has had an experience like the one I recently had involving the use of a VERY warm shower on a mom in early labor. This mom, trying for a VBAC, was experiencing a spontaneous onset of labor, which became regular and stronger from midnight on. She called me (her doula) at 6:30 a.m. and the contractions were 4 minutes apart, lasting 50- 60 secs. She kept her 10 o'clock midwife/doctor's appointment, and it was determined by vaginal exam that she was dilated 1 cm and 75% effaced. The baby's FHTs were in the 140s both during and after contractions, using a doptone. The OB had ordered an ultrasound to determine baby's weight (and thus allow or disallow a trial of labor), and baby was estimated at 8.7 pounds, the doctor's upper limit to allow labor. So we went back to her home where she proceeded to have a lovely labor for the next 4 hours. During that time she took two, 30-45 min. long, hot showers for pain relief and found them very effective. I was able to put my hands in the water, I found it very warm, but certainly not scalding, and her water pressure was pretty weak so it was not a lot of water hitting her belly. After the second shower, her husband and I both commented on how very warm and red her belly stayed, for some time.
After we arrived at the hospital the baby was put on the monitor and his FHTs were in the 180s and the 170s. One nurse took the mom's temp. under the arm because she'd just had a drink, and said she was running a temp. When it was repeated by mouth 15 min. later there was no temp. After a fluid bolus through an IV, the baby's heart rate came down into the 160s, but then started to decel with contractions and not pick up for a good 60 seconds after the contraction was over. Shortly thereafter her membranes ruptured, and there was light meconium staining. At the OB's exam she was found to be unchanged from the morning and the decision was made to c-section the baby (distress due to tachycardia). After birth the baby was taken to NICU for irregular breathing and possible aspiration of meconium, or maybe TTNB (Transient Tipnocuria of the Newborn). Within 12 hours his breathing was just fine and he is doing very well.
So here's my question: can hot showers cause the baby to react as though the mother is running a fever and distress? I am aware that water used early in labor can slow it, (and she was willing to take that risk because of how good it felt), but I was taught to allow a mom to regulate the temp of her own shower because not enough heat would build up in her body due to evaporation.
Is there a limitation on how old a mom can be for a homebirth? One of my patients is 38, gravida 4, previous baby weighed 5 kg. How do I treat her?
What about postpartum bleeding?
HANDS-ON EXPERIENCE AVAILABLE! Austin Area Birthing Center has openings for experienced, dedicated student midwives starting in June. A room is available in the center. Send your resume to (512) 345-6637 or email to email@example.com
Check out our web site at: www.austinabc.com
Midwifery Today E-News is published electronically every Wednesday. We invite your questions, comments and submissions. We'd love to hear from you!
Write to us at:
Please send submissions in the body of your message and not as attachments.
Click here to subscribe to Midwifery Today E-News
For all other matters contact Midwifery Today: PO Box 2672-940, Eugene OR 97402
Remember to share this newsletter
You may forward it to as many friends and colleagues as you wish--it's free!
For problems with your E-News subscription, or if you do not have Internet access: firstname.lastname@example.org
Please explain the exact problem when you write.
Learn even more about birth!
Subscribe to our quarterly print publication, MIDWIFERY TODAY. Mention code 940 U.S.: $50 1 year $95 2 years
Canada/Mexico: $60 1 year $113 2 years
All other countries: $75 1 year $143 2 years
E-mail email@example.com or call 800-743-0974 for information on how to order.
To order Midwifery Today products mentioned in this issue, send a check or money order to:
Midwifery Today, Inc.
PO Box 2672-940
Eugene OR 97402 USA
To pay by Visa or MasterCard, send your information to: 1-800-743-0974 (orders only)
Fax: 541-344-1422 For other matters, you may call:
541-344-7438 Or email us:
Editorial for E-News:
Editorial for print magazine:
For all other matters:
This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.
Midwifery Today, Inc., does not assume liability for the use of this information in any jurisdiction or for the contents of any external Internet sites referenced, nor does it endorse any commercial product or service mentioned or advertised in this publication. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.
The content of E-News is copyrighted by Midwifery Today, Inc., and, occasionally, other rights holders. You may forward E-News by e-mail an unlimited number of times, provided you do not alter the content in any way and that you include all applicable notices and disclaimers. You may print a single copy of each issue of E-News for your own personal, noncommercial use only, provided you include all applicable notices and disclaimers. Any other use of the content is strictly prohibited without the prior written permission of Midwifery Today, Inc., and any other applicable rights holders.
© 2001 Midwifery Today, Inc. All Rights Reserved.
Midwifery Today: Each One Teach One!