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The expectant mom had 3 previous pregnancies resulting in 3 children prior to this pregnancy. I had been doing her prenatal care in Twin Falls, Idaho at a meeting place used for the region's Women Issues meetings. It was a centrally located site between both of us. Prenatals were uneventful and everything was normal. Her health and obstetric history was normal and was also uneventful. Her last birth was also at home and she wanted this baby at home as well. She lived in Wells, Nevada, which was located about 100 miles from the nearest medical facility. I was a bit worried about getting to Wells in time for her birthing since she had a history of fast labors and her last midwife did not arrive until after the birth.
This labor and birth was different. I was called at 3 am with Barbara having strong contractions about 7 minutes apart. I immediately grabbed by birth bag and my daughter, Rio, and left to go to Wells. It was a 3 hour drive from where I lived. I arrived at her residence at 6:30 am, where I found her irritable with 9 cm dilation and signs of transitional labor. The amniotic membranes were still intact, which helped to slow the labor down long enough for me to arrive. She was completely effaced and dilated by 9 am and ready to push, but she did not have any urge. She had a slight anterior cervical lip, but this did not inhibit the descent of the baby. The baby moved down to a station 3+ on its own without her wanting to push. The membranes were still intact as they appeared at the vaginal os, so I pinched and broke them. The amniotic fluid was straw colored.
I did not even have time to begin massage or offer much perineal support. With the next contraction, the baby's head emerged and was out. I suctioned lightly and then quickly checked for the cord and found it was wrapped tightly around his neck one and a half times and once around his body. He was having a difficult time rotating as I quickly and carefully loosened the cord enough to move it over his shoulder as it emerged. I got his arms untangled as he slipped out. I suctioned him a little bit more and massaged his feet and back while talking to him. Finally he gasped and tried to breathe (he was very blue at this point and not wanting to breathe). I suctioned some more while he was on his mom's tummy and we were all massaging and talking to him. He was breathing well after this. I broke open a vitamin E capsule and squeezed the oil onto his lips to assist his oxygenation efforts. This was when I noticed the lip did not appear normal. I told the parents that he had a cleft lip (in a very calm manner, of course) and that I would do a more thorough examination in a few minutes. We covered him in warm towels and got him stabilized.
His parents were in a state of shock about the lip and I was taken by surprise as well. When the cord stopped pulsating, I clamped the cord and the father cut the cord and I handed him to his daddy to hold and bond with while I assisted mom. He was able to get to know his son better and get used to the slight facial imperfection.
A few minutes later, the placenta started to separate. I gave the mom some angelica root to assist with the expulsion of the placenta. I quickly checked the infant's mouth to see if the palate was intact. It was intact, so we put him on his mom's nipple to nurse. He didn't want to nurse so I stroked his palate to stimulate his sucking response. He started nursing and her placenta slid out, without a problem.
I did a clean up on the mom and took inventory of damage. There was a very slight tear along her old episiotomy scar. No sutures were necessary. After mom and baby, who was named Keith, were cleaned up, checked out and comfortable, we sat down and had a talk about his cleft lip. I pointed out that they were fortunate that only the lip was effected and the palate was intact, so that Keith could nurse just fine, and seriously, it was not that bad. He was a beautiful baby and they were proud of him, lip and all. We discussed the surgery he would need (which was later performed at Primary Children's Hospital in Salt Lake City).
Baby Keith stayed bluish in his hands and feet for about an hour after the birth. But other than that, he had good responses and was attentive.
I had a long snowy drive home as it had begun to snow during the last hour I was there. My daughter kept me company on the way home.
Keith after his surgery on his cleft lip at age 8 months old
(he is here playing with my son Ryan).
MoonDragon's Pediatric Information: Cleft Lip & Palate
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