to think that a senior registrar in obstetrics should be able to(27 Posts)
tell the difference between babies head and bum when palpitating your abdominal region when you are 40+4?
Went in yesterday to book a date for induction. Midwife examined me and passed me through to the registrars. The registrar read my notes and asked if I would mind if he had a prod. He then went rushing off to find a hand held scanning device because he couldn't work out which way up the baby was! If he had read my notes properly and asked me I could of told him everything was where it should be. I had a growth scan about 2 weeks ago to confirm that this little one wasn't going to be mahoosive! At the scan baby was deff settled head down and getting ready. If this one had decided to try and turn I might of known about it a nearly 9lb baby would not of been able to turn 180 degrees without me noticing!
I had a scan two days before my DD was born - and she was head down, then whilst in labour - the MW said oooo I can feel her bum I had to point out my notes
Dont let it bother you x
IME, the more senior they are, the less "hands on" (literally) they are on a daily basis, so probably knows everything there is to know about the latest research etc, but when it comes to the basics that require a bit more daily experience, probably not so hot!
I think palpation is a) quite hard, from what I hear; and b) a bit of a dying art, as hands-on techniques are less trusted than technology (a bloody shame imo).
Having tried palpation when I was a student nurse doing my Obstetric allocation, I can tell you that it is not easy at all. The head and the bum can feel very similar, and as far as I remember, it all comes down to whether you can move the lump around (in which case it's the head) or not.
I do think, though, that an obstetric registrar should have had a wee bit more experience and knowledge than I, as a second year student nurse, did, and should be able to tell his arse from his elbow a baby's bottom from its head!
I am possibly just getting stroppy about being overdue again!
But if notes say 3/5 eng ceph then I think he should of been able to work out that the midwife had already determined that baby was head down! I am fairly certain that the midwives know what they are doing as they do it all day every day!
after my experiences I think you are hoping a bit!
My dts were scanned by the consultant and they still couldn't tell head from bum. I also found weight calculations way off. Mine also moved a lot in the last few weeks even with there being two of them in there, so it'd not impossible for a baby to turn at the last minute.
I had the opposite experience. At 38 weeks the m/w and GP both decided DD was breech. Sent me for a scan filling me with scare stories about c-section (too late for that hospital to do ECV apparently).
I turned up at my scan with the consultant, he literally prodded me and went "hmmm, doesn't feel breech to me" then confirmed it with a scan.
YAB a bit U
a. registrars are not all that senior and the post 'senior registrar' does not exist in the UK anymore.
b. at least he went to check.
c. doctors are not particularly good at plapating as they don't do it often - midwives do it much more often. A house officer might be better than a consultant just because they'll have had to do it more often and more recently.
d. Heads and bottoms feel very, very similar.
A friend of mine had her baby turn into breech whilst in labour. It can happen.
5 different mw told me dd was head down and engaged. Including the one who examined me on arrival at hospital when I was 5cm dilated.
Two hours later when 10cm dilated and waters having just been broken, imagine the horror when a foot popped out.....
Sometimes, it really can be hard to tell.
<Daredn't tell a pg woman she IBU so sending you positive labour vibes instead mummyhill>
I was told throughout that DS1 was cephalic even engaged only to discover after 7 hours in labour that he was breech. Its really hard to be sure. I insisted they did a presentation scan with DS2.
I had this when I was in labour, the mw thought she could feel his bum descending, but it was his severely squished head after a few days of mild contractions.
They brought some strange guy in surgical robes with a scanner who scanned me but then said he wasn't trained to interpret the results so couldn't tell which end was up (literally!) and started talking about c sections, then luckily my consultant walked in, took one look at the screen and said "no, no, everything's fine it's head down"
I couldn't blame them if they couldn't tell which way was up through my fat belly tbh, but why can't they rely on what the mother says? His head was right there like a bowling ball crushing my bladder, his feet were jammed in my ribs. I knew he was head down but they just don't trust the mother, especially as a first timer.
Prunerz - it is a shame - I used to nurse and worked with several nurses from (I think) Tanzania - they were all trained in midwifery as a standard part of their training. One of them palpated a colleague who was 8 weeks pg and said hmmm, you feel more like 9 weeks to me - I was amazed she could feel the difference and sure enough the dating scan confirmed it!
Much easier to tell fundus height in early pregnancy than to tell between an engaged head, which doesn't move and a bottom, which doesn't move either in late pregnancy though. It hard to be sure and a good thing that the registrar did a scan to confirm when he couldn't tell easily rather than thinking 'I am a registrar and I'm going to trust my feeling because I'm senior' - that is good practice to be fair to him.
Here here curiositykilled.
I am a doc (not obstetrics) and in my limited experience as a medical student I don't think i ever got it right - its really difficult. Granted a registrar is more experienced than a med student but no doc is infallible - better to admit you are not sure than bluff it.
And with respect to those mums who felt the docs disregarded them when they knew can you think of what might have happened if actually you hadn't been right on your babies position and you had complications as a result? I don't think a doc saying 'OK so the midwife and you think its head down but for my own peace of mind I want to make absolutely sure' is being unreasonable at all. Good at their job imho
When DS was born they told me he was a girl so am not suprised at all.
alicet, there's nothing wrong with double-checking, and if they put it that way then I doubt anyone would be offended, but I wasn't even listened to at all, and that's what grates. A lot of the time first-timers opinions are totally disregarded, and while I know we don't know everything the first time round I do know when there's a foot pushing out the base of my ribcage!
boundary babe. i'm pretty amazed a midwife could determine gestation of a 9week old baby by palpating. I thought the pregnant uterus was not palpable until approx 12 weeks maybe's them Tanzanian midwives have special powers
I would far, far rather the doc checked if he wasn't sure by doing a scan.I have a friend who was told her baby was head down for weeks and went into labour, only to be examined by the registrar who palpated and scanned to find out she was breech, cue emergency c section. I am a dr too(not obstetrics) and agree with alicet I could never work out head from bum either!
My breech birth son was missed until a scan for something else showed that he was definitely bottom first. I was relieved someone spotted it before labour started.
I wouldn't trust technology over hands. With my DS2 my sis (a MW) kept telling me I was measuring weeks ahead then my own MW told me she thought the baby was big and sent me to the OB at 37 weeks, he measured and thought the same so sent straight for an ultrasound where the sonographer propmptly told them all they were talking crap and the baby was normal sized and about 7lb. I knew otherwise. He was 10lb 1oz and almost 60cm long. All the hands on stuff was spot on and the technology was RUBBISH!
Agree with James also about mum knowing. You can bloody well see the feet pushing through the skin and feel them kicking you in the ribs.
I know I am hormonal lol.
This is my third and I hope I can tell the difference in shape of a foot and a fist as it looks like it is trying to pop out through the skin up by my rib cage.
They keep telling me that it is going to be a big baby but the scans seem to show that will be about the same size as my last baby.
if you ahd not been given the scan and were left feeling up in the air and unsure, then you would not BU, but you were given the extra reassurance of the scan and as has been said, babies can turn up to and even during labour
i agree with curiositykilled
BTW, by sister's baby has been breech the whole pregnancy, except for a couple of weeks as transverse, it turned at 37 weeks and she did not feel a big turn or movement
neither palpation nor technology can always be foolproof, so double checking is great IMO
It may sound like a silly mistake but believe me surprise breeches can and do happen to far more experienced people than me. Babies can and do turn even in labour, amazing as it may seem. And as Lulu says nothing is foolproof.
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