one practicum question

With amnioinfusion, it is not recommended for meconium any more. It does not decrease incidence of meconium aspiration syndrome. It can improve cord compression and is actually linked with reduced rates of chorioamnionitis. Not sure if the doc meant they never use it for mec or they never use it at all.

I have seen the urine get orangish like that. In the absence of other problems (oliguria) we have attributed it to bladder trauma due to pressure of the baby's head.

As for the section, the biggest indicator of fetal well-being is variability. So two "big" (remember that they are not prolonged decels until they are > 2 minutes) with moderate variability is much less concerning than two decels with minimal variability. You have to look at the whole strip, not just the presence of variables.

Failure to make progress in two hours is not really based on a standard. Current guidelines are to asses progress for three hours before intervening if the patient falls off a labor curve. Friedman's curve has essentially been shown to be not evidence-based. Chorioamnionitis causes ineffective contractions and if the doctor was truly thinking chorio then he probably figured there was no value in continuing.

Assuming heart tones were not too awful I as a provider would have inserted an IUPC to see if the contractions were adequate, considered augmentation depending on the results, if repositioning the patient was ineffective considered starting amnioinfusion to relieve cord compression, and started antiobiotics for suspected chorio (keeping in mind that epidurals cause temperatures as well so chorio may not be a factor). As a CNM though I obviously try to avoid section.

This doc may have consciously or unconsciously moved to section quickly because she was a homebirth transfer for a variety of reasons- to "punish" her for attempting a homebirth, fear of liability after a homebirth transfer, laziness and desire to get home quickly after a patient was "dumped" on him, or true concern for the safety of the baby/mom. It's tough to say.

It may very well have been that the baby could not descend due to a tight cord of that the wrapping of the cord was causing the variables and would have gotten worse.

About 25% of deliveries have nuchal cords and typically there is no issue.

Sorry, I meant that 25% of all deliveries have nuchal cords and with most of the 25% there are no issues.

It's possible that the nuchal cord was causing the decels and the slow dilation but there's no way of knowing since most of the time nuchal cords cause no issue. Hope that's a little clearer.

If the decels were caused by the cord and it was preventing baby from descending then I wouldn't think amnioinfusion would be helpful. Of course we don't really non any of this, we are just guessing...

Also- "variability" is the way the baby's heart rate goes up and down over time. "Variables" are the decelerations of the heart rate. Variability is a good thing, we want to see moderate variability. Variables can be cause for concern.