Back labor dan Occiput Posterior (Posisi bayi membelakangi ibu)

Ini juga salah satu yang saya alami selama persalinan adnan. Kontraksi ada di tempat pup bukan di perut. Rasanya wowww sakit banget. aq pikir dah bukaan lengkap ternyata masih bukaan 3. Padahal sudah sering jalan, goyang2 di gym ball. Ternyata ini ada hubungannya sama posisi bayi. Umumnya posisi bayi ada didepan ibu, ini membelakangi jadi tekanan lebih kebelakang bukan pada perut saat kontraksi. Ini bisa dilihat pas USG. tapi pas kejadian saya USG di kehamilan 36weeks keatas tidak ada kecuali belum lahir di usia 41weeks. Ini bisa dicegah kalau pakai akupuntur diputar posisi bayi biar pas dijalan lahir.

Midwife bilang ini juga salah satu penyebab pingin ngejan pada saat bukaan belum lengkap karena posisinya yang membelakangi. Pas hamil azka nggak seperti ini padahal kata midwife biasanya pas kehamilan pertama kejadian. Alhamdulillah bisa melewati back labor yang menyakitkan dan bisa lahiran normal.

Posisi yang benar pas anterior, tetapi kejadian adnan pas posterior jadi menekan pinggul belakang si ibu. Saya nggak dikasi pain killer epidural, pas itu mau diepidural tapi nggak jadi dan hanya diberi morphine saja. Hebat tim dokter dan bidan bisa menyelamatkan saya dan bayi dan tetap lahiran normal.

What is back labor?

Back labor refers to the intense lower back pain that many women feel during contractions when they're giving birth. Some women even feel it between contractions.

This pain is usually attributed to the pressure of your baby's head against your lower back, but other factors may be at work, too. One unproven but interesting theory is that the pain is "referred" to your lower back from your uterus.

That idea is supported by the fact that some women complain of low back pain when they have menstrual cramps – which clearly can't be blamed on a baby! One study found that women who had back pain during their periods were more likely to have back pain during labor.

Is back labor related to the baby's position?

Back labor has long been thought to be more common when the baby is facing up during labor, with the back of the baby's head pressing on the bony part of your spine. But research suggests that this assumption is wrong.

In a 2005 study of nearly 700 women in labor, moms whose babies were in this "sunny-side up" position when they were admitted to the hospital were no more likely to complain of back labor or more intense pain at that time than those whose babies were facing down or sideways. (Ultrasound was used to tell what position the babies were in.)

Unfortunately, the study produced no information about how the moms-to-be in the study felt later in labor because over 90 percent of them ended up choosing an epidural for for pain management.

What can I do to ease back labor?

You may not be able to prevent low back pain during labor, but you can try one or more of these tactics to help relieve it:

• Get up on all fours. This position may reduce the pressure of your baby's head on your spine. (Take a look at our video on positions to ease labor pain.)
• Do pelvic tilts. These simple exercises also may help minimize the pressure on your spine.
• Ask your labor coach to rub your lower back between or during contractions – or both, whatever feels best to you.
• Many women find that steady counterpressure on the lower back relieves some of the pain. Ask your labor coach to push on this area with his fists during contractions or massage it with a tennis ball.
• Take a warm bath or shower, or apply warm compresses or a hot water bottle to your lower back. Heat may ease the achiness and bring you some comfort. On the other hand, some women find cold packs more soothing or that alternating heat and cold is helpful. You may want to give both a try. Just be sure to use a towel to protect your skin from direct contact with heat or cold.

Some women have found that sterile water injections provide some relief from back pain. This is a procedure in which small amounts of sterile water are injected just beneath the skin in four places on the lower back. The injections are temporarily painful, but afterward, the pain relief lasts for a few hours. No one knows for sure why it works, and it's not available everywhere.

Check out some other natural childbirth techniques that may help you deal with labor pain.

If you don't have your heart set on natural childbirth and nothing is helping you manage your back pain, consider getting an epidural. In most cases, it provides total relief from all kinds of labor pain, including back labor.

Sumber : https://www.babycenter.com/0_back-labor_1451580.bc

What does it mean that a baby is in the "posterior position"?

When a baby is head-down but facing your abdomen, she's said to be in the occiput posterior (OP) position – or posterior position, for short. The term refers to the fact that the back of your baby's skull (the occipital bone) is in the back (or posterior) of your pelvis.

You may also hear this position referred to as "face-up" or "sunny-side up."

How common is it for a baby to be in this position?

It depends on how close you are to delivery. Many more babies are posterior at the beginning of labor than when they're born. While as many as half are posterior when labor starts, only 4 to 10 percent of babies are posterior at birth. (The percentage of babies who are posterior at birth is higher among first-time mothers.)

It's common for a baby's position to change during labor, often more than once, and your baby may not assume his final position until shortly before birth.

A study published in 2005 used ultrasound to look at the position of more than 1,500 babies of first-time mothers over the course of labor. The results showed just how variable and unpredictable a baby's position can be.

The first ultrasound was performed when the mothers were admitted to the hospital in labor or to be induced. Close to a quarter of the babies viewed were face-up (posterior), nearly half were facing sideways, and the rest were face-down. Ultrasounds were repeated at one or two other points during labor and then at the time of birth.

Most of the babies were in the more favorable face-down position by the time they were delivered. Among the babies who were posterior late in labor, about 1 in 5 was still that way at the time of delivery. Among babies who were face-down later in labor, only 1 in 20 was born face-up.

A 2007 study of 270 women being induced found that more than a third of the babies were in the posterior position just before the induction started, but fewer than 1 in 12 were still that way at delivery. Of the babies who were posterior at birth, over two-thirds of them weren't posterior in the beginning.

Studies published since then (which also used ultrasound to confirm position) also show that a baby's position at the onset of labor does not predict his position at birth. Many babies who are posterior at some point in labor rotate on their own to the face-down position before birth.

f my baby is posterior during labor, does that mean I'll have back labor?

Back labor — the intense lower back pain that many women feel during labor – was long thought to be more likely when the baby is facing up. But research using ultrasound (much more accurate than a clinical exam, especially in the first stage of labor) suggests that this common assumption is probably wrong.

In the 2005 study above, nearly 700 of the women were asked about pain when they were admitted to the hospital. More than 1 in 4 reported having back labor at that time, but moms whose babies were face-up were no more likely to complain of back labor or more intense pain than those whose babies were facing down or sideways.

Unfortunately, the study produced no information about how the moms-to-be felt later in labor because over 90 percent of them ended up choosing an epidural for pain management.

If my baby is posterior at birth, how will it affect my delivery?

Mothers whose babies are face-up at birth tend to push longer, more commonly need Pitocin to stimulate contractions, and have a significantly higher risk of having an assisted vaginal delivery or a c-section. They also have a greater risk of a postpartum hemorrhage.

Those who do give birth vaginally to a baby who is posterior are more likely to have an episiotomy and severe perineal tears than moms whose babies are in the more favorable face-down position, even after taking into account the higher rate of forceps and vacuum-assisted delivery.

The posterior position at birth also is associated with a higher risk of short-term complications for the baby, such as lower five-minute Apgar scores, an greater likelihood of needing to be admitted to the neonatal intensive care unit, and a longer hospital stay.

Is there anything I can do to make it less likely that my baby will be in the posterior position?

You may have heard that being on your hands and knees during late pregnancy or labor helps rotate your baby face-down, but current research suggests that being on all fours won't reduce the likelihood that your baby will be in the posterior position at birth.

That said, if your back aches, you may want to give this position a try anyway. Research shows that being on your hands and knees during labor may offer some relief from back pain.

A 1983 study found that when moms whose babies were posterior at 37 weeks spent ten minutes on their hands and knees, it appeared to help turn the babies, at least in the short term. But a later study – in which one group did slow pelvic rocking exercises on all fours for ten minutes twice a day from 37 weeks on and a second group did nothing – looked at the longer-term effect and found that an equal percentage of women (about 8 percent) in both groups had babies who were posterior at birth.

Another study looked at women who used the hands and knees position intermittently during labor and found that it didn't significantly reduce the number of babies who were posterior at birth. It was associated with a significant reduction in back pain, however.

Some research shows a link between having an epidural during labor and having a baby who is posterior at birth. But it's not clear whether having an epidural makes you more likely to have a posterior baby or having a posterior baby (and often a longer and possibly more painful labor) makes it more likely that you'll request an epidural. And one study found that the percentage of women opting for an epidural was the same regardless of the baby's position at admission to the hospital.

Finally, some practitioners may attempt to turn a posterior baby by manual rotation. Once you're fully dilated, the practitioner reaches into your vagina, puts his hand or fingers on your baby's head, and tries to rotate it. It may take a few contractions to get the baby into a face-down position and it doesn't always work.

Sumber : https://www.babycenter.com/0_posterior-position_1454005.bc?page=2

Shoulder Distocia (Bahu bayi nyangkut di panggul)

Ini salah satu yang saya alami waktu melahirkan adnan. Waktu pembukaan 7 ternyata bayi nggak mau turun padahal udah mau ngeden aja. ternyata bidan bilang bahu nyangkut di panggul. Pas saya kejadian karena bayi yang besar (padahal cuma 3,45kg aja) dan proses labor yang lama.

langsung dokter yang nanganin karena ada prosedur yang hanya dokter yang boleh nanganin. Bidan memantau disebelah dokter. Setelah tau bahu nyangkut langsung tangan dokter masuk dan kerasa seperti ada yang digunting. Setelah itu bidan bilang flat, detak jantung bayi hilang. Dokter memutar bahu agar bisa keluar dan hanya 6 menit waktu yang diberikan buat bayi keluar karena ada resiko brain damage ( saya diberitahu sehari setelah melahirkan ). Langsung deh lemas..ya Allah kasiannya si adnan ya tapi Alhamdulillah saya bisa mengejan dalam waktu 3 menit dan adnan bisa dikeluarkan tanpa harus masuk ke Nicu.

Saya sudah berpikir ini bakal berahir dengan cesar karena tenaga juga udah hampir hilang. Lemas karena kena pain killer morphin dan proses kontraksi sampai lahiran yang lama. Tapi bidan dan dokter masih mempertahankan lahiran normal walau dokter bilang ini prosesnya termasuk emergency.

What is shoulder dystocia? Shoulder dystocia is when the baby’s head has been born but one of the shoulders becomes stuck behind the mother’s pubic bone, delaying the birth of the baby’s body (see figure below). If this happens, extra help is usually needed to release the baby’s shoulder. In the majority of cases, the baby will be born promptly and safely. Shoulder stuck behind mother’s pelvic bone Pubic bone Nerve, or area of nerve, stretching Umbilical cord 2 How common is shoulder dystocia? Shoulder dystocia occurs in about one in 150 (0.7%) vaginal births.

Can shoulder dystocia be predicted? Shoulder dystocia usually occurs unexpectedly during childbirth and most of the time it is not possible to predict when it will happen. However, it is more likely to occur if: • you have had shoulder dystocia before • you have diabetes • your body mass index (BMI) is 30 or more • your labour is induced • you have a long labour • you have an assisted vaginal birth (forceps or ventouse). Shoulder dystocia is more likely with large babies but nevertheless there is no difficulty delivering the shoulders in the majority of babies over 4.5kg (10lb). Half of all instances of shoulder dystocia occur in babies weighing less than 4kg (about 9lb). Ultrasound scans are not good at telling whether you are likely to have a large baby and therefore they are not recommended for predicting shoulder dystocia, if you have no other risk factors.

Can shoulder dystocia be prevented? In most instances, shoulder dystocia cannot be prevented because it cannot be predicted. If you have diabetes or have developed diabetes in pregnancy, you will usually be offered early induction of labour or planned caesarean section. This will reduce the risk of shoulder dystocia. If you don’t have diabetes, early induction of labour does not prevent shoulder dystocia, even if your baby is suspected to be large. Caesarean section is also not routinely recommended in this situation.

What happens if shoulder dystocia occurs? Your midwife and obstetrician will be aware that in every birth there is a possibility of shoulder dystocia. Shoulder dystocia is an emergency and therefore, when it does occur, speed is of the essence. The baby’s shoulder needs to be released quickly so that the baby’s body can be born and he or she can start breathing air into the lungs. Your midwife will push the emergency bell and three or four members of staff, including obstetricians, midwives and a doctor for the baby (paediatrician), are likely to come into the delivery room to help. Because it happens so quickly and lots of people come into the room, it may be frightening for you and your birth partner. However, it is important to remember that obstetricians and midwives who attend the birth are trained in how to release the shoulders using certain manoeuvres and in the great majority of cases your baby will be delivered promptly and safely. The obstetrician or midwife will usually: • ask you to stop pushing • reposition you to give your baby more room inside the vagina; you will be asked to lie on your back with your legs pushed outwards and up towards your chest (this is known as the McRoberts manoeuvre) • press on your abdomen just above the pubic bone to try to release your baby’s shoulder • consider making a cut (episiotomy) to enlarge the vaginal opening. 3 With these simple measures, the majority of babies are born safely. If the shoulder is not released easily with the above measures, either: • your obstetrician or midwife will put his or her hand within the vagina to try to free your baby’s shoulder, or • you may be helped to roll over onto ‘all fours’, which can also help to release the shoulder. Once the shoulders are free, your baby will be born, and a paediatrician will examine him or her. Your midwife and obstetrician will talk to you about what happened. If you wish to talk at a later date about your experience, ask to talk to your obstetrician, midwife, health visitor and/or GP.

What happens if I give birth at home or in a midwifeled unit? Wherever you give birth, your midwife is trained to deal with shoulder dystocia. If your baby is not born with the simple measures described above or by rolling over onto all fours, your midwife will call an ambulance to transfer you to hospital. If your baby is born before the ambulance arrives, your midwife may still suggest taking you and your baby to hospital to be checked over. What if I have chosen to have a water birth? If you are having a water birth, you will be asked to get out of the pool so that your midwife can assist you.

What could shoulder dystocia mean for me and my baby? For me Vaginal tears are more common after shoulder dystocia and may extend to the back passage (see RCOG patient information: A Third- or Fourth-degree Tear During Childbirth). Heavier bleeding than normal after birth (postpartum haemorrhage) is also more common and you may require additional treatment and/or a blood transfusion. For my baby About one in ten (10%) babies who have shoulder dystocia will have some stretching of the nerves in the neck (see figure on page 1), called brachial plexus injury (BPI), which may cause loss of movement to the arm. The most common type of BPI is called Erb’s palsy. It is usually temporary and movement will return within hours or days. Permanent damage is rare. It is important to remember that BPI can occur without shoulder dystocia. BPI can also occur in babies born by caesarean section. Sometimes shoulder dystocia can cause other injuries including fractures of the baby’s arm or shoulder. In the majority of cases, these heal extremely well. Even with the best care, in a very few cases, a baby can suffer brain damage if he or she did not get enough oxygen because the delivery was delayed by shoulder dystocia. What about future deliveries? If your baby’s birth was complicated by shoulder dystocia, there is an increased risk of shoulder dystocia in future pregnancies; around one in ten women will have shoulder dystocia again in a future pregnancy. In view of this, your obstetrician or midwife will discuss your options for next time taking into account your individual circumstances and preferences. 4 You may wish to consider a vaginal delivery if it was easy to release your baby’s shoulders, your baby was fine and you have no other risk factors. If it was difficult to release your baby’s shoulders, your baby had any injuries or the experience has affected you and your family, you may wish to consider a planned caesarean section.

https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-shoulder-dystocia.pdf

2 Minggu Ber 3 Aja sama Bocil

Hyahh..mulai dah 2 minggu suami ke indonesia soalnya adik ipar mau nikah dan suami yang  nikahin karena satu2nya anak laki. Untungnya temen2 Indonesia banyak disini jadi ada yang bisa bantuin kalau aq sudah menyerah. heee..

Hari2 kerasa lama banget. Hari pertama mulai mandikan adnan sendiri, bangun tidur mulai mandikan lanjut masak lanjut dulang azka dan jaga anak2. Kebanyakan dirumah aja si soalnya juga males mau jalan mana pas itu juga lift mati. Paling keluar pas ada bidan aja kebawah. Si Azka juga pilek batuk dan nggak lama adiknya juga ikutan flu. Emaknya g boleh tepar pokoknya harus tetap sehat,

Alhamdulillah teman2 banyak yang dateng, kadang kasi makanan atau bisa dimintai tolong belanja keperluan. kadang susu, ayam atau stok makanan habis bisa minta tolong. Sesekali keluar rumah pas liftnya nyala dan udara bagus cuma ketaman depan aja atau sekedar belanja. Itu juga pakai cepet2an dah soalnya juga kadang ni masih agak berkunang2. Tapi nggak lama setelah ada teman yang nawarin buatin telor madu susu tiap hari jadinya agak segeran dan bisa keluar belanja sendiri.

Selama ada hiburan, salah satunya tv yang bisa 16 jam nyala terus soalnya biar emaknya nggak stress. Koneksi internet jadi bisa kontak temen2 kl lagi suntuk dan bisa minum kopi udh dah wajar aja bisa aja InsyaAllah.

Tapi yang lucunya, pas mandi atau kebelet pup kadang aq tinggal anak2 dan azka kadang masih gemesan sama adiknya dan ahirnya pada nangis dah. Karena masih recovery, lupa kalau nggak boleh ngeden terlalu kencang. lhaaa udah parno liat anak nangis ngeden aja dan ternyata malah sakit pas setiap pup, dan dimarahi deh sama bidan. Salah sendiri kok ngeden.haaa...yah gmana lagi emak2 dah masa mau minta tlg temen jagain anak setiap aq mau pup.haaa..

Pas suami pulang seneng banget dah Minim ada yang nemenin dan gantian jaga terutama saat pup biar tenang pupnya.haaa..

Tempat Tidur Bayi Aman Nggak Makan Tempat

Nah ini juga mikir2 beli tempat tidur bayi. Mana apartemen kecil dan kalau mau beli cot ampun dah besar bener dan mau taruh mana. Barang juga banyak dan bakalan tambah sempit ni ruangan.

Ahirnya browsing sana sini ehh ada ni bassinet yang aman juga dan boleh dipakai kata bidan selain itu juga kecil nggak makan tempat. Langsung dah beli bassinet dan bisa dibawa kemana2. Bassinet aja tanpa penyangganya soalnya juga bingung tempatnya. Beberapa bilang moses basket atau bassinet atau tempat tidur ala2 maori gitu. Lumayan dah walau belinya second tapi masih bagus dan bisa dipake. ada matrasnya pula dan masih dalam plastik. Alhamdulillah dah

Perawatan Pusar Adnan

Nah ini yang beda..di Indo pusar udah harus dibersihkan dan higienis pakai alkohol. disini dibiarkan aja selama nggak ada nanah dan bayi nggak rewel. Pernah sampai hilang clip pusarnya. wah mau dipakai lagi juga gtau caranya. Mungkin pas kelepas waktu ganti pampers dan gak sadar,haaa..

Adnan pusarnya lepas pas 10 Hari terhitung lebih cepat daripada azka yang 16 hari. Itu hanya dibasuh saat mandi dan nggak dikasi apa2. Pas sehari mau lepas kyknya ada lendir dari pusarnya. sempet kawatir juga kenapa2 tapi Alhamdulillah besoknya pusernya lepas dan nggak pake rewel si adnan. emaknya aja yang masih kena masitis pas itu.

Puting Luka Menyusui

Aw awa..sakit pas menyusui. Semua ibu pasti mengalami ini awal2 menyusui sakit sampai teriak2 kadang sampai nangis. kalau adnan sampai putingku luka jadi pas awal pelekatan udah pingin nendang meja aja rasanya.haaaaa...

Tapi tetap semangat menyusui. Penyembuhannya kalau satu PD yang luka, berikan asi PD lain. Selain itu bisa juga dikasi krim buat nipple cracking atau kalau saya pakai coconut oil dan keduanya aman nggak perlu dibersihkan pada saat mau menyusui.

2 hari dioleskan terus di puting yang luka alhamdulillah mengering dan bisa menyusui dengan tenang lagi.so...tetap semnagat menyusui ya buibu..

Masitis Menyusui

2 minggu setelah adnan lahir, menyusui masih terasa sakit. sama aja ternyata anak pertama dan kedua pas menyusui masih sakit, Puncaknya pas tiba2 badan kerasa menggigil panas dingin dan pas itu suami lagi nggak dirumah pula. Rasanya mau pingsan aja dah. Alhamdulillah ada si kakak yang bersedia ambilkan obat parcetamol dan jaket biar g kedinginan dan si adek tertidur pulas pas itu. langsung kontak suami minta cepat balik dan bikinin teh biar anget. Telpon temen yang punya anak kecil dan dia bilang dikompres air hangat dan dingin. Langsung dah kompres dan pompa.

Alhamdulillah besoknya bidan dateng dan langsung lihat kondisi. Karena ada benjolan dan untungnya masih agak lembek dan nggak keras, masih bisa diobati pakai antibiotik dan nggak perlu ke rumah sakit. Kalau yang parah mesti ke rumah sakit buat ngeluarkan sisa susu yang membuat benjolan. selama masih bisa dipompa tetap dipompa dan dikosongkan payudaranya. 

hemhh langsung berfikir apa karena dipompa pas adnan masih di rs setiap 2 jam sekali dan memang dapetnya banyak juga 40ml sampai 80ml lama2 dan pas PD kenceng juga tetep dipompa walau adnan nggak minum sebanyak itu juga.

Jadi penanganan pas aq kena masitis :

1.  Minum antibiotik resep midwife 1 hari 4x per 6 jam sekali harus habis

2. Dikompres PD pas menyusui pakai kompres dingin dan setelah menyusui kompres hangat. 

3. Pas PD Kencang bisa pakai kubis untuk mengurangi produksi payudara tapi hanya 10 menit saja jangan lama2 nanti bisa berkurang drastis

4. Marmet alias perah tangan manual jangan dipompa pas PD penuh karena kl pompa bakal merangsang ASI produksinya lebih banyak. 

5 Tetap menyusui bayi di PD yang kena masitis walau rasanya nyeri2 gimana gitu tetep disusukan 

6. Ganti posisi menyusui kalau awal sambil tiduran, sekarang sambil duduk dan posisikan bayi menghisap pas ditempat adanya benjolan biar cepat hilang benjolannya

Alhamdulillah 3 hari udah enakan dan bidan tetap pantau setiap hari.Baik bener ni bidan ya.hee..