The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Attending a Stillbirth

These details are graphic.  There is a possibility that this may help some other midwife, some day.  I know that when I had a  discussion re delivery of IUFDs with one of the young midwives at my hospital, she was very, very grateful. She was facing her first birth of an IUFD, and  had no idea that there would be anything different in the mechanisms.  As painful as it is for me to relive this birth, I hope it might help someone.

The baby had probably been dead 4 days, and it was a 3 day induction in a woman w/ previous c/s,  so the intracranial contents had liquified, and the sutures no longer held the head solidly together. To my horror, the head just sort of elongated out and then gravity directed it to the floor.  This, to my mind, was much too horrifying for the woman and her husband to see, so I "caught" the head on  my forearm.  I just supported it  on the inside of my arm, and waited for something else to happen.

What happened is that the pressure of the contractions caused the head to get longer and longer and longer...like a water balloon being squeezed through a small opening.  Since the head was resting on my right forearm, I used my left arm to see if I could put any downward pressure on the head.  This only served to begin a separation of the neck muscles. So I continued to wait.

Unfortunately, the shoulder was held up above the pubic bone.  I think live babies have enough tone that the bisacromial diameter will naturally be in flexion, and things like suprapubic pressure, manual rotation etc will promote this flexion. This baby did not have this. With the shoulder held up, each contraction caused extension of the bisacromial diameter (think of trying to touch your elbows together behind your back, and visualize what this does to the strap muscles of your neck).

With my left hand, I tried to flex the bisacromial diameter w/ anterior pressure behind the shoulder, while I continued to support the ever-elongating head on my right forearm.  I couldn't do it. Because things were so elongated, I couldn't get the axilla either anterior or posterior, and I couldn't find the posterior arm with my left hand. Each time I attempted to deliver the baby, more of the neck muscles tore. I was truly afraid I would pull the head off.

I continued to wait. By this time, the extremely elongated head stretched from my elbow to my wrist, and I continued to hold my arm horizontally to support the head.  We were now probably 10-15 minutes since the birth of the head. With each additional contraction, I became increasingly worried that the head would explode. Is this even possible?  I don't know. With each contraction, the head came out farther, and the neck muscles separated more and more and more, and the head started to separate more and more and more.  The mom was concentrating on the birth, the husband was standing at my side (how he could bear witness in this way still amazes me).  I wish there had been another attendant in the room to assist me.

Every time I tried to get the baby out, the head separated more and more.  Every time I waited, the head separated more and more.

I finally slid the arm that was supporting the head into the uterus, and slid my anterior hand/arm into the uterus and sort of grabbed whatever was there and pulled as hard as I could, and got the body out more or less intact.

I stayed and prepared the body for the parents to see and hold.  We all cried. When I finally left the birth room, I went into the midwife call room and screamed and screamed and screamed and cried because I had nearly taken the head off this child.