Wednesday, February 8, 2012

The Turtle Sign

We found an incredible spot to call home in the Caribbean.  It's a cottage that is actually built into the ruins of a Danish school house from the 1840s.  To top it off, we inherited some neighbors when we moved in - 8 Red Footed Tortoises who live in the rest of the ruins which is essentially our backyard.
They are fun to watch and feed and I think they have become quite fond of us too since they associate us with food.

But this post is not about these turtles.  I wish I was talking about a cute turtle sign, a picture of a turtle swimming or eating.  I'm talking about something that happens in childbirth.  No recipes today, just a midwife talkin' birth.

Birth is messy.  And rarely textbook.

After being a midwife for 5 years, the order of things gets easier to read but it's still hard to know when the birthing goddesses will throw you a curve ball.  These curve balls can be nice, like a first time mom coming in at 8 or 9 centimeters, or they can be wicked, like the dreaded shoulder dystocia.

In a shoulder dystocia, the baby's head comes out - but sometimes not all the way, maybe the chin is still waiting there - and then immediately does something called the turtle sign.  The turtle sign is where the head sinks back in close to the perineum, like a turtle slinking back into it's shell.
 After the head emerges, this is usually where the rest of the baby easily slips out.  With a dystocia, something is holding the baby up and it typically is the anterior shoulder that's not coming down.  Then we have a set of maneuvers and positions we do until we get the baby out.  It may seem chaotic to a women or family involved (and maybe sometimes it is) but midwives, doctors, and nurses practice for these emergencies.

Some of these dystocias are mild and some are severe.  None are fun.   They all leave you with a sigh of relief when the baby comes out and cries quickly and vigorously, waving his or her arms around wildly.  One of the hardest thing about obstetric emergencies is that they are sometimes unpredictable, so while you have to always be prepared, as a midwife you also need to keep in mind that most of the time birth is normal and healthy.

I had the amazing opportunity to work with a home birth midwife as part of my clinicals for midwifery school.  So the first 8 babies I delivered were all at the women's homes.  In fact the first baby I delivered was on a water bed, which is not an easy feat.  I always remember this midwife talking about the process of becoming a more seasoned midwife.  As a newbie all you can see during a birth is the baby's head, and can focus on nothing else.  Then as you get more experienced you can start focusing on other things - like the fact that thereis a women there, her face, her feelings, the baby's heart rate, the feel of the room.

This applies to emergencies as well.  With your first shoulder dystocia, your inner monologue is going something like this, " Oh my god, oh my god, oh my god." After awhile that may be going on in the background after 45 seconds or so, but I've drowned it out with my steps and the faith that most of these babies will come out unharmed.

My scope of attention has expanded since I was a new midwife, not to say I'm an expert.  I still and always will have much to learn from others - both colleagues and especially women.  But I can do the maneuvers, call out instructions, and hear what's going on around me.

Oh and breathe too - that's important.

For my days off I will stick to these turtle signs  - signs of impending cuteness.


  1. I stumbled across your beautiful blog whilst researching for my art practice and I'm so pleased I did.

    My artwork at the moment would you believe it is about combining pregnancy, childbirth and motherhood with baking, trying to see them in a similar light to understand the relationship they have one another. This is all done through photography and fictional writing.

    Anyway, your blog fascinated me for obvious reasons linked with what I've said above, but also you have a wonderful style and I love the merging of midwifery with cooking and baking. I really hope you return to doing more of it as I'd love to know more about your move to the Carribean. :)

    Jasmine, from the UK :) x

    1. Jasmine - Thank you so much for your thoughtful and encouraging post. I have been doing all the things my blog is about, baking and midwifery, but not blogging - although I do plan to pick back up where I left off. Your work sounds wonderful - I'd love to learn more about it - do you have a website?
      Best - Amy/Baking Midwife