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Compound presentation

Compound presentation


A 'compound presentation' is the medical term when the baby's hand and arm (or on rare occasions a foot) comes down to lie alongside the baby's head during the pushing phase so that they are born at the same time. (If your baby liked to suck their thumb in the uterus, then they may keep this habit up until they are born and probably after!)

The main concern with this is that more of the baby will need to be born at the same time, therefore, the potential for the woman to tear is greater. On rare occasions, the baby's arm or hand can be bruised or injured (either from the pressure of the woman's bony pelvis as the hand came down the birth canal and / or the handling of the baby's arm by the caregiver during the birth).

If your caregiver sees fingers presenting with the baby's emerging head, the most common approach is to let the hand stay there, but to hold it in place, and to control the birth of the arm and elbow with the head, so that the elbow does not 'flick out' when released. Some caregivers may try to hold the hand back (or it has been known for a caregiver to gently pinch the baby's hand in an attempt to make the baby pull their hand back!)

Usually the caregiver will guide the baby's head and gently grasp the hand, extending their whole arm out, so that the baby's shoulders can be born. After this, the rest of the baby's body will normally follow. This technique is easier if the birth is slow and controlled, but may be more difficult to achieve if the baby is born rapidly.

Fetal distress

'Fetal distress' is the medical term given to when the baby displays signs that they may not be coping before they are born. In the 2nd stage of the labour this can be due to a wide range of reasons and detected by:

  • An unusually low heart rate detected by your caregiver listening in between the contractions, or
  • An abnormal pattern of the heart rate detected with continuous monitoring.And / or
  • Meconium staining of the amniotic fluid, where the baby has opened their bowels inside the uterus, making the water look green or brownish in colour.

It is normal for the baby's heart rate to drop periodically during the pushing phase of the labour. This is because the baby's head becomes compressed within the vagina, and the baby's natural reaction is to have a brief lowering of their heart rate, as low as 80 to 100 beats per minute during a contraction. As long as the heart rate recovers back to the normal rate after the contraction eases off, then it is not regarded as a problem. This is why your caregiver will usually listen to the baby's heart rate as soon as the contraction has finished, as well as more often during the 2nd stage, at least after every 2nd or 3rd contraction (or every 5-10 minutes). Sometimes it will be after every contraction, if there is concern.

If the baby's heart rate remains low after the contraction has stopped, then this can be a sign of fetal distress or the baby trying to cope with reduced oxygen via the cord or placenta. Sometimes this is the end result of the woman using forceful, prolonged pushing, or holding her breath for long periods (therefore change your pushing pattern), or the woman lying on her back compressing the large blood vessel or Vena Cava (so change position, or move onto your side). Otherwise the placenta may not be functioning efficiently, due to other health problems such as high blood pressure or the baby being overdue.

If the baby's heart rate is low for prolonged periods (over a minute) and consistent with each contraction, then these could be signs that the baby is distressed, especially if there is meconium present in the amniotic fluid. Babies who are indicating signs of fetal distress at this point will need to be monitored closely. If your caregiver believes that the fetal distress is serious enough, then they may not wish to wait for the baby to be born with you just pushing. Usually an assisted delivery of the baby will be needed with forceps or a ventouse.

If you are giving birth at home or in a birth centre, you would need to transfer to the delivery suite for this to be facilitated. Usually the caregiver will suggest this move before the baby becomes too distressed (or just in case an assisted delivery will be needed).

You may wish to read more in fetal distress.


Last revised: Thursday, 29 November 2012

This article contains general information only and is not intended to replace advice from a qualified health professional.

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