if I didn’t dilate, am I doomed to failure the next time too? December 5, 2009Posted by guinever in : birth, labor, pregnancy , comments closed
I get a lot of questions on my website from women wondering about induction. This comment from a reader is an all too familiar scenario. Her induction eventually led to a cesarean birth. She writes,
Hello. I was induced on my due date with my first baby. I was only at 1 cm, had no contractions, nor had my water broken. After I was induced, I was in labor for about 19 hrs. My baby’s heart rate kept dropping because the contractions were putting too much stress, so I ended up with a c-section. I had only reached 2 1/2 cm of dilation at that point. I do NOT want another c-section. MY husband and I want to try for baby number 2. I want to know what my chances are of not dilating fast enough before the baby goes into distress again. Am i doomed with bad luck in not being able to dilate? Please help me understand this!
I’m so sorry that this happened and that you feel that your body failed you. (((hugs))) You are a victim of the current obstetrical system that is quick to induce when it’s not necessary and when women are not ready for labor. Your next pregnancy is not doomed and you will dilate and you can have a vaginal birth. Make sure to choose a birth team who will “allow a trial of labor” and attend vaginal births after cesarean–VBAC– or better yet, plan a homebirth!
Unfortunately, situations like this happen everyday in labor halls. You were induced on your due date. The due date is not a magical day when the baby needs to be born by. The average length of first pregnancies is over 41 weeks if allowed to wait for labor to start on its own.Your body simply wasn’t ready for labor and the induction didn’t work. You were probably diagnosed with failure to progress. It’s as simple as that. Not every baby can handle the stress of a lengthy pitocin induction and will go into distress, necessitating a cesarean.
For next time, you can figure out if an induction is likely to be successful by finding out your bishop score or you can always just say no to induction. One of the things you can do to avoid a repeat cesearan is to prepare for a natural birth.
To answer the question, am I doomed to failure the next time if I didn’t dilate with my first pregnancy, the answer is no. A resounding no. Each pregnancy and labor are different.
birthing with polyhydrominos: a birth story March 21, 2008Posted by guinever in : birth, birth stories, birth story, home birth, midwifery, pregnancy , comments closed
This birth story is from Deb, a certified Bradley® teacher and doula.
I’ll do my best to recount our birth day without making it sound too bad. I wrote this a week after our birth, and even then, I could appreciate what we did and the choices we made that day, but it seems that with every birth there is something that I wonder if we could have done differently. I think that’s the way of things, though!
The midwife graciously said it will just make us better Bradley teachers. LOL I will tell you that I am a case straight out of Variations and Unexpected Situations…. not your normal birth.
knowing her options and trusting her birth team
I REALLY hope for those of you reading this and are expecting right now, that my birth story won’t scare you. This was one of those “couldn’t see it coming but you deal with it anyway” situations and I’m glad we had the chance to work through it. I think it comes down to knowing your options still and trusting your team. I felt like we always had a say in what happened…no one pushed anything on us. The only time I felt out of control was when it was ME doing it to myself! We still managed to have a vaginal birth without compromising anyone’s health. And for that I’m very grateful.
Deb’s obstetrical history
I have had polyhydrominos which is excessive amniotic fluid levels (normal levels at term are 5-25cm; my highest level has measured at 41cm. Basically, I was a whale.). I’ve been tested numerous times, because sometimes extra fluid is a result of an anomaly in the baby (such as problems swallowing or peeing in utero), but all babies have been normal. Other times extra fluid is a result of gestational diabetes, but that has been ruled out. So the docs have decided that it’s just the way I “am” during pregnancy. The down side to it is that with the extra fluid, there is no need for the baby to settle into a head down position, and for my last two babies before this birth, they have flipped back and forth between breech and head down up until birth, necessitating an external version (where the doc manually turns the baby from the outside). With this pregnancy, my fluid levels were staying sort of low (on the high end of normal, which is low for me!) and although she was both vertex and breech at times, she seemed to be settling more head down than not.
I was so hopeful that for once, I would be able to go into labor spontaneously and show up at the hospital in labor instead of for an induction. At 35 weeks, however, my visit showed that my fluid had spiked and was measuring a few weeks ahead, so they ordered an ultrasound. BAD IDEA. They did an u/s at 36 weeks and estimated the baby’s weight at 8lbs 13oz with extra fluid (at that visit my belly was measuring 44 weeks. Again, think of a whale).
They immediately went into panic mode saying that if we left the baby alone, she’d be over 10lbs at term and there would be no way they could turn her if she were breech. After a heart-wrenching week of trying to decide what was best, we decided to do an induction because we could be sure that she would be head down and we could avoid a c-section. I fully realize that others in my position would have refused the induction, thinking that if they just waited it out, the baby would flip to vertex, be in a good position, and labor could progress on its own. But with me and my past history, at this point it wasn’t only about as little intervention as possible, but my birth plan was basically one sentence:
We will do whatever is necessary to avoid a surgical birth.
planning an induction
We had decided that we were going to do the induction on Monday. As of the previous Thursday, I was just about 3cm and Chloe was head down and in a good -2 station. Things looked great for an induction that would hopefully go by “our rules”: the plan was to leak the bag of waters slowly to allow her head to settle even further in the pelvis. Then I’d just need a hep-lock and could call the shots in terms of induction, whether it be walking, lollipopping, or pitocin if we so chose. I was very optimistic that finally we have a chance to do this.
On Sunday, I was a little concerned because it felt like the baby had flipped back to breech again. My anxiety probably constricted all my pelvic muscles and wouldn’t allow her to turn if she’d wanted to! On top of that, I just couldn’t be sure of the baby parts I was feeling so I was pretty much just obsessing.Throughout the weekend, too, I’d had a few sessions of hours of contractions, some strong enough to make me wonder if labor were starting. The last set came early Monday morning before the induction, starting around 4am. At first I thought
This is great; I’m going into labor on my own!
But then Todd woke up and grumbled “Do you know how the baby is lying?” and my ignorant bliss left quickly. I couldn’t tell, but I just had a feeling that she wasn’t head down. Although earlier in our late-pregnancy saga, our midwife had warned us that the doctor wouldn’t even try to do an external version if I came into the hospital in labor, she had just last week said that she managed to get him to agree to at least try, as long as I wasn’t in transition or anything. So I was hopeful on that front that even if things were happening, we’d at least still have a shot to try a vaginal birth.
getting the heplock
We arrived at the hospital shortly after 8am and did the usual admitting stuff. The first “event” of the day was trying to get my hep-lock put in. This is hands down my least favorite part of labor. There were 4 nurses and it took all 4 of them to get a line going. My veins just run and hide when they hear the word hep-lock! Seriously, all the relaxation techniques are put to use for getting a stupid line run in my arm. So the first try was a nurse and a student nurse. I *should* have respectfully asked her to defer to a professional, just because I didn’t want to get into the hour-long saga of getting it done. BUT I didn’t. Dumb. She almost got it in and then the vein blew.
So my midwife came in and I asked her for a shot of lidocaine in my other arm, which she was happy to do. The other nurses, however, including one who kept calling me “Bradley lady”, was heckling me about getting pain meds for an IV. I had no problem with that–I know my own weakness! My midwife, who is usually very efficient at the whole IV thing, promptly blew out my other good vein. So a discussion amongst 4 nurses ensued as to where they were going to get this line in and finally the “Bradley heckler” got it but she made my midwife do the other lidocaine shot. OK, so that was stress #1 over for the day.
I was on the monitor for a while and my midwife said it looked like I had a labor pattern. I could tell I was having contractions, but they were a lot milder than the ones I’d woken up with earlier that morning. I told her that I was worried about the baby’s position and when we did an ultrasound, sure enough, that little stinker had gone back to being head up. Between the three of us, there was a collective “CRAP”. Not what we were all hoping for! My midwife checked me and slyly said “I may have to fib to Dr. G about your dilation.” He was probably not on board with trying a version if I were past 5cm. “Officially” I was 2cm (I really don’t know what I was, but at this point it didn’t matter). She went out to call Dr. G.
doing an external version
The next step was to administer a medication that would relax my uterus (I was still having contractions, but although they were regular, they weren’t terribly strong). I was already frustrated at this point, because I knew the med would stop the natural contractions I was having and would take some time to wear off in terms of getting things going again. While we waited for Dr. G. to get to the hospital, my midwife and Todd almost turned the baby themselves. It was rather humorous, but also sort of a relief, because it looked like she would turn just fine. We were right; the doc showed up, did his own assessment, slathered ultrasound gel on my belly and flipped her lickety split.
He wasn’t able to maneuver her very far down into my pelvis, though, so they were concerned again about cord prolapse if the water broke. We decided to try a little pit to counteract the terbutaline shot (the relaxer…do you see the craziness in that!?!?) and once my uterus was contracting again go back to trying to leak the bag of waters to help her slowly come down into the pelvis. They started the pit out at the lowest level and it didn’t take long before I was having at least some contractions again. I actually feel like this was when I was either going to go into labor on my own or very nearly, so the induction part of the whole day didn’t bother me too too much). Around noon-ish, I was checked again and I was 4-5cm (who knows if I had been there since we had arrived–I never asked her!) and it seemed like an OK time to leak the bag. Here’s where the biggest mistake of the day happened, in my opinion.
it was supposed to be a slow leak
Dr. C. was on call and she was the one to do the leaking. She doesn’t know me from Adam and frankly didn’t care a whit about whether she broke it or leaked it. (This is my realization upon later reflection, of course). I’m still not sure why my midwife couldn’t do it, but she didn’t do it last time with Andrew’s birth, so maybe it’s a protocol thing. Imagine the scene: Dr. C, the midwife, and Todd are all flanking me for this procedure. She goes in, we all expect a leak, but instead she busts it totally open. All three of them jumped back with a gasp. I only heard the sound of the biggest dam breaking and water absolutely pouring out. And of course relief on my part, at least physically. Dr. C. was soaked, which was my only recourse. After my initial feeling of “wow, that feels better!” we immediately jumped into the concern about the cord…remember that the baby’s head was very high still.
But Dr. C, her work done, flitted off to the next train wreck. I’m really not very upset with her, but just wish that she could have been a little more thoughtful to the situation or that Dr. B. , who at least was my ally in this situation, had been the one at the hospital. But seeing as how this day was going, it was par for the course.
My midwife did an immediate check just to feel for head parts (and hopefully not other parts). There was no cord, but she did feel something odd… She was mumbling to herself and I didn’t really pay attention too much at that point, but Todd did. When he pressed her, she just answered like she was trying to figure out *what* she’d felt. Not a cord, though. (did we have an alien child? LOL) My contractions picked up a bit, but still were not demanding my attention. Really, they were just there…. The pit had been turned up a bit but I’m not sure of the numbers (I should have had Todd chronicle every increase, but just now thought of that!).
My midwife came back and checked again (how’s that for keeping exams to a minimum?!?! what are we up to, something like 27 by this point!??!) and discerned that Chloe had her hand on top of her head. Evidently when the water broke she moved down, along with her hand. It was almost on top of her head. This is not a *huge* complication; with my 3rd birth the baby was born with his hand up next to his face. It slowed down the pushing stage and caused me to tear a little, but nothing overly complicated. My midwife assured me that they don’t do c-sections for hands, but there was that little voice in the back of our heads that cautioned us about a big baby.
We all remembered our former midwife’s claim that I had a 10-lb capacity pelvis and went confidently with that thought! She did ask that I stay in bed on my hands and knees for a bit to see if maybe the situation could resolve itself. At this point, we didn’t want her to descend any further because then her arm could get into a place where it was stuck. I was on board with that, so I just tried to relax for a bit and not let my mind totally freak out. I have to say that although I wasn’t overwhelmed, I was not dealing with everything very well.
I really had wanted to do this without all the interventions and STUFF, and I was frustrated at feeling so helpless even at this point. My mental preparedness was not that great, but thankfully I have Todd, who is just so good at reminding me of all the things I need to know. I don’t know what I would do without him.
Are you all still with me?
Sometime after 2pm, I was checked again because of Miss Chloe’s hand/arm situation. This was my midwife’s day off, mind you, and she stayed with us pretty much the whole time. She took a nap at one point–maybe when she suggested I stay in bed–but I would say that she was in the room about 80% of the day. I was so thankful. She was really fighting for our right to keep laboring when anyone else would have called it quits before now. The report from the latest exam was not good: Chloe’s entire arm had gotten in front of her head and was actually out past my cervix into the birth canal. (Don’t think the irony of having joked about this a lot in class was lost on me!)
the baby grabbed the midwife’s finger
When she did the exam, the baby grabbed her finger. Oh my word. NOW we were in a true complication situation. She sat down next to us and laid it out. It was not something that was going to resolve itself, but she thought she could try to maneuver her arm back in where it belonged and hopefully the baby would pull it back down. She thought it could work mostly because Chloe had that arm around her head and on the opposite side of her face (I can’t remember which was the offending arm, but if it was her right, then it was up around the left side of her face). Usually, she told us, the protocol for this procedure is to get an epidural and then try, because, as she said
I will have to put my whole hand in there to try and fix it.
Now I am usually OK with labor…it’s hard work and I’d call it painful at times, but it’s usually something I can work through myself without pain meds. At that point, however, whenever someone uses the two words “whole hand” together when she’s referring to your birth canal… I was very persuaded. I felt totally defeated, actually. I’m going to have to get an epidural!?! Still, it seemed like a good use for one if the procedure was going to be all that.
But then I thought to ask how long it would take… if it worked, would it be quick? or would she take 10 minutes to get it done. She said that if it was going to work, it wouldn’t be more than a few minutes. After talking with Todd, and recalling the strength of two recent students who endured other docs manually breaking up cervical scar tissue, I asked her if we could try it without, but if it was too much, if we could stop and do an epidural. She agreed that it was worth a try.
It seemed like an eternity before we actually got on with it. When the midwife was putting on her glove (which she stretched to her elbow…I should have fainted right there!) So she started and Todd held my hand and tried to be encouraging, along with the nurse. She was right; it did not take very long, but it was probably worse than any other pain I’ve ever felt. I only kept on because when it was about to be too much, she said “OK, I think I got it.” Then she had me in bed on my side for a bit to see what happened: would her hand creep back up around her head? Would she pull it back where it belonged? I was rather traumatized by the events of the last hour, so I was happy to just recover. It was probably at least an hour or so before she checked and we got the good report
“I don’t feel any digits.”
At this point, we thought getting up and using the birth ball would be good. I was 6-7cm by this point, but obviously not working or in serious labor. I was just chatting, and I was ready to get on with it, but I think it was me that was keeping it from moving. My pitocin was pretty high at this point, and my midwife made the call to keep it on. I did not argue, mostly because it wasn’t even affecting me. I think at that point we were at 20 units (can never remember what units, though!).
If we had the all-clear of digits check around 3ish, then it was a good two hours later, maybe more, when I was still just putzing around. My midwife came in and gave me the “we’ve stalled here for a while, and that’s very unusual for a para 6.” I knew it and was worried that it was me that was my mental state that was causing the plateau. I had a little breakdown with her and she gently offered an epidural again, citing maybe the arm thing we did earlier was holding things up….but she used the phrase “cruising towards a section” here and that got me all in a tizzy.
getting a pep talk from her husband
I asked to go to the bathroom and Todd was in there with me and I had my all-out breakdown. Was I not ready for 6 children? Was I holding this up because I hadn’t mentally prepared myself for another baby? Again, Todd is so wonderful at giving me perspective, and reassured me that we were doing just fine, that we had only started several hours earlier, and that I was making progress. I didn’t have to take an epidural if I didn’t want one (I really didn’t want to, and mostly because I didn’t want to have to deal with the after effects. But I was pretty close to caving by this time)
Todd’s pep talk gave me a renewed confidence and perseverance and when we left the bathroom, the midwife suggested that I lay on my left side with the bed flat for a while. Whenever she did an exam that day, if I was totally flat my cervix seemed to magically open more than if I’d been tilted or the bed was up even a bit. So hey, worth a try. She also had my pit up to 26 by that point. (I HATE the number 26, by the way)
labor rituals for transition
I don’t know if it was the pit increase or the position change or my mental adjustment, but suddenly we changed gears. I would say it was sometime after 5 o’clock that all this happened. My contractions started to get fast, furious, and just plain awful. I remember how much pit contractions hurt. My ritual was that Todd HAD to lightly rub my shoulder on top of the hospital gown when each contraction started and had to continue until it was gone. NO questions asked, no slouching. I couldn’t deal with the strength of the contractions if he didn’t do that. I always find that so funny, but even thinking about it at the time, I still needed it and he got snapped at if God forbid he missed the start of a contraction.
By now I didn’t care who was in the room, who talked, or who was even breathing the contractions were so strong. I do remember my mantra became “I hate pitocin, I hate pitocin! My midwife and her stupid pitocin” and when she came in I said “It’s too much; can’t you turn it down?” to which she answered
These are the contractions you need to get your baby out.
It sounds so insensitive (and I remember really not liking her right then, but I respond to that kind of matter-of-factness, I guess.
It was maybe an hour of that before I was pushing without trying to, but when I got checked I was 9ish. She asked me to push through a contraction and she was convinced that I could push it away, so I did. Even after 6 babies I still have trouble getting into the groove of pushing and this time was no exception. That probably extended my time a bit, but it didn’t take long. Todd managed to call his sister and mom back in the room (I knew they weren’t there, but wasn’t concerned about them missing it. I just wanted to be done) and they arrived less than 10 minutes before the baby was born. I remember the midwife asking to have another nurse come in when Chloe started to crown because we had some concern about her size and shoulders.
She announced that if she had back up there, nothing usually happened. I asked her if she thought we should lower the bed and she laughed about that later, saying “When the baby is crowning, most moms are panting, breathing, or screaming ‘get it out!’ but you were asking me if we should lower the bed!” Oh well…it was a trick I remembered seeing from another big baby birth.
Todd was next my midwife, ready to catch. Chloe was born at 6:37pm with no dystocia and no problems. It was wonderful.
The nursery nurse jumped in at 6:38 and asked to take her to do the newborn stuff (remember that her shift was ending at 7 and she wanted to get her job done so she could leave). My midwife chewed her out and said,
She has worked really hard for this baby and she’s going to hold it for a while!
She deliberately didn’t cut the cord till way after it had stopped pulsing. We both really appreciated that. The nurse got huffy and actually left! She didn’t ever come back, in fact, and Todd and my midwife did the newborn stuff themselves. I didn’t have any stitches, so that part has been great. She weighed 8lbs 13oz and was 22 in long. I was a little disappointed; I was hoping for at least 9lb!! But she was beautiful, has a very unique shade of blond hair that is really long in the back (she has male pattern baldness in the front and top) and looks JUST like her brothers and sister. It is quite amazing to see the same face in just a slightly different model.
processing the birth
So now, writing about this birth a week later, there are things I would change, but all in all, I think we took a possibly bad scenario and worked with it to keep mom and baby healthy. The next day my midwife said in all her OB years, she had never seen a complication like that and the nurses in L&D were still talking about us that we hadn’t taken the epidural. I was so glad we at least tried it without, even if we would have had to end up with one. I know the recovery without metabolizing the epidural is so much easier. Without that and without stitches, I was amazed at how I felt. I’m still tired and I was sore but nothing like past births. At least THAT part of it was smooth!
We owe so much to my midwife. She said she’d talked to Dr. G about what he would have done if it had been his patient and an arm and he replied (she said they call him Eeyore and if you use his voice, it makes it funnier!) “I probably would have tried it, but I’m not very good at it….” At least he would have tried; I’m convinced Dr. C. would have just hauled us back to the OR. We feel so indebted to her that we gave Chloe her middle name, Rose.