Jessica wrote back,
2. Did you have Pitocin in this labor? Were you offered it? No, I did not want Pitocin going into it. I was offered it at the very end, only when I was on my last hour of labor when he was “stalled” at the 9.5+cm). At that point when I thought about having to go through another several hours of the pain (pushing etc.) I couldn’t even imagine so I opted for the C-Section out of sheer exhaustion. [I asked about Pitocin to get a sense of the interventions tried before the cesarean. Adding Pitocin when there is a delay is a common practice, and Jessica was offered it. Pitocin causes stronger contractions if contractions are not considered strong enough to keep a force on the cervix to pull it open like pulling on a t-shirt. Going for stronger contractions isn’t the only way to encourage progress, as you see from the many techniques on SpinningBabies.com. Its a step that Jessica chose to decline. If the baby is stuck against a bone, Pitocin may not help, the baby has to rotate off the bone, flex, or mould to get past a bony protrusion in the pelvis.]
3. How low in your pelvis, if at all, did your baby get? He was (or at least felt) very low. My OB kept telling me at each appointment how low he was. I think I was at a zero station when I stalled. [I always want to know where baby is or was in the pelvis to know more about why baby was stuck. There are two ways a baby may be held back at 0 Station; one is because they face a hip and inside the pelvis a bony protrusion called the ischial spines extends into the birth space and can catch baby’s head, front and back. The other way is if the pelvis is a bit small or the sacrum is brought inwards by a tight muscles/ligaments, which seems to be the case here.]
4. Did you push at all? Whether your body’s own urge or directed by the nurse/doctor? Before they knew I was stalled, the nurse asked me to try and push- but at that point my epidural was SO strong, I couldn’t feel any urge. The first epidural failed and the second one was SO strong, [numbness from the epidural] went up to my boobs. I had no feeling in my legs and or urges to push. [Pushing during (but not between) 3 contractions even before full dilation has sometimes rotated a posterior baby and allowed progress. Push for three (or four) and then stop pushing if rotation doesn’t occur. Don’t continue pushing on a cervix as it will swell or, not often, rip. But a bit of pushing can make the cervix take the role of the pelvic floor to rotate baby sometimes. Its worth a shot. The epidural in this case didn’t help. Could the nurse have gotten more directive? Could the doctor come in at this point and manually rotated the baby with her hand and then let the contractions “labor the baby down” until Jessica had the baby on her perineum and finally then felt a bit of urge to push? Could the epidural have been turned down or off to see if an urge to push came back? All this speculation is besides the point that the low white blood cell count indicated an infection present and took away the time to explore these options.
5. What size head did your baby have? I am not sure! My husband is a 7.75 hat size. He has a large head. I can find out for you when I call my OB. They should have that on record right? [A posterior presentation always makes the head seem larger and fit less easily. A labor stall with a posterior baby with a 12″ head is less optimistic for a future vaginal birth after a cesarean than if the baby had a 14″ head. But as I’ve often said, presentation is more important than size, and this would be true here also.]
Did you sleep during the epidural? Barely- maybe for an hour or so. I did not eat anything.
Induction at 39-40 weeks is common when women have providers who seek induction to reduce complications more common with larger babies. One set of complications and compromises are traded for another set and not statistically significant. Cesaresan rates are higher among labors that are induced.
The birth team didn’t know physiological ways to increase midpelvic and outlet diameters. That’s established. In part 1 of this series, Jessica says her doctor told her if she would have accepted the recommendation of an induction when it was given the day before she wouldn’t have needed the cesarean for an OP baby that didn’t rotate.
Does that seem like blaming the mother for the birth teams’ lack of skills for OP babies?
My reply back:
Your answers tell me much!
Now I feel very very confident an induction would not have prevented a cesarean in this situation.
Yours was just the type of birth that catches both parents and providers unawares – unaware that this is upcoming or what to do once this labor pattern occurs. I even feel negligent for not educating pregnant parents and the birth world adequately. What if your husband and doula knew where to turn?
This sacral situation is not likely to be something you were born with but rather something that developed at some point in your past.
There is basically one technique that I know of for a tucked in sacrum, maybe two, as I have recently learned a new technique in Australia but I don’t know quite yet if it will solve the tucked in sacrum.
- A tight, short sacrotuberous ligament may have been the deciding factor here.
- Perhaps, another lesser factor is a well-developed core strength as a hamper to rotation.
These are “trending” issues with the times and are in no way a woman’s fault. People assume “fitness” is a sensible way to ease in birth and what a shock it is when labor is not easy.
Not just fitness, but myriad twists and turns in the uterine ligaments, sitting positions, even the way we use the toilet instead of squatting, sudden stops or jolts that misalign muscles and ligaments and even the cervix so that baby has a hard time navigating the space. There is ignorance in the birth profession about how the labor pattern and pelvic station reveal the issue. And fewer professionals know what needs to be done for mother and baby to finish such a birth on their own power.
I, myself, am not sure why the sacrotuberous ligament spasms (painlessly) to bring the sacrum deeper in to the pelvis and making the pelvic space smaller.
It may have to do with a fall, with core strength, tight pelvic floor, or something with the neck and jaw or nose and sphenoid…
I am seeking more info on the situation of the super fit woman’s posterior labor dystocia (stuck labor) which has been one of the trickiest to address.
He looks so strong. You both worked so hard! I am so glad you reached out to me. You did the best you could in a tough situation and made sensible decisions given the awareness every one had at the time.
I am quite impressed with how far you got and think that you can surely achieve a vaginal birth and perhaps more easily with some preparation for body balance, lengthening your pelvic floor muscles, and releasing the sacrotuberous ligament from its short, tightness (the key thing here).
Please know that you faced and solved a very challenging labor. The cesarean is an appropriate choice to end suffering for you and your baby. When labor pain crosses the line from challenging to agony, you get to decide to use that intervention wisely, right!?
Your baby got some good labor hormones and gut bacteria which are beneficial. That was only possible because you labored before the cesarean. That is a gift you gave your son to be proud of, a compensation for the struggle. It was for something important, as better gut flora is vitally important to the immune system!
Jessica’s reply again:
Would a forward leaning inversion through 3 contractions have helped reduce pain once the technique was over?
- Give Cook’s Counter pressure a try on the tuberosities, if on hands and knees or the pubic arch if on back, this helps relax the pelvic floor by giving the stretch receptors of the pelvic floor some slack. (They are stretched already and need some slack for 2.5 minutes at a time.)
- Lunges during 3 contractions on each side.
- Dangle through 3-6 contractions.
- Do not squat.
- Rope pull from “McRoberts” position if in bed, or
- Standing while holding a rebozo or sheet over the head. The sheet is knotted and the knot is thrown over the bathroom door which is then closed. The birthing woman’s back is straight and knees are bent. 3-6 contractions. Don’t go down so far as to be in a squat until your nurse can see the baby’s head.
- Try pushing for 3 contractions, then rest through 3 contractions without pushing!
- Do the 3 Sisters and rest again.