See also: TENS for Prodromal or Inco-ordinate Contractions
See also: Comfort Measures For
Labor, especially Staying Warm -
Hot Packs and Staying Cool -
Cold Packs
Conclusions: In this study, parturients progressing most slowly
after being admitted for labor appear to have LDH isoenzyme
profiles that are less equipped to contend with
contraction-related anaerobic conditions compared to those
parturients progressing most rapidly after admittance. Although
serum LDH profile assessments cannot prospectively benefit
clinicians in their admission decision-making, the findings
presented in this study suggest that watchful patience rather
than early intervention seems prudent when there is uncertainty
regarding whether active labor has begun. Such patience may
allow the time needed for important physiological changes within
uterine muscle to more fully manifest.
Antonio Ragusa, MD; Mona Mansur, MD; Alberto Zanini, MD; Massimo Musicco, MD, PhD; Lilia Maccario, MD; Giovanni Borsellino, MD
Accurate diagnosis of the onset of labor remains a problem in
obstetrics. . . . An incomplete understanding of labor may
lead to unnecessarily early intervention.
Management
of Protracted Active Labor With Nipple Stimulation: For
Midwives?
ACOG
Releases Report on Dystocia and Augmentation of Labor by
Genevieve W. Ressel from American Family Physician - March 1, 2004
Vaginal Delivery Possible Even If Active Phase Labor Arrest Exceeds 2 Hours [Medscape registration is free]
Because oxytocin-augmented labor proceeds more slowly than spontaneous labor, 2 hours of active phase labor arrest with at least 200 Montevideo units is not a rigorous enough criterion for cesarean section, US researchers maintain in the October issue of Obstetrics and Gynecology.
Active
phase
labor arrest: revisiting the 2-hour minimum.
Rouse DJ, Owen J, Savage KG, Hauth JC.
Obstet Gynecol. 2001 Oct;98(4):550-4.
Leilah McCracken wrote a response - So Whose Truth Will You Seek
Out? Whose Birth Will You Choose to Give? [Ed: birthlove.com
is not available at this time.]
Did
you know labor is less about your cervix opening and more about
the thickness and contracting power of the uterus moving baby
down and out? READ more about what empowering birth expert
Carla Hartley has to say about this revelatory perspective in
birth physiology!
DeLee (Principles and Practice of Obstetrics) speaks of some odd things now abandoned -- packings, colpeurynters, bougies etc. -- and of other techniques such as amniotomy, ambulation, enemas, and pituitary preparations still used today.
But this was a new one for me - - "a hot water bag to the fundus"; Has anyone ever tried this one?
He also discusses a "trick" we've used on occasion. He describes it better than I could!
"Occasionally in a primipara, the head will be deeply engaged, but the cervix is far back in the hollow of the sacrum and very thin, the membranes are tightly stretched over the head and there are no forewaters . By pulling the cervix gently to the middle of the pelvis, separating the membranes around the lower uterine segment for 2 inches, and pushing up the head a little to allow some liquor amnii to run down and make a pouch, the mechanism of labor is started right and the pains improve at once."
I think this is what is often accomplished when we refer to "massaging the cervix" etc.....
He also says a "hot milk and molasses enema" is "very effective".
Give
bicarbonate to pregnant women to ease delivery - new study
[1/17/18] by Henry Bodkin - Women struggling in labour should be
given bicarbonate of soda to boost their chances of a safe and
natural birth, a study suggests.
Lactate
implicated
in dysfunctional labor
Source: Obstetrics & Gynecology 2004; 103: 718-23
This would explain some of the old "wisdom" about using
pitocin. Sometimes it seems to become less and less
effective, and you need to stop it altogether, take a break, and
then start it up again later.
Possible New Clue to Higher Cesarean Risk in Obese Women
Obese
pregnant
women may have weaker contractions
Explanations for the undeniable and significant difference in the
cesarean rate in obese women can be controversial and
debatable. The real reasons probably lie somewhere in
between all of them. But a recent study published in the
British Journal of Obstetrics and Gynecology adds another possible
explanation to the pool: inadequate uterine contractions,
possibly due to high cholesterol. More research is needed,
the study authors state, to confirm this link, and to determine if
lowered cholesterol might also lower obese women's risk of
cesarean section.
[Summary from ICAN eNews
"Cervical dilation and effacement are produced from vertical
fibers in a relaxed woman. Stress causes horizontal and
vertical fibers to contract, creating non-productive first stage
labor." [Osborne-Sheets, C. Pre-and Perinatal Massage
Therapy. Body Therapy Associates, 1998.]
From a story about "quilling" a woman nearly completely dilated
with strong contractions coming only every 6 or 7 minutes and
little progress: "Quilling" was apparently using a quill as
a tube to deliver cayenne pepper - imagine using a regular
straw. Dip one end of the straw into cayenne pepper, insert
the other end into the woman's nostril and give a big blow.
This will cause sneezing that overcomes the woman's pelvic floor
resistance to allow the baby to descend into position to be
born. [Some might argue that this is interfering with the
normal lull between transition and pushing.]
About 10 years ago I was assisting a 70s era DEM at a home birth
in the hills above Los Angeles. Our client was a primip who
was complete and pushing - and pushing - and pushing. It was
beginning to look like we were going to need to transport for
forceps or vacuum as the contractions were getting weaker and
weaker. The MW asked me if I had any tricks up my sleeve -
all I could remember was that the MW who attended my own home
births had mentioned that cayenne was a uterine stimulant. I
couldn't remember or hadn't learned what dose, what route, etc. -
but we figured that we had nothing left to lose and could always
transport (actually the sr MW had been on the phone once already
to her OB consultant). Dad put a teaspoon of Tabasco (which
is really just aged vinegar tincture of cayenne!) in an ounce of
chicken broth, and mom chugged it down. In 5 minutes we had
stronger contractions and mom proceeded to push the baby out in
about 25 minutes. Oh, and she had tears running down her
face and the clearest sinuses in the world!
Chinese Medicine for Dysfunctional Labor
Geranium is good for uterine inertia and any uterine probs. I've
got some good stories about that. Just rub on lower ab. and lower
back.
when i was in labor with my daughter, jasmine oil massaged into
my feet did WONDERS!!!!! one of the properties of jasmine is to
lift the spirits of the laboring woman, and renew her confidence.
Ina May Gaskin says: Put your hands on both sides of her hips (on
the fat) and shake your hands up and down quickly (moving her fat,
not rubbing her skin) so the fat jiggles. It makes your whole
pelvis relax. Use words like "pudding" "Puddle" or about something
melting.
ENERGIQUE (phone 800-869-8078) is a company in Iowa that makes
different herbal singles/combinations and homeopathic
singles/combinations. I use their "ANXIETY HP" homeopathic
tincture (30x combination of arsenicum, phosphorous, pulsatilla,
lachesis, ignatia, kali carb, cal carb, nat mur). In my
experience, it has worked nearly every time I have used it by
immediately stopping the woman from being hysterical, calming her,
allowing her body to do its work without her tension making it
more difficult. I have felt the energy in the room change
dramatically when she uses it. I am also a fan of WISHGARDEN HERBS
herbal combination "CENTERED MAMA". It contains Valerian, Wild
Lettuce and Lobelia, and works to calm down a hysterical mama very
well in ways that the same herbs singly don't seem to match.
(WISHGARDEN, PO BOX 1304, Boulder, Colorado, 80306).
I second this recommendation! I've seen women having
strong, painful, adrenaline-based contractions for hours with no
progress, and then, after a dose of Centered Mama, they calm down,
we get a progressive labor pattern, and a baby within a few more
hours. I love Centered Mama!
Or you could try a homeopathic muscle relaxer - Formula 303 by
Dee Cee Labrotories, White House, TN 37188
I first learned about Spleen 6 10 years ago when a midwife pressed that point during my own labour. Wow! did it ever work! Within a few minutes of her pressing on the point my contractions (which had plateau-d) moved into high gear and my son was born soon after (and I don't think it was a coincidence).
With my own clients, I've found it has the greatest effect with "high risk" women who are having a very long slow drawn-out labour. It really works to increase contractions. But if I stop using the Spleen 6 point with these women, the contractions usually peter out altogether. I have this intuition that, in these cases, pressing the spleen 6 point is not very helpful because it's forcing the labour (pain with no purpose). My friend who is trained in Chinese healing says you must first understand any underlying problems with the labour before you use spleen 6. So, now I make sure we fix any positional problems (i.e. posterior, transverse, etc.) before I use spleen 6.
By accident, I found that pressing the Spleen 6 point will bring
on a period. So now I make sure I don't really press hard on my
own leg when I'm demonstrating the point in prenatal class!
Try a milk and molasses enema - or try substituting a cup of
peppermint tea.
Well, an old trick here to pick up a sluggish labor is to have mom drink labor tea from both ends (so to speak). You know I'm not terribly impressed with herbs for labor in general, but used this way I think they work "pretty well".
You make up about a quart of strong red raspberry tea, with a few
droppersful of labor enhancer tincture (the common mix -- B&B,
squawvine ,etc.). Add a good slug of honey. Mom takes a cleansing
enema, then a very slow pint of tea PR, and then sips the rest
over the next hour.
I had good success with a shot of cayenne in chicken broth; the
labor shifted back into high gear immediately.
A fully-effaced stenotic cervix is amazing the first time you
feel it! It's almost as if it's not really there. My
labor coach client had a bulging bag behind a stenotic cervix; I
was checking her at home and felt that she was 8 cm with a bulging
bag. Because I didn't want to risk breaking the bag, I
didn't feel around the center at all, thus missing the very thinly
defined os. When we got to the hospital, the nurse also got
8 cm with a bulging bag. It wasn't until the OB came and did
a very thorough check around the edges that he announced it was
fully effaced at 1 cm. Wow! I could feel that bag
bulging under the pressure of the fluid, and it's just amazing to
me to think the cervix was so thin that it felt exactly the same
as membranes.
Stenosis = a scarred sphincter that won't open. i think some
people feel when a q-tip will not go in an os for pap or chlamydia
or whatever then maybe the cx is scarred and stenosed. I have only
seen one os that would not open for a long time, the 17yo
(Deadhead) was in full blown labor contractions and 100% effaced
and I finally called in the OB cuz I was concerned, he finally
squeezed a laminaria in, which also broke her BOW. an hour later
she was complete and pushing.
I've seen one true case of cervical stenosis. This lady was an
attempted VBAC, whose first birth had been attempted in a BC with
an MD who transported only on threat of death. This was back in
the olden days, before the threat of malpractice. She was in rip
roaring labor and that cervix never even began to soften. It felt
like a non-pregnant cervix of a twelve year old. It was some kind
of cervical hypoplasia. Another interesting cervix was a double.
One above the other. She started labor at 2 cm's and the second
one never opened at all. If I hadn't experienced this I wouldn't
believe it, because both were relatively thinned out. Both ended
up sectioned. Both were attempted homebirths. Oh well.
Cervical stenosis can happen from any cervical trauma, and after
menopause from atrophy. Since this lady is pregnant I assume we
are talking about trauma. I've had two women who had some problem
with this after cones or LEEP procedures for severe dysplasia.
Both of them effaced just fine, but didn't even begin to dilate,
so the exam was really weird - it almost felt like I was touching
the baby's head, but it was perfectly smooth, like cervix, just
completely effaced. I couldn't feel where the os even was. Both
times we looked really hard with a speculum, located the os which
was tightly closed, and worked the tip of a small hemostat into
the opening. Then we quickly opened the hemostat, breaking up the
scar tissue which had held it closed. It hurts for a second, but
do it quickly. It's not really any worse than stripping membranes.
Both women went from closed to 6-8 cms within seconds once the
scar was broken, and went on to deliver normally. One has since
had a second child, with no problems.
The Cryo or Leep Procedure often will leave scar tissue which is tough and resilient. It does not mean however it cannot dilate and in fact, what happens often is that the cervix with contractions becomes thinner & thinner & thinner without opening, until someone puts their finger inside and breaks the scar tissue up.
There is usually some bleeding but no long term harm as far as I
am aware. Once a finger goes inside however, it is then -
whoosh - ad the baby comes along pretty quickly thereafter. It can
mean a long drawn out labor and if the woman doesn't know this she
can get very discouraged.
I had opportunity to work with a woman 3 or 4 years ago who had had a cryosurgery on her cervix. She was my preceptor's client.
It remains the weirdest thing I have ever felt. It felt as though she were complete. I could feel fontanelles and sutures clearly..even the hair on the baby's head. But the actual os ( wasn't sure it even was the os) felt like a tiny ring about the size of the hole in notebook paper floating on the surface of the baby's head. With some massage and stripping she dilated just fine. But I have often wondered how much danger is involved in this situation.
If a woman has a cervix that is staying closed, and her labor is
progressing without her cervix and she is effacing like that...how
does that affect the possibility of lower segment rupture if
allowed to continue without progress?
When I was apprenticing, I attended the birth of a G3P1 who had
an uncomplicated SVD with baby no. 1, followed by abnormal PAP and
conization, SAB, and her current pregnancy. For several hours, I
don't remember how long, but not long enough to cause concern, she
was dilated 1-2cm with a paper thin cervix in early labor. When
the course of labor changed, the picture didn't add up. She acted
like she was in transition, yet her cervix remained virtually
unchanged. Over the next few hours, after all the usual position
changes, shower, and EPO, nothing changed. We began to wonder if
the conization had left her with some cervical adhesions that were
holding the cervix up. To make a long story short, my supervising
midwife recommended manual dilation. I stretched the cervix just
to see how pliable it was and it began to dilate!!! As long as I
manually stretched it, it dilated.
My experience with these stenotic cervixes (which can be a result
of conization, previous instrumentation of any type, hysteroscopy,
TABs, etc.) is that they remain paper thin and anywhere from a
dimple to 2 cm. and feel very rigid after many hours of painful
labor. I deal with this by forcing one, and then two, fingers into
the os. The stenotic scar tissue will disintegrate under this type
of pressure and the cervix will immediately go to 3 cm. It's a
remarkable and dramatic change. After this, progress is usually
normal and no further manipulation or intervention is needed. I've
encountered this situation many, many times. This problem does not
recur in future births unless something happens to scar the cervix
shut once again, but it's rare in multips.
Management
of
postconization cervical stenosis by laser vaporization.
Luesley DM, Williams DR, Gee H, Chan KK, Jordan JA
Obstet Gynecol 1986 Jan;67(1):126-128
In 18 patients with symptomatic cervical stenosis after
conization, laser vaporization of the stenotic segment was
performed. Total relief of symptoms was achieved in 12 patients
and partial relief in four. In seven cases there was no evidence
of stenosis at follow-up, and in a further nine cases the degree
of stenosis was less. In seven cases it was possible to visualize
the squamocolumnar junction at follow-up. This had not been
possible in any cases before the procedure. Vaporization using the
carbon dioxide laser provides a useful conservative management
technique for ostconization stenosis.
It is not unusual to find hard spots on the cervix during
examination of a woman in labor. If the woman does not have
condylomas, most often what you are feeling are small cervical
scars from previous births or gynecological procedures. The use of
instruments for dilating the cervix or delivering the baby often
causes small tears to occur, as does pushing a baby out
prematurely (before complete dilation). These adhesions most often
will break down during the active phase of labor. If you feel they
are causing a lack of progress (the woman remains at 5-6 cm for
over an hour), you might consider simply pressing the adhesion
against the presenting part during a contraction. You will feel
the adhesion break up under your finger. This causes no pain and
readily resolves the problem. There may be a spot of blood as this
is done, but this is of no concern. The labor will usually
progress rapidly after the adhesion is gone.
There's a type of cervix that stretches amazingly under your
fingers, even with a weak or irregular labor pattern.
Sometimes the labor stalls out altogether. Have any of you come
across cervixes of this type before? How did you measure
them and what did you tell your client? How did they end up?
( always baggy to the end, finally stretched, etc..?)
On occasion. They are kind of neat. Sometimes these women are so stretchy they can open to nine or ten centimeters with a slight stretch of your fingers. Sometimes they even rest there at 8 cms or so and can walk around for days or weeks.
I finally learned (after many experiences with false labors and stalled labors , and many times of rushing to the home because I thought the baby would be born within minutes, etc.), that these women are different, and we should measure their cervix in a different way. Their cervical dilation is irrelevant to their labor. They can be at 8 cms with contractions and then completely quit. Their cervix may even go backwards and tighten up again. They may get to where they seem to be fully dilated and then quit contractions. Or they can have labor and go from 4 to 9 in one contraction. I think the type of contractions they have is really important --- because it's the type of contractions they have which gets and keeps labor going -- not the dilation of the cervix.
Eventually all of these women had normal labors -- usually about two hours. It seems as if they just went into "real" labor without all the preliminary stuff. And the babies really didn't fall out like we thought they might - -mom still had a couple hours of labor. A couple of them had many bouts of start-and-stop-labor--- I remember one woman who we spent several overnights on several occasions when she finally went (or stayed in) the real thing and had a two hour labor, but she'd been "nine cms" for a few weeks and on a couple of occasions I thought we'd see a baby within a few minutes!
To me the key seemed to be the type and quality of contractions. In all of them so far they were completely unpredictable until they started having strong contractions well over 60 seconds long. Anything shorter than that could peter out and stop at any moment.
And I also found that I think it's best to discount the cervical dilation with a loose and baggy cervix - -unless it is also well thinned (thinning seemed to be the key with some of these women). [The loose and baggy cervix may be the "shirt sleeve" cervix associated with an ill-fitting or malpositioned head.]
I've also known people to just AROM with these women when folks get tired of feeling like they are "always on the verge of labor but the baby will never come" (I say of course the baby will come and true labor will begin). It's too much stress for some midwives and for some moms. They are frantic about being so far dilated and not in labor -- or of being in start-and-stop labor -- and they can't handle it emotionally and some will go for induction (home or hospital). If AROM she will probably go into labor, but she might not and she is disposed to malpresentations. Some of the women I've worked with (or known of) handled things very well. Others got stressed out -- and we all ended up wishing there'd never been a cervical exam in the first place!
I have had women with start and stop contractions who walk around half or more dilated for weeks. The key is the word 'labor'. If labor stops I walk away. I have also found that women who have stretchy, thick cervices and are 4 cms, may have taken something to initiate labor. If that is the case, again, I go home. They will deliver in a few days, usually.
> Their cervix may even go backwards and tighten up again. They may get to where they seem to be fully dilated and then quit contractions.
Again, I have only seen that with women who have taken something to initiate labor. And I have only had 2 ladies who got to full dilation and quit. Both wanted to push their babes out in hospital.
> To me the key seemed to be the type and quality of contractions. In all of them so far they were completely unpredictable until they started > having strong contractions well over 60 seconds long. ANything shorter than that could peter out and stop at any moment.
I agree. Fooling around with irregular contractions is nothing but trouble.
> And I also found that I think it's best to discount the cervical dilation with a loose and baggy cervix - -unless it is also well thinned (thinning seemed to be the key with some of these women).
Thinning of the cervix, to me, is the true key. During a contraction you can gage that on a VE. During true labor you can feel it thin. If not, I ask her what she took :0).
Yes, both midwives and docs AROM with the 'hope' that it will "get things going". BIG mistake. Membranes should never be ruptured until the women is close to birth with strong contractions where there is no doubt that she will continue. I have talked with midwives who have ruptured membranes at 8 cms to get stronger contractions but instead all labor stopped.
Here's a scenario, tell me if I am off.
Your lady started in labor. Good chance she was already taking or began, with labor, taking something to 'move her labor along'. Nothing was moving along so the midwives encouraged her to take blue cohosh, B&B labor extract or whatever. Finally she is up to 6-8 cms, between contractions (not checked during). Then somebody AROM'd the lady thinking it would move her along and then tried different positions to hopefully correct whatever was slowing her down. Finally, everything stopped.
Midwives have been there wayyyy too long and now everyone is exhausted, but all vitals are good. Transport.
Wanna know something that is rather interesting? If you had given her 2 ms of pit say, 4 hours after you got there and without doing AROM, contractions would've ceased immediately and she would have fallen asleep. Two days later she would have delivered just fine.
I have done VEs on the stressed out ones. Sometimes they get mad at me because I will not push them. If they want pushed into labor I tell them to go to the hospital.
Yes. Not that infrequent.
I do a VE upon arrival and then again 30-60 minutes later during a contraction. Those, in my opinion, are the most accurate. I do the 2 VEs because it tells me how fast, or slow, she is moving.
Those 'baggy' cervixes in a multip are corrected by themselves fairly quickly, once mom pushes. With a primip not always so. That being said, I have intervened when needed.
In all cases when I ask the mother if she is feeling the contractions at the top of the uterus she will say no. I supply those contractions and the birth is over. there are 2 ways to supply such. One is with a couple of drops of pit and the other is with fundal pressure applied while mom is pushing. With the pit the birth should be over within 1
But you do this only if mom is actually having good contractions right? You wouldn't do if if contractions have almost stopped or are few and far between or short (under sixty seconds)? Or does the contraction pattern matter?
The contraction pattern is everything! If the lady is having contractions 10 minutes apart or less (yes, I have had some ladies whose contractions never got closer than 10 minutes but that was before I intervened), thinned out with head well applied to the cervix, good bloody show in OBVIOUS labor, I will intervene. When I intervene it is usually over in 90 minutes or less, with most delivering within 20 minutes.
I also many times ask them which hip is hurting? Then I
have them lift that foot onto the bed or chair and lean into each
contraction.
I think labors may appear to stall with a very stretchy cervix because the contractions don't have to be very strong to stretch the cervix enough to get the brain to produce more oxytocin, thus setting up a feedback pattern for a feeble labor. But, even though the contractions are strong enough to stretch the cervix, they're not strong enough to mold the head, so if the baby's head doesn't fit easily into the pelvis, the labor will appear to stall. I saw this happen with a cervix that was 5-6 cm without a contraction, and then 8-9 cm with a contraction, but the head was still not engaged and very, very round, although there was no caput. After 28 hours of an irregular labor pattern, we transported for just a little pit for about 4 more hours of labor and 3 hours of pushing. When born, the baby's head was very molded - 38cm worth! The baby also had a very large anterior fontanelle and wide spacing of the sagittal suture - not sure if that had any bearing on the labor, though.
I don't think it's the cervix "undilating" as much as a stretchy cervix that changes significantly depending on the flexion, descent and position of the baby's head which, in turn, can be affected by the muscle tension, position and attitude of the mother in labor.
I think anyone involved in birth has seen these kind of
changes; when one exam is less than a previous one, consider
what the head is doing in there (and why and what you can do to
help it!)
There was a midwifery professor who teaches that there are at least four reasons for the cervix "undilating"....
You are right, we all have a story to tell about cervical regression. As we get "older" in midwifery, especially homebirth midwives, we learn to prepare our clients for this possibility explaining in advance what will be said.
My very first client was a first time mom transport from the birth center where I was doing my internship. She labored beautifully and within 6 hours was complete and -1 station. She pushed for an hour with no progress so I rested her for about 30m and when I checked her again she was 7! I thought I was crazy! Within 2h she was complete again and pushed for about an hour with no progress. We repeated this whole thing for 7 more hours. When we transported of course she was 7cm upon admission. About 2h later, you guessed it, she was complete and pushing. Well.....................she made no progress and regressed to 7!!! I was sooooo glad she did that at the hospital too!!!! They repeated the scenario with her for another 7 hours and finally sectioned her.
One thing for sure, I was very convinced of the possibility of
cervical regression when the presenting part does not move down to
give consistent pressure. When this happens, I believe the
uterus (without pitocin) gets tired and allows regression.
The stress of transport will often cause a cervix to reverse in
dilation.
I've done 8, soft and stretchy, and back to 6 and rigid when mom got scared by a sudden dip when nurse was listening to FHT while I checked. I could actually feel it change. Reversed again shortly.
Also had mom who was checked at complete at home by
neighbor/midwife, came to hospital (planned to birth there) and
was 7 when she got there.
And maternal position really influences this too; to get the most
accurate dilation mom probably should be on a firm surface with
the small of her back flattened. That's a pretty uncomfortable
position in labor and most of the time we end up doing a "quickie"
VE -- one reason for varying estimates.
Really? what is the max. I've got a pliable, soft 9+ to a tight
6. Same examiner.
Pliable, stretchy, sl/ puffy 8 to a tight, thin 4 on planned
transport for hospital birth, same examiner.
This is a well documented phenomenon - the new MANA dataset of
over 24,000 labours (hopefully soon to be published and should
give us all some real ammunition against the partogram/alert line
business) shows that it is not that unusual. If you think about
it, the cervix is 70% slidey collagen fibres but 20-30% muscle,
which is responsive to catecholamine production and will contract
down when a mother is stressed or frightened - just like an animal
will clamp down its cervix and stop labour when disturbed. Many
midwives will know this happens when you transfer a mother in from
a homebirth for some reason - she may be 7cm at home, for example
but by the time you get to hospital and the doc examines her her
cervix has clamped down to 3cm... and then the doc looks at the
midwife like she's an total idiot...!!!.
I agree that there are at least two separate phenomena that can
cause "cervical reversal". The one I've seen most often is
the one caused by the rupture of membranes - the scenario is as
suggested . . . the baby's head is not applied to the cervix due
to malposition or a tight fit into the inlet, the membranes are
intact, and strong contractions fill the balloon "above" the
baby's head, effectively dilating the cervix. Then the
waters break (or are broken), and there's no head holding the
cervix open, so the dilation reverses. When I see this at
home, I know we need to work on realignment of the head, and maybe
consider going in to the hospital for some pitocin.
The other phenomenon - tension causing "the opposing muscles" to
tighten up and close the cervix - can be addressed a little more
easily - the herbal tincture "Centered Mama", which contains
lobelia.
I cannot rave enough about "Centered Mama". When I see a
"primip" whose "labor" starts off with painful contractions 2-3
minutes apart, and the cervix is still closed (and sometimes thick
and rigid!), I know she's scared out of her mind, and the
adrenaline is racing. In addition to sensible
support/comfort measures, I'll give a dropperful of Centered Mama
every 15-30 minutes until the labor pattern normalizes a bit,
usually shifting to longer contractions 5 minutes apart, and then
gradually getting closer to bringing a baby.
Rupturing membranes is a very common cause of cervical reversal.
Many Healthcare professionals seem to believe that this speeds up
a slow labour but there is no evidence that justifies this
procedure in a labour that is progressing well.
Sometimes it seems like you can go a few hours with a stall in
labor, and then you get to the hospital and find that the cervix
has opened and the mom is ready to push. Maybe we should
just get her in the car and drive around a bit?
Had a birth like this in January. Baby was caught up tried many different positions, finally she decided to go in. As we were in the mountains and about 45 minutes from hospital we left, as we got to the end of the long mountain road to the freeway he stopped the car. I got out and asked if all was okay and he said NOOOOOO so I said to park under bridge out of the snow (as it was snowing) when I opened the back door the baby's head was there. I caught baby, wrapped baby in a blanket and we went back up the hill to home.
Every time I pass that spot on the freeway I think of his birth.
So sometimes moving and going over rough roads will get things
moving again.
Very true. It's one of those effective “Tricks of the trade” we've all seen work.
I've often wondered though if it's the physical effects of
movement, or whether it might partially be due to the
psychological effects on the mom.
When the woman who is having trouble in labor is finally “on
the way” to the hospital, she may experience an unconscious
relaxation or release. She knows/believes she is going to get help
– and there may feel a reduction of fear and anxiety. Some
women literally have a sense of giving up – surrendering. The
contractions often cease. And sometimes – this is exactly what's
needed.
Then factor in the additional time it takes to travel and
slip into the hospital scene, and we often find the trip to the
hospital got the baby born!
I think these work because probably the baby was asynclitic and
the side-to-side and back-and-forth and climbing in-and-out moves
the baby and the baby aligns itself better. I have seen it
work....last year had a baby born in my car on the way to the
hospital.
Maybe the position of sitting in a car is a good position for
some women for getting the head fully into the pelvis?
Maybe the adrenaline levels climb with the change of scene, the
cold, the anxiety about going into a hospital where she doesn't
know anyone?
Active Management with Pitocin Does Not
Reduce Cesarean Rate
This is in response to an old post (I am slowly catching up), which put me in mind of Friedman's original article, giving times for labor and birth, which eventually resulted in a "standard of practice" firmly stating that women who go beyond the time table are risking their health and that of their child. Interestingly, I have heard a rumor that Friedman has repudiated his research (or at least it's inappropriate application from and observation to an edict governing labor "management"); kinda puts me in mind of the guy who "invented" dynamite, never foreseeing the terrible consequences. Wasn't he Nobel, of the Peace Prize, trying to make up to humanity for the terrible harm his "discovery" caused, putting the profits into stimulating/rewarding humanitarian behavior?
Anyways, I digress. I happened upon a copy of Friedman's original work (which is at home right now, and I, sadly, am not, so sorry no reference), and from memory I can state with certainty that there were a) only 100 women in his sample b) 86% were "delivered" with forceps c) I can't remember the number of cesareans, but I remember thinking that 95% of the babies were "delivered" rather than pushed out d) almost all of them had "medication".
What shocked me so much in reading this was the brazen attempt to use this observational study to draw conclusions about how long the second stage "should" be when the majority of the study participants were a) under the influence b) "helped" along by the use of instruments. Is this research-based clinical practice???????
What a joke !!!???? But not actually very funny considering the vast number of women who have been forced to undergo surgery because they "fell off" the Friedman curve.
I say it is high time we "re-evaluate" the "norms" for labor. A
CNM has started the process (I can't remember the name) by
recently publishing a report on the length of labor and birth
among low-risk women in a hospital setting, that was published (if
memory serves) in OB/GYN (the green Journal). We need this sort of
evidence to back up our practice, not only to "allow" women
physiological labor without unnecessary intervention, but also to
cover our butts, legalwise.
Dr. Leah Albers is that CNM writing in The Green Journal in conjunction with Dr. Melissa Schiff and writing in JNM as well. She is from the University of New Mexico and I am PROUD to say I collect data for her! She comments in her oral presentation of this information that no-one has been able to duplicate Friedman's curve and that in his information he describes "Data cleansing" wherein he got rid of stuff that didn't fit ;0. The WHO data and several other studies describe a curve that isn't ;). It seems to be a more linear process which demonstrates a need for more time to complete the birthing process than Friedman describes as the END point of normal.
Our data base is from a three center study, All CNM practices, All "normal" or low risk birth. A slightly different population than that described by Dr. Friedman......