Wanna Get Engaged?

Twice this year I've heard of sections being performed for "failure to progress."  As a birth worker, this term can mean many things, but typically has to do with the OB's definition of "progress", which is practically synonymous with "velocity".  How far has your baby moved in a given time?

It's true some labors are long.  Really long.  And some labors stall- which depending on who you are may or may not be such a bad thing.

Sometimes a uterus is tired and contractions need to stop and mother rest before labor is completed.  Sometimes the baby's head is presenting non-traditionally.  The mother may be dehydrated, have an emotional block, or there may be an issue with the cervix.  And yes- sometimes the baby's head can be "too big."  All of which lead to a prolonged labor and if not changed, a diagnosis of failure to progress. (birthingnaturally)

In the cases I reviewed, exams revealed the baby had not descended and in one case, dilation had "stalled" around 7cm.  In both cases, mothers had an uncontrollable urge to push.  Good?  "Bad"? What's a mother to do?  Well, I may have some answers.  First- a word from our sponsor-  err rather- a blog I admire:

Doula_Rochester_Best_Birth_process

 

Before we ask for help from medicine may I suggest we evaluate what's actually going on in your labor? Did walking around get us quickly from 1 or 2 to 5cm before we got in the shower? Sometimes though it may be less comfortable- going back to what worked before may be the answer.  When did you eat last and how long has it been since you've had a sugar boost?  Are you sure you're fully hydrated?  Mothers in active/cranking labors will rarely eat- and often if they do- their body simply will reject it.  A way around this can be small bites or sips of something energizing.  Drink.  If you can't, seriously consider an IV intervention.

Next to address is getting the baby into the pelvis.  Opening mom's pelvic bowl and making an engraved invitation to baby to fit into the space given.  Doulas- PLEASE carry a needle and hand pump with you to your births.  I can't tell you how many times I've pumped up an under-inflated hospital birth ball.  Mom- have a seat on a firm and appropriately sized birth ball and start rolling your hips in circles (pretend your hula hooping) or figure eights.  Feel your pelvic bowl stretch and visualize your little one moving into the space.

Abdominal lift- mom leans with her back against a wall, feet 6in from the wall and shoulder width apart, knees slightly bent.  During a contraction lift baby/belly with your clasped hands and "place" the baby into your pelvis.  Repeat for ten contractions.

Combine the two above.

As I've never used this third technique, I'll link to it and plug a little bit of Spinningbabies.com - one of the best baby positioning resources evah!  Filled with good research, illustrations and videos, I highly recommend birth professionals have a shortcut link on their smart phones to be accessed on the fly.  Spinning Babies refers to a technique called the "Walcher" method to engage baby.  The idea is to position mom with her hips elevated in such a way to open her pelvis front to back.

Lastly, I invite the birth team to try to "turn the page" in labor and consider whether there is pressure from the mothers support team, her doctor, you, or herself even to "get this baby moving."  Have the mom affirm-  "I TRUST MY BODY.  I TRUST THIS BIRTH."  A bold support team may ask for such an affirmation of the mother from the doctor.  This usually goes a long way for mom.   A relaxed and confident mom can open much more easily than one under pressure.

Finally to address the case where mom feels the Ferguson's reflex before dilation is complete. Professional opinions do vary.  Take mine with the weight it deserves- and know that I'll never give advice here without a credible resource to support it.  In this case I say consult your OB or midwife and have your doula show them this article from Midwifethinking.  It explains the anatomy and physiology of an engaging baby in the birth canal and how a baby's head in some cases facilitates the completion of dilation.  When faced with a client who experiences the uncontrollable urge to push AND a direction from her nurse or doctor NOT to- I offer the grunt/clenched jaw approach. Essentially I ask the mom to expel the energy of the push upward rather than down at the vagina. Eventually the direction of her energy will turn, but sometimes this is a happy medium between letting her body do it's job and keeping from putting too much pressure on her undilated cervix. Still, it's important for mom to recognize in a case like this, that her body knows better. Better than her nurse, her doctor, her doula, and even her logical sense of what is happening in a given contraction.  

In the end- the cases I reviewed ended in healthy babies delivered in less than ideal circumstances. The moms in their own time came to understand the progression of the choices they made for their births and integrated the experiences in a healthy way.   When interviewed regarding their feelings about their labors one mom had a profound reflection.  "Just because I would have done it differently doesn't mean that I did it wrong."   

It does bear repeating that there are no guarantees in birth.  Our tools help overcome some of the challenges that labor can bring- but always remember that there is a divine component to this process.  It is something beyond any human control.  It is something that requires surrender and trust.  It is the essence and the joy of birth.

Additional Resources:

http://www.birthingnaturally.net/birth/progress/slow.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595201/

http://www.webmd.com/baby/guide/prolonged-labor-causes-treatments

http://walkingwithdancers.blogspot.com/2012/05/helping-baby-engage-at-end-of-pregnancy.html

http://www.mumsnet.com/pregnancy/labour-and-birth/transition-and-second-stage

http://www.cafemom.com/group/14077/forums/read/15857916/pushing_when_not_fully_dilated