looking for advice asap!

[raeben]

1st time mama two weeks overdue. biophysical on friday said everything looked great and she had an AFI of17. her cervix is super favorable, 100% percent effaced and very anterior considering the baby is totally floating at -2 station and very bolottable. last night she was having ctx every 5 minutes and then around 11:30pm thing got pretty hot - ctx every 3 or even 2 mins, 1 1/2 to 2 mins long, vomiting, some double peaks etc, super intense so they drove in to the hosp where i met them at 1am. ctx slow back down to 5 mins apart, 1 min long and she's only 1 1/2 cm dilated. they technically cant even admit her.

she's not scared, likes the hospital, loves her MWs, feel very supported, etc - no emotional dystocia issues. she's an acupuncturist, he's a massage therapist, they are doing acupuncture, herbs and homeopathy.

we walk and massage a lot at the hosp but she is totally able to walk and even talk a little during 2/3rds of her ctx. she is feeling ctx really low but the top of her fundus is totally flaccid even at the peak of her ctx. i gave her a hot water bottle to keep on her fundus but nothing changed. after 3 hours she was still 1 1/2 cm and baby still not engaged with the cervix. we went home and everybody got a good 4 hours of sleep - even mama between ctx. this morning she was still contracting every 5 minutes but not intensely - just enough to tire her out. she is really perky and talkative (her normal personality). i left them to come home but told her to try to ignore her ctx and prescribed a lot of active, distracting activities. she is doing a round of labor tincture (black and blue, ginger, cotton rt. brk.) every half hour for 5 hours alternated with homeopathic caulophyllium 200c. she also did a serious round of acupuncture this morning and was considering trying the TENS. before i left she was really trying to visualize the baby's head applying into the cervix like a thin turtleneck sweater. she thought she felt like the baby was engaging in her pelvis more and that it was more uncomfortable.

i have felt this whole week that she will be in for a pretty precipitous labor (which makes me a little nervous since she is 30 minutes away from the hosp and 55 minutes away from me). i still think it could happen when ever things get going but how to get things going? normally i'm all for just giving it time but a) this mama is really really determined to have this baby soon before she gets exhausted and b) even though her MWs are cool, she is 42 weeks and they do have their protocols for not letting her go past sunday.

so after all that (thanks for staying with me) here are my questions:
- what would you do to help her fundus get firm? i might go back and do a castor oil pack there - any thoughts?
- got any suggestions for helping baby engage more - positions, etc.?
- do you have any experience inducing/augmenting/egging on contractions using a TENS?
- other thoughts?

[Comfy]

I don't have any suggestions, everything that has been tried sounds great. It sounds to me that baby is just not positioned in a way to move down more, but my bet is when he does...... it's gonna be fast. Sorry wish I was more experienced. Keep us posted.

[bellymamadoula]

I think she needs to see a Chiropractor is she suspects malalignment of baby. Some don't engage until they want to. labor begins. I've seen too many moms induce at advice of a midwife or related birth professional at two weeks past due, only to have these undergrown babies with complications.

I know it's probably off topic, but unless you are licened and trained to monitor body baby and mom; I think it's unethical to suggest induction by any method to any one other then the fun 3: sex, mexican and walks

I think it's best stick to supporting and listening and become an expert at that.

This isn't meant to poo poo on anyone who disagrees, just share my POV

[happydoula]

No suggestions here - seems like you've given them plenty to think about (not to mention that I'm sure they have a lot of tricks up their sleeves being an acupuncturist and masseuse!). Did she ask the midwives what they suggest?

Just wanted to mention that one of my first births was a mom whose contractions started out at 3 minutes apart right off the bat. Stairs got them closer together, but she just progressed VERY SLOWLY. Your description of mom sounds a lot like mine did (walking, talking through 2/3 of contractions), but it was a terribly long labor - 41 hours from start to finish. Baby was posterior, did NOT want to move basically until 2 hours into pushing (at which point, he finally did), and was almost 9 pounds. Just be prepared! ;o)

[DoulaCBE]

Sounds like a malpositioned baby to me. I'd back off "encouraging" labor and focus on OFP.

[raeben]

Quote:

Originally Posted by bellymamadoula I think she needs to see a Chiropractor is she suspects malalignment of baby. Some don't engage until they want to. labor begins.

yeah, i've been encouraging her to see a chiro for the past 5 weeks! they were into the idea but just never got around to it :-( when i do moving hip squeezes laterally i can feel that she is hung up or misaligned a bit in her pelvis - not badly but enough for the experienced hands to notice. he works with a chiro so i am trying to get them to see him when we go back to town, pre hospital.

[sunshine]

Quote:

Originally Posted by DoulaCBE Sounds like a malpositioned baby to me. I'd back off "encouraging" labor and focus on OFP.

just what i was thinking. maybe knee to chest to float baby up more and give it a chance to turn. definitely the chiro.

apart from the SOP issues, i don't personally think any kind of inducing (castor oil incl) is a great idea at this point. clearly, something is "stuck", forcing the issue probably won't help. she may feel like she's running out of choices if the pokey labor begins to be exhausting OR the care provider starts pointing to the calendar.

good luck. i would guess fast if things get aligned correctly too.

[DoulaYvonne]

Lunges, squats, birth ball, visualization. Do you think some nipple stimulation might be appropriate?

[doula Michele]

Misaligned baby.
Chiro, massage, maybe some rolling in the pool, knee/chest.

[sunshine]

stairs, lunges, take several stairs at a time. i would alternate that w/ knee to chest - one would disengage the baby, give it a chance to turn, the other help the baby engage well.

[Apple Blossom]

Baby sounds misaligned to me too.

Along with the great suggestions of the others, I would get my rebozo out and do some belly sifting to relax those involuntary uterine ligaments and hopefully give bub some room to wriggle into a better position.

Please let us know who it all goes.

[DL]

Yes, my first thought was malposition/misaligned baby as well and that's probably all it is. Positioning/movement and time will more than likely take care of that.

Something that happened to one of my clients, though: Your description sounds similar so far for early labor with one of my former clients. When we finally went to the hospital, I really thought that she would be near transition (had ALL the outward signs). Come to find out, she was only 2 cm (I had to be a good actress to hide my disappointment & only show encouragement). We worked on postioning to help with probable malposition. Near the end when baby was no longer ballottable, baby kept having cord compression issues and I would get her into a new position and the FHR would go back to normal for a few seconds....then plummet again....change her again and it would normalize...only to plummet again a minute later....this happened several times over and over as the OB, nurses, and I were all stumped. The OB even stated that she had no idea of why the cord compression no matter what. To make a VERY VERY long story short, she ended up having a truly needed Cesarean birth because her baby would not come down, despite our best efforts...not even after being complete and pushing for three hours (she had an awesome OB!). Luckily I got to attend the Cesarean and saw with my own two eyes, otherwise I probably wouldn't have believed it had I just heard it from the OB: Baby could not come down because of an abnormally super long cord. She was all tangled up in there! 3xs nuchal, 1x tight around each arm, 1x around the torso, and 1x around one leg. The really sad thing is that this was an attempted VBAC, and she had gotten all the way to pushing. ...but my client was happy for having tried the VBAC and was glad to know that her body could do it, that is wasn't a failure of her body but rather a super long cord that was beyond anyone's control. Oh, btw...a beautiful, healthy baby girl was born that must've had a gift of getting all wrapped up in things.

I very much doubt that this is what is going on with your client, but I thought I'd throw the unlikely possibility in there in case persistant and severe cord compression issues happen to pop up. It's really rare, I think, but cord entanglment can sometimes cause a baby to not be able to get into proper positioning. to you and your client!

[Brie+3]

Quote:

Originally Posted by Doula Sara Baby sounds misaligned to me too. Along with the great suggestions of the others, I would get my rebozo out and do some belly sifting to relax those involuntary uterine ligaments and hopefully give bub some room to wriggle into a better position.

I was going to suggest this as well.

[amymaew]

Quote:

Originally Posted by Doula Lori Yes, my first thought was malposition/misaligned baby as well and that's probably all it is. Positioning/movement and time will more than likely take care of that. I very much doubt that this is what is going on with your client, but I thought I'd throw the unlikely possibility in there in case persistant and severe cord compression issues happen to pop up. It's really rare, I think, but cord entanglment can sometimes cause a baby to not be able to get into proper positioning. to you and your client!

Yup - I'd say malposition. And Lori - a local hb mw had a super short cord that ended in a needed cesarean - I think it was 8 inches iirc? It was crazy short.

[raeben]

i got her to go see my favorite chiro after lunch. she was kind of off and it was worth getting adjusted but her pelvis wasn't severely out of whack or anything. she got a good nap but now ctx are down to every 10 mins. we had a talk about prelabor range of normal and made a plan for her to get real relaxed and go to bed tonight.

as far a sop issues goes, they were already taking homeopathies and herbs, i just gave them some suggestions for dosage/timing to make it more effective and safer. i did throw out the idea of a castor oil pack (which is waaaaay different than ingesting castor oil) but he is actually trained in doing them. she is an acupuncturist and did most of her own needles although i did suggest spleen 67 to try to get the baby to move favorably (he definitely started moving!) and i did put in some needles where she couldn't reach but it was under her supervision. i probably do have a slightly more liberal view of sop than average but i don't feel like i'm out of my scope here at all.

so here is another question - have you ever had a mama go full speed ahead like she was in danger of having the baby in the car on the way to hosp and then go back to a couple days of prelabor before having a normal labor and delivery? i just haven't seen that before and am starting to wonder whats up. i did wonder about some kind of crazy cord hang up like lori posted - lets hope not though :-(

oh, and does anybody have a good link to something i could send them about prelabor? - ideally, some nice meditation or information on how it can go on for days and its normal and how they should just chill out and not worry a bunch or over think things too much.