When transition is LOOOOONG

Abbydoula · 03-13-2007, 02:17 PM

Hi all,

I recently had a client whose transition was about 2.5 hours long (with an intense urge to push that the doctor insisted she pant through). It was just one ctx at a time kind of thing...though we tried several different postions to take the pressure off.

Once she was pushing she was too exhausted to be able to push baby out on her own and had forceps (with epidural at 10cms.).

What do you do when transition is going long, doctors insist on things that seem counterintuitive to you...etc.???

Abby

raspberrydoula · 03-13-2007, 06:51 PM

I would love to hear some suggestions too. This similar to what happened when my son was born.

tlcdoula · 03-13-2007, 06:56 PM

Did you get mom in knees chest? Sometimes that can help mom not feel that urge to push so much.

I am curious, but was she not dilated? What was the reason they wouldn't let her push?

UtahDoula · 03-13-2007, 07:01 PM

Get her in the tub - it can help reduce the urge to push and get her some rest. That's been the best technique I have found for moms in that situation.

If she has a big bulgy bag, rupturing the mebranes can help, too. I had a client once spend 3+ hours at 9ish cm. It has hard for the nurse to check around the big bulging bag, which was visible in the birth canal as the nurse was doing an exam. It was so odd, never seen anything like it before or since. But the bag was clearly an issue, and the nurse suggested breaking it. Mom agreed, but doc refused to come in and do it. (around here, only docs & CNMs can do AROM) Eventually it "accidentally" broke during an exam. I'm not entirely sure it wasn't intentional on the nurses part. She was ranting about the doctor's laziness about coming in to do it and how unfair it was to the mom when it happened.) She was complete within about 15 minutes after that.

earthgirl · 03-13-2007, 07:06 PM

Ditto what UtahDoula said. Hydrotherapy works wonders! Tub is preferable, but a shower hanging over a birth ball would work too.

Abbydoula · 03-14-2007, 02:37 PM

Yup, knees to chest, we did the tub, we used the birth ball. She was 8, and baby's head was a bit sideways (this did change by the time she was fully dilated, but by then she was too tired to push). The water did help. Doc said no pushing because the cervix was not soft and stretchy but tight, only 8 cm and "to push against that would cause swelling." I realise that this is the case a lot of times, but other times, when cervix is stretchy, it is the pushing against it and bringing babe's head further down and against the cervix that causes dilation. I mean, this was my expience...I push at around 6 cm and my cervix just opens up as I push (weird, I know, but 3 times I've had the urge to push and only been 6 cm). Anyway, we did try a ton of stuff and we did get her through to 10cm. That was HUGE...she was so strong

Abby

Stacie · 03-14-2007, 03:21 PM

ctowndoula · 03-14-2007, 04:14 PM

with others who mentioned baby's position being a bit off. I have had a couple MW who mentioned that if mom only felt pushy at the peak to go ahead and use it for a bit and see if some gentle pushing didn't help. But as a doula, I could never suggest that.

I just don't tell on mom if she does push a bit. Had a birth not too long ago where this happened:
Mom was about 8 cm and grunty at the peaks. RN told her not to push b/c it would swell the cervix. Mom would look at me at the peaks and have that "toddler pushing" face. I just smiled at her and reminded her to take some deep breathes for baby (RN was telling her to breath through the urge so I sounded fine to RN). She was complete in no time. The problem here is, as doulas we can't make the suggestion to push at anytime. We see the problem and have the research and possibily the expereince to offer some good suggestions, but it would be outside scope for many of us to do anything more than offer emotion and physical support at that time.
If you know the babe's position is off you can try belly lift and such, but honestly that seems too invasive for a doula to do if mom has ROM. My

The other suggestions of getting in water, squatting (if babe is engaged) and all are great. That we can do and suggest.

So nice to have so many wise women to turn to here, isn't it?

It sounds like you did a great job, sometimes birth just wears mom out and it is times like that I am happy we have interventions like epidural and such. I am surprised that they used forceps instead of vacuum though. Was the babe still pretty high?

JerseyJess · 03-14-2007, 05:13 PM

In October I had a client who had a 42hr labor. She arrived at the hospital and was 8cm. She wasn't complete for another 12 hrs!!! She had rented a labor tub, we tried that for a while and her contractions spaced so we figured maybe she just needed a rest-so she TRIED to sleep-no go. Baby's position was FINE. After 10hrs she consented to some pitocin-that got her to 10cm-then she pushed for 4hrs in various positions-finally she had forceps (she did this all without an epidural)

For her I think it was just a combination of a "tired' uterus and a truly narrow pelvis (afterwards she tells us that her sis had to have a c-section after 5hrs of pushing and as did her own mother)

I've had clients who've had persistent anterior lips. Usually it is a case of a slightly tilted head-I usually get them in a knee-chest position if they're feeling pushy but otherwise I don't tell her not to push-most of the time they just push right past the lip and are never pronounced "complete". As one midwife told me, late dilation (except for inductions) is often a product of descent-if a baby's head isn't flush with the cervix it's hard to fully dilate hence dilation is not the problem but rather the descent of the baby.

MyDreamDoula · 05-12-2007, 10:58 PM

Quote:

Originally Posted by JerseyJess

In October I had a client who had a 42hr labor. She arrived at the hospital and was 8cm. She wasn't complete for another 12 hrs!!! She had rented a labor tub, we tried that for a while and her contractions spaced so we figured maybe she just needed a rest-so she TRIED to sleep-no go. Baby's position was FINE. After 10hrs she consented to some pitocin-that got her to 10cm-then she pushed for 4hrs in various positions-finally she had forceps (she did this all without an epidural)

For her I think it was just a combination of a "tired' uterus and a truly narrow pelvis (afterwards she tells us that her sis had to have a c-section after 5hrs of pushing and as did her own mother)

I've had clients who've had persistent anterior lips. Usually it is a case of a slightly tilted head-I usually get them in a knee-chest position if they're feeling pushy but otherwise I don't tell her not to push-most of the time they just push right past the lip and are never pronounced "complete". As one midwife told me, late dilation (except for inductions) is often a product of descent-if a baby's head isn't flush with the cervix it's hard to fully dilate hence dilation is not the problem but rather the descent of the baby.

I had a similar experience with my labor but I was confined to bed and could not get my daughter's head in the right position while lying flat on my back. It was a mess. I wished I had a doula with me. I ended up with a cesarean. I know how tired I was. Being in that stage of labor for any lengthy amount of time is tiring.