Hello all,

Last week I had a client who was GBS+ and her water broke. She started getting antibiotics every 4 hours, going in and out of the hospital. For 24 hours her labor didn't start, so they admitted her for induction. The pit contractions were horrible with little break in between. After 6 hours she took the epidural and the contractions never picked up again, in spite of increased pitocin. After 16 hours of induction she was not progressing, still 3cm, so she has a c/section.

I'm really sad for her, since she had every intervention that she didn't want. But we talked about it at length and she was at peace with everything. It seems to me that this induction (which led to c/s) was necessary.

Just wondering if you have any experience with this kind of situation, mom is GBS+ and labor doesn't start within 24 hours after PROM. Is there any other route to take? She tried walking and nipple stimulation while waiting those 24 hours, while still catching some rest. Looks like her body was not ready for labor yet. If she wasn't GBS+ she could have waited longer, but this way the risk was too high. Am I correct?

Thank you all.
Narchi

I am really curious what position the baby was in. Malposition babies can cause PROM, she was also @ 3 cm, not progressing and sounds like alot of pain for that dilation - which can mean malposition also. then there is the fact that she got an epidural @ 3 cm...that isn't even considered active labor- taking a big risk doing that with a possible malpositioned baby and early labor.

So what types of things were you doing with her? What kinds of positions or techniques were you using?

It is possible that the baby was posterior, they never gave her a clear answer. She did lots of OFP positions for that in the previous weeks. While she was on pitocin she changed positions, tried the birth ball, rocking chair, standing, bending over the ball placed on the bed, we breathed together, things like that. I briefly tried some massage, counter pressure, and pressing some acupressure points, but she didn't enjoy that. She didn't have back labor, she felt everything in front. As the contractions got stronger and there was very little break in between, she started to hyperventilate, she wasn't able to keep focused on good breathing, in spite of me and her husband trying to breath with her, encourage her, etc. I think that the pit-induced contractions were very difficult to cope with, especially because there was such little break in between them.

Taking the epidural so early is definitely a big risk, I agree. I wonder if I could have done something to prevent her from getting it. But she was extremely distressed at that point and not responding to any techniques we were using.

How high was the pitocin turned up? Could she have possibly asked for it to be turned down a bit so she'd have had a chance to cope a bit better. It sounds like she may have been hyper stimulated?

The pit was not too high, it got to about 3.5 and then they did turn it down to about 1.5 when she became so overwhelmed. Then it was a little bit better but she still wanted the epidural. Then they increased the pitocin again.

I'm also curious about how high the pitocin usually goes with inductions. In this birth it went to about 7 but they kept lowering it and then increasing it again based on the baby's reaction.

Hmmm...3.5 isn't really that high. I've seen it as high as 20, although around here that is about the max.

Yeah, not too high and still she was so distressed... I think her body was not ready for labor and it reacted strongly to the initial pit.
Oh well. In the end she seemed at peace with everything, but I will see how she feels at the postnatal.

Pitocin can go up as high as 40 (some places higher). Some women just need a whiff while others need more. but the higher it goes the less likely things are working well. there are only so many receptors and once they are saturated thats it....like a cup over running withwater.



Are you familiar with spinning babies? sometimes the body needs some balancing in order to relax and let labor happen. sometimes we can be moving and using gravity as much as humanly possible but if the pelvis is not balanced or relaxed everything gets held up. I really believe in what gail teaches in spinning babies. i feel like it is all i have to offer these women to help them with their labor. when i only knew comfort measures and just a couple of manuevers to help with OP positions it often wasn't enough. I am so glad I found spinning babies and got to go to one of her workshops. this has really helped me with my patients.

Things that I think she could have benefitted from would be an inversion, side-lying release, abdominal release, rebozo, shake the apple tree, rebozo, pelvic tilts, and maybe even the miles circuit.

Women need to learn about the importance of their role in optimal fetal positioning during their pregnancy. Their posture and learning to loosen those pelvic muscles and ligaments can make a difference on your labor

your question.. "If she wasn't GBS+ she could have waited longer, but this way the risk was too high. Am I correct?"
I just wanted to say that I don't think the induction had anything to do with GBS status. It isn't as important as ruptured membranes, and here in england they dont' even test for GBS. Rupture of membranes for too long without going into labor can increase the risk of chorioamnionitis.

I talked to her about the spinning babies principles for months and she was following them. She was getting regular massages and webster technique chiro sessions. She did the miles circuit as well in the days prior to her water breaking. I wish we could have tried more techniques while in labor, but with all those wires on there is only that much you can do...

I will definitely go to a spinning babies workshop as soon as there is one in NYC. I can't wait!

So sorry to hear that. It is hard once they are in the hospital, you do lose alot of freedom that you have in their home. I work in a hospital and struggle with some of these techniques myself because of all monitoring and some other things I don't care to mention right now ;-)... Its really frustrating- and we don't have a birth pool so they are really on their own. This may be a very good question for Gail. She may be able to make suggestions for any future situations that are similar to this one. I would love to know what she thinks in case I ever run into this. My big feeling is getting that epidural to early-when she wasn't even in active labor. I'm guessing the hospital you were at was like mine with no birth pool as an alternative?

Well sorry I couldn't have been more helpful :-( It does sound like you did a fantastic job though. The fact that your client feels at peace with the outcome is what it's all about in the end anyway I think.

The birth pool was not an option since she was induced and had continuous EFM. You're right, it would be great to have Gail's advice for this kind of situation.
Thank you so much for your support!