I went to a birth earlier this week for a doula client, Sarah*. It was her first baby and she was hoping to have a natural birth. Sarah called me in the morning and told told me that she had lost her mucus plug and that maybe her water had broken. She also called her OB's office and was told her to come to the office to get checked to see if her water was broken or not. She had been laboring comfortably at home with contractions every 5 minutes or so and didn't feel like she needed my (doula) support yet. I was wondering how this trip to the office was going to affect her labor. I also had a feeling that she would be talked into going right to the hospital and not given the opportunity to labor at home the way she had wanted.
I got a call back from her a little while later and she told me that she was 5 cm, that her water was broken and she was being admitted to the hospital. I was a little surprised to hear that she was already 5cm, but was not surprised that she was told to go right to the hospital. So, I got ready and met her at the hospital. When I arrived she was having frequent contractions and they were enough to catch her breath, but I could tell they weren't as intense as I've seen with some other women at 5cm. Within about an hour of my arrival her contractions changed and got much more intense.
After I had been there for about 2 hours her OB came in and wanted to check her cervix. She agreed only to be disappointed that she "was still only 5 cm". Then her OB sat down and began the talk....(ya know, when someone tells you, "we have to talk", it's never the talk you want it to be). I knew just what was coming. Things weren't progressing, it had been 4 hours with no change. It was time to think about "active management" because her labor was "dysfunctional". He even pointed out on the monitor how her contractions weren't regular, they were coupled together with a larger space in between. Before the doctor left the room, I asked him what position he thought the baby was in. He told me he wasn't sure, but thought ROA, baby facing mom's back, with baby's back tilted to mom's right. The doctor and nurse left the room to let my client and her husband think about what they wanted to do, to start pitocin (which is what her OB strongly recommended) or she could have some more time. By this time Sarah was having very strong contractions, she felt that if they were any more intense she wouldn't be able to handle them, so the thought of pitocin which would only intensify things more scared her. While I was listening to her OB talk about active management and dysfunctional labor, there were two little things that he slipped in that I almost missed! Shortly after I arrived her OB had peeked in and said hello, mentioning that she was doing really well for being 4-5cm. Also, when he checked her again (4 hours after the initial check at the office) he said, "You're still 5, well 5-6." I reminded Sarah of this, that at the office she was 4 to 5 cm and now she was 5 to 6cm. Even though she was being told that she was still 5, there was still some change. She also had a big disruption to her labor in the last 4 hours, she left her home, went to the doctor's office and then was admitted to the hospital. I had only witnessed about 1 hour of intense contractions. To me this was perfectly normal, not dysfunctional. I'm willing to bet she didn't do much dilating at all during all that transition time from home to office to hospital. And what about those coupled contractions? We decided to try some time on her hands and knees to see if that might help baby to find a better position.
About an hour and a half or 2 hours after "the talk", and after Sarah had spent time on her hands and knees and then standing and leaning forward, she was feeling a lot of pressure down low. We told her nurse, who told the doctor. He came back in the room to check her but this time instead of wearing scrubs, he had changed back into his shirt and tie, he was actually getting ready to leave the hospital since Sarah had decided against pitocin. He checked her and to his surprise, she was 8 cm. he looked right at me, and said, "Did you do this?" I just shrugged my shoulders and pointed to Sarah, for she had done all the work. Her baby was born 4 hours after she had been told that her labor was dysfunctional.
Here's a lesson or two in birthing: vaginal exams are relative, four to five centimeters and five to six centimeters might both be called 5. Disruptions like traveling to the hospital and office visits can hinder labor progress. Dysfunctional labor patterns could be a sign that baby needs a new position or mom needs a new position. Most importantly, moms needs encouragement while they are in labor, not to be told that their labor is dysfunctional. Sometimes the best thing to do is nothing.
Interesting article on back labor and positioning:
http://www.midwiferytoday.com/articles/paininback.asp
*not her real name
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