"fake transition"

[snarky]

Have you ever heard of "fake transition"? Here is my birth story - induced at 40w5d due to high blood pressure. I was started at 40w4d with the Foley catheter and went into hospital for pit drip at 4 cm dilated. About 6 hours into the pit drip I started to vomit and had the urge to push, this was at 7 cm dilated. At this point my OB pushed for a section due to failure to descend and my doula agreed that this was the best course of action. With doc, doula, and husband on board I agreed to the section. My OB says this is a textbook case of true CPD, I am 5'11" and was well north of 200 lbs so I have a hard time believing that there is anything petite about me.

Anyway, have you ever heard of "fake" transition with urge to push/puke without being fully dilated? Is this true failure to descend? Is a section in this case standard protocol? I have looked all around and have not read of stories like mine before. I'd love to see pointers to women who were in a similar situation with early transition symptoms and see how their births went.

Thanks

[MsBlack]

I have seen women have those same signs/symptoms at *4* cm (not just at 7, which is far more common)...in fact when I read the title of your post, I thought that was the 'fake' transition you were referring to. What I call 'mini-transition' and for some women signals their entry into 'serious labor'.

Anyway, I'm somewhat astounded that your doula agreed to the csec under those conditions. Sounds to me like you were having a normal labor, NOTHING like 'textbook CPD'. And yes, I think your baby would have had to be about 20 lbs, given your size, to cause CPD! I'm assuming you had a normal size baby?

Your story did not give many details, so perhaps my assessment is off base....let's just say that to declare 'failure to progress for probable CPD', I'd likely have to see a mom who was eating/drinking, and trying different positions/movements, baby showing not such positive signs, and STILL stuck at 7 after several hours. And even then, the mom would have to tell me she was done trying (unless baby's signs were truly troubling, of course). I've seen moms 'stuck at 7cm' for up to 12hrs to still go on and birth vaginally. Very rapidly, in fact, once that particular 'tight spot' was cleared by baby (whether it's a tight spot in the pelvis, or a baby malposition or whatever--it's some sort of blockage of the flow, and once cleared birth is often quite soon after).

Thing is, if baby is really not descending well into the pelvis, then you are unlikely to see troubling signs in an otherwise healthy baby--because if baby is high there is just not that much pressure/compression on baby. It is mom who has to deal with the difficulty of this issue--and if she can keep any calories/fluids down at all, continue to pee (either naturally or w/catheter), and continue to try different movements/positions with rests in between, well then she is likely to get herself and baby past that stuck point. I have seen frequent pukers and I've been one in a couple of my labors--vomiting is really not that big a deal by itself.

I am not surprised at your OB--they are not paid to be patient, they make the big bucks doing csecs and having a high turnover ('clearing beds' to make room for the next mom in their work day). I'm not so surprised at your dh...I mean seriously, no offense to him whatsoever, but men hardly ever argue with docs--they are not well enough informed to do so, and they hate seeing their woman and baby in possible danger. But I am surprised at your doula. Again, maybe I just don't have all the details that influenced her and the OB's assessments....but you do know the details-- if you are in doubt about why she agreed with the OB on that, I would ask her to explain.

And just so you know, many many women who had csec for "CPD" have gone on to have a VBAC with an ever LARGER baby. True CPD is very rare!

[shelley4]

with my 3rd child, i had the urge to push at 4 cm's. i threw up alot. she was born, vaginally, at home, about an hour later. it was the hardest thing for me to feel like i need to push, but not be "allowed" to do it so soon (midwives were concerned about my cervix swelling, possible tears). i think my baby must have had her head not quite straight or something, it was causing so much pressure. once we got past that, i had her out before the midwives even noticed!

[Seie]

Doc is wrong. Most likely the reason baby was not descended was malposition of some sort. It doesnt mean that it would have magically cleared itself up if you had waited it out, but it is a posibility that baby would have moved to fit better. At least it is way to early to make any conclusions about CPD that soon.
My third labor baby never descended. It was attempted unassisted and I experienced transition for many hours. Finally we decided to call an MW as I hoped she could help baby into a better position for birth (my own attempts at moving around, wriggling hips etc had failed) She adviced transfer to hospital because baby was so high still.
We waited another several hours - 9 hours total of me being complete and in transition, but as baby was still not moving down, even after we tried shaking him down with a rebozo, I agreed to amniotomy and eventually a c-section.
In my case my son was in the military position and the way he was sitting in the uterus made it impossible for him to enter the pelvis. I doubt any amount of waiting would have changed that. But sometimes baby does move to fit even very late in labor, and a good midwife will know tricks and positions you can place yourself in to help that happen.
Again - it is possible that you would have ended with c-section even if you had waited much longer, but that should have been a joint decision after all other options were tried. Im sorry you went through that.

[lunita1]

With my first, my labor was transition-like from about 4 cm until the end 9 hours later. I became dehydrated from the vomiting (I couldn't keep water down). I didn't have the early urge to push, but as far as the intensity goes it was like the last 2-3 hours of my second labor.

(also somewhat off topic, but #2 was born posterior and I actually began pushing with her still floating. She didn't descend until after I pushed for a while. I didn't realize how odd that was at the time, but I'm really incredibly grateful that my midwives never voiced any doubt they might have had about whether she'd fit through in her position given the fact that she still hadn't engaged after hours of labor. It was a labor that could have ended very differently with a different support team.)

[Jaimee]

This article may be of some interest: http://midwiferytoday.com/articles/ruleof10.asp

Plenty of women experience the urge to push before 10cm and according to the above article, may be exactly what is necessary for labor to progress.

[turnquia]

My son was double nuchal hands and he wasn't coming down quite right. I started feeling the urge to push at 5cm. I was told I was very easily stretched to a 10, however his head just wasn't applying pressure correctly. Needless to say fighting the urge sucked and after I hit like 7cm I started doing mini pushes because I couldn't control that urge... he was born not so long after.

[etsdtm99]

with both my labors i felt like i was in transition around 3-4 cm.. horrible pain, felt like i couldn't do it etc. both times based on how i was feeling i thought i must be in transition, around 7 cm etc. when i actually got to transition, i felt fine - threw up a few times and felt a lot of pressure and an urge to do small pushes but not the panic and ctx right on top of each other that i got at 3-4 cm .. .. the 7-10 cm transition was a lot shorter and easier to deal with than the 3-4 cm one.. the 3-4 cm one was probably harder to deal with because i wasn't expecting it and both times i was in the hospital and the OB/nurses determined that since i was in so much pain my labor was stalling blah blah blah.. epidural (that didn't work).. more pit etc. next time i'll be expecting to feel pretty horrible at that stage .. both my babies did take a long time to come down.. with the first i was complete for 6 or 7 hours (not pushing or feeling the urge to push , just trying to change positions and wait for her to move down)

[snarky]

Thanks everyone, esp Jaimee for that awesome article and MsBlack. I was surprised my doula agreed so readily too, which is why I rolled pretty quickly on it, even though the rationale for the section seemed a bit sketchy. If my doula had offered other suggestions I would have taken them. At that point though, I had no epidural/pain relief and the contractions were coming every minute or two with little break, so I chose the section since it seemed inevitable.

More details: my daughter was born 8 lbs 8 oz, a healthy size but not enormous. I should have mentioned that doc broke my waters before starting the pit drip, which they said was standard hospital protocol. There was light green staining, so they were concerned about distress from baby. I was being monitored internally and the monitors were not showing anything troubling. I was up and walking around, etc until they inserted the internal monitor, so I had only been stuck in bed for an hour or so. I stalled at 7 cm for an hour or two, the pit was cranked up and the monitor was showing extremely hard contractions (I was working hard at this point) but nothing was moving. My blood pressure was hovering a bit over 140/90, not too much higher than what I was admitted with.

Baby's apgars were 9/9, so no distress. However she did not feed well, lost over 10% of body weight in the next two days, didn't gain it back for over a month.

Does anybody know where I can look at things for managing labour for people with high blood pressure? I think that's the confounding factor here. I didn't want the induction but my blood pressure had been up for over a week and given the staining, it was probably best for baby to come out then anyway.

[IdentityCrisisMama]

Interesting thread. I'm looking into this kind of thing because I'm pregnant again and had something similar for 1st birth. I had some strange feelings - don't know if it really was the urge to push but thought it was. I wasn't dilated fully but was vomiting. Off to read the article...