Please help me process my birth...

[Usually Curious]

I gave birth to my sixth child early Sunday morning and I have a couple of questions about it.

My first five births were relatively easy - 12 hrs, 5 hrs, 3hrs, 3hrs, 3hrs. I pushed for 15 minutes with my first and the others were born in 1 or 2 pushes.

Apparently, I have a pelvic big enough to drive a truck through. This is good, I guess.

My labor started Saturday afternoon and piddled out after a few hours. We had called the MW right away because of my history of short labors and she and her asst were onsite. She was happy I wasn't going over (I was 40.1 weeks) because of my GD (which was completely diet controlled but she still freaked over). She had been telling me since 38 weeks that I was going any day (even though I had gone 41 weeks with all of my other pgs). She was anxious to intervene in any way to get my labor to progress.

When she arrived Saturday evening I was at 3cm, -1 station. At my last checkup I had been a stretchy 4 and +2 station. She offered to augment my labor or break my water and I chose to labor on for awhile, even though there wasn't a lot of 'laboring' going on.

I piddled around for another few hours and when she checked me I was at 5. I chose to continue on and a few hours later was at 7. I was obviously progressing on my own but was impatient because this labor was SO VERY different than my previous ones. I agreed to let them break my water.

Oh, also, my cervix was VERY posterior and I wasn't dialating well until they pulled/held it forward during contrax so that the baby's head was really on it. How could I forget that part?

Anyway, fast forward to pushing. It took a long time and was very hard and took multiple very powerful pushes on the birth stool to push him out. It was very different than my previous births.

After an excruciating pushing stage (about 25 minutes - a LOOOONG time for me) he was born. After a few minutes rest they told me to push out the placenta and after part of it came out she began to twist it into a rope but insists she did not tug at it. Immediately after the placenta was out I saw a red, fleshy spot in my vagina and asked if it was my uterus. I KNEW it was and she said no, it was placenta. I said, not that - LOOK IN MY VAGINA. Oh yeah, that's uterus and then they pushed it back up inside (not fun).

I have not bled much (which the backup doc said was a miracle).

At our PP meeting we talked about the birth. He had a nik on his forehead from the hook used to break water. She surmised that he was a brow presentation from that. That explains the difficulty pushing, the strange, long pushing stage and the prolapsed uterus.

But does it?

Does PROM have anything to do with it. If I had not called early and felt like a watched pot could things have settled down with baby ultimately coming later in a more favorable position? If we had not interfered would we have had a different outcome? Maybe? Definitively?

I feel like this was a very managed homebirth with an aggressive third stage management although the MW says it was not aggressive.

I'm really feeling a little lost in this. It was very hard compared to my other labors and I am questioning my 'going along' with her recommendations.

Could you offer me any advice? TIA

[cathicog]

Well, were you sitting upright when you pushed the placenta out? Positioning could have had a lot to do with the prolapse, as well as a long pushing phase, especially for a "grand multip".(more than 5 babies)..Maybe the midwife thought that breaking the water would put more pressure of the baby's head on the cervix, thereby dilating it better. Given they didn't know beforehand of the brow presentation(was baby posterior at all, that could have made for a slow labor too)it IS a miracle, I think that things went that well. I thought position of baby was supposed to be checked before ROM, but maybe not. I don't want to secondguess anyone, just wondering out loud. Sometimes moms of many do have an occasional wierd labor. But it might have been advantageous to wait, as well. One doesn't always know...Have you talked to the midwife about it? PS, Congrats on your new little one! Enjoy your babymoon!

[MsBlack]

A couple things....

One is, if it were a brow presentation, wouldn't that have been obvious as baby's head emerged? I suppose it could be said that baby *had been* brow at the time of AROM, then tucked chin before birth....just seems unlikely to me. AROM is more likely to cause a baby to maintain a poor position rather than improve position. Would hope to hear from other mws on this, never seen a brow presentation (not at emergence, anyway).

Second thing is....I'm just not sure why there was so much management. I don't know, my own style is extremely hands off, I think I would have been focussed a lot more on helping you to stay in the present with each contraction, helping you to be at peace with THIS labor and it's character rather than wanting it to be more like your other labors. For instance, I doubt I would have suggested yanking on your cervix to bring it forward, or AROM--instead, acknowledging the real progress being made, and assuming that there were reasons for the way progress was occurring. As long as all signs in mom and baby are good enough, then I trust that everything is being worked out as needed without my interference. There are many possible reasons for the different character of this labor--reasons associated with baby (positioning, cord length or wraps, eg) and/or with mom (body tension, fatigue, eg).

Considering the mild-to-moderate way your labor did progress, I might have gone home, or maybe taken a nap to let you get on with it in peace, instead of sticking around and doing multiple VE and all that.

Can't say I understand 3rd stage mgmt either--it does sound fairly aggressive, at least according to my own standards. And well--a partial prolapse of uterus would seem to imply that some kind of force was applied. Ok, it can be guessed that your forceful 2nd stage pushing was involved as well, but I'm thinking with a Grand Multip, especially after a forceful 2nd stage, I might be inclined to be even MORE hands off 3rd stage. I rarely direct moms in 3rd stage, especially not so soon after the birth, unless for instance I see a goodly amt of bleeding. I wasn't there, so I can't say for sure of course.

But I do find that people's definitions of 'trusting birth', 'hands off', and 'aggressive mgmt' can differ quite markedly. I have a homebirth-CNM friend who talks about being 'hands off'--but whenever she tells me a birth story, it sounds like pretty much hands-on to me! But I realize that given her training, and earlier hosp and BC experiences, she is very hands off by comparison. Anyway--what you describe of the whole labor, including 3rd stage, sounds pretty aggressively managed to *me*. Compared to what your mw believes is needed, and what she *might have done* even more actively/aggressively, well--perhaps she doesn't feel what occurred was aggressive, KWIM?

One thing I always warn multips about--especially if their prior labors have been generally short or even generally long--that EACH LABOR IS DIFFERENT, you might not get what you expect! But in all likelihood, you and your baby will work things out just fine and perfectly, with trust, patience, and taking care of basics like eating, drinking, peeing, resting when possible. I have seen labors like what you describe--and most often (at least w/grand multips), things suddenly turn a corner and birth goes fast after hours of slow progress. In spite of what you have come to expect, a labor like that can actually be easier on mom and baby both, IMO. As long as exhaustion or fetal discomfort/distress isn't an issue, anyway....which does not seem to have been present for you/baby in this case.

[Usually Curious]

Thanks for the replies.

I wonder if she had just gone home when my contrax piddled out if he would have just waited a few more days and been in a better position and birthed more like my others.

It's hard to second guess and I know she did every thing she did in good faith, always allowing me to make the decisions. In fact, the reason it went on for 12 hours was because she allowed me to make the calls and she did not bully me whatsoever. At each stage I was tired or impatient and allowed the intervention. I am in no way trying to shirk responsibility, just wondering if my intuition about the way the birth was managed might be valid.

It just seemed very 'managed' to me.

One thing I learned about this birth is that a homebirth with a MW is not necessarily 'intervention free' that is for sure. I also learned how easily swayed I am labor, as any intervention goes completely against my grain.

I did speak to the MW about the third stage management and she denied that her asst. tugged on the cord at all.

[Natsuki]

The labor pattern strongly indicates malpositioned baby - the piddling contractions, the slow dilation compared to previous labors, the cervical position, and the pushing stage being so much longer than you're used to.

An experienced midwife should have recognized that and looked at getting the baby to move through different labor positions and techniques first before breaking your water which is pretty interventive, especially with malpositioning.

I think that she probably assumed as a 6th time mama that things would be a piece of cake and no complications, and when things didn't follow according to previous expectations her goal was to help things hurry up instead of finding the underlying issues to resolve.

(www.spinningbabies.com has a whole section on labor techniques that I used during my homebirth with DD which fixed my irregular labor due to malpositioning - I had mild scoliosis as a child so pelvis is slightly 'off' and I have malpositioned babies and long labors due to that, 52 hours with DS and 18 hours with DD).

I can't speak to the prolapsed uterus - I don't think that was related to his presentation, that would be more likely a result of being a grand multipara or if the midwife did pull on the cord.

[MsBlack]

Usually--

Gently and with respect--you say you agreed to everything (w/possible exception of 3rd stage), no one browbeat you in any way to do what was done. You also say it seemed quite 'managed'. Under these circumstances, was it you who partook willingly of that management? Was it your own impatience with the slower-than-usual process that became the 'manager', in essence?

This is not to judge in any way. I just find for myself that identifying my own part in events, my own responsibility and so forth, can go a long way in resolving any bad feelings or uncertainties I have about unsettling events.

I've seen this about mws, having worked with a few different ones, and having discussed birth with probably hundreds: many mws believe that if they can make labor shorter for a woman, then they *should* do so--or at least offer up what techniques they have, for a mom to choose or not. Many mws sincerely believe with loving hearts that to make the baby come faster is a merciful thing for all concerned. It's not the ONLY thing that a good mw thinks about...but it can be one of the big things on her mind. Also, many mws sincerely believe that by 'doing things' to/for a mom during labor, they are demonstrating an authority with birth that makes moms feel safer, more cared-for. And generally speaking, feeling safe and cared-for does help most women at birth--whether or not the things the mw 'did' were needful at all.

Anyway--not saying whether these things are good or bad, that is a matter of opinion and preference for moms and mws both. Just saying that seeing your fatigue and impatience may well have moved your mw to offer things to you to speed things up. Maybe she felt it was needful to get it done soonest, maybe she just thought you'd appreciate that. And even a good mw can fail to see that what she offers kindly may later seem 'pushed' or 'needlessly managed' to a sensitive laboring woman.

Natsuki makes a good point about your labor pattern quite possibly pointing to malpositioning. We don't know--other things could have instead been in play to make for a 'piddly' labor. I'm one to first offer things that a woman can do for herself/baby to help resolve such a pattern....sleep, various movements/positions, emotional release, trying to inspire her greater trust in herself and the present process. That is my chosen way, one that I highly value and have been working to get good at. Other mws have other ways in their bag of tricks--just the way it is, again there are differing beliefs, approaches, training at work. Some families don't hire me, because they can't feel safe enough with what they see as a 'TOO laid-back' approach--not nearly active enough for them to feel safe!

So yeah...by some lights, it seems there was a significant degree of 'management', and the true need for that management is questionable in the eyes of mw like me. In the eyes of an even-more managerial/active mw, it might not have seemed like much mgmt at all. What really matters here is YOUR opinion--and it sounds like you felt 'overmanaged' to some degree. I can see that. And again I ask you to consider if perhaps, in an unwitting, unintentional way, you might have inspired or at least agreed to that mgmt yourself. Only because it seemed right at the time, of course! Only because you were getting tired and impatient, and you had a mw whose particular bag of tricks included a more hands-on skill set rather than more hands-off.

I hope this makes sense. Everyone involved in any situation was a participant in creating that situation....sounds like you know that already. So--maybe just for future reference, for your own future births or at least for sharing with other moms you meet along the way--maybe this birth has things to teach you about yourself, your most important preferences, your psychic space during labor, as well as about your mw and the need to understand in advance about a mw's approach and skillset.

I hope your musings on this birth can be helpful in deepening your joy and appreciation as well as in offering lessons to ponder and work on, into the future. However you view your birth (and mw) in these particulars, it still remains that only YOU had the power and love to grow and birth a healthy baby--and you did exercise that power--you were still The Key Participant in a beautiful, wonderful miracle

[erin_brycesmom]

I think the interventions were likely a contributing factor to the difficulties you had...honestly starting with the cervical checks in the days/weeks before labor even started. It's hard when you are expecing labor to come and it doesn't. It's hard when it coms and it's slower than you expect. I think I would have wanted the MWs to go home. I didn't even call my MWs until almost 72 hours into my labor because I didn't want that pressure of knowing they were waiting on me. My body doesn't respond well in those types of situations. I think AROM does more harm than good especially when there is poor positioning. AROM doesn't even speed up labors or prolonged labors. That's just a myth.

[Usually Curious]

Originally Posted by MsBlack

Usually--

Gently and with respect--you say you agreed to everything (w/possible exception of 3rd stage), no one browbeat you in any way to do what was done. You also say it seemed quite 'managed'. Under these circumstances, was it you who partook willingly of that management? Was it your own impatience with the slower-than-usual process that became the 'manager', in essence?

Yes, absolutely, that is why I said this in my second post:

It's hard to second guess and I know she did every thing she did in good faith, always allowing me to make the decisions. In fact, the reason it went on for 12 hours was because she allowed me to make the calls and she did not bully me whatsoever. At each stage I was tired or impatient and allowed the intervention. I am in no way trying to shirk responsibility, just wondering if my intuition about the way the birth was managed might be valid.

Thanks for helping me think this through. I am so tired and not spending much time online but wanted to acknowledge all of your replies.

She is a new (to me) MW as we moved away from my old one. She is walking a fine line with the stupid laws in this state - I'm sure that factors in, too.

I am disappointed in myself - for letting myself be swayed when I knew better. I will be stronger next time, I hope. She would have been totally cool with hanging out in the kitchen until I felt I needed her.

The failure was mine in that I allowed her 'medical mindedness' to infect me. Next time I will handle things differently (if there is a next time).

My oldest dd is getting married soon and wants to use her when she begins to have children. I will have to put some thought into how to talk to her about all of this.

Thanks again, ladies. I love this forum!