Can you all explain what happened during my labor?

[justKate]

To caveat, I haven't requested my birth records. Mostly because it is a 4'' binder and it will be costly, but also because I think I need to be at peace with what I know happened, rather than what is written down. So with that in mind, here's what happened:

Mostly normal pregnancy (1st pregnancy, 1st baby). Slight uterine synechiae from edge of placenta to uterine wall identified at 20 wk U/S; specialist said no biggie. DD was basically using it as a footrest.

Labor started naturally on my due date at 7pm--no BHx, no prodromal labor. All back labor, no sensation in abdomen whatsoever. Increased through the night, tub, tried to rest, lots of vomiting. No sleep.
8am I go to hospital for (wishful thinking) something for the vomiting. Get phenigren (sp?) and morphine. 3-4 cm w/strong contrax. I rest in hospital. Eat. No sleep.
3pm drugs wear off, water breaks.
7pm still back labor, vomiting, I give in and call for epi (had to be done twice b/c he "missed")
10pm fully dilated, epi turned off
some pushing in here, not sure of the timeframe
11-12 pm baby won't descend. Midwife can't turn her. Fetal heart rate accelerated, moving me to my sides to keep her heartrate <200.
Midwife (who i trust completely) says she thinks its time to call the doc. We cry together. She asks whether I want the doc to come up to check... No, I trust her. 3rd epi (b/c they don't use the kind that can be turned back on).
I go to surgery.
Doc has to turn DD 2 complete 360* turns to get her out. According to midwife, she's wrapped once around her torso and once around her neck.
Baby is quiet, Huz is scared.
Her head is pretty seriously moulded, but Apgars are 6 and 9.

So I guess my questions are:
If she was low enough for her head to mold, why couldn't she descend?
Is this the kind of problem that will repeat itself if I try for a VBAC?
Did the uterine synechiae play a role?
Was this just a short cord scenario?
Why wouldn't they have tried an instrument delivery?
What would have happened in the days before c-sections?
What if it had been a homebirth? (Wasn't an option at the time due to where we lived...but just curious.)

ANY thoughts are really appreciated. You won't hurt my feelings. I'm mostly at peace with my choices--feel like I did the best I could with what I had to work with. Someday I'm hoping to VBAC but want to learn as much as I can from my first birth experience....

What do y'all think?

ETA: DD was born at 3:01 am, so it was 32 hours from real labor beginning to her birth.

[MamaChef]

If she was low enough for her head to mold, why couldn't she descend?
Possible causes:
Asynclitic presentation, or something like brow first, face first.. where was the molding? direct occiput or slightly to the side or top?
tight cord around body and neck with no slack (this one would be my guess because of the heart rate in the 200s - was she posterior?
Restricted pelvis

Is this the kind of problem that will repeat itself if I try for a VBAC? Unless it was true restricted pelvis, CPD.. doesnt sound like it.


Did the uterine synechiae play a role? - Do you have Asherman's or just this one isolated spot?

Was this just a short cord scenario? - Definitely possible

Why wouldn't they have tried an instrument delivery? Those acels and no change in downward station... asynclitic presentation..

What would have happened in the days before c-sections?
Gosh, saying stuff like this is often unpopular, but it is honest. Babies did die. If you got to the point where you were actively managing baby's hb to keep it under 200 and had pushed for 2 hours with no change in station.. either baby would need to get out soon, or baby might have died. That is alot of stress on a babe. Now, how long you would have had to push the baby out before it was critical, who knows? A old time midwife might have had a better read on the baby's postion earlier in labor and helped rotate the head digitally or suggest position changes in your early labor, when you were feeling all of that in your back.

Likely Drs would have used high forceps when they had that tool.


What if it had been a homebirth? (Wasn't an option at the time due to where we lived...but just curious.)
You would have transferred when baby started having those acels unless the baby was coming out ASAP.

It's wonderful that your cervix dialated.. you went into labor on your own.. those are all really great things. It sounds like, to me, just based on your description.. that baby had a tight cord and just might not have been able to untangle enough to free up enough cord. It sounds like baby did descend a little when you started getting decels. Do you remember if there was a change in station shortly before that?

Processing a csection is a difficult process and I hope that whatever answers you find help to bring you peace and healing. Hoping you have a much different birth experience next time.

[MNHall]

Mamachef already answered most of your questions like I would have, but I wanted to add that my DS (#1, who ended in a c/s) was also a baby that wouldn't decend. I believe he never got below zero station. I always thought it was a cascade of interventions, which I'm sure didn't help, but I also learned he was malpositioned. Facing my right hip completely. He did have head moulding too.

So, for DD (my #2) I decided I needed to go natural, in order to let my body move and wiggle the baby down basically. It must have helped a little, because she did get a little further down, but still not enough. I was pushing, pushing, pushing and she wasn't budging. Again, she was facing my right hip...not rotating down through my pelvis. Luckily, maybe because she was a little further down my OB told me if I got the epidural, he could rotate her head, so that's what we did, rotated her head and pushed some more and she finally came out...still with some work.

So, after having two babies in the same position, for this pregnancy I visited a chiropractor. My hope and now strong feeling is that I have some pelvis misalignments that were causing my babies to get stuck (not that they couldn't fit, but that they got into this comfy spot and just didn't rotate through the pelvis). So, through chiropractic visits and my chiro found that I have some severely tight muscles in my right side of my pelvis and hip area, she said it makes sense that my babies stayed there. So....now that we're working on that, I hope that my babies will be able to rotate through my pelvis just like "normal"!

Anyway, I just wanted to add that in because the more I research the more I find out that so many c-sections are due to babies that just aren't in the idea position...but between things like chiro visits, stretches, and the right position in labor (which is something I probably wasn't doing with DD, I basically stuck to one position to push and that was it...I should have tried MANY positions, including hands and knees which is supposed to help rotate a baby into ideal position), so those things combined could put so many c-sectioned women's babies in the position to come on out with no issues. That's my plan!

[justKate]

Originally Posted by MamaChef

If she was low enough for her head to mold, why couldn't she descend?
Possible causes:
Asynclitic presentation, or something like brow first, face first.. where was the molding? direct occiput or slightly to the side or top?

The molding was a perfect cone-shape on the top of her head. I have a photo...I'm going to try to find it to post.

tight cord around body and neck with no slack (this one would be my guess because of the heart rate in the 200s - was she posterior?

Yes, she was posterior from what I remember. I believe my midwife tried to turn her at some point...Huz said at one point she had both hands inside of me, up to her wrists. :bugeyes

Did the uterine synechiae play a role? - Do you have Asherman's or just this one isolated spot?

No Dx of Ashermann's...no prior M/C or D&C. So I think it was a random thing. Basically the band went from one end of the placenta to another area of the uterine wall. It was at the top/right/front of the uterus.

It's wonderful that your cervix dialated.. you went into labor on your own. those are all really great things. It sounds like, to me, just based on your description.. that baby had a tight cord and just might not have been able to untangle enough to free up enough cord. It sounds like baby did descend a little when you started getting decels. Do you remember if there was a change in station shortly before that?

I didn't follow the changes in station. Wish I had, but I was pretty out of it from being so sick, the drugs, pain, etc. Thanks so much for your input. I really needed to go over it with someone more knowledgeable than I am, and since I'm not living near my midwife any more its great to hear it from you. Intiuitively, I feel like the cord was short and that she was trying if that makes any sense, but it is good to be validated. Thank you!

Originally Posted by MNHall

Mamachef already answered most of your questions like I would have, but I wanted to add that my DS (#1, who ended in a c/s) was also a baby that wouldn't decend. I believe he never got below zero station. I always thought it was a cascade of interventions, which I'm sure didn't help, but I also learned he was malpositioned. Facing my right hip completely. He did have head moulding too.

...

Anyway, I just wanted to add that in because the more I research the more I find out that so many c-sections are due to babies that just aren't in the idea position...but between things like chiro visits, stretches, and the right position in labor (which is something I probably wasn't doing with DD, I basically stuck to one position to push and that was it...I should have tried MANY positions, including hands and knees which is supposed to help rotate a baby into ideal position), so those things combined could put so many c-sectioned women's babies in the position to come on out with no issues. That's my plan!

Thanks! That's really good to hear. I'm going to do everything possible the next time around...and its so good to hear that you got your VBAC. for your next one!

[MamaChef]

So glad to talk it over with you. Im not an expert, but I'd like to be some day. Now, with small children just isnt my time, so some things will have to be suspended in time a bit.

The molding sounds like a typical pattern from a posterior presentation.

It sounds like your gut is right on, Mama. That baby sounds like she tried her little heart out.. and so did you.

Next pregnancy and birth is a new experience. Best of luck to you.

[phathui5]

Is this the kind of problem that will repeat itself if I try for a VBAC?

I don't think it will. It sounds like it was a combination of the baby's positioning and the interventions that you had.

[lyterae]

My dd had significant head molding as well, she didn't descend past +1 station, during the c-section she was found to be ROT. We are currently expecting our second and planning for our VBAC.

[justKate]

Originally Posted by lyterae

My dd had significant head molding as well, she didn't descend past +1 station, during the c-section she was found to be ROT. We are currently expecting our second and planning for our VBAC.

ROT: rear-occiput-transverse? I checked spinningbabies but the text is coming up all blurry for some reason....

Did your care provider seem to think it would be a recurrent issue?

[Llyra]

Wondering about this... I had a synechia (sp?) with DD1, and also wound up with a c-section when she didn't descend. She had significant head molding just like you're describing-- my mom dubbed her "conehead," that first day. She was my second baby. I've always wondered what was really happening...

[justKate]

Originally Posted by Llyra

Wondering about this... I had a synechia (sp?) with DD1, and also wound up with a c-section when she didn't descend. She had significant head molding just like you're describing-- my mom dubbed her "conehead," that first day. She was my second baby. I've always wondered what was really happening...

I'm not sure whether there's any way to know whether the synechiea (too lazy to look up the proper spelling) played a role. The perinatologist said it shouldn't... but

Did you have a synechiae with your third DC?

[Llyra]

Originally Posted by justKate

I'm not sure whether there's any way to know whether the synechiea (too lazy to look up the proper spelling) played a role. The perinatologist said it shouldn't... but

Did you have a synechiae with your third DC?

The third time around I had twins. The synechiae did not show up on ultrasound at all, even though I specifically asked two different techs if they saw it. So I suppose not-- I wound up with a scheduled repeat C-section that time, so I have no idea if they would have descended.

[lyterae]

Originally Posted by justKate

ROT: rear-occiput-transverse? I checked spinningbabies but the text is coming up all blurry for some reason....

Did your care provider seem to think it would be a recurrent issue?

ROT = Right Occiput Transverse

When I was interviewing midwives one of the most important things to me was to find someone that was skilled at knowing fetal position as well as ways to “spin” baby to a more favorable position. My midwife does not seem to think that it will be an issue.

In preparation I have been undergoing chiropractic care prior as well as during pregnancy, and I will be starting to take extra vitamin c towards the end of pregnancy. My water ruptured prior to labor starting last time and I think it is likely that it contributed to baby being in an unfavorable position.

[Monkey Keeper]

Originally Posted by lyterae

ROT = Right Occiput Transverse

When I was interviewing midwives one of the most important things to me was to find someone that was skilled at knowing fetal position as well as ways to “spin” baby to a more favorable position. My midwife does not seem to think that it will be an issue.

In preparation I have been undergoing chiropractic care prior as well as during pregnancy, and I will be starting to take extra vitamin c towards the end of pregnancy. My water ruptured prior to labor starting last time and I think it is likely that it contributed to baby being in an unfavorable position.

My last two babies were ROT when labor began, though DS was LOA just 12 hours earlier. With DD2 (#2), my water broke before labor began, and she never descended to apply any pressure to my cervix instead hanging out in my right hip. She was a c/s because my ctx never got closer than 20min apart, and pit already had failed once.

DS (#3) remained ROT my entire labor which resulted in extreme hip pain radiating to my sacrum. He was hung up in my right hip near my pubic bone for hours until we did some positional stuff to move him and then broke my water. That moved him from a really asynclitic position to fully applied to my cervix, and I went from 6cm-crowning in just a few contractions.

I did chiropractic with both pregnancies, pretty religiously with DS and even had an adjustment about 12 hours before labor started. I added massage therapy with DS, and my LMT acknowledged some pretty profound soft tissue issues on my right side. We worked with them as well was we could during pregnancy, but it wasn't enough to resolve them completely and still made ROT the most comfy position for my DS.

I would recommend body work as an addition to chiro care, even before pregnancy, to try to work out some of the structural issues you might have. All of my kids have hung out on the right, so it definitely is possible that the way your body is put together, the little ones find ROT the most comfortable. I wish I had known that before this last pregnancy for sure.

[lyterae]

Originally Posted by PinkBunch

My last two babies were ROT when labor began, though DS was LOA just 12 hours earlier. With DD2 (#2), my water broke before labor began, and she never descended to apply any pressure to my cervix instead hanging out in my right hip. She was a c/s because my ctx never got closer than 20min apart, and pit already had failed once.

DS remained ROT my entire labor which resulted in extreme hip pain radiating to my sacrum. He was hung up in my right hip near my pubic bone for hours until we did some positional stuff to move him and then broke my water. That moved him from a really asynclitic position to fully applied to my cervix, and I went from 6cm-crowning in just a few contractions.

I did chiropractic with both pregnancies, pretty religiously with DS and even had an adjustment about 12 hours before labor started. I added massage therapy with DS, and my LMT acknowledged some pretty profound soft tissue issues on my right side. We worked with them as well was we could during pregnancy, but it wasn't enough to resolve them completely and still made ROT the most comfy position for my DS.

I remember the pain... I couldn't decide what hurt more, my pubic bone or my sacrum. I'm hoping that this little one will pick a more favorable position for birthing. We never made it to crowning, I dilated all the way and pushed in all sorts of random positions (midwife also tried to manually move baby) and couldn't get baby to descend.

[justKate]

I really appreciate the responses. It helps a lot with the processing and gives me hope for someday having a vaginal birth.

[buckeyedoc]

Originally Posted by MamaChef 

The molding sounds like a typical pattern from a posterior presentation.

It sounds like your gut is right on, Mama. That baby sounds like she tried her little heart out.. and so did you.

Next pregnancy and birth is a new experience. Best of luck to you.

 

[First Time Mama]

 My baby was also one that wouldn't descend, after hours of pushing. He had moulding on his head too, and I think had a deflexed chin, and was malpostioned/posterior. I pushed for more than five hours at home trying to get him out. Ended in a transfer and c section. Was very emotional for me to process, I had always believed I would have a homebirth and I almost did. I am now planning my homebirth vbac, and feeling confident that the same problem won't repeat itself, although I have had a lot of fear of another  c section, baby that won't come out no matter how hard I try this pregnancy. I am hopeful though that I will have a different experience this time. I have an awesome midwife and I know my body is capable of giving birth. I will be back to this board after the birth to tell how it went!

[roadfamily6now]

I think your baby was in a bad position and that you were not mobile enough during your labor to encourage baby to move. Extremely limited mobility and a sleepy morphine baby probably lead you down this path.

I like the ideas of seeing a chiropractor and also maybe doing some prenatal yoga next time. With back labor you will want to experiment with different techniques to help get baby into a better position. Hands and Knees, Cat/Cow pose, Rebozo, etc should all help to life baby up and out of your pelvis and encourage him to settle back down in a better position.

[buckeyedoc]

I pushed out a ROT and asynclitic VBAC baby. As I pushed, the OB gently maneuvered his head. It was a much more painful "crowning moment" than I had with my normally positioned DS, but it only took a few really hard pushes to get him out. I was almost in a squat to push (on the bed, top of bed completely upright and me leaning slightly against it). Your problem probably won't repeat, but you can do it with the right provider, time and positioning. I had chiropractic care the whole pregnancy, so I have no idea why he liked being in such an awkward position. My water did break on its own in early labor, so maybe he dropped down in a bad position.

[justKate]

Originally Posted by roadfamily6now 

I think your baby was in a bad position and that you were not mobile enough during your labor to encourage baby to move. Extremely limited mobility and a sleepy morphine baby probably lead you down this path.

I like the ideas of seeing a chiropractor and also maybe doing some prenatal yoga next time. With back labor you will want to experiment with different techniques to help get baby into a better position. Hands and Knees, Cat/Cow pose, Rebozo, etc should all help to life baby up and out of your pelvis and encourage him to settle back down in a better position.

I agree that mobility was probably a huge factor.  I had a doula, but I don't think she was the right doula for me, in retrospect. I needed someone confident enough to stand up to me and tell me to move...not blaming her for anything, but I really had no idea how scared and sick i would be. So much learned!  And I'm so ready to try again.