Processing my birth: GBS infection and Malposition/not-ideal pelvis shape?

[47chromosomes]

I'd love some insight if anyone has any on the issues that came up in our recent birth in November.  I go for our close of care appointment with our home birth midwives next week.  I'm sure we will go over time talking about our birth. 

The quick synopsis (oh, I'm sure this will be a novel and not quick... sorry):

Planned home birth of our third baby.  Second home birth.  I'm GBS +.  My second labor was difficult with an acynclitic baby (he was 8 1/2 pounds).  First birth was easy (baby was 7lbs 4oz and he has low muscle tone and ligament laxity, so I wonder if that was why he came through so easily).

This baby went overdue.  There was no sign of labor at all, so at 41+1 weeks I had my HB midwife strip my membranes, and at 41+4 I had our Hospital based midwife strip them again.  I went into labor that afternoon 41+4.

At 6 or 7pm after the baby had a HR decel during a contraction the midwives wanted to check me to make sure there was no cord prolapse.  No prolapse, and I was found to be 8cm!  Got in the tub, and labored for another hour and was at 9cm.  Labor was sort of sporadic, and not intense.  Baby was not firmly engaged.  The midwives offered AROM to get baby engaged and outta there.  AROM was the magic bullet in my second labor when I had been stuck at 9cm for hours with our baby unengaged and acynclitic.  So, DH and I agreed to AROM.  Labor became intense.  I dilated to 10 with a lip and had to push.  Midwives offered to hold cervical lip back while I pushed.  We did that for a while, but it was not working.  My dilation began to regress... DURING contractions.  Close to 10pm, I began to get fearful about staying home, so with no obvious reason to transfer, we transferred purely at my insistence for what we deemed in retrospect to be intuition.

Anyway...  We get there.  I had antibiotics hooked up and a dose of fentanyl.  I begin pushing again after re-dilating to 10, still with a lip.  Baby was still high.  That was not working.  At one point I went to use the restroom, and when I came back, baby was even higher than before.

Then his HR started to decel during contractions.  Internal monitors were placed and an OB was called in to back-up the midwife.  I was still at 10 with intense pushing urge, but had to pant through the contractions because baby was going no-where with pushing, and when I did push his HR was LOW--40's.  This scenario went on for a couple hours.  I was totally freaking out.  For one I had been having intense urge to push for HOURS and was having to pant through that urge.  When I did push (because sometimes I just could not keep on top of the contraction) baby would struggle.

Baby was rotating all around, and midwives and OB were wondering why he was not getting through the pelvic inlet.  Contractions were strong.  Baby did not feel huge.  Another dose of Fentanyl.  OB convinced me to hook up pitocin to try to ramp up contraction strength and get our critter down and out.  Our baby finally began to decend.  First OP, then turning ROA and coming out, suffering a cracked clavicle on the way.  (DS2 went OP before coming out ROA as well.  DS1, I don't remember him going OP, wasn't as aware of position then, but I know he came out ROA.)

He was blue, and taken directly to the warmer where they used the ambu bag to get him breathing, suctioned him (he was born leaving quite a trail of meconium in his wake).  He was in respiratory distress, and they worked with him for an hour in our room.  Eventually he was taken to the nursery, and put on the C-PAP.  Long story short, our pediatrician decided to take him off the c-pap and just let him try to nurse to see if that would calm him enough (he was extremely frantic) to see if he would do better, otherwise he was headed to another hospital to NICU.  That was key for him, and his condition improved as he calmed down.  He was still grunty, but his oxygen levels were good enough that he could stay at our hospital, and improved with time.

Immediately after the birth I spiked a high fever.  With the DS's respiratory distress and my fever, it is believed we had chorioamnionitis, perhaps due to my GBS + status and ruptured membranes, or the membrane sweep?  We both spent the next few days in the hospital on antibiotics.  The 48 hour blood culture for GBS disease for DS came back negative, but later my hospital midwife shared that when antibiotics are administered during labor the culture is not always to be believed if it comes back negative, and she thinks my infection and DS's issues with not handling labor and the respiratory distress after birth WAS due to GBS infection of the uterus (she said chorioamnionitis), and our excellent health and the fact that we came in and had antibiotics started during labor was what helped us to bounce back quickly and without further complication. 

It is also suspected that my pelvic inlet is narrow, or shaped as such that babies need to enter OP.  My first son flew right through, but was over a pound smaller, and a very maliable baby due to his low muscle tone and ligament laxity.  I am really scared that a baby larger than DS3 could simply not be able to get through.  My pelvic outlet is "roomy" I've been told, and truly, once my babies get into the pelvis, they come right out easy peasy.  At least that is good!

Anyway, I don't know what I'm asking for.  Insight, I guess.  I just feel the need to process this birth so I can live with the eventuality that one day we may have another baby.  So, thanks if you made it through that novel!

Edited by 47chromosomes - 1/2/11 at 8:48pm

[littlethingstx]

I would encourage you to read "Ina May's Guide to Childbirth".  I just read it and it is very much on the hippie side, but wonderful.  In that book she really discusses different laboring positions and how they affect the way the pelvis opens up.  When you are on your back like most women in our generation or made to do during labor it narrow the pelvis inlet.  In further discussion she talks about a manuever called the "Gaskin Maneuver" for when babies do get stuck.  In that position you get in a hands and knees position (or all fours position).  Also, a lot of squatting helps in labor.  More than anything I say read this book because she really talks about how the culture we live in has a way of making us believe our bodies are defective and can not do this great work.  Often it has much more to do with the circumstances around us and our own emotions.

[47chromosomes]

I've read that book so much in my pregnancies that it's fallen apart.  Definitely well versed in the movement helping babies through.  And you know what?  Both of my difficult labors the way my boys finally came through was with me laying absolutely flat on my back.  But I agree with everything she says and it was instrumental for me in my first birth as my mom and I both share a pelvic feature for which she ended up with cesarean births (a narrow pubic arch, and as it turns out for me, that narrow arch is the least of my worries.  My babies fly right out once they get past my cervix).  It helped me to choose natural birth and to choose to move around during labor.  Thanks for responding.  I love Ina May, but with my last experience I'm not convinced that birth is meant to be easy for me, despite unhindered movement.  I'm trying to come to have peace about that.  My babies had a rough time finding just the right spot to fit through, but they did fit in the end.  It was rough, though.  I guess that is what is scary to me.  I did everything right.  All my practitioners, my home birth midwives, the hospital midwife, even the OB, did everything right.  Ina May would have been impressed, and it was just a hard, scary birth.