Mwherbs--thanks for the kudos! I'm one of your biggest fans, so your praise means all that much more.
Screening as I suggested IS a tough job...it was just that issue that recently got me reported to my state med board in this illegal state. Primip, surprise breech...very happy ending in terms of everyone's safety and health (we transported, were met by best possible OB and got nothing but kind respect)--but the mom and dad were SO angry with me afterward! In retrospect I could clearly see the 'screening issues' that I should have attended to more carefully--hell, in the last few weeks of her pregnancy, I already had some reservations about this couple, based on psycho-social matters. It's just that mom was so physically healthy, and had accomplished so many challenging things in her life, that I chose to believe that normal birth would out for all of us.
Yeah, she was healthy, but 'competitive'--she was going to prove that homebirth is great to all her detractors (who were legion). She was also a 'can-do' kinda woman...the downside of that being "MUST *DO*--can't surrender". The need to control just doesn't work at birth.... She was also one of those who could NOT admit to fear, and so she was successful in disguising her fear from me for quite awhile. Ah, personalities...ours was a dynamic in which her assertiveness and 'dominant' style trumped my more laid back one--I wanted her to be in charge, empowered...well, no system is perfect, not every relationship works as well as others. Oh, I tried to talk to her, I brought up fear and control...and she denied, denied, denied....smiling and insisting all the while, and trying to self-induce from 38 wks onward (and for her pains got a 42wk pregnancy--not unheard of in her fam, doubt it woulda been different if she'd NOT tried to induce--but she did get a lot more false starts and general feeding of her impatience and urge-to-control thereby). Well, not to go on about her...but I was not surprised that they complained about me. She was humiliated, this very proud woman, and someone has to pay for that! Nevermind that she refused my 2x suggestion for an u/s based on 'weird position', nevermind that the OB offered vag breech delivery and she insisted on csec...it was MY fault, my incompetence, MY false claims and the least I could do was refund their money (did I say that my fee is lower than anyone I've ever heard of, outside of this region? And lower by a full 1/2, than many places? And that I had many false alarm calls in those final weeks, extra visits, etc...and that they signed a contract that says they would pay full fee even if hosp birth, if I came to their labor at home prior to transport? And that I did accompany transport and helped in numerous ways she never noticed?)
Well, MOSTLY I'm better about this sort of screening than in my early days. She was the first of her sort since my return to practice after some years break--and I'm just eternally grateful that in the end, she and her baby were fine--that they don't have health issues to complain about. The baby was simply breech--NOT compromised (I've never done breech yet, would hope that my first experience happens in company of a breech exp. mw). Anyway--they did show me signs of the kind of responsibility AND psycho-social issues that I mentioned...and I didn't listen! It was a very valuable reminder that no matter how well a family eats and exercises, that psycho social stuff can make the biggest difference in outcomes.
But I will say this, in agreement w/Apricot and some others here: so often, the reassuring and totally calm, positive presence of others makes the biggest diff to a mom--primips especially--in a long hard labor. Long labors don't bother me...I understand labor to be a process by which a mother and a baby work through the physical, emotional and spiritual tasks of a baby being born and a mother being born/reborn. Sometimes, there are 'physical issues'--I myself had quick labors with my smaller ones, even with my slightly contracted pelvic outlet. My larger babies all took a min of 20hrs active labor, pain in the pelvis all throughout! Not to put this down as merely physical--I'm sure it was harder for me to let go with these bigger babies, emotionally as well. But I've seen smallish babies take days to arrive--and then I usually gather that the mom and/or baby are wrestling through emotional/spiritual level stuff...and with the right care, they will do so! Hydration and calories and frequent peeing; rest and breathing, acceptance even where you don't entirely understand, assurance that motherbaby can do this--these things go a long way to keep a labor 'normal'. They say "do you really think I can do this?" and I say "Of course--you were made to do this, you ARE doing it....it IS happening, in your own way and time"
I do affirm to flagging moms in these long labors that they have many layers of power available to them, and most believe me--and do find their second (and third and fourth) wind, as it were. I urge them to allow that strength to arise, just allow, it will come without effort if they only keep breathing deep and easy. As long as baby is fine, what's to worry about? Babies for the most part are incredibly well-suited to labor, resilient to the stresses (where it is stress at all). Tho I watch the clock in terms of knowing when it's time to listen to baby again, or suggest a pee break, I have to let time dissolve as much as I want the moms to do so.
Especially in these long labors I do love my doppler...I can turn it up loud and say "listen--do you hear your baby's heart? See how well s/he is doing, still? All is well, we can just keep on" When fears arise, whether from mom, dad, or other helpers, we address this: especially if from mom or dad, I will say--'are you really feeling that something is wrong, do you truly believe med help is needed? Or is this mainly just fear?' Most admit that it's fear and fatigue, not a premonition...so we work on the fear, and most often it dissolves. If it's arising from a helper, well sometimes that person has to leave, or at least go take a nap. Laboring Moms need unqualified support and affirmation of normalcy, no one around who emanates fear or control...back to that great psychological sensitivity again.
In any event, yes, motherbabies can do the dance of descent, baby finding the path and positions that work for getting born. Moms participate in this, too--whether through finding the best 'passive position' to allow the great intensity of contrax without struggling against the pain involved, or in their movements of back and pelvis. Time need not be an issue, nor OP nor anything else--I myself have never seen what I'd call a problematic OP delivery! Not really--it usually works out and is not so devastating for the mom who can work with the process with her breath and body (and has support, which some do need, massage and other). I will have her try things, but sometimes it's not certain positions or moves that works so well as just her ability to breathe and stay calm, and let the dance happen. The main thing is, is this mom really ready for homebirth, and does she have the support she needs in her closest milieu--or at least, really good boundaries with the detractors? If she doesn't go into labor with a strong sense of her power to birth, is she willing to find/allow that power, or does she ultimately believe that that power only lives in doctors (or even in hbmws).
babbling here, I guess I'll just stop now!!
sometimes I suspect an OP position in labor and then it resolves on its own. I am committed to using things like H&K and the robozo to help with these longer labors. It's very hard!
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