What went wrong?

[EmilyVorpe]

My sister had a baby in May. She had an uncomplicated pregnancy. Right around 9 months, she had shooting pains in her bum. She was told she had a pinched nerve. At 38 weeks, she went to her appt with her ob and they said "oh! you're going to have the baby this weekend! you're 2cm! stop working!" so she left work. She got VERY big those last 2 weeks. No GD or anything, though, no excessive weight gain (30 pounds total). The day before her due date, she was induced. Contractions came so fast they turned the pit.off after an hour and she labored on her own the rest of the time. At 5:30, she was pushing. She pushed for 2 hours with ABSOLUTELY no urge to push. She said she could still feel him at her ribs and NEVER felt good during the pushing. She tried MANY different positions, even standing. They did a Csection. He was 9 pounds 11 ounces and 21" Was this baby just too big for her? She's 5'3" and 115 normally. Was there anything else they could have done to help her?

[mendomidwife]

Hmmm...hard to say. Too bad they had her push without an urge......but it could be that her labor was dysfunctional and/or perhaps her perception of the urge to push was dysfunctional as well.
Sounds like the baby was big for her. I've seen small women push out big babies...but maybe for her it was too big. Is the FOB very large?
I would have liked to see some descent after two hours of pushing.
There isn't much you can do in these situations - sounds like she tried different positions.

Carla

[pamamidwife]

again, like carla said, it's hard to say. I rarely think that babies are too big for their mothers - and have seen some nice sized babies come from women who are smaller than your sister!

Perhaps there was an issue with positioning. that is what sticks out in my mind with no pushing urge. I think that the providers always go by dilation for second stage when it should be when the mother starts getting that strong pushing urge. if time is taken, a funny positioned baby can have time to rotate before forceful pushing starts.

[CEG]

I have sometimes seen prolonged pushing result in a swollen cervix. Perhaps the baby was malpositioned and such pushing resulted in something like that? It could also be that babe was so big he never descended and she never got the urge to push, but like the PP that would be rare.

[attachedmamaof3]

My guess?

1. Induction.
2. Pushing. She tired herself pushing before she was ready. When you're ready your body usually pushes for you (you can't HELP but push, even OVERWHELMED by the urge to push)
3. Positioning. Probably maternal/fetal or a combination of both. (Can often be a problem with inductions since baby wasn't in optimum position for labor when labor was jump-started.)

[guest9921]

Not a birth professional here - but wanted to share my experience.
It mirrors your sisters a bit, though I was able to escape a cesarean.

Pre-pregnancy I am 5'4" - size 2, (never kept track of weight.)
With my son (my first,) I was dialated 2-3cm for a 5 weeks prior to birthing him. I went 10days "past" my "due date" before I accepted an induction (out of lack of education.)
They AROM, and then started the pitocin after 4 hours of labor (though I was dilating .5cm an hour, it wasn't 'fast enough') - the pitocin was too high, my uterus was hyper contracting - I was taken off the pit, and labored on my own the rest of the way. I asked for an epidural midst their pitocin overload, though it didnt work - I was confined to my back.

I pushed on my back for 2.5hrs, I felt everything, every contraction and urge (though I'm sure they were altered by the epi at least a bit.) And never felt the 'pushing urge.' Though I was told to purple push.

I did give birth to him vaginally - all 10lbs of him. (No GD.) Yet I doubt my body would have been ready 2 weeks prior.

In my unprofessional opinion - and though I'm sure our bodies do differ quite a bit - your sister and her baby may not have been ready. Her body was probably fully capable of birthing that baby.

Also - my son was covered in vernix. Though he was 10lbs, I'm sure he probably could have cooked some more.
I'm getting close to having another baby, and I'm hoping for another 10lber. Big babies are lovely, warm and sturdy.

[SublimeBirthGirl]

Seems to me like another case of medical management creating a self-fulfilling prophecy.

[janellesmommy]

I'm not a midwife, but I believe the induction was the problem. If she had been allowed to go into labor naturally, there's a very good chance the baby would have dropped on its own when it was ready.

[Benji'sMom]

I'd say, a "due date" is not perfect sience, if not induced she could have delivered vaginally 2 weeks later or something, it's no use trying to rush it. And 2 cm dialated is not a whole lot, you can be 2 cm dialated for weeks before the birth, it is not an indication that you're going to have the baby really soon, you know?

Induction, it's common knowledge that induction produces the wrong kind of muscle contractions, they don't push the baby down properly.

I think it just wasn't time and it was rushed.

[ZoeyZoo]

What really bothers me about the story is that she had no urge to push and pushed anyway.

Did they do AROM? This is typically done with inductions. If so, the baby may not have engaged properly in the pelvis.

[EmilyVorpe]

Originally Posted by ZoeyZoo

What really bothers me about the story is that she had no urge to push and pushed anyway.

Did they do AROM? This is typically done with inductions. If so, the baby may not have engaged properly in the pelvis.

She says when she got to ten, they turned the epidural down and kept turning it down til it was off and still no urge to push.
Her bag of waters was broken for her after 2-3 hours, I believe.

How long could they have waited at 10cm for her to get the urge to push? Since she didn't get it even after 2 hours.....

And the 2cm thing.....I've had babies and I know that 2cm can go on for a while..... but they made her feel like she was going to POP early and so she was at 2cm for about 2 weeks....like that was awful. This was a woman OB, but its a women's clinic. I thought those were a little different than the general runofthemill ob offices.

[bobandjess99]

Originally Posted by EmilyVorpe

How long could they have waited at 10cm for her to get the urge to push? Since she didn't get it even after 2 hours.....

.

I was "complete" for about 7.5 hours before getting the "urge" to push.
and it was transition-level hell, contrax every 2 minutes, lasting for a minute, the entire time. For SEVEN hours.
but then, when my body decided the kid was coming out...it completely pushed the kid out in like 3 pushes all on its own, like a freight train barrelling through my vagina - I could neither have helped or stopped the process. This was a 9 pound first baby at 41.5 weeks, in a diabetic mom, who is barely 5 foot tall and small-framed.

[attachedmamaof3]

Originally Posted by EmilyVorpe

How long could they have waited at 10cm for her to get the urge to push? Since she didn't get it even after 2 hours.....

For some women, it can happen very quickly. For others, it can take a while!! It shouldn't matter. No harm comes to the baby/mother by waiting while in fact pushing to early and for too long can cause issues (as you've seen). 10cm is a guideline..that's it!!

It's like....say you eat lunch every day around 12pm, varying a bit. Well, just because it's 12pm doesn't mean you're hungry. So if someone (an expert) says to you...OMG it's 12pm YOU MUST EAT!! EAT!EAT! EAT!! You MUST be hungry because it's time for you to be hungry. Then you stuff your face because it's time to eat and you wonder why you're not hungry. Then you throw up because you ate to much and now you feel like crap. Now you have to get your stomach pumped because you ate too much. Why? Because you ate when you weren't hungry because someone (an expert you trust) told you that you should be hungry and doesn't understand why you're upset that all this extra stuff happened!!

See, the thing is, once the baby's head hits a point in your birth canal it stimulates the urge to push. If the baby isn't positioned quite right, OR if pushing begins BEFORE the urge happens, the urge may be delayed or not return at all. Often if baby is malpositioned, the urge occurs as the baby moves into position.

IMO, this whole thing went off track with the induction. Just as information, I ALWAYS sit at around 3 cm (with my last 4cm which in some medical books is actually labor) for around 3 wks before labor. I also get pretty good Braxton-Hicks. Then labor hits and WHAM! I'm in it...I get the urge to push and I usually only push for around 10 minutes. My first was 15 min, my second was around 5 min and my third took 2 pushes.

Doctors like to give you reasons why it CAN'T work rather than LETTING it work. Both my boys were born occipital posterior which in many hospitals is considered undeliverable. The key is having trust in your own body, not the "law of averages" that doctors live by.