Can you help me work this through.....

[Sadystar]

Ladies I need some help working through my birth story, it´s been a year now and it still throws up whys and what ifs.

I know there can never be a definitive answer, but I´d appreciate ANY feedback on this....

The birth of my dd was planned HB with a wonderful lay-midwife, whom I knew and saw weekly from 14 weeks. I had a very healthy pregnancy and had very little contact with medical services - the main reason for searching out an independent midwife was that birth is very medical here in Spain, my local hospital has 42% CS rate. At 34 weeks we found out that baby was breech, but still everything else was fine. After getting myself in a bit of a tiz and trying EVERYTHING to turn her, at 37 weeks I accepted my fate and surrendered to the realisation that this was gonna be a bum down baby and we were still going to go ahead with HB (breech is automatic CS in hospital here). My midwife was totally supportive, she has delivered breech babies and gave me lots of positives and information. She has also taken very few women to hospital in her time and I believe I was the first CS.

My waters broke at 1am in the morning, i was 39 weeks. Unfortunately it was 8 hours before we were due to sign for our new house and move in - the place where in my head we were gonna have our baby. All our stuff was in the new house, including birth pool. We had four carrier bags of last minute stuff by the door and 4 dogs - who were shortly joined by 7 puppies as one of the girls went into labour 10 minutes after me!

I couldn´t rest after that, I couldn´t keep any food down. My midwife came sometime in the early morning, the waters were clear and remained pretty much so during the whole time. It was very calm, and whilst I was in a lot of pain at the base of my spine, the contractions didn´t seem to speed up at all. A second midwife came about 24 hours later and they both stayed with me - around 3am the following day I was fully dilated and told to push, though at no time did I feel that "urge" that everyone talks about, nor could I feel anything to push on and still the contractions didn´t come quickly, even though I was given lots of herbs. Basically we went on like this for the next 12 hours. Everything was still very calm and I was completely taken aback when the suggestion was made to go to hospital, even though I understood that by now I´d been awake for 36 hours (with only 2 hours sleep before that), neither had I eaten and I´d been "pushing" for 12 hours - added to that hospital was 1 1/2hr drive away. My contractions stopped almost immediately. When I arrived in hospital and I was scanned the OB said that my cervix was completely closed.

Needless to say dd ended up being delivered by (non-emergency) CS. Her Apgars were all 9s and the "infection" that they said she would definitely have because of coming to hospital so long after my waters broke, was BS.

I guess I´m not sure what I´m asking, but somethings puzzle me...

Is it inevitable that some breech babies have to be born by CS, even if they have the best support for natural birth - and for what reasons?

Why could I not feel the urge to push or anything to push on?

Was I simply not trying hard enough? I think that is the fear that haunts me most - that I wasn´t pushing hard enough and nobody will dare tell me and that I will go into another birth without that knowledge.

Is it normal for a cervix to close completely once fully dilated?

During the whole pushing phase my midwife thought that she could feel a pair of balls, though obviously my daughter was born without them! Could this have been a bad positioning of the baby?

Please please send me feedback, ask me questions.....I really need to move on.

Blessed be, Sadystar

[rajahkat]

Yes, some babies are going to need to be born by CS, regardless of whether or not they have the best support for natural birth. When it's not an obvious positional problem (like a transverse baby) or obviously a baby in distress (lots of mec & odd FHT) it can be difficult to get your head around the thoughts of "if I had only waited a bit longer" You won't ever know, really. But you can know that you made the best choice you could at the time. 12 hours of pushing is a LONG time, I don't care who you are!

Some women don't feel an urge to push. I can't really comment on this too much, as I've always had the urge. Maybe someone else can share their experience with you, though. I would think it might have to do with the fact the baby was breech and not coming down in a way that would stimulate your urge to push.

Was I simply not trying hard enough? I think that is the fear that haunts me most - that I wasn´t pushing hard enough and nobody will dare tell me and that I will go into another birth without that knowledge.

Oh mama, you did great. You really did. I seriously doubt you weren't trying hard enough. You followed what your body was telling you to do, and if it wasn't saying PUSH, then it wasn't. And you had someone there with you who has attended many births, I'm sure she made suggestions and helped you try things that you may not have thought of yourself.

I wouldn't worry about going into another labor with the thinking that you just don't understand how much you have to work. There isn't any vital info you are missing, and remember every birth is different. So even when we THINK we have it all figured out, we'll likely be surprised this time! The only suggestion I would make for future labors is try to eat and try to rest. Going that long without food and rest is a good way to run yourself down so you don't have the reserves to get through a long labor.

Is it normal for a cervix to close completely once fully dilated?
Your cervix can definitely "undilate" Especially if something scares you, (like the prospect of transferring to the hospital)

During the whole pushing phase my midwife thought that she could feel a pair of balls, though obviously my daughter was born without them! Could this have been a bad positioning of the baby?

Well, there was probably SOMETHING up with the positioning of the baby, since she wasn't coming down after being dilated for so long and with so much pushing! As to feeling testicles.....I don't know, anyone can make a mistake though!

Take care, Sadystar~

Kat

[fennel]

First of all, I'm sorry your birth did not go as you hoped and planned. I hope your family and care providers are supporting you as you search for peace.

Because I wasn't at your birth, I do not know what happened. It would be very unusual for a cervix to go from being completely dilated to being completely closed. Sometimes, it can be very difficult to tell how dilated a cervix is. It can be very thin and just have a small, subtle opening, and if the head is low it's easy to reach in there and think that dilation is complete when really it's not very dilated at all. Do you remember how many vaginal exams you had? Were they long or short? Did you make steady progress, or were you checked once and you were already complete?

I don't mean to disparage your midwife. You clearly trust and respect her. I just want to put the possibility out there. I hope that you find the answers you need.

[Sadystar]

Thank you Rajahkat, that is a very helpful perspective on the urge to push, among other things.

Fennel - I´m pretty sure I was fully dilated as I had the midwife check me a lot, I think maybe I was a little too insistent about it, because I couldn´t quite believe we were making any progress.

It can be very thin and just have a small, subtle opening, and if the head is low it's easy to reach in there and think that dilation is complete when really it's not very dilated at all.

Would this still apply to a breech baby? I would have thought that because the presenting part is actually a lot softer than a head you couldn´t make that mistake.

[Malga]

Would this still apply to a breech baby? I would have thought that because the presenting part is actually a lot softer than a head you couldn´t make that mistake.

IMHO, it would be even more difficult to feel dilation with a breech baby. Do your remember progressing through dilation-- like to you remember dilating from 2 to 4, etc, and your effacement progress (50 to 100%).

I'm so sorry that your birth turned out different than you had hoped. I hope your are able to move on from the experience to have a wonderful VBAC !

[Sadystar]

I had a completely non-medical midwife, so although I know that she knew what she was doing we weren´t talking in these terms so I´m afraid I´m vague on details - sorry.

If what you mean is what the other poster was referring to, I definitely remember being examined several times and her saying that I was progressing, then finally I was dilated - i.e. it wasn´t a case of her saying "right you´re dilated - now push" KWIM?

What is "effacement"?

Sorry again for the vagueness, partly it is to do with the way I chose to have my baby (i.e. avoiding treating it like a text book exercise) but also it was a long time and I was very tired.

[Malga]

I have to agree with the previous poster-- it is very unlikely that you would go from completely dilated and pushing for 12 hours to completely closed (according to ultrasound). I have seen the cervix close some when people are afraid, but only a centimeter or two. Maybe you didn't feel the urge to push after that long because you weren't dilated? Maybe that is why you also felt you had nothing to pushing against? This may also be why your contactions didn't come closer together? It may be helpful to speak with the midwife you worked with and ask her these questions.

[Charmie981]

Rather than blame the midwife for mismeasurement, my first guess is that the doctor lied to you. I've seen this in a few cases where the doctor didn't want to have to argue for why a vaginal birth was an impossibility (VBACs who were complete, for example). If they say you're not dilated at all, then of course a c-section makes the most sense and they don't have to explain why they won't "let" you have a vaginal birth when things are obviously progressing. It's terrible and deceptive and manipulative and I'd venture to guess it happens ALL THE TIME.

I've checked a mom who was complete, whose baby was breech and who ended up with a c-section. Her baby was not a frank or complete breech and she had to transport because breech homebirth is illegal in this state. She was complete for a few hours before her c-section and never felt the urge to push. I wasn't very experienced at the time, but my guess was that the baby had a positional issue because the norm with a breech baby is a "premature" urge to push. His position was such that he couldn't descend enough to stimulate her urge to push. This may have been the case with you, although of course I can't say for sure.

[Sadystar]

Originally Posted by Charmie981

Rather than blame the midwife for mismeasurement, my first guess is that the doctor lied to you. I've seen this in a few cases where the doctor didn't want to have to argue for why a vaginal birth was an impossibility (VBACs who were complete, for example). If they say you're not dilated at all, then of course a c-section makes the most sense and they don't have to explain why they won't "let" you have a vaginal birth when things are obviously progressing. It's terrible and deceptive and manipulative and I'd venture to guess it happens ALL THE TIME.

I've checked a mom who was complete, whose baby was breech and who ended up with a c-section. Her baby was not a frank or complete breech and she had to transport because breech homebirth is illegal in this state. She was complete for a few hours before her c-section and never felt the urge to push. I wasn't very experienced at the time, but my guess was that the baby had a positional issue because the norm with a breech baby is a "premature" urge to push. His position was such that he couldn't descend enough to stimulate her urge to push. This may have been the case with you, although of course I can't say for sure.

WOW thank you for that, I have to say I considered that the doctor was lying, but then that didn´t make sense because they wouldn´t even consider trial of labour for breech (he was fairly pissed off with me that I didn´t show for the CS he scheduled the week before).

But the knowledge that you transferred a woman in similar circumstances is oddly reassuring - does anyone else have anything to say about "mis-positioned" breech babies? Would she still have been able to feel the baby if she hadn´t descended enough?

I did manage to get my CS notes out of the hospital and though I can´t decipher much of it (in spanish with doctors handwriting!), the reasons given for the CS are breech/pp/waters broken over 30 hours - now I have no idea what the pp is (and remember this is a spanish abbreviation), but we had a scan a couple of weeks before and the placenta was high (i.e. not placenta previa), so could it be posterior position? or does that not make sense for a breech baby?

Thank you again to everyone who is replying, though I may not get a definitive answer, I´m feeling more and more positive that I can wrap this up :

[Reha]

could the pp be an abbreviation of the spanish form of : failure to progress??

[Malga]

I'm not trying to "blame" anyone or say that anyone "lied" (just because someone is a doctor, I don't think automatically makes them a liar). But, I would be very interested in getting to the bottom of it because, if it were me, I would really want to understand why I ended up with a c-section. I would really want to know that it was needed and I think thats why the OP posted the question- to get opinions. It just seems to me that if the OP pushed for 12 hours after she was complete the baby would have come down some and if would be unlikely that her cervix would then close completely.

[Charmie981]

Originally Posted by Malga

(just because someone is a doctor, I don't think automatically makes them a liar)....It just seems to me that if the OP pushed for 12 hours after she was complete the baby would have come down some and if would be unlikely that her cervix would then close completely.

I'm not saying that MD automatically makes someone a liar, but you said yourself in another thread that 90% of OBs do whatever they damn well please. So I think this OB lied. I've seen it before and I'm presenting it as a possibility. It seems much more likely than an experienced midwife grossly misestimating dialtion, IMO.

And yes, it's very unlikely that her cervix would close completely, which is why I don't believe it did. As for baby coming down with 12 hours of pushing...that's a huge assumption. I have a friend who pushed for 10 hours and her baby was so malpositioned that she didn't move at all in 10 hours. So I guess I'm coming from the perspective of knowing it's possible to push for a really long time and not move baby b/c of positioning.

I just wanted to present a different perspective. Frankly, I'm surprised that I'm the only one who said it.

[Sadystar]

It is interesting to think that the OB may have lied - but I´m not sure of his reasons for doing so. As I mentioned, breech presentation is automatic CS here, he doesn´t need to justify it any further by saying I´ve failed to progress etc. In Spain we have the best and worst childbirth - standard childbirth is acutely medical, there are no birthplans, no homebirth, no waterbirth, no gas and air - just do as you are told, full epidurals, lie on your back, feet in stirrups usually followed by CS (40%). However, the law is such that anyone may attend a birth at the parents request, hence the fact that I could have a non-medical midwife help me at home.

Perhaps his reason for lying could just be to humiliate me - to tell me that I didn´t know better than the medial establishment. That is the only reason I can think of.

Like the PP said, I am trying to get to the bottom of the necessity of transferring to hospital (I knew that it would be CS when we went). It is a question of whether I didn´t try hard enough, or whether at times some babies have to be born by CS regardless of trying and having the best support in the world for a natural birth.

Hearing some of these other examples is very reassuring, as the expat community I live in all use the same midwife and virtually all get the homebirth they desire, even if it takes days. I will admit that my pride was hurt alongside my confidence in my womanly abilities.

[Jane]

I don't think that the information as presented makes sense.
1. Completely dilated for a long time.
2. Completely closed some time later.
Someone is either mistaken or lying. At this point, I don't think you can figure out who or where without additional information.
Was there a language barrier? Here in the US, I find non-english speaking moms get explanations that are childish and incomplete, as if they were stupid instead of limited english speakers. Obviously you write well in in English, but I don't know what your Spanish language skills are.

Pushing - some of pushing happens when the baby gets low enough to trigger the pushing sensation - I believe it's some of the same muscles and triggers that help with bowel movements - It sure seems like it feels that way to moms. If your baby was too high, you may not have had an urge to push.
Most of the time, the mom can push the baby down a little without the urge and it triggers the urge, but if she wasn't moving...

The balls - I wonder if her labia got really swollen with "caput" from the pushing? Then it went down when your contractions stopped in the car? Caput is head swelling, but breeches get genital swelling in the same way - fluid gets into the presenting part, but can't return past the cervix or pelvis.
Posterior position - breeches deliver easier in the "sacrum posterior" position, and with difficulty in the sacrum anterior position. That wouldn't be abreiviated "pp" even in Spanish, I assume. And it wouldn't be the problem that the lack of descent was.

Honestly, some breeches should be born by cesearian section. The rule of thumb I've heard they should come easily by vaginal birth and if there are any complications, then surgery. I would certainly consider 12 hours of pushing to be outside of normal for any birth, vertex included.
Some babies won't move down, can't be pushed down, won't come out without distress in the baby. All the pushing in the world can't help.

[Malga]

I don't think that the information as presented makes sense.
1. Completely dilated for a long time.
2. Completely closed some time later.
Someone is either mistaken or lying. At this point, I don't think you can figure out who or where without additional information.

:

[Charmie981]

Originally Posted by Apricot

The rule of thumb I've heard they should come easily by vaginal birth and if there are any complications, then surgery. I would certainly consider 12 hours of pushing to be outside of normal for any birth, vertex included.
Some babies won't move down, can't be pushed down, won't come out without distress in the baby. All the pushing in the world can't help.

ITA

[Sadystar]

UPDATE - closure?

Thank you for all your feedback on this, I wanted to share with you what I have just learned.....

I´m not entirely sure how to write this, but basically it appears that my MW nay have been wrong and may not be as gifted as I once thought. i have recently become friends with someone who knows the MW fairly well and whose partner has lived in the same alternative community for over 10 years. To cut to the chase, in that time she has made many mistakes through basically a lack of medical knowledge and an attitude of "everything will be just fine if you trust in the process". Sadly including one preventable death-in-childbirth.

I don´t want to go into all the details but having this has somewhat set me free - it has allowed me to voice concerns that I had at the time but thought that I was wrong, because I mistakenly believed that she never had problem births and that therefore the problem must have been with me - she being the expert and I being the newbie.

Of course, I know that I can never know for sure that she was wrong, but this combined with what many of you have said have helped me to understand that my CS was necessary - for whatever reason.

I am still however grateful to her for having the courage to let me have a trial of labour, at least I´m not sitting here now wondering the what-ifs, if I ´d gone straight to CS KWIM?

Blessed be

[janellesmommy]

That is wonderful that you have more peace now. Also, keep in mind that because of you, your baby wasn't born a week too early!