postdates and zero dilation-mom is nervous

[happyartmama]

So I have a client who is 16 days postdates today. At today's appointment she was zero dilation, maybe 50% efffaced, with a high, firm posterior cervix. This is the same as last check at appointment 3 weeks ago. NST came back reassuring; good movement and responsiveness from baby. No U/S was done to lok at placenta or amniotic fluid.

Her OB (one of the more natural-friendly in town) gave her the options of cervadil started tomorrow followed by pitocin, or make an appointment for MOnday when she would be 43 weeks. She's sure of conception date.

So my question is, do women sometimes not dilate at all until actual labor begins; if so, are there usually other signs of moving toward labor (anterior cervix, softened cervix, station, etc.)? The OB's comment was that it was "odd" that there is absolutely no change from 3 weeks ago.

Mom is stressed and worried about baby despite NST results; she';s leaning toward cervadil in the morning; I talked with her about the possiblity of then going home to (again) try "natural" induction methods, particularly if there's favorable change with the cervadil. At this point she's unwilling to wait entirely until Monday and wants to take some sort of action.

Has anyone had a client have the cervadil, then go home and begin labor on own without pitocin? Or clients with postdates and very little to no sign of change taking place? I guess I'm looking for reassurance, advice, suggestions on what additional information to give mom tomorrow, etc.

[happyartmama]

Really? No ideas? Any help would be greatly appreciated...

[Contented73]

Headed off to bed -- but just wanted to quickly say that yes, some women start labor with absolutely no cervical change. Status of the cervix basically means nothing in relation to what will happen once labor starts.

The other thing is that I've never witnessed an OB letting a woman go past 42 weeks, let alone letting her going home after starting cervidil. In this case, since she has the option, why not encourage her to just wait as long as he'll let her (43 weeks I think you said?) and then just move forward with the standard induction process. I think this is how I would guide a client of mind in this type of situation.

Good luck!

Sorry, just reread your post. Sounds like she doesn't want to wait until 43 weeks. If this were my client and she really didn't want to wait anymore, I'd support her choice of getting induced at 42 weeks. I would remind her though that just because she hasn't shown any signs, it doesn't mean there is anything wrong at all!

[courtenay_e]

I don't know of a hospital in our area who would send a mother home "randomly" after a dose of cervidil...the stakes are too high legally. I do have one client who underwent three (you read that right) induction attempts, lasting two to three days each, and signing herself out AMA after all three, and went back for a fourth, which took. Those were all cervidil insertions...but there was definately a LOT of waiting around (and double and TRIPLE tries at new doses)to see if labor started before they'd "allow" her to leave the place.

I guess it's all about what she's comfortable with. If she's stressed out, it's not going to help her go into labor, actually quite the opposite. I suggest she do the spa thing for the next few days, massages, pedicure, bubble baths, yoga, bonding with and trusting her baby and her body to start labor when THEY are ready, not when the doc/calendar/her anxieties say it's time.

As far as "does it ever happen" that somebody who has made little early progress then has a baby almost immediately? Yup. I have a client and dear friend who had one of the worst cases of PUPPS seen in our area in a long time (as per several unrelated docs and midwives, poor mamma), and was begging for an induction. They did a Bishops score on her, and it was abysmally low. I'm talking no CHANCE of that induction taking. She was terrified of a cesarean, so chose to wait to go into labor. She went into labor that night and had a baby in her arms the next day. Thing with vaginal exams? They are completely random. We can't look in our crystal ball and know what that cervix and the REST of the physiology are going to look like in five minutes or five hours from the time we remove our hand. I have a dear friend who walked around dilated to a six for WEEEEEKS. Vaginal exams can mean nothing. She'll go into labor when she's ready. Again, that said, if she's not comfortable waiting?...then she's going to go in and get induced.

RRL tea, EPO, stuff like that been tried?

[jchawkes]

Has she ever had surgery on her cervix? Like cryo or a LEEP? Sometimes, after a woman has had a surgery like that, they form scar tissue that inhibits dilation. They usually will experience extremely painful contractions, with no change in the dilation, until the scar tissue breaks. But, when that band of scar tissue does break, it's usually very quick to being completely dilated.

This may or may not apply to your client, but I wanted to throw another option out there as to why there might not be dilation.

[happyartmama]

Thanks for the replies. I asked her about prior surgery, as did her doc, but nothing there that coupld contribute to difficulty with cervical change.

Well, at least I feel more confident in what I suggested, as it mirrors what you've all said. I first talked with her about waiting until 43 weeks (this OB is very patient if all other tests are positive), with no go. Then we talked about cervadil this morning, so I encouraged her and her husband to do something totally "un" baby related--go see a funny movie, have nice dinner out, come home and cuddle, relax, etc. since at this point her stres level wouldn't impede ease of labor even if it did start.

We'll see what happens today after the cervadil. I did find out from another area doula that this particular OB will let a woman return home with positive cervical change to try natural induction methods if she chooses and as long as FHT and everything else looks positive.

[happyartmama]

Update

So mom had cervadil yesterday morning at 8:30 a.m.; out last evening around 8:30. She had been having contractinos of varying intensity for a couple hours but no consistent pattern over a time period. (Pattern for maybe 20 minutes, then nothing, then back again).

She was checked at 8:30 p.m. and had moved from zero dilation to maybe a fingertip. Contractions picked up briefly and then FHT dropped drastically without recovering quickly; dipping into the 60s, then back up to 120's, then down again. Room immediately filled with medical staff; ultrasound was done and there was "no fluid." Gave her a shot to stop contractions and decrease stress on baby; went in for a cesarean.

Baby had no fluid, covered in meconium, but no other apparent cord issues on=r other problems.

[SublimeBirthGirl]

Too bad about the cesarean. Was she on Pit when the decels started?

[happyartmama]

Nope, no pit. The plan was to see how well the first round of cervadil did, and given that it only moved her from zero to fingertip/1cm, the plan of action was to give second round of cervadil (had there been no other problems), then if that was additionally successful, THEN start on pitocin.

Essentially her OB was trying to use the cervadil (and time and other factors) to see if her Bishop score could be raised (it had been a 3) prior to starting pit to maximize her chances of a vaginal delivery.

Given that this OB is very woman centered, pro-natural (used to work with a practice of midwives, etc.), and given that there was no fluid there, lots of thick meconium, perhaps this was one of those scenarios where the c-section was truly warranted....it certainly apppears more clear cut than others I've seen/heard of.....

[Romana]

I'm sorry, I'm not a birth professional - hence the question - but could someone briefly please explain how/why the baby wouldn't have any fluid? Thanks. :

OP - glad to hear things turned out ok, though obviously not as mom wanted. I'm wondering if mom not wanting to wait until Monday was a matter of intuition - sounds like she may have had an inkling that things weren't quite right in there.

[crazydiamond]

I'm sorry to hear about the C-section

I was hoping more people would have chimed in with reassuring stories. With my DD (my first), I went to 42 weeks with a Bishop score of 0. It wouldn't budge and I ended up with a C-section as well. However, I did have plenty of fluid and no meconium.

I'm hoping to have a homebirth this time, but am terrified of this happening to me again. My MW assures me lots can be done to naturally induce labor, but I'm concerned it won't work.