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Maternal Exhaustion

post #1 of 14
Thread Starter 
How do you define Maternal Exhaustion, how do you manage it, and is it for real/serious?

Having spent a long time - years - on the ICAN discussion lists, I've heard this concept poo poo'ed and have heard tales of women sleeping/snoring between pushing contractions.

Providers, on the other hand, seem quite concerned about the concept and I've heard about and witnessed the offering of interventions like AROM and other things to address the possibility.

Can a woman become so exhausted she just can't push her baby out?
post #2 of 14
post #3 of 14
I've never really seen it, but I believe it could happen. When moms get to eat, drink and rest as needed, they are just very unlikely to become so exhausted that their labor becomes ineffective. This is simplifying things quite a bit because I'm in a hurry at the moment--but every case of maternal exhaustion I've ever heard of (heard from the mother herself) involved a long labor and inadequate attention to her basic nurtuance throughout. Yes, women can sleep deeply between contrax and benefit from those 3-5 min of sleep--it is also possible (without drugs) to help a mom get a nap of an hour or 2 during active labor (with contrax backed off in intensity and frequency).
post #4 of 14
I have seen it happen a few times. Mostly in first time moms who are so excited that they are in early labor they stay up even though their contractions are 10-45minutes apart. Then they have a really long labor and are up for two nights in a row. We really try to stress that they should rest while in early labor if it is at night for that reason.
post #5 of 14
Yes, I've seen it occasionally... staying up all night in early labour is *definitely* a bad idea, as mentioned by the PP, but the worst problems I have seen have been in women who vomited very frequently during labour. They get very dehydrated, low blood sugar, etc, and get into this weird, uncoordinated contraction pattern, and eventually labour just stops, if the problem is not dealt with.
post #6 of 14
yes it happens-- and I agree first time moms are prime candidates
although grand multips come in a close second times-- different causes but similar results
post #7 of 14
I agree that primips are candidates for exhaustion as nashville has said--and also, women whose first birth resulted in csec, 2nd time attempting VBAC. In some ways, primary HBACs can be similar to primips, except for those who learned the hard way the first time, that it is counterproductive to become exhausted in early labor as described. And I have seen that once....I would have said she transported for pain, but probably exhaustion did play a part in her pain perception and coping, given being up for more than 24hrs even tho labor never got into serious stages of intensity. I also had a couple of transports for what was probably exhaustion in primips in my earliest years of practice (in the first 30-40 births I primaried). This taught me the importance of both emphasizing the need for conserving energy in early labor, sleeping while and when still possible, and of moms receiving adequate food and fluid throughout.

With multips, you can have so much prodromal labor that interrupts rest during the late days/weeks of pregnancy--and this can become a problem for those who don't have sufficient help with their other kids/household so as to get some sleep during the day (when contrax disrupt sleep at night). There is then the possibility that they will go into labor already pretty tired--tho most often, all that prodromal activity will result in quite a bit of cervical softening/dilation--and thus, a far shorter active labor once it really kicks in. However, malpositioning, for one thing, might bring about a long labor and possibly lead to exhaustion in this scenario.
post #8 of 14
It happens - this was me. I was a first time mom and labored for 86 hours. I couldn't take it anymore and the placenta started separating from the baby so I had a c-section. I'm hoping for a VBAC next time. I wish I would have had a midwife or doula available to help me work through the exhaustion.

By day three there was absolutely NO sleeping through contractions.

ETA - I just read the original question and I think that even after 86 hours I could have pushed the baby out had my body been ready to birth. As it was, after all that time I was only dilated to 4.5. I did not at the time though, feel like I could get up and walk around at all. I did sleep in early labor and ate and drank throughout which might be why I was able to last so incredibly long.
post #9 of 14
Thread Starter 
Thanks for your thoughts! One thing lingers..... how do you decide you are dealing with maternal exhaustion - what does it look like? It seems so subjective when some women can and will labor for days while others...not so much.

I realize this question, and my other about BS and Fluid Balance, may sound like I am looking for absolutes. I am not-just generating some discussion around two topics that I'd like to better understand.

post #10 of 14
As for making a determination...well, that is pretty subjective I'd say.

But--certainly moms make that determination in various ways. If she keeps saying she's tired, hurts too much, can't go on--and it's not 'just transition' and there isn't any progress over some hours, maybe also a reduction of intensity/frequency of contrax. I've never made the determination of exhaustion--the moms do.

However, even if a mom isn't saying she's done, but she's no longer participating in taking care of herself such as refusing food, fluids, peeing, trying positions or methods to get some rest (or better efficiency of labor), then I might expect to see some signs in the baby associated with maternal exhaustion, dehydration, low blood sugar. "Non-reassuring FHT"--not necessarily scary-bad, just possibly less variability, or rising 10bpm or a bit more from usual, even without baby's greater activity level. In this case I might be the one to raise the subject of whether or not staying home is still what she wants. For some, just reflecting what I'm seeing and hearing from her and baby is enough to help her dig deeper and get on with things. For a few it is support for their decision to get medical help....still, I'm not exactly 'determining' anything--it is the mom/partner who do that.

I'd like to know others' thoughts/experiences on this, though.
post #11 of 14
Thread Starter 
Thanks, Ms. Black. That is useful information. I would like to hear others' thoughts/experiences as well.
post #12 of 14
It happened to me while my total labor was only 16 hours 4 hours of it was second stage. I had severe hyperemesis and could not tolerate anything. Even after some IV Fluids I still was exhausted and my uterus was as well after 3.5 hours of pushing (more breathing) I had to have pit. Once I had it it was still a lot of work getting him out and still vomitting.
post #13 of 14
well I agree with MsBlack
mom's pain tolerance is shot, contractions are less effective, no progress

so basically we are kind of on an unknown timetable where mom's and baby's physical tolerance/endurance are tested and we can reach those limits we try not to and usually we don't even get near but there are times-- I would say the majority of women I have who hit a physical wall are first time moms- and I really can't get them to rest no matter what I do or say to prepare them- and because they are usually young they have great physical endurance and don't resolve to the fact that the body is in charge- that labor will take them and by the time they hit resolve they may be physically exhausted

post #14 of 14
Yes, mwherbs--I like your use of the word 'resolve' here. Makes me think of the saying 'the spirit is willing, but the flesh is weak'. Not that laboring women are weak by any means; only that a person's thoughts/wishes/ideals can be larger at times than the actual endurance of their body. It can be hard for some to acknowledge--resolve themselves to the reality--that their thoughts/wishes/ideals may well be larger than their body's abilities...that there really are limits to endurance (their own and baby's).

To be sure, *most often by far* women discover during birth that their limits are well beyond what they may have previously imagined or been asked to meet up with in their life. A reasonably healthy woman can dig deeper, and deeper still, for reserves of strength and patience during labor, and surpass all previous conceptions of what her limits are--if she is willing to try, to be firm in spirit and willing to take care of herself during labor. It's just that occasionally, for various possible reasons, a woman might indeed meet her limits before baby is out.
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