Post dates/prodromal labour?

[JeanetteL]

Hello Midwives and Doulas:)

I'm just wondering - if you had a client who was post dates (approaching 42 weeks) and was having prodromal labour for several days - what would you do (or not do).

I have a friend in this situation now - and although I'm not really looking for info to give to her (as I think she has a darn good midwife team) I've just gotten curious to see what other midwives and doulas would do, suggest or advise in this situation. I'm sure at some point I'll have a doula client with a similar situation, and I just feel in the mood to go on a data gathering mission!

This friend is planning a homebirth, and faces transfer of care to doctor/hospital at 42 weeks, so that throws a little bit of a wrench into the "wait and see" option that many would prefer without a looming deadline. Looking forward to hearing your thoughts.

Jeanette

[doulamomvicki]

Accupuncture and sex! I swear by it. I can not think of the name of the accupunturist I refered people to in Phoenix for the life of me. Just out of curiosity, who is her midwife? I am from Glendale. PM me if you feel comfortable telling me.

Go tell your friend to have sex and I will look for the name of that accupuncture person.:D

[veganmamma]

That actually happened to me. I wasn't super close to 42 weeks, but there was still pressure. For me the problem was A. Not enough rest, too much trying to get things going and not enough LETTING things get going, B. baby with a deflexed head not applied to cervix causeing active labor to 6cm, cervical edema and cessation of active labor.

Do you know what position the baby is in? Will her MW come check to see if the head is applied to the cervix>? once dd's head was flexed and against my cervix, she was born within three hours.

Hydration, food and rest can help. Changing things up can help. I ended up taking castor oil, which increased my ctx enough to get my MW to come over and do a vag and see that dd was not in optimal position. Castor oil sucks! Blech! Ew ew ew.

For me, every time I took a walk outside or was in lots of light, or even just during the day, my labor slowed. Are there triggers like that for her? Every time I would lie down in bed I would go into active labor, it was insane. Trying to do other things, talk, think, anything-- all those things shut my body down. I wasn't in a good place to be in labor already, and anything that interfered made it worse. I loved my doula, but when she would come oer, I just wanted to talk to her, so she had to go away for a day so I could get back into my labor.

I recently did a report on prolonged labor. I have the internet resources available in my email, I've C&Ped them below. The most useful is the gentle birth info at the bottom. HTH!

Oh- the info on prolonged labor and cord blood, one of my theories is that it is normal to have the cord blood be so rich and that speeding up labor denies baby of the goodies. Kind of like BF and FF, BFed babies aren't healthier... you know the drill.

Prolonged labor good for newborns and cord blood:

http://www.mercola.com/2000/dec/24/labor.htm

Definitions of prolonged labor:

http://www.hyperdictionary.com/medical/prolonged+labor
http://www.babyzone.com/features/glossary/default.asp?TermID=453
http://www.justeves.com/ipl/prolonged_labor.shtml


The prolonged labor handbook:

http://www.midwiferytoday.com/Merchant2/merchant.mv?
Screen=PROD&Store_Code=MT&Product_Code=C514PL&Category_Code=NEW

Hydration and info on amount of saline drip in hospitals:

http://www.findarticles.com/cf_dls/m0BJI/7_30/62050612/p1/article.jhtm
l

Chinese Medicine:

http://tcm.health-info.org/Acupunture/treatment/prolonged-labor.htm

Ideas for prolonged labor:

http://www.abcbirth.com/iLaborandBirth.html
http://babies.sutterhealth.org/laboranddelivery/labor/ld_var-labr.html
http://medstat.med.utah.edu/kw/human_reprod/lectures/physiology_labor/


Prolonged labor with occiput posterior:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=1522439

Epidural and prolonged labor:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=14693624&dopt=Abstract

The partograph:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=14693624&dopt=Abstract
http://www.maqweb.org/maqslides/powerpoint/Maternal/nlc/nlcnotes.pdf

Phsychological effects of prolonged labor on baby:

http://ajp.psychiatryonline.org/cgi/content/abstract/157/2/203


Last but *certainly* not least, Gentlebirth.org's take on prolonged
labor:

http://www.gentlebirth.org/archives/prodromal.html
http://www.gentlebirth.org/cgi-bin/query.pl?swishindex=%2Fusr%2Fhome%2Ffalcao%2Findex .swish&metaName=Keywords&keywords=prolonged+labor&detail=yes&maxresults=40

[CarrieMF]

It happened to me too. In my case I was 10days post date having gone into preterm labor at 28 & 32wks.

I could not relax at all, I did not have a doula(I am one now). I don't think a doula would have helped me relax, but they would have been able to tell the dr's that I did not want demerol(dh approved it :( ), By the time they brought the demerol I had the laughing gas(I had refused it earlier). The decels started at 36wks, they disappeared around 37-38wks and a biophysical came out fine(passed right at the time limit with help from alot of maneuvering). During labor the decels came back with every contraction, the lowest it got was a hr of 13. They did call a surgeon in to do a c-section. He checked me 3 hours after syntocinon was started and I had progressed from 2-3cm to 3-4cm, still 60% effaced and not engaged. They started prepping me for a c-section and were about to take me down when she & my body decided she should come out(18min after the surgeon checked me). Then she got stuck because her hand was by her face. My dr reached in and pulled her out. IMO they should have scheduled a c-section and never let me go into labor. There was a true knot in her cord and it's only luck that she's alive.

I really believe that both her and my body knew she should not have been born vaginally. Unfortunatly I also believe that even though I did not want the demerol it was probably what relaxed my body to dilate. She did have to get narcan.

[Defenestrator]

Your friend should have a conversation with her midwife about baby position. Is the baby posterior or transverse? Deep in her pelvis or not? Is she feeling pain/pressure in one particular spot?

Getting the baby into an optimal position can help her go into labor because the baby's head will apply more evenly to the cervix. That is the first task because it will make everything else easier.

Additionally, I have had really good results with some of my doula clients with nipple stimulation. When a crop of prodromal labor contractions come up, she can do nipple stimulation on one side at a time herself, with a partner, or with a breastpump. Usually the moms I work with will continue the stimulation until the contraction peaks, stop until it subsides and the next one starts, then start again. With the postdates moms I have worked with, this has been enough to tip the scales and put them into active labor.

There are studies that show that nipple stim promotes cervical thinning and ripening, so even if it doesn't put her into labor, it will help with the almost inevitable induction she will face if she transfers care.

Usually, I would just say wait and see and work on position, but I understand the desire to remain with her current provider and setting.

Good luck!

[CarrieMF]

nipple stimulation reminds me, I have a friend who was in labor and the contractions kept stopping. Instead of doing nipple stimulation, she used a breastpump until the contractions stopped going away.

[redtentmomma]

Sometimes babies don't come because babies aren't ready, or momma's aren't ready. I agree with all the things that have been said above about positioning, and softening the cervix. But I would also ask mom to sit down and "talk" to her baby and see what it is they both need for the birth to happen. Listen with an open heart, you might be surprised how simple the answer is!