cervical dilitation

[wildflower1990]

Just wondering...
Does anyone know the possible reasons why a cervix would refuse to dilate to 10? Mine just would not do that last centimeter and it took FOREVER (35 hours) to get to 9. After he was born (caesarean), it was determined he was 43 weeks vs. 40. The fontanels in the back of his head were more fused together than 40 week olds...would this have anything to do with it? I did have an epidural 12 hours into the whole thing which actually helped me to dilate some and was given pitocin the last 7 hours hoping it would help (even though my contractions were strong) with dilation but it did not do much. He was at +2 station and face down...all ready to go, but my body was just either too slow for my comfort or was not willing to stretch any further. Any thoughts you midwives out there? He turned out quite beautiful!!! I was just wondering...
Wildflower

[fourlittlebirds]

Well, I do know that using synthetic hormones to speed the labor up does not guarantee dilation. The fact that your body did not respond well to the drugs does not mean that your body was broken -- all it means is that your body is not resilient enough to function normally when its normal process is interfered with.

With my first birth I did not begin to dilate until I had been in labor for 50 hours. There was nothing wrong with my body -- six hours later my baby was born vaginally with no complications. But if interventions had been introduced earlier and ended up hindering the labor (which is a potential risk with all interventions) I could have easily enough assumed that the problems were inherent rather than iatrogenic.

It is plausible and quite possible that your body simply wasn't ready to give birth and so resisted being hurried along as best it could. I don't know what to say about your son's fontanels... my cynical side wants to point out that often doctors come up with questionable disagnoses (after the fact) to persuade their patients that they made the best choices in care. It is very common, for instance, for doctors to blame a difficult birth on CPD -- but in reality the condition is very rare; women whose pelvises are (supposedly scientifically) deemed too small then go on to birth even larger babies vaginally.

If the fontanels were indeed beginning to fuse by some freak of nature, theoretically the passage through the birth canal would be more difficult (especially if the mother was giving birth in a reclining position), but I'm having a hard time seeing the connection between that and the inability to dilate. It doesn't seem logical.

[wildflower1990]

Even though I ended up with a c-section, I feel that my birth was a successful one for 3 reasons: a) I had/have a healthy, alert baby b) I had a very strong support network of family, 2 social workers, a doula, and my lovely dh and c) I chose a breastfeeding/"do what you want to during your birth" friendly hospital, doctor, and nurses. The doc did not actually tell me my son was 43 weeks...my dh overheard it while the nurses were checking him out. We also got a peek at his hospital charts...They also mentioned CPD possibly as a result of him being 3 weeks late, but when we asked them about it, they were vague in their answers and instead focused on how healthy and beautiful he was. Overall, I feel good about the birth and would have only changed one thing...no pitocin. I did not know that it contributes to high bilirubin levels. Maybe my cervix would have dilated another centimeter given time, but since my water had broken 35 hours earlier, the doc was not comfortable taking any more time (I had a fever as well.) I have done some research on when the back fontanels close which is apparently at 2-3 months...is this correct? If so, do they close all at one time or does it happen over a period of 2-3 months? If it is the latter, then it would not be a stretch of the imagination that his fontanels would have been more (not all the way) fused than a 40 week old. I have no idea if it had anything to do with why my cervix would not dilate that last centimeter...that is what I am looking for. I did a few net searches on the subject and came up nil. Anyone know anything about it???

[fourlittlebirds]

"If so, do they close all at one time or does it happen over a period of 2-3 months? If it is the latter, then it would not be a stretch of the imagination that his fontanels would have been more (not all the way) fused than a 40 week old. "

It does happen gradually. I was always under the impression that the fusion of the fontanels is due to the release of certain chemicals that signal that the baby has been born, rather than that the baby is of a certain gestational age. I don't have sources to back that up, though.

"I have no idea if it had anything to do with why my cervix would not dilate that last centimeter..."

The cervix dilates both in response to hormones and pressure of the head. If the baby's head was for some reason high up or not fitting well within the cervix, the cervix wouldn't benefit from that pressure and might dilate slower than otherwise.

"Maybe my cervix would have dilated another centimeter given time, but since my water had broken 35 hours earlier, the doc was not comfortable taking any more time (I had a fever as well.)"

Yeah, I think this was probably the real concern, not that your cervix would never dilate.

[wildflower1990]

Thanks for your input, blueviolet! I did not know exactly what caused dilation...

[birthinglau]

well, I think blueviolet said it all very well. good answers.

I would also add a few things. You mentioned that your husband overheard the nurses say that your son was 43 weeks, but that you didn't know this yourself. were you past your EDD? the EDD is just a guess, and the dates based after birth are also just a guess, meaning you can estimate, but actually not all babies are "cook" for exactly 40 weeks. I also suspect this was an answer created to explain the way the birth was handled, though I can't say for sure.

my intuition is that malpresentation of the baby's head against the cervix was the much more likely reason for you to stay at 9cms. were you lying down in the bed as opposed to sitting, standing, or squatting? if you experienced alot of back labor prior to the epidural, he might have been posterior (facing the opposite direction from the way babies usually come out.) psychological issues like fear and anxiety play a big part too.

I would also ask you to consider not choosing an epidural if you want to avoid pitocin in your next birth. the reason is that an epidural is more likely to result in prolonged labor, slowing down the contractions, and making it difficult, sometimes impossible for a woman to labor her baby down actively by walking, squatting, etc. if you do choose one, waiting until later in labor, at least 6-7cms is a better bet. also maybe researching options for pain management such as laboring in water and deep breathing, . the cervix opens best when mom feels safe and comfortable and open herself.

and you are right - you had a good birth because you feel positive about the outcome (healthy you and healthy him). congratulations!

-Lau