What can be done for failure to progress? - Mothering Forums

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#1 of 34 Old 01-22-2004, 04:04 PM - Thread Starter
 
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Say I have a baby who is posterior, or shoulder dystocia and the labour is progressing slowly.

What can be done? What can I do? Is there any danger to the fetus? This is something I would like to know more about, since it seems to be a big cause of interventions...

Jen
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#2 of 34 Old 01-22-2004, 04:14 PM
 
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Well, I have had two homebirths and both were posterior (or is the wrong way transverse, darn it, I always confuse the two) when labor started. I did pelvic tilts (I think that's what my midwives called them) where I was on my hands and knees and tilted my pelvis up and down. You can also find out before labor if your baby is posterior and start the pelvic tilts during pregnancy.

To hasten labor with our second, now don't be disgusted since we delivered a baby 2 hours and 20 minutes afterwards from only 2cm, we had sex. It worked for us, but of course we were at home where we were free to do that.

Squatting or on your hands and knees to push is the best way to deliver a baby with shoulder dystocia, I've heard, since it opens your pelvis just a little more which is usually all that's needed.

Jessi
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#3 of 34 Old 01-22-2004, 06:20 PM
 
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Posterior labors do go slow sometimes, and shoulder dystocia is something that happens at the birth of the baby, so it does not affect labor length. Just wanted to clear that up.

"failure to progress" is another term that is applied to our horribly faulty bodies by the medical model. FTP should be retermed "failure to be patient". There are all these rules about how labor "should" be, rather than respecting each individual case and baby's needs.

Staying hydrated, slowing things down with warm baths and/or herbs rather than spending enormous amounts of time trying to speed it up, and recognizing the value of a slower labor is key.
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#4 of 34 Old 01-22-2004, 07:43 PM - Thread Starter
 
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We are planning a hospital birth, but my experience has been nothing like what I usually read. Maybe it's just different up here. I'm also not in a hurry to get there and spend the whole labour at the hopital. With dd, I laboured at home and only went to the hospital when I felt *something* was iminent. Given this, I can manage my own labour for the most part. And, if I do wind up at home, the midwives are close by and I'm not freaked out by that. Dh is, :LOL.

Pamamidwife, can you expand on that a little, is a shower ok, which herbs? Can you describe for me a slow labour? Sophie was pretty quick, I wasn't scared at all, and I don't want to get scared, just because it's not the same. Is there a good site to read all about labour? Sorry to be so demanding, but I want to know!

Jen
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#5 of 34 Old 01-22-2004, 09:39 PM
 
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I can describe for you a slow labor -- BORING! :LOL

My first was 56 hours, and my third was 32 hours. What I've learned from them is that it really really really helps to amuse/distract yourself with non-birth related things as long as you can. Go out to eat. Watch a funny movie. Go shopping. Have sex as much as you can. Masturbate. Put on some groovy music. Dance around. Get your husband to slow-dance with you. Get him to give you a massage. Visit with friends. Work on a project. Take a walk. Make a birthday cake.

The good thing about long labors is that they aren't usually unbearingly painful throughout. I started out for the first 3/4 of the labor having mildly painful tightenings every so often, then most of the next 1/4 having contractions that I had to stop and breathe through (but I could laugh and talk and walk around fine between them) and only the last hour or so was really hard.
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#6 of 34 Old 01-22-2004, 09:51 PM - Thread Starter
 
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Wow! Wow. That is a long time. I can see how, if not painful, it would be boring!

So, it is the prelabour, or the first part of labour that is usually slow? You don't have people in hard labour for 30+ hours do you? I can understand the part where the cervix is dilating and effacing going on for some time. So what happens in hospitals? Is it that dilation takes "too long"?

And, you wouldn't push for hours, would you? Or would you? I don't know. I had four hours of labour, and 15 minutes of pushing. I would like that again please! :LOL

Jen
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#7 of 34 Old 01-22-2004, 10:12 PM
 
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Just wanted to add my own little story here. With both pregnancies, but especially this one, I've been in early labor almost constantly for about 2 weeks so far. I have an irritable uterus and had preterm labor at 23 weeks, with 1 cm dilation on the outside and closed inside. Was put on bedrest and terbutaline until 35 weeks. The terb did not stop the cx but it did make them mild enough to prevent dilation.

At 35.5 weeks I started getting more intense cx 2-3 min. apart and went to the hospital, where I was given a shot of terbutaline to stop the labor since it was still too early for an ideal birth. I had all the symptoms of early labor including diarrhea and loss of plug. At the hospital they checked me and I was at 2 cm.

I'm now 37.5 weeks along and have had several episodes (like 2 days on, one day off) of cx anywhere between 2-5 min. apart. Lots of diarrhea or loose stools, nausea and occasional vomiting, loss of plug. This has been going on for 2 weeks now.

I went in for my 37 week check up and was found to be at 3 cm, 75% effaced, and baby is at +1 station. So obviously those cx are real and are doing something slowly. At my appt. this week I was given a non-stress test and the cx during that test were 2-3 min. apart. They were, and are, semi-painful and not allowing me to sleep well.

My doctor told me that I could go into the hospital after the non-stress test and be admitted since I'm dilated so much and having cx, but he recommended against it. It would just start the clock on me and they'd probably end up giving me pitocin or rupturing my membranes. Here I am almost 5 days after the appt. still having cx and obviously not in active labor. I'm glad I have such a wise doctor who's willing to let nature take its course as long as baby's doing okay!

I guess my point is to agree with the others, that failure to progress is often "failure to be patient." I know this has nothing to do with stuck shoulders or posterior babies, but I wanted to add my own experience here. Everyone's different and we don't always conform to what a typical labor is supposed to be, as defined by the medical community.

Darshani

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#8 of 34 Old 01-22-2004, 11:21 PM - Thread Starter
 
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Thank you so much Darshani. I've been following along the other thread, and I really admire your patience.

I can see that going into the hospital would "start the clock". I would like to spend as much time at home as possible. I really appreciated hearing your story. It gives me a different perspective to think about it.

I can't wait to hear how your baby arrives!

Jen
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#9 of 34 Old 01-23-2004, 12:57 AM
 
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I feel if the midwives and I are bored out of our minds, something must be going right! If we were always trying to "do something" to change the way the birth was going, instead of accepting it the way it was, maybe it would be more entertaining but I don't think it should be messed with just because it's slow.

If I have FTP I guess I can catch up on some housework or phone calls, or read a book.
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#10 of 34 Old 01-23-2004, 03:03 AM
 
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Thank you so much Darshani. I've been following along the other thread, and I really admire your patience.
It's forced patience. If you heard me whining to my friends and doula you might not admire my patience so much. lol! But my doula's been working with me to see this as a good thing, to relax and know that my body is preparing for the big day.

I had this same sort of thing happen with dd's pg but not to the same degree or length of time. Then boom! I was in labor with her just like that and it was sooo intense and sudden. So I'm not venturing too far from home these days. My greatest fear is being out somewhere and boom! there I am in the store holding onto the cart for dear life while someone calls 911. Of course if I had the baby at Wal-Mart I'd be set for life, right? Maybe I should start hanging out at that expensive fashion mall by my house instead.

Darshani

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#11 of 34 Old 01-23-2004, 05:11 PM - Thread Starter
 
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So, just roll with whatever you get. If you have no preconceived expectations, then you should be able to cope, whether its 15 minutes, or 56 hours....
Thanks to you and Darshani, Hilary, this is what I decided last night. Relating Darshani's story to dh was enlightening too...he also found it difficult to overcome the preconceived notion that something was "wrong".

Thanks again,

Jen
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#12 of 34 Old 01-23-2004, 11:33 PM
 
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Jen, I'm glad you and your dh have found some peace of mind with this, and hoping that your birth goes great when the time comes.

Darshani

7yo: "Mom,I know which man is on a quarter and which on is on a nickel. They both have ponytails, but one man has a collar and the other man is naked. The naked man was our first president."
 
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#13 of 34 Old 01-24-2004, 10:24 AM
 
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My doctor told me that I could go into the hospital after the non-stress test and be admitted since I'm dilated so much and having cx, but he recommended against it. It would just start the clock on me and they'd probably end up giving me pitocin or rupturing my membranes. Here I am almost 5 days after the appt. still having cx and obviously not in active labor. I'm glad I have such a wise doctor who's willing to let nature take its course as long as baby's doing okay!


I cannot agree more strongly with this. The easiest way to prevent a diagnosis of FTP is to not say you are in labor until you are in active labor! I was having contractions at 37 weeks with DS--- for hours, 3-5 minutes apart, couldn't sleep, walking around, etc... I am confident if I had gone into a hospital, they would have admitted me with no problem and I would have either been induced or had a c-section. By 39 weeks, no more contractions and DS was born at 41.5 weeks, just ready and perfect.

FTP is often diagnosed differently by different doctors, hospitals, etc... One month before I gave birth to my first, a friend of hers was born c-section for FTP (immediate pitocin induction, 24 hours since water broke= immediate c-section w/her doctor). My DD was born 30+ hours after my water broke (induction w/pictocin, active labor w/in 24 hours). After that birth I realized if they had just kept their dirty hands out of my yoni, it could have been indefinate. What some medical personel, though highly educated, do NOT seem to understand is that, by definition, some people have to be faster and some slower than AVERAGE. Instead, they take the average and as soon as you are not as "good" as average define it as a problem to fix.

 

 

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#14 of 34 Old 01-24-2004, 02:09 PM
 
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FTP, at my hospital, is defined as anyone who does not dialate at least a centimeter an hour....from start to finish.... and if you are diagnosed ftp, c-sec is ALWAYS the recommended course of action....
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#15 of 34 Old 01-24-2004, 02:37 PM - Thread Starter
 
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Okay, so what about water breaking? Policy here is not to let you go more than 24 hours after your water breaks, ostensibly to prevent infection and I would assume harm to the baby.

Say my water breaks and a few hours later the contractions stop. What can I do to protect myself and allow my body to catch up? Is it possible to continue indefinitely after your water has broken, or is is that 24 hours is kinda short, and you could go as long as X number of hours?

Jen
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#16 of 34 Old 01-24-2004, 03:11 PM
 
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I was in the hospital for 3 1/2 weeks w/my water broken w/dd. It broke at 32 weeks and I was admitted b/c of risk of infection. (I could have gone home and done monitoring and bed rest there, but they didn't like to do that if you lived more than a certain distance from the hospital. DD was my first, so I was ok staying put in the hospital and having them wait on me had and foot.)

It was a slow leak, so I'm not sure if that made a difference or not. Amniotic fluid is always replacing itself. I think 24 hrs after water breaks is pretty standard, but 32 weeks is too early for any doc to induce. Knowing that now, if I ever had a doc tell me I was 'done' waiting after my water had been broken for 24 hrs, I'd tell them to go blow.

Michelle -mom to Katlyn 4/00 , Jake 3/02, and Seth 5/04
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#17 of 34 Old 01-24-2004, 03:18 PM
 
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Say my water breaks and a few hours later the contractions stop. What can I do to protect myself and allow my body to catch up? Is it possible to continue indefinitely after your water has broken, or is is that 24 hours is kinda short, and you could go as long as X number of hours?
Different places have different policies, which tells me it's not so much about the baby at all. Some let you go as many as 48 hours, some as few as 6.

If your water breaks at home, you could always lie about when it actually broke.
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#18 of 34 Old 01-24-2004, 03:24 PM
 
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OK, may I chime in? My fist birth was a medically managed 36 hour labor, ended in a stupid c-sec, supposedly CPD (baby 10'2"). but I think the real reason was impatience.

Alstro, if your first birth was only 4 hours it is curious you are worried about a long labor this time. My exp was: first birth--36 hours; 2nd birth--home VBAC (baby 8 lbs), 12 hrs; 3rd birth--home again (baby 9 lbs), 4 hours! I think each time I was more relaxed and trusted my body and my birthing team more, and my psychological mindset shortened my labors.

I figured out over time that I have a shallow pelvis that leads to a couple things. First of all, my fundus measure high early in prg, leading to an ultrasound with my first pg to see if it was twins. 2nd, it makes the babies not "drop" until labor itself is well established. With the 1st 2 births, my waters broke before labor and this led to my docs for the first one wanting me to come in and be monitored in case of cord prolapse. This was a drag, as then I was their puppet and the whole nightmare began.

With the 2nd birth, we didn't worry about cord prolapse. Think about it, if pelvis was shallow, how was the cord going to go under the baby and get out?

To answer your q from my POV, waters breaking is only a problem if you then get lots of internals from lots of practitioners, which can of course, intro germs. At home the midwives tend to avoid internals during labor. They use outward signs to check progress, until you seem to start pushing.
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#19 of 34 Old 01-24-2004, 07:58 PM
 
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"So, it is the prelabour, or the first part of labour that is usually slow? You don't have people in hard labour for 30+ hours do you?"

Not me. I counted labor as starting when the contractions were regular and did not stop and start again. But it's possible that my long labor was similar to other people having braxton hicks for weeks, or episodes of "false" labor. Those people wouldn't get to count all that contracting as part of labor, but I did because mine was all together. So it really not that big a deal. Just, like I say, boring. I can't say, though, if it was mostly "prelabor" as opposed to "active labor", at least this last time, because we weren't measuring dilation. Although I personally find those kinds of distinctions unhelpful anyway. Labor stages are different for everyone -- one person's "false" labor may be much more painful and difficult than another's "active labor." It's all your body working toward the end goal, you know?

"And, you wouldn't push for hours, would you?"

There's no reason for anybody, no matter the length of labor, to push for hours. If you're pushing for hours, you're pushing too soon, or pushing under adverse conditions that are keeping your body from functioning optimally. The hours leading up to "second stage" are priming your body to get the baby out. Once it's fully primed, the actual moving out of the baby should go swiftly.
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#20 of 34 Old 01-24-2004, 11:23 PM - Thread Starter
 
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Alstro, if your first birth was only 4 hours it is curious you are worried about a long labor this time.
Well, not worried exactly, but it occured to me I have limited experience and not so broad a view because my labour and birth were IMO straight forward and everything I was hoping for. I loved Sophie's birth, it was so neat. I remember saying to dh "well, not next weekend or anything, but I'll definitely do that again!" I felt good about it because I met all my "goals" say, like no interventions, meds, or dictated pushing.

So, what would happen if things were different, or say in Darshani's case, reeeeally different. I don't know, so you guys are really helping me out. The midwives say it will likely be pretty quick this time, but I'd like to broaden my knowledge base a little, so dh and I don't get freaked if something weird happens.

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Once it's fully primed, the actual moving out of the baby should go swiftly.
This is what happened, it actually happened so quickly I was a little bewildered when they flopped dd up on my chest. A large percentage of my friends, though, have said they "pushed for hours". I always feel a little bad and so don't talk about Sophie's birth much because I have no complaints, in fact I hold that experience close to my heart. I can't help but think in some cases it's because they were totally unprepared for what they were going to do Maybe I should tell my story more, just so they aren't all horrifying!

Anyway, you guys are great.

Jen
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#21 of 34 Old 01-25-2004, 02:09 AM
 
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Alstrameria: one of your questions was what if your water breaks and the contractions stop? Well, that is exactly what happened to me. Water broke, a few contractions, then nothing. About 10 hours later, my midwives suggested having an acupuncturist come over. Apparently there are acupuncture points in the wrist and in the ankle that help start labor. Almost exactly 2 hours after the acupuncurist treatment my contractions started in earnest and the baby was born within 1 hour.

Now, since you are planning a hospital birth, I am not sure this would work for you. But I just wanted to relate my story so you could have options.

cmd
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#22 of 34 Old 01-25-2004, 05:35 AM
 
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I am in the same situation right now. As of Thurday, I was at 4 cm and I have been having mucosy, bloody show since Friday. This is my third pregnancy and I can tell that I am in pre labor/early labor. I have been feeling this way since Friday morning. I feel my baby moving and everything seems fine, so I haven't even called my midwife. My dh is trying to facilitate giving me space and time to do wheatever I want. Yesterday I did some cleaning around the house (while I was home alone), I went to a book store, walked the local mall, ate, and slept a lot. I also talked with a freind who suggested a massage. I will be having someone come to my house on Monday for a lomi lomi massage if I am still feeling this way.

I am trying to distract myself and relax as much as possible.
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#23 of 34 Old 01-25-2004, 09:55 AM
 
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MamaOui, that's great! Will be thinking of you. Positive vibes coming---OOOOMMMMMM....

BTW, b/c of my shallow pelvis, I pushed for an hour with the first baby and "they" said, she isn't coming out, let's do the c-sec.

With 2 and 3, 45 mins of their relatively short labors were pushing. No 5 or 10 min pushing stage for me. It was kind of a tight fit, I used hands and knees, supported squat, even just standing up. With ds, my miswife, who was also a Bradley instructor, requested me to lie back at a 45 degree angle at the end, and the baby slid right to the opening. He was fully encased in his bag of water, and they broke it to make more room, as I breathed and sort of inched him out, no tears.

Odd that his amniotic sac and his cord were so tough, as the girls' sacs broke as the first sign of labor.
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#24 of 34 Old 01-25-2004, 11:00 AM
 
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with this pregnancy my midwife loaned me a book by penny simkin called progress of labor i think.some of the info there probably saved me from a transfer to hospital.the baby was positioned head down with both hands by her ears.so we tried the suggestions to move her into a more favorable position they worked! at 3 days old she still sleeps with her hands by her ears!this was the first time i had had to deal with a slow pokey labor,irregular contractions,and a premature urge to push,allsigns of a malpositioned baby.it's certainly drove home the importance of moving and changing position often in labor.my midwives also gave me liquid calcium and magnesium by nf formulas,3 tbsps every 30 min,it definately helped with muscle cramping and leg pain
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#25 of 34 Old 01-25-2004, 01:06 PM
 
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I agree with whoever it was who said that long labors are just borning:LOL I also felt really antsy for the thing to just START already, which probably wasn't such a great frame of mind. When you have a slow labor, my best advice is to stay the heck away from the hospital. I didn't go to the hospital until I was 8cm. I just felt that something was going to happen soon. Sure enough, babe was born 2.5 hrs after getting to the hospital. If I had gone in two days before when labor started, my perfectly normal, slow labor could have been labeled ffp. If I was lucky, I would have been induced and babe would have been born. If I was not so lucky, I would have been sectioned. Although, personally I probably would have thrown a fit and threatened to walk out the door if they didn't let things progress naturally.
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#26 of 34 Old 01-25-2004, 01:37 PM
 
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MamaOui, that's great! Will be thinking of you. Positive vibes coming---
Thank you DaryLLL.

My babe is so far down right now that I cannot close my legs when I sit. I spoke with my one of midwives this morning just to touch base. She's on the same page as me about just letting everything be. My dh is a dream right now. : swoon He will work from home until I deliver at this point and I have not had to attend to anyone's needs but my own for the last couple days (unless I feel like it).

Saintmom, I have Penny Simkin's Birth Partner and I love that book. I wsh I could get my hands on a copy of the book that you are talking about today, so I'd have something informative to read while I am in limbo.

For those of you you have been through this, did you even notice most of your contractions? With ds#2 I was dialted to 6cm and I did not realize it (well not really). I was with a different midwife group at the time. When I called to say that I suspected something had changed, they wanted me checked at the hospital. I ended up there overnight and then the interventions started in the morning. Yuck.
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#27 of 34 Old 01-25-2004, 02:56 PM - Thread Starter
 
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He was fully encased in his bag of water, and they broke it to make more room, as I breathed and sort of inched him out, no tears.
Same with dd. I had a great L&D nurse who used to deliver babies in Saudi Arabia. She broke my water when dd was fully descended and I felt such relief! Dd was born 10 minutes later, also no tears. Everyone commented on how alert she was, looking around at everything!

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#28 of 34 Old 01-26-2004, 08:16 PM
 
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Just wanted to post an update on my saga. Went to 38 week appt. after another week of cx. and 4 cm. and 80% effaced, baby's still at +1 station. I actually asked NP to strip my membranes since I've been having a good run of cx since yesterday. I'm starting to lose patience, but baby's forcing me to wait. Having a good amt. of painful cx this afternoon. Maybe it will go somewhere, maybe not. We'll see. It can't be *too* much longer, right?

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7yo: "Mom,I know which man is on a quarter and which on is on a nickel. They both have ponytails, but one man has a collar and the other man is naked. The naked man was our first president."
 
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#29 of 34 Old 01-26-2004, 10:44 PM
 
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Hang in there, USAmma. I'm with you. I got my massage today (3.5 hours of bliss) and I am trying to stay relaxed. It's a weird state to be in this not quite in labor /not quite not in labor. I'm working on just trying to go with the flow.

I wonder how Alstrameria is fairing.
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#30 of 34 Old 01-26-2004, 11:16 PM
 
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Say I have a baby who is posterior, or shoulder dystocia and the labour is progressing slowly.
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What can be done? What can I do? Is there any danger to the fetus? This is something I would like to know more about, since it seems to be a big cause of interventions...
There's no danger to the fetus. At all. The big cause of interventions is, as others said, just a failure to wait on the doc's part.
If babe is posterior, you'll need lots of counterpressure on your back. You should do hands and knees, pelvic tilting, stair climbing - which helps wiggle the pelvis and allow the baby to turn - etc.
As far as shoulder dystocia goes... don't birth on your back if you can help it, and you probably won't have that problem. If you do, a quick switch to the hands-knees position should allow the pelvis to open enough to allow the babe to pass through. If not, the midwife can insert two fingers and maneuver the baby's shoulder down and out. No biggie Another way to deal with S.D. is suprapubic pressure, where your pubic bone is pushed down, I believe.
The best thing to do for a slow or start/stop labor is to totally ignore it. My labor lasted, technically, 36 hours but I ignored it until transition. Just do lots of shopping, napping, errands, whatever. It's not that bad, trust me.
About the water breaking....... no baths and nothing - NOTHING - inserted into your vagina. (Hands outta there, docs!!!) Women can go for a week like that and not have any problems, as long as they take their temperature every hour or so to make sure an infection isn't setting in. That's what I'd do
Good luck!
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