Is this a valid c-section reason? - Mothering Forums
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#1 of 18 Old 01-28-2011, 10:08 PM - Thread Starter
 
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I had a friend who just had a c-section and it just seems really bizarre.  Now I'm kind of freaking out that it might happen with my next (I have no idea why, I just worry a lot and mispositioned babies really freak me out.  I was so worried about that with both my pregnancies.).  She was in labor for 36 hours or so, finally showed up at the hospital dilated to 9.  Was there for 2 hours, didn't get past 9.5 b/.c the baby's head was crooked.  They gave her an epidural to see if that would help her dilate more (how would that even help?) and after another hour she wasn't dilated anymore so they sectioned her.  It just seems odd that she'd get to 9.5 at 6pm and they wouldn't do forceps or vacuum or something like that.  I just assumed once you got to 9 that if you didn't dilate the last centimeter they'd just stretch you and tell you to push.


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#2 of 18 Old 01-29-2011, 03:50 AM
 
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If she wasn't completely effaced, they couldn't have stretched her a full centimeter and it would have been EXCRUCIATINGLY painful if they'd tried, even through an epidural. If the baby's head was at an angle that might be why she wasn't dilating all the way since he couldn't put the right kind of pressure on the cervix to get it to open, and could have resulted in a birth injury, it would have been risking injury to both the mother and baby trying to use vacuum or forceps extraction. The epidural might have been to give her a break since she'd been in labor for 36 hours and give her a chance to rest.

 

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#3 of 18 Old 01-29-2011, 04:02 AM
 
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 The epidural helps moms relax, if labor pain is keeping them too stressed/tense--some malpositioned babies are able to wiggle themselves into better position with mom more relaxed.  Also, a mom might even sleep a few hours with an epi--and wakes up with renewed energy.

 

The csec was probably done because mom was tired--and the doc was tired of waiting.  Hospital people often don't know beans about helping moms help themselves/babies to fix poor positioning.  For instance, I've heard that knee-chest position can help bring baby off the pelvis/cervix, and give a baby more room to adjust itself. 

 

6pm?  Doc might have had important plans that evening...or just likes to be home by bedtime.  If you're worried about malpositioning next time, have a homebirth--and make sure you find a midwife who knows good ways to help deal with malpositioning!

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#4 of 18 Old 01-29-2011, 07:19 AM - Thread Starter
 
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6pm?  Doc might have had important plans that evening...or just likes to be home by bedtime.  If you're worried about malpositioning next time, have a homebirth--and make sure you find a midwife who knows good ways to help deal with malpositioning!


I had a homebirth with my last and plan on it for the next.  I'm just a chronic worrier lol.  After I heard her birth story I immediately started to worry about the next baby and it's positioning even though I'm not pregnant and the midwife we're planning on going with again is completely awesome.


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#5 of 18 Old 01-29-2011, 01:03 PM
 
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I have a friend who had an over 48 hours of labor eventually got to 10 cm and pushed for 4 hours or so I think.  She had great midwives and a great doula and husband.  The whole time here contractions were never regular and patterned and would go from hard to easy etc.  Baby never moved or descended at all during the pushing time.

 

they sort of worked step by step through her birth plan and all the possible things they might try... eventually did do an epidural after this point and then eventually a a c-section.  They think several things contributed.  Baby was always slightly angled, cord was wrapped around his foot and mom was small and baby long so he just could never get in the right position for constant pressure.  Doc also mentioned something about her pelvis (I can't remember now, some bone maybe tilted in an unusually way).

 

After talking to my friend a lot I feel they really did everything at that point.  She was exhausted and had a really hard time in the weeks after the baby was born and this is probably a case where an earlier c-section would have been better... but of course if it had been done earlier it would be hard to say for sure how necessary it was or not so that result would have been harder to deal with in that way.

 

---

The situation you mentioned sounds possibly similar but with the c-section coming about 12 hours earlier.  Of course each case is very individual and different so it is hard to assess.


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#6 of 18 Old 01-29-2011, 09:49 PM
 
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That is definitely a valid c-section reason.  It happens.  When a baby is crooked it is called acynclitic.  I've birthed two acynclitic babies vaginally, but I'll be honest, I don't think birth is a good idea for me in the future.  My first acynclitic baby was a difficult home birth.  My midwives were very skilled in positioning issues, and we sort of methodically went through the list of what we could do to help that baby be born, and eventually he was born.  It was a rough birth for him, and his head was cocked to one side for weeks afterward.

 

My second acynclitic birth was horrendous.  Same midwives.  I transferred to the hospital at 9 cm, stuck again.  Did every thing that could be done to aid his decent, and very nearly ended up with a c-section.  At the last minute he found a way through my bones, and was aided by pitocin and the midwife pulling to get him out.  It was a really rough birth for him, and he suffered a broken clavicle in the process.

 

After two acynclitic babes in a row I'm thinking I might be prone to that, and I don't want to risk having to have a c-section, so no more bio babies for me!

 

I'm a chronic worrier too, so I know it won't help you too much to say "don't worry, it's rare.  You'll be fine."  But, that's the probably truth, so don't worry too much.


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#7 of 18 Old 01-29-2011, 11:02 PM
 
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To me it does sound like a valid reason. 36 hours of active labor is a long time. My ds was doing a similar type of thing and MW said that if we had been in the hospital we would have ended up at the very least with an epi (to get pain relief and rest) and vacuum but more likely a c-section and my labor wasn't nearly as long as your friends. Luckily my MW was very experienced and was able to work through the bumps we hit along the way. The baby's head was cocked to the side so part of my cervix wasn't dilating. She had to stretch me through each contraction for about the last hour - ouch!!! But it worked. We also had to go through different pushing positions to get him out, he had a big head and stuck shoulders. Thankfully he was born very healthy but it was a struggle to get him out because he was a 9 lb. baby. The MW had to pull on him while I pushed until he came all the way out. She did mention that if this had been my first we might have transferred to the hospital but she had been through a birth with me before and knew we could make it work. I was hoping for a fast, calm and collective birth and it was way more painful and difficult than I imagined but it still was a good birth.

 

I was always a worrier about things like that too. I think that all you can really do is put yourself in the best possible starting place and be ready to change plans if need be. You never know what bumps you may hit through labor and delivery but in the end what counts is a healthy mom and baby and sometimes that does mean being open to necessary interventions even as much as we would prefer not to need them. I hope your birth is everything you hope for. 

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#8 of 18 Old 01-29-2011, 11:42 PM
 
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I've had two c-sections for asynclitic babies.  While forceps can be a way to get an asynclitic baby out, I'd much rather have a c-section.  So few OBs are skilled in the use of forceps these days (a quick Google revealed they're used in fewer than 3% of deliveries these days, and I'd wager even fewer than that based on my friends who've had hospital births) and often you wind up with a big episiotomy to boot. 

 

There's a point where it becomes evident that the baby is just not going to come out easily vaginally, if at all.  Does that mean the c-section was absolutely necessary?  We kind of have to define necessary.  Would she or the baby have lost their health or lives if she had labored longer?  I'm guessing not, but would it have benefitted either of them?  There could have been other factors at play too that your friend didn't know about or care to share.

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#9 of 18 Old 01-30-2011, 12:29 PM - Thread Starter
 
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Thanks for the input.  I'm just a chronic worrier and having friends who have kids has made it worse.  Out of 4 friends that have had babies this year 1 was induced and 3 had c-sections.  2 went with an OB group that highly manages pregnancy (I went there for a few appts with my first until I realised it was not at all what I wanted) and took the hospital birthing classes.  It was what worked for them and all but the friend who got induced were fairly happy with their births, but it just freaks me out, even though we're planning on the next with a midwife and staying as far from the hospital as I can get. 


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#10 of 18 Old 01-30-2011, 06:05 PM
 
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Also, OBs won't use forceps any more unless conditions are just right. Forceps may not ever have been an option, depending on baby's position and station.

 

I don't think you can conclude, as one poster did, that doc was just "tired of waiting" and wanted to get home because it was 6pm. Tbh, the kind of doc I've heard of who's really impatient doesn't want you to go 36 hours to begin with.

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#11 of 18 Old 01-31-2011, 08:40 AM
 
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Also, OBs won't use forceps any more unless conditions are just right. Forceps may not ever have been an option, depending on baby's position and station.

 

I don't think you can conclude, as one poster did, that doc was just "tired of waiting" and wanted to get home because it was 6pm. Tbh, the kind of doc I've heard of who's really impatient doesn't want you to go 36 hours to begin with.



Agreed - I think most docs who would do that kind of things would have done it between 12-24 hours in or so... if the doc waited and helped for 36 hours it shows a reasonable level of dedication to natural birth etc.  

 

It is impossible to ever know what would have happened with alternate paths - waiting a few more hours could have either gone great and baby could have positioned.... or waiting a few more hours could have resulted in some kind of more serious distress or major issue for mom/baby ... or anything in between.  It seems like a reasonable situation from the information we have and that as a good a decision as could have been made, was made.  


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#12 of 18 Old 01-31-2011, 09:51 AM
 
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I think the baby has to be quite low to use forceps or vacuum.  If this mom wasn't even fully dilated, I assume her baby was not low enough to use forceps or vacuum.  Who knows if patience would have helped.  For asynclinic babies, it's a toss-up because it depends on so many things.


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#13 of 18 Old 01-31-2011, 11:45 AM - Thread Starter
 
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Also, OBs won't use forceps any more unless conditions are just right. Forceps may not ever have been an option, depending on baby's position and station.

 

I don't think you can conclude, as one poster did, that doc was just "tired of waiting" and wanted to get home because it was 6pm. Tbh, the kind of doc I've heard of who's really impatient doesn't want you to go 36 hours to begin with.



Agreed - I think most docs who would do that kind of things would have done it between 12-24 hours in or so... if the doc waited and helped for 36 hours it shows a reasonable level of dedication to natural birth etc.  

 

 


She was only actually at the hospital for a few hours of that, I think she said 3. 

 

I don't know why this is getting to me so much, it wasn't my birth.  I just get so freaked out and sad.  Then I start to worry my body won't work.


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#14 of 18 Old 01-31-2011, 01:34 PM
 
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Quote:

I don't know why this is getting to me so much, it wasn't my birth.  I just get so freaked out and sad.  Then I start to worry my body won't work.



It is wonderful for us to share our birth stories with each other, but I think it's a mistake to conclude anything about what might happen to you based on hearing one story from one friend. I'm sure your friend would not want you to be freaked out and sad because of what she told you. Her experience tells you nothing about your own body's ability and what might happen to you...it's just her story.

 

hug.gif Hugs to you, Mama. It's so common to have fears and worries prior to giving birth. I hope you can find your way to peace.


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#15 of 18 Old 01-31-2011, 01:48 PM
 
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This sounds a lot like my first birth. I got through the first 6cm in about 24 hours, and then it took 4 hours to get to 7cm. In the end, I did get a natural vaginal birth, but only after hours of back labor, trying every trick in the book to get that baby down, ultimately pushing before 10cm (for almost 2.5 hours) to get out my acynclitic baby (with a hand up there to boot)! And as the pp mentioned, my DD did keep her head turned that way for weeks afterwards.

FWIW, DD2 started out acynclitic but slipped into position quickly; then she basically flew out! If you asked me which birth I liked better, I couldn't tell you. Birth 1 was long and exhausting, but manageable. Birth 2 was intense and almost overwhelming, but I felt great afterwards. That's just to say that you can still have a good birth even if the positioning isn't perfect. smile.gif

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#16 of 18 Old 01-31-2011, 07:13 PM
 
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I was in labor with my son for 36 hours.  At 17 hours, I was having back to back contractions, very painful contractions.  Midwives checked me and I was only 3 cm.  I asked to be transferred because I was exhausted.  Got to hospital and found tons of dark meconium  in my pad.  Next, I got epidural and pit and ended up taking another 15 hours or so do dilate to 10 cm.  Then I pushed for 2-3 hours and my son would not descend.  I basically was so exhausted that I was right on board when doc suggest c-section.  I never felt bad about my decision at all....


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#17 of 18 Old 02-04-2011, 07:54 PM
 
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I have a 42-hour labor that ended in an eventual C-section at -1 station, 9cm, and 100% effaced. She was lodged in the birth canal and never budged the entire labor. She was too far up there to try outside devices. 

 

To read details of every single thing we tried to do to get her unstuck, you can read my birth story:

 

http://www.mothering.com/community/forum/thread/1105463/hannah-claire-s-3-in-1-birth-novella

 

Honestly, I don't feel like there was much else we could have done. We even did some things from spinning babies and whatnot but no dice. 


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#18 of 18 Old 02-04-2011, 08:14 PM
 
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Originally Posted by gemasita View Post

I think the baby has to be quite low to use forceps or vacuum.  If this mom wasn't even fully dilated, I assume her baby was not low enough to use forceps or vacuum.  Who knows if patience would have helped.  For asynclinic babies, it's a toss-up because it depends on so many things.



Forceps can be used to extract a baby past the cervix (it's called a high forceps delivery), but because of the pain and the risk involved, OBs no longer do this.  Surgery is considered safer for both mother and baby, and since the technique has fallen out of use, few doctors are trained in it and even fewer are experienced.  If I happened to wind up in the care of an OB experienced with this technique (and that OB would certainly be seriously out of practice), I would be concerned that high forceps on an asynclitic babe would risk breaking the neck. 

 

I wouldn't assume impatient OB either.  At many hospitals, OBs leave at the end of their shifts unless they're in mid-delivery (catching or stitching) or mid-surgery - if you have a long labor, your care will be passed from one OB to another.  This situation has a long labor and a significant complication.  Sometimes doctors and patients agree to try waiting it out, and sometimes they agree to move to surgery sooner rather than later.

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