Question About Cord Prolapse (MWs - Would Love Your Thoughts) - Mothering Forums
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#1 of 14 Old 05-12-2004, 02:28 PM - Thread Starter
 
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Here's the scenario. Mom goes into labor with mild irregular contractions at 39 weeks. One week her prior mucous plug was lost and baby was posterior at -2 station with no dilation or effacement. Mom has irregular contractions for about 12 hours (enough to keep her awake but not enough to make her fret -- she actually thought she wasn't in labor) and her water breaks. Mom goes to hospital, is examined, and baby is at -2 station still, is still posterior, and she's 20% effaced and 3cm dilated. She is put on her back for the duration of her labor until baby engages due to risk of cord prolapse. Baby never engages until mom starts pushing (8 hours later), and baby remains posterior.

In your opinion, what were the real risks of cord prolapse and would you have done anything differently? Yes, this is my scenario (more or less), and I'm trying to process a rough, not-at-all-as-I-planned delivery.

Thanks!
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#2 of 14 Old 05-12-2004, 02:59 PM
 
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I would think that the focus on getting baby turned anterior would far outweigh any risk of cord prolapse. Posterior labors, esp for first time moms, often end up with a "failure to progress" diagnosis and cesarean.
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#3 of 14 Old 05-12-2004, 03:20 PM - Thread Starter
 
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Pamamidwife ... what would you recommend doing to turn baby anterior during labor? Hands & knees? Other positions?
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#4 of 14 Old 05-12-2004, 05:05 PM
 
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My 2nd child was clearly posterior after my waters broke at home (about 12 hours before I delivered him). I stayed upright despite the warnings that I might have a cord prolapse... My nurses at the hospital were concerned, my midwife was not so concerned, and more worried about the posterior laying baby. I cannot remember the station he was at, but I do remember the nurses telling me that he was too high to walk around the hospital halls. My midwife promptly let me up to wander.

Walking, birthing ball and squatting made him turn appropriately so that he could descend. I cannot imagine laboring in bed, it would have been excruciating. to you.
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#5 of 14 Old 05-12-2004, 05:16 PM
 
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Definitely walking around, or doing knee/chest (the position used for prolapsed cords, incidently) during a series of contractions. Lunges help, too.

www.spinningbabies.com - here is more info on turning a posterior baby before and during labor.

I hope this information helps.
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#6 of 14 Old 05-12-2004, 05:29 PM - Thread Starter
 
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Laboring in bed was awful, especially b/c I experienced a lot of back labor and was in pain between contractions so I could never quite catch my breath. And since I was on my back, we couldn't utilize counter pressure which might have helped. Not an experience I care to repeat.

Thanks for the advice & info. I'm just trying to process my birth and learn more just in case it should ever happen again.
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#7 of 14 Old 05-12-2004, 06:38 PM
 
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A lot of places still go by station as to whether they let a woman up and around with ruptured membranes, but many go by "is the presenting part well applied to the cervix". I have to say, I don't ever remember a case where the membranes were ruptured and the presenting part *wasn't* well applied - except in cases where the OB has artificially ruputured membranes with a high presenting part to try and encourage engagement (grrrr - which often winds up an "OB induced cord prolapse"). Explain to me if the head is up against the cervix, how is the cord supposed to prolapse around it?
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#8 of 14 Old 05-12-2004, 07:03 PM - Thread Starter
 
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Quote:
Originally Posted by Mom2six
A lot of places still go by station as to whether they let a woman up and around with ruptured membranes, but many go by "is the presenting part well applied to the cervix". I have to say, I don't ever remember a case where the membranes were ruptured and the presenting part *wasn't* well applied - except in cases where the OB has artificially ruputured membranes with a high presenting part to try and encourage engagement (grrrr - which often winds up an "OB induced cord prolapse"). Explain to me if the head is up against the cervix, how is the cord supposed to prolapse around it?
That makes sense to me. I was wondering how on earth I was dilating fairly rapidly post-ruptured membranes (greater than 1cm/hour). Wouldn't quick dilation usually require the head to be applying pressure to the cervix? And ds had a pretty severe conehead (despite eventual c/b, don't get me started), and I kinda remember the OB saying he's got a conehead from being at 4cm. So if his head had a 4cm conehead, how could it not be against the cervix? Urg ... must get medical records. I'd love to see what they say.

And also, wouldn't it have been far more likely for the cord to prolapse at the time my water broke (or shortly thereafter since I was laying on my side in bed when it happened but got up pretty quickly right after!) than hours later? I was upright walking, squatting or sitting for 2+ hours (I even showered) after my water broke.

I'm very angry.
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#9 of 14 Old 05-14-2004, 03:05 PM
 
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Laboring in bed with a posterior baby! As a mom who had excruciating back labor I really feel for you. What a cruel thing to do to a woman with a posterior baby.

As for the cord prolapse -- I am really not getting why they wanted you to lie down to prevent it. Seems to me that would increase chances of cord prolapse -- since the cord is lighter than the baby, the only way it's going to float toward the cervix ahead of the baby is if you're lying down, the baby is floating around, and your water goes "whoosh!", carrying the lighter cord with it toward the cervix. If you're vertical, gravity is going to pull the baby's head down first, and the cord will float upwards. If you are get to the hospital sometime *after* the water has broken, and you've been upright all that time and the cord hasn't prolapsed, it's not going to if you remain upright. It's just logical.
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#10 of 14 Old 05-15-2004, 12:22 AM - Thread Starter
 
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Quote:
Originally Posted by blueviolet
Laboring in bed with a posterior baby! As a mom who had excruciating back labor I really feel for you. What a cruel thing to do to a woman with a posterior baby.

As for the cord prolapse -- I am really not getting why they wanted you to lie down to prevent it. Seems to me that would increase chances of cord prolapse -- since the cord is lighter than the baby, the only way it's going to float toward the cervix ahead of the baby is if you're lying down, the baby is floating around, and your water goes "whoosh!", carrying the lighter cord with it toward the cervix. If you're vertical, gravity is going to pull the baby's head down first, and the cord will float upwards. If you are get to the hospital sometime *after* the water has broken, and you've been upright all that time and the cord hasn't prolapsed, it's not going to if you remain upright. It's just logical.
Thanks for the sympathy. I've really come to such a point of anger about it all. I really want to get my records and then write a letter to the hospital & OB asking WHY. Doubt I'll get a response though. Actually, I think its b/c the hospital was litigation afraid so they practice litigation-based medicine vs. evidence-based medicine.

Your thoughts make sense to me. Thanks for sharing them!
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#11 of 14 Old 05-16-2004, 11:46 PM
 
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I'm not a midwife, but a family doc who attends deliveries, and it's never occurred to me to put a mom with spontaneous rupture of membranes in bed. I generally figure if the cord is not presenting at the time of rupture, it's not likely to later. (Or at least not anymore likely lying down than standing.)
I also like hands and knees for posterior babies, and the birth ball. Also, if mom likes to be upright better, often standing and leaning over the bed or our hospital's wide windowsills seems to help, and gives good access for counter pressure. We put the bed flat, just a little higher than waist high and have mom lay her head on the bed during contractions, and rock her hips back and forth while nurse, dad, or me does firm counter pressure. This has been a great position of comfort for a lot of moms with back labor. Also, since I'm supposed to abide by hospital rules and monitor continuously, I find no problem monitoring with mom standing, sitting or rocking. Our nurses are great about encouraging mom to find whatever position suits them, then the nurse worries about the monitor.
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#12 of 14 Old 05-17-2004, 12:07 AM - Thread Starter
 
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Quote:
Originally Posted by doctorjen
I'm not a midwife, but a family doc who attends deliveries, and it's never occurred to me to put a mom with spontaneous rupture of membranes in bed. I generally figure if the cord is not presenting at the time of rupture, it's not likely to later. (Or at least not anymore likely lying down than standing.)
I also like hands and knees for posterior babies, and the birth ball. Also, if mom likes to be upright better, often standing and leaning over the bed or our hospital's wide windowsills seems to help, and gives good access for counter pressure. We put the bed flat, just a little higher than waist high and have mom lay her head on the bed during contractions, and rock her hips back and forth while nurse, dad, or me does firm counter pressure. This has been a great position of comfort for a lot of moms with back labor. Also, since I'm supposed to abide by hospital rules and monitor continuously, I find no problem monitoring with mom standing, sitting or rocking. Our nurses are great about encouraging mom to find whatever position suits them, then the nurse worries about the monitor.
Can you be my doctor next time?

This information is just making me feel like the hospital (and/or OB) used my water breaking and baby's position as a big, old excuse to keep me in bed. They just didn't want to deal with a mom who wanted to move around. Too much work. I really believe had I been able to move around that many interventions (including the resulting c/s) would've been avoided. I'm very angry at all of this.

Thanks for your input, though. It helps me greatly.
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#13 of 14 Old 05-17-2004, 10:53 AM
 
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to you!

I think that those of us who have had a disappointing birthing experience are or were on the same journey that you are. I was there 8 years ago with my first, and it was a very difficult place to navigate.

Just know that your feelings are justified (sounds like) and that birth does not have to be like that. (Even in a hospital, though it sounds like you would be *perfect* for a direct-entry midwife.)

It took me years with people telling me, "But look! You got a great baby out of the deal!" But, for me, a baby was not all that birth was about. It was a process for me to becoming a mother, one that I was cheated out of by my OB. I felt violated, used, demeaned and abused (and I didn't even have to have a cesarian birth).

My subsequent births have been healing and beautiful. Much love to you as you figure out your place in Henry's birthing.
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#14 of 14 Old 05-17-2004, 11:30 AM - Thread Starter
 
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Quote:
Originally Posted by onlyboys
to you!

I think that those of us who have had a disappointing birthing experience are or were on the same journey that you are. I was there 8 years ago with my first, and it was a very difficult place to navigate.

Just know that your feelings are justified (sounds like) and that birth does not have to be like that. (Even in a hospital, though it sounds like you would be *perfect* for a direct-entry midwife.)

It took me years with people telling me, "But look! You got a great baby out of the deal!" But, for me, a baby was not all that birth was about. It was a process for me to becoming a mother, one that I was cheated out of by my OB. I felt violated, used, demeaned and abused (and I didn't even have to have a cesarian birth).

My subsequent births have been healing and beautiful. Much love to you as you figure out your place in Henry's birthing.
Thank you, Amanda. Your words are beautiful and so kind (and so on point). I very much appreciate it.
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