[azjen43]

My student is 40 w 4 d with her first baby. She is a petite woman, about 5 ft 2 and her hubby is at least a foot taller than she. After lots of BH contractions, she finally consented to a VE this week and it has been found that her cervix is not effaced at all, is firm and closed. She went in for a BPP and everything looks great. However, (wait for it, you know it's coming....) the baby is measuring over 9 lbs and it seems the abdomen is larger than the head, putting her at risk, says her doc, for shoulder distocia. Not that she'll have it, but just that she's at increased risk.

The doc thinks that the reason the cervix hasn't changed is because the baby's head may be too big to engage in the pelvis and is not putting any pressure on the cervix.

So far, doc has been very nice and is willing to give more time, but at 42 weeks, she says, if nothing has changed, " the game plan will have to change." So, my client is feeling very motivated to help things along if possible. She is already walking 2 miles a day, and is thinking of increasing that, doing squats and lunges, having daily intercourse, drinking red raspberry leaf tea, and is considering using evening primrose oil orally, and/or vaginally. (Her doc is not crazy about her inserting anything vaginally, and I think this is actually a good sign) However, the doc is talking about using a prostaglandin gel pack next week if her cervix hasn't changed.

We've talked about relaxation, talking to her baby, believing in her body's ability to bring her baby forth. Any other ideas for this mama?

 

[turtlewomyn]

Have her contact the International Cesarean Awareness Network: www.ican-online.org Hopefully they will have a chapter near her.

The scenario you are presenting is almost exactly what happened to me 3.5 years ago with my daughter. I caved into the c-section and I am still processing and am pretty certain I was coerced into unnecessary major surgery which has put all my future pregnancies at risk (due to the threat of Uterine Rupture) and that prior surgery was the only risk factor I had for my ectopic pregnany that I had in November which almost killed me (and of course terminated my third pregnancy).

ACOG has put out a statement that does not advocate for prophalactic cesarean for fetal macrosomia, at least not at 9 pounds, maybe if they were estimating the baby to be eleven pounds. There is a paper online somewhere, I will see if I can find it and bring it back here.

I am 5ft2, DH is 6ft3, our dd was 9lb8.5oz at birth. I was also told she was not engaging and I was not going into labor because she was too big. They were also concerned about the head to abdominal ratio. However, I have cousins that were 9 and 10.5 pounds at birth, and since the time of my daughters birth one of them had a child almost the same size as her, and he was born vaginally. I have had at least three medical professionals tell me that my c-section was unnecessary.

What is the baby's position? I think that dd was posterior, and that was part of the reason she was not engaging.

Let me try to find that position paper so that you can give that to her.

 

[turtlewomyn]

Oh, if that doctor is waiting until 42 weeks, I would not worry about it too much. I thought they were trying to talk her into a c-section NOW. Or induction (which is also not a good idea). If her dates are correct, she will most likely have that baby before 42 weeks.

However, she might want to make sure the baby is positioned well, and maybe spend some time at www.spinningbabies.com. I think hands and knees and leaning over a birthing ball are good ways to help get that baby in a better position.

Also, being in a hands and knees position for pushing is better for big babies. The United Brachial Plexus Network has a great brochure about using positioning in labor to prevent Shoulder Dystocia.....
http://www.ubpn.org/ubpnweb.nsf/web/prevention.pdf

And here is a link to the ACOG guidelines for fetal macrosomia, they are against induction or c-section until the estimated fetal weight reaches 11 pounds.
http://www.drplace.com/ACOG_Issues_G...s.16.27195.htm

 

[kcparker]

Sifting with a rebozo might help baby wiggle around a bit, in case it's a little asynclitic or needs to reposition to apply good pressure on the cervix.

Also, I'd put this in the 'won't hurt, might help category,' but pineapple is supposed to help with cervical ripening.

 

[Jane]

Walking doesn't bring on labor. It can inhance a labor that is already going, but walking doesn't induce at all. That's my biggest pet peave - women walking to exhaustion. It's not a good place to start labor.

Also, how can the ob simulaneously say "big head" and "big abdomen" Those are the two measurements that are taken...(well, length, too). If they are both big, the baby is symetrical.

I do agree with the doc. At 42 weeks, the game plan has to change. But it is extrememly likely that she will labor before then, statistically speaking.

Are her dates good? Is it possible she's a week ahead of where she really is? High and not effaced is really normal at 39+4.
There isn't much I like about this scenario. Lots of misinformation...cervixes efface without baby heads on them. The fact that her baby is unengaged at 40+4 is not an ominous sign. I'm surprised that she had a BPP at 40+4. She's not even at 41 - a more common time for 1st timers to labor.

Is her abdomen pendulous? Sometimes a belly that vastly overhangs the pubic bone (short women seem to be more likely) lets the baby hang out there instead of over the cervix. As mentioned, a rebozo can help. So can lifting the abdomen with the hands.

 

[Beccadoula]

I strongly second the idea of working on position. Baby's head may just not be putting pressure where it works...spinning babies is great!!!

 

[turtlewomyn]

Also, does she have a male romantic partner? Lots of hetero sex can help with softening of the cervix since semen has lots of natural prostaglandin in it.

 

[dewi]

Quote:

Originally Posted by kcparker Sifting with a rebozo might help baby wiggle around a bit, in case it's a little asynclitic or needs to reposition to apply good pressure on the cervix. Also, I'd put this in the 'won't hurt, might help category,' but pineapple is supposed to help with cervical ripening.

Thank you for the pineapple link. This is fantastic.

I have no idea why I never stumbled upon this before! I adore the midwifery archives, and still never saw this before!!!
Thanks again.

For azjen43:
It's fascinating they think the baby's head is too big to engage, did she have a sonogram for a doctor to say something like this?
It seems very open minded of him to wait until 42 weeks, almost none of the docs around here do that anymore.

It seems likely it is a positioning issue in general not "big headed baby". Don't you think it's a really weird thing for him to say to this women?

 

[mwherbs]

so I would probably recommend belly binding and see if the baby would move down- yes it will probably change mom's comfort as far as if it pulls the baby in then her organs are going to be squished- but it will often line the baby up- the prostaglandin gel isn't a bad idea but it is the start of an induction process and you probably need to be clear about that, the doc may not have made that clear-- and what exactly is the routine if the gel is used? hospital admission? monitoring....

 

[azjen43]

Thanks so much for all the replies and information. I do agree that it's a bit early to worry, and I think she wouldn't be worried if the doc had not planted those seeds.

Dewi, yes she did have a US. That's where they came up with th 9 lb number and she will have another one next week if babe isn't here.

I know it has become unusual for OBs to "let" moms go to 42 weeks, and she (the OB) is suggesting scheduling an induction on 41 and 5 days. I just hate to see her wrestle with the possibility and am trying to help her refocus her thoughts to " this baby will come on it's own when my body and my baby are ready."

As far as walking, this mama is quite a fitness buff and enjoys the walking. I have cautioned her to not over extend herself and to balance rest with activity.

She's been on spinningbabies and is spending time on hands and knees, having daily intercourse with her hub....

Interesting about the pineapple, I learned something new! I'm gonna stop by her house this afternoon with a nice plate of fresh pineapple.

As far as a pendulous belly, It's not really what I think of when I hear the word pendulous. Meaning it doesn't lap over itself...however, she is really out front and it may be that lifting up or binding her belly may get the babe more lined up. I'll suggest that to her.

She did report some blood tinged mucus this morning, so that's good.

Thanks again for all you suggestions. I know I could count on hearing good things here!

 

[shellnurse]

Is accupuncture available in your area?