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Large client had c-section after 20 hours of labor...

606 Views 6 Replies 6 Participants Last post by  pamamidwife
Again, a little history on my client: she's 6ft and weighs 375lbs, and the MEDwife insisted the baby was at least 11lbs. Client had an u/s at 39w and the tech's report said macrosomia: 10lbs8oz. Since she went 10 days past that, the MEDwife was totally insistent this baby would be at least 11lbs. She would say, at the appts, "I can't palpate anything because it's all just baby!"

(And since the baby came out weighing only 9lbs5oz, I'd say that's a huge load of BULLCRAP -- of course she couldn't palpate anything, it was all freakin' tummy fat, not baby!

I went to client's house last night at 10:30p. Ctx approx every 3-4 min, lasting about 45s-1m. Finally client wanted to go to hospital around 12:30A. Hospital has weird triage rules that I've vented about before -- so I didn't see her for 3 hours while she was in triage. Finally her dh came out and gave me his "visitor" tag and I went in and saw client. She was 2cm, ctx still about every 3-4m lasting 45s-1m. We walked the halls for a while. Client was a CHAMP during ctx. Hypnobirthing helped immensely. I went home for a while, told client to call me when she was actually ADMITTED, took a catnap, went back at 7:30A, when client was finally admitted.

Client was at 6cm and 100% by 11am, still a champ with ctx. Walking, leaning over on bed/hubby/me/birthing ball. However, baby was posterior, and not descending. Ctx backed off to about every 8m. At 3pm, client was actually down to 5cm and he still hadn't turned or descended. MEDwife broke water. Still nothing. So, client had been in labor for like 19 hours, hadn't slept, no pain medication, ctx slowing. MEDwife offered pit, but said it would not help baby descend, which was the main problem. Client cried. We talked about it for a while. I explained it was NOT her fault, she was doing everything RIGHT and the baby just wasn't moving into the most optimal position and not descending. I said (honestly) I didn't know what she could do that she hadn't already done: squatted on birthing ball, leaned forward, walked, rested.

So, client decided to have c-section. Baby boy was perfect, 9lbs5oz, 20inches.

Anyway, I'm just wondering what happened? Is that common? She got to 6cm, and she was doing so well! Could the pit have helped? Could anything have helped? I really feel her obesity was obviously working against her but she still believed she could birth this baby. Every freakin' nurse was like WOW that's a large baby! Grrrrr. 9.5 is NOT that large. Gah!

I think overall her experience was positive, and I told her that just because this baby didn't descend and she stopped dialating at 6cm did not mean that future babies would be the same way. I told her what a great job she did, and her dh. But I'm still bummed out -- another c-s.

Opinions? Feedback? Thanks for reading this epic. Forgive me if my grammar is a mess; 3 hours of sleep in 24 hours isn't my forte.
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What might have helped is having her on H&K with her butt in the air to back the baby out a bit, so that he could get some room to turn around into a better position. Another option would have been anything that kept the pelvis asymmetrical, like walking up stairs sideways, or lunges, or even standing with one leg up on a chair, knee bent out, if that makes sense.

It's really common with an OP baby for the ctx to back off or space out or stop, and then AROM which takes away the fluid cushion and causes the head to settle even further into the pelvis. Add to that the pit that usually follows and you're jackhammering that baby's head into the pelvis further and further in a funky position... it's no wonder why so many OP labors end in cesarean.

Have you read Optimal Foetal Positioning or Sit Up and Take Notice? These are *invaluable* and I recommend having at least one of them in your birth bag!
Sometimes sqatting and walking don't allow for baby to rotate. Using a Rebozo sash to pull upward on uterus and allow baby to come up and rotate or laying side to get baby to turn. My midwife rocked me back and forth at the hip to help my son turn. It worked in 20 min. And also a large woman can have a small pelvic inlet. Sorry for the stress and mamas birth not as hoped!
Just be there for her as she'll need to work through this.

My first labor sounds alot like hers, except I didn't go to the hospital so soon.

I also think that our bodies know how to birth babies, no matter how fat we are.

A little patience and allowing her to do what feels best to her could have gone a LONG way. Seems like you tried everything you thought was right, but she was the one birthing and she experiencing it. It's maybe more difficult the first time when maybe you aren't as connected or able to listen to when your body is telling you to do. Hmmm?

Maybe (this is way out there) she is a bit disconnected from her body's signals anyhow..based on her physical state?

She did labor, and that was great for her and her baby. I don't know that you could have done more. The whole point is her feeling powerful in her birth. What can a doula do, when the dr is right there threatening and undermining her confidence? Her dr was planning to section her and getting your client mentally prepared for it for months.

Agree with the last poster about the books. I'd stress that more in the future as well as helping women understand that they KNOW how to give birth already...with or without a doula.

Simply from some of the doula posts, seems some clients search out doulas so they don't have to do all the prep work and education themselves.
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Sorry, but not at all surprised.

IMNSHO all she and babe needed were more time and less stress. babies know how to be born, even OP ones. I have NO reason to nbelieve that she is a special woman that is in the 2-4% of women that need surgery to remove their baby. I don't buy into the fact that it was her body at all that failed. Some women labor for days... she could have done it with more time.

I have no idea what your relationship was/how you practice... so also have no idea what fears/obstacles/issues she had to deal with in labor, or how you helped her through it all. It is possible that things were briefly "held up" from emotional issues as well as the OP issue.

I am glad you are there to support her as she heals. I hope you refer her to ICAN. Their online community is wonderful, and if she is not ready for it now, then she may be later.
Well, looking back now ita that she needed more time. I'm also thinking there was some impatience/expectations on her side and her dh's side (and also of course the midwife) and even me

There is only one hospital here, and one series of childbirth classes taught at the hospital. Women have it in their heads that if ctx are 5 min apart, it's time to go to the hospital and the baby will be born within 24 hours. I mean, at her house her dh said -- hopefully -- "Do you think she's at 6 or 8cm???" when the ctx were about 3-4 min apart. (My answer: NO. I think she *might* be at 3cm.)

So I think that had something to do with it. Expectant (first time) parents are taught that labor is 99% dialation and that's the way to mark progress. So there was a sense of disappointment when she was at 6cm for like 5 hours and not making progress past that.

Okay I have more to write but the barbarians are calling for me and dh is in LAS VEGAS this weekend, at a bachelor party!
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it's so hard to palpate with a mom who is large. but, if you listen to her responses on where she's feeling kicks, where she feels hiccups, etc., it can really help figure out position.

there is so much fatphobia that infiltrates not only the medical model, but also the midwifery model. like somehow these women are just time bombs with hypertension, gestational diabetes, etc., looming on the horizon. crazy.

it sounds like classic posterior labor pattern - it could have helped to not have the water broken, but then again, when labor stops like that, I'm always wondering what position baby is in. sometimes there needs to be a readjustment for baby.

cesarean surgery has more complications for large women. it's why we need to really evaluate the evidence in regards to their true risks of difficult births. most really large women I know birth fairly easy - it's the fear of their bodies that the providers have that causes problems.

{{hugs}} - I'm glad you were there for her. Surely she'll have lots of examination over the next few months/years.
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