[paintedbison]

I'm a postpartum nurse and have a question about my friend's delivery over three years ago (it's been bothering me this whole time). I was working on the unit (cross training, fresh out of school) the day she had her baby.

She was electively induced and got an epidural early on. Dilated to ten pretty quickly. The nurse said she could feel the baby's head coming down and then going back up. Said the baby wouldn't fit through her pelvic bones. Never attempted to have her push at all.

They knew the baby was big per ultrasound. She had a c/sec at 5pm and delivered a nine lb baby.

I'm just wondering if she had been asked to push if it would have made any difference? Or if she hadn't had the epidural and could have squatted or something else for pushing? Or does what happened sound right to you?

[feebebe23]

If the pt is completly dialated but at a -2 station......it is a waste of time to make the pt. push for 2 hours just to end up with a CS. Did they offer to let the pt push??? And how long was she 10cm before the CS?? If they let her labor down for 1-2 hours and the head never decended then why exhaust the pt just to "give her a chance" unless the pt wants to......unfortunately not all babies are coming out from the bottom???

If the mom is adament about wanting a vag delivery I would deffinately have them push.....even if I know it's never going to happen. If the mom really doesn't care which way the baby comes out then I would discuss my opinion that I wasn't feeling confident about the baby fitting, explain all options and see what she says.

[CEG]

Induction and epidurals increase the risk of fetal malposition. They also prevent mom from assuming more effective birthing positions like squatting, standing, etc which open the pelvis as opposed to lithotomy which actually restricts the pelvis. A 9 lb baby is not that big, depending on the size of the shoulders and whether or not mom had gest. diabetes (big babies from GD tend to have larger shoulders rather than just being chubby). It does sound like it could have been a case of "cool plans for dinner" rather than "cephalo-pelvic disproportion", but it is hard to say without being there.

In any case it was not in her or baby's best interest to induce electively, even if they did suspect a big baby. There is no evidence to support the practice and even ACOG recommends against it.

[Dayray]

They should have let her push (imo). Yes there is CPD and yes sometimes you just know a baby isnt going to fit - but sometimes you are wrong.

In busy high intervention hospitals people tend to become very pasamistic. After you see allot of bad outcomes (or near misses) you realise that all that really matters in the end is a healthy baby and mom.

Well that is ultimately, true to the pateint (who hasnt seen all theose bad things) other things are still important. Even if a vaginal delivery was not in the cards for her She will always wonder if she does not see for herself and maybe your wrong so IMO dont say anything and let her push for a while if its not happening expalian that you think she is going to need a c/s and offer the choice. if she still wants to push but define an end point with her i.e if we push for 3 hours then we do a c/s.

Offten we forget that childbearing is an important social/emotional/spirtual thing - yes our job is to safeguard the lives of our pateints but as long as the risk is not too great we should also care for those other parts of the people we call pateints

[HeartsOpenWide]

Your friend should have been aloud to try pushing, IMO...I have heard enough stories where women are told they have CPD and they deliver a even larger baby vaginally on their second birth. CPD seems to be an abjuratory Dx when the OB does not want to have to wait...

[CMCRN]

Originally Posted by CEG

Induction and epidurals increase the risk of fetal malposition. They also prevent mom from assuming more effective birthing positions like squatting, standing, etc which open the pelvis as opposed to lithotomy which actually restricts the pelvis. A 9 lb baby is not that big, depending on the size of the shoulders and whether or not mom had gest. diabetes (big babies from GD tend to have larger shoulders rather than just being chubby). It does sound like it could have been a case of "cool plans for dinner" rather than "cephalo-pelvic disproportion", but it is hard to say without being there.

In any case it was not in her or baby's best interest to induce electively, even if they did suspect a big baby. There is no evidence to support the practice and even ACOG recommends against it.

[babyktchr]

The magic number of 10. Seems it is forgotten that where the baby's head is relation to that 10 cm cervix also comes into play. If she had a good epidural, allowing her to labor down for a few hours (given the baby handling it well) would've given that baby time to declare itself as too fat to fit. Position changes aren't out of the question with an epidural...couple that with some time, and maybe this kid could've come out. I don't know that I would've never let her push.....maybe only if she had labored down for a few hours with no change in station. I think though that at least an hour of pushing would've made me feel like we did everything.

[OzMW]

Stuff I'd wanna know:
where was the head?
what were her contractions doing?
what was the position?
how long was she left from fully dilated?
was there lots of moulding?

[paintedbison]

Originally Posted by OzMW

Stuff I'd wanna know:
where was the head?
what were her contractions doing?
what was the position?
how long was she left from fully dilated?
was there lots of moulding?

I'm assuming from what I heard that day that the head stayed about -2 and she was fully dilated for a couple of hours. I don't remember there being lots of molding.

[OzMW]

Originally Posted by babyktchr

The magic number of 10. Seems it is forgotten that where the baby's head is relation to that 10 cm cervix also comes into play. If she had a good epidural, allowing her to labor down for a few hours (given the baby handling it well) would've given that baby time to declare itself as too fat to fit. Position changes aren't out of the question with an epidural...couple that with some time, and maybe this kid could've come out. I don't know that I would've never let her push.....maybe only if she had labored down for a few hours with no change in station. I think though that at least an hour of pushing would've made me feel like we did everything.

What she said