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Need Your help... Vaginal Delivery Management & "NOT pushing"



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Sep 12, 2009 01:04 PM

Need Your help... Vaginal Delivery Management & "NOT pushing"


Hi There,
This is my first post:

I have been pondering about this for a while an have started my research on this topic..

I am a pre-nursing student and Mom of a 16 month old son. I also have a neurological condition called Syringomyelia or (SM). SM is essentially a fluid filled "cystlike" cavity in the spinal cord. SM can be associated with Chiari Malformation (CM). Management in Pregnant females and SM such as myself are quite tricky. We are usually told "C-section, under General...No vaginal Birth and no epidural".


When it comes to patients with this condition, there is simply not enough research or concrete evidence that points to one absolute recommendation about delivery. The only research in this topic with Pregnancy only covered 12 women... However there is some medical information that DOES support pushing during a Vaginal Delivery can enlarge a Syrinx and create a mass progression in the women's condition. The use of Epidural is usually contradicted because risk of intracranial pressure and the use of a Spinal is usually contradicted, but not completely contradicted. So I would like to explore here....and with your help

I need some info on Laboring options....particularly vaginal delivery...WITHOUT pushing...How can a women's OB, RN or other Practioner assist her in this type of delivery?

Here is what I am thinking:

We all know that if every woman explored this option, especially those women with conditions...labor and delivery rooms would be overflowing even more and things would not be as "scheduled". But just for this instance, in this particular patient, with no complications..Non-eventful pregnancy and baby "looks great".

Now..can a woman NOT push during labor(considering baby is tolerating labor well, tracings look great, no sign of distress, or LGA, etc. etc.) The issue with the SM is the increase in intracranial pressure, and the Valsalva maneuver and anything that causes in increase in abdominal pressure is an absolute contradiction in individuals with SM and Chiari Malformation.

I know it might take longer but does a woman REALLY need to push a baby out...can she just let her uterus "do the work", and vaginally deliver the baby that way. I know this essentially would occur in women who deliver a baby in a car on the way to the hospital, or before OB arrives to deliver. But has this "method" of delivery been done for a medical reason in OB patients, either with or without a medical condition. (Such as Syringomyelia or let’s say quadriplegia).
What about "Laboring Down", Forceps Assist, and Vacuum Assist...etc.etc

What have you had experience with in patients with similar situations? Have you had a patient with SM or CM?


Thank you
Take Care
Trish, CNA, ASAP (www.asap.org)

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18 Comments
No. 1
from CEG
Old Sep 12, 2009, 01:19 PM

Default Re: Need Your help... Vaginal Delivery Management & "NOT pushing"
This is just my opinion, I don't have any experience or knowledge about this condition.

It is absolutely possible for a baby to be born with no pushing...

But a patient without an epidural will more than likely have a hard time not pushing. The urge to push can be overwhelming. Pts with an epidural will often have the urge to push as well but it is rarely as strong as in a women with no pain meds.

But a patient without an epidural will not naturally tend towards valsava pushing (in reality it should ALWAYS be avoided but that's another thread ). But I am sure any pushing would result in an increase in abdominal pressure. But pregnancy itself and labor would also increase abdominal pressure, right?

So possibly a very dense spinal with a plan to labor down as far as possible and use vacuum/ forceps as needed? I'm not sure, it would probably vary widely based on the care provider.
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No. 2
from island40
Old Sep 12, 2009, 01:34 PM

Default Re: Need Your help... Vaginal Delivery Management & "NOT pushing"
The uterus is not strong enough to evacuate a baby with out the assistance of abdominal muscles. Failure to push during vaginal birth equal failure to progress. Forceps can cause damage to the baby. Vacuum can cause damage to the baby. continued stress on a baby from uterine contractions can cause damage to the baby. I think you would be hard pressed to find an ob that would take on the risks involved even if you pinky swore not to file a law suite once you had your precious brain damaged child in your arms.
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No. 3
from mmt4
Old Sep 12, 2009, 07:40 PM

Default Re: Need Your help... Vaginal Delivery Management & "NOT pushing"
Not an OB nurse (I'm taking pre-reqs) but a veteran of 4 vaginal deliveries (with one I had an epidural that worked on one side of my body but not the other). I cannot imagine resisting the urge to push or bear down. It would be immensely difficult. My deliveries were fast, requiring 1-3 pushes, but I just can't imagine not giving those pushes. I had to wait with my 5lb8oz baby til the CNM got her gloves on (things happened pretty fast) and only pushed a little but that was because he was so tiny. With my last baby I went from 6cm to giving birth in under 5 min and the urge to push was so strong I pushed him out when the nurse turned around to get all of the stuff ready for the delivery that she sensed was imminent.

I know this is merely anecdotal but I surely cannot be the only woman who would have an almost impossible time resisting the urge to push.
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No. 4
from justiceforjoy
Old Sep 13, 2009, 01:37 AM

Default Re: Need Your help... Vaginal Delivery Management & "NOT pushing"
There was a case of a comatose woman giving birth vaginally.

There is NO WAY I would have been able to not push my baby out. She was a quick birth as well -- 6 pushes.
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No. 5
from Marissasmommy
Old Sep 13, 2009, 02:44 AM

Default Re: Need Your help... Vaginal Delivery Management & "NOT pushing"
I had a natural vaginal delivery with NO spinal, epidural, or any other drugs. When I had the urge to push there was NO stopping it, it is OVERWHELMING! I didn't care that the doctor wasn't even to the hospital yet, I HAD to push.
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No. 6
from morte
Old Sep 13, 2009, 05:12 AM

Default Re: Need Your help... Vaginal Delivery Management & "NOT pushing"
Originally Posted by island40 View Post
The uterus is not strong enough to evacuate a baby with out the assistance of abdominal muscles. Failure to push during vaginal birth equal failure to progress. Forceps can cause damage to the baby. Vacuum can cause damage to the baby. continued stress on a baby from uterine contractions can cause damage to the baby. I think you would be hard pressed to find an ob that would take on the risks involved even if you pinky swore not to file a law suite once you had your precious brain damaged child in your arms.


not germaine to the question, and i hope you dont take that attitude with your students!
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No. 7
from CEG
Old Sep 13, 2009, 06:56 AM

Default Re: Need Your help... Vaginal Delivery Management & "NOT pushing"
Originally Posted by island40 View Post
The uterus is not strong enough to evacuate a baby with out the assistance of abdominal muscles. Failure to push during vaginal birth equal failure to progress. Forceps can cause damage to the baby. Vacuum can cause damage to the baby. continued stress on a baby from uterine contractions can cause damage to the baby. I think you would be hard pressed to find an ob that would take on the risks involved even if you pinky swore not to file a law suite once you had your precious brain damaged child in your arms.
Babies are often born without pushing... in fact the evidence shows that laboring down doesn't increase the length of second stage at all. The uterus is very efficient. Of course when I have seen babies born into the sheets with no pushing it was patients with very dense epidurals, I couldn't imagine a natural patient not noticing that change in contractions and/or having an urge to push.

It's true that forceps and vacuum can cause complications. It's also true that c-sections can cause complications. This is for both mother and baby. There are many valid reasons for a woman to want to avoid c-section and making unfounded threats about brain-damaged babies is not helpful.
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No. 8
from dishes
Old Sep 13, 2009, 06:58 AM
Updated Sep 13, 2009 at 07:28 AM by dishes

Default Re: Need Your help... Vaginal Delivery Management & "NOT pushing"
mommi007
I imagine it is difficult to find medical journal articles with documented vaginal deliveries in women with syringomyelia. You could ask Dr Wise Young on the carecure forum if he knows of any, he is a neurologist who specializes in spinal cord injury and he might be able to locate more information for you. http://carecure.rutgers.edu/
I am guessing most woman in your situation would be too uncomfortable with the risks associated with vaginal delivery and would opt for c-section, so the actual numbers of vaginal deliveries in women with syringomyelia will be too few to make any generalizations.
It would be unethical to conduct a clinical trial in this situation, so I don't think your question can a woman with syringomyelia have a safe vaginal delivery without pushing, will ever be answered by solid evidence.

regards
dishes
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No. 9
from SiennaGreen
Old Sep 13, 2009, 08:20 AM

Default Re: Need Your help... Vaginal Delivery Management & "NOT pushing"
Also, my opinion after 3 med free vag deliveries. I did not have an overhwelming urge to push. MY MW's ask me to push at one point or another, but mostly my body just did what it did. Position plays a huge role in the progress. I have no doubt that a uterus would find it difficult to move a baby out lithotomy...but squatting, kneeling, standing...maybe. However, one would never know if they will have that urge or not...it seems pretty risky. In many women the urge is absolutely irriesistible in their own power, and in others they can control it through breathing, hypnosis, or another non med means.

Would that be your patient? Is it worth the risks involved?
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