Help! Acynclytic? Accynclitic?? Ever heard of this type of presentation??

rn&momof3 · Dec 17, 2004

"cockeyed" is what comes to my mind, also.......NOT good and hardly ever succeeds at vag delivery.

THANK YOU ALL FOR YOUR REPLYS! WHAT A GREAT FORUM. iF YOU HAVE A MINUTE I WOULD REALLY APPRECIATE YOUR INPUT ON THIS.

When I delivered 9 months ago my nurse said the same thing after it was all over. I remember it exactly "wow you are amazing...in 16 years of practice I have never seen an -asynclitic, brow, posterior- delivery lady partslly". Well the fact is that I am not amazing...in order to delivery I suffered an extensive symphysis pubis diastasis. This was my third baby...my other two had relatively large heads and delivered within 4-5 hours with no complications. Although my membranes ruptured spontaneously at 8am (40 weeks) and I was having sufficient contractions for 5 hours the head was not decsending. The nurse artificially ruptured a remaining pocket of fluid (to get this over "before change of shift" and since the dr. had already had a "long day") and then things just got worse.The dr finally did a bedside US and determined the position (because I kept telling them something was WRONG!). Although the nurse and doctors shared this info about the position..they decided it best to just tell me ..good presentation...just need to push that baby out! The pain was so excruciating that I opted for an epidural (which I know now was the worst thing I could have done for a diastasis). My legs were pulled way back and I continued to push to exhaustion the entire time saying that something was not right. I finally opted to go to hand and knees in my delerious desparation. Nothing. After 12 hours of this I was petrified as I saw decels on the strip..and they applied O2. I was frantic I pushed like a mad woman (again just desparate to deliver). I asked that the Dr. come back in. I continued this way for another 2 hours untill "miraculously" he was delivered. Afterward, I heard the details about how they had the paperwork all prepared for C/S "for some time" and how they thought it best not to alarm me regarding his presentation. I was grateful that he was finally delivered but very concerned about his health and my own as I felt I had been "ripped apart"...seems that is just what happened. My babies head was terribly mangled and bruised. After delivery I could not walk without support. I would drag myself down the hall to his room using the railing. It was horrible and not to mention I had a 4 yr old, and a 22 mo old to take care of and no family or help around (of course my husband tried..but it was hard fo him to help when once he was back at work). An x-ray taken 1 week postpartum showed "significant" separation. I was told to wrap myself with an ace bandage and wait for at least 6 months to allow myself to heal. Since then I have suffered with continuous, unrelenting pain. Fortunately It has made everyday a srtuggle just to take care of my kids. I returned to the Dr. yesterday after 9 months and a repeat x-ray shows not only separation, but now one side is higher than the other...makes sense as I have the sensation that one leg is longer than the other and "things" are moving around. I delivered in a military hospital and I am concerned about the follow-up care (or lack thereof) I will receive. Phew! Probabaly much more than you cared to know! I would apprciate any feedback on this..how things could have been managed better during labor, if it is reasonable to let it go so long given I had delivered two large babies just 4 yrs and 22 months earlier relatively easily...and any ideas for the future management of diastasis. Thank you so much for taking the time on this!

klone, MSN, RN · Dec 17, 2004

Your situation sounds a lot like mine was. The difference in outcome was that my midwives allowed me to continue laboring at my own pace, and didn't force me to push or do anything that seemed contradictory to what my body wanted to do. The long, arduous labor with posterior or asynclitic presentation is usually because the baby is trying to get into optimal position, and hastening that process often results in a bad outcome.

Also, with poor positioning, *usually* the WORST thing you can do is rupture the membranes. Once the membranes are ruptured, the head usually gets lodged in there like a cork, and there's no longer that cushion between the head and your cervix that allows free movement for the baby to move around and find his best position.

It's hard to Monday-morning-quarterback your birth experience. Just try to take from it so that next time (if there is a next time), you might know how to handle things differently.

klone, MSN, RN · Dec 17, 2004

Your situation sounds a lot like mine was. The difference in outcome was that my midwives allowed me to continue laboring at my own pace, and didn't force me to push or do anything that seemed contradictory to what my body wanted to do. The long, arduous labor with posterior or asynclitic presentation is usually because the baby is trying to get into optimal position, and hastening that process often results in a bad outcome.

Also, with poor positioning, *usually* the WORST thing you can do is rupture the membranes. Once the membranes are ruptured, the head usually gets lodged in there like a cork, and there's no longer that cushion between the head and your cervix that allows free movement for the baby to move around and find his best position.

It's hard to Monday-morning-quarterback your birth experience. Just try to take from it so that next time (if there is a next time), you might know how to handle things differently.

keeper · Dec 17, 2004

I observed this presentation at my third homebirth as an apprentice. The mom had a slightly crooked spine and uneven hips (probably congenital), and I'm sure that had some bearing on the baby's presentation. The cervix dilated unevenly, with a firm lip for many hours. Labor seemed to ebb and flow and baby was constantly moving to find a way down. Heart tones were good throughout and mom was tolerating labor well, (as well as any woman does), so we just worked with her on changing positions often and helping that little boy descend. She got the urge to push, but still had the lip, so my preceptor had to manually dilate it away, using evening primrose oil to soften it, while I worked with mom to keep her from bearing down. She pushed in several different positions, but squatting was the most effective. Her baby boy was born with a caput on the right side of his head, but otherwise all was well. It was a difficult labor, but not impossible. She would have been sectioned in the hospital.

I'm sorry to hear you had such a rough birth and of your continued pain. I hope you are able to get some help soon and can move ahead to a full recovery.

Sarah

keeper · Dec 17, 2004

I observed this presentation at my third homebirth as an apprentice. The mom had a slightly crooked spine and uneven hips (probably congenital), and I'm sure that had some bearing on the baby's presentation. The cervix dilated unevenly, with a firm lip for many hours. Labor seemed to ebb and flow and baby was constantly moving to find a way down. Heart tones were good throughout and mom was tolerating labor well, (as well as any woman does), so we just worked with her on changing positions often and helping that little boy descend. She got the urge to push, but still had the lip, so my preceptor had to manually dilate it away, using evening primrose oil to soften it, while I worked with mom to keep her from bearing down. She pushed in several different positions, but squatting was the most effective. Her baby boy was born with a caput on the right side of his head, but otherwise all was well. It was a difficult labor, but not impossible. She would have been sectioned in the hospital.

I'm sorry to hear you had such a rough birth and of your continued pain. I hope you are able to get some help soon and can move ahead to a full recovery.

Sarah