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

Specialties Ob/Gyn

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hi there,

this is my first post::typing

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 lady partsl birth and no epidural".

[color=#111111]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 lady partsl 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

[color=#111111]i need some info on laboring options....particularly lady partsl delivery...without pushing...how can a women's ob, rn or other practioner assist her in this type of delivery?

[color=#111111]here is what i am thinking:

[color=#111111]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 lady partslly 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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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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Specializes in ICU, School Nurse, Med/Surg, Psych.

The uterus is not strong enough to evacuate a baby with out the assistance of abdominal muscles. Failure to push during lady partsl 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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Not an OB nurse (I'm taking pre-reqs) but a veteran of 4 lady partsl 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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There was a case of a comatose woman giving birth lady partslly.

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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Specializes in Rural Health.

I had a natural lady partsl 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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The uterus is not strong enough to evacuate a baby with out the assistance of abdominal muscles. Failure to push during lady partsl 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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The uterus is not strong enough to evacuate a baby with out the assistance of abdominal muscles. Failure to push during lady partsl 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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mommi007

I imagine it is difficult to find medical journal articles with documented lady partsl 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 lady partsl delivery and would opt for c-section, so the actual numbers of lady partsl 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 lady partsl delivery without pushing, will ever be answered by solid evidence.

regards

dishes

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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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Thank you so much for all your replies...hope they keep coming...Again the reason for this post is to gain knowledge and experiences and information to explore what is being done with Pregnant SM and or CM patients. It is quite difficult and almost unfair to be "all or nothing"...you know...If you have a lady partsl delivery your baby will be brain damaged or if you have a c-section it's more risky to mom b/c of the spinal and or general anesthesia (ie. puncture and increased risk of intracranial pressure) because at the moment .....we really do not know....and that is what I am try to figure out. I kind of feel, that as an advocate for myself, and others with this condition and a healthcare worker....there are too many pregnant woman being told contradicting information, and I really am afraid that they are becoming human guinea pigs.

I mean you have one specialist telling one girl "no probelm, epidural okay, no problem pushing, lady partsl delivery is okay"......But in the other hand this is the same physician that is telling you never to strain during a bowel movement...no sit ups....you get where I am going....

Then you have another specialist telling other woman, "C-section, General Anesthesia", and about how one of his patients had SM..had her baby...had a lady partsl delivery...deliverd healthy baby...but "as a result" of the lady partsl delivery and her condition, she could no longer hold her baby...She lost neurological function of her arm...Scare Tactic or Fact?

I had surgeon who specializes in this condition say... "C-section....spinal is okay"...So what is the damn answer?

I do not like (anyone in general), but especially woman with precious angels in their bellies being thrown around worrying throughout their whole pregnancies with these conditions (adding to even more worry to an even anxious mommy, and this is not even considering if they have other high risk conditions), whether they are making the "correct", safest, decision for both mom and baby. I guess that is why they call it practicing medicine?

I had one physician tell a pregnant mom w/ SM and CM "Go research this condition"...Are you kidding me? :banghead:

I am really passionate about Perinatal medicine, especially when it concerns these two Neuro conditions.

Can't tell you how much your insight and knowledge means to me...thank you and thank you for all you do!

Please keep your input coming...Negative or positive.

Take Care

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Specializes in OB.
The uterus is not strong enough to evacuate a baby with out the assistance of abdominal muscles. Failure to push during lady partsl 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.

Pretty harsh, and spoken like someone who is NOT an OB nurse...also very untrue. I've had several primips that I labored down, pulled back the covers and had a head crowning....uterus is very efficient!

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