Of Labors and Births…..

Posted on: January 3, 2009

I return to this blog, invigorated from having taken part in a number of incredible events, each marking a significant moment in the lives of seven members of our Healthy Mother family. Seven “Healthy Babies” joined our Healthy Mother family between the 9th and 21st of Dec. Five of our mothers gave birth in Hyderabad, one in Bangalore and one in the northeastern state of Assam.

I usually do not write about every labor and delivery, but in this group of mothers we had such a complete gamut of birth stories, that I felt, by revisiting these experiences and putting them down on paper, we would be able to learn about the myriad of outcomes and accompany childbirth. These experiences also highlight to me the full range of variability in the progress of labor, and the occasional necessity of Caesarean Sections when it becomes medically necessary for either the safety of mother or her baby.

9th Dec, 2008: Our first mother was attempting a VBAC (Vaginal birth after C- Section). On the day of her delivery, she came in to the hospital with her bag of waters leaking. She had been having small leaks on and off for the past three weeks, and was being monitored periodically for both fluid levels and CTG (cardiotocography – this test measures the baby’s heart rate and indicates how reactive the rate is to both the baby’s own movements and to mother’s uterine contractions). Since baby seemed to be doing well, and since baby’s movements were good, we adopted a wait and watch strategy. However, on the day of admission, mom’s bag of waters burst around 3 pm. After this there was some continuous trickling, and mild cramps, which indicated the start of labor. I told mom to get to the hospital, and told her that I would meet her there. However, mom was reasonably confident that she wanted to monitor the progress of labor at home, and by the time she and her husband reached the hospital, it was around 8 pm. By this time mom’s contractions were about 7-10 minutes apart, lasting for about 30-40 seconds and very manageable with breathing. Mom was in the early stages of labor. However, she was still continuously leaking fluid. On internal examination, it was found that her cervix was posterior, long and completely closed. We felt that it would be prudent to assess her amniotic fluid levels since she had been leaking fluid on and off for several weeks, and it was found that the level was low, with one pocket measuring 5. CTG was still showing reasonable reactivity, and therefore mom decided to labor for a while longer. We tried everything – walking, pelvic tilts, side lunges, wall squats, butterfly, etc. We rested in between and tried again. By about 11 pm, there was no progress in the intensity or duration of contractions, and CTG results were also not definite. Although we normally avoid frequent internal exams, we decided to conduct one in this case to check if there was any progress. Cervix was still long, posterior and completely closed.

We now had to make a choice. Mom had history of a previous still birth and C-Section. In that pregnancy, she had been leaking fluid on and off from her 6th month. It was shown that her baby had IUGR (Intra-uterine growth retardation) and had suddenly stopped moving at around the 36th week. With this history, and the current low levels of fluid, CTG results, and the condition of the cervix, we felt that the risk to the baby would be greater if we continued with laboring. Due to her previous C-section, she was also not a good candidate for any other intervention. We discussed all the possibilities with mom and dad every step of the way, while mom continued to labor until 1 am. By this time it had been about 10 hours since her bag of waters broke, and the CTGs were not showing good responsiveness either – the only reasonable option was to go in for a C- section. Mom and dad also agreed that this was the safest option. Dad, who had been very supportive all through labor, was present during the surgery, to support mom and see the birth of his baby girl, who weighed in at 3.3 kg. He was with his daughter all the time while mom was in surgery. Within the first hour, we had mom and baby in skin-to-skin contact, and nursing commenced without any difficulty. Mom was up and about the next day and both she and baby were doing great when I visited them for a post-natal checkup the next day.

Lessons learnt: Not all births end up being normal, despite the fact that we do everything possible to facilitate normal childbirth. Every mother’s labor is unique and how we deal with mothers’ labor tends to be different in each case. In this instance, mother and dad were diligent about following the advice given to them in their childbirth classes, however, in the interest of her baby’s well being we all made an informed choice of going in for a c-section. While C-section was a required medical intervention, the 10-hour period of labor was good for mom and baby.

In my next blog I will write about yet another birth that I had the opportunity to assist – a completely different experience..

I invite you to share your experience as well

Dr. Vijaya Krishnan, DPT, PT, LCCE


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