Significance of waiting and giving mothers a say in childbirth – a case in point

Posted on: January 21, 2009

December 19th, 2008: I had known this mom since her 4th month of pregnancy. She had joined one of our antenatal programs early, since she knew she would be traveling to her hometown of Assam, in northeastern India within the next couple of months and would remain there for her delivery. However, the very next week she was discovered to have placenta previa and was put on complete bed-rest. After a month and a half , she was allowed to be up and about, as her placenta started to pull itself up. Mom and dad finished the rest of their sessions and headed for Assam. After the 7th month, mom started practicing her birth fitness exercises – by this time placenta previa was no longer an issue. She continued to remain in touch with me after every OB check up, and was waiting for labor to start on her due date of Dec 14th.

Dec 14th and went, and there were no signs of labor. On December 18th, mom was admitted to the hospital and was started with gel priming and induction protocol. Since her cervix was not ready to begin with, even after several hours of induced labor, it could finally open up to only 1-2 cm when her baby’s heart rate started to show decelerations. Finally, on December 19th a healthy baby boy weighing 3.5 kg was delivered via C-Section.

Lessons learnt: In this case, mom’s delivery was done by a family member who is an OB. Mom felt that she did not have much say in the process. In my opinion, waiting for labor to start on its own would have been the ideal plan of care, especially considering that mom and baby were both doing fine. Since natural hormones had not yet started to cause the cervix to ripen and be ready for birth, induction failed, leading to a C-Section that could have potentially been avoided.


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4 Responses to "Significance of waiting and giving mothers a say in childbirth – a case in point"

I have a question about the previa — what was the purpose of the bed-rest? I’ve heard of previa resolving itself (because it was not “true” previa, but just a low-lying placenta, which moved away from the cervix as the uterus expanded), and I’ve heard of bed-rest in later pregnancy and/or when there was a threat of preterm birth or cervical dilation. Was that the case here?

Kathy,

Mom in this case had slight spotting, which caused her placenta previa to be diagnosed. So I think bed rest was appropriate for the initial week to 10 days. After this period, I think the OB was just erring on the side of caution. In fact, I did counsel mom that it was okay to carry on with moderate day to day activities – and she did start moving around her home a bit after a month or so of the previa being diagnosed.

Unfortunately, in India it is a very common practice for the OBs to put would-be-mothers on bed rest for the flimsiest of reasons, and sometimes for no reason at all – Definitely not evidence-based practice. We at Healthy Mother are trying to educate our would-be parents about these kinds of practices all the time. However, once fear for baby’s well-being sets into parents’ minds, it is difficult to completely get rid of these fears.

Dr. Vijaya

Thanks for your answer, Dr. Vijaya. I’ve heard many cases of placenta previa, but no early bed-rest for it. It seemed that the long bed-rest was not necessary (and I’m glad to know that it probably wasn’t in this case), and I’m always glad to learn. 🙂

Kathy,

Thank you for your comment. The online community is a treasure trove of information, and what better way than to share and learn from each others’ experiences!

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