Is a C-Section at Ten Centimeters Appropriate?

You’ve had an ideal pregnancy without major issues, developed a custom birth plan and life appears to be good. You’re finally admitted in labor, cruising along but then your contractions suddenly became abnormal. After some help with Pitocin, you reach ten centimeters and then push for over two hours. There is now a growing concern that your baby might be too large. Your physician is contacted, reviews your fetal tracing, examines you and decides to perform a c/section. The labor room nurses breathe a sigh of relief. Was the physician correct?

The patient, who experienced the scenario just described, gave a resounding “yes!” and was extremely grateful that her 8-½ pound baby arrived safely albeit via a C-Section. Most obstetrical textbooks would also agree; this patient had an Arrest of Labor.

An Arrest of Labor occurs when the contractions of the uterus does not allow the baby to come down the birth canal or is not powerful enough to open (or dilate) the cervix. The labor has been “arrested” or stopped. This can happen for a number of reasons including having a large baby, inadequate contractions, abnormal pelvic bones or uterine cavity. An accurate diagnosis of an Arrest of Labor is important to avoid birth complications. The most common (and dreadful) birth complication is a Shoulder Dystocia, meaning that a baby’s head has been delivered but the rest of its body is stuck, especially at the shoulders. Several maneuvers are made in attempt to deliver the baby including pushing on the top of the uterus (aka fundal pressure), using a suction cup excessively (called a vacuum extractor) or tugging and pulling on the poor baby to no avail. ALL these maneuvers are inappropriate and could cause serious harm. If caught off-guard there ARE appropriate maneuvers that can be done but a better strategy would be to avoid the issue altogether. This is exactly what occurred with the patient described above. Her physician had the good sense to take the path of least resistance.

How do you know if you have an Arrest of Labor? If you dilate to a certain number of centimeters and remain at that same number for over two hours despite several interventions. Your lack of progress in labor suggests that your baby might need some help. The victory is not in having a vaginal delivery; it’s bringing home a healthy baby.

For additional information I invite you to obtain a copy of The Smart Mother’s Guide® to a Better Pregnancy. Remember, a healthy pregnancy doesn’t just happen; it takes a smart mother who knows what to do.

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5 thoughts on “Is a C-Section at Ten Centimeters Appropriate?

  1. Pingback: Tweets that mention What May Shock You About A C-Section at Ten Centimeters « Dr. Linda Burke-Galloway -- Topsy.com

  2. Pingback: Mother Accused of Child Abuse for Not Agreeing to C-Section | Strollerderby

    • Protecting the rights of a mother and her unborn child is a delicate balance. The “pre-authorization” consent to have a C. Section was requested to satisfy insurance requirements and had nothing to do with an obstetrical reason. If this indeed happened (and I have no reason to believe that it didn’t), then the mother’s rights were clearly violated and there was a breach of the standard of care.

  3. The mom did not want to sign the consent form and then later the she refused a cesarean that she needed. Her baby was born fine.

    IT is easy to put this on the insurance companies, but this went beyond that. Her doctor was ruthless and made VM pay dearly for refusing to do what she wanted. She reported her to cps . You can read the whole case here: http://caselaw.findlaw.com/nj-superior-court-appellate-division/1152604.html There are updates in the case too and it looks good for VM, BG and their daughter.

    Also, I’m a little unsure about your statement: “The victory is not in having a vaginal delivery; it’s bringing home a healthy baby.”
    It is really unfair to portray mothers as wanting a vaginal birth so they can have a “victory” when moms who want to avoid cesareans are doing so out of health for their babies, their future babies and themselves. You state this as though a vaginal birth and cesarean are equal in terms of risks. This is erroneous. I wish you would do some posts on the risks of cesareans. No one told me of the risks of my cesarean.
    I’m sure you are aware that the WHO recommends a cesarean rate of no higher than 15%. I don’t know anyone against necessary cesareans, but when our national rate is higher than 30%, as Dr Macones says, the continuing rise, “Is not going to be good for anybody”

    Out of curiosity, what is your cesarean rate???

    • I’m not sure who you are talking about or what case you’re referring to. The patient discussed in my blog was my personal patient who was delivered by an on-call physician. My statement regarding viewing a vaginal delivery as a victory refers to healthcare professionals who take care of pregnant women but who do not have the training to perform a c/s if it’s necessary. My present c/s rate is 0% . When I was doing deliveries, it was 16%. There are colleagues who abuse the system and perform unnecessary c.s. but Dr. Macones also states that “the risks of obstetrics and childbirth are often under appreciated.” Be grateful that you have a healthy baby. There are more women than need be who have children who have permanent physical and mental disabilities because their healthcare providers did not recognize clinical situations that warranted a c/s.

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