January 6, 2010
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.