Not sure I understand the reasoning...

LiluBee

I had an appt with my doctor's backup OB.  It went well, overall I got a positive vibe from him even though he did slap the 40-50% chance on the outcome.  I expected that.  Anyway, here is the background....

I went in for an elective induction at 40 wks 3days.  I was dilated to 4cm before going in.  With pitocin and withouout the epi I dilated to 8.  I didn't know I was at 8 when I got the epi.  (I was told I was going to be there a long time and might as well get it) Shortly after getting the epi baby was having decels and they halted labor with a shot and turning off the pitocin.  After awhile they started the pitocin back up and I never progressed past 8.

And here is what I'm not understanding...

 It was labeled failure to progress and it's not noted anywhere what baby's position was.  So the OB assumes that he was too big to fit.  (He was 8lbs 9oz) My question is, how the heck do they know if he wouldn't fit if I never even got to the pushing stage?  I told him my theory which was that before the epi I was up and moving around and using the bathroom and with the epi I was laying down and after all the labor halting, it makes sense to me that I wasn't dilating further because gravity wasn't on my side.  But I guess lots of people lay there numb and further dilate and push babies out so I guess that's not a good argument.  I guess my question is, if the baby is too big, why would you stop dilating at 8?  

MAprincess

That baby was NOT too big.  Some people's labor stalls with an epi and some don't.  For me, I was in for the long haul with my induction (when I had my VBAC).  It took me 16 hours or so to get to 5 cm at which point I got the epi so I could rest because I had actually been up for almost 36 hours.  DD was born less than 2 hours after I got the epi, so for me it helped me relax a little more and get those last 5 cm.  The pit makes it unbearable!

But DD was 8 lbs 5 oz and I pushed her out in 40 minutes.  I do not have wide hip or anything by any means.  Your body makes the room.  DS (who was an emergency CS) was over 10 lbs and my midwife was certain I could have pushed him out.  And I have a friend that pushed out her 10 lb, 12 oz son without medication, god love her.

iris427

Some doctors think that if a baby is too big to fit, they won't descend low enough to put adequate pressure on the cervix to dilate all the way.  That may be true in some cases but I don't think they can say that definitively from your situation.

To me it just sounds like typical failed induction.  I don't think failed inductions should be labeled "Failure to progress," they should be called "Failure for Pit to work."  A natural labor is probably a lot more complex in terms of hormones and changes in your body, and inductions are just an approximation.  They work a lot of the time but not always.  And that's not necessarily a reflection on your body as much as it's a reflection on the shortcomings of medicine.  It also sounds like your baby was not tolerating the induction well and that's why they had to turn the Pit off--again, not a reflection on your body and ability to have a VBAC.  Your uterus isn't a machine that can be turned on and off at will.  Combine that with possible effects of the epidural that you mention and it's not surprising to me that things stalled out.

Anyway I agree there's no way to know for sure that your baby wouldn't fit if you didn't even get to the pushing phase. 

MissyOlivePants

iris427:

Some doctors think that if a baby is too big to fit, they won't descend low enough to put adequate pressure on the cervix to dilate all the way.  That may be true in some cases but I don't think they can say that definitively from your situation.

To me it just sounds like typical failed induction.  I don't think failed inductions should be labeled "Failure to progress," they should be called "Failure for Pit to work."  A natural labor is probably a lot more complex in terms of hormones and changes in your body, and inductions are just an approximation.  They work a lot of the time but not always.  And that's not necessarily a reflection on your body as much as it's a reflection on the shortcomings of medicine.  It also sounds like your baby was not tolerating the induction well and that's why they had to turn the Pit off--again, not a reflection on your body and ability to have a VBAC.  Your uterus isn't a machine that can be turned on and off at will.  Combine that with possible effects of the epidural that you mention and it's not surprising to me that things stalled out.

Anyway I agree there's no way to know for sure that your baby wouldn't fit if you didn't even get to the pushing phase. 

Iris - I always love your info...but I especially love the way you phrased these 2 things just now!

cchill01

I agree with PPs - you had a failed induction - not FTP.  I would think your chances of a VBAC are pretty good, especially if given time to progress on your own.

shihtzu51

I disagree - you did not have a failed induction.  You were in labor, you got to 8 cm.  Everyone is in active labor by 8 cm.  Failed induction means that they couldn't get you into labor, not whether or not you deliver vaginally.   It totally depends on what your pelvis is shaped like for whether baby is too big - not baby's size.  Some women a 7 lb baby may be too big and others can deliver a 11 lb baby without a problem.  Granted, the first situation would be unususal.  Your baby may just have been stuck in a funny position that made him/her not fit.  I doubt the epidural caused the problem - from what I have read and talked with my OB about, the epidural can slow down the early phase of later and delay pushing time, but not the active stage.  Did your OB check the operative report to see which way baby was facing?  or did they not say?  If they didn't say, I would definitely try a VBAC and hope for the best.

papagena

I don't think they can legitimately say it had anything to do with your LO's size.  It sounds more like the epi causing a chain of events that lead to the c/s - having to halt your labor and then not being able to progress past that.  Maybe it was your body reacting to all the chemicals that halted progression, or maybe it was the fact you were lying down as opposed to being active.  Either way, with all that going on, I'd be skeptical that baby's position or size had much of anything to do with it.

bensbabe

shihtzu51:

I disagree - you did not have a failed induction.  You were in labor, you got to 8 cm.  Everyone is in active labor by 8 cm.  Failed induction means that they couldn't get you into labor, not whether or not you deliver vaginally.   It totally depends on what your pelvis is shaped like for whether baby is too big - not baby's size.  Some women a 7 lb baby may be too big and others can deliver a 11 lb baby without a problem.  Granted, the first situation would be unususal.  Your baby may just have been stuck in a funny position that made him/her not fit.  I doubt the epidural caused the problem - from what I have read and talked with my OB about, the epidural can slow down the early phase of later and delay pushing time, but not the active stage.  Did your OB check the operative report to see which way baby was facing?  or did they not say?  If they didn't say, I would definitely try a VBAC and hope for the best.

 

I agree that you were not a failed induction. A failed induction means you were not able to get to active labor (4 cm w/a good contraction pattern--measured w/an internal pressure catheter.). Did they place an internal monitor for contractions? If you have strong enough ctxs for 2 hours, and you don't dilate, this can lead to the diagnosis of Failure to Progress.

Failure to Progress just means they couldn't get you TO the pushing stage. Failure to Descend is usually terminology that indicates that you pushed, but the baby couldn't descend low enough to deliver vaginally.  You can have a baby "too big to fit" if it never descends to your cervix to help you dilate more. That may be where your OB is getting the thought. Since I don't know those specifics, I can't help you there.

I also do not think the epidural caused the problem--as this pp stated, it slows down early labor & can delay pushing time.

I would wager that the baby was not in the correct position. I'm not sure if it's always listed on an operative report (they usually only say they were vertex when delivered). I also know that most OBs don't pay attention in a c/s to the position of the baby when delivering, if they are not open to VBAC in the future. My OB specifically looks at the position of that baby's head or other problems that would affect vaginal delivery.

I am glad you have a more VBAC-friendly OB. They overall sound as though they are positive to a TOL.

I got to 8cm/+1 w/DS, but he was acynclitic OP (being in L&D, I know the signs to look for & he came out football-headed, w/the conehead to the back of his head). My OB is a great VBAC pusher & very patient. I have a clotting disorder, and had GD last time, and she's still okay with me attempting VBAC. She gives her patients every opportunity to have a vaginal delivery. It was very important to me to find someone who didn't have a bunch of rules. HTH, GL!