Friday, September 12, 2014

Prolonged First Stage and Maternal Exhaustion

A prolonged first stage is not, in and of itself, dangerous to mother and baby.  As long as you are handling it well, eating, exercising and resting as needed, and going on about your normal life, it need not be of concern.

If the contractions get to a point where you feel you can no longer go about your daily life, and they have gone on for hours and hours with seemingly no progress, it may be time to check dilation.  Many women who choose unhindered birth do not want to do cervical checks, but simply trust the natural process.  If this is what you feel you want to do, that is fine.  If you are still able to feel like trusting the natural process after hours and hours of contractions, there is probably nothing wrong and you should continue to go with the flow.  If however, you are feeling uncertain, checking dilation can at least tell you whether you are making any progress.  If you are at
six centimeters or so, and don't seem to be making any progress despite regular strong contractions, you may have lack of descent and insufficient cervical stimulation.  If you are at one or two centimeters, you need to eat a meal, drink a glass of wine, and go to bed to get some sleep.  After rest, the contractions will often return and be more effective.

An arrest of progress before 6 centimeters is of little consequence.  After that point, the uterus is already up to full speed, and probably will not take another break despite maternal exhaustion.  It's the point of no return.

Signs of maternal exhaustion are:  ketones in the urine, elevated pulse and temperature.  If the mother's urine has ketones, this is an extremely acidic condition.  Pretty soon the baby's pH is going to turn acidic as well, and when this happens, the blood carries less oxygen which can lead to fetal distress.

If you are at the 6 centimeter stage, try to determine why the arrest is happening.  It could be the position of the baby's head in the birth canal.  It could be cervical edema, or posterior arrest.  Feel around.  Does the head feel engaged in the pelvis, or is it floating?  A large baby that was not engaged before labor could still be floating, and the head not dilating the cervix.  In that case, some walking, squatting and waiting are in order to see if it descends.  Feel the baby's head inside.  Do you feel the saggital suture running directly across the cervical opening, or do you feel it running high or low in the pelvis?  High or low means the head can be asynclitic. The baby's head is deflexed with the chin jutting out, and the forehead pointed down toward the cervix.  This malpositioning of the head can mean the cervix is not receiving the right amount of pressure from the head and therefore isn't dilating.  If that is the case, try to reposition the head as in  posterior arrest .

Progress can also come to a standstill because of emotional factors as well.  If you have been indoors for a long time, get outside.  Have some contact with nature, go where the wide open spaces can help you feel an expansiveness that perhaps was lacking before.  Being in the same room for hours can be positively depressing.  Feel the wind blowing across your face, walk barefoot in the grass, listen to water running, feel the warm sun on your face, experience the majesty of the trees....whatever works.  This is often helpful in stimulating labor.  Those endorphins are powerful, and feelings of satisfaction encourage the production of oxytocin.

Try the squatting position for a while to help bring the baby down and enourage proper dilation, rotation and descent.  Remember, this is the position our bodies were designed to give birth in.  It works for a reason.

If you have a small pelvis, you might consider the pelvic press.  This takes a strong helper, usually the husband or male partner.  The partner kneels behind the mother, and the mother squats down.  The partner places his hands firmly on the mother's hip bones, and presses firmly together, toward the spine.  This causes the lower part of the pelvis to flare open.  You should press as hard as possible, or until you feel some movement.  You should do this procedure during a contraction and bear down while the partner presses.  You will probably have to do this more than once. 

Once again, I recommend using muscle testing to determine the reason for the prolonged laboring, and using the Accu-Balancing to clear any issues that are becoming obstacles to the birth process.  To learn more about ABT, click here.  

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