"Only at 9cm. Let's start pit!"

• 10-04-2008 6:08 PM

  Mom~of~Munchkins Joined on 09-14-2005 Posts 266

  "Only at 9cm. Let's start pit!" Reply Contact Quick question for the natural labor ladies, doulas, professionals out there.  I have a friend who says she can't have a natural labor because she can never get past 8-9 cm dilation.  Of course, her labors were all the traditonal hospital setting that you'd see on "Deliver Me."  She said that, for her first child, she labored on her own until she was 8.  Then she sat at 8 cm (with intact membranes) for 3-4 hrs.  She walked upright, etc.  Then she made it to 9, but stalled out again and the baby was "coming."  She had the ready to push feeling.  She said the doc had her lay down and they started her on pitocin at that point, because she wasn't dilating fast enough.  She's had two babies since then, and her doctor ordered pit each time at about 5 cm, citing the first incident. This struck me as BS.  I've seen enough videotaped natural homebirths without even a dilation check before the mom delivers.  Its goes from "ready to push" to "here's baby."  No "Lay down so I can make sure you exactly 10 cm dilated."   Not to mention, pit is for contractions, not dilation and her contractions were fine, she says.  So, my question is this:  is there a consequence of clinically "incomplete" dilation and being ready to push?  If 8-9 cm is plenty enough, at what point IS there a consequence?  What would happen if you pushed out a baby with an incomplete cervix?

• 10-04-2008 6:59 PM

  In reply to

  sjcush Joined on 09-19-2006 Posts 73

  Re: "Only at 9cm. Let's start pit!" Reply Contact Generally, the cervix 'disappears' when you are complete...10 cm means the cervix is fully effaced, and there is NO cervix to get in the way of baby descending into the birth canal.  Now, I've known moms, including myself, that can sit at 9+ centimeters (with just a lip of cervix left) for 1.5 hours or more...with just a lip of cervix left (meaning only a small part on one portion of the cervix remains) a nurse or doctor can generally try to manually slide the cervix to the side and out of the way.  It's also not uncommon to start feeling the urge to push before you are fully dilated (moms can sometimes feel it at 8+ centimeters) If you push before the cervix is fully dilated you run the risk of the cervix swelling and then you may not be able to deliver vaginally if you have a inflammed cervix in the way of baby's descent.  The pelvic outlet is generally 10cm in diameter, and the average baby's head is 11.5cm in diameter...so I highly doubt anyone would be able to push without being fully dilated without a consequence.  The only instance I've ever heard of a mom NOT needing to be fully dilated is when baby is a premature and is TINY.   Now, that being said, I'm guessing if the mom you mentioned above was let to labor on her own without being in bed on her back she WOULD, indeed, fully dilate on her own.  Also, rupturing membranes is a much more natural way to go than starting pit...has she ever had her membranes ruptured prior to starting pit?  Rupturing membranes may allow baby's head to put more direct pressure on the cervix and help dilation. You mentioned that pit is for contractions, not dilation.  However, pitocin will make the uterus contract STRONGER, which will push the baby down HARDER on her cervix, and THAT is what causes dilation.  I'm guessing that she was having contractions, but her care provider deemed them 'insufficient' in strength to aid in dilation and that was their reason for starting pit.  Also, it's not at all uncommon for moms to get a break between the first two stages of labor (for things to 'stall' once you are fully dilated before you feel the urge to push).    If labor stalls, baby may be working on changing position, descending, etc...there are many normal reasons that labor might appear to stall out.  Other reason for having trouble with getting the last 1-2 centimeters of dilation: a malpositioned baby...if baby isn't positioned correctly it will be difficult to get enough pressure on the cervix for it to fully dilate.  So again, mom being mobile, upright, changing positions can help. a full bladder will keep baby from descending and can hinder dilation, so emptying the bladder every hour in labor is important a baby that is too big for the pelvis, and can't fit down far enough to put pressure on the cervix appropriately could also hinder dilation, but I doubt this is the problem with the mom you mentioned since she did deliver vaginally. sometimes labor will stall if mom needs nourishment...if she hasn't eaten in a long time, getting just a small something in her system can help give her body the energy it needs to continue the work of labor (even gatorade, ANYTHING with calories may help...obviously only light foods). I'm guessing her care provider likes pit for her because she tolerates it well and it speeds things up, gives them a bit more predictibility.  However, if left to labor naturally, changing positions, emptying her bladder, I would think this would be the best chance this mom might have a delivering naturally.  Mother nature RARELY fails us!  :)  This got longer than I had intended, but I hope the information helps!  I'm a doula and a childbirth educator and I've delivered three babies naturally myself...so this is all based on my experience, knowledge, and education.

• 10-04-2008 7:24 PM

  In reply to

  Chamelyan Joined on 10-30-2007 Midwest Posts 79

  Re: "Only at 9cm. Let's start pit!" Reply Contact  It's not uncommon for labors to stall, even as far as 8-9 cm.  All moms are different.  Since she was in the hospital, she was more or less placed on their schedule, and since she had a "history" of so-called failure to progress, pit is the doctor's way of staying in control.  If she had been left to labor on her own, no doubt her labor would have progressed and if she had been encouraged to push when the urge came, more than likely she would have been able to deliver without any aid.  The only consequence I can think of is if a mother had the urge to push and was far from being complete, the stress on the cervix could cause it to swell and prevent further dilation.  However, from my understanding, after a few pushes, mom should be able to tell that the baby is not moving and clearly her body is not ready.  I also have heard that back in the day that our grandmothers were giving birth, should they be lucky enough to consciously push their babies from their wombs, 9 cm was considered fully dilated.  So, being that far along it doesn't appear there would be any harm in mother pushing in response to her body. I agree about the intact membranes.  Had they ruptured them instead, it may have been enough change to allow mom to dialate naturally instead of jumping on the pit drip.  If doc had allowed mom to push when she felt like pushing, she probably would have stretched to 10 in one or two pushes, but from a more upright position, like a semi-squat.

• 10-05-2008 8:20 AM

  In reply to

  Mom~of~Munchkins Joined on 09-14-2005 Posts 266

  Re: "Only at 9cm. Let's start pit!" Reply Contact Very informative, ladies!  Thank you very much.  I am not sure if she was allowed much movement. She said she walked around a little from 7-9, but she's not versed in positions like all-fours or squat to change position of the baby.  Her hospital isn't very natural-centered (from personal experience).   All-in-all, her labors never exceeded 8 hrs. though.     I actually wondered, myself, why they didn't ROM before they started pitocin.  Maybe her doc felt like it would cause the baby to come out before she was dilated?  I dunno.  I have also heard of manual dilation. There was a poor woman on one of my old birth boards from Canada or GB (can't remember which) who was sentenced to manual dilation from 5-10cm, bc she could never pass 5 cm...or something like that.   I guess I'm just disgusted by the thought that she was told that she "can't" have a natural labor because she stalls at 8-9 cm.  Oh, well.  She's very content with her labors, so I'm not gonna push the issue with her.  I find it to be a curse to know how wonderful things could be, after suffering through an augmentation.

• 10-05-2008 12:11 PM

  In reply to

  Pandily Joined on 04-10-2008 Nebraska Posts 161

  Re: "Only at 9cm. Let's start pit!" Reply Contact I agree with the other ladies and wanted to add there's more to how well the mother is progressing than how dilated her cervix is. There are many components that have to be in place before the baby is born and dilation is just one of them. If a woman stalls, her body may more than likely be working on one of the other aspects such as effacement or thinning of the cervix, the cervix moving to a fully anterior position, or the baby rotating and working his/her way into the best position. All of these things need to happen for the baby to be born. If a mother's dilation stalls, but in that time her cervix moves from a posterior, or middle position to an anterior position- that is a lot of progress!

• 11-16-2008 10:25 PM

  In reply to

  Dave's Buttercup Joined on 06-20-2008 Victor Colby due 1/7/09 Posts 3,683	Re: "Only at 9cm. Let's start pit!" Reply Contact Very informative!!!    I would also like to say that I think her case would be a different story had she not been seen by an OB/GYN and perhaps a midwife.  The use of pitocin is greatly abused in hospitals without this staffing!

• 11-17-2008 9:44 AM

  In reply to

  Robin671290 Joined on 01-26-2005 Silver Spring, MD Posts 259	Re: "Only at 9cm. Let's start pit!" Reply Contact I would also like to add that labor is a VERY mind/body thing. There's a good chance the stalling has to do with some kind of unresolved psychological issue she has. It must be incredibly frustrating!