Poor Progress??

[{sarah}]

I just had a look at my discharge sheet from Zander's birth & it didn't say the usual "failure to progress" but it said "poor progress >3cm"

What does that mean exactly? I thought my progress was pretty good considering I got to 9cm....

[tiggy]

Sarah,
was it a long labour?
When I was a student we were told that a woman should dilate 1cm an hour. Perhaps, they were infering that you didn't fit that 'text book' dilatation?
When you are 3cm, you are considered in active labour, so I suppose they are insinuating that your progress was poor once you had established(?)

[christy]

Maybe the time it took? I have the usualy "failure to progress" followed by transverse (which makes no sense at all) and the OB who saw me during this pregnancy was reading my chart and saying that I barely progressed at all... I was 6cm when I had the c/s (10 hours after 3cm) and apparently it was a very poor progression (in her words) but I didn't ask her to explain.

ETA snap Tiff...

[{sarah}]

Tiff I was at 1-2cm when I had a midwife appointment at 12pm Friday, 3cm at midnight, 6cm (I think) at about 1pm Saturday when I had ARM, synto drip & an epidural, then 9cm at 7pm Saturday night. From 7pm-1.30am Sunday there were no changes, I stayed at 9cm.

Does it make a difference to future labours?

[tiggy]

Sarah,
Was Zander posterior?

No, it doesn't say anything for your next labour at all. Each labour is different but the fact that you got to 9cm is great, at least you know your body can do what it is supposed to do. That's a fantastic start!

Was Zander in distress at all, why did they do the caesarean?

[{sarah}]

Yep he was posterior.

Hmm to tell the truth medically I'm not 100% sure why they did it. They epidural worked for an hour & kept wearing off leaving me in agony feeling like my back was going to break in half. I don't remember the exact circumstances surrounding the decision, but I do remember a few things... At about 10pm I was screaming at them telling them to do a c/s because I was in so much pain, I wouldn't have cared if they cut my arm off so long as the pain went away. Around 12.30 there were discussions about what should be done. The Dr checked if she could do a vacuum extraction but for whatever reason she said it wasn't possible. She may have explained, but I don't remember. And then it was decided that they would do the c/s. When Zander was born he had this massive ring around his head that made it look like he had become stuck along the way.....

[tiggy]

Sarah, the whole thing sounds fairly traumatic for you.

Are you hoping to do things differently when your next baby comes along?

Posterior babies are known to be longer labours, with lots of back pain.
I'm sure you know that though.
What you describe with Zander's head sounds like caput, where the babies head is squashed so hard against the cervix, the 'ring' sounding like where the cervix was positioned while you were contracting.

[{sarah}]

Do you think having his head squashed like that would make a difference to the outcome?

Sorry for all the questions, just researching options at the moment

[Fi]

Poor progress is definitly when you dont dilate 1cm/hr. After I was 2cm my midwife told me to go home for as long as I could because if I progressed slower than this they would take intervention to speed things up.
Apparently second babies turn from posterior more quickly. Not sure why, but my midwife told me this 2-3 weeks ago.
Fingers crossed huh?

[BellyBelly]

They like you to dilate 1cm an hour but that is absolutely not realistic especially given current birthing environments in hospital. I know my teacher Rhea likes to say it's active labour from 4cms and still early labour at 3cms, but no biggie in the scheme of things. Posterior like tiggy said can be more painful but it's not something you 'can't do'. Optimal fetal positioning can be helpful during pregnancy to avoid posterior presentation but of course doesn't guarantee anything, but it's believed to be of great help. It also doesn't mean you will be destined to have all posterior bubs, it's a positional thing and sometimes it can be because of the way things are physically - i.e. placenta position, pelvis shape - but it's not a guarantee either way.

I don't like the words 'failure to progress' because there is nothing wrong with the mothers effort or body. Something was going on (THAT WASN'T YOUR FAULT!), even fear can keep your cervix from dilating. If you had the whole fear, tension, pain, cycle going, unless you have someone really experienced in support to help bring you back it can be difficult to overcome. First births can be very frightening, we've never felt such intensity before and panic - they often do not go like we plan in hospital. Second births are usually much better. Your body has been in some labour before - it knows whats going on next time. You just need to focus on coping skills in labour with your support person, be it your partner, mother etc - HypnoBirthing is great. Being able to understand it at another level really does help. Having deeper understanding also brings with it more resolve if you need intervention. Because you know you needed it.

[christy]

Urgh the bain of my existance are the words "failure to progress" what a way to start life!!

[{sarah}]

If you had the whole fear, tension, pain, cycle going, unless you have someone really experienced in support to help bring you back it can be difficult to overcome.

Hey Kelly, have a look at my post today in my birth de-brief.... This was really an issue for me & the midwife I had was fantastic and helped me when I was freaking out but I realised after talking to Cailin last night that it was losing her support may have been what stalled everything.

[BellyBelly]

This is a big problem - continuity of care is a big part of birth and this is why the Maternity Coalition are fighting for it. Shiftwork and unknown carers are not good for a birthing mother. Yes you can get an Ob, but they are not there for the birth and wont hold your hand and get you through birth - they are not ideal birthing partners. You might like to considers your own private midwife or doula Studies say (including a report in the Cochrane Library) that birth goes much better with continuous care IDEALLY with someone who is not a staff member of the hospital. You can get a great midwife like yourself and go really well, but things change and it's hard leaving it up to chance that you will get a midwife you will click with for your whole birth.

[tiggy]

Sarah,
I have seen babies born in the posterior position, with molding, with caput but still born vaginally and I have seen babies born via caesarean, with molding and caput also. It's hard to say whether this changed your outcome. I would be more inclined to say (without knowing your history) that you didn't fit into what most hospitals consider a normal timeframe and so felt that they needed to do something. Perhaps, Zander was having some decelerations on the CTG and they made the call because of that?

[{sarah}]

Perhaps, Zander was having some decelerations on the CTG and they made the call because of that?

This I have absolutely no idea about

[tiggy]

Sarah,
If you ask to see your notes, all the CTG recordings should be in there.

[{sarah}]

Ok cool, thanks Tiff

[tiggy]

Sarah,
On your other q's in ask professional support...

It would have said vertex OA because the doctor would have rotated him to birth him via the caesar.
Some babies don't spin until head on view. I have seen it - pretty amazing, so maybe you would have felt it and maybe you wouldn't have. iykwim.
There are lots of positions that you can use during pregnancy to encourage an anterior baby and again, use them during labour.
Have you thought about getting the pink kit? It was fantastic when I used it.
Hope I'm not being too pushy here...