Speaker 1: The information in this podcast is provided for education and
Speaker 1: research information only. It is not a substitute for professional
Speaker 1: health advice.
Speaker 2: Welcome to the Kick your Expert led podcast, helping you
Speaker 2: explore and learn everything about getting pregnancy, birth, and becoming
Speaker 2: a parent.
Speaker 1: On the podcast and our online pregnancy program grow My Baby,
Speaker 1: we share my experience of helping more than four thousand
Speaker 1: babies to.
Speaker 2: Be born and our experience of running a women's health
Speaker 2: clinic and parenting for boys.
Speaker 1: We're here to help everyone to feel empowered in pregnancy
Speaker 1: and birth with real life, practical information.
Speaker 2: Welcome everyone. I'm Rigid Maloney.
Speaker 1: And I'm obstetrician doctor Patrick Maloney, and a.
Speaker 2: Big thank you for all of our returning listeners. We've
Speaker 2: got so many listeners that tell us at there hang
Speaker 2: out every week to hear our voices.
Speaker 1: We've been listening since the start, which is awesome.
Speaker 2: Yeah, which is nearly This is our sixth year, pat fantastic.
Speaker 2: We did have one whole year off in twenty twenty.
Speaker 1: Two pulled our feet up, but apart from that, yes,
Speaker 1: so there's quite a lot of back episodes now and
Speaker 1: it's just terrific that sometimes people find us and binge
Speaker 1: the whole lot, and some people have been listening all along, yes.
Speaker 2: And I know that we might have some new listeners.
Speaker 2: So perhaps for a little bit of context, let's just
Speaker 2: give a quick overview of who we are about that
Speaker 2: perfect all right, I'll start you start, okay, good, Well,
Speaker 2: we are husband and wife, we have four boys, and
Speaker 2: we run a women's clinic in our hometown, which is
Speaker 2: be At Women's Clinic. And in the clinic we've got
Speaker 2: a couple of O and g's, which are obstricians and gynocologists.
Speaker 2: That's what Australians call obstrican and gynecologists want.
Speaker 1: Obbgyn Lots of people listening in America. We love that. Yeah, yeah,
Speaker 1: we love Americans. But yeah here called O and g s.
Speaker 1: Yeah yeah.
Speaker 2: And sometimes we talk about well I talk about my
Speaker 2: full births, so just to put that into context for people,
Speaker 2: My first birth was an emergency cesarean. This was before
Speaker 2: I met doctor Pat. The next one was a vback
Speaker 2: which didn't work, another cesarean, and then in twenty twelve
Speaker 2: I met doctor Pat and I had two planned cesareans.
Speaker 2: So sometimes we talk about that and people might be
Speaker 2: going on a minute like how does that all fit
Speaker 2: in but you know, it's just so fair.
Speaker 1: That's your story, that's our story.
Speaker 2: Yeah. So for new listeners, that's us. So we are
Speaker 2: so thrilled to have you on board.
Speaker 1: It is terrific that you're listening, that you are engaging
Speaker 1: in this super important area and an area that really
Speaker 1: grabs the interest and focus and imagination of people who
Speaker 1: are pregnant, perhaps for the first time, perhaps for the
Speaker 1: second or third time.
Speaker 2: Yeah, and I know we have a global audience. Primarily
Speaker 2: obviously we talk about Australian obstetrics, but you know, pregnant
Speaker 2: people are pregnant people. Yeah.
Speaker 1: Yeah, it's a new universal human experience that's the same
Speaker 1: the world over, give or take some slight differences in
Speaker 1: international systems testing the way things are done, but obviously
Speaker 1: the process itself is same around the world.
Speaker 2: Yep. Great, all right, Well, I hope that helps people
Speaker 2: that are new to us and welcome a big, big,
Speaker 2: big welcome, thanks for joining us.
Speaker 1: What are we talking about today?
Speaker 2: Well, we want to talk about a labor that's stalled.
Speaker 1: Okay, good, yep.
Speaker 2: So I think maybe let's start by defining what part
Speaker 2: of the labor we're talking about.
Speaker 1: It's important that we that we sort of have some
Speaker 1: sort of understanding about how this works, because it might
Speaker 1: be very relevant not only to the management of that
Speaker 1: situation on that day, but future pregnancies and so forth.
Speaker 1: So if the labor has stalled, there was a sort
Speaker 1: of the old fashioned term of failure to progress is
Speaker 1: a bit unfortunate because it includes that failure word. It
Speaker 1: makes it sound like it's somebody's fault. And so we've
Speaker 1: kind of moved away from that into ideas into terms
Speaker 1: such as non progressive labor. And it could basically it
Speaker 1: happened at any stage. It could be that the labor
Speaker 1: never really gets up and going waters break, nothing happens,
Speaker 1: and then we try and perhaps intervene to bring the
Speaker 1: labor on and maybe it just doesn't happen, or more commonly,
Speaker 1: it does start up, cervix does start to open, and
Speaker 1: at some point the progress is stalled.
Speaker 2: Yep. And this is this sort of starts being measured
Speaker 2: in active labor.
Speaker 1: Yeah, it's a good idea to measure the progress to
Speaker 1: a certain degree, just to make sure that things are
Speaker 1: moving in the right direction. But there's some debate as
Speaker 1: to exactly how fast it's supposed to go and exactly
Speaker 1: where the sort of goalposts is supposed to be to
Speaker 1: say that's too slow.
Speaker 2: Yep.
Speaker 1: Then there's some difference of opinion on that.
Speaker 2: Yeah, and I really want to get into that.
Speaker 1: Yeah, so we will get into that the boat. There's
Speaker 1: some universal truth that when labor gets up and going,
Speaker 1: that it should remain somewhat progressive from that point. Yeah.
Speaker 2: So we're not talking about when someone may be at
Speaker 2: home just having sort of niggles, not quite sure whether
Speaker 2: they're in. Yeah.
Speaker 1: Yeah, that's exactly what we're not talking about. And it's
Speaker 1: super important to know that that that to not be
Speaker 1: progressing at that stage is perfectly normal.
Speaker 2: Yeah.
Speaker 1: So so it's not like the cervice starts to open
Speaker 1: with the first painful contraction and it keeps going at
Speaker 1: once and any and now from then on. That's that's
Speaker 1: not right. And there are several hours, sometimes days of
Speaker 1: relative inactivity of the cervix at the very very start,
Speaker 1: when we're in that latent phase of of something's happening,
Speaker 1: but we aren't cooking along yet having regular painful contractions
Speaker 1: that open the service.
Speaker 2: All right. So that's that's what defines this active labor
Speaker 2: is and when when kind of you go on the clock,
Speaker 2: let's say.
Speaker 1: A little bit. Yeah, so we when we get in
Speaker 1: to active labor, having regular painful contractions that are opening
Speaker 1: the cervix, then a degree of forward progression from that
Speaker 1: point onwards. Is why a question is what counts as
Speaker 1: normal and what doesn't.
Speaker 2: Yeah, what do people tell you that those painful contractions
Speaker 2: feel like? And what as an obstration are you looking
Speaker 2: for in those painful contractions.
Speaker 1: Yeah, it's a good question because it varies enormously from
Speaker 1: woman to woman and pain tolerance to pain tolerance and
Speaker 1: so forth. What most people will tell you is that
Speaker 1: if they've been through a period of latent phase where
Speaker 1: they're getting some tightenings, some painful contractions at home, and
Speaker 1: then later come into the real deal, they can tell
Speaker 1: you in hindsight that it's very different. Yeah, that the
Speaker 1: pain is worse, that the intensity is much stronger, and
Speaker 1: they can tell you eventually that Okay, once I hit
Speaker 1: three or four centimeters and really started to cook along,
Speaker 1: then that was very qualitatively different to the contractions at home,
Speaker 1: you know, six hours ago.
Speaker 2: Yep. Now, in my first labor, I had a very wishy,
Speaker 2: washy sort of stalled labor, and my contractions happened a lot,
Speaker 2: but weren't useful. I know that I'm degrading myself here
Speaker 2: that they were useful, but you know, they just weren't
Speaker 2: going anywhere. So it's it's time and pain, is it? Like,
Speaker 2: how can you tell a good contraction?
Speaker 1: Well you really can't, and so that because there's such
Speaker 1: variation between what people are experiencing. So so it's terribly,
Speaker 1: terribly painful. It must be doing something. Sometimes people look
Speaker 1: at that at a ctging a fiddle heart rate trace,
Speaker 1: and it can show that there's a great big loop
Speaker 1: in the in the trace at the time of a contraction,
Speaker 1: and that just tells you that there is a contraction.
Speaker 1: It's not a measure of intensity. Oh god. So on
Speaker 1: that piece of paper coming out of that machine, if
Speaker 1: it looked like a really big deviation, that just means
Speaker 1: that the belt around your tummy's a bit tight, and
Speaker 1: if you loosen off the belt a little bit, it'll
Speaker 1: look like a little bump on the trays. So it
Speaker 1: doesn't measure intensity. It just says whether there's a contraction
Speaker 1: or not.
Speaker 2: Oh my god, that is just like a light bulb
Speaker 2: moment for me, because in my v back I had
Speaker 2: to wear a CTG the whole time. Sure, and I
Speaker 2: thought I was having these big, massive contractions and I
Speaker 2: was really proud of myself because I couldn't feel it.
Speaker 1: Yeah yeah, right, well there you go. So it was
Speaker 1: just saying that there's a contraction there, because when your
Speaker 1: uterus contracts, it changes the attension on that belt around
Speaker 1: your tummy, and the machine can pick that up, but
Speaker 1: it can't tell you how strong the contraction is, just
Speaker 1: whether it's there or not. So the whole point is
Speaker 1: we don't know. And this is why if someone appears
Speaker 1: to be in good labor, there's some value in internal
Speaker 1: examinations because nobody loves to stay in that latent phase forever.
Speaker 1: And it's very common for someone to say, well, I'm
Speaker 1: getting a lot of paint and I'm still clearly in
Speaker 1: Latin face. It's not kicking on. You know, how long
Speaker 1: do I have to put up with this? So eventually
Speaker 1: we you know, we are in discussion with the with
Speaker 1: the woman, we might perform a vaginal examination to say
Speaker 1: is the cervice opening or not, And if it's getting
Speaker 1: to the point where it is opening, then to a
Speaker 1: certain degree, the whole it's it's hard to avoid the
Speaker 1: concept of being on the clock from then on. Yeah,
Speaker 1: because once the service starts to open, we are looking
Speaker 1: for forward progress from that point on.
Speaker 2: Yeah. Yeah, and sort of what what time frame like
Speaker 2: it might be worthwhile for our listeners to sort of
Speaker 2: talk about the timeframes that you're looking for in an
Speaker 2: active labor.
Speaker 1: Yes, sure, so, so what we might do if we'd
Speaker 1: established that the cervix was definitely starting to open would
Speaker 1: be to talk to that about that woman at that
Speaker 1: point about to confirm her plans, her desire for to
Speaker 1: just wait and let the situation progress entirely naturally or
Speaker 1: or whether there's whether there's room or need or evidence
Speaker 1: for intervention, and then, assuming everything's fine, check again four
Speaker 1: hours later.
Speaker 2: And so for first time berths, I know that they're
Speaker 2: a little bit different in terms of the active labor
Speaker 2: stage than second time. How many hours for the whole
Speaker 2: active labor phase is what an obstric or a midwife
Speaker 2: is looking for in first and second time births or
Speaker 2: subsequent births.
Speaker 1: Yeah, sure. So again, there's some variation in opinion on this,
Speaker 1: but I would think that it would be safe to
Speaker 1: say that if that once the labor is active enough
Speaker 1: that the woman is having regular painful contractions and the
Speaker 1: cervix has started to open, then it's reasonable to expect
Speaker 1: half to one centimeter of progress per hour from that
Speaker 1: point onwards for someone happened there first baby. And we'll
Speaker 1: get in a little bit later into the different ways
Speaker 1: of measuring that and the evidence behind that being reasonable progress.
Speaker 1: But that would be the sort of progress that we
Speaker 1: would really like to see. It doesn't mean that if
Speaker 1: that progress is not there, we give up and do
Speaker 1: a section or something. No, there are ways of intervening
Speaker 1: to assess that or and there's some flexibility in waiting
Speaker 1: if mother and baby are well. For second and subsequent babies,
Speaker 1: that's very different, so there's a lot more variation and when.
Speaker 1: Whereas the progress for our first time it tends to
Speaker 1: be somewhat linear, the progress for a second and subsequent
Speaker 1: tends to be sort of nothing, nothing, nothing, nothing campower. Yeah,
Speaker 1: so you can have a very little change in the
Speaker 1: cervix and then when the labor really really kicks in,
Speaker 1: you could go from three centimeters to fully dilated in
Speaker 1: one hour very easily.
Speaker 2: Yeah. Well, okay, so why did we start timing this fas?
Speaker 1: Yeah, that's a really good question. That dates back to
Speaker 1: observations made in the I guess the early part of
Speaker 1: the twentieth century when they started to apply some scientific
Speaker 1: principles to the concept of labor and birth. And that's
Speaker 1: because in a lot of the world, the outcomes were
Speaker 1: pretty poor for a natural physiological process, and the number
Speaker 1: of women and babies not surviving the process of childbirth
Speaker 1: was unacceptably high, and in parts of the world that's
Speaker 1: still somewhat true. So they started to look at the
Speaker 1: process and one of the first things that they really
Speaker 1: observed was that was that labors that took way too
Speaker 1: long had the poorest outcome. So then for better or worse,
Speaker 1: they started to say, what can we do about that?
Speaker 1: That idea that the progress should be half to one's
Speaker 1: ameter an hour, that's called a Freedman rule, named after
Speaker 1: doctor Friedman who who first described that, and it led
Speaker 1: to an understanding amongst medical care as in the birth space,
Speaker 1: that there should be some a quantifiable progress of about
Speaker 1: that amount in a healthy labor. And a common criticism
Speaker 1: of that is that it probably made too many rules,
Speaker 1: too narrow a definition of normal progress, and probably too
Speaker 1: much intervention in labors that might have been normal but slow.
Speaker 2: And I did read in that was in nineteen fifty five,
Speaker 2: and the people that he studied were presumably white women
Speaker 2: in their twenties who were thinner. Yeah, yeah, a bit
Speaker 2: different from the cohort today. So does that make any difference.
Speaker 1: Well, I think it would probably make a huge difference.
Speaker 1: So if he was studying a very healthy cohort of thin,
Speaker 1: healthy young women, then firstly they would have been more
Speaker 1: likely to labor well in the first place, and then
Speaker 1: the ones that didn't were a more obvious outlier who
Speaker 1: probably had a more genuine problem. He wasn't dealing with
Speaker 1: the same cohort that we're dealing today, when the first
Speaker 1: time is older and heavier, and where there are more proven,
Speaker 1: justifiable indications for induction of labor. Oh yeah they're so.
Speaker 1: You know, the data for induction of labor for severe
Speaker 1: obesity very strong. You are better off if you're severely OBEs,
Speaker 1: give or take. With a term induction. There's more gestational diabetes, yes,
Speaker 1: so more people being induced. And that's that's where we're
Speaker 1: perhaps not comparing apples with apples between that even cohort
Speaker 1: and today. But for all the criticisms of making rules
Speaker 1: about labor supposed to go this fast, It should go
Speaker 1: this fast. One thing they did achieve were colossal improvements
Speaker 1: in safety, yeah, for women and babies by applying some
Speaker 1: scientific principles to the birthing process throughout the developments that
Speaker 1: were made in the twentieth century.
Speaker 2: Because it is still a criticism today that you know
Speaker 2: that births monitored too hard and then decisions to intervene
Speaker 2: it made too fast. But there was another person that
Speaker 2: studied it later, isn't it doctor Zang in twenty ten.
Speaker 1: Yeah, this is interesting. So that the Zang approach was
Speaker 1: to say, was to try and make a new partogram
Speaker 1: and a new way of assessing labor, a progressing labor
Speaker 1: that allowed for the different curves between first birth and
Speaker 1: have latent progress at the start active progress at a
Speaker 1: certain point. And they were hoping that that that new
Speaker 1: way of analyzing normal progress might have created a new
Speaker 1: safety pathway that was that would result in less intervention
Speaker 1: and in particular less Toeserian sections. And I think that
Speaker 1: way of looking at it does take into consideration the
Speaker 1: actual physiological process of normal first birth and certainly the
Speaker 1: normal physiological birth progress of second and subsequent births, But
Speaker 1: unfortunately it hasn't led to fewer interventions, and it hasn't
Speaker 1: led to fewer cerian sections, and you know, that's a bummer.
Speaker 1: It would have been really nice if it did. But
Speaker 1: what I think it's highlighted is that there's a signific
Speaker 1: that there is benefit in understanding the physiological process as
Speaker 1: best we can before we start putting limits on it
Speaker 1: and saying what's normal and what's not.
Speaker 2: Yeah, and not being so heavily protocolized and saying, Okay,
Speaker 2: so that woman came in at this time, and therefore
Speaker 2: we expect her to have done got to ten centimeters
Speaker 2: dilated in eight hours time. Whatever.
Speaker 1: Yeah, that's right, because what I think the holy grail
Speaker 1: of modern obstetrics is that we should be trying to be,
Speaker 1: you know, as cautious as we can about unnecessary intervention,
Speaker 1: but also practicing obstetrics in a way that maintains the
Speaker 1: safety gains, Yeah, that were achieved in the twentieth century.
Speaker 1: Do we go backwards in safety? And I think that's
Speaker 1: how that's our big challenge, how to keep the safety
Speaker 1: and the awesome outcomes in the developed world without overdoing intervention.
Speaker 2: Yeah, all right, So I think this part of the
Speaker 2: podcast has all been for perhaps birth care workers themselves
Speaker 2: and women who are really motivated to find out the
Speaker 2: nuts and bolts. And we've got a lot of people
Speaker 2: that like to hear all.
Speaker 1: That our if anyone's new to the podcast our a
Speaker 1: lot of our listeners don't shy away from the nitty
Speaker 1: gritty Yeah that's right. Yeah, and they're actually listening to
Speaker 1: hear an expert and experienced medical practitioners view. But we
Speaker 1: try not to give only that.
Speaker 2: Yeah. So what we're going to move on to is
Speaker 2: for those people who either had a birth where the
Speaker 2: labor stalled and then all this intervention happened and they
Speaker 2: want something to explain that, or someone that's going into
Speaker 2: a berth and what should they expect labor has still
Speaker 2: confirmed stalled label? Are you? Are you worried about the
Speaker 2: progress being too so or a stored labor.
Speaker 1: More installed labor more? But if we you know, if
Speaker 1: we're thinking about not just identifying that, but to sort
Speaker 1: of say that personal we ender next, this is where
Speaker 1: we have to stop, take a big breath and try
Speaker 1: and take a whole woman and baby view of what's
Speaker 1: going on and why and why this appears to have happened, right,
Speaker 1: And one of the dangers of an entirely protocolized flow
Speaker 1: chart approach is that you might say, oh, well, this
Speaker 1: lady was four centimeters at three pm, and she's still
Speaker 1: four centimeters at seven pm, and yet she's been having
Speaker 1: regular painful contractions that whole time. What are we going
Speaker 1: to do? Okay, well, we'll break the waters and put
Speaker 1: up some sintost on try and push her along harder,
Speaker 1: But there may be limited benefit of doing that if
Speaker 1: she's already been having terrifically strong contractions. So we might say, well,
Speaker 1: hang on a minute, what's what appears to be the
Speaker 1: problem here? And you take a step back from the
Speaker 1: end of the bed and you can see that, hang on,
Speaker 1: this appears to be enormous baby. Yeah, petite woman, Maybe
Speaker 1: this is a square peggan a round whole problem, and
Speaker 1: this boast to be to fit out. So we have
Speaker 1: to sort of have it at least a go at assessing,
Speaker 1: at least an attempt at assessing why the problem might
Speaker 1: be happening, and then making a sensible suggestion of an
Speaker 1: intervention based on what we think the problem is. Yeah,
Speaker 1: and this is where obstetrics is a little bit of
Speaker 1: science and a little bit of art. Sometimes you can
Speaker 1: tell from experience that, Okay, here's a problem that I
Speaker 1: think we can fix by improving the contractions, and here's
Speaker 1: a problem that perhaps I don't. I think we can't
Speaker 1: fix it all.
Speaker 2: So big baby or and small palvis, those things you
Speaker 2: sort of you probably have an idea about the big
Speaker 2: baby before the labor, but you wouldn't know what the
Speaker 2: size of that woman's palvis.
Speaker 1: Some people think that they can tell we're looking at
Speaker 1: the woman on the outside. Yeah, but if you look
Speaker 1: at someone's hips on the outside, that's just a bony
Speaker 1: part of their hips. You can't see the inlet where
Speaker 1: the baby comes down, So we don't know how white
Speaker 1: that is at all.
Speaker 2: Yeah, And I have a sister who's twelve years older
Speaker 2: than me. I should know off the top of my head,
Speaker 2: but I don't. And back in her day, they would
Speaker 2: take X rays of pelvis's. She had an X ray
Speaker 2: of her pelvis to see whether her pelvis was too small.
Speaker 1: Yeah, right, so that yeah, so the old that's the
Speaker 1: old pel vimetry. And it didn't work. No, Yeah, as
Speaker 1: a science it didn't hold up. Yeah, yeah, all right,
Speaker 1: it didn't take into consideration stretching of the pelvis, squishing
Speaker 1: of the baby's head and so forth. Yeah, so we
Speaker 1: don't do that anymore. Yeah, not to mention, you're given
Speaker 1: a baby an X ray.
Speaker 2: Yeah, oh that's right. So you've talked about somebody that's
Speaker 2: having what you see as good contractions, what's another reason
Speaker 2: why they may not be progressing?
Speaker 1: So a lot of this, most of this perhaps is
Speaker 1: male position of the fetal head, so that the baby
Speaker 1: is just not in a good position to be coming
Speaker 1: down with its chin tuck down against the chest and
Speaker 1: the small diameter of the baby's head presenting down into
Speaker 1: the pelvis.
Speaker 2: Yeah.
Speaker 1: Remember, a baby's head looks more like an Australian football
Speaker 1: which is oval shaped than a than a than a
Speaker 1: socer ball of the football whether it's round and so
Speaker 1: it's got a long diameter and a short diameter, and
Speaker 1: the baby wants to be tucked in so that the small,
Speaker 1: the small aspect of the head is presenting down into
Speaker 1: the pelvis. So if we think that's the problem to
Speaker 1: a certain degree, that can be assessed by vaginal examination,
Speaker 1: by external examination, and sometimes by ultrasound examination, and then
Speaker 1: in for example, the example I mentioned before where where
Speaker 1: the woman might be having terrific contractions but the progress
Speaker 1: is not there. Then on vaginal examination we may also
Speaker 1: be able to find through the partially dilated cervix that
Speaker 1: the baby's head is developing what's called capput, which is
Speaker 1: like swelling around the head or molding where the bones
Speaker 1: of the head seem to be overlapping each other. And
Speaker 1: if we're in a position where we think there's a
Speaker 1: lot of capput and molding the and the there's no progress,
Speaker 1: then that may be an uncorrectable situation that definitely needs
Speaker 1: a Caesarean section on By contrast, we might have somebody
Speaker 1: who's made very little, very little progress over four hours,
Speaker 1: but the contractions have been a bit ordinary, and on
Speaker 1: examination there's no cap, but there's no molding. The fetal
Speaker 1: position looks good, and the problem seems to be the
Speaker 1: power of the uterus to push babia. Well, in that situation,
Speaker 1: we might be very wise to break the walls, put
Speaker 1: up some sintosinon and improve the quality of the contractions,
Speaker 1: and that could put the whole thing back on track.
Speaker 2: Yeah, that's an equals one, but that's what I wish
Speaker 2: had have happened in my first birth when you weren't around, pat.
Speaker 1: Where were you? Well, yeah, that is a danger of
Speaker 1: a very hands off approach, and there are some people
Speaker 1: who really come into that first berth fully wanting a
Speaker 1: hands off approach, entirely hands off approach, but perhaps not
Speaker 1: understanding the benefits of a hands on approach if the
Speaker 1: progress is poor.
Speaker 2: Yeah.
Speaker 1: Yeah, So sometimes people are very surprised to hear that
Speaker 1: they may benefit from intervention. Yeah, which is really strange
Speaker 1: because I don't know why intervention would ever have been
Speaker 1: invented if it wasn't with benefit in mind.
Speaker 2: Yeah.
Speaker 1: Yeah, So we we've lost a sort of educational battle
Speaker 1: there as obstetricians, because if intervention is seen as as
Speaker 1: as such a problem and only a cause of problems,
Speaker 1: then we then we've we've failed in the task of
Speaker 1: educating people about the potential benefits. So, for example, if
Speaker 1: someone's having a labor where they're clearly cracking along listening
Speaker 1: to the fetal heart after every contraction, baby is totally happy,
Speaker 1: woman's huffing and puffing gets to fully dilate and push
Speaker 1: the baby out, what are we going to inter intervened
Speaker 1: in that late before entirely are necessary, and in fact,
Speaker 1: interventions in that labor could only cause up. But if
Speaker 1: somebody's labor is stuck at force entemes over six seven,
Speaker 1: eight hours, intervention is only going to help that person
Speaker 1: get that labor back on track and get to their
Speaker 1: original goal, which was a vaginal birth.
Speaker 2: Which kind of the first vaginal birth does help to
Speaker 2: set up your second and subsequent births as well, doesn't it,
Speaker 2: you know entirely?
Speaker 1: Yeah, yeah, so if we look at the whole situation,
Speaker 1: not just for that birth, but over the woman's obstetric lifetime,
Speaker 1: then some judicious, judicious intervention to get that labor back
Speaker 1: on track. If that results in that baby born being
Speaker 1: born vaginally, then give or take, the other babies will
Speaker 1: come vaginally as well. Yeah. The clincher is the is
Speaker 1: the mode of delivery the first baby.
Speaker 2: I want to go back to the intervention that you
Speaker 2: may use. If there is mele positioning of the baby's head,
Speaker 2: is there anything else you can do or can You
Speaker 2: only have to wait until it gets in the actual
Speaker 2: birth canal and the pushing phase to perhaps tuck the
Speaker 2: head in.
Speaker 1: And yeah, interventions to improve that tend to be focused
Speaker 1: on before full diletation, then they're focused on the fact
Speaker 1: that if you improve the contractions in a lot of cases,
Speaker 1: then the uterus will push their head down better, and
Speaker 1: the pelvic floor is shaped in such a way that
Speaker 1: it usually but not always or will get the fetal
Speaker 1: head in a good position. So the interventions before full
Speaker 1: didtation are usually focused on improving the strength and efficiency
Speaker 1: of the contractions.
Speaker 2: Yea.
Speaker 1: If someone's at full diletation and the heads are way
Speaker 1: down and the head's not pointing in the right direction,
Speaker 1: there are some interventions that can correct that with the
Speaker 1: use of force us and vacuums, but that's a different
Speaker 1: subject in.
Speaker 2: Different episode topic.
Speaker 1: Yeah.
Speaker 2: Good, all right, So we've talked about the tools in
Speaker 2: your toolkit. The obstrics talk it if there's intervention, So
Speaker 2: just to recap, it's breaking the waters.
Speaker 1: Yeah, that seems to help in itself improve the quality
Speaker 1: of contractions, probably by removing the water that's between the
Speaker 1: head and the cervix and letting the head push more
Speaker 1: effectively against.
Speaker 2: The putting up a sintosinin drip.
Speaker 1: Yeah, so careful and safe in judicial use of sintocinon
Speaker 1: to make the contractions come more strongly and efficiently try
Speaker 1: and get up to contractions that last at sixty to
Speaker 1: ninety seconds four to five in ten minutes.
Speaker 2: What about I know we've talked about previously. Sometimes an
Speaker 2: epidural can do the opposite of what we all think,
Speaker 2: and that is that it can if at that stage
Speaker 2: it can help someone relax.
Speaker 1: There's a few schools of thought on how epidurals will work.
Speaker 1: Will work, I mean, they take the pain of way,
Speaker 1: that's brilliant, But how do they work to make labors
Speaker 1: seem go better? Seem to go better, certainly achieve a
Speaker 1: state where because the pain's gone. If we're using sintosinon,
Speaker 1: we can use more, but we can use enough to
Speaker 1: get contractions that are longer and more frequent, and that
Speaker 1: can put a labor back on track. And that's easier
Speaker 1: to do if by blasting that sintosin on you are
Speaker 1: not causing the woman excessive pain. Then there are some
Speaker 1: abnormalities of a fetal heart heart rate trace, which for example,
Speaker 1: the fetal heart rate appearing to go too fast, which
Speaker 1: you might see if the woman's heart rate is going
Speaker 1: too fast, which you might see if she was excessively
Speaker 1: stressed or in pain, and so you can use any
Speaker 1: in that situation to in a sense or relax the
Speaker 1: woman and things that seem to go better. And lastly,
Speaker 1: of course the epi can be used to sort of
Speaker 1: block some of the pain of painful painful interventions that
Speaker 1: might be done at full dilatation. Now, these are all
Speaker 1: of the ways in which an eppie might actually improve
Speaker 1: your chances of having a vaginal birth. Again a controversial statement.
Speaker 1: It's not what people expect to hear. Because we know
Speaker 1: that there are some issues with using an epidural and
Speaker 1: then requiring more intervention. There are just as commonly some
Speaker 1: situations where the careful use of an epidural might get
Speaker 1: you might help you to get to full dibertation in
Speaker 1: the first place, which, in fact, which kind of gets
Speaker 1: you to the starting line of a vaginal birth. And
Speaker 1: if had you never had that epidural, you may have
Speaker 1: had a section for various reasons. So there aren't bad tools,
Speaker 1: they're just bad ideas. And the right tools used at
Speaker 1: the right time may actually get us back on track
Speaker 1: and back on track for the desired vaginal birth.
Speaker 2: One other thing, you know, it's always these are what
Speaker 2: happens to a woman. But there's things that she can
Speaker 2: do as well, Like she can move, ye, yeah, change positions.
Speaker 2: Listen to what the midwife's saying about. You know how
Speaker 2: you've been on your back for a long time. How
Speaker 2: about we swap it around and get back on her
Speaker 2: swiss ball or you know, if she's been in the
Speaker 2: bath forever, like, maybe it's time to get out of
Speaker 2: that bath and how about we stand for a little
Speaker 2: bit or have your partner support you.
Speaker 1: Absolutely, we know that changes in position can certainly help
Speaker 1: at full dialtation to get to a point where you
Speaker 1: develop an irresistible urge to push. Whether changes in position
Speaker 1: are very important during the dilating phase of the cervix
Speaker 1: first stage of labor is less clear, but we think
Speaker 1: that for as long as possible, being mobile helps.
Speaker 2: It also helps from a psychological point of view. I
Speaker 2: think you know, it makes you feel like you're doing
Speaker 2: something and.
Speaker 1: It's a long time right. Yeah, it's very very unusual
Speaker 1: that we would spend ten to fifteen hours in one
Speaker 1: room in one place.
Speaker 2: I think that that is all I wanted to ask
Speaker 2: you about if a labor stalls. If we haven't actually
Speaker 2: answered your question about a stored labor, we're still here.
Speaker 2: Pop it on the speak pipe. I think that would
Speaker 2: be a really great idea and just say, hey, what
Speaker 2: about in this situation if I was to do blah blah.
Speaker 1: We love those questions, yeah, or or tell us about
Speaker 1: your labor did this and that stopped? What was that
Speaker 1: all about?
Speaker 2: Yeah?
Speaker 1: Because it's common for me to meet people who've had
Speaker 1: a labor that didn't do what they wanted it to
Speaker 1: do the first time around, and they still have an
Speaker 1: incomplete understanding of that a couple of years later when
Speaker 1: they're ready to have another baby. So you know, if
Speaker 1: you've got a story and a question, we'd be keen
Speaker 1: to hear it.
Speaker 2: All right, everyone, Well that's it for this week. I
Speaker 2: hope you've enjoyed this episode and if you enjoy the
Speaker 2: type of education that we provide any free podcast, you
Speaker 2: might also enjoy the free newsletter, which is a week
Speaker 2: by week newsletter which marries up with your week of
Speaker 2: pregnancy and that can lead to our program which is
Speaker 2: a more in depth discussion on each topic as well.
Speaker 2: So all of that can be found at our website
Speaker 2: which is grow Mybaby dot com dot au, or just
Speaker 2: pop into the show notes in either past Apple Podcast
Speaker 2: or Spotify, and the links will be all there. We
Speaker 2: hope that you have a wonderful week and will be
Speaker 2: in your ears next week.
Speaker 1: Thanks for listening, everybody, Bye for now.