Thursday, August 25, 2016

40 weeks, lots of fluid, baby not engaged

Congratulations on your baby, beautiful Mama!

You've made it to 40 weeks and have much reason to be proud!
But you're doctor has expressed a concern that the baby's head is not yet in the pelvis.

Julie checks to see if her baby's head is in the pelvis and finds that is not.

This baby is engaged and then some. 0 station, shown here where the  "0" sits between two arrows, shows the middle of the pelvis. When the top of baby gets to "0" Station, the baby is considered "fully engaged."

Forehead over public bone. 

Some phrases for a full term baby that hasn't moved down into the pelvis are, 
  • Still high 
  • Floating 
  • Not engaged
  • Unengaged
  • And, sometimes I talk about the head that is "overlapping" the pubic bone
  • This last is often because baby's forehead extends beyond the pubic bone (occiput posterior)


Readers,
this is an answer to an email. Read on for the personal experience: 


You've mention that the doctor thinks your baby may not be engaged because of the amount of fluid. Additional reasons (above) a baby is not engaged due to fetal position,
soft tissue issues or pelvic alignment, or a more unusual reason of size.
Checking for the baby's head. Is it deeper than the pubic bone or does it overlap?
The engaged head is deep inside and can be hard for a mother to find.
The unengaged head of a posterior baby will overlap the pubic bone.



I am guessing this is your first baby since you didn't mention another pregnancy.
When I was a practicing midwife, I noticed that many first pregnancies often begin labor at 41 weeks and 2 days. Expecting baby to come at 40 weeks is all very round and tidy, but not particularly likely.

To prepare for a good chance of you starting labor on your own about 41 weeks and 1 day to 41 and an half weeks, having a pelvic alignment session with a myofascial body worker and chiropractor is a reassuring idea. 

If cesarean is an option for you, then timing becomes a variable. It is too easy to slide into a decision that once you accept a cesarean to get things over with. Rather, hold that thought for the appropriate time. My personal opinion, based on Dr. Michel Odent's descriptions in his book, Cesarean, is that if a cesarean is needed to do it after labor begins on its own.
But it is approximately 50% likely that if you begin labor with baby still high that labor will bring baby lower. There are several studies showing that statistic. I've found some easy-to-do techniques 
helps baby get lower into the pelvis. Many women find these help labor to speed up but also EASE up! A fantastic combination!

 Spinning Babies Quick Reference download teaches you what to do to if baby stays high, but I'll give you a quick version of the quick version here:


Adding balance, alignment, and mobility now will help success for you once contractions begin.
After contractions begin and are predictably regular and coming 4-5 minutes apart, doing ten Abdominal lift and tucks will often engage baby's head in the pelvis. It's important to open the top of the pelvis when lifting the belly. See the instructions. Do ten in a row the best you can. These don't work unless you are having a contraction!

When finished with that you should feel pressure on the cervix and not on the back (or less so on the back as before).
Only after trying that and waiting an hour or two to see how labor goes (if given that time in the situation) then try Walcher's Open the Brim

Sometimes, though there is a bit of a risk of malposition from breaking the bag of waters. In 30 years, I have not found it necessary at the low-risk, normal births I attended. 

For women with truly high levels of amniotic fluid, doing a slow leak release of the waters brings baby down. Preceding this intervention with balance first may help the mother's muscles be softer and more symmetrical for baby to drop lower in the pelvis. The resistance of shortened or unconsciously held muscles will reduce.  

I notice a cesarean is less likely if the epidural or the rupture of membranes is done after 5 cm dilation. The data collection on that is not great. But it is clear in the studies that epidural is associated with more posterior babies than no epidural. If an epidural is planned, timing it after active labor has rotated baby to occiput anterior may offer the best chance at vaginal birth. It's not an either or issue, but there is an issue with how babies rotate after some epidurals. You take a chance. 

Getting baby on the cervix with the above plan will help baby onto the cervix and then dilation will be steady as long as rotation is equally easy for baby. 

Nature will engage most babies. Supporting nature means reducing the effects of living in gravity. It's not about right or wrong. It's more about having experienced a number of events or a single key event while living in gravity! A sudden stop during a twist or a previous sprained ankle are two such events that SOMETIMES effects pelvic alignment and thereby baby's path through the pelvis.

Again, balance makes rotation easier for baby
Rotation makes engagement more successful. 

It is quite likely labor will begin spontaneously
When labor starts about half of babies come into the pelvis with no other action needed.  Baby will come down with engagement. It is also fairly likely that doing these activities will help a slow labor or a labor that hurts more than one with which you can cope. (Mindfulness, breathing, and relaxation techniques are excellent.)  Adding balance means helping release what is tight or twisted or support what is loose. Often supporting what is loose is done by releasing some muscle or ligament across the body from the loose area. 

Beginning labor has many benefits
Preparing baby for breathing air is one benefit. Awakening areas of the mind to maternal intuition is reportabley another. Knowing your body can start labor has a satisfaction in itself that is missed by some women who never get the chance. 

Decision Time
Whatever you and your doctor decide, whatever course you choose, you can aid your chance of a vaginal birth by activities before and during childbirth to make room for your baby. Easier birth for babies means easier birth for you.



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Changing the Earth by supporting Birth

Mothers bring forth life; medical corporations do not. Birth can be simple, powerful and loving. Fetal positioning, natural birthing and practical help for normal birth.