LifeART (and/or) MediClip image copyright 2008. Wolters Kluwer Health, Inc.- Lippincott Williams & Wilkins. All rights reserved.There are two very important key factors to giving optimal chance for baby to rotate out of a deep transverse arrest and into a better position for vaginal birth. The first key is mobility, while the other is relaxation.
Deep transverse arrest has such a high rate of cesarean because it is nearly impossible for a mama to relax her pelvic floor muscles without medication (because of the urge to push and pressure on the hips), and it is highly improbable for a baby to rotate if she has no mobility from an epidural.
Wow, talk about double whammy!
Anyone else have a story about Deep Transverse Arrest they would like to share?
See more information here:
Malposition and Malpresentation
Operative Vaginal Delivery: A Survey of Fellows of ACOG
Mode of Delivery in Deep Transverse Arrest
5 comments:
Wow, thank you for this. I always knew my first was asynclitic, but this is it exactly. He was turned to the side that way for weeks leading up to the birth, didn't budge a bit. (I even have extra stretch marks low on the left from his shoulder) I had months and months of BH, and weeks of what one would consider prodromal labor. Went to the hospital to be induced at 41weeks 5days, almost no dilation at the start. Cytotec, foley bulb, two days of pitocin did almost nothing to my cervix.
I finally progressed when my water was broken, got an epidural for the ceaseless pain of contractions, and made it to 10cm. "Practice" pushed for an hour, and then the urge to push settled in a bit. (Although it never really manifested quite as strongly as it did with my second birth, which was at home) Looking at your diagram, reading the stories, I guess my hips are pretty darn spacious. My son was ten lbs with a huge head, but I did manage to push him down just shy of crowning. After four hours with no more progress (and some half-hearted attempts at other pushing positions, as the hospital staff were no good at getting me comfortable and I was too tired to stay upright between contractions) we tried the vacuum, no luck. C-section it was.
I think what bothers me most is if they did know what was really going on with his position (and I don't know if they did, my dr was a family practitioner but you'd think the OB who did the CS would know) they never told me anything. When he was born it was all "Hallelujah, he's ten lbs, you poor tiny thing you!". It was only months later that I was able to piece the puzzle together, seeing the word asynclitic in my records and matching it with the odd placement of the sore on his head from the vacuum.
Not only was he LOT the whole time, but his head was angled, if you can picture it, so that his right ear was down closer to the cervix.
(With my second I was very aware of his position the last few weeks, did everything in my power to keep him mobile, and went smoothly into labor at 41 weeks 1 day, delivered him two days later after a long, very easy early labor, 3hrs active labor, and 25 mins transition plus 25 mins pushing. Glided right out into my arms. He was 8lbs 8oz, so still not tiny by any stretch and even longer than his big brother!)
I recently lost all my bookmarked sites, but I was just on my own blog and noticed my own links, LOL. I nearly gasped when I saw that picture as it's exactly how I imagine my son was positioned. I wrote his birth story on my blog (and my mother in law chewed me out about it!!) http://theothertracykmblog.blogspot.com/2008_06_01_archive.html It's quite the introduction to birth, having your baby in that position. I'd love to know if I had the arthritis in my SI joints before I was pregnant, or if it is somehow related.
I had a doula client who experienced deep transverse arrest which ended with a cesarean. She dilated very quickly for a first time mom right up to 7cm. But then she stayed there, in active labor, for about 12 hours. I tried EVERYTHING I could think of, but unfortunately, before it became obvious what was happening, she agreed to AROM which I later realized had probably prevented the baby from moving. She received a epi, dilated to 10cm, pushed squatting and on h&k for 2hrs with no decent before agreeing to a cesarean. Baby was about 8.5lbs and transverse. My only regret was that I had spoke of AROM as a potentially good thing since she was already at 7cm. I will never present that option lightly again!
This is an old post but still useful.
I likely had this... so another birth story to add to the collection.
During pregnancy, I had no back pain and no indication that my baby was posterior. I went into labour suddenly just past 38 weeks. I had a lot of fluid and was large enough to get a late ultrasound. But otherwise, my family has all had extremely easy quick labours and births.
My waters broke at home at 11:30pm and we were off to the hospital almost immediately as my contractions were 5mins apart after just going to the bathroom. I was fully dilated in less than 2 hours. No issues but also no option of any drugs, including an epidural.
During the pushing phase, I had extreme back pain and I spent 4 hours pushing. I had a million nurses putting me in a ton of positions. We almost got an emergency epidural (which they never do in second stage) when it seemed like we had some progress and baby might have turned. Then it all stalled again and I was put on Pitocin, which was the worst pain of my life and did not do a bit of good. I had an IV since I was so tired. 4 doctors came in including two OBs.
I was given the option of trial of vacuum or C-section (doctors weren't practiced in forceps, especially with baby in its position). I chose C-section and baby was born healthy with a cone head. He was in LOT/ROP position in -1 head engagement. It seems like maybe he was trying to turn but got stuck. Birth stories really are amazing.
I find this very interesting. I just had my 3rd baby (2nd VBAC) a month ago and his head was stuck transverse. I was in labor for 3 hours before I started pushing (got to the hospital just in time to be rushed to my room and then started pushing). Anyways, I pushed for an hour naturally without making any progress, he was still +2 station and all of the pain was in my hips and down my legs, I was on my knees holding on to the back of the bed pushing with all my might and I just felt like my legs were so stiff and I could keep pushing like that forever and he still wouldnt budge. My Dr offered me an epidural so that he could manually reach in and rotate babys head and it worked! He confirmed that he had been facing one hip, (transverse) but he got babys head to move, he then left the room and let me "labor down" for another 3 hours before I started pushing again and he was born less than an hour later
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