Failure to dilate during labour .........why?

[PuffTheMagicDragon]

Can anyone explain why this happens (I'm sure there's a myriad of possible reasons), but I've never really understood what happened when I had ds2 (tried a vbac). Midwives said I should have been dilating given that I was having good, strong, regular contractions over a long period of time (felt like forever ), but I never got beyond 2.5 cm. I was 2.5 when I was admitted on Saturday morning (waters had broken Friday morning) and was still 2.5 when I had an emergency cs at 8.00am Tuesday morning.

I started to use gas and air v late on Monday night. Was transferred to the main labour ward at 2.00am Tuesday (birth centre midwife v concerned and said I needed to be moved). Given an epidural at 4.00am. C section at 8.00am when baby's heartbeat disappeared (he was ok when he came out though ).

I have tried to research this myself, but can't seem to find much info as to why a cervix doesn't dilate despite a woman's body working very hard to make it.

I know it's said that epidurals can halt dilation, but I'd been having strong, fast (few seconds apart) contractions for a long time before I had one, so if anyone can tell me about other possible reasons I'd appreciate your input .

[chipmonkey]

Sorry, PTMD, same thing happened to me on DS2, very disppointed to be told 2cm after 8 hrs of agony! would also love to know why.

[Steppy1]

Hi to you both...I'm not a midwife (but am an antenatal educator) so I'll tell you what I know. Even though contractions can sometimes be extremely strong (the uterine muscle has to work really hard, effectively "pulling up" during the early and active stages of labour (stage 1) this doesn't necessarily mean that the cervix will thin and efface: A big factor can be two "baby" related issues, baby's position ie if not in a good position and not placing maximum amount of pressure onto cervix it may no dilate. No. 2 is baby's size. If it's "technically" a big baby then baby may not progress down the birth canal so again, won't be pressing on the cervix to help it thin and efface. Another factor could be previous cervical surgery (say colposcopy treatment for pre-scancerous cells) which would leave scar tissue on the cervix.... Unfortunately there are also instances where everything seems to be right (baby in right position, mum upright to help gravity assist with baby's progression) and the cervix still doesn't efface. Blimey, feel as if I just answering some exam questions again Hope this helps. I've sent a quick email to the tech. advisor within our company (she's a degree qualified midwife who's delivered around 300 babies)so I'll post any updates to you on receipt

[chipmonkey]

Thanks Steppy1, would a previous C-section have anything to do with it?

[Steppy1]

a previous Section shouldn't have an impact on your cervix dilating ...were you trying for a VBAC with your second labour ?

[chipmonkey]

Yes was trying for vbac, but discovered in theatre that prev scar had ruptured.

[Steppy1]

so it ruptured during labour ? If yes, then this is always the major concern when trying for VBAC, they use the awful terminology "trial of scar" which sounds very dramatic but,as you know, extremely serious if it does happen. I;m attending a "VBAC" weekend (how exciting !!!!!!!! ) in April so will be learning lots lots more on the subject.

[Steppy1]

by the way, when I say how exciting with huge big smiles I'm actually being sarcastic...don't want you thinking I'm a nerdy nerdy, really turned on by talking about scars rupturing and stuff !!!

[PuffTheMagicDragon]

Thanks for that info Steppy1 - really interesting and useful.

Chipmonkey - that must have been a v frightening experience. Was everything ok in the end? From what I've read of scar rupture, it can have serious consequences for the baby and sometimes Mum.

[pupuce]

If you ask more alternative midwives - like Ina May Gaskin in America - they will tell you that they see some women get to 8 cm and back to 2 cm... they believe there is a strong psychological side to dilation.
I do agree that size and position of the baby are factors... from my experience I would tend to agree with Ina May but I don't expect everyone to

[PuffTheMagicDragon]

That's interesting pupuce - I think I was examined 4 times and each time, no change , but no idea if I dilated further, only to drop back.

[pupuce]

Puff.... I worked with a woman who - you would not know it from talking to her - had a lot of past trauma (from a sexual nature) and she never dilated either. Not saying at all this is what's happening to you (I have no idea who you are) but in the US they have doulas who are very experienced (and have even written books) about supporting women in labour who have had sexual trauma in the past... some never dilate.... some just can not give birth vaginally.
It is very sad state of affairs I think... and am only raising it her for interest.

P.S. Whilst usually these fears are from a sexual "problem/past"... it can be other things and they can be burried deep down too.

[PuffTheMagicDragon]

Thinking about psychological factors, I know during the labour I became very agitated about the possibility of my scar rupturing (although I knew the chances were small). There was a change in shift and a different midwife came in who kept asking me about the pain in my scar area. I got very scared and at that point, angry with myself for insisting on a vbac.

[chipmonkey]

Sorry not to reply puffthemagicdragon, went out for meal with dh! Not very scary at the time, very painful but thought it was just normal for labour! Only found out afterwards what had happened

[chipmonkey]

I hope I'm not scaring anyone off vbac, it is worth a go, I just seem to be the person that the worst case scenario happens to!

[suzywong]

very very interesting, all POVs

I never got past 8cm with ds1, they said I had a stubborn anterior lip and he was OP and over 9lbs. Similar story with ds2. Result 2 Em Cs, but drawing on Pupuce's idea, I have never ever, despite Active Birth Centre classes and all of that, been able to actually visualise popping a baby out. Interesting eh?

[pupuce]

Suzy - intersting....
I would have thought (an opinion here not a fact) that if you are going as far as anterior lip left than you probably have a baby that is either in a bad position (head not pressing down on cervix), you are yourself in a bad position (on your back with an epidural -usually) or the baby just won't fit in pelvis.

I would have thought not dilating "at all" is more from a either psychological nature or a dysfunctionment of the cervix itself though I don't know if that is possible.

Puff- getting into labour is a hormone driven process, hormones start in your brain.... so your psychological state is quite a key factor but not necessarily a be all and end all.

[ButtonMoon]

I am convinced that I wouldn't dilate (only 1/2 cm in 12 hours of very painful contractions!! and the mw was sure I would need a c/s) was due to being very tense, nervous and unable to relax. I was so scared about giving birth to a big baby (10lb) and didn't cope with the pain very well at all. As soon as I had an epidural and was pain free I relaxed and went from 3 cm to 10cm in less than 2 hours. For me it was mostly psychological.

[suzywong]

I see what you mean pupuce, now I can blame it on those pesky kids . Even though I was epiduraled for both labours I was pedantic in my requests for being aloud to be in good postions and with d2 I did actually ask the MW as they were stitching me up if a different position would have made a difference and she said "no"

Actually I think I will also blame my DH's handsome but big round head

[chipmonkey]

as a matter of interest, what happened 100 years ago to women who failed to dilate, did they eventually dilate 3 days later? Did they die in childbirth?

[suzywong]

bloody good question chipmonkey, one that I often think of in the small hours

[PuffTheMagicDragon]

I was thinking exactly the same chipmonkey re what happened years ago.

Buttonmoon - very interesting about what happened to you re dilating properly once you were relaxed. I hoped for this with me once I had the epidural, but grrrr! It was very frustrating to be congratulated on my great contractions that weren't doing anything !

[jodee]

Interesting you should ask this, Puff, I never got to the bottom of it after 36 hours in labour and a piddling 2cm dilated. DS was OP as well, probably a factor, but never really given a proper explanation.

[Steppy1]

love all the different comments, just goes to show you how different everybody's labour can be and that however much you think you're prepared or read up on or think you know what you're going to do or how to approach that labour you can never really tell until it happens ! Before I had my first I was very "sit on the fence" about the whole thing, not adverse to having an epidural "if that what it tooks" (despite all of my antenatal class mates insiting that going for"natural" was best). I'd had a rotten pregnancy (sickness from 8 weeks to 36 weeks including hospitalisation for dehydration !) then when it (labour !) finally took me by surprise (3 wks and 1 day early so technically premature) I popped baby out within two and a half hours..fully dilated within 45 minues - boy was that intense - and found it the most fantastic thing that I've ever done. it was that experience that made me become an antenatal educator and birth doula something I would never have imagined at all possible in my wildest dreams before I had children. I'm sure some of it was physcological in that I was so relieved that it was finally over and that I was not to continue being sick that it was a huge relief to be gettin on with it, to this day I would gladly give birth any day of the week...pregnancy though you can stick it !!!!! (sick with preg. no 2 as well !)

[Heathcliffscathy]

i never got past 8cm despite 37 hours of active labour cause of scar tissue from colposcopy...

having said that, i did fully dilate, after being given a mobile epidural, and had ds within half an hour of that!!!!!!! so maybe also was tired and tense too?

good news is that apparently, now that i've dilated once, if there is a next time, shouldn't have the same prob!

[Steppy1]

...really interested in your inputs on mobile epidural..our local hospital doesn't have them but I've previously heard really good reports from women that it kinda gives them best of birth worlds...how much "feeling" sis you have left, presumably some as you wouldn't be able to be mobile otherwise !!!!