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Head not engaged at 40+4 --- chances of normal delivery?

(9 Posts)
xtina86 Fri 24-Aug-07 13:06:24

This is my first pg and i was hoping for a natural (as natural as possible), minimal intervention birth at a midwife led unit (wishful thinking perhaps?). But my chances of this happening seem to be more unlikely My midwife was concerned that the head is still not engaged and the babes position is back to back so she referred me to a consultant who i saw this morning. After me telling the consultant that i had hoped for a natural birth as possible he said that there is only a 50-60% chance of a vaginal delivery - even less chance of a vaginal delivery without a good deal of intervention. He said the best thing to do is wait and see as labour progresses if the baby engages and hopefully turns or if not a cs will be likely (the complete opposite of what i had intended for this birth).Im trying to be positive and hope that as labour begins baby will get in the correct position but im petrified at the possibility that she is too big for my pelvis (consultant says this is a good possibilty due to my size and the fact that she is a 'fair sized' baby) - - You'd surely think that there must be someway they could find out before labour wether the baby will be too big or not ?? I know pg/labour/birth can be unpredictble but i just feel so gutted to go from planning such a simple birth to having a good chance of a cs/lots of intervention and the consequences of that. One of the main things stressing me out is that the consultant said due to the risk of cord prolapse(due to head not being engaged) that i will need to be admitted as soon as labour begins or waters break - I had been planning to stay at home as long as possible to stay relaxed and to spend as little time as poss at the hospital

Has anyone had a similar experience to this??
Do i just need to accept that no matter how much planning/hoping you do that you just can't predict what will happen in the end ?!

Reassurance needed- desperatly!!!!

Thanks

ZoeC Fri 24-Aug-07 13:14:05

Ok, my first baby was back-to-back as yours is and I'll tell you the very end of the story before I tell you anything about the labour itself ..... I did not have a c/s, she was born vaginally and I followed it up with a second birth that was at home without any help at all.

I won't pretend to you that a back-to-back birth will be easy (but then, no birth is ever 'easy'), but it happens a lot and how it goes varies. I just found it made labour a lot, lot longer and a bit stop/start. Eventually I was put on a syntometrin drip to help the contractions become stronger, more regular and more productive and this did work.

The contractions turned dd1 so eventually she came down the birth canal and was the right way round. If she had only not turned her head to come face forwards I could have birthed without any help, but as it was I couldn't get her out face first so they used forceps to turn her and then deliver.

Bottom line was, she came out eventually, we were both fine (I had a tear, it healed, it's fine). It wasn't the birth I had imagined either, but it was they way it was and dd1 was perfect, which was the main thing after all was done with.

margieo Sun 26-Aug-07 05:19:40

Hi xtina-
Just really felt the need to tell you my story. I was 41 weeks and a couple days and my son's head was not engaged, I was 1 cm and 80% effaced. I will never forget the moment the doctor sat me down in his office and told me chances of having a vaginal birth, given the lack of descent. He said I was pushing it going past 41 weeks and suggested an induction. I was prepared only for natural birth. I didn't show up to first the induction he scheduled (I called and asked for another couple days). Finally, I caved when he said something about risking my baby's health. I was induced in the morning and my son never did come down. At 10pm I had a cesarean. It's not easy looking back and wondering if I faught hard enough.
I am now 26 weeks pregnant and I read anything and everything I can get my hands on about my situation.
It seems like there are 3 or 4 reasons why my son's head did not engage. 1- possibly something to do with the umbilical cord being too short and holding him up high. (don't think so, in my case). 2- it was simply going to be the kind of labor where the baby does not descend until pushing begins. 3- he wasn't in a good position. 4- we just weren't ready. I feel in my heart it was because of 3 or 4.
Optimal positioning allows baby to descend. To get your little one there, you can do many things. Have you visiting spinningbabies.com or just search the internet for "getting baby into proper position". And #4 reason, I do believe in the emotional connection, trying to let go of fears, etc.
I'm surprised your midwife hasn't suggested some things to help that baby of yours turn. There is TONS of stuff out there on the topic.
From everything I've read, too, 40 weeks is too early to start predicting how thing s will go. I just read a couple stories a few days ago where the women's first babies didn't drop until the pushing stage.
I truly do know how you feel. You feel all alone, in a way, scared and desperate to know the truth or what is very best. Maybe a little shocked because this wasn't what you prepared for.
If I had it to do all over again, I'd just stay active, do lots of movements that would help turn him around and even get a second opinion.
What I did- completely trusted my doctor, took the pitocin, stayed in bed and waited for something to happen. I realize now, looking back, I was so scared, I was sort of immobilized. And I trusted a man in a white coat who did not have my interests at heart.
What you said in the end, though, is the best answer of all- be prepared for anything. Learn a little something about c/s, just in case- everyone should- just in case. For only one reason, to feel prepared for anything, which is always more empowering. I didn't and so I had no idea what to expect. You'll probably find that they are way over done and that your issue is not an indication for c/s. You will also find, that it can be life saving.
But keep your eye on the prize, your head in the game, and most of KEEP YOUR FAITH IN YOUR BODY and if your doctor recommends that you be induced or have a cesarean becasue the baby didn't engage- make sure he/she fully explains and that ALL other options have been exhausted.
I'll be thinking about you.
Maggie

margieo Sun 26-Aug-07 05:44:35

Hey-
Found a thread you might be interested in.
I did a search here called "baby not dropping into pelvis", then found "38 weeks-first pregnancy- head not engaged". Just wanted to share. (Hope you can find it.)
There are some very encouraging posts there.
Maggie

rubles Sun 26-Aug-07 09:47:01

My baby (first) did not engage at all as far as I can tell from the notes until the birth when she came out naturally with no intervention whatsoever. But in my case nobody seemed bothered, so I am surprised that there has been this hand wringing in your situation. The midwife came out the night before the labour and she was still not engaged.

I think Margieo has said lots of what I would have said. I would agree to get a second opinion, reading more and talk to midwives about what you can do to help things, and your fears of getting an unnecessary intervention-lead birth. They should be on your side advocating for you - that is one of their roles. You can ask them to go to consultants appointments with you if you want or if it would help.

My baby was ROA the night before labour so she somehow turned correctly (and without any back pain) during the labour to come out LOA. I was advised that if there was potential of an OP labour then to lean forward sitting on the birth ball and gyrate my pelvis in circles with each contraction to help the baby turn. Another thing for OP labours is to lean forwards over something or get on all fours.

To bring the baby down you can do big deep squats, and when sitting keep your legs wide and your knees below your pelvis (a birth ball helps with this).

But the baby might not be coming down for its own reasons. At the end of it all, sometimes the baby is just in the position they are in and we can't budge them. But at least if that were to be the situation with you, then you would have it clear in your head that there was genuinely nothing more that you or anyone could have done to change things.

Good luck.

TuttiFrutti Sun 26-Aug-07 13:54:28

Xtina are you still there?

Don't worry - although I know that's easier said than done. I got to 11 days overdue without my baby's head ever being engaged, and I was going mad by the end, searching the internet for statistics as I'm sure you are now. Strangely none of the medical team ever seemed concerned at the lack of engagement, and I was eventually induced although I have since found out that induction without baby's head being engaged is only successful in 20% of cases. It didn't work with me and I had an emergency c-section after 23 hours in labour.

In my case there was a physical reason for lack of head engagement: fibroids in the womb below the baby's head, not picked up on any scans.

That's probably not what you want to hear, but the important point is we are both fine. My top tip is to avoid being induced if you possibly can. And yes, get a second opinion.

nightshade Mon 27-Aug-07 12:12:26

dd wasn't engaged at 10 days overdue. booked in for an induction, went into labour the night before (actually felt her drop whlst i was in the bath)! very scary!

went to hospital when dh decided enough was enough, she was born without intervention, 6hrs later.

Dropdeadfred Mon 27-Aug-07 12:37:23

my dd3 wasn't engaged when I was in labour!!

I don't think it matters really..they find their way out!

potoroo Mon 27-Aug-07 12:45:04

DS wasn't engaged (first baby) before labour. Then he turned back to back while I was in labour.

I ended up with an epidural which was brilliant - allowed me to rest (it was a long labour...) and the contractions turned him around so he was born vaginally.

My midwife recommended scrubbing the kitchen floor (ie get down on hands and knees) to turn babies into right position.

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