This approach makes no sense to me-can someone explain why this would be best

So a woman who is a member of a site I am very active on is pregnant and just posted a blog updated and I am very confused by it.

"Lets see. I am 38 weeks and 4 days today. WOW. I have been so frigign miserable lately. We have our induction date and time. Lucas should grace us with his presence Jan 7th. We have to be at L&D on the 6th at 10PM. I'm guessing so late, so that they can get everything started and let me labor all night since I will not be pushing or anything. It's a matter of time and how long it takes my body to push him out itself. It's so weird. I will be holding my son in less than a week."

Someone asked about not pushing and she responded with

"With my heart condition (congenital aortic stenosis) the pressure on my heart during actual pushing would be too dangerous. They are going to let me "Labor Down" which is basically what they did back in the 40s or whatnot. My body will do the work for me during the first stage of labor and most of the second stage. Once the baby is close enough to delivery, the doctor will either ease him out with his hands or if needed forceps or vacuum. The amount of blood volume loss during a c-section is more than vaginal plus the benefit of a quicker recovery and less risk of infection. So I will be very comfortable with a long range high dose epidural and they will tell me when he's out."

Does this make sense to anyone?
First, induction is much more intense on the body and baby, causing much stranger, longer and more intense contractions. And some of the side effects for mom are cardiac arrhythmia, premature ventricular contractions, hypertensive episodes as well as severe vomiting, all of which put a lot of pressure on the heart and make it work harder. If the condition is so bad that she can't push because of the strain to her heart, wouldn't letting natural labor take it's course be better for the heart(and for all the other normal reason too).

Secondly I have heard that it is very hard to labor down with pit, as it is not natural and being controlled by a pump. It seems like this could be very stressful on the baby.

Third, I understand that the epidural can help lower BP, but to have it up to the point were mom feels nothing seems like it will stall labor significantly. Also with the epidural mom wont be able to really use gravity to help get this baby low in the pelvis.

Maybe I am just crazy, and a little too obsessed with natural birth, but this sounds like a horrible plan and a recipe for very long, painful and traumatic birth with a ton of vaginal trauma and/or c-section.


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interesting I don't think I've ever heard of this. I thought it was just a normal thing to get urge to push ans then do it. I does seem like you would need to be in some other position besides on you back, but I don't know I guess.
You can also wait to push if you are going natural because some women don't even feel the urge then. Or some feel it less intense. The idea is, the baby needs to be in the right station(where the head is in relation to the pelvic bones), in order to feel the urge.
With natural labor, a woman pushes when she is ready. Her body tells her when to push and she listens. She will often "labor down" but the term is not usually used with natual labor because usually we trust that a woman knows when to push and she does. No confusion.

When a woman has an epidural however things can get a little sticky. Her body may dilate to 10cn and not only does she have no urge, to push, depending on the dose of the epidural she may not be feeling ANYTHING. What we used to do is start coaching a woman to push as soon as she dilated to 10cm even if a woman had no urge to push and even if her baby was still high like at a zero station. We coached closed glottis pushing. Long pushing with breath holding. Not good for mom or baby and depending on the station of the baby it was completely futile and exhausting for everyone involved.

We have learned that a woman does not have to push just because she is 10cm dilated. Surprise! ;-)Now we will allow her to "labor down" We may change positions and allow her body to continue to contract. Her contracts alone with no maternal effort will bring the baby down into the birth canal closer to delivery. During this time most women begin to feel some sort of urge to push. For some the urge is greater than for other and since the baby has moved down the pushing stage of labor is much shorter. It doesnt really take any longer to labor down. It just changes what we do with the time. We used to push for 2 hours. Now we labor down for an hour and push for an hour or even less. Like Cherylyn said its much less stressful. I don't think it has much affect on tearing or an episiotomy that is more related to vaginal tissue integrity, size of baby, pushing position, how quickly the head is delivered and skill set of your delivering provider to name a few things. I hope this helps!
did you tell her all this?? Did somebody well informed as you tell her all these things she should know before it's too late?
Do you mean did I tell the woman with the heart disease all of this?? I dont know her at all. I heard of her just through this posting. However I would bet that she has been told much of this which is why she is getting the induction/epidural/laboring down plan. Based on the small amount of info I have re: her heart condition... as much as I hate to say it, I think she is doing the right thing. We have to remember that while many women are convinced to do things that are really unecessary, there are women with real health problems that need medical management. A women with the congenital heart problem like she has is one of them. I don't know if you saw my original response to this discussion, but I think in her case, medical management and intervention may very well be the best thing :-(
She does not want a natural birth. I know when another women on the site had a homebirth she pretty much told her she was crazy for wanting to feel the labor. So I know she is not upset about this plan. I personally was just wondering why pit that early would be best and an epidural that early. I knew they would most likely be included, but I was thinking with a condition like this letting nature work the best it can first would be best for mom and baby.
I think they were probably just worried that a natural labor might be too hard on her heart. It can be very physically exhausting. It's too bad she did end up with a section, but she really did have a medical condition that made this not a normal laboring patient. Hard to say if her heart could have taken the stress...
Just an update I c/s was called for failure to progress. She got the epi at 4cm and labor pretty much stopped at that point.
I expected that, I don't trust hospitals any more. Poor both, it's always so bad when nature is interferred with.
Oh, that's too bad, especially since the c-section was likely to be more stressful on her than the planned method. I know this sounds rote, but at least she and the baby are healthy, right?
From all of these posts, the conclusion that I've drawn in my mind is this: for women like her, I am glad we have the technology and skilled medical doctors available to deal with her type of situation. Before modern medicine, the outcome would have been possibly deadly for Mama and baby. But, this why we are grateful for what we do have and we can pray that mother and child are healthy and bonding well.
I agree completely.



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