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Long ass labor

Shieva Ghofrany: [00:00:00] All right, so a bunch of you have actually asked about these long labors since I commented on it last night. Um, I had a patient who, poor thing had been in labor on her own, meaning spontaneous labor. She came in, she did need augmentation, meaning she was laboring on her own. Her cervix had started to make some change. 

She was having regular contract. So it wasn't exactly an induction where we started afresh and took her body from doing nothing and gave it contractions. It was augmentation. We kind of helped it along. So she got Pitocin, which is synthetic ox oxytocin. Oxytocin is a hormone that's in your body that makes you go into labor and makes your uterus contract among other things. 

Um, Pitocin is the synthetic form that we hang from the IV bag, so she got that. Um, she slowly progressed and got an epidural and then ended up basically stopping at nine centimeters and it was about [00:01:00] 24 hours to get her from one centimeter to nine centimeters. Now during it, if you asked me what I thought, um, and I told her what I thought, I suspected that she was not going to deliver vaginally because. 

I could tell the baby was in a funny position. The baby was head down, but was looking most likely what's called sunny side. . Um, so she and I had a few discussions throughout the whole labor. She really wanted to try vaginally. I was very much in favor of her trying vaginally cuz it was safe. And I told her, like, I tell everybody, I don't care how your baby comes out, as long as your baby comes out happy and healthy. 

If it comes out vaginally, that's great. If it comes up by C-section, that's great. But she was in labor. She wanted to try, it was appropriate to let her try. It was appropriate to let it take that long because she was fine and the baby was fine and the heart rate was fine. Um, and once she hit nine centimeters, in the old days old, meaning just in the last, as of the last probably year or two, we would've [00:02:00] said after two maximum three hours, I would say for most of us as OBGYNs of the cervix. 

Stopping dilating, meaning what we call arrest of dilation. We would've said, okay, you need a C-section, and we would've proceeded. Newer guidelines have come out saying that you can actually allow people to wait and not only allow, but maybe should allow people to wait up to six hours before you diagnose what's called arrest of dis of. 

Meaning they stopped dilating. Um, I can't say I love these guidelines, not because I wanna section everybody. I don't, I don't get more money for it. It costs me more time. It makes me have to see patients in the operating in the hospital longer. So none of it is good for doctors. Believe me. We would all love these babies to come out easily and vaginally if it's the right thing. 

But these new guidelines we kind of have to comply with and if it's safe and the patient really wanted to try, so I. Wait a full six hours and I checked her periodically myself so I could tell 'em what was [00:03:00] happening. Um, and that cervix, we tried all kinds of tricks. Repositioning her this thing called a peanut ball, and pit, extra pitocin, all kinds of things. 

None of it worked. She didn't get past nine centimeters, so, , she had a c-section. Was it easy? No. When you've labored for that long, your uterus is um, more likely to not contract when we need it to, once you're actually in labor, I mean, once you're in the operating room and the placenta has come out, so while we're asking it to contract beforehand and we're getting it to contract by giving it Pitocin, now we're in the operating room and I really needed to contract to stop the bleeding and it sometimes gets lazy. 

What's called a. Lack of tone. A tous of the uterus, so atna. So I had to give her four different medications to get the uterus to contract, to stop the. and the lower uterine segment where we make the incision ends up. Unfortunately, because it's already been so stretched out from labor, now I have to get my hand deep down into the pelvis to pull the head out of that incision.[00:04:00]  

It's much more likely to get extensions of the incision, and that can lacerate into very specific and important arteries in the uterus, the uterine arteries, and that can cause more. So we, we do everything very carefully, but these things happen as they did last night, which was not a surprise. It was not, um, incredibly challenging, meaning in the realm of hard c-sections I've done. 

It was not even close to the hardest, but it wasn't the easiest. She did overall great. She definitely lost blood. Um, and today she's feeling fine and is resilient and gonna bounce back and gonna be okay. So as I say, there's no sadness, there's nothing bad about it. But to answer all of your questions about how do I feel about long laborers? 

I hate long laborers. I've had long laborers that have been very successful and I've had long laborers that have not been successful in my eyes. Meaning yes, the baby was okay. Yes, mom ultimately was okay, but there was a lot of difficulty either in a c-section that occurred after long labor or a vaginal delivery, like [00:05:00] my own, my first child came out vaginally and it was not a delightful, um, wonderful, I would say healthy. 

so long labors can be good. It really depends on you and your doctor. You guys should discuss it and make sure that you know, every kind of couple hours you're revisiting the situation to really know if this is the right thing and if the risks are worth it. When it works out, it's great, but it doesn't always work out so easily. 

So it's important to not take risks when they're not needed. Okay. I hope that all makes sense.