"What if you only get to work with pregnant women WHEN they are in labor? A case study of Mid-Pelvis challenges using OMP techniques during labor to get labor to progress.
One of the common questions healthcare professionals ask about OMP techniques is “What if you only get to work with the pregnant mother during labor and birth and you did not meet with her prenatally? Will these OMP techniques still work?” This is a case study of a first time mother who had mid-pelvic issues.
Women labor in corridors instead of individual rooms in Guiyang, China so bypassers all have access to this ‘public space’.
I will debrief this birth using the OMP's Guide for Labor Progress:
Background information:
The Obgyn of the hospital called when we were at dinner to ask if I could come over and see if we could use Optimal Maternal Positioning (OMP) with one of her laboring mothers to enable labor to progress as the mother in labor had stalled at 4cm over the past 12 hours with regular and strong contractions in a hospital that does not offer pain relief options which means if her labor does not progress she is going in for a cesarean. Husbands are still not allowed in the delivery room and women are roomed in 3-4 bedders at the labor ward and labor alongside each other either in the shared room or corridor.
We arrived at 7.50pm where her contractions were about every 6mins apart and 40 secs long. The laboring mom has been waiting for us to arrive as she was told that the ‘expert’ would be coming to see her. I felt like no expert, just a mother and a birth professional reaching out to another mother wanting to help her.
I was invited to deliver her baby but I politely declined not having attended a birth in China prior and understand the medical differences and protocols. Instead I used more OMP pelvic mobility protocols to create more space within the pelvis and baby was born at 10.10pm - less than 2.5 hours since we arrived!
1. Where is the baby in relation to the pelvis?
Station -1 which means this baby is moving from inlet to mid-pelvis.
2. What is this baby trying to do?
Internal Rotation and flexion
3. Is there a road block?
Sounds like it from the information I have been given. Mother has been in labor with regular but not progressive contractions for the past 12 hours where she has been at 4cm. I asked the Obgyn to time 5 consecutive contractions and let me know whilst I made my way to the hospital. Contractions are about 6 mins apart 40 seconds long. A vaginal exam showed that mother was still at 4cm dilated station -1. No reversing protocols have been used.
My first step was to use the OMP Reversing Protocols which is the combination of doing 1.4 FLI and 1.5 PRF concurrently based on what I have heard however when I saw the mom for the first time laboring in the corridor and watching her go through a contraction. It was very intense and she was clearly exhausted and i felt that I should provide some relief first and get her to rest so i decided to start with OMP Pelvic Alignment Protocols 1.1 PSLR first instead.
4. Have any comfort measures that are helpful with increasing pelvic alignment and pelvic mobility been used?
No.
5. Has the laboring mother used any pelvic alignment protocols to align her pelvis to increase pelvic mobility?
No until I decided to start with 1.1 PSLR.
The staff gave us a private room where we could use OMP Pelvic Alignment Protocols with the mother. When I touched her body, it was stiff as as board from her thighs/hamstring, pelvis etc.. My plan was to use 1.1 PSLR and 1.2 ITR for 4-5 contractions on each side before assessing the situation.
Whilst doing the OMP Pelvic Alignment Protocols, the nature and intensity of the contractions started to change. It was noticeably spacing out and less intense after 3 contractions on each side and the mother even managed to fall asleep in-between contractions. By the time we sat her up after the 4th combination of 1.1 PSLR and 1.2 ITR on one side (right), she reported that the contractions are not as painful and we moved on the do the combination of 1.1 PSLR and 1.2 ITR the other side (left). She now found that she could cope with the contractions.
It was also noticeable that she had much less mobility on her right side during the 1.1 PSLR compared to her left side. What was encouraging was that her body responded by quickly to both the 1.1 PSLR and 1.2 ITR, I could actually feel her tension and fascia release. We used a combination of 1.1 PSLR and 1.2 ITR for 4 contractions on each side and her waters broke after the last PSLR ITR!
Another vaginal exam was performed and she progressed 2cm and the baby’s head descended to +1 within those 8 contractions of PSLR ITR on both sides.
The laboring mother was given a private room to use so we could use OMP Pelvic Alignment Protocols to enable her labor to progress.
6. Has the laboring mother used any pelvic mobility protocols to facilitate baby’s cardinal movements?
No.
She was moved back to the corridor to labor and I suggested using Pelvic Transitions whilst sitting on the birth ball. As it was new to her, doing the figure 8 was difficult and she was quite stiff so we switched to circular motions instead in both directions which the mother found manageable. You could tell that the mother was very motivated and went into "la-la-land" aka labor land. In less than an hour, we moved to the delivery suite.
As her labor progressed, the laboring mother was moved to the delivery suite to prepare for the birth of her baby and husbands are still not allowed in the delivery rooms. This birth took place in July 2019 at one of the hospitals where there are no pain relief options for women during labor, its either a vaginal birth or a cesarean.
7. Has the laboring mother used any pelvic mobility protocols to modify her pelvic openings?
No.
At the delivery suite, they attached continuous CTG and she continued her circular pelvic transitions on the ball. As she started pushing, I suggested going on all fours on the delivery bed (read: China style delivery bed which is designed for cesareans, not your Hill-Rom delivery bed!!!).
From the way the mother was breathing ie. she was blowing as she exhaled, i could see the pressure of the baby's head not descending but just moving up/down so gave suggestions on the way she could breathe that would help her baby to descend. At the same time, I encouraged extreme flexion whilst on all fours. It helped yet there was also that pressure of lack of progress around. So i got her to go into the Arch Back Squat Lunge and within 5 contractions, head was now visible.
I was invited to deliver her baby but I politely declined after seeing them smear betadine all over her thighs and her vagina - realising that having NOT attended a birth in China prior and understand the medical differences and protocols, it was better to observe.
As the bed was very narrow, we moved her back into extreme flexion in all fours and she pushed her baby out at 10.10pm - less than 2.5 hours since we arrived!
Below is the footage of the baby's birth - China style! I was shocked at the lack of sensitivity to the mother's environment yet by China's standard, this was considered a relatively gentle birth and I was asked to facilitate skin-to-skin of the baby with the mother which only meant passing the baby to mother!
Post-birth Debrief
It was such a surreal experience yet an absolute privilege to be able to attend a birth in China. A first for me yet also the first of many to come! There is much to be said that is so culturally different from what I have been exposed to and what I am used to but this is where cultural exposure and tolerances come in.
What was interesting for me was that during her 5-6 contraction when she did the combination of 1.1 PSLR and 1.2 ITR on the second side, I intuitively knew that the baby’s head had dropped and that she was 6cm. And the vaginal exam after the OMP Pelvic Alignment Protocols confirmed it.
I got to meet the mother and her family in the morning, and they were so grateful. She shared how she had lost hope and thought it was going to end up in a cesarean yet she was scared because that would be more painful than childbirth. She was told that the 'expert' would come at 8.30pm so she decided to do what she can to cope whilst she waited. Her friends all could not believe how quickly she progressed after OMP protocols were being used.
As she was laboring in the common corridor at the labor ward, another couple who was in early labor was also at the corridor watching together with the 'crowd'. The husband approached us to ask if we would be back tomorrow so we volunteered two of our OMP students to be their doula so the training doulas had to leave my OMP workshop halfway through the morning and by noon, I was shown a photo of the family with their new baby!
Meeting the mother and her baby one day postpartum.