Can My Cervix Still Dilate Having Contractions if the Baby Is Not Head Down
I was woken at near 12.30am by a midwife working in the Birth Unit. A patient had arrived in spontaneous labour and her cervix was now fully dilated. But the baby's head was very high. The midwife told me the head was all the same at the level the brim of the pelvis. Membranes were all the same intact. I advised her I would attend.
When I arrived I told Karen I wanted to do a vaginal examination to check and try to determine why the baby'southward caput was so loftier. Karen had a very constructive epidural and then my examination did not crusade her any discomfort.
I confirmed the baby'southward head was still at the level the skirt of the pelvis. Antenatal ultrasound scans and clinical assessments had indicated an average size baby that should fit through the birth canal. Likewise there had been no evidence of hydramnios (actress liquor), another possible reason. On internal examination, I confirmed at that place was not a brow (forehead) or face presentation, where the diameter of the baby's caput that was presented was too large for vaginal commitment because information technology was and so deflexed. The infant was in an occipito-posterior position which meant a greater degree of deflexion of the head then a bigger bore presenting than if information technology was in an occipito-inductive position. I was also checking there was no umbilical cord below the head. The caput was and so loftier then poorly applied to the pelvic brim that a loop of string slipping below the head was certainly a possibility. That was non the case. No umbilical string was felt.
While doing this very thorough vaginal test between contractions I accidentally ruptured the membranes. It was proficient this happened every bit my hand was in the vagina against the infant's caput when this occurred equally I was then able to control the flow of liquor, make sure the head was not displaced sideways with the liquor coming out and also minimise the chances of umbilical string prolapse.
Later the flow of liquor ceased the head was yet at the brim of the pelvis but was better practical. I encouraged Karen to button with the side by side contraction with my paw remaining in identify in the vagina confronting the head to guide the head and to cheque progress.
Karen pushed very well. Over the next three contractions with her good pushing she was able to button the baby'southward head through the birth canal. The head rotated to occipito-anterior position with descent through the birth culvert. Karen had a spontaneous vaginal delivery of a healthy infant girl weighing 3500gms. Karen's perineum remained intact.
A very unusual presentation with a fabled outcome.
I frequently go asked in advanced pregnancy: "Is my infant's head engaged yet?" Oftentimes this is because of an erroneous belief that the baby'due south head must be engaged before going into labour. This is not the instance. 'Engaged' is defined as when the widest diameter of the baby's head is beneath the level of the brim of the pelvis on abdomen palpation. On internal exam, it is when the elevation of the caput is at the level of the ischial spine, a torso landmark on each side of the bony pelvis virtually halfway down the birth canal.
In Karen'southward case, she was in labour, fully dilated and even so the infant'due south head had not entered the pelvis!
Many women go into labour without the babe's head being engaged. It is very common if you have had a vaginal delivery before as the uterus is not as firm and there is less pressure pushing the babe into the birth canal before the onset of labour. Equally well a baby'southward head can be engaged one 24-hour interval and not the next, peculiarly if yous accept had a vaginal commitment before.
A adult female usually knows when her babe'south head is engaged. She feels a lot more pressure in the pelvis and is non as tight in the upper abdomen.
While the baby'due south head being engaged is not necessary for the onset of labour or for induction of labour it is encouraging if it is so. An engaged caput implies a more efficient and quicker labour. Sometimes, and especially with the showtime baby, a head that is not engaged at term is due to an occipito-posterior position of the babe. That implies a more difficult labour. In well-nigh 65% of cases occipito-posterior rotate to occipito- anterior during descent through the birth canal in labour. Sometimes this rotation happens at the level of the vaginal archway simply before the caput delivers.
Source: https://www.obstetricexcellence.com.au/labour-delivery/fully-dilated-babys-head-not-engaged/
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