Sometimes in birth if a labor isn't following a normal pattern you strive to determine the root cause. Baby not descending? Is it truly 'too big' (pretty rare) or is it a positional thing? Are contractions strong enough to be functioning well to produce the desired effect in labor?
In birth, you have four "P" factors: Power, Presentation, Passenger and Passageway
If birth does not seem to be functioning normally, you take a look at each of these items to see what might be causing a holdup.
Sometimes, it is simply a "tincture of time" that is needed. Sometimes mom gives up or gives out before that needed time can be prescribed.
That's where the bell curve can bring some understanding to a tired midwifery mind.
If you remember from your math or statistics classes, the bell curve represents where the general population falls according to the majority (of whatever you are trying to classify).
On the left of the bell curve, you have a woman with a pelvis you could drive a Mac truck through! She has a gynecoid pelvis (the most typical shape), baby ends up in a great position, and she labors and delivers with expediency and efficiency. She most likely will deliver a baby even if they are malpositioned, breech or huge. Yes, she is the ideal but you can see, she isn't always the most typical.
In the middle, you have the majority of women. They may need a little evaluation or assistance or just plain old time, but they are also going to deliver their babies without much interference. Maybe a positional change or time to let a baby rotate, but by and large they are good to go without working too hard. God bless them, they compose the majority of the birthing population.
Then over on the right, you have moms who will probably need some assistance. Either nature gave them a pelvis that statistically is in the minority and therefore slightly more challenging for a baby to traverse, or a baby is very malpositioned and causing problems, or nutritionally mother/baby have been undernourished and this can cause problems (pre-eclampsia, abruption, etc.) or baby is large and needs time to mold his bony structures to fit, or any number of other challenging situations. Midwives are usually pretty good at meeting these challenges. Unlike the medical community, which sometimes solves all malposition issues by simply creating stronger contractions with pharmaceuticals, midwives really strive to determine the root cause and see if it can be resolved another way.
Sometimes, we have just the right little trick up our sleeve.
And sometimes, we don't.
I really hate it when someone falls into that last category. It is usually absolutely through NO FAULT of their own. Fortunately, this is again the minority of women but we still see them. We have pulled every trick out of our Mary Poppins bag and nothing has worked. Sometimes, in the medical environment, their pharmaceuticals have not only NOT helped but then have stressed out the baby so that the surgical solution is the only one left.
These are the ones that leave you feeling frustrated. Perhaps there was just one more trick you could have used to reposition that malpositioned head and reduce that swollen cervical lip, one more maneuver you could have used to turn that reluctant or persistently posterior baby, perhaps if you had just had a little bit more time...
But you didn't. Mom may be tired of trying and just wants pain relief. Maybe the bag of waters has been broken longer than is safe to continue, maybe baby starts expressing their own stress in their heart rate and you know it is time to throw in the towel and admit mom has fallen into the far right of the bell curve. Those who will need more intervention than you can give them at home. I know this is necessary and at times is life saving. You are especially grateful for caretakers that will work with them and help them to have a vaginal birth if possible. And equally grateful for physicians that have the skill to perform a cesarean if it is truly needed, though it is performed way too often in our country.
So, why does it feel like a failure? You know statistically there will always be those that fall into that last section of the bell curve, but you keep trying to keep your own clients from falling into that statistical divide. Mine today transported and was so blessed to get a physician that assisted her to continue on and get a vaginal birth and for that I am ecstatic, but it always makes me sad that someone didn't get the birth they hoped for.
Stinkin' bell curve.
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