# Caput during labor?



## SeaDoula (Jan 13, 2006)

Hello,

I am wondering if anyone can tell me about caputs and out of what scenario's they arise.

I am a doula, and hopefully soon to be midwifery student, but this is actually about my own labor and daughter's birth. it was very long, pitocin to augment after water broke and no ctx after 24+ hours. I made it to 9.5cm but she was -2, maybe -1 but the CNM whom I hated said the movement was just the tissue of her head molding and not the boney part of her head coming down. I tried pushing past the lip...at that point I had an epidural because I felt like pushing around 7cm and at about 7/8cm my labor just stalled out. I started getting a fever (not likely due to the epidural but probably because of infection after having my water broken for 3-4days in labor) My dd's HR also started to change and I opted for a cesarean at that point because I was worried she'd end up in the NICU.

Do you think this means my pelvis is too small? what could have caused the caput? Do you think I eventually could have pushed passed it? It was hard because I had no idea what I was doing, couldn't feel anything....but maybe after doing it a while it would have made a difference.

I think about this off and on and feel like I am constantly searching to fully understand my experience as a mother, but also on a professional basis.

Thanks for any input.


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## kathan12904 (Jun 23, 2006)

Almost every time labor progresses to 7-8cm and stops, its because baby is OP. You'd most likely need to have suffered from malnutrition, polio, or severe pelvic injury sometime during childhood for your pelvis to be truly inadequate to birth your baby. Do you know her position? OP babies just don't put that good hard well applied pressure on the cervix to open it up and they have a hard time twisting their way past the pelvic bones. You can do things during pregnancy to encourage good positioning at birth, check out www.spinningbabies.com, for more info on that. Also, moving often during labor and staying off your back and not breaking your water prematurely are important aspects to turing an OP baby OA during labor. Since your water broke to start your labor, labor positioning would have been the only way to affect her position and it isn't very easy to turn them without the cushion of water. You can push a baby out in the OP position, but it is definitely more desirable to have them faced correctly. An op labor is long and slow, so a good doula and patient practitioner are important. You can usually tell if your baby is OP because your belly just doesn't have that bulbous basketball shape to it or if you feel a lot of small movements (arms and legs) along the front of your belly instead of big whole belly sweeping movements (back and butt).


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## nashvillemidwife (Dec 2, 2007)

OP also explains the premature urge to push.


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## SeaDoula (Jan 13, 2006)

That is something I have thought about, because she was head down but always LOA and not ROA, which I believe I read was more likely to turn OP. My doula(s) and I all thought she was likely positioned funny and that was the problem. We tried using a rebozo very late in labor, but felt futile at that point.

Is it possible to tell if a baby is OP via VE if she is that far up and has a caput? (she was -1 or 2, or would it be too difficult to know? In hindsight her face did look very smooshed up, which sounds right for OP.

Do they normally write down baby's position in the surgery notes, or at that point do they not care?


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## SeaDoula (Jan 13, 2006)

Quote:


Originally Posted by *kathan12904* 
Almost every time labor progresses to 7-8cm and stops, its because baby is OP. You'd most likely need to have suffered from malnutrition, polio, or severe pelvic injury sometime during childhood for your pelvis to be truly inadequate to birth your baby. Do you know her position? OP babies just don't put that good hard well applied pressure on the cervix to open it up and they have a hard time twisting their way past the pelvic bones. You can do things during pregnancy to encourage good positioning at birth, check out www.spinningbabies.com, for more info on that. Also, moving often during labor and staying off your back and not breaking your water prematurely are important aspects to turing an OP baby OA during labor. Since your water broke to start your labor, labor positioning would have been the only way to affect her position and it isn't very easy to turn them without the cushion of water. You can push a baby out in the OP position, but it is definitely more desirable to have them faced correctly. An op labor is long and slow, so a good doula and patient practitioner are important. You can usually tell if your baby is OP because your belly just doesn't have that bulbous basketball shape to it or if you feel a lot of small movements (arms and legs) along the front of your belly instead of big whole belly sweeping movements (back and butt).

I just wanted to say that I didn't have my water broken, it broke with a slow but mostly continuous trickle, then after 24+ hours with no ctx my midwife transfered my care to the hospital for an induction/augmentation. after a couple hours on pit I had a gush. ctx never started on my own which also sounds right for malpositioning. She was LOA whenever I checked her position, but I do not know what happened in labor.

I got an epidural at about 7/8cm because they would not turn off the pit for relief due to my water being broken so long, but I was exhausted....wanted to push, cervix was swelling, and making no progress for hours.

Do you think if my provider was more patient (the midwife at the hospital outright told me she didn't think I could have a baby vaginally) even if I was 9.5 (cervical lip) and she was still -1 or -2? I have wondered myself if I had just kept pushing could she and I done it...or would we have just ended up with her in the NICU?

I think I made the right decision for what I knew and was feeling at that moment, but I do often wonder if I was just given more time...could I have pushed her out? The way the midwife made it sound was that my dd's head was not coming down, and only the tissue was coming down, not the boney part.


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## berrymama (Jul 7, 2007)

The doc may have written in the notes what position baby was in. Another way to tell if baby was malpositioned is to look at the molding/caput right after baby is born. If baby was malpositioned it will be off to one side or more toward the front.


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## MidwifeStephPDX (Feb 24, 2009)

Good luck with your journey and the processing of your birth!
In reading your story, a couple of points came up for me:

1) Water breaking before labor begins, can help "cement" an unfavorable position and make it harder for the baby to present, but by no means impossible. A slow trickle the way you're describing would make that less likely though. Your body and the baby's body continue to produce more fluid as long as you stay hydrated.

2) ROA is the position more likely to turn OP, not LOA. If you get the birth report from the hospital, it can tell you the position your baby was in. Do you remember where the caput was? That usually makes the presentation very clear: an OP baby will have a caput and/or molding much closer to the front of the head than an OA baby.

3) The length of time water is broken does lead to higher risk of infection, but I don't think you can assume you had one just because of the length of time it was broken. It is much more likely that it was the epidural.

4) In my experience (and what my research shows) is that an "early" urge to push is very common. Unfortunately, when there is an attempt by the practitioner to work against that pushing urge, it can make it very difficult--or even impossible-- to connect to that feeling again. I'm not sure if that rings true as a possibility to you, but it's a thought...

I do agree with the fact that it is highly unlikely that any of this has anything to do with your pelvis: just circumstances, that day, that baby, etc. I have seen enough successful VBACs to see that proven over and over.


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## MsBlack (Apr 10, 2007)

ITA w/midwifeSteph--and thanks Steph for that concise summation, says it all very nicely IMO (I never coulda said it so briefly!)


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## SeaDoula (Jan 13, 2006)

Quote:


Originally Posted by *MidwifeStephPDX* 
Good luck with your journey and the processing of your birth!
In reading your story, a couple of points came up for me:

1) Water breaking before labor begins, can help "cement" an unfavorable position and make it harder for the baby to present, but by no means impossible. A slow trickle the way you're describing would make that less likely though. Your body and the baby's body continue to produce more fluid as long as you stay hydrated.

I agree, as my daughter continued to move down, and labor progressed after my water broke. It was later after a big gush and more time that it seems she was "stuck"

Quote:


Originally Posted by *MidwifeStephPDX* 
2) ROA is the position more likely to turn OP, not LOA. If you get the birth report from the hospital, it can tell you the position your baby was in. Do you remember where the caput was? That usually makes the presentation very clear: an OP baby will have a caput and/or molding much closer to the front of the head than an OA baby.

I just know that i could never sleep on the side that is always advised (I think right side) and if you were standing in front of me you would see her kicking on of the right side of my body or my left (from my perspective) I was told this position is more likely to turn OP. Also the funny thing is that I never noticed her head being shaped any differently than any other baby. She had molding that looked cone-y...but her head was covered in a hat...I am basing this off of my cloudy memory and pictures of her being born/right afterward. Her face does look very puffy and smooshed though.

Quote:


Originally Posted by *MidwifeStephPDX* 
3) The length of time water is broken does lead to higher risk of infection, but I don't think you can assume you had one just because of the length of time it was broken. It is much more likely that it was the epidural.

Well I do think I was likely getting an infection because I was in labor for 4 days in total from the time my water broke to my daughter being born, had several vaginal exams/cervical checks toward the end, and I had the epidural in place for a long time, it was very gradual. I even asked my doula when they started to mention my temp going up if she thought it was likely the epidural and she said she didn't think so. Who knows? They gave me antibiotics for sure though, due to the cesarean.

Quote:


Originally Posted by *MidwifeStephPDX* 
4) In my experience (and what my research shows) is that an "early" urge to push is very common. Unfortunately, when there is an attempt by the practitioner to work against that pushing urge, it can make it very difficult--or even impossible-- to connect to that feeling again. I'm not sure if that rings true as a possibility to you, but it's a thought...

I do agree with the fact that it is highly unlikely that any of this has anything to do with your pelvis: just circumstances, that day, that baby, etc. I have seen enough successful VBACs to see that proven over and over.

Thanks for your thoughts. It definitely helps me process my experience, and give additional things to think about. My doula said the same thing, she doesn't think there is any reason I wouldn't go on to have a successful VBAC.


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## nashvillemidwife (Dec 2, 2007)

My baby was OP (and asynclitic) and had a banana head! It certainly wasn't a problem with the size of my pelvis - once I was complete I pushed her out in 9 minutes.


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