False Labor: Can it Be Caused By a Small Pelvis?
I have started "false labor" twice. I am 39 weeks pregnant, 2 centimeters dilated and 75 percent effaced. One day, contractions were very regular at 1 1/2 minutes apart and lasting 60 seconds for about 10 hours! When checked, I was not progressing. They gave me something to "sleep" and let my body rest. I trusted what they said about my body needing rest to start into full labor. It did, but with that drug I didn't sleep for 20 more hours! Needless to say, labor stopped at that point. It started once again with regular mild to strong contractions two nights later, only to stop again. My baby is rather large and still at minus two station. My hunch is that labor is stopping because the baby just doesn't fit. Is it possible the baby just "knows" it won't fit?Question:
How frustrating for you, and I would agree with you to some degree. I always tell my students that babies are smart. If the pelvis is too small, they simply don't engage or else must be prodded to engage with very strong contractions and sometimes with augmentation (Pitocin). The baby then may have to turn to accommodate the tight squeeze and mold the head a bit to fit through.
This relates more to station, however, than the initiation of labor. We don't really know why labor starts but it does start just as predictably in women with small pelves as those with large ones.
Primigravidas (first time mothers) generally start labor with the fetal head engaged (-1 to 0 station). If the inlet is adequate, but the midplane of the pelvis is too small, the contractions, once established, do tend to space out and labor can become dysfunctional. Dysfunctional labor or failure to progress in labor or arrest of dilatation or descent may all signify that the pelvis is too small. But you are correct, it sometimes takes hours of labor to find this out. As long as the baby is tolerating labor, the decision to do a cesarean is based on several hours of good labor without significant change in the cervix or in the station of the fetal head. At times, the baby turns (eg from a posterior to anterior) and then fits better and labor progresses normally.
I would not attribute your false starts to a small pelvis. Nor do I blame you for accepting medication to help you sleep. If labor really is like a marathon, imagine running it without sleep.
I just delivered a baby the other day -- it was a first baby; the mother had several days of false labor. She finally went into the hospital and the midwife gave her morphine and vistaril. She slept on and off for three hours, then ruptured her membranes on her own. I stripped what remained of the membranes and ruptured a forebag and she delivered five hours later. I think all the preparation and false labor primed her cervix so well that once she started labor, she just flew!
Try not to worry; let it happen. Eat, drink fluids and rest in your final days. Plan lunch with a friend, something that you really want to do -- odds are you won't make it!
I hope all goes well for you.Answer: