A talk was held last 16 February 2017 at Medical Center Manila by select obstetricians from MCM to provide an overview of a very common problem that pregnant women may encounter during labor. They call it Dystocia.
Dystocia, also called obstructed labor, is when, even though the uterus is contracting normally, the baby does not exit the pelvis during childbirth due to being physically blocked.
Dra. Maynila Domingo, a doctor of Maternal and Fetal Medicine discussed that the patient is generally assessed according to the five P’s that influence labor and delivery. These are the Passenger, Passage, Psyche, Position, and Power.
The Passenger refers to the fetus. Complication may be a result of the fetal position such as transverse or breech. The birth weight, known as macrosomia, is a fetus that s greater than 4000 gm. or 8lbs and 15 oz. Other conditions are the presence of fetal anomalies such as hydrocephalus or multiple gestation.
During labor, the fetus assumes positions and attitudes that are determined in part by the configuration of the mother’s pelvis. Thus the Passage refers to the pelvic bone and muscle structure of the mother.
Another factor of dystocia refers to the Positions for labor and pushing. Incorrect technique, fear, decreased urge, and exhaustion contribute to an ineffective pushing which can cause a difficult labor.
An interesting factor that may cause difficulty in labor is the reaction of the patient and physician during labor. An anxious patient may influence the physician’s work environment including his attitude and the capacity to perform the procedure. Also, Psyche refers to the mother’s attitude, level of anxiety and and pain tolerance and of course with the support of her love ones especially her husband, she will overcome the fear of giving birth. So always remember what Jane Weideman said, “Giving birth should be your greatest achievement and not your greatest fear.”
Finally, the fifth P which refers to Power is the condition in which uterine contractility is inadequate in effecting dilation and descent. The contraction maybe too weak, too short, or too far apart. This often results to a prolonged labor which causes maternal exhaustion or even fetal distress.
Several studies have been made to create an effective management for dystocia. Aside from understanding the five P’s during labor, it is also important to know the augmentation process that is in place to prevent or handle a difficult labor. Part of these is to ensure that staff are competent in performing assisted delivery including the need for a Ceasarian section.
The health of a pregnant woman does not lie alone with her doctor. It is her responsibility to bring herself to an assessment if she is at risk. It is often identified as a result of confirmed obesity, extreme of age, and co-morbid conditions such as diabetes. These risk are determined using high index of suspicion based on history, clinical examination, and diagnostics. To manage or avoid such complication it is prescribed that mothers maintain a normal weight, comply to prenatal checkups, and other supportive activities that will increase the chances of a healthy and safe delivery.
For more information, you may contact Medical Center Manila 02-525-6836 or visit their website http://manilamed.ph/