05/09/2025
Back when I was a resident, I had the opportunity to take care of my cousin during her pregnancy. The antenatal course was unremarkable.
I admitted her at 38 weeks at 4 cm around 10 in the morning. I augmented the labor and rupture the membranes after 2 hours. The labor progressed to 5 cm cervical dilatation. It was then that the labor got really dysfunctional. The labor progressed to 6cm only after 3 hours, then did not progress thereafter. It was classic Friedman’s dystocia. I tried recalling Dr. Siodora’s lecture on the P’s that need to be considered during labor - POWERS, PASSENGER, PASSAGEWAY. I have no problems in these P’s! Then I remembered a very important part of the lecture - that continuous monitoring may be performed as long as maternal and fetal status were reassuring. I looked at the mom - sleeping with stable vital signs. Fetal heart rate pattern was normal. I was already tired as it was way past midnight and I had ORs in the morning. So I tried to rest at bed side, occasionally checking on the monitors without doing cervical examination. I told myself that by 6am, this baby must be delivered already. By 5:30 am, I did my internal exam. Lo and behold, the cervix was fully dilated. After 2 maternal pushing efforts, the baby was delivered. It was 6:47 am. This was 10 years ago today.
This photo is a reminder that dystocia guidelines are just guides. They are not an absolute rule. From then on, I’ve become an advocate of vaginal delivery. CS is relatively easier to perform and will not take away a lot of our precious time, but convenience should never be an indication to perform it. Also then, I thought that another P should be added to our considerations during labor. And that, my friends, is PATIENCE.