Just Right...the Retrospective Diagnosis

One of the two April babies came. It was a much longer labor and push than we all anticipated, due to a posterior presentation. I hate to be a pessimist. I have a running dialog of silver-lining reassurances during times like these, but I was concerned about the outcome of this birth. When the head went from asynclitic and relatively evenly applied to posterior and ballotable at -1 with a consistently 6 cm cervix, I was wondering what the night would look like. In the end, the posterior resolved with some hard work on the part of the mom, and a little help from her midwives. The take home message, for me, was this: the diagnosis of dysfunctional labor is a retrospective diagnosis. Had the outcome of this birth been different, I would have termed it clearly dysfunctional. However, with the good outcome and 20/20 hindsight, I am able to clearly discern a pattern that made sense and contributed to the vaginal birth of the baby. Sure, it may have taken the better part of all of our lives had we not urged it along, but the change in the babies station and the sometimes easy going contraction pattern allowed for position change that resulted in a vaginal birth. I'm not sure that I will let my guard down about posterior, I've been stumped by it too many times. But was this woman's labor dysfunctional? Nope. It was just right.