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I agree with everything Debra has to say on this. And also agree that for me, especially with primips, that I look for engagement in the weeks leading up to the EDD. If a baby is remaining high I will make sure that pre-birth acupressure is happening at home, that the birthing person is stretching and moving each day and I’ll needle or tack points such as SP6, GB34, LR3 and UB60 (though probably not all at once) – along with a root treatment and other points for their EAM dx. I’ll also often do bodywork down both sides of the spine, moving the paraspinal muscles away from the lamina groove. I also am a huge fan of cupping on the low back (thanks to Debra).
In labor for an unengaged baby I would likely use alot of movement including some of the rocking techniques that Claudia teaches along with hip circles and abdominal lift/pelvic tilts (a la Spinning Babies). I’d probably tack and do lots of acupressure on points such as SP6, UB67 and UB32 to address weak ctx and baby position as well as ctx wrangling (tapping UB67 mixed with chafing the KD line at the foot and ankle). I’d also keep an eye to the constitution and diagnosis of the birthing person and address that as needed. If the environment is chaotic at home I’d get the birthing person into a dark quiet room and clear out the house…sending people on long errands to search drugstores for very specific types of gauze (that may or may not actually exist) is a great way to clear a house. 😉 I have, just personally, seen a relationship between home births that are overpopulated by family members and disrupted labor patterns. I’m not saying it played a role here, but in my personal experience I don’t think it helps.
At the end of the day, birth is chaotic and unpredictable and we do all we can, but sometimes things are puzzling or don’t go well and we’ll just never know why.
I do think this case is interesting because it doesn’t make sense mechanically to me how someone could get to complete dilation with weak ctx and a baby who is not engaged in the pelvis. I’ve certainly seen babies who won’t descend, but this seems a bit unusual?