J and S started care with me in the start of the third trimester with their first baby.  They had watched some documentaries and done some research and felt that midwifery care and home birth were a better fit for them. At 37.3 weeks, J sent me a text that she was feeling some braxton hicks.  I was on my way to church as she messaged saying she was having some bleeding.  After further discussion, it sounded that it might be her water was broken.  There was a group prenatal going on at my house in a couple hours that J really wanted to attend so it was decided J would come an hour early so I could do an exam and check the leaking fluid that J was experiencing.  Baby was moving well and J said the braxton hicks she was feeling were maybe every 7-10 minutes. J and S arrived almost 45 minutes passed the expected time.  When J walked in I immediately could tell that she must be experiencing more than braxton hicks.  J said on a pain scale she called them a 9, and she felt like she really needed to used the bathroom.  Before checking any other vitals, I told J I felt I really needed to do an assessment.  I could tell her water was broken, and did a cervical exam and found that J was completely dilated to a 10, 100% effaced and baby at a +1 station.  I told J and S what the exam meant and knowing they lived 35 minutes away, I recommended we set up for delivery in my extra bed room. At this time, contractions were coming every 3-4 minutes, lasting about a minute long.  I, with the help of my assistant who was leading the group prenatal and apprentice, quickly got things set up for delivery.  Within 30 minutes we were ready and J was ready to start pushing.  And push and push we did.  J tried pushing on the birth stool, then pushed in a squatting position.  When she got tired, we positioned her on the bed and pushed in every position on the bed, on her sides, semi reclining, tug of war with the rebozo, hands and knees. The contractions became very wonky, spacing as far as every 10 minutes apart.  J moved to the toilet for a while, then walked around the house, watching the Business of Being Born in the background.  I discussed with J and S that I thought we should consider moving to their house to see if it was emotionally/mentally hard to push baby out in an environment that wasn’t their own.  I did a final exam and noted no change in baby’s station, but told everyone that I suspected baby was ROP and that could be causing an issue with baby moving down.  J’s contractions were staying 10 minutes apart as we loaded up and headed to J’s house. Contractions were still every 10 minutes upon arrival to their home.  I started giving J some herbal tincture every few minutes to help bring them back.  Within an hour, J was contracting about 6 minutes apart. J walked around her house, leaning on her counter with contractions.  Rowan used essential oils and worked on pressure points to help bring on contractions.  J snacked and then I recommended she go out for a walk with S before we got more serious about really pushing this baby out as we were coming close to needing to decide if we needed more help to have a baby. After the walk, J was ready to actively manage pushing.  Baby was still in the same position, and I noted a lot more molding on the baby’s head.  I could tell baby wasn’t budging with pushing.  J and S wanted to spend some time in prayer over pushing, and we left them to spend some time alone, to pray and decide what needed to happen. J felt that things were more productive on the toilet so she labored a bit on the toilet.  Rowan went and spoke with her and J said she really needed to walk outside once more before checking final progress and making any decisions to go to the hospital.  J and S enjoyed a walk, and then came inside for another assessment.  Baby was in the same position, same station.  There was no change.  I discussed with J and S that I felt it was time to transport to the hospital for further help with getting this little guy out.  After asking some questions, they decided it would be best to move to the hospital.  They packed a bag and I called the hospital and we were soon en route to the hospital to have this little one. After a couple hours in triage, J was moved to a labor room and pitocin was started.  We were allowed back to be with her.  J was initially in the bed, but moved to the toilet and the birth ball.  She found the bed uncomfortable.  Contractions began to pick up very quickly on pitocin, coming every 3 minutes.  J had a great nurse who was trying to help her try different positions to push.  After about 90 minutes, the hospitalist came in to assess things and found there had been no change.  He believed baby was posterior and was unable to come down do to the position, and he recommended a surgical birth.  J was hesitant, but after realizing she could try for a VBAC with her next baby decided that she would like to go in for a surgical birth. Welcome to the world sweet Ezra!  Born earthside on February 8th, 2016 at 3:33am, weighing in at 6lbs 8ozs!  J was such a trooper!  No matter what Rowan or I recommended she readily tried it and was willing to do any and every thing to birth her baby.  It was such a joy to serve this sweet couple! #sacredjourneymidwifery #houston #midwifelife