A and C started care with me at the start of their second trimester of their second pregnancy. A began having some borderline issues with her blood pressure as she was 34-35 weeks, and was on maternity leave by 36 weeks. At her 38 week prenatal appointment, A joked that she wishes her water would just break so she could have the baby and be done with things already. She was 3cm dilated, 60% effaced, and baby was at a -2 station. I talked to her about the baby being acynclitic and recommended some curb walking and stair climbing daily to help. The next afternoon, A calls and tells me she thinks her water has broken. She had been squatting beside her daughter when the initial gush had happened, and continued to leak from there. A decided she wanted to come see me to be checked and verify that her water was broken. At 7pm on April 21, A and C arrived and I confirmed that A’s water indeed had broken. There was no change in her cervical exam. I encouraged A to be active for awhile, and then get some sleep as active contractions should hopefully be present by morning. Contractions had been very infrequent and short through the evening. A slept through the night. Since nothing had picked up, I headed out first thing in the morning to join A to see if I could help work with her and get a good contraction pattern going. I did my initial vitals on A and then began giving A tinctures every 15 minutes to help bring on contractions before going outside for a walk. The weather was nice and we walked for quite awhile. Contractions seemed to come every 3-4 minutes, 20 seconds long while walking. A had made a chiro appointment and we soon left for the chiropractor to see if an adjustment would help baby get in a better position and bring on some contractions. We continued the tinctures and added in a homeopathic to see if it helped. Contractions were very spread out and sporadic when they did happen. We went for another long walk after the chiropractor. We walked miles that day! C prepared lunch, and A ate up while she could. I did our first cervical check around 130pm. There had been no change. A was feeling very emotional that nothing was working and her water had been broken since 22 hours. Contractions seemed to only come when she walked. It was warming up considerably outside, so A decided she would walks laps around her house. Contractions would come again quite frequently, but short and mild as she walked. As soon as she took a break on her birth ball, the contractions would fizzle. I worked with A to do a few captain morgan’s on each side, as well as walk her stairs, but nothing seemed to bring on any active contractions. As the 24 hour mark neared, A and I started going over different plan options. I was scheduled to teach midwifery students the next day, and would have to have back up switch me out around 3am. Most hospitals would not allow continuing labor after 24 hours of rupture of membranes. A was feeling tired, emotionally, mentally and physically. I encouraged her to lie down for an hour. She was sleeping so deeply I let her rest for two hours. Meanwhile, I talked to my back up who said she could augment A if she wanted to go into the hospital. When A woke, her irregular contractions were no longer present. We talked over options. She was now 27 hours past rupture. A and C decided they would like to transfer to my back up. The unfortunate thing was that the drive was an hour away. We arrived at the hospital at 7pm. It took awhile to get all the initial assessments done at the hospital, but pitocin was finally started a little before 10pm. During this time, A felt no contractions. The pitocin was increased at a regular rate, and still A felt no contractions. Since I would have to be up and out the door at 7am to teach that morning, A and I agreed I would leave at 2am if she wasn’t close to having a baby. At 2am, A was still not feeling many contractions, despite being on pitocin for several hours. I had offered to bring in a doula to take my place, but A chose not to have one. This was my first time having to leave a birth in the middle of labor and it was very emotional for me! I hugged A and told her to keep in touch with me and I would continue to support her from afar the best I could. When contractions came, they came hard. At 9am, A had an epidural and was 8-9cm! She began progressing quickly from there. With two pushes, A brought her sweet girl earth side at 1121 am, weighing in at 7lbs, 9ozs and 21in long. I was told by my back up that A had the most perfect expression as sweet Hannah was brought to her chest. Despite the sorrow of not being able to birth this sweet baby at home, I am grateful for a beautiful back up who allowed A to deliver vaginally after 40 hours of her water being broken.
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