R and S started care with me in the first trimester of their first pregnancy. I had the privilege of being S’s preceptor, and it was such an honor when she told me she wanted me to be her midwife for this journey.
S’s pregnancy progressed with some hurdles along the way, unfortunately. At 33.0 weeks, we had an unexpected gap in appointments. S talked with R, and we decided to do her appointment during the open spot in the schedule. We soon discovered that S’s blood pressure was rising, she was holding on to a great deal of fluid as could be seen by her weight, and the decision was made to do some lab work and put S on modified bed rest. No more clinic, no more births. We talked about immediately starting an anti inflammatory diet, increasing supplements to help, and a couple other natural modalities.
Things maintained and lab work looked great. A couple of weeks passed, and S sent me a text with an elevated home reading. It was a weekend, so she came by to see me and went into the lab for labs.
S saw my CNM friend for an appointment in the event that a hospital birth would be needed. The appointment went well, and since we were two days away from being safe for a home birth, we were hopeful we could get labor going and not have to worry about further issues with blood pressure, and the risks that has for pregnancy.
S came over the morning of August 10 for a full labor encouragement. She was 3cm dilated, 70% effaced, and baby at a -2 station. She was feeling some contractions and cramping anyway, so we were hopeful a membrane sweep and herbs would do the trick. Baby was LOA at this point, which is important to note as we work through his journey earth side! I sent S and R out to go for a walk, and we made plans for them to return that evening for a follow up sweep if not in labor.
S and R came back that evening for a follow up sweep and herbs. There was no cervical change, but S was experiencing mild contractions every 4 minutes, lasting 30 seconds. I sent S with a 24 hour urine jug to start again the next day in the event labor did not begin, and made plans to see each other in 36 hours for blood work and another membrane sweep.
The next morning, August 11th, S texted me at 4am that she woke to her water breaking. We thought that we would see this little guy sometime in the next 24 hours, but boy did he have other plans in store!
I was suppose to do a couple home visits after church, but with the way things were going, I decided to go do the home visits in place of church so that I was not far away when S needed me.
Once I finished the home visits, I stopped by to check in on S. It was about 130pm when I arrived to check in. S was experiencing uncomfortable contractions every 4 minutes, lasting 45 seconds long. All vitals were fantastic. In fact, S’s blood pressure was the best it had been in weeks during labor, which was super interesting! I did an exam, and found her to be 4cm dilated, 100% effaced, and baby at a -1 station. He was now ROT. I sent our fantastic chiro, Dr Nora, a text about coming to adjust S to see if fixing baby’s position would get things more active. I headed home, so that S and R could nap and work with their doula, with the plan I would try to meet back when Dr Nora would arrive.
I arrived back that evening around 8pm, when Dr Nora came to adjust S. What a blessing to have such a lovely chiropractor to make after hours calls like this! S’s contractions were coming every 4 minutes, lasting 60 seconds in length. S ate some soup after Dr Nora left. Once she was ready, I did an exam. Contractions were more intense now, and we were happy to find that S was now 5cm dilated, 100% effaced, and baby at a -1 station. His little head was better applied to the cervix now, but I was feeling some caput. Baby was now in an LOT position.
We entered the night of work! S did some slow dancing with R, gently working through the work of contractions. Her doula, J, recommended a few things to increase the strength of contractions which S decided to try. The contractions definitely picked up in intensity. At 1015pm, contractions were coming every 3 minutes, lasting 60 seconds in length. S was feeling nauseous with the contractions, which we felt was an excellent sign. She was alternating laboring on the toilet, standing. She was being in tune with what her body needed in the moment.
S decided to lay down on her side at 1030pm to see if she could get some rest in between contractions. She got some rest, but J and I noticed her contractions spaced to every 10 minutes while she was resting. J went in and encouraged her to get up around midnight to try some active positions again.
S was ready to meet her baby, and talked to use about drinking castor oil. She had already done various herbs, oils, and homeopathy, and wanted to try something different. After reviewing risks and benefits, S decided to try it mixed with orange juice, and chugged it around midnight.
S decided to labor on the toilet, and then was ready to work. J did lift an tucks with S for ten contractions to try to help rotation and make labor more active. Contractions were 5-7 minutes, lasting 60 seconds after the lift and tucks.
S was tired, and decided she should get some rest, and J and I encouraged a good nap. S layed down at 130am, and resting between the waves until 4am.
S agreed to a cervical check, and I found there had been no cervical change. There was a lot more caput noted on baby’s head, and I kid you not, baby was now ROP. What was he doing in there? It was very perplexing. This kid was never in the same place twice! I recommended S try open knee chest for 40 minutes to see if it would help with rotation.
S labored on her birth ball after open knee chest, snacking on grapes. As the sun began to slowly rise, the emotions were increasing. The contractions were painful, S was doing all the things. S labored in hands and knees, and then alternated side resting in the bed.
I did an exam at 8am, and was so upset to have to say no change. Baby was now LOP! S was emotional. We discussed a plan, and S wanted to throw everything else possible at it for the next two hours. She drank more castor oil, and got to work. J had a circuit of positions she wanted to try to help rotate baby, and I began dosing with homeopathy to help rotate the posterior little guy. S was incredibly strong, and such a trooper!!
10am came, and I had to give the news that the cervix was the same, and their was a tremendous amount of caput now on the head. My recommendation was to transport. Since S’s water had been broken over 24 hours, transfer options were so limited on where we could go and get pitocin and an epidural. I had been in touch with my CNM friend, and we moved forward transporting to her. However, she soon found out her back up was not available, and the on call would demand a cesarean. We were back at square one. After looking at options, J had a connection at Texas Children’s, and we opted to transport there.
S was in her l&d room at 1230pm. Her exam in triage was the same as home. Her epidural was administered at 1pm, which was a blessing to get some relief from the painful contractions she had been experiencing for over 24 hours.
One of the blessing moments was that the two male residents that came to ask admit questions around 2pm had both experienced home births with their wives. They were very kind, compassionate, and understanding that this is not where S wanted to be, and hoped the experience could still be honored and nice for her.
S was checked at 230pm while they placed an IUPC and catheter. She was 5cm, 90%, and baby at a -2. S was able to get some rest. J stepped out to her home which was very close for a shower and mini nap while I was there.
As the evening progressed, the scare tactics from the on call OB increased. It was a very unprofessional event that went on over a period of time, with the doctor trying to scare her into consenting to a cesarean when it was not warranted.
At 630pm, S was exhausted and feeling conflicted. She did not want to put her baby in danger, but also did not want an unnecessary cesarean. S decided she wanted me to sneak an exam so she knew honestly if she had made any progress.
First, it is so weird doing an exam with so many wires. It really messed with my head at first! I felt all the way around, and then looked at S and said that I was fairly certain she was complete. She felt like 10cm, 100% effaced, and baby at a 0/+1 position.
S was so encouraged. Shift change was happening at 7pm, and she was going to ask the new OB to do an exam, and hopefully start pushing.
The on call OB was an angel. She was so soft spoken, and so encouraging. She did an exam about 8pm, and S started to push shortly after.
S pushed with so much power. You never would have known she had an epidural or that it was her first baby. She pushed with everything within her, and when the nurse or doctor would do an exam while pushing, you could see his head emerging under the pubic bone. The vagina spot light was brought down an hour into pushing, and we were all so happy that this was finally happening!!
S continued to push and push. Around 10pm, she found the strength to move into hands and knees to push. She pushed and pushed some more.
The OB came in at 1120pm, assessed the pushing, and had a heart to heart with S. She had been pushing with power for over three hours. The OB told her that her recommendation was a cesarean as the baby was not continuing to descend with pushing. S cried, saying “I will push better.” We all could not tell her enough how good, powerful, and effective her pushes were.
It was very emotional. S was not just my client, she was my apprentice, and she was my friend. This is emotional to walk with anyone, but we both cried over the broken journey and the gratitude that after 44 hours, she was finally going to meet her sweet baby.
Sweet Emre was born earth side August 13th, 2019 at 1230am, weighing in 6lbs 14ozs, 19.75 in long. Her sweet reward was here.
It was found that Emre had a super short cord, and we guess that he turned so much trying to accommodate the space he had with the short cord, but did not have the length in his cord to help with the further descent needed for a vaginal delivery.
S was a powerhouse of strength. The journey she was given was hard and not as planned. I am so honored I got to be with her to support her through the hard journey.