C and A had started care with me in the first trimester of their first pregnancy. She had a very easy pregnancy and did well with preparing for her first birth by taking a childbirth class and hiring a doula. 6 days past her expected due date I received a text from A around 2am saying C was hurting really bad and contractions were coming every 3 minutes lasting over a minute. I arrived at 245am and found C sitting on her birth ball in her dimly lit room, her doula at her side providing her counter pressure during contractions. Contractions were definitely close, long and strong. At 315am, I did our first ever cervical exam. I found C to be 1cm dilated, 100% effaced and baby at a 0 station. Her cervix was tight and had scaring on it. I talked to her about this and the need to massage it out. C agreed and allowed me to “massage” (very deceiving, as it hurts badly) on her cervix. She responded well to the massaging, and opened up to 4cm. Over the next hour C alternated between walking around her house and getting on her hands and knees, leaning over her couch. She liked having hot water bottles on her pubic bone and heat on her back. We all kept the water bottles and rice socks hot for her through out the day. I put some oils in her diffuser as she requested in her birth plan to help the environment. A little after four I talked to C about trying to do three sets of captain morgan with slutty circles (got to love the name!) to help baby move his position around. After she alternated between sitting and kneeling over her couch (that was a very common position for her) as I worked on getting the birth pool ready for her. At 5am the pool was finally ready and C wasted no time getting into the warm water. She kneeled in the birth pool for awhile before asking A to get into the pool. I began offering her rescue remedy to see if it would help take the edge off from the intensity of the contractions, which seemed to help some. As 6am drew near, C said she was feeling some pressure at the peaks of the contractions. She decided to get out of the pool and kneel on her couch for a few contractions. C was talking in between contractions that she was feeling so tired, understandably so! We talked about trying the bed where she could lay and try to rest in between contractions. As 7 drew near, C and A got into the bed and C alternated between doing left side and right side lying with lots of pillows to give baby room to come on down. C and A rested until a little after 8. I talked with C how it had been almost 5 hours since our last exam and we should consider doing another one to see where we are at and check on the scaring. C was 5-6cm, 100% effaced and baby at a +1. The cervix was posterior and I tried to bring it forward while massaging on the cervix. Baby appeared to be in the left occiput anterior position. As I began the check, C’s membranes ruptured on me and we noted clear fluid on the chux. I apologized profusely as I felt so awful that it broke while I was checking her! C tried semi reclining in the bed for a few contractions before moving back to the living room and kneeling on her couch. Contractions were more intense with the membranes ruptured, coming every 2-3 minutes, lasting 75+ seconds long. R, my soon to be apprentice, and I discussed what I felt during C’s exam. I talked that I felt we needed to do lift and tuck for a few contractions and was still trying to ponder what else as it felt like C’s ischial spines were prominent and concave. Right before 10am, C got into the birth pool and R massaged on the spines. I talked to C about how I felt about the lift and tuck, and that it would be uncomfortable but it could be effective. A few minutes after 10, C agreed and stood up as her doula began helping her do lift and tuck through a few contractions. After doing the lift and tuck for a few contractions, C said she was feeling more pressure. She sat on the toilet for a few contractions, then moved to the couch to kneel. Her doula began alternating doing a couple more lift and tucks with the booty shake using the rebozo. C labored backwards on the toilet for a few contractions before moving back to the birth pool. Contractions appeared to be very intense, and C was struggling through them. We surrounded her with words of encouragement and I gave her a dose of Rescue Remedy. As 11am drew near, C asked me to pray so I put my hand on her back and prayed over her for strength and endurance and that her sweet baby would be born soon. R read her scripture affirmations and reminded her of all she wanted in this birth. Around 1120am, C got out of the birth pool and moved back to kneeling on the couch with hot water bottles. She said she got the most relief from that position. I gave her some more rescue remedy to help take the edge off the very strong contractions that were now coming with very little breaks in between. At 1150am, C tried laying on her left side on her bed, but felt it was harder to breathe. After talking we decided we should do another exam. I sadly had to give the news that there was no cervical change, but not the cervix was swelling and baby had a lot of molding on his head. C was understandably emotional from the exam. I talked her through her options. Nothing was wrong with her or the baby and if she wanted to do this at home longer we could. I had a position in mind that we could try that was either going to do magic or nothing and would be a big deciding factor. We also thoroughly discussed the hospital and transporting and what that would look like. C was unsure so I requested she get in knee chest position while I answered her questions and while her and A had a few moments to talk and figure out what they want to do. Knee chest is often a wonderful position for swollen cervices! After 7 minutes, C sat up and said she couldn’t do it anymore. We gave her and A space to talk and at 1250, C decided she would like to transport. We started gathering supplies and getting things ready for a transport to an area hospital. I called ahead and gave a report to the charge nurse. At 130pm, C and A were on the way to the hospital. C and A got into triage and were told she was 4cm dilated, 80% effaced and baby at a 0 station and the hospitalist was recommending a cesarean. After talking over the phone with me as they would not let me in triage, C and A stuck to their guns to desiring a continued trial of labor with an epidural and pitocin. The doctor, who C has called Dr. Cesarean, wasn’t overly pleased with this and insisted on all internal monitors and informed them that their baby was very big and she would refuse to do an assisted vaginal birth with forceps or vacuum. Finally at 330pm, C got her epidural. Her doula and I were allowed back in time to hear Dr. C talking about how the baby was going to have a shoulder dystocia and major nerve damage because of it since he is so large. C finally got some much needed rest. Her doula provided her with an eye mask to help shut everything out and she slept. The nurse would come in occasionally and give me some information so I knew what was going on before it happened. The baby was having some variables in his heart rate so the nurse, doula and I rotated her from side to side as we saw the variables becoming more prominent. I asked the nurse about an amnioinfusion. She asked the doctor, but Dr. C refused. The pitocin was soon started a little after 5 once baby looked better on the monitors. C got some good rest meanwhile. At 745pm, Dr. C walked in to do an exam. With a look of shock, she said “I am really surprised but you are complete.” I asked what the baby’s station was and she said +2. A few minutes later, C began to push. Unfortunately her epidural was so strong that she felt nothing, not even pressure to push. We coached C when a contraction was coming on the monitor and rallied around her as she pushed. Within 3-4 pushes, we could see part of the baby’s head right inside the vagina. During pushing, C alternated between holding behind her legs, doing tug of war with me with the rebozo, and pulling on the handle bars. Soon the baby’s head was staying at a +3. She was doing amazing!! Then Dr. C came back into the room. After having some ugly things to say about the pushing, the doctor began threatening her with a cesarean because the baby was having some deep decels after pushing and taking awhile to return to baseline. I was quite furious inside watching this because Dr. C could have chosen to use forceps/vacuum at any point to get the baby out faster since her was having decels. After the next push, Dr. C told her only a couple more tries and she was going back to the OR. I couldn’t believe it. The head was right there, with a clementine sized amount hanging on the perineum in between. C’s doula asked the nurse which thing C did caused her to push the most effective and the nurse said when C grabbed behind her own legs. C grabbed behind her legs and began bearing down. I got very aggressive in my tone in helping coach her to get the baby out as I knew we didn’t have much time. With that contraction, the head began to appear more on the perineum, and the next the head began to crown. Dr. C, who was not ready for delivery, began yelling at her to stop pushing. After a couple minutes, the doctor was ready and C birthed the head, followed quickly by the rest of the body. I was so incredibly impressed with C and A sticking to their guns through the grueling time at the hospital. It was a fight, but C fought to get her birth her way and I am so amazed and impressed with her strength and her gumption through it all. Welcome to the world Huntelaar, born earthside on November 5, 2015 at 8:20pm, weighing in at 8.0#, 20.5 inches long. So blessed to have been part of your birthing day and supporting your awesome mom and dad.
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