E transferred care to me in the third trimester of her first pregnancy. Her OB had several red flag conversations with her, the last was that she wanted E to push flat on her back due to the risk of shoulder dystocia. She wanted to be prepared to move into the McRobert’s Maneuver for if shoulder dystocia would happen. E decided to interview me and transferred care soon after. At her 39 week appointment, E asked for a cervical exam. It was a perfect lesson in how cervical checks tell us nothing in regards to how soon or long it will be for mom to go into labor. We did a check and found her cervix to be closed, thick and baby to be high in the pelvis. Her cervix was posterior, but soft. I palpated her abdomen and felt like baby had made a large amount of growth in the previous week and documented baby to have an estimated weight of 8.5#. Later that night, E text me about some cramping she was feeling. We talked about drinking water, taking a bath and taking benadryl to quiet her uterus and allow her to get some rest. E agreed and tried to rest. Around 3am contractions came on in a regular pattern, about every 2-10 minutes, with bloody show. E agreed to try a shower and drinking fluids. At 6:30, things were still consistent and E decided she would like to call her doula to help her through the contractions. I kept in touch and told E I would stop by around 11 to check on her and set up the birth pool if she doesn’t need me sooner. I arrive a little after 11 and find E sitting at her kitchen table with her doula, eating some chicken and pasta. I sit with them and chat, observing for signs that E is contracting and how she is coping with the contractions. Through the thirty minutes sitting there, I out right only observed two contractions. E commented about every 5 minutes that she was having one, but she would carry on with eating and chatting through the contractions. My first assumption was that we were still in the latent phase of labor and I would probably set things up and head home for a few hours until labor picked up. When she was done eating, we went to E’s bed room to do vitals and a cervical check. Her vitals were perfect, but the cervical check was shocking. I was surprised to find E to be 5cm dilated, 60% effaced and baby still on the high side at a -2 station. Her cervix was still posterior, but she had made amazing change in 22 hours since she had been at my office for her weekly appointment. E went outside with her doula to take a walk while I went to work setting up the birth pool and filling it so it would be ready for E when she wanted to immerse in the pool of warm water. I called my apprentice and told her to come quickly as we did not know how long or short the rest of the labor journey would be. After walking, E came inside and ate a snack and hydrated while sitting on her birth ball and watching a movie with her husband. Occasionally she would make a face to indicate she was having contractions. She would mention that they were feeling hard, but her face was very hard to read. As 2pm neared, E decided she would like to get into the birth pool. She relaxed into the water and surrendered to the labor progress. Her eyes were closed, her body was limp and relaxed and she focused and rested through each contraction and the break that followed. One point when I snuck in to listen to the baby, E looked at me and said she felt like it would not be much longer until it was time to push. As 4pm neared, we decided to do another cervical check while in the pool and see what progress had been made. E was now 7cm dilated, 70% effaced and baby was a little lower at a -1 station. The baby’s head was not well applied to the still posterior cervix, so I encouraged E to change up her position in the birth pool. I encouraged her to try squatting, hands and knees and the “captain morgan” to help baby’s head wiggle and become better applied. A short while later, E got out of the pool and walked around the house. A little after 5pm, we did a check on the bed so I could feel baby’s position better. E was still 7/70/-1, and I could feel that baby’s head was acynclitic. I encouraged her to go outside and curb walk (dreaded words according to some of my patients!) and see if that would jiggle baby’s head and help apply it better to the cervix. I drained some of the water from the birth pool and added hot water so it would be ready for her when she was ready to get back in. E came back inside and hydrated and ate another snack while sitting on the ball. It was obvious the contraction pattern was shifting. Contractions were coming every 3 minutes, lasting 90 seconds. A little after 6, E got back into the birth pool. The pool was very calming for her. E would sleep well between contractions and go limp as she rode the wave of each contraction that came. As 7pm neared, E stated she was feeling some pressure. E continued to state that the pressure was building. A little after 8 she decided to go sit on the toilet for a couple of contractions, then came to the bed for a cervical check. She was now 8cm dilated, 80% effaced and baby was much better engaged and positioned at a 0 station. E sat on her birth ball and walked around the house, sipping on apple juice and water. E stated she was getting tired. Labor, indeed, is very hard work! Ten until ten, E requested a cervical check to see if she had made further change. She was waivering on if she wanted me to break her bag of water. There was no further change, but her cervix was very stretchy. The nausea that comes in transition hit E, and she went running to the bathroom. E decided she wanted me to break her bag of water and see if it would speed up the process. A little after ten, the water was broken. Clear fluid was noted and the baby sounded beautiful through the procedure. E’s cervix completely effaced with water breaking, still staying at 8cm dilated. E got back into the birth pool that we had drained and added fresh, hot water to make it more comfortable. E got in and melted into the birth pool. Transition was in full force, with the nausea and vomiting, temperature shifts and the hard contractions that the body needs to dilate the rest of the cervix. As 11pm drew near, E began to moan quietly with each contraction. One of my most memorable parts of labor with E was as a new contraction was beginning, E would sit up and say, “Oh, dear. Oh, dear. Oh, dear.” over and over. She reminded me of Chummy from Call the Midwife at this point in labor. It was sweet. A little before midnight, E stated she really needed to push. I checked her quickly in the pool and found her with a thick anterior lip of cervix, 100% effaced and baby at a +1 station. I talked with E about me holding the lip back to reduce it or her getting in a forward leaning position and blowing through a few contractions. E leaned over the tub and blew through a few contractions. Her strength amazed me. Never once did she say she could not do it. Never once did she ask to go to the hospital. She pulled within herself for the strength to get through the labor process. A few contractions later, we found the lip to be much thinner and very floppy. I encouraged E to lean on her right side to help reduce that last bit of cervix. She did that for a few contractions then moved to the toilet for a few contractions. At quarter to 2am, I checked the lip on the bed and found it paper thin and floppy. E requested that I do not hold it back. I told her I thought she could push through it if the urge to push was strong. E got beside her bed and squatted while pushing for a few contractions. She moved into the bed and pushed in hands and knees for two contractions and then got on her left side so she could rest in between. Thirty minutes from the last check I checked again and found E to be completely dilated and effaced, baby at a +2 station. And E pushed. And Pushed. She would rest between contractions, sipping on lemonade and water to stay hydrated. We rotated the clock through positions, each one moving baby in a different way. She moved from her left side to semi- reclining, pulling back on her knees. Then to pushing on her right side. 3:30am she decided to get off the bed and stand beside her bed for a few contractions.She moved back into hands and knees position, and then back into the left side lying position. An hour later, we could see the head emerging slowly from the perineum. E could feel his head and felt encouraged that the work was almost done. She would be holding her baby very soon. Watching the slow crowning process, I prepared the birth team that we may need to rotate mom into hands and knees after the head is born to help the shoulders let go. At 4:50, the baby’s head was fully crowning. One push brought the head and the next brought the entire body at 4:54am. Sweet, baby John was birthed earth side and placed on E’s abdomen. The cord was very short. We allowed it to pulsate for five minutes, then clamped and cut the cord so that E could better hold the baby. Welcome to the world sweet baby John, born on March 27, 2014 at 4:54am, weighing in at an amazing 9.15#, 22 inches long (head 14.5 inches and chest 15.25 inches!). E’s strength is empowering. She was amazing through her challenging labor journey, persevering through the journey and awaiting the beautiful gift at the end. Honored to have been invited to be part of E’s labor journey.
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