Micayla 1 M and C started care with me at the start of the second trimester of their first pregnancy.  M’s mom had had home births and when M found out she was pregnant, it was only natural she followed that route.  M and C soon started childbirth classes and found a doula, and were well prepared for their labor journey. Soon M’s due date came and went.  As each day passed, M became more frustrated that her baby wasn’t coming.  9 days past her due date, M text me that she thought her water broke right around midnight.  I encouraged her to sleep and to come see me at 9am that morning. M and C came to see me.  M was having some mild contractions and was continuing to leak through out the night.  However, when I assessed her, everything came back negative for rupture of membranes.  The amnioswab was negative, and although I felt no bag there was no fluid on the chux pad after the exam.  M was 3cm dilated, 60% effaced and baby was at a -1 station.  I encouraged M to go for a walk, eat lunch and come back and see me later that afternoon. Close to 2pm, M came back to the office and said her leaking was heavier.  The amnioswab was positive this time.  Her cervix was 4cm, 70% effaced and I could palpate a forebag.  After talking over risks and benefits with M and C, they decided they would like me to break the forebag.  I broker her fore bag and talked to her about going for a good walk. Within an hour or so, contractions came on, much stronger than she had felt and seemed to be coming every 7 minutes. As evening neared, contractions became stronger and closer.  M called her doula over.  At 7pm, I talked to M through a few contractions.  They seemed to be coming every 3 minutes, lasting a minute long. I arrived at 8:45pm, and found M laboring standing beside her couch, leaning during contractions as her doula provided counter pressure.  Contractions were coming every 2-3 minutes, lasting 80-90 seconds. A little after 9pm, we did an exam.  M was 6cm dilated, 70% effaced and baby at a -1 station.  The baby had been consistently LOA through appointments, but baby was clearly rotated in a LOP position. M did a set of the Captain Morgan position to help rotate baby’s head, then moved to laying in her bed on her left side.  When we tried rotating her on her right, she spontaneously threw up.  Every time she tried to lay on her right side, she would vomit. Micayla 3 Half past ten, M got out of the bed and did another set of three of Captain  Morgan position on each side, followed by C holding the rebozo up to do a lift and tuck of M’s belly. Over the next couple hours, M continued to alternate positions around.  She tried hands and knees, standing in the shower, and then doing sets of 10 lift and tucks with the rebozo to help baby rotate.At 1am, M moved back to the bed to lay on her left side to get some rest. At 2am, I did another check.  M was now 7cm, 90% effaced and baby at a 0 station.  Caput was on the head, and baby had rotated into an LOT position.  We were happy with the progress! Contractions were coming about every 3.5 minutes apart, lasing 90 seconds.  M moved to sitting on the birth ball, C helping her do lift and tucks of her belly with the rebozo.  Then she instinctually moved back to standing, leaning against the wall, her doula providing counter pressure during contractions. Micayla 4 During the 3am hour, M decided to lay on her sides again in the bed, to try to get some rest.  Contractions seemed to slow over the next couple of hours, coming every 4-4.5 minutes. At 4am, M got up and started moving around the house again.  She tried hands and knees and sitting on the ball.  She was ready for the birth pool.  We finished warming it up, and at 5am M got into the birth pool. M began alternating between semi reclining and hands and knees instinctually as she labored.  At the peak of some contractions, M said she could feel a small urge to bear down. As 6am neared, contractions were coming very infrequently, every 6-7 minutes apart.  M was resting in the pool.  At 630, I suggested she get out since labor was stalling. As 7am neared, we did another exam and found M to have no cervical change, and baby felt back into the LOP position.  I talked with M and C about options and choices to consider since we were looking at minimal change since 9pm, and being ruptured for 31 hours.  After talking, M and C decided they would like to transport to the hospital to continue their labor. There was a bit of hoopla in transporting as my back up’s hospital had no available beds.  M and C decided they would transport to another hospital and we soon got loaded up and moved our birth location. At 940am, M and C arrived at the hospital.  M was in triage for a couple hours. before moving into a room.  M was 6/90/-1 at the hospital. At noon, contractions were every 6 minutes, 60 seconds long.  Around this point, pitocin was started and anesthesia made their rounds to discuss an epidural and go over any questions M had.  The anesthesiologist asked M, “How are you feeling?”  She looked at him like he was crazy and replied, “Ummm pregnant?”  She still had her sense of humor! Immediately, her contractions picked up and became stronger and closer.  Just a little bit of pit was all she needed to get things to pick up again.  Soon, contractions were coming every 2.5 minutes, lasting a minute long.  M was sitting up in the bed, C and I gently helping her moan through surges.  C was hilarious as he spouted off funny words of encouragement.  My favorite being,”I thought your last name was Warrior Princess, Xena, the way you handle those contractions.” Close to 1pm, M decided she would try a dose of fentanyl in her IV to help her manage the contractions.  The contractions kept coming closer and stronger.  A little after 2pm, M asked to be checked as her contractions were harder to handle.  She had made no change.  Her contractions were finally at the level they should be at.  M decided she would like to get an epidural.  At 215pm, C and I stepped out while M got the epidural. We walked back into the room at 2:50pm to the nurse doing a cervical check.  M was feeling lots of pressure.  In a matter of minutes. M was now 10cm, 100% effaced and baby at a +1 station. M started pushing at 3pm in a semi reclining position.  It wasn’t long before we could see the head sitting on the perineum.  The epidural hadn’t taken affect yet, and M could feel the pressure of the head on the perineum. In another comical moment, M grabbed for the bar on the bed and missed and grabbed the nurses boob.  M laughed and said, “I am so sorry.  I just grabbed your boob.”  The nurse responded with witty comment, and we all laughed. Soon the head was crowning, followed by the sweet baby at 330pm. Micayla 2 Welcome to the world Khaleesi, born earth side on May 7, 2015, weighing in at 8.0#, 19 5/8″.  Your mama worked so long and hard to bring you earth side.  <3