K and N began care with me at 8 weeks along in their first pregnancy.  K was glowing from excitement of being pregnant and getting to plan her first home birth.  She had been planning a home birth for a few years, and her mother in law had home births in the past. K’s pregnancy progressed beautifully with no issues, until she came in for her 38.1 week appointment.  Her weight was up 6 pounds and her blood pressure was elevated.  K was well otherwise, so we made a plan for her to see me in three days and make a plan from there on what we needed to do. At 38.4, K was back in my office, up another 3 pounds and blood pressure still elevated.  K agreed with my plan for a membrane sweep.  She was 2-3cm, 70% effaced, -1 station.  I swept her membranes and talked to her about seeing the accuchiro in our area to help with labor encouragement. K came back next morning for a membrane sweep.  The accuchiro had done wonders.  In 24 hours, her weight was down 3 pounds and her blood pressure was a little lower. Cervical check was 4/70/-1. K called me later that night saying contractions were coming every 5 minutes and much stronger.  I stopped by to check in on her.  Vitals were good and cervical check was the same.  I encouraged her to take a walk and then rest and encouraged her that things were moving at the perfect pace. Later that night, things picked up more and K called her doula over.  She labored for a few hours, and then everything stopped.  She sent her doula home, and later that day at 38.6 weeks, stopped by to see me for a vitals check.  We made a mutual decision to do no labor encouraging today since her blood pressure was hanging at the same point as the day before.  K had an appointment to see the accuchiro the next morning, and would follow up to see me after. At 39.0 weeks, K went to her accuchiro appointment and had eight contractions on his table in 40 minutes.  Contractions were visualized every 5-6 minutes, lasting 45-50 seconds while K was at my house.  I swept her membranes and told them to keep in touch.  I expected to be seeing them soon! Around 6pm that night, K’s doula asked me to come since contractions were coming every 3 minutes, lasting a minute.  I arrived and scared things away.  Vitals were great, and cervical check found K to be 5cm dilated, 80% effaced and -1 station.  Since I lived close to K and I apparently was spacing her contractions, I told her I would go home, but would come right back as soon as she needed me, even if it was an hour later. An hour later, K’s doula text and asked me to come back.  I arrived back at 9pm, and did vitals soon after.  All was well and a cervical check found K to be 6cm, 80% and baby at a 0 station.  Contractions were coming every 3 minutes, lasting over a minute long. K was alternating positions around her house.  From hands and knees, to laying on her side, to walking an bouncing on her ball.  She was feeling very nauseated.  We got her pool filled so it would be ready for her when she was ready to get in. Quarter to 10 that evening, K got into the birthing pool and labored in hands and knees position.  She commented on how lovely the water felt. A little after 11pm, K said she was feeling lots of pressure with contractions, and soon she felt like she needed to push.  I did a cervical check while she was in the pool.  It was a bit difficult to reach around, but told K she felt to be 7cm dilated, 80% effaced, 0 station.  I instructed K to try a different position so she could resist the urge to push. K snacked on a popsicle and continued her labor journey.  Her doula pulled out peppermint essential oil to help with the nausea. Around 1230am, K got out of the pool to use the toilet and have a couple of those beloved toilet contractions.  She moved to the bed for a check when she was ready.  I confirmed that was 7/80/0.  K was feeling discouraged that there was no change.  I encouraged her that she was doing so well, and we always had the option to talk about breaking water if that became needed.  She was making very appropriate change. K got back in the pool, alternating hands and knees with semi reclining.  Contractions had spaced some, and were now coming every 5 minutes, lasting 60 seconds.  I encouraged K to rest while she could, since she was feeling tired. At 330am, K asked to be checked and wanted her water to be broken.  She was 7cm, 100% effaced and baby at a 0 station.  I broke her water, and K’s determination was back.  She ran up and down her stairs and walked fast laps around her house.  She was going to work this baby out. A little after 4, K got back into the birth pool and decided she would like to sit on the birth stool while in the pool.  Contractions were stronger it appeared, and K moaned through each surge.  K asked to be check at 445, and was about the same.  Baby had moved a little lower, and was at a +1 station. K decided to get out of the birth pool and walk some more.  Contractions were coming more frequently, every 3-4 minutes. Quarter after five, K got back into the birth pool, laboring in a semi reclining position.  Contractions were coming every 5 minutes, a little over a minute long. As 6 am neared, it was obvious that K was very tired.  Contractions seemed to be spacing.  K said she did not know how much longer she could do this.  After a bit, I talked with K about a plan.  She agreed to it.  We discussed her moving to the bed and letting me try to hold her cervix while she pushed.  We alternated her position around the clock, starting on one side, then hands and knees, laying on the other side and then semi reclining.  K got to 9.5cm and a +2 station as long as I helped hold her cervix.  It is not pleasant to have your cervix held back, and K asked for breaks.  Unfortunately, her cervix would go back to that stubborn 7cm and baby would move back up. I felt a good amount of caput on the baby’s head, which I imagined was from the baby’s acynclitic position earlier in labor.  K asked to labor in the shower.  Her contractions were spaced out to every 5-7 minutes. K got out of the shower and went to rest in her bed.  Contractions were every 10 minutes now, and it was obvious that not only K was exhausted, but so was her uterus.  K for the first time, requested to transport.  Not one person blamed her.  It was time to move the labor journey to the hospital for some help.  I did a final set of vitals, and let K know that she was 7cm, 80% effaced and baby at a 0 station at this point. K arrived at the hospital a little after 11am.  Contractions were very erratic, sometimes coming close, sometimes far apart.  Around 2pm, K’s epidural was placed, and was told she was 6cm, 70% effaced, 0 station. K got some rest in over the next few hours.  The nurses started pitocin and increased it every 15-30 minutes.  However, a contraction pattern never really developed.  Sometimes a few would come every 2 minutes apart, and then it would space to 7 minutes.  K’s poor uterus was tired. At 7:15pm, K began running a fever.  Her contraction pattern was abnormal, and she hadn’t made any cervical change.  After talking to N, K decided to consent to a cesarean section. K was one amazingly tough mama.  So honored to have gotten to serve a mama whose strength is so inspiring and who stayed focus on the labor journey, no matter what curve balls were thrown her way. Welcome to the world Skylar, born on September 9, 2014 at 9:24pm, weighing in at 7.10#, 21.75″ long.  He is so loved and cherished by his sweet parents.