Friday, September 27, 2013

Cervix of Steel

A week ago, my client was told by her OB that she had a cervix of steel.  Sitting at 40 weeks, her cervix was still totally shut, long, and hard.  You know, just the opposite of what you want it to be.  So she spent the week trying to get things softened, and was able to get herself to a whopping 1 cm.  


So the decision was made to induce labor at 41 weeks.  Mom and dad arrived at the hospital at 7 am Thursday morning, and mom was given cytotec.  She had been having small contractions the previous evening, and thought that there might be progress already.  

Nope, still 1 cm. 

Mom and dad spent the day at the hospital, trying to get things moving while cytotec was administered twice, and the contractions kept coming enough that mom wasn't even given pitocin.  But at 4:30 pm, mom was still only 1 cm.  Her spirits were still good though.

Around 6:00 pm, there was a noticeable change in mom's contractions, and I was called and asked to join them around 7:30.  When I arrived, mom was laboring in the tub.  She was doing great!  I could tell that things were really intensifying, and I figured early labor was well behind us.

But at 9:45, mom was checked and was now only dilated to a 2.  The nurse cheerfully pointed out that mom was TWICE AS FAR as she had been last time, but still, the news was very discouraging.  We then spent time walking the halls and squatting, and mom was a 3 at 11:15.  

Around midnight mom became exhausted, and asked for the epidural.  It kicked in quickly, and we were all able to sleep off and on for about 5 hours.  At 1:40 she was dilated to 4, and her water was broken at 2:30.  I thought for sure we would wake up and find out that mom was complete, but at 6:30 am, she was only 5 cm.  Still, she was progressing!  

Mom was then given some pitocin to try and get her the rest of the way, but dilation still came slowly.  The contractions began to become intense enough that the epidural was only dulling them.  At 9:20 mom was dilated to 6 cm, and was given an intra-uterine pressure catheter to determine the strength of her contractions.  The decision was made to up the pitocin, and hope that things picked up.

I stepped out for lunch at 11:30, and when I returned at noon, mom was bright eyed.  She was now dilated to an 8 1/2!  Now we're getting somewhere!  We figured we were just moments away from pushing.  This far in the game, dilation should happen very quickly.  But 2 hours later, there was no change, and mom's cervix was starting to swell.

Because of the prolonged labor pattern, it was getting safe to assume that baby boy was not in a good position, and may never engage in the pelvis enough to be born vaginally.  Mom was given two options:  1: Go ahead and have a cesarean.  2: Keep waiting it out and see if she ever dilated fully.

This is an extremely hard decision to make.  But ultimately, mom and dad both felt that there was a reason her body wasn't dilating anymore, and they opted for the cesarean.  

During the birth, I was able to chat with all four grandparents in the waiting room.  It was fun to answer their questions, and it gave us something to do while we all anxiously waited to see the new baby!

Welcome Carter!
Born Friday, Sept. 27th, 2013
8 pounds, 11 oz
2:56 pm

I was so impressed by how these parents handled this hard situation, and didn't let it ruin their day.  They are so in love with each other, and so excited to start this new step in life together.  They worked together as a team the entire time, and it was such a privilege to be their doula.

A cervix of steel, and a heart of gold.  

Friday, September 13, 2013

The Long and Short of It....

My latest client had a loooooong first birth.  She labored over the course of several days (yes days), pushed for about 3 hours, and ended up with a cesarean.  Her child was posterior (positioned incorrectly) which makes labor longer, and can ultimately make a vaginal birth unsuccessful (especially in first time moms).  The experience was difficult and disappointing.  I hoped so much that she would be able to have a VBAC.  The days have ticked on and on, and mom was approaching 42 weeks, and had to schedule an induction.  This was not at all what she wanted, but I was still optimistic that things would go well.  Especially because an ultrasound had shown that her baby was in optimal positioning for a vaginal birth. 

The night before the schedule induction she called me at 7 pm with my heads up call.  Considering how long her first labor was, I thought I still had time to do an evening walk.  Shortly before 7:30, her husband called and asked me to come to their house.  So I RAN home, put the baby to bed, and jumped in the car.  During my drive, he called again and told me to meet them at the hospital!

I arrived at 8 pm, and found mom laboring in the tub.  She was already 7 cm!  

Things were moving so much quicker than I had expected (which is wonderful!).  Mom was vocalizing through her contractions, dad was there to hold her hands and offer encouragement, and I provided music and massage.  Mom listened to her instincts the entire time.  Shortly before 9:00 pm I sensed a change in mom's vocalizations.  It sounded almost like she was pushing, so I encouraged her to be checked and she was already complete!  

Then mom hit a wall.  Pushing felt scary, and her previous birth made her worry that this baby wouldn't fit through the birth canal.  It is a common fear for a VBAC.  We talked it through, and mom began really pushing.  It was amazing to see her reach inside and find that inner strength and faith in herself.  

Shortly after the shoulders slipped into the world, the OB instructed mom to reach down and lift her baby onto her chest.  It was such a beautiful moment, and I was thrilled that this woman got to experience such a wonderful birth.  

Born Thursday, September 12th, 2013
10:39 pm
8 pounds 7 oz

The smile says it all.  This birth was so much shorter than her last one, and couldn't have gone any better.

Right away, this little man knew who his mama was, and loved snuggling.

Living proof that sometimes it really does take 42 weeks for mom and baby to be ready.

Dad joined in on the skin-to-skin contact, which I loved!  It's so awesome to see so many dads out there really wanting to be a part of the birth and a great father.

Couldn't be happier for this couple!