Wednesday, September 11, 2019

Forward and Backward

 Two and a half years ago I had the privilege of supporting this sweet family during the birth of their first child.  It was a long and difficult birth, and I was excited for her to experience the benefits of a second, shorter birth.  On Monday my client was 3 cm and about 60% effaced, and decided to have her membranes swept at her weekly appointment.  By Tuesday morning she was having contractions, but nothing very consistent or intense.  We kept in touch throughout the day, and contractions seemed to come and go.  As soon as it seemed like things were moving forward, they would take a step back again.

But at 7:00 pm she felt it was time to head down to the birth center and see where she was at.


I arrived at 7:30 and mom was being assessed by the midwife.  We were all thrilled to find that mom was already 7 cm at 7:45.  We chatted a bit, but things began to intensify quickly.  



By 8:30 pm mom was ready to get in the tub.  The water was really hot, but she enjoyed the relief.  She had some nerves and turned on some uplifting, Christian music.  I still remember them introducing me to the music of Lauren Daigle at their last birth!  The lyrics "with heart and with soul, I will always love you" filled the room.
 

As the evening progressed, labor continued to intensify and back off.  We filled the down time with pleasant conversation and our mutual love of all things Disney.  Mom moved her body and rolled her hips, and did many positions to encourage an open pelvis.  I provided counter pressure to help with back pain.
 

By 10:00 pm mom was vocalizing through her contractions and they were closer together.  But progress still didn't seem to be coming.  I reviewed some of the strategies we did during her previous birth, and we did some lunging and position changes in case this birth was going to be a little longer like the last one.
 

At 11:04 pm mom said she was starting to get the urge to push!  The midwife did an exam and felt that the bag of water was probably causing that feeling, and not the baby.  At 11:20 my client chose to have her water broken to try and speed things along.  The opposite happened.  Contractions spaced out and the urge to push was gone.  At this point mom was 9.5 cm with just a little bit of a cervical lip.  The midwife tried to push it out of the way, but it was too uncomfortable.  

At 11:40 baby started having some heart decels, so we got mom out of the tub and found some different positions to make baby happier.  
 


At 12:10 we moved mom to the birth stool to try to encourage descent and bring about the urge to push.  At 1:00 am, we got mom on the bed in hands and knees position, and I did some rebozo sifting.  Her husband leaned in close and said "Thank you for working so hard."


The midwife felt the baby to be a little crooked in the pelvis, so mom did several contractions on each side.  All the moving/rotating did the trick, and suddenly at 1:40 am, the urge to push became very strong and progress came very quickly.  The baby was at plus 2 station, and this time the midwife was able to push away that darn cervical lip that insisted on being present during both labors.  

The head came out smoothly and timely, but the body didn't follow.  One of the shoulders was stuck under mom's pubic bone.  Mom quickly moved from laying on her back, to hands and knees, then back to her back, then back to hands and knees.  I am not certain, but I believe she flipped positions a total of 6 times.  It was intense.  It was stressful.  The midwives worked quickly.

Finally the baby was born.  (I think at 1:56-1:57, I'm not certain.)  She was pretty shell shocked and required some assistance from the midwives.  They encouraged mom and dad to talk to their baby.  Mom looked me in the eyes and asked me if her baby was ok.  And to be honest, I really didn't know if she was or not.  All I could say was "the midwives are taking really good care of her".  

Finally, at 1:59, baby girl let out her first cry, and I think we all breathed an enormous sigh of relief as our eyes filled with tears.


She was quickly placed into her mother's arms.
 

Welcome Juniper!
Born Wednesday, Sept. 11th, 2019
Weighing 8 pounds 9 ounces

Mom and dad were hoping to not have a Sept. 11th baby, but then the midwife pointed out that her birthday is the same forward and backward.
9-11-19 
I guess that won't be possible again for another hundred years or so! 
 

It wasn't the second birth I was hoping for, for this sweet mama who really had to work hard to get her first daughter here.  We did shave off about 12 hours, but this birth was definitely more difficult than we anticipated.  But this mama was so strong.  And those baby cheeks are so sweet!

Tuesday, August 20, 2019

41 Weeks and 6 Days!


Hanging out at 41 weeks, my latest client reluctantly agreed to an induction on Friday evening.  After processing a change in birth plan and coming up with a new plan, she arrived at the hospital to discover that it was too full that evening, and her induction was put off until Monday morning!  

But her baby had different plans.  Her water broke around 10:30 am Sunday morning.  Along with it was meconium, so off to the hospital they went.  When she arrived she was 1 cm dilated and about 70% effaced.  Baby was high and contractions were mild.  Around 2:30 that afternoon, some pitocin was administered to try to get things moving.  But bay didn't love the pitocin and labor wasn't progressing.  So at 2:00 am on Monday, they decided to just turn off the pitocin and try to get some sleep.  (An almost impossible task at the hospital!)

I heard from my client at 6:00 am Monday.  They were about to start the pitocin again and she was worried about coping with pain due to her exhaustion.  My back up doula met her at 8:00 am as I had a morning conflict.  She texted me at 10:00 saying my client was now 4 cm and 90% effaced, and that she was thinking about getting an epidural soon.  I felt bad for missing all the action!  By 11:00 mom was comfortable with an epidural.  I raced to the hospital as fast as I could.  When I got there shortly before noon I was shocked to find out that my client was now 9 cm!  I had missed almost everything!


Mom was in good spirits when I arrived.  We chatted for a while and worked on positioning to help baby descend.  Then mom tried to nap again.  She had a great playlist going with tons of Josh Groban, my fave!

At 2:00 mom was checked and was complete!  We reviewed pushing techniques for breathing and positioning.  And by 3:15 mom was pushing!


Pushing is really exciting at the beginning, but that excitement can quickly wear off when moms discover how difficult it can be and how long it can last.  This mom had the best epidural ever though.  She had so much control over her legs and was able to utilize a ton of different positions.  We did hands and knees, side lying, squatting, semi-reclined, you name it. 


At 5:30 mom was exhausted and her tissues were really starting to swell, and progress was minimal.  So we decided to rest for a while.  She pushed her epidural button and went back to deep breathing.  Mom was also starting to show signs of infection.  Her skin was very warm and she started having uterine pain, so antibiotics were ordered. (Once the water breaks, women are at an increased risk of infection.)

Mom was also hungry and she daydreamed about eating a cheeseburger and chocolate milkshake once her baby was born.

Shortly after 6:00 pm we started pushing again.  This mom was determined and we tried everything.  All the positions and this time we added tug-of-war with a sheet to help her really focus her energy down.  She was so freaking strong.  This yoga master was amazing, yet the baby was still hardly moving.

There were several residents supporting the birth, and I really enjoyed working with them!  They were so easy to talk to and asked me a lot of questions about positions and my take on things.  It was such an awesome collaboration, I wish every birth room could be like that!  There was one point it looked like mom would deliver on her hands and knees and the resident doctor was asking me to tell him about my experiences with that position!  He had never seen a birth that way, but was so open to learning about it and supporting it.  So awesome.

At 7:00 grandma arrived and brought with her encouragement and love.


At 7:30 a new OB came in to evaluate and felt that the baby was still too high to try a forcep or vacuum assist, and felt that a cesarean was the best option at this point.  This news can be so disappointing after hours/days of laboring and pushing, but sometimes it is the only way.  Mom said she was too tired to feel emotional about it.  Dad wasn't.  After his wife was wheeled in the OR, the emotions were strong.  His father in law offered him a religious blessing and blessed him to feel Christ's love, peace, to be strong for his wife, and to feel the love from his heavenly and earthly parents.  A feeling of peace entered the room.

Shortly thereafter though the nurse came into the room crying.  She was so sad to tell the dad that he would not be allowed into the birth.  Mom was not responding well enough to the anesthesia and would have to be put under for the cesarean.  It was a new disappointment to deal with and emotions quickly returned.  

Finally at 9:00 pm, sweet Mae was born.


During the cesarean, the doctors discovered a uterine abnormality that they believe swelled during the labor and prevented the vaginal birth.  It's nice to have answers, but it's even nicer to finally hold your baby!  I'm sure this mama is exhausted with sore muscles all over.  She worked so hard!


Welcome Mae!
Born Monday August 19th, 2019
9:00 pm
Weighing 6 pounds 6 ounces
13 days past her due date
And look at all that hair!

Monday, May 13, 2019

Graduation-Mother's Day-Birthday

 My latest client is a repeat client who had her first baby a little less than 2 years ago.  Her first birth was AMAZING, so I knew this birth would be great, too.  On Thursday she was checked at her appointment and was already 3 cm dilated and 90% effaced.  But she wanted her baby to stay inside for at least a few more days because she was graduating with her Bachelor of Arts Degree on Saturday!

She was able to march at graduation, but felt like she had pushed her body a little too far because the busy day brought on painful, but inconsistent contractions.  She texted me Sunday morning say she had a gut feeling that her baby would be born that night or the next day.  We kept in touch over text throughout the day.  By afternoon, she was having contractions every 10-20 minutes.  Nerves were starting to come as well, as mom remembered how difficult childbirth is!  Mom wondered if she should go in and be checked, even though her contraction pattern wasn't active yet.  

Around 6:30 pm, mom decided to head to the hospital and see if this was real labor or not.  She was checked at 7:00 pm and was 5 cm and 100% effaced, and baby was at a minus 1 station.  I arrived at 7:30 and found mom preparing to get into the tub.  She was definitely nervous and doubting her ability to do this again.  Normal emotions, but no fun.


Once in the tub, mom focused on her breathing and vocalizations.  I turned on relaxing music, and reminded her to blow her contractions away and fully relax in between.  After just a handful of relaxed contractions, mom began to tell us that she felt like something wasn't right, and that she would definitely be getting an epidural.  I encouraged her to have her cervix checked before making a decision like that.  She was talking like a woman in transition, and I wondered if her baby would be born too quickly to get an epidural anyway.  Two contractions later she started grunting and I ran in the hall to alert the nurse.


Within seconds, several nurses appeared with a wheelchair and we quickly got mom into her birthing room at 8:30 pm.  I could tell she was overwhelmed, and we had a quit chat about how it's OK to feel scared right before you give birth.  I reminded her that we were all there to help her.  At 8:40 the midwife confirmed that mom was 10 cm, baby was at plus 2 station, and it was time to have a baby.  The midwife broke her water and...


two minutes later, this little girl slipped into her daddy's hands.
 

It was all so fast, I think it actually took mom a few minutes to process that she had given birth! 
 

Baby girl nursed within 20 minutes of being born, and was so sweet holding onto her  mom's finger.

Welcome Ivy Grace!
Born Sunday, May 12th 2019
Mother's Day
10 days before her due date
Weighing 7 pounds 7 ounces


This little girl is so loved by both her parents.  She was delivered into her dad's hands, and then got to snuggle him skin to skin within the first hour of her life.


I love this photo.  It reminds me of one I took at their first birth when mom watched dad hold their baby for the first time.   So much love.


She may have doubted her ability to have a natural birth, but she totally proved herself wrong!  We are usually much stronger than we give ourselves credit for.  Within 36 hours, this amazing mama graduated college, celebrated Mother's Day, and rocked her natural birth!

Sunday, March 31, 2019

Face Presentation

 My latest client is a repeat client from Oct. 2017.  Her last baby came 9 days late, so we weren't expecting an early delivery this time around.  Once 41 weeks hit, talk of induction was abounding, but this mama did not want to induce.  She scheduled an induction for the very last day possible, and ended up giving birth the day before her time was up!

Her contractions began early Saturday morning, around 2:00 am.  But by sunrise they had stalled out quite a bit.  We kept in touch throughout the day.  She contracted sporadically and lost her mucus plug around 5:00 pm on Saturday.  But by bedtime things were pretty chill, so we both went to bed.  She woke up with contractions every 10-15 minutes at 3:30 am, and by 7:00, it was time to head to the hospital.


I arrived at 8:00 am and found mom laboring in bed with dad offering support and encouragement.  Mom was feeling "shaky and emotional", which is a pretty normal way to feel in labor!  She was 6 cm, and we assumed things would progress really fast like last time. (Last time we arrived at the hospital at 6 cm, and her baby was born 68 minutes later.)


 At 9:00 the OB arrived and mom was now 8 cm, 90% effaced and her baby was at zero station.  There was a bulging bag of water, too.  

We spent the next couple hours changing positions.  I rubbed mom's back during contractions while dad pretended not to have a headache.  (Poor guy suffers from chronic, cluster headaches.  I kept telling him he could take a break, but he wouldn't leave his wife's side.)  After a trip to use the restroom, mom literally crawled across the floor and back into the bed.  Not a glamorous way to get around, but a great way to change positions and encourage good positioning!


At 11:30 we were all a little surprised that things weren't progressing.  I kept wondering what would happen if the water broke.  In an attempt to see if gravity could help us break the water, mom got out of bed and did some leaning and lunging on the edge of the bed, and at 11:40 her water leaked.  It wasn't a gush, but there was definitely something.  But it didn't change anything.

At 12:30 the OB came back in and mom was 9 cm, but there was still a bulging bag of waters.  The OB offered to break the water to see if that would encourage the baby to descend more.  She broke the water and exclaimed that the baby "came down miles", ha!  

Things did intensify a bit, but I was surprised that the urge to push wasn't taking over yet.  Dad and I held each of mom's hands while she moaned almost continuously.  She was totally in the zone.

At 1:10 mom said she wanted to push, so she was checked again and was complete, and baby was almost at +2 station.  I could tell the urge to push was still a little off, but mom worked hard and figured it out! 

Several minutes later we were all surprised to see a little face presenting instead of the crown of the baby's head.  A face presentation is rare, and often requires a cesarean.  But with the skilled technique of the OB and mom's incredible strength, this baby girl was born at 1:36.


Weighing 8 pounds 6 ounces




I was so happy my client was able to have the natural birth she desired and was able to go into labor before she needed to be induced!  So often women feel like they will never go into labor, but they will.  :)  Even if it is 12 days late.

Tuesday, March 5, 2019

44 Hours

 My latest client started texting me Sunday morning saying she was having low back pain, and what felt like menstrual cramps.  We kept in touch throughout the day, and I made sure to get a Sunday nap because I assumed we would be up all night!  She went to the hospital at 7:00 pm, but was sent home with a sleeping pill because she was only dilated 1 cm.  At 3:30 am her husband called saying they had been admitted to the hospital at 4 cm/80% effaced.  


I arrived at 4:3o am and mom was still struggling with back pain.  So we did lots of position changes and I provided back massage during contractions.  At 6:15 an ultrasound confirmed that baby was posterior, so we continued working to get baby to rotate by moving often and utilizing hands and knees positioning.  At 6:40 her husband turned to me and said "I'm so glad you are here!".  :)

At 7:50 mom spent some time in the tub, but her contractions were so spaced out she decided to get out and move around more.  She arrived at the hospital with contractions coming every 4-5 minutes, but now they were every 6-9 minutes.  The nurse mentioned breaking the water or starting some pitocin, but my client wanted to keep working with her naturally progressing labor.  We also discussed the possibility of going home for a while if the cervix wasn't changing.

At 10:20 mom endured 3 cervical exams before the nurse with the longest fingers confirmed that mom was now at 6 cm.  To be honest, I was pretty surprised!  I didn't think we would be making progress with so few contractions.   So the option to go home was gone, but we still needed to speed up contractions.


Mom was motivated and energized.  She walked up and down several flights of stairs, stopping to lunge during her contractions.  Things started to pick up and mom said it was "a good pain".  
 

The entire day mom was all smiles.  She had originally planned on getting an epidural, but found that she could easily cope with her contractions, and that she preferred being able to move and work with her labor. 

At 2:30 pm her OB stopped by to check on things.  Mom was now 7 cm and 90% effaced.  She offered to break mom's water, but mom wanted to let things progress the way they were.  At 3:30 mom decided to get in bed and rest in between contractions, and they spaced out to 10 minutes apart!


Mom got out of bed at 4:15 pm and contractions picked up again.  Her own mother attended the labor and offered lots of physical and emotional support throughout.
 

We hit the hallway again to keep things moving and stopped in the family waiting room to talk to all the expectant grandparents.  Both sets of grandparents came from India for the birth.  I loved learning more about their culture and awesome family values.  I met them all about a week ago and answered many questions about birth in America and the support I would be giving their daughter.  It was such a fun night!

At 5:30 pm mom was now 8 cm, but progress was coming slowly and night was quickly approaching.  We were starting to worry about mom being able to maintain her energy throughout the night, so the decision was made to break the water, which would hopefully speed things up.  Losing the water put extra pressure on the baby and we worked with the nurse to find positions that worked well for both mom and baby. 


At 8:30 pm mom was still 8 cm.  Contractions were getting more painful and closer together, but it was clear that the birth was still hours away.  Mom opted for an epidural and a well deserved nap.  After sleeping for a few hours, mom was at 9 cm, so some pitocin was started to help mom get through the final dilation.  But baby didn't like the pitocin, so it wasn't on for long.  

At 3:30 mom was finally dilated to 10 cm and it was time to push.  I assumed that pushing would take several hours because everything had progressed slowly throughout the entire labor, and because she was a first time mom.  But I was wrong!  

Less than an hour later, this sweet little girl arrived!
 

She had so much thick, dark hair.  So adorable!
 

What a journey!  Approximately 44 hours from the first text to holding her baby!
 

Welcome sweet baby girl!
Born Tuesday, March 5th 2019 at 4:14 am
One day before her due date.
Weighing 6 pounds 2 ounces