A Difficult Induction

My latest client texted me Thursday afternoon letting me know that she was in the hospital being induced!  A combination of labs and high pressure made the induction necessary, even though she was just 37 1/2 weeks.  Her bishop score was about as low as it could be, so the OB prescribed cytotec to ripen the cervix.  Ripening can take a long time, especially with a first time mom with a closed cervix.  So I prepped them for a long road ahead, and was really surprised when they called me about 12 hours later to join them at the hospital!

During the night, contractions had started and her water had broken.  She also had the added bonus of vomiting profusely for a while.  I arrived at 3:30 am and found mom laboring in the tub.  She was vocalizing through her contractions.  She got out of the tub at 4:15 and we tried some different positions to help baby rotate.  Over the next few hours we tried many different positions and techniques for pain management and progress.  At 5:30 am she turned to me and said "it's getting more intense and I'm not loving it."  Totally cracked me up. 

At 6:30 am the nurse went over some options, explaining that the OB would be in soon and would want to check her and probably start pitocin.  At 7:20 the OB arrived and checked my client, and after all that she had been through, she wasn't even quite 1 cm dilated.  Her baby was high in the pelvis and her cervix was 50% effaced. 

We kept walking and leaning and breathing and massaging as the morning continued.  We listened to music, walked the halls, and used the rebozo.  The baby's heart rate was near impossible to find, and my poor client was constantly being poked and prodded as the nurse unsuccessfully searched for a good place to put the monitor on.  Pitocin was started and things were intensifying quickly.  At 10:00 a doctor was called in to do an ultrasound to help locate the heart, but even that was fruitless.  What finally did make the difference was an adhesive monitor. 

Mom was coping through her contractions beautifully and was starting to even have bloody show.  I was feeling so encouraged about her progress!  The heart rate was finally being monitored but mom's back pain continued to sky rocket.  We tried everything to get that baby to rotate! She opted for some nitrous, but it brought back her nausea, so that was a no-go. 

At 11:20 mom asked for her cervix to be checked again.  By this time the cervix had come forward and fully effaced, and baby had descended and engaged in the pelvis, but she was still only dilated 1 cm.  Very discouraging after almost 24 hours of hard work! Mom needed a break, and she got one.  By noon she had an epidural, and we all said "good night".

At 2:15 mom was 5 cm and baby had descended further into the pelvis!  I couldn't believe it!  Things were finally going smoothly.  But it didn't last long.  Shortly before 5:00 pm the baby started to have issues with his heart rate and mom's cervix began to swell.  The decision was made to deliver the baby via cesarean. 

Some tears were shed.  It's an emotional crossroad when a mom has to say goodbye to her birth plan in order to say hello to her baby.  Of course the main goal is to always get to the baby, but a woman's experience and goals are meaningful, too.  Inductions make those goals harder to reach, but sometimes factors beyond our control make inductions necessary.