Thursday, September 29, 2016

Time To Cut the Cord

A little over two years ago, I attended a pretty scary shoulder dystocia birth.  Everything worked out fine, but those first couple minutes were very nerve-wracking!  So when my client told me she was expecting again, I knew shoulder dystocia would be a big concern this time around.  

After several weeks of having contractions, my client was admitted to the hospital late Tuesday evening, dilated to 5-6 cm.  They called me around 11:40 and I arrived shortly after midnight.  Contractions were coming regularly, and mom was sitting on the birth ball and swaying,  After about an hour, mom climbed into bed to rest... and totally fell asleep!  By 3:00 am, contractions had pretty much stopped and mom was given the choice to sleep or have her water broken.  

Mom decided to continue sleeping and have her water broken in the morning.  So I went home to grab a few hours of sleep, too.  

At 9:30 am, her midwife broke her water.  She was 7 cm, but still not in active labor!  To encourage her contractions to pick up, we went walking outside in the courtyard.

The fall leaves were gorgeous, even though it was about 80 degrees outside!  Mom leaned over during her contractions and swayed her hips while I provided counter pressure.

The midwife came back around noon to discuss what would happen if this baby also had shoulder dystocia.  She recommended a drastic position change.  This information is great to have beforehand, as I have had clients with shoulder dystocia be very confused and alarmed when a team of nurses is suddenly forcing them into a different position.  

By 12:20 contractions were strong, and at 12:40 mom said "I must be in transition because I don't think I can do this!"  But she was doing it and doing it extremely well!  She was so focused and calm, back on the birth ball and listening to music.  Several minutes later I could tell we were close, so I ran out to find the midwife.  At 12:50 mom was 9 1/2 cm and starting to feel the urge to push!

Mom pushed in a modified hands and knees position on the bed.  Once the head was out, our fears were confirmed and it appeared that shoulder dystocia was preventing her baby from fully being delivered.  Quickly, everyone helped mom flip over onto her back.  The shoulders started coming, but something else was holding this baby in.  He was all wrapped up in the cord.  So wrapped up that the midwife clamped and cut the cord right then and there!

In 13 years of attending births, I have NEVER seen the cord cut before the baby is delivered.  But once it was cut, this little cutie slipped into the world at 1:17 pm, Wednesday, September 28th, 2016.

Tipping the scale at 8 pounds 13 ounces, he was a little shell shocked, but not near as bad as his brother had been.  The nurse took care of him while the midwife continued to care for the mom.

We all agreed it wasn't as scary as the last time, but I'm sure it still had dad's heart racing.  Here he is watching his little boy figure out his new environment.

It's hard to not hold your baby right away, but it didn't take too long to reunite these two.  Even though this baby was struggling at first, he perked up quickly and was perfectly latched about an hour after birth.  

Welcome to the world, Weston!

Monday, September 26, 2016

Laughing and Crowning Usually Don't Go Together...

When I woke up Sunday morning, I saw a text from my client from 6:00 am saying she was having contractions every 20 minutes or so.  Being a first time mom, I figured she would stay there for a day or so.  But by 1:30 pm her contractions were 5 minutes apart, and by 3:30 she was wanting some support.

I arrived at 4:30 and found mom at her computer.  In between contractions she sent instructions to the teacher who is going to cover for her during her maternity leave.  I could tell her contractions were getting intense, but she was popping right out of them and very conversational.  I couldn't tell if she was really in active labor yet or not, so I suggested hitting the pavement.

It was a gorgeous Sunday for a walk!  Mom was cranking out the contractions, and some people driving by yelled "get a room!" as she labored on the sidewalk.  So funny! (And I was loving her cut polka dots and denim shirt!)

By 6:30 is was clear that mom was in active labor, and we went to the birth center at 7:30 pm.  Mom was very instinctual and very quiet.  She changed positions frequently, and really just followed what her body wanted to do.  I was really impressed.  So impressed that I couldn't tell if she was progressing or not because her demeanor never changed!

At 12:45 am the midwife decided to check and see how far along mom was, and discovered that she was 10 centimeters!  Her bag of waters was bulging, and it seemed like the end was close.  But an hour later, the urge to push still hadn't come, so my client decided to have her water broken to try and bring on the urge to push.

Most people think that once a woman is fully dilated that she will start pushing out her baby.  And sometimes it works that way, but other times it requires patience as the baby's head molds and descends into the birth canal.  This process of "breathing the baby down" can take anywhere from several minutes to many hours.

The urge to push was nowhere to be seen.  So we did a lot of position changing, hip moving, stair climbing, vocalizing, hip squeezing, tub sitting, and waiting.  I was blown away by the strength and endurance of my client.  She never complained, never appeared to be frustrated or concerned, never asked how much longer it would take.  She just kept breathing through her contractions and trying everything I suggested.  

Finally around 5:00 am mom began to have the urge to push.  And once it came, mom knew exactly what to do.  Her baby's head began to crown in the tub, and unlike most mothers who wince in pain as their skin is stretched and burned, my client started LAUGHING!  In 13 years, I've never seen a woman respond to crowning with a laugh.  She appeared to be overcome with joy and excitement, and it was such an amazing thing to witness.  

At 6:18 am, Monday, September 26th, Silas slipped into the world.
Weighing 7 pounds 15 ounces

The cord was short and wrapped around him, so he had a bit of a time figuring out how to breath right at first.  The midwives knew exactly what to do, and within a minute or two, he was breathing and back in mom's arms.  Phew!

The room was very dark, so the pictures don't do any justice to how cute this little boy is!  His face is just perfection, and he was so happy to snuggle in with his mama!