Birth #0036

This story has been shared with permission from the birthing Momma. 


This story begins at this mom's 41 week appointment. She had a non-stress test done to be sure baby was still doing okay. Some tests came back that amniotic fluid was low. They asked them to come back in the evening to start induction. They took some time at home to pack up, and enjoy their last moments as a couple before baby and eventually made it to the hospital. Around 11pm, this Momma text me to say they would be putting in a Foley Catheter to hopefully help dilation. A few hours later, I got a call from the father, concerned, saying that the baby's heart rate was dropping with contractions. The OBs were watching along with the midwife to be sure no emergency precautions needed to happen.

I arrived at the hospital around 4am. The nurse was in with this mom, who was sitting happily on the ball, checking to be sure baby was okay. She told me that sitting on the ball was helping, but now they were concerned that the baby's heart rate was getting too high. After a little while longer, the baby's heart rate seemed to normalize. Later, she was able to get comfortable on the ball leaning over pillows on the bed to try to get some rest. Since things were still very early in labor, and they were able to get some rest during this time, I also went home to also to to get rest before needing to join them both for the day.

Later that morning,  I received an update from the birthing momma, saying that her water had broken around 5am. Because of this, they decided to remove the foley catheter. She was now open to 4 cm! Baby's head was at -1 station, and her cervix was 60% effaced. This was excellent progress, and her body seemed to be responding well to the induction process so far. They were planning to start pitocin soon to get contractions moving along.

A couple hours later, I received a call from this mom, saying that the contractions were much stronger now, and much closer together.  When I came to join them, this mom was still in very good spirits, standing and leaning over the bed with a stack of pillows.
After more laboring, she started having more back labor as well as very intense contractions that were pretty close together. Despite this, this Momma was BEAUTIFULLY relaxed, breathing gently through each one. She was an incredible picture of power, strength, and endurance. Now, she was open to 5cm, 70% effaced, and baby was at about-1 Or 0 station. This was excellent progress, however, not quite the amount of progress her care providers were hoping to see. They asked this Momma if it would be okay to put in an intra-uterine pressure catheter to see how effectively the pitocin was working. She agreed to this, as well as having a fetal scalp electrode placed to be able to better and more accurately monitor the baby's heart rate.

After this, the baby was still having some heart decelerations. They asked this Momma to put on some oxygen, lay on her left side, and also if they could offer her an amnio infusion-- to put some fluid back around the baby to give the baby more space to move and protect the cord from becoming squished.

A couple hours later, and her progress was appearing to be relatively the same, and she was still coping beautifully, baby's heart tones overall good.This mom enjoyed laboring on the toilet, and sitting up in bed.

At one point, I asked her how she was doing and she said, "I feel good. I actually feel like I'm on drugs or something!" Thank you, endorphins!

A couple hours later, her progress remained the same, so they began discussing the possibility of a c-section. Another big concern in this discussion was the various times that the baby's heart rate would dip down to a concerning level. They told her they would give her one more hour to see if anything could change, but that it was not looking good. The birthing Mom and Dad had some time to talk it over with each other and with the midwives. At this point, the mom felt this was her best option. The midwives then came back to say that the OBs were happy to give her even more time- about an hour and a half to see if something could change. The main change they wanted to see was the descent of the baby's head, since it was not well applied to the cervix.

After this conversation, Dad left the room to consult with a doctor friend. The Momma and I talked about how they had really been wanting and hoping for a natural, vaginal birth. I reminded this momma that a lot of progress could happen in an hour and a half, and that that progress could most easily happen by changing into some positions to help open the pelvis and allow the baby's head to descend. This momma agreed that she still wanted to achieve a vaginal birth and that she would be willing to try to make it happen. I again affirmed her strength, and how she had been doing an incredible job this entire time. She also expressed her belief that things can change in that amount of time. When the Dad came back into the room, they both decided to try hands and knees position with the Rebozo scarf.

In a little while, this mom got up to use the bathroom, and began vomiting while on the toilet. Dad was quickly at her side with a basin and ready to comfort her. He had been so attentive to her and willing to serve her in any way that he could! It was beautiful to see them both working as a team through this process. While on the toilet, (and still vomiting) the baby's heart rate began dipping and remained somewhat low for about two minutes. This caused the midwives, OB team, and many nurses suddenly rush into the room. It took a little bit to get this momma repositioned onto her hands and knees, but it did help baby stabilize.

After trying various positions, the midwife checked this momma and her progress was about the same. They discussed some options-- that this momma could continue as she had been, or, try an epidural to see if sleep and relaxing some of those muscles could help, or, to decide to opt for a c section. We all talked about the benefits and risks and alternatives to each of these options, and then gave them some time to talk. When I came back into the room, this Momma decided the best option for her would be to try an epidural.

Around 1am, the epidural was placed. Everyone tried to get some sleep. At one point, this momma's blood pressure was dropping, so the nurse gave her some medication to help control her blood pressure. The baby's heart rate was also dipping at certain points in the labor. When this momma had oxygen and was breathing deeply during contractions, the baby seemed to be doing better.

Thankfully, this Momma did get a couple hours of sleep. She told me in the morning, "I do not at all regret getting the epidural!" She seemed very positive and with renewed sense of energy.

The OBs came in around 8 am. Progress about the same-- 5-6cm dilated, 0 station, and 80% effaced. The options were put on the table-- to continue laboring as she had, and see if any more progress could be made, or to opt for cesarean birth. This couple asked some questions, talked about the pros and cons (such as trying some new positions if deciding to try for vaginal or being more at risk for an emergency c-section and too much postpartum bleeding), and then took some time to talk with me, and then took some time to talk alone.

After some deliberation, they decided to do the cesarean. They expressed to their care team that they still wanted to have skin to skin contact as soon as possible, breast feed as soon as possible, and take the placenta home. I was very proud of them for continuing to advocated for the things that they could have control over in this situation. 

Soon, this Momma was taken in to the OR. The Dad and I talked back in the labor and delivery room about what to expect for the surgery. After some prep time, Dad was taken back into the surgery as well. I waited for them to finish in the waiting room, to meet them in recovery. I must say that is always the longest wait for me, as the doula. I am always so concerned and hopeful the the family will still get nurturing and tender care during their birth experience. 


It seemed like this family was able to get that. When I was allowed into recovery, I was happy to find a very proud father, holding his son tenderly to his chest, and in awe of his new baby. Soon the Momma joined in the recovery room as well, and as soon as she was able, took her new boy into her arms. It was as natural as ever. This family was so happy to have a healthy beautiful baby. I was thankful to have the honor of supporting them through their birth journey.