Every Birth is Different

Sarah had her first baby almost 4 years ago at 40 weeks + 2 days, after 68 hours of very slow labor. Yes, active phase of labor was really that long. In fact, she went to the hospital and was check 5 centimeters, went home and came back the next day at about 6 cm! That was her first birth and this is her second:

Friday night, almost midnight on 5-23-14, Sarah’s water broke with no contractions. This time she was a little more then a week early. She decided to take a bath at that time to wait and see how things go. Her baby had already been very low and she had been doing Cross Fit her entire labor. I had told her that it can take a couple hours for contractions to start. By 4:15 am, contractions were 10-15 minutes apart and lasting about 30-45 seconds. Sarah had gotten some rest in-between contractions and was letting her husband rest. She actually felt like being along, which is really normal at this point in labor.

An hour later, I got an update that her contractions were the same, she got another hour of rest and was eating and trying to relax. Sarah did such an amazing job of following her instincts and knowing what her body needed. At this time of night and early morning, it was better to relax incase labor was really long like last. If labor was going to go fast, resting was still a good idea. We texted back and forth about drinking enough water and going to the bathroom.

Within a couple hours Sarah was in a pattern of having some big long contractions with little ones in between. She was having some blood when going to the bathroom and she was going to the bathroom a lot. Labor sounded perfect to me. I was just waiting for her to be ready for some help. I don’t like to suggest I go over too soon, so I leave it up to the mom.

At 9:15, I checked in with Sarah. I wanted to let her know I was going to the store so she knew how far I was from her. She had told me things were still the same and she was sleeping between contractions. Her ability to relax during labor was amazing, I had remembered this from last time. I had mentioned if things did change in an hour or so to try nipple stimulation. I didn’t want her to go to long after her water broke without being in active labor. From text, I couldn’t quite tell where she was in labor.

A little while later, Sarah had a 90 minute contraction. I asked how she was doing and she said “Good”. I was surprised, it seemed like it should be getting intense, but in the back of my mind I was thinking, maybe it would be like last time. She was packing and picking up between contractions. But, she did say they were way stronger this time then with Harper, her first baby. By 11:30, contractions were still consistent and, “Maybe a little more frequent.” But again, she said she was going good and had a snack. I told her I was going to take a nap. I wanted to get some rest in because my guess was I could be joining her any minute and we didn’t know how long this would last. About a ½ hour later, Sarah texted that she had a few 3 minutes or longer contractions that were 1-2 minutes apart. This time, I just said, “Are you ready for me?” To which she replied, “Yes!”

I arrived at 12:30 and just one look at Sarah told me she was in transition! (I couldn’t be 100% sure, but I was as sure as a doula could be.) I told her she looked great. I was so happy to see that. This was a little over 12 hours after her water broke! She had her first contraction with me and I did the hip squeeze. No complaints with that, yep, transition! Then we sat down on an ottoman and I had her hang while Rick squeezed her hips. Sarah’s contractions were long and strong. She couldn’t relax all the way through and broke down a little about how hard it was. I told her and Rick I thought the baby was coming and that we should get to the hospital. As she is having contractions with lots of pressure and mini pushes, I mentioned, maybe I should just took for a head and we should call 911 instead. Nope, she said they would make it to the hospital.

It took us a while to get to the car, she did feel to see if she could feel her baby’s head and it wasn’t there yet, so went to the hospital. I had Sarah sit backwards in the seat so she could be on her hands and knees. When we arrived, Rick said she had only about 2 big contractions. I told him about how many times when you reach 10 cm, there is a little break in the contractions. The next 15 minutes was like a scene from a movie. We got to the hospital just before 1:30 pm, 5-24-14; Rick was running down the hall with Sarah in the wheel chair. I ran on ahead to get the door for him and when we walked into Kaiser L&D, I told the lady at the front, “I have a mom here having a baby, now!” She opened the door to let us in. We went to triage and Angelette walked in. Yay! She is the most amazing nurse, I was with her just too weeks ago. She was so calming and asked me if I thought she was complete, I said, I can’t be sure, but I’m pretty sure she is. She said, “Ok, we are full, but we’ll just deliver this baby right here.” Then another nurse came in and said another room just got cleaned up and the midwife came in ready to check her. As we walked to the room, Ricked signed the papers and I answered the questions I could for her regarding 1
st or 2nd baby, water breaking, etc. I’m not even sure Sarah was that aware of what was going on at the moment. When we got in the room, the midwife checked her and said, “Well, your baby is right here, it’s time to push.”

With that, Sarah was in disbelief! She just kept looking at us, saying, “Really?” “I can push?” “I’m ready?” Yes! You are ready to have this baby! I was so happy for her. This was the best news every. We knew she had been working really hard while not letting herself fully believe this could go faster. By 1:46, Rick and Sarah’s second baby girl was born all natural. 8 lbs, 6 oz. Rick got to announce they had a girl, at first he thought he saw boy, so he had to double announce the sex. He got to do the big reveal twice, with just as much excitement both times. There second little girl latched onto the breast within a half hour of delivery and nursed so well. I am so happy for Rick and Sarah, it was just what they wanted for their birth.

A Beautiful Birth

At the end of Stephanie's pregnancy, she started to get a little nervous about the events leading up to her delivery. Her first birth story leads into her second birth, so I will be sharing a quick version of her first as best I remember from what she told me.

With her first baby Stephanie was induced at 43 weeks. the first time was very difficult as the midwifes and doctors were trying to force an induction on her at 42 weeks simply because she was 42 weeks. They did this by using scare tactics and being down right mean to her and her husband, Bill about their choices. A doctor even called Bill at home to tell him what a horrible husband he was to let his wife put their baby in danger. (Personally, I think he is a wonderful husband to support his wife in what they know is right.)

All the non-stress tests (NST) were perfect, there were no signs the baby was in distress. Stephanie's fluid levels were good also until 43 weeks. Everything looked healthy with mom and baby, so, there was no need to induce because of an estimated due date. She and her husband, Bill, understood the risks involved with an induction before the baby is ready and wanted to wait until her baby was ready to be born. At 43 weeks, she went in for her NST and ultra sound. During the ultra sound the midwife specifically told her she couldn't get a number for one of the pockets of fluid because the cord was in the way, so she added up all the other pockets (I think it came to a 5) and told Stephanie her baby was in danger.

Those were the key words to Stephanie and her husband. If their baby was in danger, they would induce without a second thought. That night, they induced with a foly bulb and pitocin. (She was 0 cm). Her induction went well, other then the fact that the staff was horrible to her and her husband, but the baby did extremely well and Stephanie birthed a healthy, not late baby girl covered in vernix without an epidural. Nobody was going to take that part away from her! She wanted as little interventions as possible and that was one she could control. The midwife and nurses all commented on how her baby was not late, the placenta was very healthy, the baby was covered in vernix and her due date must have been wrong.

Stephanie knew her due date was accurate then and this time around she knew her due date was accurate as well. Stephanie also knew she was likely not going to go into labor by 42 weeks. She was very concerned and there was so much prayer going into this birth by so many people surrounding her. She was very worried about how the hospital staff would treat her. As her due date approached, she noticed her specific midwife doing things to protect them from the awful doctors, like scheduling when she was there and not with doctors. Already it was turning out to be better. After her NST's when Stephanie and Bill decided to go home, they always had to sign against medical advice with the first pregnancy. This time, she didn't have to sign against medical advice until the last ultrasound. Just like the first time, the NST's were perfect. However, it kept getting harder and harder to get the fluid count. There was a lot of cord in the way.

The evening of 42 weeks, plus 2 days, she had the usual NST and ultrasound. The fluid was a 3. This time they didn't say, "Your baby is in danger." They advised induction and gave her the choice to induce and when. She accepted the induction for the second time, but this time decided to go home and sleep in her own bed, then come back in the morning to start the induction. She did have to sign against medical advice, but it was without threats and her midwife was very understanding.

In the morning, they went back to the hospital after a good night sleep, prayer, some time processing everything and a good breakfast. At 11, another midwife, Cheryl, was on. Stephanie was asking questions about monitoring and IV. Cheryl, the midwife suggested starting the induction by breaking her water so she could have the freedom she wanted. Cheryl didn’t have a problem with this method because Stephanie was already 4 cm. Bill called me to get my thoughts on that. We talked about the risks involved, but also that, it was what Stephanie really wanted. She absolutely did not want pitocin again. Bill and Stephanie decided to have Cheryl break her water. I stopped in and checked in on them at noon. They were in a good routine of walking, bathroom, drinking and snacking. There was no IV, not even saline loc and she was on the monitor for 20 minutes, off for 30 on for 1 minute, then off again for 30. I left and told them to call when they were ready for some help.

When I was gone, Cheryl had told them they could walk where ever they wanted around the hospital as long as they came back for the monitor checks. Bill and Stephanie walked all around out side and stopped off at the cafeteria for some food. Contractions were getting painful, but bearable.

At about 5:30 pm, Mother's Day, Stephanie was checked and was 4.5 cm and 90% effaced. That was some progress. I decided to go check in on them again. She was doing really well, breathing and completely relaxing through the contractions. Walking a ton and fast and going to the bathroom often. They had gotten a salad that she was eating from the cafeteria. While I was there, contractions got to 3 minutes apart so I stayed. Stephanie was in a great rhythm and was checked again at midnight. Just before the exam, I could see a shift in her, so I was anxious, thinking it was going to be good news, but not a ton of change. It ended up, she was 5 cm and very soft. Cheryl suggested pitocin and Stephanie asked if she could have a minute to talk about it. Cheryl said that was fine, she would do another exam in an hour and if no change, then she was going to strongly recommend pitocin, she did also mention nipple stimulation. When Cheryl left, Stephanie said no pitocin. I reiterated the nipple stimulation. Either that worked or she was just ready to turn that corner with her labor because it got really intense for her. We also had an amazing nurse come on at midnight. Angelette that told us she would put a bug in Cheryl's ear that Stephanie's labor was progressing and she wouldn't need pitocin.

Amazingly, Stephanie was still so calm and controlled during her contractions. She was breathing and very relaxed. She went on a few more walks and got in the shower a couple of times. All along the baby did wonderfully. After 3 am sometime, Stephanie and Bill were in the shower and I could hear Stephanie saying she couldn't do it anymore. So far, this was the birth she wanted, no medications, no IV. I went in and had a little talk with her. I told her that she could do it and she was doing it. Before her birth, Stephanie had told me absolutely no epidural. She got out of the shower, sat on the ball and hung from the rebozo. Back in her zone, close to 4 am, Stephanie was feeling a lot of pressure. She had felt she needed to go to the bathroom all along so we weren't sure if this was it. Stephanie was afraid to have an exam incase it wasn't good. But with all the signs, I didn't want her to sit there thinking she had hours to go when it was actually time to push. She decided getting checked by the nurse would be ok. At that time, she was 9 cm with a thick anterior u-shaped lip. I suggested hands and knees and the nurses in the room said either that or flat on her back. We did 5 contractions on her back, then hands and knees it was.

It wasn't long after that, that the urge to push was uncontrollable. I called the nurse back in and the lip was still there, but with Stephanie on her hands and knees, Angelette was able to slip the lip easily around the baby's head. Angelette told Stephanie to stay how she was, she could birth her baby like that. Stephanie gave her first push at 4:26 and Cheryl came in. Immediately, Cheryl told Bill, "Dad, come down here, your job is more important over here." Then she had Bill put his hand under the baby's head to catch the baby. Cheryl guided Stephanie on pushing perfectly; when she need to push hard, stop pushing or just a slow push. This gentle guidance helped Stephanie to have just the tinniest 1st degree tear. Bill got to guide his baby out, announce they had a girl and hand their child to his wife at 4:37 am on 5-12-14, just 11 minutes after that first push.

For the second time, Stephanie delivered a beautiful, healthy baby girl that was not a late baby. Healthy placenta, healthy baby covered in vernix. Their little girl, Olive Ann was 9 lbs, 9 oz, yes, in 11 minutes with a first degree tear.

After Stephanie had her baby in her hands, turned around and got comfortable the cord stopped pulsing. Cheryl had Bill cut the cord and waited till the placenta was ready to come out. There was no pulling or tugging. There was no pitocin after birth. It was the most natural, gentle, and hands free birth I have seen and it was in a hospital of all places! It was absolutely beautiful. This shows me that there really is so much hope for hospitals getting it right.

Mary's Gift

I met Mary through a past client (http://www.bestocdoula.com/Blog/files/Alicia%20Taylor.html) who is now also a doula. She lives quite far and wanted to partner with a surrogate mom in my area. Of course I was excited! I loved attending her surrogate birth. It is such an amazing gift to someone. Anyway, Mary just had such a huge heart for carrying a baby for someone that couldn't carry her own. I loved our conversations. Unfortunately, we assumed Alicia was going to be the one attending her birth as I was supposed to be on call for just a few days and if Mary's water broke, I would get there sooner. However due to unforeseen circumstances, I was on-call the first week and luckily for me, Mary went into labor. 

It started slowly with contractions often, but not often enough on Friday, April 18th. Instead of getting closer together, they spaced out. Again all weekend, it went like this until, Monday night / Tuesday morning. About 2 am Tuesday morning, we received a text that Mary had been having contractions about 5 minutes apart. She was ready for some help. When I arrived, her contractions were about 7 minutes. The IM was also going to join us for labor. I waited a bit to see what was going on, we took a walk around the neighborhood and it just seemed like she was in early labor. I told Mary to get some rest, she didn't quite need me yet and that I would go home and rest also. I told her to call me if there was any change. That was about 5:30 am. 

At 6:30 I received a text from Mary saying she was going to head to the hospital to ask them to break her water. (With her previous labors, once her water broke, the labor dramatically sped up.) I decided to go ahead and meet her at the hospital. The doctor came in to check her and she was 4 cm. She did not want to break her water because she was a VBAC (last pregnancy was a surrogate with twins by c-section). Also, the doctor looked at the monitor and she had had 2 contractions in 4 minutes, so she thought she was contracting regularly. In actuality, Mary was contracting every 10 minutes while lying down and 5 minutes while walking. We spend as much of the day walking as we could between getting monitored. Finally, at around 3 the doctor came into see her and she was only 5 cm. The doctor thought that Mary's contractions had slowed down and told her she could go home or have her bag of water broken. Mary decided to have it broken after wanting that originally and being tired from laboring 1/2 the night and all day. With in 1/2 an hour, contractions picked up to about 2-4 minutes apart.

Around 4:30 Mary decided on an epidural so she could get some rest. Unfortunately, the epidural didn't work at all. This is a very difficult thing. Mary had 2 previous natural delivery's in the past, but once you have decided on an epidural are expecting relief, when it doesn't work, it is worse then if you never tried the epidural. The other difficult part was because she had an epidural, she was not allowed off the bed or even on her hands and knees.
We had to deal with the pain she was having with very limited positions. We basically spent the next 2.5 hours with me squeezing her hips while laying on her side and sometimes sitting in bed. This was the only relief she got. Multiple times the anesthesiologist came in to up the medication. When she was about 9 cm, he gave her the c-section dose to see if the epidural was in the right position. It made a little bit of a difference, but not much. But finally, she was able to push which only took 11 minutes and the relief was finally there! Mary gave birth to a beautiful, healthy baby girl at 7:15, April 22. She was 8 lbs, 14 oz.