long birth

Selfless Birth / Beautifully Traumatic

When I first met Alicia, I knew I wanted to be at her birth. She is such a selfless person and she loves birth and pregnancy. She was determined to have a natural birth, one of the reasons is because she herself wants to be a doula. I thought that was awesome. I was also very excited because she was a surrogate. I think that being a surrogate is such an amazing selfless gift you can give someone.
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Alicia first started contracting at 36 weeks. She had pretty strong contractions about 5 minutes apart, but they were not a whole minute. But it looked like it might be the start of labor. So, Alicia called me. I had another post due already, so I called her and told her that I might be going to another birth that night. Turns out when I hung up the phone, that client's water broke. Since, that birth was happening, I went to that hoping that Alicia would hold off a while longer. We also wanted her to hold off because it was still very early. She was very worried about the baby's lungs. I think she felt a huge sense of responsibility to the intended parents and that little baby boy.

Luckily her labor slowed in the early morning hours, but pretty much from then on she had contractions all the time every day. More so when she would rest. It was very strange, walking and activity would weaken them and resting and bath would strengthen them. We had another tease November 18th. Contractions were 5 minutes apart that evening at 7 pm. She tried the bath and a walk and they stayed the same, walking actually didn't take them away this time. I decided to head over to her house around 10 pm. By about 1:30 she was having contractions 3 minutes apart, but they were only 45 seconds. Then it seemed like the contractions were weakening at about 2 pm, so I sent her and her husband on a walk at 2:30. I already knew this was going to stop, but I thought I'd try a few things. After the walk I told her to try to sleep in-between because they really seemed to be going away. She was able to sleep in-between and I could hear her breathing change when she would have another. At this point they were back to 10 minutes and I decided to go home.

At this point, Alicia is 4 cm and about 60% effaced. Her body is SO ready to go into labor. But, it just wouldn't keep up. We were thinking it was a position problem, so she tried the inversion, standing in a deep lung with one leg up, and side lying. She would feel that little guy move but about 10 minutes later the little stinker would move right back. At Alicia's 40 week appointment, her doctor told her if that labor starts up again, just to go into the hospital and get her water broken. But, on her next appointment 5 days later, they would schedule an induction. So, that's what she did after taking castor oil Saturday night. Contractions started up again in the early morning of Sunday, Dec. 4th. At 3 pm she went into the hospital after things started slowing down.

Alicia really didn't want pitocin, but not much was happening and the nurse wouldn't break her water since the baby still was too high, it could cause a cord prolapse. So, she got a low dose of pitocin Saturday night at about 7, it gave her some contractions, but not a great pattern still. At 9 pm the intended mom shows up in the hospital room. She was very excited, but Alicia is still in active labor where anything atmosphere change can affect her labor. The intended mom also told Alicia that there won't be a need for her to pump breast milk for her baby anymore. Alicia's contractions completely stopped and then at about 9:30 pm the doctor ordered the nurse to turn the pitocin off. This particular doctor is the only one that will deliver his patients. There is no on call doctor for him, he's it. So, basically in a round about way the nurse told us the doctor didn't want to deliver in the middle of the night.

Between the intended mom coming in, the news about not pumping and the doctor wanting to slow things down it was all very overwhelming. So, I got everybody out of the room to give her husband and her time to process everything. Later we decided the intended mom needed to wait till pushing to come back, I went to the waiting room and told her it would be a while and it would be best if they got a hotel for the night. She agreed with that suggestion, so she left. Contractions started again an hour later and Alicia was happy with pit being off. She didn't want it anyway. We figured around 11 pm, things might start up again. It did a little and she was 6 cm by midnight. That's 2 cm progress after 9 hrs. Alicia had a friend that was a photographer there to take pictures, (aren't they beautiful?!) her and I decided to take a break for some sleep at almost 1 am.
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At 4:45 I got a text from Jason, her husband, "She's 7 cm and throwing in the towel, she wants an epidural" Finally! Some really good labor going on. I rushed out the door to make it back to the hospital in time. An hour after I got there I realized I left so fast in the dark that my shirt was backwards.

Transition can go very fast and it is the hardest part. Up until this point, Alicia was handling contractions beautifully. She didn't need any help coping with them. It was almost as if they didn't bother her at all. But, when I got back to the hospital, I could see a complete shift. I knew this was finally it! I was very excited for her.
AandJ
It came to a point that Alicia was having trouble coping. She just looked to her husband, he held her close encouraging her as she wanted it all to end. He was so supportive of her and never left her side. He new this was something she wanted to do and needed to do. Jason did everything he could to help her do what she wanted so badly to do.
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I suggested the bath and she didn't want the nurse to get mad at her for getting off the monitors. So, I explained that she is allowed to go to the bathroom, basically when the nurse sees on the monitor that she has been "on the toilet" for too long she will come in and find out that she is actually using the bath. Sure enough, within 10 minutes the nurse came right in and would not let her off the monitor. About 6:45 am she stopped coping well again. There was no talk from her of pressure, so I suggested to call the nurse, I said, "Tell her you are going in the bath and if the baby needs to be monitored then bring the Doppler along." This entire time, the baby's heart rate was beautiful, he was handling everything perfectly, the only reason they wanted her on the monitor was because she was 7 cm. The nurse came in and decided to check, Alicia was complete! The nurse said, "Oh! He's right here, don't push." Side note, we were told earlier that nurses try not to deliver because if they deliver too many, they will loose their job. But, I know how impossible it is to hold that baby back without an epidural. (We called the mom and had her come back to the room.) As the nurse is telling Alicia to take short breaths and not push, I whisper to her that she can just go with her body. Try to blow out, but if you have to let your body do what it wants to. "Push if you want to." She nodded slightly and she pushed.
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This whole time I could hear the mom crying in the back ground. The nurse actually tried to push her knees together! I don't really think they understand labor without an epidural. I kept telling Alicia to go with her body and the baby boy was born at 7 am, 8 lbs, 9 oz, the doctor didn't make it. The baby was pink and healthy, tears were just streaming down his mom's face. It was so amazing. I told her to go and follow the baby, touch him, be with him. She walks over and in broken words says, "Oh, look! He has my chin." It was so beautiful.

The doctor shows up and then things take a turn. The doctor is ready to deliver the placenta, he actually tugs a bit, the placenta isn't coming out. He tugs some more and it's not coming out. I can actually see the placenta right there. Alicia is saying that it hurts, the doctor says, "Oh, it shouldn't hurt to deliver a placenta." Then he mumbles almost to himself, "Boy, this placenta is harder to deliver then the baby." I said, "Not quite!" The doctor is pulling and telling her to push. She yells, "It hurts!" I'm concerned about all this pulling so, I ask, "Is it detached yet?" The doctor sticks his fingers in and says, "I think I got it." He's tugging, telling Alicia to push. She tries to push and says it hurts again. He lets her wait for a contraction, then pulls and tells her to push, she literally screams, "It hurts on the inside" That right there is key, something is wrong. ALWAYS listen to a mom without an epidural. You will know if something is wrong, usually it is a relief to deliver the placenta. I am watching, not knowing how I can stop this and seeing what looks like a HUGE placenta come out then the doctor goes, while looking at it fascinatingly, "Oh... Well... That's something you don't see." He mumbles a few other things and tells us she pushed her uterus out. I also hear him say something along the lines of "What are we going to do about this?" My insides just dropped as Alicia is panicking. She's asking what can she do while the doc is looking at her uterus, trying to detach the placenta. Yes, the placenta is still completely attached. I'm just telling her to try to relax everything in her body, "Don't do anything, the doctor is taking care of it." While I say that, inside I am thinking, panicked thoughts knowing how serious this situation can be.

** Side note: I have a problem writing negative things surrounding birth because I don't like to scare moms. I fully believe that birth is a natural non medical process. Yes, sometimes things can go wrong, but it is a rarity if things are done with little to no intervention and if things are done properly. However, I feel that it is also important for everybody's story to be shared. On top of that, this particular story was a beautiful birth where this complication could have been avoided. The doctor rushed and pulled something that should NEVER be done. This is not something that a mom should ever just be scared of, if she is, talk to your doctor before hand and ask how much time they give the placenta to come out.

** Back to the story... The doctor finally detaches the placenta Alicia is in pain and I am asking the nurses and doctor to give her something. I asked about 3 times and her nurse says she is. Then Alicia asks what is that, the nurse says saline. We were thinking a med after the saline that would take the pain away, but she only gave her pitocin. Then, the doctor shoves it back in with his arm up in her to his elbow. Still no meds. He stitched her up with extremely shaky hands. He even missed a part, I asked him to add another stitch and he did. Then he left so quick, he didn't even sign the cord blood paperwork. The placenta was sent to the lab and Alicia is left worried about "what now." I called the next day and nobody has come to talk to her about what happened, to explain it or to talk to her about possible future risks and recovery. The staff all knows what happened, but it is such a rarity that nobody has come to talk to her about it. I am angry over this and what happened. The doctor hasn't even been back to see her. Before the delivering the placenta, she had a beautiful birth almost completely in her control.

In the end, there was a good and a bad to this story. But, by telling it I want it just to teach people about what can happen. Not at all could this mom have changed anything. It was the doctor that choose to do what he did. But we can learn from what happened to her and just have more questions to ask other care providers. Educate yourself, choose a caregiver that you trust and be firm with what you want. Of course, understand if there is an unforeseen circumstance out of anyone's control were we do need to make changes and have interventions. Thankfully, Alicia didn't end up in the OR and thankfully she is ok now. No signs of hemorrhage or retained placenta. No shock when it happened. Go back to that picture in the beginning, that was after everything. Alicia is ok and recovering wonderfully with a smile on her face.

Marathon Birth / 60 Hours of Determination; Sometimes Medical Intervention is Necessary

Sarah’s birth was unique in so many ways. There is so much to say about it, I don’t even know where to begin. You can probably see a bit of that from the title. My husband thought I should call it “Marathon Birth” I thought, 60 Hours of Determination; but I wanted something in there about the medical intervention. So I had to put them all.


Part 1: The events of labor
Sarah was planning a natural child birth using the Bradley Method. One big reason she wanted to do this was because her mom birthed her this way. There were, of course other reasons as well, but this was a big reason. Sarah’s mom had told her that her labors were fairly short and baby size was around 7 lbs. So, naturally Sarah thought she could expect a fairly short birth and a bigger baby because her husband was about 9 lbs at birth. She did however know that might not be the case, her birth could be very different then her mom’s. Little did she know it was going to be the exact opposite.

Wednesday, September 22, Sarah had her appointment with the midwife who told her it would be ok to take castor oil because her due date was Sept. 19th, 4 days prior. Being uncomfortable and ready to have her baby, she did. But there really was no effect except a slight upset stomach. Thursday morning about 1:45 am September 23rd, I received a text message from Sarah. I didn’t get it till my daughter woke a little after 2 am and I checked my phone. Normally I don’t hear a text message in the middle of the night, just a call. Anyway, she said she thought her water broke and her contractions were about 10 minutes apart. So, I messaged her back asking her some questions and telling her to do a few important things like drink water, rest, pee every hour and eat. That night she took baths, showers, and did everything else in the instructions. The contractions got a little closer together, but around 5 am, she fell asleep and the contractions slowed way down. All day on Thursday she had contractions mostly 10 minutes apart, but some 20 minutes. I suggested she and Ricky, her husband do something to take their mind off the labor like go to the movies. They watched a few at home, but didn’t go out.

Thursday night, her contractions picked up again but were inconsistent. She labored all night and tried to get the contractions stronger and more regular. It was about 12:30 when I got a call from her that she wanted me to come over for an hour or so, to help her relax while Rick was resting. I got there and gave her some suggestions. She was very uncomfortable laying down so I had her on her hands and knees doing pelvic rocks. Her back was extremely uncomfortable so we tried to get the baby off of it by doing the pelvic rocks. I ended up staying until the next day because it looked like her labor was progressing. But it would have periods of slowing down and we could not keep it consistent. Sarah kept getting so discouraged that she wasn’t progressing. I kept reminding her that things were happening in her body. Just not the expected way.

About noon on Friday, September 24th, Sarah decided to go to the hospital to have them check her progress. She went to triage and she was 5 cm dilated. The baby was doing good. She did not tell the midwife her membranes were ruptured, she didn’t want a time limit on her labor. The midwife recommended she check into the hospital, but Ricky and Sarah decided to go home. The midwife was not too happy about this. In-fact she was a little bit threatening about what would happen if they go home and don’t get back in time or can’t monitor the baby. The midwife was even more upset to hear they took Bradley classes.

Sarah and Ricky still decided to go home. She wanted to work on flipping Harper around and I went home to rest. About 3 pm I picked up Sarah to get an adjustment, which can help with the baby flipping but most importantly it helps with being aligned to minimize some pain and helps to open up the hips. After that Sarah went back home. They decided to go back to the hospital around 8 pm and I would meet them there.

When Sarah and Ricky got to the hospital, she was now 6 cm. Her contractions were still inconsistent. So we had a plan of constant nipple stimulation. Usually constant isn’t recommended, however she was able to start while on the monitor and we could see that the baby could handle it. Harper was doing great every time she was checked on. So Sarah kept that up along with walking and the shower. Her contractions were still so inconsistent, they would fluctuate from 2 or 3 minutes apart to 10 minutes apart. At 2 am, September 25th, Sarah was having a lot of pressure, so she was checked and was dilated to 7 cm. She got back to her routine of nipple stimulation (more aggressive this time), shower and walking. The midwife came in and checked her again and she was dilated to 9 cm. Wow, that was exciting! Finally, some encouraging news. This is the most progress she made in the last 2 and a half days! 2 cm in 4.5 hours. We were very excited. Sarah’s spirits were up. She was very motivated and encouraged to keep going.

Sarah kept up with her routine. However, all this time, the past 3 days, she wasn’t eating much. It was very difficult for her to eat. She was drinking tons of water, just no juice or food. She also wasn’t able to sleep. The midwife came in maybe around 7:30 to check her again before shift change and she was dilated except for a anterior lip of cervix. That was very exciting news. So now my plan was to keep her on hands and knees, walking or doing pelvic rocks. We needed to get the pressure on that lip to help it dilate.

At 8, there was a shift change and the midwife that Sarah originally saw Friday afternoon was back on. She checked Sarah and discovered she was 9 cm with an anterior swollen lip of cervix. The difference in 9 or 10 cm may be just how 2 different people checked her, however the swollen lip was defiantly going backwards. We were disappointed, but we still had a plan. Sarah was so determined to do this naturally. Now, we had to keep Sarah on her back or sides to stay off that lip. Definitely no hands and knees and no pelvic rocks. However, at the next check, Sarah was more swollen.

Now it was time for a decision. The way things are going are not good at this point. It was time for some intervention. The contractions would keep up with constant nipple stimulation. Even then, they were not regular or incredibly strong. Sarah had also been awake for 3 days now with little to no food. She needed fuel and so did the baby. After a lot of thought, Sarah decided to get pitocin so her contractions would get stronger on their own and keep up, she decided on the epidural because she definitely needed sleep and she needed to get that swollen lip to go down. They also gave her sugar water which helped both her and the baby. They needed that fuel. Sarah was administered all of this about 1:10 pm Saturday, September 25th, 59.5 hours after labor began.

After a few hours of rest and some awake relaxing time she was finally 10 centimeters. The midwife allowed her to labor down and she was finally able to push. After 1.5 hours of pushing, Harper was born just after 7 pm Saturday night, she was 9 lbs 14 oz and 21 inches long. Did I mention, Sarah is a small girl, about 5 feet 2 inches tall.

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Part 2: Thoughts on the labor
This birth was so unique and amazing all in one. The main thing that was so different about it is the contractions were the same throughout, some close together some far apart, she’d sometimes get a group of good intense contractions all at once, then a half hour with maybe 3 smaller ones. The entire time, I kept thinking there has got to be a reason this is happening. Why does God want the contractions to be like this, why does he want the labor to be so long? I knew there had to be a reason. When Harper was born, I thought maybe this was the reason, Sarah’s hips needed that time to open up enough for her little body to fit Harper through. Harper even had her hand up by her shoulder. That makes it even harder to push her out.

To me this birth was so amazing. Sarah had such determination through the entire labor. She never wanted to give up after discouraging news every time she was checked. Sarah was discouraged and disappointed at times, but she kept right on working at her labor. She wanted so badly to have a natural child birth, that she said no to the doctors when they would recommend something over and over until her and her husband felt it was necessary. They really took a stand for what they wanted. It was amazing. That is such a difficult thing to do. I am so proud of them. If Sarah had gotten the pitocin earlier, maybe (I don’t know for sure) but maybe her hips wouldn’t have had enough time to open like they did. If she had gotten an epidural without pitocin, her labor probably would have completely stopped. But in the end, both were needed to finish the birth of her little girl. She waited until it was needed, so even through the entire birth wasn’t natural, the first 59.5 hours were and she was extremely happy with the outcome. To be able to deliver her baby vaginally was such a blessing.

I loved how this birth turned out and once again I learned so much from it.
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