long labor

Peaceful Birth

Ashley and Sam were so excited for the arrival of their daughter. They have 2 older sons as well. They really feel like she was going to complete their family. Ashley and Sam took a while to get pregnant and spent a lot of time preparing not only for their daughter, but for her birth as well. No decision was taken lightly. Ashley carefully looked at different doctors and what she wanted for her birth.

Through all of her planning, Ashley thought her little girl was going to arrive early based on preterm labor symptoms, which began at 24 weeks. Ashley was put on strict bed rest for 3 months and then modified bed rest for the final month. The arrival date is one that you really cannot control or plan for if left to nature’s way. So, in all the planning, Ashley and Sam thought the best decision was not to induce labor. When her due date rolled around and her doctor had to leave town for a family emergency, finding another doctor that respected the birth process and her choices with no baby that seemed even close to being born, they got a little nervous at the prospect of having to face an induction. Ashley and Sam ended up with a wonderful doctor as a back up, he was actually a doctor that she almost chose in the beginning.

Four days past her due date, a day after Sam’s birthday, Ashley went into labor. They were so excited partly because the induction was scheduled for the very next morning. This little girl knew she had to meet her parents soon. After talking to Ashley, it seemed like her membranes did rupture and there was concern about the color, so I advised her to call the doctor. He had the same feeling as me and advised her to go into the hospital. She did about midday to discover she was in early labor with ruptured membranes. Ashley was admitted and was extremely pleased to have a nurse she knew well and was comfortable with be assigned to her. During the day, Ashley was allowed to walk, eat, drink and relax as she pleased. I kept telling her to walk and rest in-between so you don’t over do it. But who can relax when they have waited so long for this little baby and she is finally on her way. Both Sam and Ashley had so much energy. The day went on like this and Ashley did all she could to get her labor going stronger.

I went by Anaheim Regional around 6 pm so Sam could go out and get something to eat. He needed his energy also to be there for Ashley. When he got back, it still seemed pretty early and they didn’t need me yet, so I went home to wait till labor got a little stronger.

About 9 pm, Sunday night, Ashley texted me that the contractions were intensifying and she was starting to bleed. She also said the contractions were 5 minutes apart and she was doing fine. Her
e routine at this point was pelvic rocks, walking, resting and walking. The nurse asked if she could check Ashley’s cervix at 10pm and she was ok with that, but still felt like she was handling things well.

About 45 minutes later, the contractions were getting longer and were 3-5 minutes apart. She was asking about breathing during these contractions. I reminded her and she seemed to be getting uncomfortable through the next ½ hr. Finally at 10:45 the nurse checked her and she was 2 cm. She was disappointed because she was so tired and wanted to rest just when labor started to get active. Unfortunately at this time, my text messages were not coming through. Ashley asked me to come and I didn’t get it until midnight. I arrived at Anaheim Regional after midnight to find Ashley uncomfortable and losing a bit of control with each contraction. I got her in the shower and we got it really warm in there because she was pretty cold and that helped a lot. But she was still so tired. All her adrenaline was used up during the day. She wanted to lie down so she went back to the bed and we put the TENS unit on her back. That helped a little, but we couldn’t touch anywhere near her back with it on. Also, the only way comfortable was on her hands and knees, she had most control over relaxing in that position, but it wouldn’t allow her to rest or relax.

We tried all kinds of positions to find one that was most comfortable and about 2 am, Ashley said she really needed to rest. She just couldn’t do it anymore without resting. She said about 10:30 she felt the contractions slipping away from her like sand through her fingers. She was struggling to listen to Sam’s suggestions at that point and did not have my support at the hospital. So, now she just needed to relax. Sam and I had her do a couple more contractions because that was what she wanted us to do and then we talked some more. She also got re-checked at 2am and was 5 cm. That was great news, but she still needed to rest. It wasn’t that she couldn’t do labor, it was just the circumstances that all her energy was used up during the day in early labor so by the time active labor hit, she was spent. She decided to get the epidural after a lot of talking about it and was content with her decision.

At 3 am, Ashley got her epidural. Anaheim Regional has one anesthesiologist who
gives walking epidurals. The hospital will not allow the moms to walk, but they could if they wanted to. Ashley was very happy about being able to move her legs freely and still lightly feel the contractions while lying comfortably. So, she and Sam rested, but neither really slept. By 6 am Ashley was done resting. She was re-checked again and was 9 cm and at 7:38am, there was just an anterior lip. We positioned her to get rid of that lip, then since the epidural was so light, we had her use the squat bar to bring the baby’s head down more on the cervix. Even though Ashley couldn’t get out of the bed, she was able to do lunges, squats and hands and knees to help bring the baby’s head down.

Through all of this the nurses at Anaheim were amazing. They didn’t mind if Ashley was eating or drinking and were not strict about the monitor. If she needed to take it off she could and they found the wireless in the night when Ashley was in the shower. The nurses let Ashley do what her body felt best.

At 9:50 am Monday morning, Ashley started pushing. Pushing was exhausting for her. The epidural had been turned off by 9am but her contractions were not terribly strong and her pushing pressures were not strong. Ashley had to push mostly with her own powers and not much help from her body. This made pushing more exhausting and slow. About an hour or two into it, there was meconium, but the baby seemed to be doing well. Her heart rate
would drop during pushing, but the recovery was great if Ashley took a couple big breaths.

After 3 hours of pushing, beautiful Elizabeth Ann was born at 12:47pm. Her APGAR’s were 8 and 9. Mommy and Daddy were so excited and overcome with emotion. Elizabeth latched on about an hour later and was on her way to a great nursing relationship with her mommy.

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.
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.
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.
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.
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.
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.