Birth of Baby J!

Before reading this birth story, please see my previous BLOG POST on the birth stories that I tell here.

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A beautiful baby boy was born last night!  He weighed in at 8 pounds 10 ounces and a whopping 22 ¼ inches long! (and boy is he a cutie!)  The parents not only gave me permission to share their story, but actually REQUESTED it by saying to me, “I can’t wait to see your blog about this!”

So let me tell you a story…

It didn’t surprise me when she went past her due date – it almost always surprises the first time mom when she sees her estimated due date come and go, but not me.  It’s pretty common that I sit in my office with a mom 37 pregnant with her first baby and she declares that she doesn’t think she’ll make it to her due date because she is feeling full and has started feeling Braxton-hicks contractions and, most importantly, she is “done”!  I smile and don’t correct them – after all, there have been the exceptions to the rule, those mothers who actually do have their first babies before their due date – but the “rule” is that they will see their due date come and go and they will still be sitting with me at their first appointment after their due date has passed and be frustrated and say to me that they can’t believe they are still pregnant.

By 41 weeks, she was still trying her best to be patient – but couldn’t hide how anxious she was getting and how much she was ready to welcome her baby. An internal was requested and she was not dilating at all yet and barely 50% effaced.  She was disappointed, I know…but (and this makes me laugh) had read my blog post on internal examinations and knew that she shouldn’t put too much stock into it.

At 41 weeks and 2 days she started having very mild contractions – and by 41+3 they were starting to come much more frequently and much more strongly.  For days she dealt with these contractions – getting stronger, then fading down, coming more frequently, slowing up…..trying to rest but finding it almost impossible.  It’s what we in the birth field call “prodromal labor”….a very long early labor phase…and it always ALWAYS makes me wonder what position the baby is in as it’s frequently a sign that baby’s not in the best position and these early labor contractions are working to try and get baby moved into a good position before kicking up and becoming active labor.  I did ask her how she felt the contractions, how the baby was moving, did she feel that the baby was still in the same position…and she felt everything was okay and was able to eat and rest some, so my job became one of patience and letting her body and baby do what they needed to do.

41+4…41+5….now it’s Easter Sunday and she had been having contractions for 3 days that were interrupting her sleep and making her miserable.  I finally offered to come over and do an exam so that we could make a decision – do we actively try and slow things down for a night so she can get some sleep (I was getting VERY worried about her level of exhaustion) or do we try and speed things up.  I was anxious to see what was going on, too!  So finally, on Easter evening, I went over.  Baby sounded great, everything was healthy….and finally, the internal exam (cue suspense music)!

5 cm and 100% effaced cervix!!  WOWIE!  I don’t know who was happiest as I think everyone was relieved and happy.  As much as I wanted to I couldn’t feel the position of the baby’s head (my concern because of the days of contractions) because there was a bulgy forebag of waters and the last thing I wanted to do since I was concerned about baby’s position was accidentally break her bag of waters.  I could feel that the baby was still sitting a little higher on her bones, which just confirmed that I didn’t want to mess around in there too much and give this baby as much opportunity as he could to move into a good position.  Mom at this point was OH MY GOSH my hero!  She was walking around, smiling…you could barely tell that she was in labor!  I was simply amazed, in awe of her and all that she had already been through and what good spirits she was still in!

Mom’s doula was called in and arrived shortly after.  As can happen, my internal exam caused things to strength a bit and mom said with a smile that I took her happy away as they got more intense.  She labored with her doula for hours, surrendering to the Vita Mutari and enjoying the freedom that the birth pool she had set up in her bathroom gave her as she floated in the water.  We monitored the baby, but that’s how things stayed for the next several hours – mom in the water with dad and doula supporting her, me and Kate (student midwife) in the other room only occasionally checking in to make sure baby was still happy and all was well.  We smiled when we heard mom start to grunty push some, and waited to hear the progression into full on pushing.  When we heard her push with force, we were poolside and monitoring more closely.

As I would normally do, I instructed mom to just listen to her body and do what it tells her to do.  She was only doing one good instinctive PUSH at the very peak of the contraction, so I wasn’t worried about checking her yet.  When I failed to see changes to her that I would expect and she was no longer able to control the urge to push, I asked if she would mind if I check to see if she was fully dilated and see what was going on – she didn’t mind at all.

This is the turning point, in my opinion.  Right here…right now.  This is where her story changes…you know when you look back and can point to that one moment where things take a drastic turn for the better or worse?   Yup, this was that moment.

I checked her and found a VERY swollen cervix, 7cm dilated, could feel the bulgy bag of waters still but could also feel that the baby’s head had moved down dramatically, although I still couldn’t feel for position through the bulgy membranes (it’s like trying to feel a dolls head with a water balloon sitting on top of it).  My heart sank – my student said that she saw a flash of “something” in my eyes and she knew that I didn’t like what my fingers felt.  I did not.  I did not like it one bit.  I don’t often do this, but I made an executive decision and said, “There’s still cervix here all the way around, you’re at 7cm.  I want to break your water with my fingers if I can because I really really do not want you pushing, okay?”  She agreed and I poked with my finger and it easily broke.  Puffy cervix, definitely 7cm dilated – and it was 3am, a full 7 hours after I’d checked her to be 5cm.

I asked her if she would mind getting out of the tub so I could get a better check and see what was going on inside with the baby and I could do it so much better out of the tub (and also, since her water is now broken, I didn’t want to do a ‘thorough check’ in the water.  She agreed and we got her out and dried and onto her bed – and what I had feared was true….baby was in what we call “deep transverse arrest”….in layman’s terms that means that the baby’s head was coming down straight sideways (facing mom’s hip) rather than facing either forwards or backwards.  So many people fear having a “posterior baby” – but those babies, while more challenging, still come out vaginally all the time…but when they are looking at mama’s hip?  Those babies rarely are able to make their way out and the pressure of the baby’s head sitting on the pelvic bones so tightly trapped and pushed on that cervix, it just swelled up.  We had a conversation where I explained to them what I felt – puffy cervix, got a good feel of baby’s soft spots and knew he was facing her left hip, we had to get baby into a different position or he wouldn’t come out this way.

Mom got up onto her hands and knees, rocking her hips, while I pressed on baby’s head with a finger to try to dislodge baby’s head from the pelvis so that he could move into a better position….I could feel mom had plenty of room to birth this baby if he would just pick a direction!  I could feel that baby’s head had a swollen spot on top (called a caput) and that, above anything else, concerned me the most…because it’s really hard for babies with heads like that to change position.  This mom bravely worked..and worked…and worked.  From 3am until 8am she worked, breathing through contractions, changing positions, swaying, moving, more positions, then grunting through contractions…finally struggling against an uncontrollable urge to push that she could do nothing about.

And she was still 7cm dilated, caput on the baby’s head, puffy cervix, baby was still looking to the side….and my heart was heavy.  I knew what was coming, I think everyone did….baby sounded GREAT and we didn’t have any medical concerns at this point – but this wasn’t working.  At 6am I explained to them that there hadn’t been any change, and while there wasn’t any medical concerns so she could choose to keep trying what she’d been trying (continue to try position changes and movement and everything else we were doing)…I didn’t see it making any change at all.  For 2 more hours she rocked and moved and breathed….while her body pushed (while she apologized TO ME, poor thing…like it was her ‘fault’ her body was pushing??  Of course not!)

At 8am we revisited the previous conversation – still no change, baby sounded great but without any change and with these issues and blah blah blah…..I think we’ve done everything we can do at home.  We can keep going, but things aren’t changing.  This is the only time I saw mom break down….and would be the only time.  She got tears in her eyes and showed how disappointed she truly was at transporting to the hospital.  All her hard work…*sigh*  She agreed that the hospital was the best options at this point.

At 8:15am I made some phone calls, got a doctor that I have a good relationship with to assume care, and at 8:30am we headed to the hospital.  They checked her – 7cm, puffy cervix, caput on the baby’s head – and mom’s body still pushing with each contraction. She requested an epidural (and made it VERY clear to everyone that it wasn’t because of pain, it was because of fatigue and this urge to push!) – she got an epidural and rested.  I left the hospital at 11:15am so she could get some rest.  I got some lunch, attended a few prenatals, and kept in touch with them by text messages.

Hours go by – no change.  They start Pitocin, baby’s not as reactive as they would like to see, mom has an enormous contraction with baby’s heart rate decelerating, so they stop the Pitocin.  Mom starts to run a fever, they start antibiotics.  Dr finally checks on mom at 6:30pm and declares mom 9cm with a swollen puffy cervix and baby with a big caput on his head.

15.5 hours she hasn’t really made any notablel progress, baby’s no longer looking as good, mom is running a fever and now it’s 101.5 under the arm.  Over 15 hours this mom has struggled, fought, worked for her baby.

At 6:40pm the decision is made to do a cesarean.  At 8:31pm a sweet 8 pound 10 ounce baby boy is pulled out of her belly and into the world.

I wasn’t there for the surgery as only dad was allowed in – but it was relayed to me that baby scared them for a little while.  Baby’s APGAR scored were 2 at one minute, and 8 at 5 minutes.  They there was meconium present (clear fluid until the surgery) so they used a laryngoscope to make sure vocal cords were clear (although poor traumatized daddy thought they intubated baby because people weren’t explaining to him what they were doing).  There was also a pretty notable infection present in the uterus (which means mom did not get her placenta for encapsulation like she’d hoped).  Baby came out with a caput on the top of his head where he had lodged himself into her pelvis.

I am simply in awe of this family – and wish that things could have been different for them, but know that everyone did the best that they could!  Looking back I don’t know what could have possibly been done differently, I really don’t – and I’m not sure at this point that it matters all that much.  Everyone worked hard (especially mama) to bring this baby into the world, the family is thrilled – not that they had to go through what they went through, but that they were respected and given every opportunity to do this how they wanted.  I am proud of them…and lucky to know them and their son  (and he is such a little cutie….yummy cheeks you wanna snuggle into!)