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Tuesday
Jun272006

New Orleans VBAC Story

I stumbled out to the back porch and sat in the upper-90 degree muggy heat, cell phone in hand. As I dialed the phone, hot tears began falling. My apprentice was at a birth, so I re-dialed one of the very experienced student-midwives – the assistant at the last birth. When she answered, I began telling her how we’d been in labor for so long, how she’d been pushing for so long, how the baby was doing fine, how tired I was – by this point, I was blubbering and she asked me to slow down, take a deep breath and try to speak more clearly because she couldn’t understand me. A flood of emotion streamed out of my mouth and I could barely contain my distress at how tired I was and how worried I was my client was going to go to the hospital and be cut. Once again, the midwife asked me to slow down because she couldn’t understand me through the tears.

I took several deep breaths and began at the beginning.

I was called to check on mom right after midnight, but sent mom to the bath and to bed and left to sleep again myself. I was awakened at 4:30am and once I got into the house at 4:45am, I could tell mom was finally in true and active labor. Vitals were great, the baby sounded wonderful and mom wandered and moaned with the regular contractions.

Her two-plus days of prodromal labor had taken its toll on everyone in the house. No one more than mom, of course. We let her husband sleep for as long as he was able to and called the doula to find her way over to the house when she was able to (she has kids she needed to get to a sitter). Come to find out she’d spent the night awake babysitting some drunk co-workers and hadn’t gotten any sleep at all.

Wandering, leaning, sipping water, mom puttered around, moaning lightly with the contractions that were 2-4 minutes apart and lasting almost 60 seconds. She’d been watching and timing contractions so one of the first things we did was to cover the clocks. It was almost a symbolic gesture in that she never once looked at them again or even asked what time it was. Around 9:30am, I reminded her to take a medication she needed and she thought she was very late taking it, thinking it was 4pm or so. When we told her what time it was, that was the last time mentioned for the rest of the day until the birth of the baby.

Dad woke up somewhere after dawn and then the girls got up and were sent to a neighbor’s house for the day. They had a great time, coloring for mom, reading – having fun that wasn’t labor watching.

My client’s mom was up from the first time I was called over. She, a trooper throughout, was supportive and reassuring – having 8 kids of her own.

An amusing sidelight: All three of us – laboring mom, her mother and I all share the same first name. The birthing mama and I also share the same middle name! And it isn’t something usual like “Ann,” either. It got confusing with all the same names in the house, so I was nicknamed my name with _wife on the end to designate me from the others. Funny!

When the doula came over, she was exhausted. She grabbed a Coke, sat in the glider in the bedroom where mom was laboring and promptly fell asleep. She looked much like a toddler in a car seat… you know, when they are all curled sideways, hunched over, looking so incredibly uncomfortable, but they never wake up? That’s what she looked like. Tired myself, I shooed her out of the room about an hour into her nap. She then curled up on the couch, pillows on her head and slept 2 more hours. I teased her about it all afterwards. She said she never would have done that in a hospital birthing woman, but felt like there wasn’t a lot to do. That feeling is expressed often by doulas attending homebirths, especially the first few times.

Mention needs to be made of the client’s dogs. She has a Bouvier that weighs 105 pounds and a Staffordshire Bull Terrier – both of which are her dearest friends and a great support to her when she is scared or worried. Her first labor, she hugged the Bouvier for hours and expected to do the same this time. During some of her prodromal labor, she did in fact hug her puppy, but they merely stayed close while she was in labor, sometimes on the bed, other times at the foot of the bed.

The Bull Terrier seemed to have eaten something horribly rotten the night before and was sharing the foulest farts in the history of farts. When the doula woke up, she was barely coherent and the dog farted and the doula nearly passed out from the stench. All of our eyes were burning and the doula really did turn sheet white and sway. I was worried she was going to fall into mom so had her move to the glider rocker where she put her head between her legs. The farts were disgustingly amusing. Mom doesn’t remember smelling them at all! Let’s here it for LaborLand!

At one point on the toilet, mom wasn’t sure if her water broke, so I got out the nitrazine paper and it turned dark blue. Ayup. Amniotic fluid there.

Labor continued for awhile and it got to a point where mom was pushing, but nothing was happening, so I asked if I might do an exam to see what was happening. The baby was doing fine, but didn’t seem to be budging. An exam showed she was 9 cm. Light pushes for a few more contractions and then the urge was overwhelming.

For a midwife who tries hard not to do vaginal exams, this birth had more than its share of them. Something wasn’t right and I couldn’t figure it out. Over a several hour period, mom went from 9 to complete and +2 to 8 and -1 to 9 to a lip… it was the strangest thing. Frustrated that position changes, talking, wonderful pushes and her water breaking again, this time with a humongous gush that soaked me enough to send me to change clothes didn’t show any progression towards birthing. Fluid was clear again, baby sounded great, but I had exhausted my mind and ideas. It was time to call someone.

During the labor, mom leaned on dad physically and emotionally. He was loving and kind and her mom was equally loving and supportive. As time went on, however, I could see their growing nervousness which turned to agitation and then to franticness regarding the situation. I tried to calm them as best as I could, but my main focus was mom and trying to figure out what was going on.

It’s interesting writing this because in the moment, all of this wasn’t entirely conscious. A lot of this is an undercurrent of care as a midwife. I don’t remember thinking: Why is the baby stuck? at all. It wasn’t until I called the midwife and she suggested perhaps there was a cord holding the baby up that I was able to put into words my frustration and concern.

I so wanted her to have a VBAC. While I try hard to allow each woman to have her own walk, I also do have dreams and wishes for their births – the same as they do for themselves. After my sobbing talk on the phone, I pulled myself together enough to talk to mom in the tub (she was trying not to push for an hour to see if that helped the cervix issues). As soon as I got in there, she said she can’t do another hour. The baby had moved into a position that dug her feet into mom’s ribs and she was in excruciating pain. Two other points of stabbing pain on either side of her spine made it difficult to concentrate on the contractions at hand (she tells me later). The decision was made to transfer to the hospital.

I wept some, apologizing and they said it was perfectly fine, not to worry at all.

During the times we spoke leading up to the birth and even in the hours before labor began, we’d assumed that any trip to the hospital would be for a cesarean. It was a given. Later, mom tells me she never even had one iota of a thought that she’d have a repeat cesarean as we talked about going in. She isn’t sure where that belief came from – and her husband shared it – that it seemed odd to have me sad that we were moving to the hospital. She knew surgery wasn’t in the cards.

Then we set about getting to the hospital. I called the doctor, but her doctor (who’d said she’d come in for the birth and asked that she’d just come in before crowning, please) wasn’t on-call, so I spoke with the doc on-call. She insisted on talking to mom and it was then I knew we were really heading in and would be there in about 15 minutes.

Besides the cervical flip-flopping and stopping pushing periodically for a few minutes, she’d been pushing for 5 hours by the time we left the house.

Looking back, it’s so interesting to me that I didn’t even have one iota of a concern regarding the length of time she was pushing. I didn’t worry for her uterus at all. I worried for her stamina and peace of mind, but health-wise, I knew she was strong and healthy and could do this; I never had any doubt.

During the 90 minutes or so before transferring to the hospital, I could see the tension mounting in the grandmother and husband. Imploring eyes became nervous agitation and by the time mom was in the tub trying not to push again, I could tell both relatives had reached their tolerance-for-a-homebirth limit.

I prepped mom with the happenings in the car and how fast things move in the hospital, pokes, BP, temp, questions and more questions. She nodded her understanding, got in the car and I followed in the doula’s amazingly trash-filled car. I brought the birth stuff in case she delivered on the way. One can wish, right?

At the hospital, we entered in the ER and admissions had too many questions for us to answer. Fumbling, we finally found mom’s paperwork, told them she was pre-registered and said, “She’s going to have this baby right here if we don’t hurry up!” The security guard grabbed a wheelchair and nearly shouted, “Not down here she isn’t!” and took off with mom, zipping faster than any wheelchair with a laboring mom has any business going. The service elevator wouldn’t come, so we took the regular ones – they took so long, all of us old and fat people caught up enough to get into the elevator at the same time.

In L&D, the nurse who weighed twice what I do told us to go into the room directly across from the nurse’s station. The one nurse and an LPN were the only people there. When they were in the room, no one was at the desk. We never saw another nurse at the desk the entire time, even when grandma, the doula and I sat in the hall waiting for the doctor to insert the epidural.

When she got into the room, my client was handed a gown and she said she didn’t want one. What was very interesting about the gown experience is that it was a large-sized gown! The large gowns were the norm and the smaller gowns were the exception. How clever! The nurse didn’t seem concerned about the gown issue except in the door and curtain remaining closed to protect my client’s privacy. There really wasn’t anyone ever in the hallway, so it seemed, moot, but we were respectful and complied anyway.

The nurse, Jill (not her real name), assessed my client’s contractions quickly and pulled out a sterile glove after I told her she’d already had rupture of membranes with clear fluid. We could tell she was giving all of us the once over, who are these people? and she firmly, but kindly explained to my client she couldn’t call the doctor until she examined her. She didn’t even want to hear the baby’s heart tones until she’d done an exam, so my client, naked to the world, hopped up on the bed and had yet another vaginal exam. She was 8 cm and -2. This was the craziest cervix I’d ever experienced!

What could make a cervix do this back and forth trick? When I was crying and talking to the other midwife, she reminded me that short cords do this sometimes and they needed some bungee time to stretch enough to allow the baby to be born. While I’d heard of such things, I have only seen it happen once or twice, but nothing this dramatically. To go from complete and +2 to 8 and -1… well, that was just so odd. And it is important to note that her cervix was not swelling, either. She was completely effaced – an aspect that never changed. It’s just that there was cervix there. And then there wasn’t. And then there it was again. I was baffled.

When the nurse heard my client was a VBAC, she said, “So you want to do this naturally, right?” and my client burst out, “NO! I want an epidural!” Confused for a moment, I heard, “You want a vaginal birth” whereas my client heard, “You don’t want medication.” Jill quickly said the anesthesiologist was already on the way in for another mom, so she’d have to get the IV going quickly so she’d have enough fluids on board for the timing of the epidural.

As Jill moved around the room, I could see her trying to figure all of us out, too. Doula, grandma, dad, midwife and mom – all encouraging mom and helping her get comfortable. I didn’t want to seem too know-it-all, but I also wanted her to know I had the clue bucket in my hand. Before 10 minutes was up, I casually made a comment that we were a room full of nurses and midwives – (grandma is an RN) – and Jill visibly thawed.

Suddenly, there was something for everyone to do.

Jill went for the vein in mom’s left hand, but it blew (bad) and she had to move to the right hand. Dad was holding the gauze on mom’s bleeding hand and I stepped over there to take over so he could be with her without having to do clinical things. The nurse got the vein in her right hand quickly and I handed her the IV tubing and started it running.

Sitting here writing, it sounds so silly to mention the things I did – like I am some big shot or something, but that isn’t how I mean it at all. What I am sharing it all for is the aspect of how needed each of us was… how we all worked as a team. There was never any turf war between us at all. At one point, Jill said her job was to stay out of our way as much as possible so mom could birth. Huh? Where did she come from and can we clone her?

Jill asked us to put the pressure sleeve on the bag of Lactated Ringers and grandma began doing so. I looked at this piece of equipment and felt like I was in a foreign land. I’d never seen such a thing! I’ve always had to mash the bag to get it to run wide open. Who invented such a cool device? (I am not sure of the technical name for this sleeve, either, forgive me if I am calling it the wrong name.) Grandma hung the bag by the sleeve instead of the LR and it began slipping out, so the very tall doula replaced the sleeve over the bag of fluids and we pumped the thing up as high as it would go. The pump-y thing was just like a blood pressure cuff pump… I knew what to do with that. Once the contraption was working correctly, a liter of fluid ran into my client in less than 10 minutes. Wow!

Before long, the anesthesiologist wandered in – in tennis whites with Nike tennis shoes – he looked 12 from afar! (He really was about 50 when we spoke with him later.) Happily, the doula, grandma and I stepped out so mom could have the epidural of her dreams. She’d been phenomenal and deserved to have some pain relief. Those three stabbing points were still excruciatingly attacking her; she could barely contain her joy at seeing the doctor. The nurse had gone out for the epidural tray, a far cry from the epidural cart I am used to. The doc never gowned (that I saw) and came out of the room not 8 minutes after he walked in, mom in complete comfort almost immediately. I asked if she’d had a spinal (because those usually take effect so much quicker and are easier to place), but the doctor said no, it was an epidural. This was confirmed by the nurse later, too, when I was really confused by the lack of a pump or thread or anything. Apparently, I am not so hip on regional anesthetics.

In the hallway, we three sat in wheelchairs and they were all the extra-wide wheelchairs. Large-sized gowns? Super-sized wheelchairs? Was I in the land of the Fat-as-Normal?

The doula told us she had to go to work and wasn’t sure how to tell mom. Should she just go? I shook my head and encouraged her to just say it outright. She said if she was doing a regular doula job, she would never leave her, but being in such good hands, she felt she should go to work.

As soon as we all re-joined a now-chatty mom, Jill said the doctor was right behind her outside the door. The doula explained that she needed to go to work and mom was fine with it, so we lost one part of the birthing team.

When mom said she felt intense pressure, the doctor came in and was all smiles.

During the pregnancy, mom had another female doctor who’d paid lip service to having a VBAC. As the pregnancy progressed, however, it became more and more apparent that she really didn’t believe in my client’s abilities to birth vaginally. At one particularly disturbing visit, my client was told she wouldn’t be able to birth a baby bigger than 6.5 pounds out her very small and odd-shaped pelvis. The last straw for desiring change came when mom said she wanted to have a tubal ligation after the baby was born and the doctor was crazy angry that she wouldn’t just have a cesarean so she could do both at once and “not waste time.”

Finding this new doctor, who’d had two cesareans herself, she learned she had an 80% VBAC rate. The first doc said she could do that too “if she was picky” with the patients she chose. The new doc, however, takes anyone desiring a VBAC and works her ass off to provide just that.

My client had two prenatal visits with the new doctor before seeing her in the LDR. One visit was a pelvic exam that had the OB blinking in confusion as she said mom had a “perfect gynecoid pelvis” and would be just fine delivering vaginally. At the second visit, the doc asked if she planned on staying home for a good part of her labor and my client hesitantly mentioned her friend the midwife coming to be a doula for her. The doctor didn’t bat an eye and asked if I’d be able to take heart tones during labor and was told yes, I would. She then laughingly asked if my client could please come in before crowning – it makes things much easier.

As the doctor walked in, I said to her, “You asked that we come in before crowning… well, here we are!” She was a delight, introduced herself all around and asked how mom was doing. “Great now,” was the answer. The OB grabbed a sterile glove and did a vaginal exam saying the baby was so low! That mom was complete (she felt around for a goodly amount of time, surely checking the baby’s position, too) and a +4. What!? I looked down and saw no sign of a head. + 4? The nurse’s eyes bugged out of her head and the doc said mom could keep pushing and she’d be back in a few minutes.

So, the bed was broken (down) and we began helping mom push with the contractions. As she pushed, the heart rate was fine and dandy. However, when she stopped pushing, the heart rate began dipping lower and lower. Oh, that stinking cord again! We flipped mom on one side then the other and then just said, “It’s time to get the baby out.” I went to the desk to get the OB and she came in, gowned and said, “Let’s have a baby!”

Pushing, pushing and more pushing didn’t bring that baby down, but did bring the heart rate down in-between pushes. At first, the heart rate was in the 80s in-between contractions, but then would climb to 100 – 120 during the contractions. The doctor looked up and said, “It’s probably a cord somewhere.” Aargh! I was never more sure of that than that moment!

Calmly, the doctor asked the nurse to go get the forceps. Huh? They aren’t on the delivery table? I looked at the delivery table and saw how sparse it was decorated. Minimal instruments – something I’d never seen before this moment – lay on the sterile table… no forceps, no vacuum under the table… one set of suturing instruments. Interesting.

As Jill was walking out the door, the OB was gowning and another nurse breathlessly walked in and said she (the doctor) was needed for a stat section. The OB said she couldn’t go and the nurse said, “But they need you!” Looking at my client and the monitor, she continued gowning and said, “You’ll have to find somebody else, this baby is important, too.” This was yet another sign of the lack of personnel the hospital was working with. One of many.

The LPN sat at one of those hospital tray thingies and charted the whole time. She never got up from her seat and never said a word, just charted everything as it unfolded. Picture her quietly sitting throughout the story.

Jill came in with the forceps and the doctor asked her to alert Peds that they would be needed for this birth. Jill left as the OB clanked the forceps together to scare the baby out (sometimes just the sight of them is enough to inspire moms to push harder and faster). When Jill returned, she said that Peds was in with the section and they would come in when they were finished. This was nurse-speak for “We’re alone here.”

The OB asked me to go turn the warmer on for the baby, so I did that quickly and returned to mom’s left side. Jill was on her right, dad at her head above me and I am not sure where grandma was. Down near the bottom?

My client was pushing with all she was worth, even with the epidural, and the baby remained high and immobile. It was time for the forceps.

I’ve seen forceps used a lot, but never quite so skillfully as this time. The baby was absolutely not a +4 – was possibly at a zero station, perhaps higher. The OB was using mid-forceps on the baby – it was easy to see because of how much of the instrument was inside mom. Without an episiotomy, she pulled on the baby with gentle force and we watched as the baby did the same odd heart rate pattern of falling in-between contractions while climbing during pulling and pushing. The baby’s heart rate was dropping into the 70s, but wonderful Jill never said a word and all mom heard was, “Heart rate’s over 115.” It didn’t register that it was over 115 and that was great news, just that it was over 115.

Jill put oxygen on mom and I encouraged her to breathe deeply in-between contractions. She listened well.

Neither mom nor dad knew how low the heart rate was going and that was just fine and dandy to me. Dips into the 60s and the low baseline being in the 70s was typical. Climbing up to the teens during pushing and pulling happened every single time. The OB and I looked at each other and waggled our eyebrows. She chuckled and said “This baby sure likes to be pushed and pulled,” to which mom replied, “She better, you’ve seen her sister!” It was a light moment in a time of growing concern.

Forceps were used for 12 minutes that I counted. I had never seen them used for so long before. She never asked for the vacuum and she placed and re-placed the forceps 4-5 times. Miraculously, mom never had a perineal tear.

At one point, mom made a comment that went something like this: Don’t make my baby a Sylvester Stallone – and I shot her a look of, “Good GOD, don’t say something like that! That’s lawsuit talk right there!” Amazingly, the doctor nor the nurse understood that she meant not to paralyze her child’s face with the forceps and just thought she was talking about the oxygen. Later, I explained to mom that no doctor ever purposefully paralyzes a baby with forceps or anything else. Accidents happen. Sure there are negligent docs using forceps, but this wasn’t one of them. She wasn’t teaching an intern or allowing a resident to have a hand at the tool; she was getting a pretty darned depressed baby out of her body as fast and as safely as possible.

Once we could see the head – now at a +3 or so – then the forceps were removed and mom exhorted to push the baby out on her own. The heart rate was still doing its funky thing, but at least an end was in sight – and it was a VBAC end.

Instead of using the metal forceps, the doctor used her hands as forceps to help pull the baby forward and down. Goodness, this child was being a challenge!

As glorious as this doctor was, one small complaint is all I have, but I wasn’t in her head, so can’t really be all that mean about it. She started doing some incredibly aggressive perineal massage... easily pulling mom’s vagina and labia out about 6 inches from her body. Over and over, she pulled and pulled and pulled her body – I thought I was going to be sick, she was pulling so hard. I say I don’t know what was in her head, but perhaps she was nervous and wondered if there really was enough room. Maybe she was nervous and this was her way of tending to the fear. Maybe this is her normal treatment of a vagina. If so, ACK! If I ever get the chance to see her again and talk to her, I will surely ask her what was on her mind as she manipulated my client’s body so aggressively. Postpartum, mom’s perineum was bruised so badly it looked like someone took a baseball bat to it. I’ve seen bruising and I’ve seen swelling, but it was nothing like this. From leg crease to leg crease and clitoris to anus, a hugely purple bruise along with some grand varicosities helped to keep mom off her butt as it healed. She had been sitting at the computer before I saw the extent of the bruise and could see one of the varicosities bleeding and explained that if she didn’t get off her bottom she could very well end up back in the hospital with a hematoma or worse. It was all she needed to lie down, where she remains a week later.

The baby finally moved lower and we could all see her crowning. I encouraged mom to open her eyes to watch her baby be born, but she couldn’t see over her belly yet. She tells it that as the doctor lifted her head upwards, then she was able to see her child. I pulled mom’s arms out from under her knees and towards her vagina so she could bring her baby out onto her belly. As she did, it was so wondrous and I wanted to shout with glee. “She did it! She did it!” It was news for all to hear.

I ran to the warmer for blankets (I think the doc asked for them as she was being born) and covered her as soon as she was out and on mom.

A massive amount of meconium followed the baby’s entrance into the world and the baby lay flaccid and quiet on mom’s belly. Jill took the O2 mask off mom and gave it to me and I put it next to the baby’s face, being careful of her eyes (mom and dad saw that, yes, it was a girl). Both Jill and I rubbed the baby and I went to get new warm blankets and we changed them out. I called one minute, but Jill said we’d already passed it and gave the baby a 6. I laughed and said she was a whole lot more generous than I would have been. By the time we hit two minutes, the baby was still not happily breathing (very gunky), but her heart rate was a fabulous 140. She was still totally flaccid and her color, while not horrid, still left a lot to be desired.

Somewhere in there, the OB said, “Short cord,” and the cord was cut – she told mom, “Don’t worry, I waited until it stopped pulsating.” Mom laughingly told me she couldn’t have cared less at the moment, was flattered the doctor even thought of it. (I can’t imagine a cord being done pulsating in less than 2 minutes, however – unless it was pretty flaccid to begin with.)

Short cord.

Was she pressing on the cord in-between contractions and then lifting off of it during the pushes and pulls? We’ll never know, but it was very reassuring to know that it was, indeed, a short cord.

sigh

“Carry her to the warmer,” someone said and I grabbed the baby and had mom kiss her before lifting her off mom’s belly and walking her to the warmer.

Never before, nor can I imagine ever again, will I experience carrying a newborn to the warmer. Me, a non-hospital, un-insured, not-under-contract person being asked to do something so supremely hospital-oriented – yet another moment of internal shaking of my head wondering, “Is this for real?”

I turned on the suction and the nurse gave me the DeLee to hook up to the tubing and she began suctioning as I stimulated and changed the blankets yet again.

The baby finally began perking up, but remained pretty darned quiet. I called dad over because babies always respond much better to their parents than to their midwives and he was so loving to her, touching her hand and hair and talking to her to bring her into her body. She never really hollered like many newborns do, but she showed her irritation and left it at that.

I went back to mom and saw the doctor already beginning to suture. Mom had a deep first degree vaginal tear. (I watched some of the repair and would have considered it a second degree.) Even with all the manipulations and forceps, she never did have a perineal tear. What a testament to mom’s nutrition and tissue integrity!

The baby was wrapped like a burrito and brought to mom – did she unwrap her and put her skin to skin again? I can’t recall, but all of us were giddy with joy and I was oh so happy for the VBAC and the doctor was sewing and mom was happy and the baby was fine and there was still no one there from Peds or the NICU. Grandma was talking delightedly, dad was sweating and thrilled – and I sat in the chair and cried for a few minutes… tears of relief and release. I just needed to cry.

Mom asked if the placenta was out and the doc said it sure was, it had come out at 5:45pm… the birth, we learned, was at 5:40pm.

6 hours and 25 minutes of pushing.

Do I count it like that? Or do I count it from when she was complete in the hospital? If I were at all inexperienced with vaginal exams, I would question what I felt while we were still at home, but I know what I felt – I know she was complete and then not complete. I know she was pushing from before noon. I wrote in her chart that she pushed for 6 hours and 25 minutes. She deserved every second of that time charted and acknowledged.

Amusingly, when we got to the hospital, the doctor made comments about the baby coming fast… that mom had been 8 and then complete in a very short time. When we talked about labor really kicking in about 4am, she said that was still really great for a first time vaginal birth. We all kind of looked at each other and I wanted to blurt out how long she really had been pushing, but I kept my mouth shut and let her believe what she needed to believe.

We were all so tired. I’d not napped at all in the 15 hours or so of active labor and immediate postpartum period. Dad wanted to go get the girls, so he and I headed off about an hour after the birth. I still needed to go home, to their home, and clean it up from looking like a birth room. Oh, to have an assistant!

As a midwife, I have always worked with an assistant, usually another Licensed Midwife. When I knew I was going to New Orleans, it was one aspect of the trip that was cause for concern. My client had just the doula that we could tap into, but she’d only been to 10 births. While mom was an RN, she wasn’t an OB RN. She was game for listening to heart tones, though, but I never had a chance to teach anyone how to listen because I remained awake the whole time.

Being sick, I’d explained to mom and the family that there simply are times when I would need to sleep. They all knew this and it wasn’t a problem at all. Until labor. When I would try to go into the living room, even for an hour’s nap between listening to heart tones, I couldn’t get anywhere near sleep before someone came into the room and looked at me with frantic eyes and I knew I was needed once again in the birth room. Dad, trapped under mom, tried to sleep in-between contractions, but didn’t get much sleep either. No one but the doula and the dogs had a nap.

When I arrived, I tried to see if we might find another midwife so I could tag team as I am used to doing at births. It didn’t seem palatable to mom and the one midwife lived very far away. I never did call her. I simply thought about all the midwives who work alone and thought if I needed help, we’d just get our butts to the hospital. It’s the same as my not having oxygen – it was the first birth I attended ever without oxygen. Well, the birth did have oxygen; it was the labor that didn’t have any present. I figured, again, if we needed oxygen, then we were off and running to the hospital.

Remember my list I wrote of things to take to a remote birth site? Those are the things I had at this birth. Now you can look at my supplies through knowing eyes.

When dad and I were on our way home, mom called and said the baby latched on with a delicious slurp and hadn’t let go yet. Dad was so excited and tired, he almost ran into a car in front of us twice. I had to grab his arm to pull him from his reverie to stomp on the brake!

Once back to their house, I cranked the air, turned on the fans and cleaned up the birth supplies. I put my things away, sat and charted, changed the bed, started a load of laundry, washed the dishes and then took a shower and went to bed out in the RV I was staying in. And I slept.

Mom came home 2 days later (she would have come home the next day, but her leg was some numb from a tweaked femoral nerve).

At a week postpartum, she remains happy with the experience, still somewhat in disbelief at it all. Dad is happy… glad we went to the hospital finally. He said it was so difficult enduring his wife’s increasing pain. I told her I never really saw her as in pain, but just in kick-ass labor. She said she could have gone without the epidural just fine if it hadn’t been for the horrid three-point stabbing going on. Of course, with all the genital manipulations, it was a darn good thing she did have an epidural in place! Grandma is also very happy and so glad it turned out the polar opposite of the last birth experience. Mom worked so hard to create a birth team that supported her belief in a VBAC. I was so honored to be a part of that team.

She had her VBAC. Yes, she had her VBAC.

The baby weighed 7 pounds 7 ounces. So much for not birthing anything bigger than 6.5 pounds. I told her she should send the old OB a birth announcement with both mom and baby sticking their tongues out. While she won’t be doing that, she is going to send her a VBAC birth announcement.

She had her VBAC.

I am so proud.

Reader Comments (4)

This birth almost mirrors one of my own, except I am not a VBAC. My second planned home birth ended up a transfer after pushing 5 or 6 hours. I needed the epidural to stop pushing and allow a swollen lip to unswell. My holdup was a 10 lb 14 oz baby combined with pushing before I was fully dilated. After allowing the epi to wear off, I was able to squat and birth the child while I instructed the MD to hold the lip back. It still took another 45 min to birth that boy.

June 27, 2006 | Unregistered CommenterBekah

hmmm...I'm glad your VBAC went so well but why does some of this feel so familar?

June 30, 2006 | Unregistered CommenterOpening Pandora

Bekah: Wow on the baby's size! You go girl! I am thrilled you had a vaginal birth. Sometimes it seems like the luck of the draw whether a doc will linger over pushing or if 2 hours is the outside limit they will take. I wish more would chill and allow a baby to come down and out - doubt that's going to happen anytime soon, though.

Pandora: I'm not sure what you mean? Did you have a birth like this? Does one of my other birth stories sound like this? Care to expound?

June 30, 2006 | Unregistered CommenterNavelgazing Midwife

Baby probably liked the contractions because it brought the fundus down and reduced the resistance on its cord.

So glad to hear that everything worked out beautifully.

July 7, 2006 | Unregistered CommenterBean

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