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Saturday
Jan242009

Precipitous HBAC

I was the Monitrice for a client who wanted a VBAC. As a Monitrice, I go to a mama’s house while she is in early labor, hang out with her, listen to the baby, do vitals on her and do vaginal exams if warranted/wanted. I then move with them to the hospital, being their doula for them there. After the birth, I see them at least a couple of more times for closure. 

So, this woman worked through her pregnancy to prepare for her anticipated VBAC. For her first birth, she had a cesarean for a placental abruption and severe fetal compromise. Having prepared for a natural birth with a CNM, she was terribly traumatized by the birth and had a horribly long and painful recovery. She needed this time to be different. 

As the birth came closer, she was more and more concerned about her ability to cope with the pain of labor. A hypnobirthing convert, she was worried because she didn’t practice during the pregnancy, but found she was able to quickly fall into the relaxation of it all. 

With each day, she worried more about labor... she didn’t know what it was like at all... and had many typical first time mom worries. She did, however, tell me that she struggled with the practice surges and as they came upon her, she would immediately stop what she was doing to stop their progression. I reassured her often, giving her the image of a waterfall and when the surge came, to walk towards the waterfall... that the surge was the sprinkling water and the birth was on the other side of the waterfall. She said it helped her a lot to be able to picture that. (Sometimes I come up with new imagery – this was one – and they seem to fit perfectly for the woman I am speaking with.) 

My client emailed me yesterday morning, letting me know the surges woke her up about 4:00am, but they were about 10 minutes apart – and she was able to BE with them. I emailed back how thrilled I was for her and that I was close, to call me whenever she wanted to talk or have me come over. 

I showered, got dressed in my pretty new scrubs (I don’t wear scrubs unless I go to the hospital) and hung out on the recliner. All day. I talked to her a couple of times and the contractions were still about 10 minutes apart, she went about her day, doing errands for a couple of hours and being with her 3.5 year old daughter and live-in mom. Dad was at work where she thought he should be so he didn’t worry about her too much. 

During the early evening (about 8pm), I asked mom if she wanted me to come over to check on the baby and be with her for awhile. She said they were still about 10 minutes apart, so she didn’t think it was time yet. I let her know that if labor kept going until morning, she might want to take a nap. I said she could take one Benadryl or a glass of wine (not both!) to relax the uterus and take a nap for as long as she could. She went to lie down. 

I got a call from dad at 10:45pm asking me when they should call. He said he was looking for something concrete and he told me she was still resting in bed. I let him know that labor would eventually get her out of the bed and that would be the perfect time for me to head over. 

At 11:04, he called again saying she had gotten up onto the toilet and could I please come. Absolutely! 

At 11:24, when I was already on my way, I got a call saying she wanted to push and I could hear her HOLLERING in the background. I was easily 20 minutes away. Because she was going to be a hospital birth, I told dad to call 911 and I was flying there. 

Driving 90 mph (on empty roads, blessedly!), I called dad again at 11:35pm. I could hear mom howling through contractions that were quick in succession. Dad said he thought the ambulance was already at the gate, but the gate wasn’t opening (it is a gated community)... I knew then that I would meet EMS at the gate – and I did! I was right behind the ambulance as they physically lifted the gate up. The fire truck and ambulance went so flippin’ slow I nearly had heart failure from their lack of speed. Down through the complex, s l o w l y going over every speed bump... it drove me crazy 

When we got to their house, I zoomed around the ambulance (and they screamed at me about it, too) and ran in with the fire department folks. (Running. On a broken foot. Eek! I didn’t even think about my foot for a second.) I pushed past them in the hall (one holding the screaming older child) and met a fire fighter in her bathroom, telling her to get off the toilet. She fell to her knees and crawled to the bed where I met her. 

She got onto her hands and knees on the bed and said she did not want to move! “Please don’t make me lay down!” I told her she was perfect right where she was. One of fire fighters asked, “She can have the baby like that?” “Absolutely!” I answered. 

While this is happening, EMS is asking a hundred questions and I am letting them know I am her midwife, but she was going to deliver in the hospital, not at home. Mom pushed and there was head showing, membranes intact. I quieted everyone down, and continued answering questions as I soothed mom inbetween contractions. During the contraction, she would holler, “Don’t leave me! Don’t leave me! Don’t leave me!” clinging to her husband. I cooed and sent her love. I asked one of the EMTs for a pair of gloves and a pair appeared in front of me. I put them on. 

The EMS folks were baffled about what to do. Stay? Go? I asked mom what she wanted to do and she shouted, “Stay here!” EMS said they had some things to do anyway and I welcomed them to do whatever they needed to do. One guy said he needed to vitals and I said, “Wow! That would help me a lot! Please go right ahead.” I think they freaked out that I liked them so much. 

The captain came up to me and picked up my hanging nametag (that I have NEVER worn until this moment!) and wrote down my name. I told them I was licensed by the Medical Board of California and absolutely licensed to do this. He asked, “So, this isn’t one of those couples doing it on their own unless something is going wrong?” And I told him, “Absolutely not! She totally meant to birth in the hospital!” 

When contractions came, we all quieted, she howled and I soothed. And the head appeared more and more. Inbetween, she offered her arm for vitals, one guy tried to put oxygen on her (??), but they handed me the mask and tubing saying, since you don’t have any oxygen... and I said, “I do, too! It’s in my car with all of my equipment.” A female EMT said, “Can I go get it for you?” I was so thrilled! Not having an assistant, EMS became my other pair of hands. 

Miraculously, my equipment appeared, but not my doppler which was in a different place (Donna, my apprentice, had set it up with the BP cuff, etc. in a smallish container so I could carry it around in my Rollator) and I quickly ran out to get it. (Yes, ran again.) 

I got fetal heart tones (the emergency folks were impressed!) and the baby’s heart tones were 140. Absolutely spot on! I ended up getting them twice while EMS was there... the captain spending a few minutes telling me that if they left, she would be signing AMA, that we understood there was a risk of complications up to and including death... I acknowledged everything he said. At the same time, another guy is leaning over to my mama asking, “You had a normal delivery last time?” “Yes,” she says. “No surgery?” “No!” “Everything is normal in this pregnancy?” “Yes.” (Later said she knew damn well what she was saying. Her husband said she was lucky he didn’t hear that conversation!) I peripherally heard it since I was so busy answering my own questions. 

The captain also made sure to tell me to call at any time if we needed them and I said I absolutely would not hesitate. That I appreciated them so much. Thank you, thank you. 

The guys and gal gathered all their belongings as mom began howling, “Don’t leave me! Don’t leave me!” again and one guy hesitated and I smiled and said, “She means us.” 

As they walked out of the room, her perineum bulged the same as it had been – and then the baby crowned, the head was born (in the caul!), the shoulders and torso came (in the caul!) and all at once, the baby was OUT! The EMS folks couldn’t have even made it to the living room before the beautiful 6 pound girl was born at 11:59pm on January 23, 2009. I pulled the amniotic sac off, from waist to crown, and she gave a lusty holler that lasted all of about 5 seconds, then she quieted, turned beautifully pink from head to toe and looked at her mama who quickly turned onto her back and picked up her baby. She was absolutely stunned. I smiled and laughed and told her over and over that she had an HBAC! Her husband was wonderful! He was so excited it had gone so fast and well. 

It took mom a few minutes to get into her body again, but she cuddled her wonderfully alert baby, looking at her and looking at me – and then the baby... as if she was thinking, “What happened here?” 

I watched her bleeding, wishing my Donna was with me – sent grandma out to get my phone in the car and woke her up, asking her to please come help me. Until Donna got there, I monitored mom’s bleeding, watched the cord, listened to the baby who remained silent (she was perfect!) and once mom wanted to push the placenta out, lifted it out of her vagina. (Mom had asked if she needed to get up to deliver the placenta and seemed relieved when I said she did not at all... that I could get it easily from where she was.) 

The room was a chaotic mess! Donna is truly my right hand and with my now aching foot, I moved only when I needed to. In order to get the baby higher on mom, I had dad cut the cord (where was that cord bander? I had to use one of those goofy plastic cord clamps). 

Donna got there within 10 minutes of my calling her (goddess bless her for speeding, too!) and after meeting the family, jumped right in doing what needed to be done... cleaning up mom, moving the placenta to the sink, cleaning up the towels I’d asked dad to get me and used and all the while, we replayed the birth over and over, talking quietly about the commotion there was for awhile, yet how beautifully focused she remained through it all. 

Over the next three hours, we did our usual postpartum care, doing the newborn exam, making sure mom was stable, cleaning and giving a LOT of information since this couple had not had the nine months of homebirth preparation the rest of my clients get. We did all of this without a birth kit, without the typical homebirth goodies we use (like peroxide and Chux pads... although they did have puppy pads, so we used those!). I will be bringing over a birth kit this evening to get her the cord care and peri-bottle, along with anything else she might need out of one. 

As Donna took my midwifery kit and oxygen back out to the car, we prepared to leave, seeing a hugely smiling woman and her equally happy husband. Grandma came and went, bringing food and drink for everyone and as we retreated, I laughed and laughed at the joy this birth had been. 

Talking to mom this morning, she is still as high as can be about her HBAC. 

So, so proud of her. From fear of surges to doing the entire labor and most of the birth alone inside her Self. 

What a joyous day today is.

Reader Comments (20)

How wonderful! I hope my own (hopeful) HBAC goes so well! Minus all the guests, that is. ;)

January 24, 2009 | Unregistered CommenterStassja

I wish for you a peaceful HBAC, too!

Mom, tonight, was flabbergasted that she'd had an HBAC and a baby born in the caul - on her due date! So many rare occurences all with one baby.

She is still so flippin' thrilled. I had tears from enjoying her high!

January 24, 2009 | Registered CommenterNavelgazing Midwife

That is absolutely beautiful and reminds me in some ways of my friend kat's birth story.

http://www.karlandkat.com/2008/06/this-was-not-birth-plan.html

January 24, 2009 | Unregistered CommenterMaria

That story was so similar, it was eerie! Thanks for sharing it... I left them a msg on their blog. Great parallel story!

January 24, 2009 | Registered CommenterNavelgazing Midwife

YAYYY for HBAC, even unintentional ones! That is one awesome mama! I bet the EMS will be thinking about this night for a long time!

January 24, 2009 | Unregistered CommenterJill

Amazing story. Loved the EMS people.

January 25, 2009 | Unregistered Commenters

I didn't even think of how EMS will see it! That is a cool thought!

January 25, 2009 | Registered CommenterNavelgazing Midwife

Yay for your birth, Barb! I've tagged you in a 25 Things about Me post. Please see my blog if you'd like to play along!

http://studentnursemidwife.blogspot.com/2009/01/25-things-about-me.html

Amanda

January 25, 2009 | Unregistered CommenterStudent Nurse Midwife

THANK YOU so much for posting that birth story! What a phenomenal job everyone involved did! I'm the HypnoBirthing practitioner that taught this couple & I'm so glad that Barbara was their monatrice. I knew they would have a great birth because of the techniques they learned but mostly because Barbara was going to be with them. They missed the last class & were super busy throughout their pregnancy due to travels & a toddler, so they didn't have a lot of time in their schedule to practice the HypnoBirthing techniques. It sounds like the mom & dad got out of the class what they needed though & then the additional (incredible!) support of Barbara made all the difference!

January 25, 2009 | Unregistered CommenterCarol Yeh-Garner

Fab story - love it love it love it!!!!!

January 26, 2009 | Unregistered Commenterciarin

Great post. I love it. It was all about destiny and fate. I am so happy for them and happy for you. Have you thought about what might have happened had she said her first was a c/s?

January 27, 2009 | Unregistered CommenterKelly

thanks for the comment - great story!!! birth stories never fail to surprise and inspire me!

January 27, 2009 | Unregistered Commenterkat

Just love this story, the mum will be floating on a high for a long, long time, and will be a great advocate for home birth :0)

January 28, 2009 | Unregistered CommenterLeanne

WOW! Amazing HBAC! I am so proud of her!

January 28, 2009 | Unregistered CommenterRandine

I'm so glad you were there for this family. My second child was an unintentional, unattended homebirth and I so wish I'd had a backup midwife to take care of us instead of going to the hospital to be yelled at. We called EMS, also, but such was my disbelief that I coudl really be labor with so little discomfort that we left even that late and baby was born into one of my bath towels with my dear friend catching (she'd come to be with my 6 yr old son at a planned hospital birth with a CNM.)
Bravo to this mama and family, and to you for helping them have a lovely birth.

January 28, 2009 | Unregistered Commenterdoctorjen

How wonderful! Great job everyone!

February 2, 2009 | Unregistered CommenterKneelingwoman

that is so simular to my hbac a few days after hers, it brings joy to my heart that she had such a beautiful birth... mine is minus the emergency crew though :)

February 7, 2009 | Unregistered CommenterJenn

That was a WONDERFUL birth story!

February 9, 2009 | Unregistered CommenterJanuary

What a beautiful story. I hope that when I get to go into placement I will have some of my own. Thanks!

February 16, 2009 | Unregistered CommenterTwo Hands

Wonderful birth and so happy for the momma getting an HBAC!

Thank you so much for talking about it taking the mom a while to get back into her body. It perfectly describes how I felt after the birth of my son and I kept thinking there was something wrong with how stunned I felt those few minutes post birth rather than taking joy in my son (3.5 hour from AROM to birth, labor 'starting' about 45 min after AROM). Definitely feel it was partly due to labor being so quick and partly due to going from pain disapearing so quickly.

May 21, 2010 | Unregistered CommenterDanielle

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