Monday, August 10, 2009

C's Birth Story

C was someone who I had been seeing for most of her pregnancy so I was really hoping that she would go into labor when I was on call. I would really have a good time with her and her significant other when they would come in for visits. She was planning a natural childbirth and I was very excited to support that. This would be their first child. Unfortunately things didn't go quite as we all had hoped they would...such is the nature of labor and birth!

C came in at about 41.1 weeks with SROM (spontaneous rupture of membranes) during the weekend I was on call. However, her labor hadn't really kicked in yet. She was contracting about every 4-6 minutes or so but feeling very mild discomfort with really just early labor. She was 1-2/60/-2 according to the nurse. That was pretty much the same exam as she had been in the office the day before. I was a little disappointed to hear that as I hate the whole water breaking before labor has really kicked in thing! It makes for a very long day for mommas.

The baby looked great, so the plan was to just wait for her labor to kick in. C did her thing - she walked, used the tub, the birth ball, and seemed to be getting more uncomfortable as time went by.

Once we hit the 12 hour mark from the time her water had broken, we decided to check her progress. Her exam was now 3/90/-2, which was good progress. I reassured her as I think she was a little discouraged. I explained that early labor was often the longest portion of labor and that she had made good progress. So C continued to do her thing. D, her significant other, stayed at her side throughout all of this and was providing great support for her. I was running back and forth between C's room and another woman who was also going natural.

C continued to labor, working hard. She would walk, then use the tub. I would rub her back with yummy lavendar scented massage oil. After about three hours had gone by, we decided it was time to check again for progress. I had really hoped that she had made some great progress as I could tell she was getting a little tired. She hadn't had much sleep the night before since her water broke during the night.

Her exam was 4/90/-2...very little change in the past three hours. Yet she was having contractions every couple minutes and they felt moderate. I was a little surprised. C was very discouraged at this point. After all, she had been laboring for many hours now. But she had been handling things so well. Unfortunately, she was so tired she opted to get an epidural, so she could get some rest. We also discussed the use of pitocin to augment her labor and they agreed with to this as well.

So C got an epidural. Once she was comfortable and relaxed, the nurse started the pitocin. I encouraged C to get a nap as she would need her energy for later. After a couple of hours had gone by, I was planning to check her cervix with the intention of also putting in an IUPC (internal uterine pressure catheter - long flexible tube that goes in the uterus around the baby and can measure the actual strength of the contractions) as contractions were difficult to trace. Mommas with epidurals need to be repositioned frequently, and side-lying positions tend to help baby make their way. With pitocin, it's important to know when a woman is having contractions as the medicine is titrated based on that. We don't want to overstimulate the uterus since babies tend to not like that! When I checked her, to my surprise, there was a BBOW (bulging bag of water)! I hadn't felt membranes previously so was definitely caught off guard. There are actually two membranes very close together. Sometimes the outer membrane (chorion) will develop a leak. But the inner membrane (amnion) remains intact.

So I broke her water with her consent. Her exam was 6/100/-1. Everyone was happy that things seemed to be moving along. She had been ruptured now for quite some time and remained afrebile (without a temp). We had given her a couple doses of antibiotics also (she was GBS positive).

Time went by...C rested...I had to go into the OR for a couple emergency sections with the doc on call with me. When I came out of the second section, C had just started pushing. She had begun to feel pressure and so the nurse checked her and she was completely dilated.

C had some work ahead of her to push her baby out. I suspected a baby that would be close to 9 pounds...but I can really suck at guessing baby weights sometimes! I stayed in the room with her, D, and the nurse while she pushed. She was an excellent pusher, got it down right from the git-go. She made slow but steady progress. She pushed for awhile sitting semi-upright, then we went to one side for awhile. Then the other side for awhile. Then back to semi-upright. She finally 'rounded the corner' and delivered a beautiful little girl, weighing 8 pounds 7 ounces, after an hour and twenty minutes of pushing.

C got her daughter latched on to the breast, and all were happy :)


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