J was sent over from the office to the hospital for a NST (non-stress test) and to check the fluid around the baby as she was 41.2 weeks pregnant. The plan was for her to come in the next morning to have her water broke as a means of getting labor started. Her cervix was 4cms in the office that day with the baby's head quite low in the pelvis. Diane had called me to let me know she was coming. Diane would be on call the next day.
J had previously had epidurals with her other children. From what she told me, it sounded like she would get to transition then was offered an epidural, where her response was yes. Then she would deliver 30 minutes later. Her previous children were all caught by doctors. She very much wanted to do this natural.
When J arrived and was put on the monitor in triage, I was a little concerned. I didn't like how the baby's heart rate looked so opted to just keep her for the night. Well, I may have jumped the gun because once she came back to L&D, and was on the monitor, the baby looked fantastic. She was also contracting about every five minutes but feeling just a bit crampy with them. I asked her what she wanted to do...stay and break water tonight, stay and do nothing tonight, or go back home. Her and her husband had already made arrangements for their other children (a set of twins and a singleton) and they lived a fair ways away. She decided to stay.
We discussed breaking her water versus not, and she decided to have me check her first. Her husband wasn't there yet but would be in about an hour. She asked if breaking her water would cause her to deliver before he returned. I told "oh no, you won't go that fast!".
Famous last words.
She was 4-5/100/0 when I checked her so she opted to have her membranes ruptured. We even waited until after the nurses' shift change (maybe 20 minutes) before we did it. Once her water was broke, I asked her to walk a bit. She was also looking forward to getting in the tub and trying the birth ball. I went to do some paperwork and saw her walking a bit in the hallway. In hindsight, she looked a bit out of sorts, but at the time I didn't think too much of it.
A few minutes later she went back in the room and the nurse came and asked me if she could have something to eat as she was feeling light-headed. I went in to check on her and she was sitting on the edge of the bed. She told me this was what she didn't like about labor last time either...I suggested some protein as well as carbs. I told her I would be right back to check on her. I went to another patient's room to check in on her. While I was in there the nurse came and stuck her head in the door to tell me that J was asking for an epidural.
I was like "what???" She was doing fine when I had just been in there. So I tell the nurse not to do anything, I'm coming to check on her first. When I get to the room, she's still sitting on the edge of the bed. She tells me I can't do this. Then she grunts and bears down.
I'm thinking "what the heck?" I told J, let me check you before we make any decisions, you haven't tried the tub yet, and it sound slike you are getting close. She was spontaneously bearing down with each contraction. I checked her and she was 9 and a half cms! I said no epidural. She wanted to get in the tub so she squatted in the tub. I sat at her side holding her hand. I started worrying that her husband wasn't going to make it. I don't think she was in the tub more than 10 minutes when she started pushing again. She told me that the baby was coming. I checked and she was certainly correct - she was completely dilated and the baby was at a +2 station. I asked her if she could get out and maybe squat by the bed for delivery (we aren't supposed to do waterbirth although if she hadn't been able to get out, oh well). She was able to move over by a chair in the room. My thought was that she could lean on the chair and I would catch the baby from behind. Not quite how it worked out.
She squatted while I sat on the floor. She had one arm around my shoulders with her other hand on my leg for support. The nurse stood near by, not really sure what to do. She wanted to listen to the baby's heartbeat but I said not to worry about it, we could listen when the baby came out. I could not see what was going on as my head was crushed against J's chest. It was kinda funny :) I kept talking her through her contractions. She would talk completely normally in between contractions, asking what to do. I had one hand at her vagina, where I could feel the head crowning. She slowly and gently pushed the head out. It was such a thrill to not be able to see what I was doing but feel the head being born into my hand. We had a little trouble with the shoulders but nothing that wasn't remedied by me getting both hands involved. She gracefully pushed out the rest of her baby. I brought the baby up to her arms and the nurse threw a blanket over them. The baby was doing absolutely fine as was momma. We helped her move to the bed where she could rest while latching the baby on to the breast. Her husband walked in literally five minutes after the birth.
She pushed out her placenta just as gracefully. She had just a small perineal tear requiring no stitches.
Congrats J on a beautiful birth!