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!
Showing posts with label natural. Show all posts
Showing posts with label natural. Show all posts
Thursday, October 15, 2009
Saturday, August 8, 2009
I Can't Do This - birth story
S was scheduled to come in for an AROM induction (where the membranes are ruptured to hopefully bring on labor) the following day as her cervix was very ready at 4/80/-1. This would be her third baby. She had epidurals with the previous two but was really wanting to have natural childbirth this time.
S came in the day before the induction was scheduled with increasing contractions that felt stronger. Her exam was basically the same so I offered to go ahead and break her water, which she promptly agreed to :) There was clear fluid and the baby was quite the happy camper so I sent S off to walk. I wanted her to wait until the contractions were becoming more uncomfortable before using the jacuzzi tub. She walked for a bit with her boyfriend and I attended to someone else who was also laboring naturally for a bit (it was a busy 6 hours of running back and forth between the two!).
After maybe an hour, S was starting to feel more intense contractions about every 3-4 minutes, so in the tub she went. She stayed in the tub, doing squats or just lying back resting. After some time had gone by, her contractions seemed to be spacing out a bit and less intense, so I suggested walking again. I suspected that the baby may have been OP or 'sunny-side up' due to the back pain she was experiencing and the fact that labor wasn't progressing quite as fast as I thought it would (shows how much we can predict these sorts of things!).
The walking seemed to do the trick, as her labor began to pick back up again. She was also feeling a little pressure so we decided to check her cervix prior to getting her back in the tub. She was 7/90/-1 which was great progress. Things began to really pick up speed at this point. She stayed in the tub for a bit. The night shift nurse came on around this time, and happened to be a very NCB friendly nurse by the name of Kim. Fortunately Kim was able to sit tubside when I would need to leave to check on my other lady. Unfortunately, I would come back to find S getting more agitated and restless. I would then sit with her and she seemed to become a little more at ease. My other lady got an epidural around this time so was able to focus more time on S.
S started to feel more pressure so we got her out of the tub and checked her - she was now 8-9/100/0. But she was definitely hitting that transition phase. She was starting to say 'I can't do this Tiffany' over and over. She was becoming very restless. I got her back in the tub. She was asking for pain medicine but I had told her that it was too late...that she was moving along quickly now....she could do this even if it felt like she couldn't. Maybe fifteen minutes later, she started pushing in the tub. I decided to attempt to check her while in the tub as I didn't want to make her move unless it was time for the birth (unfortunately, we are not doing waterbirths...yet). She was definitely ready - 10/100/+1-2. So she got out of the tub and wanted to sit in the bed to push. She pushed for maybe 10 minutes, the entire time telling me that she couldn't do this :) She pushed out her first daughter with wonderful control over an intact perineum!
The first thing she immediately afterwards?
"I did it!"
Tiffany
S came in the day before the induction was scheduled with increasing contractions that felt stronger. Her exam was basically the same so I offered to go ahead and break her water, which she promptly agreed to :) There was clear fluid and the baby was quite the happy camper so I sent S off to walk. I wanted her to wait until the contractions were becoming more uncomfortable before using the jacuzzi tub. She walked for a bit with her boyfriend and I attended to someone else who was also laboring naturally for a bit (it was a busy 6 hours of running back and forth between the two!).
After maybe an hour, S was starting to feel more intense contractions about every 3-4 minutes, so in the tub she went. She stayed in the tub, doing squats or just lying back resting. After some time had gone by, her contractions seemed to be spacing out a bit and less intense, so I suggested walking again. I suspected that the baby may have been OP or 'sunny-side up' due to the back pain she was experiencing and the fact that labor wasn't progressing quite as fast as I thought it would (shows how much we can predict these sorts of things!).
The walking seemed to do the trick, as her labor began to pick back up again. She was also feeling a little pressure so we decided to check her cervix prior to getting her back in the tub. She was 7/90/-1 which was great progress. Things began to really pick up speed at this point. She stayed in the tub for a bit. The night shift nurse came on around this time, and happened to be a very NCB friendly nurse by the name of Kim. Fortunately Kim was able to sit tubside when I would need to leave to check on my other lady. Unfortunately, I would come back to find S getting more agitated and restless. I would then sit with her and she seemed to become a little more at ease. My other lady got an epidural around this time so was able to focus more time on S.
S started to feel more pressure so we got her out of the tub and checked her - she was now 8-9/100/0. But she was definitely hitting that transition phase. She was starting to say 'I can't do this Tiffany' over and over. She was becoming very restless. I got her back in the tub. She was asking for pain medicine but I had told her that it was too late...that she was moving along quickly now....she could do this even if it felt like she couldn't. Maybe fifteen minutes later, she started pushing in the tub. I decided to attempt to check her while in the tub as I didn't want to make her move unless it was time for the birth (unfortunately, we are not doing waterbirths...yet). She was definitely ready - 10/100/+1-2. So she got out of the tub and wanted to sit in the bed to push. She pushed for maybe 10 minutes, the entire time telling me that she couldn't do this :) She pushed out her first daughter with wonderful control over an intact perineum!
The first thing she immediately afterwards?
"I did it!"
Tiffany
Wednesday, July 22, 2009
ROM+2hrs=birth
I had a woman by the name of E come in for her postpartum visit recently and we were re-visiting her birth story. She graciously has allowed me to share her birth story here!
E had her first child a little premature at 36 weeks. This pregnancy was hanging on a bit more! She had been experiencing lots of bouts of contractions since about 35 weeks with some cervical change. She came into the hospital triage at 38 weeks contracting very regularly at every 2-2 and half minutes. She was 4/90/-1 (the first number is how many centimeters dilated with the ultimate goal being 10cms/the second number is effacement which is how thin the cervix is and ultimate goal being 100%/the third number is where the baby's head is in relation to certain landmarks in mom's pelvis - +3 is crowning). She walked for a bit with no change in her cervical exam...just these persistent contractions that were causing her some discomfort but not really changing anything.
I know that E was ready to be done with the pregnancy and offered her the option of AROM (artificial rupture of membranes). I explained the risks (infection, fetal distress, need for pitocin) and benefits (onset of labor!) to her as well as letting her know she had the option of therapuetic rest (little trick where morphine is given to someone in prodromal labor - will allow the woman to rest and she will either wake in full-blown labor or it will knock the prodromal stuff out) or just going home.
She and her husband discussed the choices and opted for the AROM. Her first baby had come very quickly after ROM but she was 8cms at the time. She had natural childbirth with her child and planned to do the same with this one. Once she was settled in her room, the plan was to break her water and then send her out walking, then into the tub. The ROM worked very well as E became increasingly uncomfy while walking so we moved her to the tub. She was coping very well with her contractions and working hard. She had not been in the tub long when she felt she needed to push.
She moved to the bed and I checked her cervix - she was 10/100/+1. She pushed beautifully, very well controlled and delivered her baby over an intact perineum (bottom).
I looked at the clock...total time elapsed from ROM at 4 cms to birth was 1 hour and 51 minutes. WOW!
Tiffany
E had her first child a little premature at 36 weeks. This pregnancy was hanging on a bit more! She had been experiencing lots of bouts of contractions since about 35 weeks with some cervical change. She came into the hospital triage at 38 weeks contracting very regularly at every 2-2 and half minutes. She was 4/90/-1 (the first number is how many centimeters dilated with the ultimate goal being 10cms/the second number is effacement which is how thin the cervix is and ultimate goal being 100%/the third number is where the baby's head is in relation to certain landmarks in mom's pelvis - +3 is crowning). She walked for a bit with no change in her cervical exam...just these persistent contractions that were causing her some discomfort but not really changing anything.
I know that E was ready to be done with the pregnancy and offered her the option of AROM (artificial rupture of membranes). I explained the risks (infection, fetal distress, need for pitocin) and benefits (onset of labor!) to her as well as letting her know she had the option of therapuetic rest (little trick where morphine is given to someone in prodromal labor - will allow the woman to rest and she will either wake in full-blown labor or it will knock the prodromal stuff out) or just going home.
She and her husband discussed the choices and opted for the AROM. Her first baby had come very quickly after ROM but she was 8cms at the time. She had natural childbirth with her child and planned to do the same with this one. Once she was settled in her room, the plan was to break her water and then send her out walking, then into the tub. The ROM worked very well as E became increasingly uncomfy while walking so we moved her to the tub. She was coping very well with her contractions and working hard. She had not been in the tub long when she felt she needed to push.
She moved to the bed and I checked her cervix - she was 10/100/+1. She pushed beautifully, very well controlled and delivered her baby over an intact perineum (bottom).
I looked at the clock...total time elapsed from ROM at 4 cms to birth was 1 hour and 51 minutes. WOW!
Tiffany
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