Friday, July 21, 2006

This is What We Call "Butter"

Remember how I said due dates are only accurate 5% of the time? And remember the lady we agreed to meet with on Wednesday? Well, she was in the 5%. I'll call her "S"

I was at my preceptor's house anyway for some midwifey stuff, and since we are still waiting on the HBA2C lady, my preceptor wanted this couple to come to her. They drove 2.5 hours and brought cash payment. They were a fun, lively, lovely, neat couple. We all had a good feeling about the birth and agreed to take them on. We filled out a chart and did a prenatal. The baby's head was really down in the pelvis and she had been losing some mucus, so I knew it wouldn't be terribly long before she had her baby.

Her mother spent all day Wednesday getting together and ready every single item on our homebirth supplies checklist. We have some moms that have had nine months to prepare for their birth that don't have everything on the list! This lady was really wonderful and very motivated for her daughter.

I picked up an inflatable fishy pool from one of the other midwives. I was planning a home visit for yesterday to check their supplies and go over "emergency childbirth" with the dad (I'll call him "T"). Instead, here is the timeline of my day yesterday:

6:15 AM Hubby wakes me up for our morning walk with the dog.

7:10 AM
On our walk, my cellphone rings. I recognize the cell number of the mom we took on yesterday. She says, "My water broke 15 minutes ago." The water was clear, but she hadn't felt the baby move yet, so I tell her that I will be over as soon as I get home and quickly shower off to listen to baby.

8:10 AM I arrive at their house. Baby's heartrate sounds like there could be some decels. I listen for a long time and decide the baby's baseline is actually lower than most babies I hear, but the baby is having good variability and is moving well. A nitrizine test is positive for amniotic fluid. I take S's vital signs, encourage her to finish her breakfast (2 boiled eggs, an English muffin and orange juice) and to go "do something interesting." She's having a few contractions, but they are very very mild and she says they don't hurt at all. I tell S to call me by noon and around 9 I head home for a while.

12 noon Punctual phone call from S. She has walked up the street from her neighborhood and is getting her nails done with her mom. Baby was moving well. I told her to call by 4 o'clock and that I'd want to come and listen again then even if she wasn't contracting any stronger.

3:15 PM T calls. He says the contractions are now 5-7 minutes apart, lasting 30-45 seconds, but she is feeling them more intensely. She ate a big lunch of chicken, broccoli and almonds. I tell him that I'm going to come over and listen and call my preceptor as well. My preceptor has a bad headache that she is hoping will go away before she has to drive, so she tells me to go and observe S for a bit and see what is going on.

4:00 PM I arrive at their house again. S is contracting, starting to have to breathe through them a bit, but is still very chatty and "herself". Her contractions are still about 4.5 to 5 minutes apart and lasting on average 45 seconds. I tell her we still have a ways to go and that it may be a long night. I encourage her mother to go home for a bit and give the couple some privacy. I encourage S and T to take a nap together or at least try to rest. I call my preceptor and we agree that I should go home again for a bit. I tell S to call me again by 7.

7:20 PM Phone call from S. She says contractions are about the same frequency and duration, but that the intensity is increasing. She says she doesn't need anything right now. She ate dinner. I tell her that I will be over when my preceptor arrives and we both are going to sleep over at S & T's house to monitor the baby through the night. Her doula is there now. I call my preceptor and she says she's going to get going. I expect her to arrive between 10:30 and 11:00.

9:00 PM I get a call from S's mother. She says the doula told her to call and tell me the contractions are getting really close together. I say I'm on my way!

9:10 PM I arrive at S & T's house. Her mom and dad are there. They are setting up the tub in the kitchen. Her dad has a lot of nervous energy and they've asked me to find jobs for him to do, so I make sure that he is set on getting the pool just the right temperature. S is in the bedroom, kneeling against the side of her bed. She is vocalizing well with contractions that are on top of each other. She says she's feeling lots of pressure. I listen quick, baby sounds great, so I start setting everything up.

9:30 PM The tub is full enough for her to get in so she moves quickly to the kitchen and gives a sigh of relief as she drops into the tub. The next contraction I hear that telltale "catch" in her breath. She says, "I'm pushing." I remind her softly to only push as hard as she absolutely has to. To let her body do the work, and her baby come down nice and gentle. I encourage her to reach inside and tell me what she feels. "I can feel my baby's head!!"

I set her dad on charting heart tones, which I take after every push. Love that waterproof doppler!! With S on her hands and knees, pressing back towards her heels, I have to reach between her legs from behind to try and get the heart tones. The baby is so low, that I have to press in towards her pubic bone. My wrist is killing me today!

She is just amazing. Her whole body is relaxed completely except her uterus. She is just letting her body do the work of pressing that baby out every so gently while she moans and occasionally roars her baby down. I sit quietly by just watching and occasionally reminding her to feel her progress. At one point, she says she feels something "squishy" in front of the baby's head. I ask her if she minds if I feel what it is. She doesn't, so I put one finger in (to the first knuckle only, mind you) and I feel a bulgy bag in front of the head! Wow. So it was only the chorion that broke earlier.

I am aware inside myself at certain moments of a weird sort of impulse to tell her to "push". I hate doing that. It goes against the grain of everything I want to do as a midwife, which is mostly to allow women to trust birth, to trust their babies, to trust their bodies and for me to step back and allow the process to unfold as unhindered as possible. So, why was I feeling this absurd impulse to hurry things? Every contractions brought the baby closer, she was doing fine, the baby sounded great. There was no reason to interfere. So, I kept my mouth shut. What causes this impulse to rush things? Is it our cultural story of birth that is so deeply ingrained that even hippy midwife types like myself have been tainted with it? At any rate, I'm glad I didn't interfere.

About 10:15 her perineum started stretching as the baby's head came lower and lower. She was still kneeling against the wall of the pool. Her mom moved to hold her head, her doula was by her left hand, I was by her right hip, her dad was charting heart tones for me and her husband moved around behind her. As her bottom bulged more and more, I encouraged her to support her vulva at the top. Her husband reached his hand down and supported her at the perineum.

10:30 PM My preceptor arrives. She quietly scrubs up, makes sure everything is accessible to the pool area and just watches. I can see that sometimes it looks like the mom is actually holding the baby back instead of letting her come down. I tell her that it might feel good to add a little effort to the contractions, but remind her to only push as hard as she feels is good and necessary and to not hold her breath.

With the next contraction, she ROARS that baby down. We all smile. I tell her that there is nothing wrong at all with roaring her baby down, but that her throat is going to be very sore if she does. I suggest she put some of that vocal energy downward instead of in her throat.

Her next push makes even more progress as the baby's head almost crowns. Her husband and her are holding her bottom together, feeling their baby emerge tiny bit by tiny bit. I remind the mom to give little, little pushes to get the rest of the head out gently. She is fabulous making little coughing sounds as she eeks that head out so slowly. The dad is crowing happily with every contraction about feeling his baby emerge. It's not long before we see a little face come out. The dad is just about beside himself with joy at seeing and catching his baby.

I reach in by the baby's ear and gently pinch the bag and pull it over the baby's head. I wait for restitution, then gently guide the baby up until I can feel the anterior shoulder, then guide down for the posterior shoulder. At this point, the baby is half out and I tell her to give another push for the rest of the body and the baby slides out. I shuttle the baby through her legs and tell her to pick up her baby. The time is 11:03 PM. On her due date. Her dad and mom are weeping with joy, they are overwhelmed. Her doula is laughing, I'm laughing, we are all just grooving on this awesome gentle birth. The only thing I would change is that instead of taking over and helping with the baby's shoulders, I should have verbally guided the dad and let him do it.

So, we got 8 # 11 oz of pure sugar. Beautiful little girl with not a lick of molding on her fuzzy little head. Really beautiful baby. The only mar on her little body was a bruised foot where the cord had been completely wrapped around.

The cord had a really odd little anomaly too. Each artery made a perfectly round little loop-de-loop inside the Wharton's jelly about halfway down the cord. Very odd.

I'm so tired, but couldn't sleep because of that "birth high". What a beautiful, peaceful entrance for this little baby girl.


ladyelms said...

I know what you mean about this. I've been thinking lots about what it is that causes us to think in terms of speeding things along, as if we're encouraged on a subconscious level. I witnessed this with the last birth I assisted, and that's not how I want to practice. Is it looming protocal in the back of our minds? Is it feeling responsible for making mom free of pain as soon as possible? Is it not completely trusting birth? It's surely interesting to think about.

Sounds like you managed this birth wonderfully. Good for you.(curious about how long you've been apprenticing and catching under supervision) I'm excited to get where you are.

One Hot Mama said...

Ladyelms, I have been apprenticing for 3.5 years and catching under supervision for 1.

My biggest hope is to be the kind of midwife I want to be. To be at peace with sitting on my hands, but to have the skills and knowledge to help when really needed. And the wisdom to know the difference.

Sage Femme said...

i love the picture of that cord! :)

I think it's wonderful that you're questioning all those feelings that come up, rather than acting on them. Bravo!