Monday, October 09, 2006

The Rest of the Story**

786 miles. Three round trips. 1 night on a (very uncomfortable) sofa and 2 nights on the (much more comfortable) floor. 2 exhausted midwives. 1 baby boy.

As I left off Friday, I had just learned that the dad of this baby due was upset with how I behaved at their first birth. My preceptor was with another client having her baby. I was nervous about having to go alone. Well, the other lady birthed at 5:15 on Friday. There were some minor complications with that birth and my preceptor (that's such an awkward thing to keep saying. I'm going to call her FaeryLady because she just loves Faeries) was pretty wiped out. She said when I talked with her at about 6:30 that the mom I was waiting on was still puttering around, and she would keep me posted.

I got the call from FaeryLady at 10:00 that the mom's contractions were about 8 minutes apart, but were getting regular and felt strong. She felt I should drive to their home and sleep there that night so I wouldn't have to get up at 2 AM and try and drive then. She also said she was pretty wiped out from the other birth and didn't want to have to unload her car and set up by herself in the middle of the night. I told her that I was upset about our earlier conversation, that I had stressed on it all day, and that I felt weird going there alone. She told me not to worry, just that the dad was a worrier and that I had to be very careful how I phrased things. That he was upset that I was not saying things about his baby in a way that he understood and he was upset and scared. She said I needed to just give him information, but try as much as possible to keep it positive. She said to just relax at the birth, not be uptight or frantic, and try to hang back and give him access to his wife and child at all times. So, I say all right, I will go. She calls back 10 minutes later and says that she talked to the dad to tell him I was coming and that she told him we had this conversation and that I was stressing about it. He said, "Oh, tell her not to. We like her!" HUH????

Now, after spending several days with them, I feel like I understand how this all came about. He is nervous about a lot of things.
FaeryLady: "Her blood pressure is 120/70."
Dad: "What? What does that mean? Is that bad? Why is her blood pressure like that? Is that normal?"
I can now "hear" in my head the tone of voice he probably said "she better stay out of my face" and it is completely different than the one I originally pictured, or even the way FaeryLady said it.

I left my house by about 10:30. Stopped for gas and bought a Diet Dr. Pepper, a Reese's peanut butter cup, some Chex Mix and some water. The attendant asked if I wanted some pastries too. Haha. I needed caffeine and sugar! I'm not used to staying up all night anymore. It's been a long time since I've been to a birth and now I'm pregnant to boot.

So, I arrived at their house at 12:35 AM on Saturday. The dad had waited up for me to arrive. He let me in, gave me a hug and asked how I had been. No awkwardness at all. None. He gave me sheets and blankets and offered their comfortable looking sofa for me to sleep on and went to bed. The sofa was not, in fact, comfortable to sleep on. It tried to eat me and several times in the night, I had to extricate myself from it's marshmallow soft depths. I briefly considered moving the cushions to the floor, but I was so tired I just made do. I woke up sore in places I didn't realize could be sore. At 7 AM. With no birth.

The dad came downstairs and said FaeryLady wanted me to listen to the baby. Baby sounded good and was LOA. The mom said everything had stopped. No contractions at all. FaeryLady suggested I check her cervix. Heh. With her not in active labor, there was NO WAY my stubby fingers would be able to reach her cervix. I told the mom if she was going to consent to an exam, she might as well wait for FaeryLady to come over because she has fingers almost twice as long as mine. So, the mom and I went downstairs and ate some of her homemade pumpkin bread for breakfast. We had a really nice, really long conversation about babies and childrearing. Not one awkward moment at all.

FaeryLady arrived. The check revealed an extremely posterior cervix that was maybe a fingertip dilated, 60% effaced, very soft and baby at -2. We did a prenatal and I headed home.

I got home, took a nap, got my kids some pizza and went to pick PreacherMan up from the airport. He had been in Izmir, Turkey for the week. I warned him I'd probably be going back again that night. I went to bed at 9:30 PM feeling bad about not spending more time with PreacherMan, but worried about getting called in the middle of the night.....

3 AM. The phone rings. FaeryLady says the contractions are 6.5 minutes apart and getting closer. Mom wants to get in the tub. She says the parents told her to call me now so I would be sure to have time to get there. "See," she says, "they want you there."

I arrived at 5 AM (more Dr. P, and sugar). The mom was contracting harder than the day before, but still real chatty in between. FaeryLady was getting a bad headache, so she laid down on the love seat in their little seating nook of their bedroom and asked me to get the next hearttones. We listen every 30 minutes in active labor and after every push in 2nd stage. If we take turns, we can each get one hour of sleep. I sacked out on the floor. It actually feels divine (especially after the sofa!) The mom was in her rocking chair breathing quietly and sometimes dozing between contractions. The first time I set my timer, for some reason it stopped with 17 seconds left (?!) but I woke up right on time anyway. I don't sleep well or deeply at births, so I woke up for the next one as well. FaeryLady was snoring, and I was awake anyway. No sense waking her up. The next time, I looked over and the mom was sleeping in the rocking chair. We don't wake sleeping moms. 15 minutes later, I saw her awake and go listen. When I went to chart it, FaeryLady opened her eyes. I told her what was going on. It had been 15 minutes since the last contraction.

It was by this time around 7:30 AM or so on Sunday. FaeryLady and I speculated about what was going on. Is this just normal multip promdromal labor stuff? Is there a problem? FaeryLady told the mom she would like to do another exam. Mom consented. She was now 3 cm, cervix right in front, a little more effaced, baby at -1 and now ROA instead of LOA. FaeryLady could feel the posterior fontanel, so the head was nicely flexed. We discussed that sometimes ladies that have had babies before can do this. FaeryLady offered several herbs to kick things in and we talked about other things the mom can do. She said she is afraid of herbs and doesn't want to do anything. We said that's okay too. FaeryLady says she's going home to sleep. I'm going to go all the way home instead of to FaeryLady's because my parents were arriving from Michigan that afternoon. The mom and dad asked if the other apprentice will now come. No! We replied, this is what a midwife does. When it's time, you come. If it turns out to not be time, you come back later. For me, I wouldn't want to have done all this and then miss the payoff!

I got home at 11 AM on Sunday and slept for an hour. Cleaned up the house for my folks. PreacherMan and the kids got back from church and we hung out and ate lunch. I got on the computer to start writing this story and told PreacherMan to go take a nap. His body thinks it is 9 PM at this point and he's still jet-lagged.

My folks arrived around 3 PM. It was good to see them and we had a nice visit. I called FaeryLady at 5 PM because I haven't heard anything. She said the contractions are still going, about every 10 minutes, and haven't really stopped. She said she'll keep me posted the next time she talks to them. At 6:00 the phone rang...

FaeryLady says the dad called and that the contractions are getting much stronger. She tells him that she's coming on over and that she is going to stay this time until the baby comes out. She asks me what I want to do. I don't want to wait until I'm so tired that I have to stop and drive. I tell FaeryLady that I can't do another false alarm trip either. She says she'll go over and evaluate and call me when she's there. 7:30 PM FaeryLady calls. The mom is now having bloody show (YEAH!!) and is working hard with the contractions. I say that I will leave in an hour and just drive there.

I tell my 15 year old that I'm leaving again and hug him. I tell him that this time I'm staying until the baby comes out. "See you next week," he mumbles.

I call FaeryLady on my way out to let her know I'm on my way. She says, "We just had a scare." The mom was in the tub and the baby started moving very frantically. FaeryLady got the doppler to listen and the heartrate was very high. While they were listening, the heartrate dropped below 60. Immediately, she had the mom get out of the tub. She listened for 15 solid minutes and it didn't happen again. She did an exam... no cord felt. She then listened every 10 minutes for the next hour. Although the heartrate remained high for about that hour, there were no decels heard. After an hour, the heartrate returned to baseline. I asked her, "Are you thinking cord?" "Yeah, I am," she said. When a baby has a cord entaglement or a hidden pinch somewhere, the heartrate will often go down at semi-random times. It's a clue. The mom is now 5 cm. Baby is at 0 station.

I arrive at 11 PM. Mom is now working hard. She's not talking between contractions any more. Her sisters arrive. By 12:15 AM on Monday, she is 8-9 cm, baby at +1. By 1:20 AM, she is pushing on the toilet. She doesn't want to be there, so we get her moved to the bed. FaeryLady feels and there is a lip of cervix and it is a bit tight. We get out the Evening Primrose Oil. 4 capsules of oil massaged into the cervix and it melts away. The mom hates semi-sitting on the bed (I don't blame her!), laying on her side is no fun. She doesn't want to try hands and knees. Since she loved the toilet so much, I suggest the birth stool. "YES!" She says. She gets on the birth stool and at 1:36 her water breaks. It is completely black with meconium. 1 minute later, the baby is born. He immediately sputters and starts to breathe. We hand him to the mom. I listen and his heartrate is good and he is breathing. I reassure the parents. FaeryLady looks down and say, "Oh, my gosh! Look at this!" There is a true knot in the cord. So THAT'S what his deal was!

Then we hear that sound. That sound where you go, "Who turned on a faucet?" But it's not a faucet. It's the mom. FaeryLady tells her, "Stop it!" and tells me to grab the HemHalt (herbal anti-hemorrhagic). I put some under her tongue and the bleeding slows. A minute later, it starts again. The mom starts saying "I can't hear! I can't hear!" Her eyes start rolling and she passes out for a split second. We give her a shot and the bleeding stops again. I say, "We should get her laying down." The dad and her sister lift her onto the bed. FaeryLady is checking to see if the placenta is going to come and I'm grabbing her uterus like an eagle talon, clamping it down. The bleeding has stopped again. Some color is coming back into her lips. Her pulse is high, but her blood pressure is okay. We push juice like crazy.

Gradually, she comes back around. Her uterus keeps getting boggy, so we give her a tablet to chew. The baby nurses and that helps too, but only while he is nursing.

The placenta comes, the mom eats, we give her a sponge bath. She has a second degree tear, but it lays together very nicely even with her legs open. No need to stitch it. We feed the mom and have her drink some more. Whew. That was intense.

I do the baby check. He is 7 lb 15 ounces. Although she was, by the calendar and early ultrasound, 42 weeks and 4 days, the baby doesn't look a day over 41 weeks. He is healthy and normal and looks exactly like his siblings. We do blood typing on the cord blood because the mom is Rh-. The baby is A+, just like daddy. So mom gets a shot of RhoGam.

FaeryLady stays until we get the bed cleaned, the baby check done and mom has been up to try and pee. Since I am staying to sleep for a while, she feels comfortable leaving at this point. It is 5 AM on Monday when I lay down, once more, on their bedroom floor. At 7 AM the mom gets up to pee again. She asks the dad to help her and asks me to hold the baby. He is just wonderful. So soft and fuzzy, and smelling so good. Her blood loss is minimal now.

I sleep for another hour and get a call from FaeryLady. She asks if we're all up yet. "No." And say, you're not going to believe this! As soon as she got home, her hubby told her that a client was going to be calling her cell with a "heads up". The client calls. She's been having contractions since 3 AM. FaeryLady says, "I am SO DEAD!!!" The mom says, "Oh, I don't need you yet, I just wanted you to know." 2 hours later the dad calls and the mom is having contractions right on top of each other, but they are only 30 seconds long. By the time FaeryLady gets on the highway, the baby has been born into his daddy's hands. Another boy.

This is the life of a midwife.

Some things I learned:
1. A mom can lose a LOT of blood and still be okay.

2. Honor the long labor. There is a reason for it. In this case, the uterus needed to follow the baby's cord down to prevent that knot from tightening. Good night. If we had broken her water, it could have been a complete disaster.

3. It's hard to be a pregnant midwife.

4. My baby moves all night long

5. There is nothing wrong with me. I still love doing this as much as ever, and I definitely rose to the occasion.

6. It is hard (nay, impossible) to make your tenses agree when you write a post this long over several days. :P

**I was waiting to post this story until I had talked with the parents and asked their permission. I called the mom last night and she told me I could share her story without identifying details

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