Friday, December 22, 2006

Very Beautiful And Courageous

My monitrice client had her baby on Tuesday. Her first birth was a cesarean 12 years ago. During the surgery, they nicked her uterine artery and their own hands. She got to 10 cm and pushed for an hour (no doubt on her back, dehydrated, with an epidural) when the baby's heartrate baseline began to rise, so they did a c-section. They called it failure to progress.

They came to my CBE classes wanting a natural vaginal birth. It was shortly decided that I would be their monitrice. It was very nice to be able to barter out a years' worth of guitar lessons for my 11 year old!

They have become good friends as well as clients, having me over for Thanksgiving dinner when my family was all at my brother's (3.5 hours away) and I had to stay home waiting for a mom who was due.

Her "guess date" was December 26. As we approached last week, she was having lots of signs of getting ready. Monday night, she called saying she was having some bleeding and wasn't sure it was okay. She said it was mixed with mucus. She said she was having some contractions, but had no idea how far apart/long they were because she was ignoring them. (Good sign!). I told her to monitor what happened over the next hour, feel how the baby was moving and monitor the bleeding and call me back if things changed. I went promptly to bed, expecting to be woken by the phone in an hour. It wasn't for another 8 hours that the phone rang.

At 5:20 AM Tuesday, the dad called and said, "C is having some contractions, and lots of bloody show, but I can't time them because she won't talk to me. I don't know if she's in labor or not." Uhhhhhh...... yep!

I got there at 5:50 AM. She was in the rocking chair, working well with her contractions. She tried the ball, walked a bit, used the bathroom. It was starting to look like time to go to the hospital, so I offered to check her. She was paper thin and about 4.5 cm. We talked about pros and cons of going in at that time. The dad loaded the car and we decided to stay for a bit.

Mom got in the shower (her 12 year old daughter was present for the whole thing. She was really excited about it all and a big help). The shower kicked things up a notch, which I expected.

We left for the hospital at 7 AM. When we got there, she vomited in a trash can before going up to L&D. By the time they checked her about 7:40, she was 8 cm. By 8:30 she was complete and her body was pushing. She said she was scared that she couldn't do it. We kept encouraging. She was complaining and complaining about pain in her sacrum.

The baby was a bit stuck on her pubic bone, so we tried having her recline and push. That was the most effective for her. After 2 hours and 20 minutes, we had a full crown (with an obvious caput) As the head came out, that face turtled back against the perineum. Uh-oh....

The doc got her in McRobert's position. I tried giving suprapubic pressure to help out, but he said, "Don't push!" The posterior arm was up, the baby's elbow next to her face, with her hand on the back of her neck. The mom obviously tore as the doc freed the arm. Baby came out and pinked up right away. The parents wanted the cord left to pulse. The dad said, "The baby's not breathing!" and the doc said, "She doesn't have to, she's still attached." (!!!! Never heard a doc say that before!)

When the cord stopped, they handed babe to mom and she cried nicely. She then developed some Transient Tachypnea of the Newborn. She ended up transported to the local NICU while mom had to stay at the hospital she was at. Mom had a complete third degree tear -- through the anal sphincter muscle, but not into the rectal mucosa. The doc was a bit irritated that she hadn't had an episiotomy (like that would have made things BETTER!)

Baby returned to the parents the day before yesterday. She's now got a very high bili level from not nursing for 24 hours, and they are battling difficult nursery nurses, but they are doing great protecting their rights as parents (with some nudging).

Mom said to me the other day when I visited, "Thank you so much. I feel that I've had so much healing from this vaginal birth."

This was the 13th "successful" VBAC I've helped.

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