Michelle and Ryan –
Oh what a journey! You have displayed immense strength in the face of adversity, and come out together, as a birth warrior and birth companion! I cannot begin to tell you what an honor it was working with the two of you as you fought for your baby’s and your body’s rights and health.
You prepared for birth by attending a Wonderfully Made childbirth class. There, you learned how to cope with labor, talk with your care provider, the pros and cons of medications and interventions, and how to be an educated consumer. Near the end of your 6 week series, you asked me the question I was hoping you would, “Will you be our doula”.
Your due date was May 2nd. It came and went uneventfully. You patiently waited on your bodies timing. On May 11th, you went to a prenatal appointment where they performed an NST. The nurse pointed out that you were having contractions rather regularly; they were so gentle, though, you hadn’t even noticed.
The next morning, May 12th, around 2am, I was awoken by a phone call that they were getting more intense. By 4am, I was on my way to your home… your contractions were 5 minutes apart and beginning to demand your attention. After working well with your contractions at home, including squatting, taking a shower, doing some nipple stimulation, walking the neighborhood, and taking a short nap, we talked a bit about comfort of moving to the hospital versus staying home.
Your emotional indicators said that you were in early labor. Your physical indicators were saying you were in late active first stage. The behavior of your body and contractions led me to believe that your baby was still not lined up correctly in your pelvis. We worked on positioning some more, but nothing changed. Ryan was fine staying home and ‘playing guitar’, while Michelle was more inclined to want to stop by the hospital to see about your progress.
We talked about trying to pick things up in intensity with cohosh, stopping at your doctor’s office rather than the hospital to avoid being ‘admitted’, what would most likely occur if we went to the hospital, and the benefits of just staying home. After talking about all of your options, the benefits and risks, and trying to call the doctor’s office to be seen there and not receiving a response, you decided it was time to go to the hospital.
At the hospital, they found you to be 4cm and 75% effaced. Contractions were varying between 3-5 minutes standing up or sitting up and 7-10 minutes while lying down. They deemed that you were ‘in labor’ and considered you ‘checked in’. We had discussed that, if you were not 6cm or more, you wanted to go home, but the pressure between hospital staff and yourselves mounted, so you consented to staying.
By the time they had you checking into your room, though, your contractions had spaced out to around 15 minutes apart and they were very faint. We talked awhile about your options. You were prepared to request an AMA and check yourselves out, but then you had a nurse change. She was sympathetic to you wanting to leave, so she performed a vaginal exam and deemed you ‘only 3’, and made the request to your doctor to send you home.
Michelle, you were very frustrated, but Ryan mentioned something that awed me and put things into perspective… You had not consented to anything that you could not walk away from. You did not consent to pitocin or breaking your water, two things that they had urged you to do and would have put you at the point of no turning back.
You continued to have mild, but regular, contractions throughout Wednesday and Thursday. During those days, we continued to try positions to move baby into a better presentation. Your doctor had scheduled an induction for you on Friday morning at 7am. In your heart, though, you did not feel ready to relinquish your pregnancy to the doctor’s schedule and asked the doctor to give some time to prepare and think about it more.
At this point, Dr. Olds made some very threatening comments and attempted to manipulate and coerce you into the induction – even stating she was going to drop you if you did not show up in 1 hour. You were not persuaded.
Friday and Saturday brought you regular contractions about 5-7 minutes apart, off and on, a little stronger, but no more demanding. On Sunday night, you came to my home for a Ribozo sifting, At that time, we also talked about options… including midwives, home births, making amends with Dr. Olds, switching hospitals, switching doctors, and rights of the patient. Your main concern, and I agreed, is that you were ‘overdue’ and were without prenatal care under any doctor at that time. No doctor would take you at 42+ weeks, and your doctor’s office was not returning calls or releasing records to you.
You outlined a plan to find out who was on-call the following morning at your hospital, Baptist, and decided that, in the a.m., you would consent to an induction.
Monday morning, May 19th, we arrived around 9:30am and began the paperwork to being admitted. A small power struggle ensued, where you had to remind them of your rights to request a different doctor (based on ethical disagreements) and you were given Dr. Richs, the hospital’s ER OB, as your primary during your stay.
Dr. Richs was very accommodating to leave a relatively open schedule for your birthing time. You requested pitocin rather than an Amniotomy, which they had wanted to perform. At 11am, Michelle was started on Pitocin, so Ryan and I grabbed a quick lunch. You were assigned an amazing nurse who was a great advocate of unmedicated birth. The three of you formed a wonderful team.
Contractions soon picked up, even on a low-dose pitocin drip, and you began to have to work through them around 1pm. You sat on the birthing ball, received a foot massage and hand massage by Ryan and I, squatted beside the bed, slow danced with Ryan, and knelt on all fours over the birthing ball.
I encouraged you both to cuddle and nap if you could, and I went into the waiting room to let you both reconnect and rest.
Contractions became very intense after dinner time, and Michelle continued to move with her labor, getting into every possible position that would accommodate the continuous fetal monitoring.
Baby was slowly turning into a better position, which I could tell by the demand of the contractions on you mentally and emotionally, while your wonderful nurse could tell by the position of your uterus to your cervix, the position of your cervix itself, and the presenting part over your cervix.
Around 9pm, you requested your water to be broken in hopes to kick things into high gear.
You both were beginning to show some of the wear that the last week had had on you. Michelle, you were physically exhausted and the pitocin was giving you strong contractions. Ryan, you were emotionally and physically fatigued, though you were a constant support to Michelle. Michelle, you began to get the shakes, becoming nauseous, and questioning your ability to continue.
You were checked and found to be 7cm around this time. Michelle requested an epidural around 10pm. You were adamant. Ryan and I talked with you about the benefits and risks, and I truly believed that you were getting ready to transition. Your nurse felt the same and encouraged you to continue on. Baby was still moving well, getting into position.
Your nurse’s shift, though, was ending. Her replacement was the same nurse we had seen 1 week prior and who had helped you to be able to go home. Though Ryan and I worked at making sure that you were making an informed decision to the benefits and risks of the epidural, she, surprisingly, gave false information on the epidural and encouraged you to get it.
Also, on examination, she said you were between 5-6cm. Dr. Richs came in to get your verbal confirmation that you wanted the epidural and did a vaginal. She did not tell us what she thought you were.
After making sure there were ‘no regrets’, you received your epidural at 11:30pm. Within 15 minutes of receiving it, your blood pressure dropped, babies heart rate was lost, and you were put on oxygen. They stopped your pitocin and, though it hadn’t been increased in over 2 hours, the nurse who had encouraged you to get the epidural and given you false information on it stated that the baby was not tolerating the pitocin well.
Dr. Richs had the internal fetal monitor ready to insert, when another nurse finally found babies heart rate. It was found in the same position he had been early in your labor, low and posterior. It was at a higher baseline than before, even without the pitocin, and non-reactive to the contractions. But he was strong and you were stable. Knowing that they were going to leave the pitocin off for a few hours, I encouraged you both to get some rest and I headed home for a few winks myself.
At 2:00am, I received a text that they had checked you and found you to be 8cm. I headed back to the hospital. At arrival, Ryan informed me that Michelle only had a small lip left before you were complete and could start pushing.
Around 3am, you began pushing. Baby descended quickly, and his heart rate stayed constant. Your blood pressure remained even. Baby descended straight down the birth canal, though, and his forehead met with the pubic bone directly. He was not turning his head in order to fit down the birth canal.
We talked about continuing to push as you were or your alternatives, including turning off the epidural so that you could get into more accommodating positions to try to turn him back into the more favorable position he had been in earlier in your labor.
After pushing for 2 ½ hours, you consented to turning off the epidural and we worked on getting you into different positions, including attempting the Gaskin Maneuver, all-fours, modified knee chest, side-lying, and modified squat. He was not budging. Your perineum was swelling considerably, though, and babe had developed a caput.
Around 6:30am, you began to request the epidural be turned back on. At that point, your doctor said that baby was healthy and you were healthy – she was willing to let you continue as you were, doing what we were doing to try to move baby, as long as babies heart rate was stable, although you might want to start talking about the possibility of a cesarean as things were not progressing.
Her veiled statement was that an epidural could very well be a step backward – it would make it unable for you to get in the positions that we would need to be able to have you in to even have a hope of moving baby down, and it might mean another ‘crash’ like what had happened the first time.
I talked to you about the possibilities: a new ‘dose’ of epidural could have the above affects, and would definitely not allow baby to budge for the limits in positions, we could continue without the epidural and hope to turn baby (although he had not budged with our attempts these first 3 ½ hours), or you both could talk with Dr. Richs about a cesarean.
You both talked about it, we spoke about risks and benefits, pros and cons of all options, and made sure that, regardless of your decision, that there was to be no regrets. You opted for a cesarean. While they prepped Michelle on the process and Ryan dressed in his scrubs, I talked to Ryan about how he could best support you in the OR. And then, when they were ready to wheel you out, I took our bags down to the family waiting room and talked to Ryan’s mom.
On Tuesday, May 20th, 2008, some time after 7am, Eli was born into the world after his parents made a very harrowing and difficult journey into parenthood.
I can already tell that he has the stubbornness shown by his mama because of his intent to stay in as long as possible. But more than that, he has the strength and fortitude that his parent’s have displayed in that he is a strong and healthy babe, with a good appetite and hero’s heart!
Congratulations Michelle and Ryan! I was honored to attend you both during this amazing transformation. You are parents, and you are conquerors! The path that was chosen for you gave you many opportunities to take alternative routes, some better than others, and you navigated this journey with a strong compass of what you were willing to accept and that which you weren't. Those things that you were not willing to accept were simply not an option - and nothing that anyone could tell you would make a you change that compasses due North. I have never met a couple more compelled to accept ONLY true informed consent, and accept both the benefits AND risks so wholeheartedly... taking every step as a deliberate act of 'no regret'. On the same note, 7 hours postpartum, I visited you again and one of the first things out of both of your mouths was that you HAD no regrets, but you already know what you WILL do differently next time.
Again, I am SO honored!