Shoulder Dystocia, Crash Courses, and Great Birth Teams

What a journey, what a ride.

Let’s start a few months prior. When I first met you, B, and you found out what I do for a living, your first words were ‘You’re crazy’. As time wore on, though, and your belly began to blossom and grow, your interest began to pique.

Bee, your mom, began taking my classes and had access to a multitude of resources which she began to share with you. Still, you were ‘interested, but not sure’. Around 5 and ½ weeks before your due date, you were handed a copy of The Business of Being Born. A few days later, we sat and talked, and the papers were signed – I was going to be allowed to witness the birth of your baby!

On March 19th, I blogged this:

“I will be attending my friend's birth in mid/late April (though I *think* she will be around 1.5 weeks early)”

The Saturday and Sunday after that, you attended a Weekend of Relaxation hosted at your friend’s house. We talked about the sounds, attitudes, emotions, and actions of birth. Jo was a constant support and encouragement, trying out every relaxation technique and vocalization right along with you. It was great to see his active participation and involvement. I knew that he was going to be a great birth companion.

On Friday, April 11th and Saturday, April 12th, I could not get the two of you out of my mind. So, on Saturday, late in the afternoon, I called to see how you were doing. I saw you on Sunday at church and your baby had dropped considerably. You mentioned that you were having a lot of Braxton hicks contractions and you seemed rather breathless. I had a feeling it would be that day.

Sure enough, around 5 that evening B called to let me know she was pretty sure this was it, your contractions were coming consistently and demanding your attention. You were laboring at 1.5 weeks before your EDD. I let you know that Calvin was gone but that, if you thought you needed me then, I could call him and have him come home. You assured me you were ok and agreed to update each other as the evening went on.

We talked a few more times, then, at 8pm, as Calvin pulled in the drive, you called to let me know you thought it would be a good idea for me to come over. I arrived around 8:30 to find you walking with your hand on your lower back, with a look of ‘ah, this is it’ on your face. Jo was nearby working on his i-pod and sitting at the computer. Son was tiredly but excitedly walking back and forth from his room to you.

After he went down to bed, things seemed to pick up and soon we were able to time them about 3-5 minutes apart. B, you continued to pack your bag and, between contractions, you did your hair and makeup for last minute pregnancy photos. Around this time, Bee showed up, we began baking cookies for the nurses, and Jo took a few pictures of you.

Soon, you found your most comfortable position to be on all fours, draped over the ball. Sometimes you would alternate to kneeling beside the bed and placing your head and arms on the bed. As soon as your bag was packed, you got much more serious and laid down on the bed for a short time while Jo packed the car and we talked about when to move to the hospital.

That time came sooner than I expected. Your contractions soon picked up to about 3-5 minutes apart and they were demanding your full attention. As soon as you began making noises, Jo began to show concern and, after talking about how spousal anxiety can affect labor negatively just as much as arriving at the hospital too early, we decided to pack up the bags and move to the hospital.

On arrival, the receptionist had you fill out your paperwork while Jo parked the car. You were still quite on top of the contractions and you only really needed to get serious with contractions.

In triage, they found your contractions about the same as when we left the house, and your work was over half done!

Whereas earlier, rubbing your back and applying counterpressure felt good, at this point, you did not want your lower back touched and so Jo and I moved into more verbal encouragement.

Settling into the hospital room, we turned down the lights and Jo really began to merge into his role as protector and partner. He spoke lovingly to you between contractions and gave you undivided attention during them. A simple touch was all you wanted at this point, a hand resting on yours or your hair being swept back between contractions.

You were definitely in heavy labor. You favored lying on your side, and I knew you were nearing transition as your face became flushed and you were no longer sweet B.

Your progress picked up and soon we both knew you had, indeed entered transition. You began saying you didn’t want to do it anymore and you were ‘mad’ and ‘pissed’. We found out later you were mad at your mom for ‘getting you into this’ and she had never done it herself.

Jo drew near to your side at this time and soon you were feeling like you ‘wanted to poop’. Jo grinned from ear to ear as he looked up at me, knowing you were starting to push. Soon, you were actively pushing on your side, then you turned into the classic position when your doctor arrived.

B, you were such a good pusher, bringing your baby down quickly and easily. Without coaching or counting, your body and baby worked together seamlessly, and soon she was crowning. There was not even a hesitation as you slowly brought out her eyes, then her nose, and mouth. Once her chin passed, though, she stopped moving.

Your doctor was patient and unhurried, though, and waited to see if you would be able to move her down without help. After around 8 minutes of baby not moving with each contraction (which were still coming a close 2 minutes apart and now heart tones began showing worrisome variables), she and I began to piston your legs with each push in hopes of opening your pelvis to allow enough room for your baby to rotate herself. When that didn’t work, she asked the nurses to apply suprapubic pressure. When that was not helping, she asked them to apply fundal pressure while also offering suprapubic pressure. This whole while, she did not attempt to manipulate your babe, in hopes of reducing risk.

After it was obvious she was not moving and had a good case of shoulder dystocia, she let you know that things had to get heavy at this point. She never frightened you, but let you know this was important. You pushed harder than I had ever seen a woman push, bringing yourself to a nose bleed (wow, superwoman). At the same time, the nurses gave fundal and SP pressure, and your doctor attempted and internal rotation by hooking her shoulder to turn it.

At that time, Jo was so concerned with you that I gently reminded him I would take care of you bleed and help you focus, his job was to love on you and watch his babe be born.

The pop was almost audible. Her top shoulder moved free and the rest of her quickly slid along. She was feisty from the beginning and an audible sigh of relief came from every person!

You did splendidly! Your body worked beautifully in tune with your baby and your choice in birth teams made for a wonderful assistance to a surprising ending! C was born!

The two of you did a marvelous job all-together! Let alone, as a crash course. What a beautiful quilt of love and trust that you both wove together to give your baby the best start possible and share in one of the most joyous events of a lifetime – the birth of your child! I was honored to attend the two of you!

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