Carol and Shawn

During the week of March 20^th, your NST showed that you had three mild contractions in the 20 minutes you were on the TOCO. That would equal contractions around 7 minutes apart. You were still pain-free, simply uncomfortable.

March 26^th, we were to meet for a refresher course. I called to find out how you were doing and if our plans were still on. You and your family decided to head out and try to get the lower backache and cramping to turn into labor. At this point, I definitely would consider you, from your symptoms, in early, unestablished, 1^st stage labor.

On March 28^th, I called to see how things were going and if Sunday’s outing helped at all. You were still pregnant, achy, and feeling lots of lower abdominal cramping and backache. No Babes. We met for a refresher and so that I could meet your mom that evening. Throughout class, Carol, you were practicing effleurage on your own abdomen, repositioning every once in awhile, and stopping to ‘ugh’ yourself through a discomfort. This kept up throughout the next two days with intermittent spells of consistent contractions... only to have them taper off again after awhile.

March 29^th, you had an appointment with Brenda Daniels. At your previous appointment, you had discussed induction, as you were nearing the 42 week mark, in the event you were not in labor by March 29^th. On that Wednesday, Brenda checked and found you to be 2cm dilated. You both agreed to induction on Friday, March 31^st if you had not established labor on your own. The mode of induction was requested by Brenda as Cytotec as a cervical ripener, following by Pitocin. We all prayed you would dilate and begin labor on your own.

The following day, Thursday, March 30^th, you went in for a routine NST. During the ultrasound scan, they found little water around Babes and over-reacted, sending us all into a panic. After getting a second opinion and consulting with Brenda, you continued with your plan for induction the following evening. That night, I received a phone call at 6:30 that you were having consistent contractions and cramping every 8 minutes. We were all excited! Babes was coming!

On the day of Friday, March 31^st, we were all praying solidly that you’re labor would progress to the point that you would not need induction; or, at the very least, that you would not need a cervical ripener. At 8:45, 15 minutes before your scheduled induction Time, you called to let me know that you were headed to Your hospital as your contractions had reached every 4 minutes. You were in solid active 1^st stage labor.

When I arrived, they were just preparing your 20 minute strip and you notified me that your contractions had slowed to every 6-8 minutes in the car ride over. They did a vaginal exam and found you to be 3cm dilated. Not much dilation progress, but you were 70% effaced and were handling contractions like a pro.

After your strip was done, we walked the halls and did some labor dancing. Shawn was an excellent coach, giving you solid support while also moving with your body’s need to open and move the baby down. Your movements were amazing, swaying to accommodate baby and keeping gravity in your favor. Breathing with each contraction, you welcomed the surges and worked with your body beautifully; a strong and confident woman. I offered back support and counter-pressure, administering acupressure to your spine only when your contractions were putsy.

After a check in from Brenda, and a few contractions on the toilet, you decided on a bath. During your bath, your contractions seemed much more manageable, but also spaced out to 7-8 minutes apart. You stayed there for a good 25 minutes before deciding on having some crackers and getting out. At this point, we noticed that your labor was well established while walking, but, slowed down considerably and seemed less manageable while laying or sitting. Unfortunately, this meant for a tedious and active labor for you, who had already been working on labor on some level for the last 6 days. Toward 3am, you began to favor the all-fours position and pelvic rocks. At one point, you even took a short nap on the floor so as to be able to get into the all-fours position again as soon as the next contraction waved over you.

Roughly 3:30am, Brenda checked your progress, and we were all surprised to hear that you had only progressed to 4cm and were still at 70% effacement. With all of your previous work, not only this night, but others, we knew that Pitocin was the only option to get your labor well established. Exhaustion was sneaking up on you. So, until the Pitocin was administered, we attempted to allow you rest while waiting for the medicine to be ordered. Again, while lying down, your contractions spaced out and you were allowed 30 minutes rest. It was at this point that I began to think that it was not your labor that was stalling out, as it could not be a natural alignment plateau that was keeping you from dilating. This is when I began to think that there may be cord issues with Babes – you were mirroring my own first labor in too many ways.

Pitocin was an excellent decision in this case, as it forces your body to have stronger and more consistent contractions – no matter the position. In this manner, even if cord issues were preventing Babes from descending further, the Pitocin would establish stronger contractions to push him down at an accelerated rate. Around 4am, they were able to establish a good line for your IV, after botching the first attempt. At this point, your confidence began to wane – and Shawn and I could see the correlation between past experiences with IVs and the fear that you were associating with this one. Fear inhibits labor, as well as inhibits relaxation. For this reason, you began having more intense contractions that seemed less manageable and more difficult, even though the Pitocin had not begun to affect your body.

We knew it would not be long now as you began exhibiting symptoms of transition at this point. I continued to give you counter-pressure while Shawn gave verbal encouragement. At this point, you did not want rubbing or touching of almost any kind, snapped frequently at Shawn and ordered me to “don’t make my contractions harder with acupressure”. Your favorable position at this Time was bending over and standing… though the IV line and TOCO belts inhibited your movement. You began doubting your abilities and requested an epidural. Shawn was an excellent coach, working through your fears with you and reminding you of your goal. Brenda encouraged you to make it through one contraction at a Time. I reminded you of how far you had come and all that you had accomplished to this point. You were a wonderful laborer and we could see the signals of transition in your body language as well as your emotional state.

After choosing an epidural, Brenda contacted the anesthesiologist, but they were in a cesarean at the Time and would not be available for 45 minutes or more. You began vomiting and shaking, another symptom of transition… you were giving up and giving into your labor. At 4:15, to give you some rest until the epidural could be run, Kelly, your wonderful accommodating nurse fed Stadol into your IV. Immediately, you feel asleep and only woke to work through contractions. Even though were loopy from the meds, you handled each contraction amazingly well – breathing slowly and deeply and relaxing the tension from your body.

At around 4:45 or 5, they were able to give you the epidural. They checked you immediately after and found that you were 7cm! You had gotten through transition on your own, and now the Pitocin would give you the last few centimeters needed! You were getting the rest you needed from such a long labor, and you would soon be 10cm! It was not going to be long and you would have Babes… or so we all thought. Brenda broke your water at this point as well and found meconium in the water. Soon, we noticed that, the epidural combined with the supine position that it necessitated you be in, was giving Babes mild bradycardia. We moved you onto one side and he evened out considerably.

At 6:30, you began to feel pushy with lots of pressure in your rectal area. Shawn encouraged you by reminding you that this was the Ferguson reflex and that you should be close to full dilation. We tracked down Brenda and you were found to be 9cm and completely effaced.

At 7, the urge began to be overwhelming, even with the epidural, and Brenda was summoned once again. She found you to be 10cm and it was Time to begin the pushing stage. Your pushing was hard to establish as your sensations had been inhibited, but you soon got the knack and you became a world-class pusher! Pushing began in earnest around 7:30. Shawn coached your left side while your mom coached your right side. You began in the near-full recline, but soon moved into the 45-degree angle (or classic) position. You pushing seemed very efficient, until +2 to +3 station, when Babes did not want to move down anymore. His heart rate, at this point, began to fluctuate even more, lowering during each contraction to around 56; at some points even lower.

Under Brenda’s direction, we moved you over to all fours on the bed to try to help him descend further. We continued to flip you from all fours over to pushing position, and back. This went on for awhile with no progress. You tried a variety of pushing positions as well. In order, they were: supine, classic, side-lying, upright, and, finally, modified squat. At this point, Dr. VanVelkema was paged to assist with a vacuum extraction. She applied the vacuum to Babes’s scalp and, in essence, held him down after the contractions ebbed – to keep him from moving back up. It took 2 contractions for his head to emerge. At this point we found the culprit for your erratic contractions, ineffective dilation, and difficult 2^nd stage – the cord was looped like a sash across Babes’s neck and across his abdomen.

After looping the cord off, Carol, you gave one more push and he slip free. Babes was born! You only had a 1^st degree tear, and Babes was healthy as can be! He hesitated on crying and was quite comfortable lying on mommy’s abdomen. You delayed clamping or cutting the cord for 5 minutes – until it was decided he needed a little jostling to get him active and breathing independently. As soon as he was cut free from your body, he began crying heartily.

Beautifully done, he was born at 9:35am, 7lbs 10ozs, and 20 inches long! You were an amazing couple to work with. Shawn, your coaching was top rate. You supported her like a professional – moving with her movements, providing solid support when she leaned against you, verbally encouraging her and recognizing/anticipating her symptoms and emotional needs without question. Carol, your relaxation was amazing. You moved with your body and listened to it’s cues beautifully. Your relaxation was complete and your breathing was deep and consistent. Vocalizing, you kept it open and low – you both were model laborers!

Congratulations on your beautiful baby boy!