2.04.2010

Welcome Tres

I was privileged to be called on for your birthing time, Melanie. For the birth of your 3rd child, you had decided to look into the help of a doula, and I was ecstatic. Each pregnancy, you had desired an unmediated birth but, every time, you had opted for an epidural. I promised I would help you to achieve your desires as best I could and would support your choices along the way, it was a match!

After working with you and your husband Matt, your two daughters decided that they wanted to be there to welcome their little brother into the world. So, 1 month before your estimated due date, we held a sibling class and worked our way through a birth video and Cary York's coloring book, "When is The Baby Gonna Hatch".

Then, we waited...

On January 11th, you called around 8pm to let me know that you believed your water had broke. We talked about what it felt/acted like, the smell and color, and I recommended that you put on a pad, lay down on a towel or plastic bed covering, and try to nap until contractions started.

By 9pm, your contractions had moved up to around 10 minutes apart, 30 seconds long, and strong. I encouraged you to have a bite to eat, still consider napping, and perhaps call your husband home (who worked 3rd shift).

At 10:30, you called to let me know that it was time for me to come over because you were timing them around 5 minutes apart and very difficult to work through alone. Though your mom was there, you wanted Matt and I there.

I got dressed, woke my 9 year old (who had been invited to be your daughter's mini-doula) to get ready, and we headed out into a light snowfall.

I arrived at your home at 11:30 at night and you were working through some strong back contractions. With every contraction, you lifted your buttocks off the bed and breathed through them. Your face was flushed with each contraction and you described it as 'low pressure'. I timed a few of them and noted that your contractions were coming every 3 minutes consistently.

You decided that you were ready to move to the hospital. I let you know that your emotional markers said 'early active labor', but your contractions were saying 'active labor'. You were ready to go, so we packed up and made the 10 minutes drive to the hospital, your kids piled into my van with my daughter and all of our bags, my doula bag and their entertainment bags.

By 12:10, we were settled into the room and you were checked and found to be 80% effaced and 4 cm. As soon as you were able, you moved onto the birth ball and commenced to rock your way through a great many contractions which were consistently 3 minutes apart, and 30-45 seconds apart.

You became increasingly more tired and soon had a hard time focusing, feeling a nearly overwhelming urge to push with every contraction. You asked to be checked and found you had rocked your way to 5 cm in 1 hour.

At this point, I encouraged you to try getting into the tub to reduce the pushy feel and to try to give you some rest-time. The tub worked wonderfully to allow you to get from a semi-recline into a side position with every contraction. Matt massaged your hips, which were beginning to cramp, while I vocalized with you through the contractions. Your bloody show increased and I could tell you were making great progress.

At around 3am, baby began showing minor decels, but you had 'aaahed' your way to 7-8cm, 90% effacement, and +1 station.

Your urge to push was overwhelming, though, so we began trying different positions, from walking the halls to getting on the birthing ball, to all fours. You ended up spending most of your time on the birthing ball as it allowed you to stretch your hips without requiring you to stand (because of your exhaustion).

At the peak of every contraction, you arched your back and attempted to move away from the contraction. I tried to coax you to focus your energy forward and down, without pushing. It was your nurse, though, at this point, who was able to get you to focus all of your energy forward. As the urge was overwhelming, I sat between your feet at the base of the birthing ball and held your hands, met your eyes, and vocalized through each contraction. Your wonderfully supportive husband sat behind you on the bed, his thighs were your arm rests, and continuously traded out warm washcloths for cold ones.

Around 3:30, it was back into the tub for you as the warm water called out to your aching hips. We working on using the roll-over technique, in the tub, while Matt resumed massaging your hips. Your pushes were grunty at this point, so you asked to be checked again.

At 4pm, you were measured at 8cm, very swollen from uncontrollable pushes, and +1 station. We went for a walk through the halls at this point, and then you gravitated back to the tub. While in the tub, we talked about your options. With your cervix swelling from the overwhelming urge to push, we walked through a few scenarios: we could work extra diligently on finding a way to keep you from pushing without medication, or you could have a low-dose epidural.

You opted to get on top of the contractions.

Around that time, I went out and spoke to your nurse at the nurse's station. She didn't understand your desire for an unmedicated birth and, at one point, asked Katy and Amelie, your daughter's caregivers, why she wouldn't just take the epidural. I explained that you and I had already gone through the options, you understood the situation, and this was what you had chose, my number one job was to support your decision. Kindly, I was hoping she would understand that that was her job as well.

Returning to your dimly lit bathroom, I again sat beside you and watched as you moved through your birthing space with determination. Your tenacity and strength poured from you in waves that nearly brought tears to my eyes as you worked for the next 3 hours, with all of your emotional and physical fortitude, to climb on top of every contraction that wanted you to bear down with all of your might. The strain in your body was evident as you pushed your face closer to mine with every contraction, demanded my eye-contact, and we puffed our way through contractions that were coming strongly every 2 minutes and lasting 60 seconds or more.

Without any prompting, we fell into a rhythm: every contraction, you would move onto your side or into a frog-squat and would seek out my eyes. Then, we would deeply and deliberately breath through the climb of the contraction. When the peak came into site and your body curled around itself, trying to barrel baby down, we would 'Lamaze' puff our way through the increasing pressure, sometimes loosing the battle, most times triumphing! Matt scooped water over your rounded belly, massaged your hip, and whispered his encouragement and pride of your strength.

After every contraction, you would sag, exhausted, against the wall of the tub and close your eyes, sometimes overwhelmed to the point of tears.

At 5:45, you were measuring 8cm, less swollen, and baby was still sitting nice and low. You were showing signs of transition, saying that you didn't think you could go on and wanted to be done. Baby was showing more decels, but was still strong and moving plenty. Back in the tub you went, and we moved through more of the same.

at 6:45, your doctor came in to talk with us. He asked what I was seeing, I told him how well you were working through the contractions, what the obstacles were, with an overwhelming urge and swollen cervix, the decels I was seeing, and the possibility of a malpositioned baby.

He did a vaginal exam and said you were a beautiful 9cm! He then confirmed the decels, but made sure to say that they were nothing to be worried about at this point and that, as long as baby was healthy, you could continue working through things they way that you had been. He also noted that baby was in "deep transverse arrest" (see here for a description), though, and that, when he got back from a surgery he was heading to, he wanted to talk with you about what this meant for your birth.

He left for his surgery and immediately you stated you were ready for your epidural. I knew that we had a small window to move baby, so I said that we would get it for you if you were absolutely certain, no regrets. The nurse called up the anesthesiologist, and I asked you to get on all fours. Unlike the other times, I didn't help you, but made you rotate on your own.

When you moved onto all 4s, you had two strong contractions back to back and said that you had to have a bowel movement. You insisted that it was not just the pushiness, but something actually 'there'. I smiled and encouraged you to squat beside the bed and go to the bathroom. I threw a bed pad on the floor and you squatted on it. Immediately, you were all out pushing.

At the exact same time, the nurse peeked into your room and asked what you were doing on the ground. I replied that you were having a baby (actually, I think I said you were pushing). She threw herself on the ground and peeked up between your squatted legs. There was babies head pushing on your perineum.

The smile on my face could not have been any larger - YOU had moved your baby!

She ran out to stop the doctor from getting into the elevator. While she was gone, you climbed onto the bed onto all fours again and kept pushing. Your doctor returned and you moved your babies head out and into his hands. Immediately, babies head pulled back toward your perineum. When you had a good 4 contractions without any further dissent, he told you to flip over onto your back. In a 140 degree recline, we began trying McRobert's maneuver to move baby out. When that didn't work, doctor quickly moved onto the Wood's maneuver and, with an audible pop, Tres squeezed slowly out into the doctor's waiting arms.

He had a slow start but, with the doctor working diligently to get a response out of him, and mama and daddy calling him home, Tres let out a lusty cry!

At 7:45am, Tres was born, weighing 9lbs 3 oz and measuring 19 inches long. Mama showed one of the strongest wills I have ever seen in the face of adversity. Melanie and Matt, thank you for the honor of attending this miracle! Your family of 5 is beautiful!



7 comments:

Sharon Muza, New Moon Birth said...

This is a lovely tribute to the strength of your mama client and her baby! Thank you for sharing! Good job doula!

Jamie said...

This was a beautiful story! It truly brings home the importance of how positioning the Mom in a natural birth can really move a baby through a pelvis.

Sarah H said...

Wow, thanks for sharing. You sound like a great doula and the woman sounds amazing. What an inspiration. I learned a lot reading this story.

Dou-la-la said...

Great job mama, and DOULA! Perfect instincts.

Wendyrful said...

Awesome!!! What strength! I am impressed the dr. 'allowed' the mom as much freedom as she had - we'd never get that where I'm at! Doula work is hard, and I needed this little lift! Awesome birth story! Thank you for sharing, and with such beautiful writing, to share all the events and emotion of the day!

Tiffany said...

what an inspiring story!

Chri-Chri said...

This brought tears!!! Thank you for sharing!

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