Tuesday, September 2, 2008

A VERY Narrow Pelvis

I’m so grateful for cell phones.  My daughter is moving to a different state, and I wanted to help her get packed up and move.  In February I my sweet husband bought me an iphone for Valentines.  (Yes, I LOVE, LOVE, LOVE my iphone)!  I had to switch carriers to support my new phone, and in doing so, I now have service where my daughter lived (until this weekend) and I could go help her with the ease of knowing my clients could call me if they needed something. 

I got this call about an hour after returning home from saying good-bye to my oldest daughter and sweet granddaughter, (her hubby was already at their new destination). 

Mom is having contx, but not very regular yet, so I encouraged her to get some rest and I planned on taking that advice also.  I called my birth team to put them on alert.  Thank goodness my partner was back in town from her two-week church camp out of state.  I knew from this mom’s history I did not want to be at this birth without my whole birth team.

Active labor started to kick in around 10 PM.  I count active labor from the time contx are regular, usually every 3-5 minutes and dilation is about 5 cm.  I arrive at mom’s house at 11:30 pm.  She is doing a super job relaxing in the tub through some very strong contx.  Dad is right by her side softly coaching her through each contx with encouragement and affirming her amazing relaxation.  This is dad's most important job during labor!

I am setting things up for the birth.  On my list of supplies is a cookie sheet.  Everyone asks what this is for, no I’m not usually going to be baking cookies at a birth, but you never know, I’ve done some pretty strange things at births before.  Actually the cookie sheet is what I lay all the birth essentials on, like instruments, cord clamp, baby hat, etc.  This makes it easy to transport from one room to another in case baby decides to come in a different room than first planned.  It has come in handy many times!  It also serves as a flat surface in case I have to do CPR on baby.

I check baby’s heart rate, and it is strong and happy.  Mom is up to pee from the tub a couple of times during the next two hours.  Around 1:15 AM she is feeling a little urge to push, so she gets out to pee one more time, and while she’s out I check for dilation to make sure she is complete.  I was happy to tell mom she was complete with a bulging bag of water, she didn’t want me to break it, so I just pushed a small lip of cervix back behind baby’s head, and I know we were going to have a baby SOON!  I asked mom if she wanted to have baby here on her bed, or in the birthing tub, she said, the tub, and with that, she QUICKLY got up and walked VERY fast to the birthing tub.  Talk about strong; these pregnant moms can do ANYTHING!

She gave a couple of pushes, I listened to baby who still sounds great, and soon we see a head with lots of hair.  Mom was amazing as she very slowly pushed her baby’s head out.  I feel for a cord and there it is, but loose enough to not be a concern.  This baby’s shoulders do not want to come out very easy, so I have mom turn to her hands and knees careful to keep baby under water so it doesn’t take a breathe yet.  We have already talked about this scenario in our prenatals, so mom didn’t say, “you want me to do what??”  It’s hard enough for a 40 week pregnant mom to roll over in bed in the night, let alone one in labor with her baby’s head out, but like a trooper, she did exactly what I told her and with grace and ease turned to her hands and knees.  This usually opens mom’s pelvis another cm to allow room for baby to rotate out, but in this case it wasn’t quite enough.  I think mom has a VERY narrow pelvis, and I know this because I had to go inside with both hands up to my wrists to gently rotate baby to help him come out.  I resolved to reaching under his armpit to make the diameter of his shoulders a bit smaller.  Try shrugging just one shoulder up toward you ear, and you can see this changes the diameter of your shoulder measurement.  All in the same moment I am calling on ALL my ANGELS!  What seems like 20 minutes, really was only about 2, but when challenged like this, the 0 is added on for intensity.   

At 1:38 AM mom and dad welcome their 8 lb 13 oz son to their family!

A few hours later mom was tucked in bed happily nursing her baby, laundry was in the wash, the birth tub was emptied, and we head home.  Grateful for my skills and for my amazing birth team, including our ANGELS, who assist us, and work overtime at births!

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