Wednesday, October 1, 2008

Not according to “OUR” plan

When things don’t go according to “our” plan, we often wonder why?  As we look hindsight, we find this WAS the plan after all, we just didn’t see it clearly.  Looking back with 20/20 vision is very enlightening.   I’m grateful for that enlightenment, because it helps us understand the events that we didn’t plan for, and it helps us grasp a hold of the lessons that are there for us to learn from.

8:30 AM Mom calls with contx, they have been very regular, every 5 minutes for a couple of hours.  We visit on the phone, and she is doing great.  She is going about her regular activity and will call me when there is a change.  Three hours later I go over to her house to check on her and babe.  All is well, she is working well with contx, and not needing me there, so I send mom and dad out to walk, and I head back home.  We are in contact with each other throughout the day as she continues to have contx getting a little stronger and closer together.

9:00 PM I arrive at her home after she calls and feels like she would like me there now.  She is having strong contx 3-5 minutes, I check dilation and she is 6 cm and 90% effaced.  This would be considered “active labor”.  For the next several hours’ mom and dad labor together, dad doesn’t leave her side, he is very devoted and treats his wife like the queen she is.   My two assistants and myself continue to give labor support, checking heart rate, and take our turns resting.  I could give an hour-by-hour detailed story of the next six hours, but it would be suffice to say that mom and dad are an amazing team.  The two of them went from the tub to the bed to the toilet and back again several times, while eating lightly to keep energy levels up and keeping well hydrated.

4:00 AM Mom is feeling like she wants to push, she is feeling some pressure and pushing feels better.  Mom tries for a bit to push, but we aren’t seeing any progress, so I check her, and she feels complete, but baby has moved up out of the pelvic a little bit.  I suggest she lay on her side, with one leg propped up on a stool with pillows; sometimes this helps to bring the baby down.  Mom continues to lie on her side for bit, then up to the bathroom to do a few contx on the toilet, and then back to laying on her other side. 

9:00 AM  Mom is back in the tub, she complains of incredible back pain, and not able to support her back in the tub, so dad gets in with her, to give back support and allow mom to rest on him in between contx. 

11:30 AM Mom is feeling like she needs to push again, so I check for cervical dilation, and she is back to 9 cm., but baby had moved back down into the pelvic.  I can feel a bulging bag of water and mention to mom that we can break it, and this will probably help have a baby sooner, as I mentioned this her cervix closed down a couple of cm, so I decided it wasn’t a good idea to break her bag of waters at this time, (for some reason I felt I wasn’t supposed to do this), I suggested we go a head and let it be, and tell mom it shouldn’t be much longer. 

12:30 PM Contx are very strong with bringing with them a strong urge to push.  I encouraged mom to push through a few contx on the toilet, and then back to the bed.  She wanted to go back to the tub, but earlier I had an impression we were not going to do a water birth.  I couldn’t tell you why, just that I felt we were to go to the bed.  So I encouraged mom to go to the bed, we would check her one more time just to make sure the entire cervix was gone and it was okay to push. 

1:30 PM Still only dilated 9 cm, with a bulging bag of water, so we decided to go a head and break it this time.  When we did, the amniotic fluid was stained with meconium.  Meconium is normally stored in the infant's intestines until after birth, but sometimes (often in response to fetal distress) it is expelled into the amniotic fluid prior to birth, or during labor. If the baby then inhales the contaminated fluid, respiratory problems may occur.   

There are different degrees of meconium, and this was the most severe.  Amniotic fluid is usually clear, but this looked more like chunky pea soup.  My assistant and I looked at each other, not wanting to alarm mom and dad, but they knew something was up.  I wanted to make sure my assistant and I were on the same page about transporting before I said something to mom and dad.  It was clear to me that baby wasn’t coming down through the birth canal anytime soon, so we discussed a transport to the local hospital.  We discussed calling an ambulance, but it didn’t appear to be an “emergency”.  I felt we had plenty of time, and baby sounded GREAT.  Heart tones were proving to be very strong and responsive, so we packed up and drove to the hospital in our own vehicle.

When a situation calls for a transport like this, I call a head to the hospital and talk to the Doctor on call.  I let him know that I have a patient I am bringing in; I give him the pertinent details, and ask to have a room ready for her.  I bring with me a transport form that gives the information needed about labor history and why I am transporting.  I come in with my client and I am with her throughout her labor.  I continue to give labor support and act as an advocate for my clients.  I help bridge the gap between home and hospital.  This transition can be a very difficult time for both parents.  We came from a home environment where everything is natural and familiar to the hospital where nothing is natural or familiar.  We are in the hospital because there is a problem and mom and or baby needs to be very closely monitored.  Now there are IV’s, monitors, machines, catheters, no eating or drinking, everything but natural.

2:30 PM We arrive at the hospital, get checked into a room, and settled in.  The nurse checks for dilation and mom is still 9 cm.  I am thrilled, because sometimes just the transport and all the emotions and fear that go along with it will close the cervix down a bit, but not this time.  The nurse asked mom on a scale from 1-10 with 1 being nothing 10 being most severe, what was her pain level at.  Mom said a 5! I couldn’t believe this, she was handling these contx, as if they were nothing, and anyone who has been through labor knows that when you are that close to complete, contx are VERY intense.  The nurse commented that mom acted like she had an epidural in.

4:00 PM The nurse checked mom’s cervix and said she was complete and could start pushing.  We are excited and doing the “Happy Dance”.  This is great news!  Mom pushes with great strength, for about an hour.  It’s now the change of shift and a new nurse comes on.

5:00 PM New nurse checks mom’s cervix and says she’s 9 cm.  She asks the charge nurse to come in and double check, sure enough she is back to 9 cm.  They have mom roll to her side, and breathe through contx for ANOTHER hour.  Can you say AMAZING, because that is definitely what this mom is!  Her strength is incredible!  In her mind she intuitively feels she should have a c-section, she has felt this from the time we drove to the hospital, but she keeps on going and doing exactly what the nurses tell her.

6:00 PM Mom has had enough; she is tired, and doesn’t feel like she can do this anymore.  I give her a pep talk, and go get the nurse.  The charge nurse comes in to check her one more time, and again she is complete.  The nurse continues to give vaginal support while mom pushes with all her strength.  Dad and I are holding her legs up and back for her and counting her breaths as she pushes.  During the hour and half, Doctor is in and out a couple of times checking progress, and mom continues to find strength she had no idea she had.

7:30 PM The Doctor orders pitocin for mom to help create even stronger contx to hopefully bring baby down.  Mom is directed to NOT push during these, again VERY STRONG contx to give pitocin enough time to work.  I encouraged dad to go to a vending machine and grab a snack and take a 10-minute break, he comes back 5 minutes later with a sack lunch the nurse hooked him up with.  The nurse came in with one for me as well, and I have to say, food never looked or tasted so good.  Neither of us had eaten all day. 

7:45 PM Mom resumes pushing; I can’t even imagine how tired she is, no, how EXAHSTED she is, but somehow she finds what little energy there is left and continues to push.

8:15 PM The nurse went to get the Doctor and brief him on her progress, I knew this wasn’t good.  Doctor came in and sure enough the baby was still just as high in the birth canal as it was when we came in several hours before.  He discussed her lack of progress despite her efforts, and his recommendation was a c-section.   He wanted to give her until 9:00 PM, but mom said, NO!  She really felt like the only way this baby was coming out was through a c-section, so by 8:30 PM everyone consented to a c-section.  Preparations were made, and into the OR she went.

After a VERY long and strenuous labor, this AMAZING Mom and Dad welcomed a sweet baby boy 8 lbs 4 oz, at 9:04 PM by c-section, baby was posterior, (face up).

20/20 VISION:

As I look back on this experience there are details that come to my mind that give me hints of the outcome.  I don’t think these hints are meant to second guess myself, or kick myself because “it was right there, why didn’t I see it?”  I think they are there to help us understand this was the plan all along for some reason, and there was nothing you could have done to change things, a kind of resolve. 

When I first met this mom, something struck me just slightly that we would be transporting.  I quickly put that thought out of my mind, I can’t tell you why I thought this, it was just a flash that came and went very quickly.  As I got to know her more intimately through our prenatal visits, I was impressed by her outlook on life and was pleased to have met someone with such a like mind as mine.  (This doesn’t happen very often).  Wrinkles were smoothed out in my mind, and I became very excited for this birth, I knew it would be wonderful and this mom had something to teach me.

In one of our prenatals we discussed making a “mind movie”.  This is much like a creation board; only it is in a slide show presentation with music.  It was to represent everything you expect your birth to be like.  We talked about making it as personal as she could, because the more personal the more powerful.  She came the next prenatal and shared it with me.  I was impressed that she followed through with this suggestion.  It was beautiful, and very personal; the one thing I noticed right away was there weren’t any pictures of “home birth”.  In my mind I thought of having pictures of women laboring at home, birth tubs, midwifes, etc., but that aspect wasn’t there.  Again, it was beautiful and very personal, with lots of GREAT affirmations, but that main aspect was missing.

I didn’t want her in the tub to have this baby, why? Probably 75% of my babies are water births.  I love water births, but this one didn’t feel right.  I’m glad mom’s water broke on the bed instead of in the water.  It might have looked more diluted, and I may have not thought it was as dark stained as it really was.

I wanted to break her bag of waters the first time I checked and she was dilated 7 cm, but something stopped me.  Why? I don’t know, but I do know there was lots of divine communication going on here, lots of messages coming through.  This labor was one that many angels attended bringing with them a powerful love, strength and most of all protection.

This baby was posterior, and that makes for a very long, hard labor.  It also makes it hard for baby to fit into the birth canal.  It’s like fitting a tight puzzle together.  I don’t think baby was posterior the whole time.  It think he turned around 4:00 AM when I checked mom and felt baby had moved up and out of the pelvic.  Why?  Again, I don’t know, was there a short cord, was it a weak cord, was it wrapped around him, was the cord in a space that it would compress coming down the birth canal?  Did we just need to be in the hospital for baby’s sake?  Baby stayed in the hospital for a few days; did mom need to deliver there, as not to be separated from baby?  I don’t know these answers, but what I do know, is this baby is very smart, he helped us make the choice to transport when we did, he knew what he had to do to help us make that choice, and I have no regrets about that.  For whatever reasons, I know this birth happened just the way it was supposed to happen, and we were all divinely guided.

I also know, this mom is TRULY one of the most AMAZING mom’s I know.  This was an incredibly long labor, and with her innate knowledge of knowing this baby would be born by c-section at 1:30 PM as we were driving to the hospital, and still giving it her all, finding strength and energy she didn’t know she had for HOURS longer, not giving up, truly enduring to the end with grace, and with what looked like ease, but we all know it wasn’t ease at all.

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