Another OMazing Birth
A few Tuesdays ago, I received a text from a distressed client asking me to call her when I had a minute. She was due on that coming Friday. We’d been working together for nearly seven months. I taught her prenatal yoga. We had a few childbirth and breast-feeding classes and she hired me as her birth doula. She was 39 years old and pregnant with her first baby. She was starting to formulate a plan for her birth. I encourage all my clients to swap out the word “plan” for “preference.” We all know the old Yiddish proverb “We plan, God laughs.”
Her birth preference was to not use medicine in her birth unless necessary. As her due date crept closer, her doctor was pressuring her to be induced - using medicine to start labor. Her doctor was not comfortable with the risk of going past her due date because of her age. It upset her that he wanted to induce on Thursday, a day before her actual due date. She wanted to wait to see if she would go into labor naturally. She and her husband were at odds. In a text to me she said, “As a pilot, he is trained to avoid risk.” She appreciated the recommendations to be induced, and it was hard. We talked on the phone. I do not give medical advice as a doula. Instead, I listen and ask questions. This is how I help my clients develop their own plan.
I told her that regardless of whether she was induced or not, she needed to work on accepting the situation. Going into an induction kicking and fighting will not help her open up. I suggested seeing an acupuncturist. I sent her evidence-based research on induction and pregnancy at age 35 and older. I encouraged her to talk with her doctor about timing. She knew she needed to relax into whatever decision she made. And while she was disappointed, she came to a place of peace and scheduled her induction for Friday, April 22nd.
She had an early morning emotional encounter with her doctor at 7:30 am. He asked her if he could break her water when he gave her Cytotec - the medicine that is used to soften the cervix. She was very upset. She did not feel heard. Her husband told the doctor and the nursing staff that she wanted to move slowly throughout the induction. No, they could not break her water. They had preferences and they expressed them. The doctor had told them earlier that he had to leave at 5pm for a soccer game. Clearly, they were not on his schedule. What they wanted was more important than the doctor being present to delivering their baby.
I was proud of them! I teach the importance of agency and using voice. Being induced can be tricky. We were in touch via text all day. At 2:30pm, her husband texted me: “The doctor has broken our water, and we are progressing. Consensus is probably Pitocin in an hour. Mom and baby are strong.” At 5:30 pm, I arrived at the hospital. Mama stood by the side of the bed. We caught up for a few minutes. Her cervix was dilated to 3 centimeters. Her baby’s heart rate looked good. We giggled that her husband packed his Ford Mustang 1971 Manual in case he had time to read. He hadn’t cracked it open. The laughter stopped with the arrival of a contraction. We breathed together. The contractions continued. She focused and coped well despite the intensity. Pitocin, the contractions were strong and not very spaced out. My client kept her eyes closed and breathed down low.
Before 8pm, the nurse checked her cervix and reported progress: 90% effaced and 3.5 cm dilated. Soon after, there was a shift. Her contractions continued and became even more intense. I encouraged change positions each 30 minutes. She sat on the birth ball, laid on her side and spent time on her hands and knees with her arms draped over the back of the hospital bed. She was not comfortable.
Running out of energy, she told her husband she wanted an epidural. She shared the information with the nurse. The nurse called the anesthesiologist, who lived close. We thought he’d arrive in a few minutes but it took him an hour. In hindsight, this time made a difference with the labor. Her body opened up. She never complained as you waited for the anesthesiologist. By the time he walked in, she was ready for the epidural. It was clearly the right choice.
A bit before 9:30 pm, the doctor placed the epidural. She sat still and continued to dig deep. When he was finished, she laid on her side. Initially, the right side of her body was not as numb as the left. One in ten epidurals do not work perfectly the first time. There are three options if the epidural does not work: 1. Wait and see and don’t do anything. 2. Tinker with epidural and see if the doctor could get the right side more medicated. 3. Replace the epidural. As it turned out, she didn’t need to choose. Her right side became numb and she was able to relax. We were all happy that the epidural worked and she had a break from sensation.
At 10:30 pm the nurse checked her again and her cervix was 6 cm dilated and she was 100% effaced. Progress! Moments later, she closed your eyes and it wasn’t long before she was asleep. Sweet mama. The nurse came in an hour later. She was having a hard time detecting the baby’s heart rate and at they suggested placing an internal monitor on the baby’s head. My client woke up and agreed. When they placed the monitor they announced she was 9 cm dilated. She fell back asleep.
Another hour later, at 12:30 am, her cervix was 10 cm dilated and she was 100% effaced. It was time to push! Pushing started out slow. My mama couldn’t feel her contractions very well with her epidural. She was pushing into her face instead of her core. The nurse patiently coached her. We mixed it up with a few different pushing positions and set up a mirror which my client ignored. Nothing worked well until we wrapped a sheet around a squat bar. It was a game changer! With each contraction, my client gripped the sheet, curled her belly and pushed all her breath down to the baby.
Although she made progress, she was still so tired. Every couple of contractions, she didn’t push giving her baby a rest. A little after 1 am she closed her eyes in between contractions. The nurse suggested that she rest for 30 minutes. What a gift! She needed that rest.At 1:45 am, the nurse came in and announced that it was time to push again. She was concerned about the baby’s heart rate and contacted the on-call OB. The nurse wondered if he’d want to use the vacuum to assist with the end of the delivery. The doctor arrived moments later in a jovial mood. Kindly, he said that the baby’s heart rate recovered in between contractions and didn’t see a need for assistance. He encouraged my client to push as her baby began to crown. The birth team cheered her on as the baby moved closer to the world outside her womb. The doctor told her that her baby boy would be born in be another one or two pushes. He was right. The second to last push he was so close. The doctor tried to pull the baby out and until the contraction stopped he slipped back in her body. Once the next contraction started, we all knew that this was it.
My client breathed in deep. She pushed, pushed, and pushed, and at 2:16 am on Saturday, April 23rd, her baby boy was born.
Covered in vernix, the nurse put the baby boy on her chest. Her husband’s eyes filled with tears. The emotion was incredible. The baby boy they had waited so long to meet was here at last.
The doctor asked the husband if he’d like to cut the baby’s umbilical cord. “No thanks Doc,” I heard him say as he gazed down at his beautiful wife and son. The doctor offered me the opportunity to cut the cord. I cut his umbilical cord, which was rubbery and as the doctor commented, healthy and strong. That was a first for me. A few minutes later, may client delivered her placenta.
Although baby had good color, he was pretty quiet. The respiratory team waited for him to cry or cough. A few minutes later, they asked if they could take him off my mama’s chest and assist with removing the birth fluids from his lungs. Her husband walked over with the baby and I stayed by my client’s side. The nurse turned him on his belly and after a few pats, he spit out fluid. He was back on my client’s chest in a few minutes.
The baby peacefully laid in his mama’s arms alertly absorbing his new world. At 3:00 am, we decided he was ready for his first latch. With help, we put him on her belly to see if he’d crawl up. While he was close to her breast, he didn’t latch. We regrouped and helped reposition him into a cradle hold. Without issue, he latched and nursed for 18 minutes on one side and then she moved him over to her other side. It was quarter after 4 am and the baby was still nursing. I said good night leaving a beautiful scene: a brand-new family.
It was an absolute joy to walk this journey with my clients. I was honored to have been a witness at their incredible life event. I am really proud of the way that they both were able to accommodate the induction and relax into the birth experience. My client let go of her expectations and present in the moment. This is the way to be. I know this skill will serve her well in parenting and life.
It was another OMazing birth.