K and C started care with me in the beginning of the second trimester of their first pregnancy. K had a friend who has a home birth with me, and after we met, they decided they wanted a similar experience.
Pregnancy was uncomplicated. The normal aches and pains of pregnancy were present, but K was blessed with a healthy pregnancy.
At 39.3 weeks, K was feeling very done with being pregnant. She asked for an exam and a membrane sweep to see if it would get things going. Her cervix was 3cm dilated, 80% effaced and baby was at a -1 station. I did a gentle sweep, and K scheduled to see me on her due date.
We repeated things four days later on her due date. She was 4cm dilated now, but otherwise everything was the same. K tried the tea blend to see if it would jump start things. Baby was feeling 8-8.5 pounds to me at the appointment. I sent K with reminders that God’s timing is perfect, and that baby would come when he was ready.
Five days later, K came by for an early labor check and to try and see if we could get things moving along. This was the morning of Sunday, October 2. She started having bloody show and irregular contractions with back pain the night before that was persisting and becoming more regular now the lunch time was near. While we talked, her contractions seemed to be coming every 5 minutes, mild, but noticeable is what I observed. She was 4cm dilated, 100% effaced and baby was at a 0 station. I swept her membranes, and K drank the tea blend again. K’s mom drove her home and we discussed walking to see if it would strengthen things.
Contractions were all over the place through out the day, making K feel like this was another false alarm. Her doula came by and helped her use some clary sage essential oil, which K responded well to. Contractions regulated at 10pm, coming every 3 minutes, lasting for 60-90 seconds. K was going for a walk at that time, not sure things would stick. I told her I was taking a nap and call me to come if these stayed in this pattern for a couple of hours.
K’s doula sent me a text right before 2am saying it was definitely time to come. The contractions were every 3 minutes, lasting 90 seconds and were making K feel emotional. K lives quite a distance from me, so as soon as I could, I was out the door.
I arrived at 315am and found K to be laboring on her feet, leaning on her husband while her doula did hip squeezes during contractions. I did vitals, and found K’s pulse to be slightly elevated, so I began to push fluids to help with hydration.
K was able to lay for an exam at 345am. Her cervix was 5cm dilated, 100% effaced and baby was at a 0 station. I felt scar tissue on the cervix. K’s contractions were coming every 2.5-3 minutes, lasting 90 seconds and seemed very hard in intensity. She did not want me to massage the scar tissue. I was hopeful the hard contractions were going to break up the rigidity. I gave K an herbal tincture to help take the edge of the pain.
The birth team helped finish filling the pool so that K could get in the pool. I was hoping the pool would act as the “aqua dural” and take the edge off for K so she could relax some. The pool was ready close to 430am, and K got in on her hands and knees. C was by her side outside the pool, comforting her and encouraging her through the process.
Contractions spaced to every 5-6 minutes while in the pool, but were lasting 120 seconds and palpated strong. We encouraged K to enjoy the 3-4 minute breaks in between and rest.
The next few hours we settled in a routine. K labored so calmly in the pool. About every hour she would get out of the pool to use the toilet, and labor for a few contractions there before moving back to the pool. She would sip on coconut water or take a bite of banana after every couple contractions.
As 7am neared, K was feeling panicky and seemed like something was changing. She agreed to a cervical check, however the intensity was too much and K asked me to stop. I told her I thought there had been change, but I didn’t get a good enough feel to know.
I gave K another dose of the tincture to help relax, and recommended she try side lunging in the pool to help baby’s head rotate. As 8am neared, I gently began discussing with K the need for a cervical check since it had been a little over four hours since our last exam and with the rigidity, we needed to know if there was change or if we needed to discuss me working on the scar tissue.
K’s contractions were coming more frequent again, q3-3.5 minutes, lasting 90+ seconds long. K agreed to a check, and we talk about her getting in a semi reclining position so she could relax her bottom and allow it to float at me so that I could get a good feel.
K moved into semi reclining and allowed me to do an exam at 805am. Her cervix was 5-6cm dilated, 100% effaced and baby at a +1 station with the scar tissue still noted. I strongly encouraged K to consider allowing me to massage on the scar tissue through one contraction. K was reluctant, but was willing to try anything to help things move along. K’s mom and C were at her side, helping to support her and keep her calm while I worked out the scar tissue. I felt the scaring break up on my fingers, her cervix opening up to 7cm.
I gave K a couple doses of rescue remedy to help with the increase in intensity that followed after me working on rigidity. I encouraged her to change her position to try to help her cervix not to swell, as I thought the baby’s position on the cervix might be causing a little too much pressure. K was such a trooper through all my recommendations.
As 9am came, K was struggling with back pain. She labored on her hands and knees in the birth pool, with everyone of us supporting her at the birth taking turns providing counter pressure on her sacrum. I could feel the baby’s head “wiggling” on my hands as I provided pressure to her sacrum.
I encouraged her to try semi reclining for awhile. K was exhausted and weepy, feeling like she has been in labor forever from the fatigue. We rallied by her, encouraging her that she was doing a beautiful job. Labor is such hard work. We did not know just how hard the work was going to be.
Awhile later I discussed with K about laboring out of the pool in an open knee chest position for 40 minutes. I was hopeful this would help move things along with her cervix and get us closer to pushing time.
This position is an uncomfortable position to stay in through contractions. C got up beside K, gently encouraging her when she wanted to give up. I stayed on her other side, providing continuous counter pressure and verbal encouragement through the hard waves. K was a trooper, staying the full 40 minutes in that awful position, before moving into left side lying to try to close her eyes.
A few minutes passed and K’s water broke spontaneously with a contraction. Her fluid was clear, with flecks of vernix noted. Contractions were coming every 6 minutes, lasting 120 seconds. We did not know that this was going to be a theme for the rest of the day. The theme of slow and steady contractions.
An hour passed and we did an exam. K was 9cm, 100% effaced, baby at a +1 station with a thick lip of cervix in the front. We all encouraged K on what lovely progress she had made.
K labored on her hands and knees for a few waves. I began giving her a homeopathic remedy to help with nausea and vomiting, which seemed to do the trick after a couple of doses.
Over the next hour and a half, K alternated between laying on her sides and laboring on her hands and knees. Her contractions were coming every 6-7 minutes, lasting 120 seconds. I attempted to help reduce the cervical lip, but it wasn’t time, and I continued to encourage K to breathe through the waves.
Middle of the afternoon was upon us, and K still had this stubborn cervical lip. I gently encouraged K to try open knee chest for me one more time for thirty minutes to see if it would move the lip. K reluctantly agreed. We surrounded her with encouragement and the count down of when she was done. It did the trick, and it wasn’t long and K was spontaneously bearing down with contractions.
We didn’t realize then how much work pushing would take. K pushed well, but contractions fizzled to every 8 minutes with pushing. This was wonderful in allowing K to get some rest in between contractions, but unfortunate at making things move faster through the pushing phase. We alternated doing oils, pressure points and herbs to get the contractions stronger.
A couple hours in and we could see a nickle sized amount of head peaking under the pubic bone, which was a great encouragement for us all to see. K alternated during this time between pushing on her sides and in semi reclining, playing tug of war with the rebozo with whoever was available to tug against her to give some pressure.
My birth assistant recommended a while later to try the “dangle” position, so she set up a couple chairs and helped C in a position to support K in the dangle while she pushed. After a few pushes, I recommended K side lunge in the dangle while pushing. It felt like baby was moving some, but it was hard for me to know since I couldn’t visualize. K pushed a bit on the birth stool, then moved to the toilet to empty her bladder and labor on the toilet for a few. All the while, K’s vitals and baby’s vitals were perfect.
K moved to her left side on the bed, and fell asleep between contractions that were coming every 7 minutes, lasting 100 seconds. I talked to K about moving into semi reclining so that I could get a better visual if there had been any progress made during pushing. About thirty minutes later, K moved into semi reclining. The amount of head we could see under the pubic bone was noticeable. I told K I could see a good amount more of head under the pubic bone, and that it would be more work still, we needed to discuss options. K had been pushing for a few hours and was tired, but progress was being made and vitals were perfect. We discussed what a hospital transport would look like and what my hopes would be (in a nut shell: continue for a vaginal delivery). After discussing, K, C and her mom all agreed they wanted to continue at home as long as K and baby looked good.
K’s spirit was renewed. She snacked on a protein bar and continued guzzling water and coconut water. She continued to move his little head little bits with each push. K soon became very worried and fearful of the burning sensation the head would provide. I used a topical numbing gel to try and help take the edge off, which helped K feel better about pushing.
A few more pushes, and C announced to the whole room that “the doors are opening.” We were excited to see a small amount of head coming on the perineum when K pushed.
Contractions continued coming every 6-7 minutes, lasting 120 seconds. K snacked, hydrated and rested during her long breaks in between waves.
A few more waves, and a small amount of head was staying on the perineum constantly. K could feel burning, which brought on nausea. Peppermint essential oil was helpful at making the waves of nausea pass and supplying K with energy. K joked that “the green bowl (where we placed a couple drops) of peppermint is my friend.”
As a new day was on us, the head began to crown. Waves still stayed far apart. We could see the baby visibly rotating his head during waves. Now the real work was on us.
K’s perineum was tough, and baby was having a hard time birthing through it. We began changing positions after every couple pushes. K pushed on her right side for two pushes, then pushed in hands and knees for two pushes. I alternated hiking up one of K’s legs into a runner’s position in hands and knees while pushing. The head would not budge. I had one last ditch position to try before we had to talk options that we did not want to discuss. All the while, baby’s heart rate was perfect, averaging 130s.
We moved K back into the dangle position, my hope was that gravity allowing the perineum to tear to release the head. K pushed so well, and we could see the head trying to push through, but the perineum was taut and acting almost like a cervical lip, refusing to release the head.
The head had been crowning for awhile, and I looked at K and told her that I would need to perform an episiotomy. K was emotional at the thought, but agreed to do whatever was necessary to help the baby be born.
We got K back into semi reclining in the bed. I applied some topical numbing gel per K’s request to help provide some numbing affect. Her doula helped K push with the rebozo. With the next wave, the episiotomy was cut.
The head was birthed four minutes later, and immediately began to show the turtle sign. When baby was going to be born in that position, we moved K quickly into hands and knees, which normally releases the shoulder. This time, hands and knees did not work. I attempted the corkscrew maneuver unsuccessfully. I could feel the shoulder stuck on the pubic bone. I went in after the shoulder and helped rotate it out. As the shoulder released, the baby began to rotate and was born. I began to stimulate him as my birth assistant brought over the oxygen tank. I performed PPV, which baby responded to beautifully. He was soon crying and pinking up, and his five minute APGAR was 10.
Welcome to the world sweet Blaise, born earthside on October 4, 2016 at 110am, weighing in at a whopping 10lbs 4ozs, 20″ long. I have never had a mama work so hard to birth her baby at home. Her focus was on whatever was going to bring a birth that was safest for her baby, and she labored with so much strength, never asking once to transport, even when I brought it up more than once as an option. She did an amazing job. It was such a blessing to support this sweet couple in welcoming their first son into the world. <3
#sacredjourneymidwifery
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