J and J started care with me in the first trimester of their second pregnancy. I had met J at BIRTH Fair last October before she was pregnant. When she found out she was pregnant, she scheduled a consultation and started care right away.
J’s pregnancy progressed along well until the third trimester. J came in for her 32 week appointment and I discovered that baby seemed to be growing a little quickly. I felt that baby was around six pounds for an estimated weight. J had a follow up on her anatomy scan in a couple days, so I told J after we see what her ultrasound estimates we will make a plan.
Four days later was the ultrasound and it estimated the baby weighing 6lbs 5ozs. I saw J next at 34 weeks and discussed reevaluating glucose screen, change diet and continue following up with the specialist. Baby was weighing about 7lbs to me at this appointment.
I saw J for her home visit two weeks later at 36.2 weeks. J and I discussed a plan. I discussed my preference to try and have a baby no later than the 38th week to prevent any chance of him getting too large and potentially having delivery complications that would prevent a home birth. J agreed with everything and felt that baby was bigger than he should be. Making plans to work the baby out also helped her get her husband home in time for the birth. J was working out of state and they wanted him to make it home before the baby came.
I saw J almost a week later. I did an exam and found her to be 1cm dilated, 50% effaced, and baby at a -3 station. We discussed a couple options to help the scaring I felt on her cervix, and made plans for J to come back in 4 days to start the homeopathy protocol and do the first membrane sweep.
I saw J at 37.3 and gave her the homeopathy and discussed the 6 day protocol and plans that it would hopefully help her go into labor. I did the first membrane sweep and discussed with J about seeing her again over the weekend once J was back in town to repeat sweeps with the herbal labor encouragement tea blend. I anticipated that it could take a few tries to get labor going.
J and J came at 38.1 for their first big labor encouragement session. The plan was for J and J to come see me every afternoon until labor commenced. It ended up taking three tries, but we accomplished getting J into labor. At 38.3, J came for what would be her last sweep and round of tea. She was 3cm dilated, 70% effaced and baby was at a -2 station. I estimated baby to be weighing ten pounds.
I heard from J that evening around 8pm. She told me her contractions were every 3 minutes, lasting 50 seconds and were getting stronger. A couple hours later, she sent me a message asking me to come. While driving, I heard from another patient that she thought she was in labor.
I arrived at 1135pm and did a full set of vitals on mom and baby as well as a cervical exam. J was 4cm dilated, 90% effaced and baby was at a -2 station. Baby was in a ROA position. Her doula and husband were present and supporting her. I talked to J and told her I thought it was going to be awhile still, and that I needed to go check in on this other mama and see what was going on. I had two dear midwife sister’s available to step in if needed. I left J laboring on her birth ball with her husband and doula and headed to the other birth.
J got a little rest, but things began picking up. J wanted someone to come by and assess things around 330am. My other patient was close to pushing so I asked another midwife, M, to stop in. J was 6cm dilated, 100% effaced and baby at a -2 at 535am. M gave her some recommendations and encouraged hydration, before heading out around 7am.
I sent my student R ahead of me to start working with J on some positions she might find less than comfortable. I arrived right before 9am and found J doing the abdominal lift and tuck for ten contractions. I did an exam at 930am and found J to be 7cm dilated, 100% effaced and baby at a 0 station. I did feel a bulgy bag of water, which I told J since she had suspected her water had broken in the night.
After the exam, J did the captain morgan position with slutty circles for three contractions on each leg. She sat on her birth ball for a break after that. Contractions were coming every 3 minutes, lasting over a minute and J was moaning with contractions.
I next suggested moving to the bed to try open knee chest for 40 minutes to continue helping baby navigate deeper into the pelvis. R helped J get into the bed and encouraged her doula to do the booty shake with the rebozo and helped J be closer to J to give verbal support and encouragement.
As 11am came, J was back in the bathroom doing captain morgan’s and slutty circles on her own. She was feeling very tired and emotional. We talked over options, and J decided she wanted me to break her water to see if it would help move things along.
At 1119am I broke J’s water. Her cervix was 9cm dilated, 100% effaced, and baby was at a +1 station.
R had J’s friend put on some good dancing music and got J to twerk through a couple songs to help baby navigate his little head. Contractions were coming every 2.5-3 minutes, lasting 90 seconds long.
J did an excellent job at changing her position and working so hard to help get baby out. Over the next hour, J alternated from slow dancing with spouse and sitting on her birth ball while doing slutty circles.
J was sounding grunty and was beginning to push at the peaks as 1230pm neared. I did an exam and found there was a cervical lip. J decided she would like to reduce the lip. She was in a standing position, using J as support as she fully pushed through waves. The lip reduced after a couple of contractions.
J changed her position multiple times through the next half hour. She pushed in hand and knees on her dining room floor, then moved to pushing on the birth stool. She has asked for the birth stool and had envisioned that being helpful. J’s older child A was present at the birth. Around this point A stated, “If you just push, the baby will squirt right out!” (If only it was that easy!)
A little after 1pm, I recommended J consider trying semi reclining in bed. At this point she had her self reclined against her birth ball in her dining room and I thought reclining into J in the bed might be more comfortable. 
She agreed. We helped move her to the bed. I knew this baby was going to be big and that she was tired, so I suggested J use the rebozo to play tug of war with different members of the birth team.
Contractions had spaced at this point, coming every 5 minutes, lasting over a minute long. We encouraged J to close her eyes and rest in between labor waves.
J rotated onto her left side a little after 130pm. One of the assistants helped hold up her leg as she pushed. Baby was almost at a +3 station, and we could start to see the head peeking more under the pubic bone now.
J moved into hands and knees at 149pm. My student, R, and I had reviewed positions and things that would help for a shoulder dystocia in the days prior to J going into labor.A few minutes passed and R encouraged J to put one leg up into a lunge to open up her pelvis more with pushing.
The lunging hands and knees position was very effective. The baby was on perineum at 201pm, followed by the head crowning at 202pm. J did beautiful letting the baby stretch and blowing through the strong sensations crowning brings. The head was birthed a minute later.
I noted the classic “turtle” sign seconds after the head was birthed. I gently encouraged J to keep pushing as I worked on gently guiding the baby to get under the pubic bone, while R encouraged J to change the leg she was lunging. I was able to get the shoulder released, and slowly the rest of the baby came out at 205pm. I brought him to J. It took him a little bit to come around, but after a little oxygen, he was wailing for all to hear and beautifully pink in color.
Welcome to the world Phillip, born on August 31, 2016 at 205pm weighing in at a whopping 10lbs 10ozs, 23.5 inches in length. I joked he was born a toddler, or at least it felt that way when I was helping him out!
I am so proud of J for the hard work she put in bringing this big boy earth side! Also an amazing accomplishment was that she had no lacerations at all from delivery.
Side note: Phillip was the first baby to every pee all over me during a newborn assessment. It caught me so off guard and I laughed hysterically!
#sacredjourneymidwifery
