Sunday, December 26, 2004

A Series of FORTUNATE Events!

Client came for childbirth class on Sunday and looked kinda funny.

Near the end of class, she asked me for a pad and I raised my eyebrows and asked why. She said she couldn't stop peeing and I asked if I could have some of her pee in her undies. She laughed (she is a joy-filled client) and I said perhaps she had ruptured her membranes. It was clear, so she wasn't sure, but it had started leaking at 2am (it was now 1pm the same day). I got my prenatal bag and nitrazine paper and checked and ayup, it was positive for amniotic fluid. She had no contractions. I did a sterile vaginal exam and she was 1-2/40%/-2. I was disappointed and concerned.

This client had also chosen to do a GBS test and was positive. She did the alternative regimen, but remained positive 2 weeks later and wanted antibiotics during labor because of this.

We were on a time limit.

I gave the client several options including the hospital induction route... cimicifuga and cauliphylum; castor oil; nipple stimulation; visualization; acupuncture. She was game for them... all but the hospital one.

On the way home, she called the acupuncturist who came to her home within an hour. She had begun the C&C in the office and was taking that every 4 hours. She knew to put nothing in the vagina and was taking her temperature every 4 hours, too. I was going to meet her at 7pm (18 hours post-rupture) to start IV antibiotics.

I got to the client's house at 7pm and loved her house! She had just moved in with her roomate... her man is in South America having just gotten his visa to come to the US. She was going to move to a local Indian Reservation to birth at her mom's (she wanted a teepee birth, but that didn't pan out; she is Native American), but knowing that there was a possibility of transferring to the hospital that was a few miles from her own home, she decided to stay home.

The CNM in the practice came and we had a long talk about what might come down the pike without labor even a hint. She tried to get a vein three times and missed. I was going to try next and then kept thinking: save something in case you go to L&D.

It was 9:30pm and her family was starting to assemble. We needed to make some decisions.

She had had 3 acupuncture treatments (was having her third at 9:30pm) and not a hint of contrations.

After discussions, she decided to move to the hospital. Never ever did we "see" this birth in the hospital. It was very odd.

So, we get to the hospital at midnight and she is admitted from Triage by 2:15am. She decided to fudge 12 hours off her real rupture of membranes time. She didn't come up with that idea on her own. We offered ideas of how to speak about her membranes and it worked. "I wasn't sure, but I thought I started leaking at 2 or so." and then I piped up and said, "and so I checked and she was positive!" They wrote 2pm instead of the true 2am. Her sterile VE showed 1-2 cm/40%/-2.

Once in L&D (we had a HUGE room), I finally sat with my leg up and the drama of admitting began. One nurse tried to start the IV twice and blew the veins the same as the CNM did at the house. Another nurse came in and didn't even feel and started the IV within seconds. I want her to start all my IVs!! The pit was started and the long night continued.

I went to the car to sleep at 3:30am. Her mom slept on the pull out chair thingie I had my leg up on. I awoke at 6am and went back in. Nothing happening. That is how it was all day. The pit was increased every 20-40 minutes and then by noon, she was at the max amount. A nurse took me aside at 8am and asked if I knew where this was going. I said that I did. The OR was what she meant. She said she would probably have the baby by noon.

Later, we were told the doc would be in around noon and a decision would be made. No vaginal exams until the doc. I told the client and her mom the doc wouldn't be there until 1:30. At 3pm, a new nurse (we had a bevy of nurses) came in and said the doc was held up at another hospital and gave orders to up the pitocin.

Very shortly after, the client began feeling the contractions and having to breathe through them. I was extremely tired and called my midwife-friend in to help me. I needed to sleep. She got there quickly, but by the time she got there, I didn't want to even go sleep in the car lest I miss something!

The doc got there at 5pm and did a vaginal exam. She was 2/80%/-1. It didn't look good. But, there was some change, so she wanted to wait awhile and see what happened. Maybe another hour. The nurse (and I) thought she heard some late decelerations and the doc ordered an intrauterine pressure catheter (IUPC) and the doc, 2 contractions after the last exam, put the IUPC in and commented that mom was now 3 cm. Woo hoo! Hope!

Nurses would say, "you know, she will be having this baby one way or another by midnight" and I believed them. I couldn't believe we had bought so much time so far!

With the IUPC in, the nurse became alarmed because for the first time they could SEE the contractions my client was experiencing. She is a master meditator and she was extremely peaceful and none of the nurses thought she was feeling a thing when she was, in fact, doing slight breathing for quite awhile. She didn't get "working-feeling" contractions until 3:30pm or so, though. When the nurse saw the contractions on the monitor, she stood and watched because my client did NOT have an epidural and was experiencing massive contractions. For those that know: the TOCO was nearly zero'd out... 3-5 being the baseline. When she had a contraction, it would go to 80-90 each time... some of them off the damn paper and higher! The other midwife and I were worried about the client's uterus! The alarmed nurse turned the pit down after about 3 minutes seeing the strip. She was having contractions every 45 - 60 seconds and while they were short, they were hard. She ended up turning the pit down 4 times before it settled where it did.

Now, the doc was supposed to come back after feeding her cats (after her 5pm visit), but she was called to the other hospital again and wasn't there. My client labored on. I took a nap from 6:30-8pm. I thought I was going to throw up I was so tired. I laid down in my car and shut my eyes and then the other midwife called me. 90 minutes had passed! I went back upstairs.

A vaginal exam at 9pm found my client 3/100%/-1. Change! A long discussion about getting an epidural or just asking for a cesarean began. The other midwife and I shared our thoughts and in the end the mom decided to let the doc make the choice (via phone). The doc voted for epidural because she was... you guessed it... at another hospital! Wheee!

The epidural went in at 10pm. Quick, easy, and comfortable. Mom went to sleep and the midwife and I went to eat. We were in the lobby yacking and heard a call to her room so we hightailed it over there. Apparently, at 10:30, she was 5cm and now, at 11:15pm, she was complete!

Mom felt some urge to push and pushed really well with the nurse's fingers inside showing her where to push. All those things she learned in class to not do were inacted. She laughed a lot about that happening. Even the exercises about working with pain so it doesn't overtake you... she had to focus and make the pain hurt or her contractions would peter out and go bye bye.

So, she is pushing and the nurse is readying the room, so I ask if I can sterile glove and help my client. Sure! she says. I glove up and work with the client about where to push. We get the client to put her hands in her vagina and feel the head and she does over and over. Joyous! Her face was filled with bliss (and we said as much several times). She was ecstatic that she was having a vaginal birth after being led all the entire day that a cesarean was where she was going. She was more than bliss-filled.

The doc was called and she got there, gowned and sat behind me watching. As she was gowning, I said to her to just let me know when she needed me to move, that I would jump off the bed the second she needed me to. I worked with the client until about 3 contractions from delivery and the other midwife shoo'd me away from her vagina. I asked her later why she didn't wait for the doc to say something and she said she was the kind of doc that wouldn't say anything and then be very angry afterwards. Oh. So, I trust my midwife-friend, so moved and they broke the bed and put her feet in the pedals inbetween contractions and the head came out and the baby was born and it was delicious and fabulous and wondrous all at once! We all wept with joy!

It is a boy and he is gorgous! A Native American mom and an Hispanic dad. Oh, how yummy he is. 8 pounds 10 ounces. Small tears that needed repair (I think from the doc's pulling on her vagina... I was very gentle and had no blood when I was in there), all inside.

The baby was doing great, but has had some transient tachypnea and they were especially freaking because of all the time with ruptured membranes and the GBS issue, but he is fine.

The baby did end up with ABO blood incompatibility and under the bililights for a couple of days. Mom just got home and told me the baby continues with some tachypnea at times. We'll watch that. They gave her a lot of education about GBS infection, so I won't have to harp on her or anything.

Because of the ABO incompatibility, this baby would have also been hospitalized after birth. His jaundice levels rose high and went high FAST (15 at about 30 hours postpartum) and while the bili experience was not as positive as my last client's (nursing in the bed, keeping the baby in the room under the lights, etc.), mom is coping well and has been out of the hospital for a day now (the baby is 6 days old now) and nursing is moving along beautifully!

What a cool story of hope for me. I am constantly surprised and amazed.


kayla said...

Oh, I am tickled to have found your site!

My second (and last) baby was born at home with a midwife. He was a 42 weeker, over 12 pounds. His birth was the single most empowering, incredible, challenging, moving, life affirming, (ok I'm running out of adjectives here) experience I've ever had! I never tire of hearing and reading birth stories, and am looking forward to reading more from you.

Navelgazing Midwife said...

Thanks, Kayla! I am on a slow place of having babies at the moment, but am glad you found the site. I write more about midwifery and writing at my other site:

I'm glad you found this and congrats on your own great birth! 12 pounds... sheesh, girl! (You'll read how I help women to have smaller kids, eventually.)

Thanks so much for writing.