Monday, October 24, 2005

A Baby & a Nap (homebirth)

Sunday morning at 1am, a woman called saying she was a nurse and during her shift, several calls from my cell number came in and she wanted to know who I was. It was from the 714 area code and the only people I know in that area are some of my daughter's "friends," so was worried and called her at 1:30am. She picked up right away and was doing fine. I was relieved. It's amazing how my mind works even totally asleep: daughter's in the hospital, her friends don't want me to be notified and they see the nurse talking to me and hang up on me and threaten her if she calls me again. I heaved a sigh of relief that she answered. That she answered on a Saturday night meant she hadn't gone to a Rave that night. Yay!

I went back to sleep and was awakened again 90 minutes later by my newest client who was also due (she'd left the hospital midwives a week and a half ago because they were squawking about her baby being macrosomic [HUGE], her BP being horrible, blah blah blah). While she did have some BP issues a couple days earlier with me and we spent 5 hours in the hospital getting labs done, all checked out perfectly fine and we left feeling very safe and secure about how well she really was.

We arrived at 4:30am yesterday, set-up while having comical issues with the fishy pool that wasn't blown up yet (including "discussions" with dad and the pre-schooler about the location of the pool - while mom kept insisting on its location even as she labored), and kept busier than usual for a pre-birth ritual set-up because of the pool. Note to fishy-pool birthers: BLOW IT UP AT 38 WEEKS!

The pool, finally blown up, was filled to ankle deep before the water heater gave up all the hot water (and we did ask them to crank the heat up). Mom didn't get in the pool despite wanting to birth in the water; ankle deep just didn't seem so comfortable after all.

We took her BP once before the birth and it was 130/90 - perfect compared to other blood pressures from a few days earlier.

The baby was doing well - the FHTs ran about 120 during the 10 days I knew her, slightly lower at times, including on the monitor at the hospital, but when we heard her starting to grunt a little and I listened, his heart tones of 80 got me to throw a glove on and do an exam to see where we were.

1. Is she pushing and the baby close so we can get the baby out?
2. Is she 3 cm. and we need to call 911?
3. Is there a prolapsed cord (despite membranes still being intact)?
4. Get her to change position.
5. Get oxygen on mom and resuscitation ready for baby if birth is close.

These thoughts and a thousand more flew through my mind in a split second as I did an exam and found her 8cm/80%/0 and asked the other midwife to find the baby's heart tones. While she looked, I felt through a contraction and tried to open her cervix with my fingers - not hard, but it did hurt mom and she said she really wanted me to stop, so I did. The midwife wasn't able to find the heart tones, so I stripped the glove off and found the baby - 60 to 70 now. My mouth got dry and I asked the other midwife to glove and go in to stim the baby. I'm now lying on the floor under mom, between her legs as she leaned on the dining room table. The midwife said she was 9cm, but that the cervix was thick. I moved just in time to avoid drinking the mom's clear fluids as her water broke (coincidence, no pre-knowledge), yet remained on my back under the standing mom. The apprentice said it looked like I was checking the oil in a car because I was not only under mom, but under the dining room table, too. She made me laugh later at that vision. Not something I even considered it looking like.

We put oxygen on mom (all of this happened in a 2-3 minute time frame) and then she wanted to sit down, so we got pillows and sat her on the floor of her dining room and within 20 seconds, saw the baby's head - slightly blue, but pinking up quickly. The baby was born in another contraction and he seemed momentarily stunned, but we didn't suction or need to do any resuscitation at all as he snuggled with mom. We took the O2 off mom and, amusingly, dad grabbed it and put it on his own face! The apprentice was closest to him and was helping him to center as everyone took a giant deep breath and fell into place with their son's birth.

This "macrosomic" baby was 8 pounds 8 ounces and nursed nearly immediately. Her BP went immediately down to 120/80 and was even slightly lower upon departure with the usual reminders about pre-eclampsia occurring postpartum, too, so to keep watching the signs and symptoms for a couple of days. I go back today after school.

Whew.

It was interesting taking someone on so late in pregnancy who hadn't ever had a homebirth before because there was so much to catch up on. For example, it was odd that they were going to take the baby to the lab to do the newborn screen. I wasn't able to explain the why's and wherefore's about why to have the midwife do it (love, gentleness, not having to leave home, etc.), so wrote an email explaining, while also tell them I am not trying to "sell" myself, because I don't make any money from it at all, but that because they would have learned this in the pregnancy and I am merely catching them up.

They are also going to circumcise. VERY odd for the type of family they are, but I also explained about circumcision with a mohel as opposed to going out and getting it done at the doctor's office or in the hospital.

I explained about the 2 week rest period - BabyMoon - and that she wasn't an invalid, but that she was "open" to lots of things besides germs... the mean and sad thoughts of others that can't keep control on their feelings and love to dump them into open vessels - as pregnant, postpartum, nursing, and bleeding women are. (I know she's going to think I'm a fruitcake, but oh well.)

(Postscript: I ended up doing the NBS and they chose to not circumcise!)