Monday, December 25, 2006

December Birth # 3

Mom called me and told me things were starting and I called my assistant and asked her to come to my office, half way to the mom's house from hers, and and sent my apprentice home to take a nap and asked her to come back a few hours later and we waited. And waited.

Those who have read here for any length of time know that if I stay the night at my office, the woman's labor will surely peter out and I will have spent the night for nothing, but if I go home to do anything, her labor will speed into overdrive and I will have to pick my head off the pillow and drive back half-asleep. Weighing what to do is one of my biggest challenges when a woman isn't in full active labor.

We sat on my princess bed (well, two of us did, my pregnant apprentice sat on the camel chair) and talked as the afternoon darkened the room and we giggled and yacked about all things midwifery and relationship. How can three women talk so much about birth?! We ask ourselves that everytime we see each other. Do we ever get bored? Never! It is so nice to finally have someone with whom to talk incessently to. Finally. Our families sigh with overwhelming relief.

Dinner time comes and mom feels contractrations are about the same-only-less, so says we should go home and she'll call me in the middle of the night. I sat there on my triangle point trying to figure out which side to go down... stay at the office (20 miles from her house) or go home (55 miles from her house). The girls tried to help, but they were as undecided as I was.

We decide to go to On the Border. You see, On the Border is our restaurant of choice when a woman is in piddly labor that is sure to kick into high gear as soon as we are served 1) drinks 2) dinner. This has happened no less than three times and we laugh that we need to go there when we are in that odd place trying to figure out if we should stay with a mom or go home... "Where's there an On the Border?"

My apprentice lives kind of on the way home, right by the On the Border, and the other lives past where I live. After dinner (where we didn't hear from the mom at all), I took them home with me thinking she was surely going to call, but, once there, she called and said she was going to bed. Each woman called a family member to come and retrieve her from my house. I went to bed the moment they left.

About 2 hours later, the dad called and said things had picked back up and we should think about coming now. It was 10:30pm. I called the girls and got myself together and drove to pick each of them up (neither of whom had slept) and got to the mom's house about 12:30am.

Labor was ineresting. When we talked on the phone, mom said her contractions were every 5 minutes lasting a minute or so, but they were much shorter than that upon observation... maybe 20 seconds. She had to concentrate for a very short time when she had contractions. This was her second baby, but she'd had an epidural and pitocin for the first, so it is, for many women, almost a primip birth. My apprentice and assistant set things up while I assessed the contractions and figured we had a long night and day ahead of us.

Mom was in good spirits and dad was very excited. Their daughter, still nursing, was sleeping. She didn't have an in-depth relationship with dad, so mom had to tend to her when she would awaken. Dad did a great job trying, but mom, in the end, had to go and nurse her back to sleep. We wondered if this affected her labor progress. I believe it probably did.

There were a couple of requests from mom and dad: dad did not want to catch the baby and mom wanted the baby cleaned off before being handed the baby. Not mine to question, just mine to follow.

During the pregnancy, the daughter took a serious liking to my apprentice. I mean, such a liking that she (the daughter) thought I was the assistant and my apprentice was the midwife (it was a great opportunity for her to take a very active role as the lead midwife)! Pretty early on in the care, I'd decided that this would be my apprentice's first catch and a couple of month's ago, let her know it would be. She was demure and sweet and said such kind things like, "This isn't about me, it's about the mom and baby." I would have been all giddy and happy about my first catch, but she wasn't and I thought it was interestingly odd, but shrugged and thought it was just her quieter style. I tend to be more noisy. Surprising, I know.

I needed to sleep, so the "head midwife" spent the night awake with the mom and dad as I slept on the couch a few feet from them. The assistant slept in an adjacent room (where the birth was going to occur... not the bedroom, where the toddler was sleeping). Every once in awhile, I could hear snippets of conversation and got a gist of the contractions... short and sweet... not moaning... I kept thinking, "oh, yeah... plenty of time still ahead!"

About 4:30am, the toddler awoke and dad tried to quiet her, but once that wasn't going to happen, mom nearly jogged to tend to her. I blinked my surprise at her laboring agility and made a mental note of "where would a woman have to be in labor to jog to her child to nurse her?" The dad, who'd given a valient effort, seemed sad that he'd failed.

The apprentice went to bed, the toddler got up, I went to doze on the couch, and the mom went back to laboring in front of the fireplace.

She'd been having some mean posterior-type contractions earlier, so we showed her hands and knees and that position seemed to help. She remained on hands and knees for a few hours and the back pain seemed to subside compared to what it had been earlier when we'd arrived.

I laid on the couch, half-awake, listening to the family interacting - mom eating oranges, drinking juice (she did not like water very much at all, but would drink ice water occasionally) and counting contractions. They were so far apart... and so short. I was sure we were still in such early labor, we could go home for awhile, or at least get out and eat and have some time in a bed before returning.

As dawn broke, I awoke and sat with the mom who pulled in tightly as I talked with her about her contractions being far and short and how they seemed to be in early labor and not as long as she described them. She said that when I wasn't there, they were longer and I said that I believed her! I said that happens often and that perhaps we all needed to go so she could find her rhythm once again and then she could call us when she was about ready to have the baby. I told her I just thought she was still early and would have so much time based on the ebb and flow of the contractions. I offered to do an exam, but knew she would say no because she had expressed no desire for any exams the entire pregnancy and when I needed to do one to determine a head or a butt a couple of weeks earlier, she was less than pleased.

When I woke the apprentice and assistant, we also helped the dad and daughter get ready to go to the store for awhile to allow mom to rest. Her contractions had completely stopped by this point and she was suddenly extremely tired and wanted to go to bed. I thought it was great for us all to give her some time to sleep so she could wake up in labor.

When we drove away, we talked about mom's possible inability to focus on labor with the toddler there - how she literally jumped to her needs and how we thought it was good she was going out of the house, too, for awhile. I thought it was good for all of us to head out for awhile.

We drove down, in morning traffic, to where the On the Border is (45 minutes away), but went to IHOP. We were tired, but talking about the upcoming birth and how nice it will be, how we thought it would be at dusk (we usually see births shift at dawn or dusk) and waited for our food while we sipped our iced tea and coffees.

Mom called and said she was having a feeling like she had to pee every few minutes, like with the contractions, was that normal? I said, "Sure," that she might feel it lying on one side more than another and if her bladder is full. She said she was still resting. We still waited for our food. What was taking so long?

Just as our food was being set down (and damn we were hungry), mom calls and tells me she feels something in her vagina... a bag or something... and immediately I know, the baby is coming - and I won't be there.

The girls hear nothing coming from me, but see my face and I begin digging in my wallet for money and I throw $40 at the assistant and begin slowing and calmly talking to the mom about what she is feeling so I can talk her through this. She is alone.

My thoughts that fly through my head in one flash:

You ass! She's alone. Get her husband back home. Call her husband's cell. Her daughter's gonna freak. Call 911. Offer to call 911. DON'T CALL 911!! Please don't want me to call 911. Stay calm. Please don't be breech. You can do this (the mom). Slow and calm (me). Why am I so fucking far?! I will never make it. Why is it morning traffic time?

And probably a lot more expletives I conveniently forgot.

As the assistant pays, I remember getting into the car, me driving, and telling mom how to stay calm and how to deliver her own baby, that is, by the way, in the caul. I tell the apprentice to call the dad - mom has to repeat his cell phone number about 10 times - and tell him to go home NOW - and that's all he hears and hangs up on her. She calls him back and tells him if he goes in the house and finds a baby, to please put a blanket on the baby, which further freaks him out.

I stay on the phone with mom, talking to her gently throughout while careening through rush hour traffic (sorry everyone) and she moves from the toilet to the bedroom where she wants to deliver and gets on her hands and knees. I reminded her that she knew how to do this instinctively, that she had the power... anything to keep the banter going. I told her I had to offer to her to call 911, but that I believed in her and I knew she could do this alone if she wanted to and that we were calling her husband back to her. I had to let her know I wouldn't make it to the birth, but I wouldn't leave her on the phone.

Dad gets home about 9 minutes after we call him and we talk him through the birth, which happens about 4 minutes after that. When dad got on the phone, I asked him to center and focus because he'd been out in the world and running and he needed to be centered to catch his child. He was fantastic as he took a breath and I could hear him audibly relax.

He kept asking what he should do and I stressed making sure the baby could breathe once the baby was born if the sac was still over the face. He said the sac was coming out and he could see the head was coming out... he was giving me the sizes in coin sizes, but I think they were European coin sizes. As more and more of the head was born, he started telling me the head was purple.

At one point, I thought he told me the baby was born and not breathing and I told him to take the sac off the face and rub the baby's back... I didn't hear her crying (they knew it was a girl)... and I was getting scared. Then he finally said only her face was out and looking at him, I relaxed and said she would come in a moment and as I said that, she was being born and cried right away.

I was thrilled. Can I say now that every pregnant woman should be required to have speaker phone?

They got blankets on her (I'd had him turn the heat on 80 as he ran in the door and turn the heating pads on) and then I told them all they had to do was just sit with each other and wait.

We arrive 19 minutes after the birth. 28 minutes to get about 45 miles in morning traffic - not too bad. Too late for the birth, but we made it for the placenta!

We came in (after calming before entering) and set to work assessing - all was well, but there was some bleeding we had to tend to. The placenta was born with some assistance, mom needed a shot of Pitocin, the baby's cord was cut (it had long stopped pulsating), and we cleaned mom and the bed up before righting the room and getting the things that we no longer needed out of there.

Mom was pretty stunned and it took a couple of days before she was happy with her birth experience. She is proud now, as is dad. Remember, he did not want to catch and she wanted the baby cleaned off before holding her; neither happened. But, he was promoted to midwife and she was the first to hold her child - both are very proud to have been alone when their baby was born. The daughter was scared and ran out of the room at the moment of birth, but she has acclimated to her sister just fine and is even finding a way around tandem nursing.

Amazing what we can do when we have to, isn't it?

So, my apprentice didn't get to catch and even when we were going to have her catch the placenta, that didn't work out either because of the bleeding, but she did get to cut the cord and did that very well (it was her first time). She told me that throughout the pregnancy, she just didn't see herself catching this baby. She'd said that she couldn't even picture the actual birth itself, which none of us could either (and that was odd), but now we know why! I still don't think she'll be as giddy as I was anticipating my first catch, but perhaps she'll be able to visualize it.

Oh, and one final note: Postpartum, I looked over at the bookshelf in the room where the baby was born and what was there but Anne of Green Gables. I laughed and we wondered aloud how many births Anne has witnessed! We know of at least two in a row this December of 2006.

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