Miss Anna Grace 3 Sept 2008 - long

Mom - R - called me a while back. She had already talked with my friend C about Doula services, but C didn't think she would be available as she planned to be studying for and taking her MW exam when this mom was due. I had my CAPPA Doula conference to attend in Dallas, and hoped I wouldn't be gone when she actually went into labor and had her baby, but we talked about C being her back up doula, just in case. As time went on C met with her, I sent her birth plan information, and she continued to talk with her OB about the things she wanted for her birth.
R and her husband A knew what they wanted. R is the 2nd of 8 children, all born with midwives out of hospital. She herself was born at the Farm in Summertown, TN. She was at several of her siblings births, and actually helped at two of them. When we talked over birth plan stuff, she had no idea she would be expected to have an IV at a hospital birth. (her whole experience and expectaions of birth were all out of hospital). She dicussed with her OB that she didn't want an IV. Her Dr. wasn't happy with that, and wanted at least a Hep-Lock, but it was possible, depending on how things went.
R - told her Dr's that her mom went past her Expected due date with all 8 of her baby's, closer to 42 weeks with most and 43 weeks with one. She told her Dr's that she was sure her EDD was the 18th of Aug, but the first Dr she went to had put down Aug 11th based on a 28 day cycle, which she has long cycles, and it does make a difference. After she swithcd OB's to a 2nd one who she thought was willing to work with her on a more natural birth, the Dr. still wouldn't change her date to what mom thought was correct, but did 'agree to let mom go to 42 weeks'.
As the time neared, mom discussed things with her OB, and it started to become appearant that the Dr. wasn't as open to what R wanted. At what was really 40 weeks but the Dr. said was 41 weeks, she insisted mom go over to the hospital for a non-stress test. Mom went, and everything was fine, but the Dr. still wanted to talk about induction. Mom agreed to come back a week later for another non-stress test, and in the mean time mom tried a few natural induction methods - castor oil. She got to have the fun of a day of running to the bathroom, but it did nothing to induce labor, as her body was not yet ready to have a baby. (or her baby wasn't quite ready to come).
Mom went in for her regular apt. and the Dr. told her all of the 'risks' she was taking, by not agreeing to induction as she was so far over due already... Mom knew her 'risks', and knew that everything was fine, and did not want an induction. The Dr. pointed out that there were study's to back her up, and mom said she'd like to see the study's she was refering to.
Mom showed up for the next non-stress test. The Nurses at the hospital, on the Dr's orders, had her do several different tests, over a period of about 3 hours. They wouldn't tell her anything, but eventually told her the Dr was coming from home to tell her the results.
All of the tests showed the baby was fine, although, she was told however that when you went past 40 weeks your placenta stopped working and got calcifications, and several other negative things. The Dr. brought several pages of ACOG (American College of Obstetrics and Gynecologists) study's to show the mom to 'back up' her statements that she needed to have this baby right away. Based upon an ultrasound, the Dr. said the baby was going to be huge - over 10 lbs.- and recommended an immediate cesarean section. Mom declined both the cesarean and also an induction. The Dr. made her sign papers that she was going AMA (Against Medical Advice). Meanwhile all of the non stress tests showed the baby to be fine, and was not in distress at all. She left and was certainly feeling a lot of stress personally. She couldn't imagine how her birth would be successful with all the stress that she now felt with her care provider.
She happened to be somewhere public and called C on the phone to tell her how the non-stress test had gone and the resulting conversation and having to sign the AMA. Another sweet person -L- happened to be where this mom was at and overheard part of the conversation, and since pregnant women are her job/life, she couldn't help but feel the need to help her. When she finished the phone conversation, L approached R and started up a conversation. She offered for her to come up to TN for a consultation. (this was on a Friday).
On Tuesday the mother went back to her Dr. for her appointment. Mom had brought back the ACOG statement papers and showed the Dr. where they said that the problems of a mom who goes into labor post dates on her own are no greater than those of a mother who gets induced. The conversation did not go well and eventually the Dr. told her she would like to dismiss her as a patient, but couldn't. (A Dr. cannot fire an expectant mother as a patient, within 30 days of delivery - it would be patient abandonment, and it is illegal.) After the mother left the office she called -L- and asked to come for a visit.
Though her husbands insurance would completely pay for a hospital birth, and he was a bit concerned for his wife -him not having been around Midwifery or home birth, and with this being a first birth, so although she would have liked a midwife assisted birth out of a hospital, she had agreed to go to an OB and have a hosital birth. After planning for a hospital birth and trying to get the best birth experience possible and the most natural birth in a hospital environment, she was frustrated and with all that they had gone through in the past couple of weeks with the medical side of things, he agreed to the consultation visit. After meeting with -L-, they switched. Mom was so relieved to have a different option to be able to try to get the birth she wanted. No mom was not being selfish and only worried aobut her birth experience, she was also concerned for the health of her baby and wanted the best chances for the best outcome, which in her research and study did not include pitocin induction, or a cesarean surgery.

Over labor day weekend mom had several nights of constant contractions that would go away during the day. She had some contractions on labor day and then that night all night long and on Tuesday 2 Sept. the contractions continued, and after her prenatal appointment that afternoon she stayed up in TN and labored away. I arrived early evening, and mom was laboring in the birth tub. She had been about 5 -6 cm before she got in the tub.
Mom would rock back and forth on her hands and knees durring her contractions. She would blow air out witheach contraction (most often buzzing her lips) and often she would put her face slightly into the water and blow bubbles as she labored. She was doing such a great job!
C commented that she labored - blowing bubbles - just like her mom had done. R's mother had, had her last baby 3 years ago with K and C had been there.

R labored in the tub, sitting on the birth stool, sitting on the birth ball, kneeling on the floor next to the bed, laying down, etc. We kept her hydrated with drinks, and she ate lightly, yogurt, and such for nutrition and energy and she had a couple of spoonfuls of honey (that they brought, as dad has bee hives and sells local honey) for a little quick energy. About 6 am we took a walk outside on the front porch and went up and down the steps a few times. It was a good change of pace, and we all got some fresh morning air. We watched the sun rise over a beautiful new day. It was quite pleasant out there.
After many hours R was checked and though she'd made some progress, the cervix was more effaced and moved forward, she was still really only at 6 cm's. Mom was so amazing. She was like the little train who could... Whenever we gave her a suggestion for some sort of move or different position she never told us no, or said she couldn't do it. She would always answer, "I'll try" or, "I guess I can try". She was such a trooper!
After many hours at 6 cm's I can't believe she was not more discouraged. We all knew she had to be exhausted!!! We were and we weren't going through the hard labor like she was, for most of those hours she was having contractions about 4 min's apart.
C and L both checked her to see if they could determine exactly what was going on, and how the baby was positioned. They determined after really feeling the suture lines on the baby's head that she was turned mostly posterior (the back of her head against mom's back, instead of against mom's front side). Because of this the head was not engaging well and not putting the pressure on the cervix like it needed to so it wasn't dilating well. We then went about turning the baby around. We had mom do some knee to chest positions, to see if the baby would float up out her her pelvis a bit and we had her do some lunges with one leg up on a chair and the other foot down on the floor to see if that would help rotate the baby. The other thing we did was a 'trick' with a Rebozo. http://www.birthingnaturally.net/cn/tool/rebozo.html It is essentially a long rectangle cloth (mexican women use it for many things, a sling, a shawl, etc.) that you place under the woman's hips while she lays on her back. you hold the cloth up (while stradling her), and pull the ends of the rebozo, and litterally rock (very gently) the mom's body, and every so often give a little stronger tug one direction (the direction you want the baby to turn), to get the baby moving. After all of that, the baby finally moved and mom began to make more progress. It was so cool to be a part of something that really was so simple, and yet it made such a difference for the mom and baby.
Once mom began to dilate past 6 things really went well. Mom was quite tired, but did so well. She spent some time back in the tub, and side lying, and eventually when she was checked again, she was at 9 cm with just a lip of cervix left. L came in and had mom try to push past the lip while she held it back out of the way. It took some doing but it worked and when mom started to actually really push for birth, she was having a hard time figuring out how and where exactly to push. It is hard to figure that out, especially at first. I used the rebozo again for another 'trick' and I handed one end to the mom and I held one end. Basically you do 'tug-of-war', where mom pulls on one end and you hold on to the other end. When mom pushes with a contraction, she pulls on the 'rope' and it really helps direct the pushing down in the right place/direction, and get some good effective pushing happening. Mom really liked the rebozo for pushing, it helped a lot!

Finally at 6:33 p.m. on Wed. Sept 3rd, Miss Anna Grace made her appearance! She was 9 lbs even. She was nearly 22 inches long, with a 15 1/4 in chest. She was definitley post term, no vernix anywhere, and her hands and feet were creased deeply/wrinkled/pruny, but wonderfully healthy and oh soooo cute! Mom didn't even have a tear or a skid mark at all and delivered all of that baby over an intact perineum! Awesome. She did so well at listening and breathing and birthing the head slowly, and the midwife L supported the perineum and helped it to not tear. It was a great birth and I'm so thankful to have been able to be a part of it. It was a team effort birth. Mom, Dad, C, L, mom's mother K (grandma to the new baby), and myself. We all worked long and hard for a labor that was over 30 hours. It certainly wasn't easy, but it was beautiful, and amazing. Mom did it, and the baby was awesome! Strong and healthy! Never any stress, no meconium in the fluid before birth. Mom definitely did not need a c-section, and was also glad that she hadn't gotten induced with pitocin that would have forced the baby's head down, with unnaturally hard contractions, into her pelvis at that unnatural position, probably stressed the baby, and if she had not progressed fast enough she would have gotten a c-section for a 'failed' induction.
She was so happy with her birth, and her mom was pleased with all the help that she received to help her to make it through. Dad was quielty supportive and did a lot to hold her up durring her labor. She was truly an inspiration.
Congratulations on a wonderful birth.