Wheat Ridge Area Doula: July 2014

My relationship with T started off as client/doula, but I quickly became fond of her and her family and was eager to see her succeed in an unmedicated vbac. Her first daughter was a c-section after a failed induction. We were anxious to see how this labor played out.

Tuesday afternoon T began having regular contractions and we texted back and forth. I was pretty sure that she was in early labor; SO exciting since she never went into labor with #1. My advice is always to rest and see if the contractions will go away because they will pick up if it is real labor, but I never took my own advice as a laboring mom, and I didn't take it as a doula either. lol I spent the day gathering my supplies and attempting to leave my house clean for my family.

We kept in touch and by 9:30 things were looking promising. The contractions had spread out, but were getting longer and stronger. I decided to go to bed and see what sleep I could get before I was called out. I had just gotten in my pajamas when T asked me if I could come up because things were getting harder. Any tiredness I was feeling was instantly gone because this was it!

I was on my way about 15 minutes later and got to her house about 11:00. T was a little nauseous, so I diffused some peppermint and we talked until she had a contraction. The pain in her back was so bad that she could only deal with them on her hands and knees. I noticed that she also went into an asymmetrical squat (which can help get a baby to turn). I highly suspected that the baby was back to back with Mom, so I encouraged those positions to try and get the baby to turn.

I talked her through contractions and encouraged her to lower her moans. Her husband told her to channel Barry White. lol High pitched vocalizations close the throat which in turns closes every other sphincter (aka the cervix), so that's why we were going for low. She had about 10 contractions in 45 minutes and they were getting longer and closer together. Because the hospital was 30 minutes away and she's a vbac we decided to go in and see what was up.

After all the questions and getting situated, the triage nurse checked her and she was still 1cm and posterior, but 50% effaced. I admit that I was shocked at this news since she had been contracting regularly for 9 hours already! However, 50% effaced was good news and I tried to focus on that. After the required monitoring they sent us to walk with the threat that if she didn't progress she would be sent home. T was in a LOT a pain and I just couldn't imagine them making her leave!

We walked the loop around the maternity ward, all of us falling to our knees when a contraction would hit. T got sick once and I could tell by her pace and the look on her face that she was *exhausted* and her body was probably having an internal battle over sleep or dilation. So after only 30 minutes of walking they let her get in the spa and I set up the diffuser again.

Every time they checked the baby she was happy as could be. The tub helped the pain somewhat, but the contractions were still really hard on T and she got sick once again. She stayed in there for about an hour and a half and then decided she was getting hot and wanted to get out and see if she had made any progress.

4:00am - 3+ hours of regular, painful contractions since her last check... NO change! I was shocked and devastated for her. The best they would do was give her some Ambien and send her home. She had an OB appointment scheduled for later that day and they advised her to keep it. I asked if she could take the Ambien and sleep at the hospital, but no way. I couldn't believe they would send her home in so much pain, but there really wasn't any other option except giving her a c-section right then.

So they headed home and I slept in the car for a couple hours before I headed home. I crawled into bed with my phone nearby ready to head back up at a moment's notice. I woke up about 11:00 and hadn't heard anything from them. I was hoping that she was still in a drug-induced sleep and I texted her about 11:40 with some suggestions on positions and things she could do to try to help the baby turn. Ten minutes later her husband called me to tell me they went to their OB appointment and T was 6 cm dilated!! This was FANTASTIC news as she never got past 4cm with her first labor.

So I jumped back in the car and headed back up to the hospital. T was being monitored and wanted some lavender essential oils so I put some on her gown. I could tell by her vocalizations that these contractions were different. She would count during contractions and it seemed to be a great distraction for her.

She labored in every position we could think of and tried walking some more. Nothing was comfortable (if labor can be comfortable) and nothing took away the back pain. She was recovering well between contractions and when she was checked 2 hours later she was 8cm, completely effaced and -1 station.

I tried to have her use the bathroom often and keep changing positions. She tried the shower, but that wasn't doing anything for her. The Ambien had only given her a couple hours sleep at most and she was now at 24 hours of labor.

At 5:00 she used her code word "Squirrel" and said she couldn't do it anymore. I could hardly blame her, she was a super hero in my book! It was a tough decision for her and she went back and forth; between contractions she would say she wanted to go a little longer, and during contractions she would call out "squirrel!" At 5:30 the OB broke her water to see if that would help move things along. She was still at 8 cm (stuck there for 4 hours) and there was meconium in the water, but the baby was still happy.

The anesthesiologist came in at 5:45 and talked to T about her options. T opted for a walking epidural so that she could still move around and squat to push. She had to stay in bed for a hour until she could actually walk with the walking epidural so we used this time to rest. Her husband ordered dinner and I thought about eating after he was done, but really didn't want to miss anything so I got some chips out of the vending machine.

We all made guesses as to when the baby would come and how much she would weigh. She was checked again an hour after the epidural and was still 8cm, but the baby was now at 0 station (that's good - negative numbers are above the pelvis, 0 is the pelvis, and positive numbers mean the baby is on its way out).

We went to walk some more and got a new nurse. She had just finished her nurse-midwifery training and was assigned to T because she wanted that natural model of care. Side note - I was impressed with the hospital and staff. The first nurse was very helpful and brought in a kit of tools to assist in labor. They had some aromatherapy available there (which came in handy because T loved the lavender scent and I ran out). The second nurse made sure that T understood all her options and the OB did everything she could to help T have a vbac...other doctors might have thrown in the towel and suggested repeat c-section after being stalled for so long.

T's OB came in and discussed starting pitocin. Normally, this is not the way to go with vbacs, but augmenting is different than inducing and they were going to start at a very low dose. However, her contractions had picked up with just the threat of pitocin, so T got another dose of her walking epidural and we pressed on.

A 8:45 she was checked again and her cervix had started to swell. I asked if there was any chance of scar tissue, but the OB said everything was soft and stretchy it just wasn't moving. She said that all of the leaning forward was causing the anterior swelling, but T was leaning forward to try to get the baby to move. She was stuck between a rock and a hard place.

The OB suggested a full epidural to allow T's body to fully relax and then to start pitocin. Before they did that they put an internal monitor in to see how strong the contractions were, and they did an amnioinfusion to try to clear out some of the meconium. So T was hooked up to almost everything imaginable, but at this point her body and uterus was so exhausted that she didn't have many options. She needed that rest!

We all tried to rest. I got Dad set up on the bench with a pillow and a blanket and we turned the lights down low. The epidural did not take away all the pain or pressure, but it was enough to give T a much needed break. Two hours after the pitocin was started T was checked again and was found complete and at a +1 station! There was much rejoicing!

The nurse put a catheter in to empty T's bladder and allow more room for the baby to move down. The nurse left to let T rest more, but it wasn't long before she was saying she felt a different kind of pressure. We were told that because the baby was posterior that it might be hard to push her out. Not long after that, Baby had a decel that had me holding my breath and T sucking down the oxygen. Baby's heart picked back up and when T started doing her practice pushes we were thrilled to discover that the baby had assumed the perfect position for birth!

It was clear from the practice pushes that Baby was coming down and it wasn't long before the OB and the extra nurses came in and started setting up. I woke up Dad and it took him a few minutes to process what was going on. ;)

Pushing was incredibly painful for T, even with the full epidural. But she only had to push for 20 minutes (and endure 33 hours of labor!) and Baby J was earthside! She had a tight nuchal cord that had to be cut before she was fully out, but she didn't have any adverse effects to the meconium.