Amazing Model of Care
Yesterday I received a call from a third time repeat doula client. She felt something different was happening from her normal braxton hicks contractions. She has FAST labors and is 40 minutes from the hospital of choice, so watching and being mindful is imperative for her with two little ones to settle first. She chose to go into the office for a labor check first. So, the exam was inconclusive. She was dilated to 4 cm and was 40% effaced and definitely contracting, but could it be early labor or prodromal labor, who can tell. Oh I forgot to tell you, her usual behavior in labor is to contract without any real pain until transition- then she speedily gives birth. She is a no mess around, get her done kinda birther. So the fact that she is not moaning, not swaying but contacting every 2 to 3 minutes with a firm belly is her normal labor. So she decided to wait around the area of the hospital for another hour and sure enough the pattern became stronger and closer together, so she decided to check into the hospital. Her dad and mother in law were called to come help with the kids and she enlisted me to come meet her and her husband.
I took more than an hour to get there due to the rain and nearing after work traffic but found her the way she is in the middle part of her labor. She would stop and breathe heavy ever so few contractions and then begin to talk and chat about wishing she had eaten more since she was now hungry but feeling a bit nauseous at the same time. She would sway, stand by the bed, sit in the bed, eventually eat a sandwich and chat. She began to be frustrated with the lack of progress and eventually at the recommendation of the midwife on call, decided to try to sleep. And exam 12 hours after the first one- with another offered somewhere in the middle- showed no further dilation. We had kept hoping that something would break loose and she would be having a baby quickly like the previous times.
This is where the amazing model of care really goes into action! I mean I loved the fact that she was seen in the office without an appointment for a labor check without being told to go directly to the hospital like many care providers require. I loved the fact that the midwife in the office upon finding her to be 4 cm dilated did not insist that she go to the hospital or ensue any type of panic! I loved the fact that since she has rapid labors usually she bypassed triage. I loved the fact that they set up the tub since the first time she gave birth here she was unable to get in the tub due to blood pressure issues and really wanted the tub experience- although she never got in the tub. But I loved the fact that although the mom was curious a few times and asked about an exam, Kimary and Anjli both said that the exam was not necessary since they would be doing nothing differently based on the exam. And at the final exam to determine if we needed to head home, Kimary offered to break her water to get things going and warned that this could cause her to possibly need pitocin if it did not do so. Nope, this mom liked the idea of no intervention and declined the offer- although let me make sure you understand it was not a suggestion to get her water broken- Kimary only said she needed to provide the mom with all of the options.
But here is the statement that I think is often missed by both care providers and women in labor,
Labor is the presence of contractions that are bringing a change to the cervix. If the cervix is not changing, it is not actual labor yet!
What would have happened in most situations is this mom would have been initially sent to the hospital earlier in the day. The nurse would have called the doctor and declared the mom in labor. After all she is contracting every 2 to 3 minutes lasting a minute- firm fundus- and she is dilated to 4 cm! She would have been in the bed on the monitor, not encouraged to eat, given an IV with possible fluids, and made to feel like a patient. She would have eventually had her water broken which could have caused her contractions to become more intense and bring on cervical change or not- she would have possibly been given pitocin to bring about the change and honestly with a third baby, she would have had a baby. But not without a lot of intervention. If she had suggested that since her cervix was not changing she would have asked about going home, she would have been reminded that her IV is already in place, that she might as well get the show on the road and would have been scared with comments on having the baby in the car on the way here if they let her go home now. But she decided to go home with full faith in the birth process.
Are either way wrong? Nope- some women would have preferred to go ahead and have the baby. After all it is the holiday season and this would insure she would be home for Christmas and get the tax break too. The pregnancy would come to and end and you get to take a baby home to boot! I do think it crossed this mom’s mind for sure! But if you are choosing a nonintervention way, the way this turned out thus far is the path you would prefer. I am glad that there are a few good providers out there who are willing to offer this model of care. I give praise to Kimary at Intown Midwifery for modeling this care this morning!