I wanted to share a bit of a story of a woman’s journey in labor and birth to help you see things from a perspective that is not the norm in our area. A highly interventive hospital does not mean lots of interventions if you make some other choices that help avoid just that!
This is a first time mom who started her labor right around her due date. Her labor started with a bang! Contractions started fairly intensely lasting about 45 seconds and coming every 3 to 4 minutes. She tried laboring in the tub at home for a while, but as they escalated and were timed at 2 to 3 minutes apart lasting a full minute, she went ahead and left to go to the hospital. She had been in labor for about 4 hours at this time.
Upon arrival to the hospital the exam showed she was about 3 to 4 centimeters dilated and the contractions had slowed down to 6 minutes apart. This happens often when adrenaline is pumping when change happens in labor. She nestled into her new surroundings and soon the contractions were back to 4 minutes apart. She was GBS+ so the antibiotics were started soon after her IV was placed.
6 hours later she agreed to having another exam and found out that she had dilated to 5 centimeters now and her baby remained high still at -2 station. Her bag of waters were bulging but still intact. She walked around in the room, moved a lot into positions that helped her cope- kneeling over the chair, swaying by the bed, walking around the halls of the hospital and even tried the tub. The midwife suggested no more exams since she did not want any further intervention. This was exciting news!
Nausea overcame her a few times and we were feeling assured progress was being made. She had gone from being quiet during her contractions to now needing to vocalize with them. We had a new nurse assigned to us since the first one’s shift had come to and end. We would keep our midwife for another 12 hours before she would also be replaced. We felt like surely we would have a baby before then! Monitoring was occurring every hour for 15 minutes but now the suggestion that she lay down to do so was no longer acceptable. She remained standing swaying for these times or on her hands and knees.
11 hours had passed since the last exam and the idea of helping to move this along came up in the conversation with the nurse. Perhaps having an exam and determining if she was close, she would agree to having her water broken. She had been in labor for 24 hours now and only caught a few naps while in the tub over this whole time. The current midwife joined us and did an exam. She was now 7 to 8 centimeters. She broke the bag of water, something this mom had not wanted, but had been considering for over 4 hours now. There was meconium. This meant no more returning to the tub. But the last time in the tub had offered little respite.
Ironically we now get the original nurse she had had 12 hours ago as shift change occurs. And we get a new midwife as well. Two more hours past, now more than 27 hours since the first contraction and she is so spent that the idea of getting an epidural seems more feasible. She asks for medication for the first time. She knows she wants one more exam to make sure things are not close to the end before doing so. The new midwife says she feels more like 6 centimeters than the 8 we expected to at least be!
A bolus of fluids is soon accompanied with an epidural placement now 22 hours after arriving to the hospital and 28 hours since the labor began. And an IUPC is placed to “shower” away some of that thick meconium that the baby is surrounded by. Some napping occurs by everyone in shifts while we watch over the mom.
Six more hours pass before she begins to push her baby out. Two hours of pushing her son is born with the cord around his neck two times. Never in this labor did he ever show us any distress. There was a short moment of having back labor, but nothing besides the slow moving labor caused us to think this baby may be malpositioned- occiput posterior although an hour before she was pushing, the midwife had encouraged a little bit of spinning to line him up perfectly.
The baby boy was born strong and healthy. Although the neonatal team is always called when there is meconium, they soon left after seeing how great he was doing on his own. I sit and think about so many things about this labor and it causes me to want to share these things with you.
Did she go to the hospital too soon? If you say so in the hindsight or realizing how long before the baby came, we would all say yes. But if you do not go when contractions seem intense (and yes she understands now intense then and intense in the end was different!) and are 2 to 3 minutes apart, when do you go?
What kept her from all the interventions that usually plague a labor like this? Having a midwife helped! Having a supportive back up physician who suggested no more exams if she did not want intervention, helped a ton! Having a doula they felt like helped. The mom being well educated to birth was essential. She made wonderful decisions all along the way. She knew what she wanted and why she had made those decisions beforehand. She also knew that labor is unknown and had not made her plans so concrete that she would not be able to make the “next best thing” decisions along the way.
She waited to have any interventions until she had exhausted all of her other options- or all the options she could see as feasible. She knew this was possibly going to be the hardest work she had ever done and she prepared herself emotionally for this day.
We had a great supportive team. Although this hospital is not known for being super supportive of a natural birth, we had a team of nurses who never undermined her ability and found support essential to their nursing skills. Her husband and mother were also there to offer support and love.
This mom moved and stayed upright and active all along the way. She was open to new ideas but mostly listened to her own natural rhythms and patterns of movement that felt right for her. She developed her own rituals of labor that helped her to cope during contractions.
I have to wonder if this baby was occiput posterior or sunny side up. But I also wonder if this little boy knew that if he rapidly moved down the birth canal he could cause himself trouble. Never was Pitocin ever needed. Never did the contractions space in such a way to make anyone suggest this. Although I have seen some providers assume that the contractions are not strong enough and insist on doing so. The midwives here never did. But maybe he needed this long labor to stretch his cord and help him navigate the way down through the birth canal.
The mom used the term “threw in the towel” to express her own disappointment in choosing an epidural but in the next breath remarked she had probably gone a half an hour longer than she should have! The last hour before the epidural was placed she could no longer relax and she felt so hyper-stimulated by the contractions that she could not even focus on any supportive words offered to her. She had been tightening and drawing upward with her breath. It was apparent to us that this was not going to work toward her letting go and releasing the baby. Within a half hour of the epidural she indeed dilated 2 centimeters. I do think once she was able to fully let go she progressed.
Do I then think that means all women can benefit from getting an epidural. Absolutely not! In fact if she had gotten an epidural early, her labor may have stalled. If her labor had stalled, Pitocin would more than likely been used. If Pitocin had entered the labor, that nuchal cord could have been tightened by the artificially induced contractions and we could have ended up in the OR with a stressed out baby instead.
The mom even said she was sure with her next baby, as long as it was not longer than 24 hours, she would be able to do it without an epidural! And to that I have to agree. She was quite the warrior woman! I can not feel anything but admiration for this mother!
Oh and for those who wondered- he was an averaged sized little boy with a rounded head that showed no malpresentation swelling. He in fact was gorgeous and reminded me of the photos in journals showing what a normal newborn looks like! I look forward to the call in a few years hopefully inviting me back to this couples next birth!