How Would This Story End Elsewhere?
We recently had two clients in our group of doulas who achieved vaginal births in spite of the way their labors unfolded. I wanted to share their time lines so you could see how most anywhere else these births would have been derailed to the OR for a cesarean. Look at the timelines and compare it to the stories you hear most every day that start this way.
This first birth was at North Fulton under the guidance of fabulous midwives and nurses. The doula met them at the hospital:
- Labor started that evening and they were in touch with their doula throughout the night
- Arrived at hospital contractions were 3 minutes art, lasting 60 sec and had been for 3 hours.
- (Last hr in the car in rush hour traffic)
- They arrived 7am – checked and found to be 6cm dilated
- Contractions went to 5-7 minutes, still lasting 1 minute but losing strength
- Gradually picked up by noon
- 1:30pm got in tub
- Declined vaginal exam
- 2:15pm – got out of tub – contractions slowed to erratic and shorter
- 5:00pm checked by nurse – no change, confirmed baby was OP
- Given options of fentanyl, epidural, break water or pitocin
- Chose to do nothing
- 7:30pm Checked by midwife -maybe 7 cm, otherwise no change
- Contractions every 5 minutes, lasting 90 seconds and very painful
- Chose to do ,1 dose fentanyl and await an epidural.
- Declined breaking water or pitocin, wanted to see if rest would turn the baby.
- Made several refusals for checks or interventions through the night
- Contractions remained erratic, but lasting 1 minute+
- 10:30am 9cm dilated , effaced 90% with the baby at +2
- Midwife broke water
- 12:50pm anterior lip +1 baby flipped to anterior
- Started pitocin
- 2:00pm started pushing
- 4:44pm – baby boy born vaginally
Thanks to the Lalani family for allowing us to share their beautiful slide show of the birth of their baby Julian. Charlotte Scott is the doula. And the beautiful birthing gown is the one we sell here!
This second birth occurred at Atlanta Medical Center with a fabulous midwifery group and a staff of nurses that were less supportive but not interfering. The mom was induced due to low amniotic fluid.
- 4pm mom arrived for an induction but did not get a room until 8pm.
- She was given cytotec at 9pm
- Cytotec caused a bad response from the baby
- But soon the baby recovered after giving the mom fluids
- The mom received an ambien and encouraged to sleep the night to begin the next day
- Pitocin was started at 10am
- Her doula arrives 12:30 pm
- But after Pitocin was started the baby had decels due to her uterus being hyperstimulated
- By 1:00pm there was a better contraction pattern
- At 1:40pm the mom was standing forward leaning
- Tootsie roll dance was following
- 3:30pm much more active labor pattern
- 4:30pm toilet sitting– really feels productive to her
- 5:20pm singing and dancing
- 5:55pm an exam shows she was 2cm dilated, 50% effaced and the baby at -2 station
- 6pm her water broke
- Contractions fade, mom sleeps
- Her doula left soon after to give her a night of sleep.
- 6:00am and exam showed overnight she had progressed to 5cm, 70% effaced and the baby remained at -2 station
- 10am doula returned
- 1:00pm 5cm, 75% effaced and the baby had moved down to 0 station
- 1:37pm shower
- 3:30pm epidural was placed
- 4:00pm Pitocin was started back at 1
- 4:30pm Pitocin was turned back off due to the baby having decelerations again
- 6:15pm an internal pressure catheter was inserted and the midwife made a wonderful decision to add an amnio infusion to see if “floating” the baby would allow the baby to tolerate labor a bit more
- 8pm restarted Pitocin
- Doula stayed the night
- At 1am she was dilated to 6cm, 90% effaced
- 4am the exam showed she was 7-8cm, +1 station , 90% effaced
- And by 5;40 the mom began pushing
- And a long labor ended in a fast pushing stage with the baby being born at 5:49am
And although ACOG says labor should not be halted for failure of progressing and ending in a cesarean should not occur until the mom is over 6cm dilated, I would dare to say that in most locations this story would have ended either on the 1st day or at least the 2nd with a cesarean, must less continue into the 4th day. Although there were many interventions offered and some declined. But the resounding piece of each labor was patience. No one was in a hurry to make these babies come. Both babies were eventually born gently. Neither mom had a rush to the OR for an “emergency” cesarean. And although in postpartum the NF mom received negative feed back to not agreeing to a cesarean by the postpartum nursing staff and having wanted natural births, they had gotten the outcome they desired, a healthy baby and mom. But even more the moms felt empowered to make decisions along the way, being heard and supported.
I think both of these births also are witness to how a doula’s support can make a huge difference. A doula not only offers great position changes and pain coping ideas, but the continued support that encourages a couple to keep moving forward despite long labors. Where you birth and who your care providers are really do make a difference.