Both were fairly straightforward . . . mostly, but not entirely . . . and the babies were a little more challenging than I'd like.
The first was a first time mom who was 42 weeks. She'd been in to see the OB, who gave her the all clear to have her baby at the birth center because she was finally in labor! She labored for about 10 hours, and after 2 hours of pushing quite effectively, we opted to give her an episiotomy because her vaginal tissue would NOT stretch, and she was tearing further down her perineum. The baby was starting to have trouble, too, as she had been almost born for quite a while. As soon as the cut happened, the birth was within about 30 seconds. Finally!
The little girl went to her mom's chest, and overall looked good. She pinked up nicely, had good tone, and her heartrate was normal. However, her respiratory rate was high, so we watched her closely as she transitioned to life outside the womb. She did okay for a while, first held by her mom, then dad, then mom again. She was put to breast around 30 min of age, but didn't seem really interested in feeding. It broke my heart when the mom said, "she doesn't like it!" After giving it a good college try, including stimulating her, switching breasts, etc, I finally said - "anyone else have any ideas? She's just not that interested in eating." The midwife said, "Breastfeeding is a vital sign, so if she's not interested, it could mean that something is wrong."
The midwife took the baby, and did another evaluation. She was now almost 90 minutes old, and when we turned the lights up higher, it was clear that her skin was not quite as pink as we'd like, but more dusky. She also started to have retractions, meaning that she was putting a lot of effort into breathing. She hadn't been doing this on mom's chest. First we suctioned her, and then gave more oxygen, which did pink her up quite nicely. But her respiratory rate remained high. More suction revealed some blood in her throat, strangely. She'd sounded "juicy" and been spitting up "gunk" for a while, but it was all clear . . . until now. Not good. We recommended to the parents that we send her over to the NICU for more observation, so as soon as we'd copied records and called ahead, she was on her way.
According to the neonatologist, that night things were "touch and go" with her - she was put on a respirator with 100% oxygen. Fortunately, about 36 hours after her birth, she was improving in all ways measureable. They were calling it "blood aspiration" at the hospital, which really didn't make much sense . . . because the birth wasn't really bloody. So it's possible she had a pulmonary bleed. Why? No one will ever know. Maybe a familial clotting problem, or maybe a fluke.
Meanwhile, when we sent the Dad and the baby to the NICU, we stayed to complete the care for the mom. She was exhausted! We had her eat & drink, and then get up to go to the bathroom - all requirements for discharge. After sitting on the toilet for a minute, she got very lightheaded and almost passed out. We had her lying on the floor of the bathroom with oxygen on her, too. What a mess! After a while, we got her back to bed, put in an IV, and gave her 1500 mL of LR (a fluid with electrolytes & sugar). That perked her up for sure. By then, her husband was back from the hospital - it had been too much for him to handle, and he didn't really understand why it all happened or what it meant. But we packed them up and sent them back to the hospital because mom wanted to see her daughter, of course.
When we visited them in the hospital a few days later, they were still exhausted and a wreck. But mom was pumping a good quantity of milk, and they knew that their daughter was on the mend. There were questions and tears, so after talking with them for a while, we left when his family showed up, after arriving from another city. We'll keep in touch to see how things progress. Ugh.
It seems that we transferred care at just the right time. The baby girl just didn't look sick . . . and then she did. It was scary, but taught me a lot.
The second birth was a few days later. This was a second time mom, who had her first in a hospital with an epidural. I was called at 4 AM, arrived at the BC at 4:40 and the baby was born at 5:40. Mom was in the tub when I arrived, breathing through contractions. As they got more intense, she started saying "frick," and then "I can't do this anymore," then "I don't want to do this anymore," and then finally, "F@CK!" Of course, in my head, these are all good things, since transition (the end of labor, before pushing starts) is the hardest part. At the same time it is sad to watch, since I know how miserable it must be. For a second time mom who had an epidural first, it might even be harder, since usually the second time goes faster, is more intense, and you have no real comparison. Her husband was a terrific coach, staying with her and talking her through each contraction. When the midwife examined her, the cervix was mostly dilated, except for a thick and tough layer in the front. She suggested that she stand up, climb out of the tub and do a little dancing or walking. The mom stood up, stepped out of the tub, and hung on her husband through two contractions. (I thought she might pull him over!) Then we got her over to the birthing stool, where as soon as she sat down, the top of her baby's head was visible at the perineum - crowning, basically.
She had a nice slow & controlled delivery of her baby, with no tears. She was thrilled!
The baby came out with a cord wrapped tightly around his neck. He was pretty pale and floppy. Not my favorite. His heartrate & respiratory rate were okay, and with lots of stimulation, he started to breathe and cry. But we kept a close eye on him for a while. His color improved, but wasn't great. After a while, we took him from mom and gave him some oxygen. It helped a little, but then his color worsened again, so we tried again. With the second try, and about 10 puffs of air, he pinked up really well and stayed that way. Thankfully!
Throughout, I kept thinking in my head, "I do not want another bad baby! . . I do not want another hospital transport! . . Not again!" and things like that. I was glad to see him breastfeed very well three times before we sent them home.
The mom was THRILLED with her birth and pleasantly surprised at how great she felt afterwards. After we got her up to pee, she stayed up for a while, she was feeling so good. I love that!
So those were the week's highlights. Hope you enjoyed. I learned a ton!!!
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