I'm not quite recovered from the first birth I attended here at the Birth Center where I'm doing my last bit of training before I graduate. On Monday, a woman came in, laboring well. She'd been having contractions over the weekend, and when examined, was about 6 cm dilated, with a mostly effaced cervix. This was her first pregnancy, and those births often take a long time, but she was already 6 cm when she arrived, so we were all hopeful.
This woman was incredible. She was young - 24 years old, strong and confident. She was willing to try or do anything we suggested to help her labor along. That proved to be important in this story. She was not at the birth center for long, before she was moaning well - in a way that makes us smile because it sounds like discomfort that actually makes a cervix change - and we were pleased. We settled in for the night. She continued to labor well, with her husband and doula at her side. Her baby seemed well, also, with a heart rate that reassured us every time we listened.
Being at a birth center, we don't check the cervix too often - we try to do it only if and when we feel it is necessary, or when the client asks. Often the woman's reactions to her contractions tell us a lot. But after hours had passed, it seemed prudent to check her again, and her cervix hadn't changed much, except that it had changed position, possibly due to a change in the baby's head. No big deal. But when another chunk of hours had passed again, and her cervix still wasn't much different, or maybe even less open than it had been before, we started to wonder what was going on or how we could help her continue to progress. She seemed to labor well in the tub, in the dark bathroom, and when she was left alone. We tried all of that. She seemed to have more cervix on the left side, so we had her try positions that would help the baby's head push on the left side to help it open more. We suggested walking the stairs, doing lunges, going for a car ride, laying down to rest. We offered to break her bag of waters, we offered to give her some meds to help her sleep. She tried everything we suggested (except the meds), although breaking her water took her a while to feel okay about. Finally, sometime around 24 hours after she had arrived at the birth center, her cervix was 9 cm dilated! Progress! A couple of the midwives did some relaxation work with her, using the rebozo, and also used it to help move the baby into the best position possible, with the back on the mom's left side. That must have been uncomfortable for her, but she did it with grace, and was willing to do more. At the end, while the rest of us ate a dinner of pizza & calzones, she went in to the birth room alone to labor on her left side - a position she hated, but knew would help move things along.
Throughout all of this, this woman never complained, ate, drank, peed regularly, and kept her sense of humor. She was amazing.
Around 10 PM, her cervix was completely dilated, except for an anterior lip. One of the midwives held her cervix aside while she pushed, attempting to get that lip around the baby's head. As it turned out, getting her into a hands & knees position while doing that worked well - it was easier for the midwife, and allowed the baby's head to use gravity for assistance as well. At last, pushing commenced! She pushed well for about 2 1/2 hours, in hands and knees, on her side in bed, and for a long while on the birth stool, with her husband sitting behind her.
With a slow, deliberate effort, she delivered an 8 lb 9 oz healthy baby girl just after 1 AM Wednesday morning. Her perineum was intact, a midwife's way of saying that she had no tears! And she was absolutely thrilled with the experience - she did itHer baby was breastfeeding well within 35 min of the birth, and other than feeling weak and tired (like we all did!), she looked no worse for wear. Her mom and in-laws came to the birth center around 3 AM to meet their granddaughter, and help them get home.
The report today is that she's doing well. We'll do a home visit tomorrow to check in. What a happy ending.
The sad thing is that if she'd been in a hospital, she would have had a cesarean due to "failure to progress." Sometimes women just need time to let their bodies do it. And we need to remember that sitting on our hands and doing "nothing" can be best. Doing nothing is really hard- and truthfully, we were doing something really important: believing in the process, in her body, and making sure that she and her baby were okay.
I'm exhausted. And thrilled. I teared up several times today just thinking and processing the experience. It was peaceful and joyful and exhausting for all of us. I'm honored that I got to play a part in helping this woman bring her daughter into the world in such a lovely way.
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