Thursday, April 7, 2011

A Perfect Intervention

I just had the honor of attending one of the most amazing births... and not in the way that most may consider "amazing".  No, it wasn't quick, it wasn't easy (are they ever easy?), it wasn't all natural, and it wasn't even at home which was something VERY important to this particular couple.  In fact it was almost everything they DIDN'T want (almost) as the cards were truly stacked against them, yet in the end it was perfect in every way.

A few months ago a seriously adorable couple came to me looking for a doula for the home birth of their first baby through the midwives of Birth By Design. Aside from an incredibly not-fun pregnancy for this mom (in many ways), all was looking good for them to be candidates to have their baby at home. That is until about 38 weeks or so.  At this point (a few weeks ago) mom's blood pressure started to rise quite high, coupled with weight gain, swelling, and the same general feeling of "truck-hit-ness" that she'd experienced through her whole pregnancy, to the point where we decided to head to the hospital.  We suspected preeclampsia which of course would no longer be conducive to her having a home birth.  So we did our best to prepare these parents for what to expect at the hospital... a huge change from what they wanted their birth to look like.  So with heavy hearts and some baked bribery for the nurses to treat us well, we headed out on our journey to Fauquier hospital.  We prepared these parents for the high probability that the doctors would push to induce, but with her blood pressure as high as it was, we all knew intervention in this particular case was likely best.  Much to our surprise all labs came back clear, they monitored her blood pressure for a few hours, baby looked great and they happily sent us on our way saying "you go have that baby at home"!  We were shocked and amazed as we all walked out to our cars with a major extra pep in our step!

Cut to early Monday morning of this week.  My phone rang at 12:30am and in my sleep I woke to an ecstatic voice squealing, "MY WATER JUST BROKE!!!".  Mom was SO excited that labor had begun on its own as she was now 41 weeks pregnant, and like many first time moms who reach 41 weeks, started to wonder if her baby would ever come on its own.  We chatted briefly about what was going on... she wasn't contracting yet... so we all went back to bed to be ready for the journey ahead.  (From the excitement in her voice I knew she would be getting very little sleep!).  I waited through the night and heard no updates.  I woke the next morning and still nothing.  I sent mom a text to see how she was doing and she said she'd started contracting in the night, everything was manageable, and to come over around 1pm.  I headed over and could see that this mom was still in very early labor. (Usually after membranes rupture we want moms to be in active labor by approximately12 hours after). She was in a great mood folding her laundry and setting up the house for everything to come.  Kim Pekin and Peggy Franklin came over at about 2:30pm to see how she was doing.  Her blood pressure had stayed consistently high since our hospital visit a few weeks prior, and with continued lab monitoring every few days, all else was still looking ok.  Kim checked mom's cervix and she was only 1cm dilated and 50% effaced.  Gulp.  We knew that since her membranes had ruptured at the onset of labor 14 hours prior that we were racing against the clock to have this baby.  Suddenly it became an incredibly real possibility AGAIN that we may have to head to the hospital if we couldn't get things moving along.  The midwives left us for the day to labor after our team devised a plan of action.  Every 15 minutes and every minute in-between there was something to do...from nipple stimulation to walking to belly lifts to ligament releases to acupressure points to herbal tinctures... we were on a mission!  This couple worked tirelessly with me as dad's watch went off every 15 minutes for our next dose of herbs between all of our activities.  It didn't take long for mom's contractions to go from 10 minutes apart to every 2 1/2-5min!  Things were looking good and the intensity of the contractions began to grow, but when Kim returned at 9pm (6 hours later) to assess the situation mom's cervix had not changed. At all :(  Talk about hearts sinking!  Everyone was disappointed as we knew right then that we needed to go the hospital.  We packed our bags and cars while talking about what to expect upon arrival:  If we're lucky they'll give mom Pitocin (never thought I'd use Pitocin and lucky in the same sentence) to get her labor going and if not so lucky; cesarean. Kim called ahead and thankfully the nurse who answered remembered all of us from our last Fauquier excursion.  Thankful for our ability to have intervention when necessary, I quietly sent some prayers "upstairs" on my drive over. I'm sure I wasn't alone.

Upon arrival we were thrilled to have a nurse who quickly said, "I just want you to know, I'm on your side.  I had 2 home births myself."  You could feel all of us let out a huge sigh of relief as anyone who births in a hospital knows that the nurse assigned to you is just as important, if not more so, than your doctor when it comes to your experience as a whole. [So...Great nurse? Check]  We got mom settled in and set the room with lights off, dim flickering candles, and the calm scent of lavender masking the sterile environment as we waited anxiously to meet our OB.  While waiting, the nurse told us that they don't administer Pitocin during the night because the Dr. isn't there. "UM... WHAT? What do you mean you don't administer it??" we thought. Now for a 'normal' birth we want to run as fast as we can from Pit, but when it's Pitocin vs. Cesarean, we were practically begging for Pitocin to give this mom a chance!  At this point we just knew it ~ our Dr. was going to walk in and say this mom needed to be sectioned.  But instead when the Dr. arrived from her home she quickly flipped on the lights separating us from our zen space [Peaceful doctor? Negative] and much to our surprise ordered some Pitocin (jaw drop!) and said that as long as mom and baby were doing fine that she would allow her to labor well past 24 hours with ruptured membranes!!! (double jaw drop!) [Taking back negative comment from Dr turning on lights? Check].  Oh my gosh were we elated!  She was going to have a chance!

It didn't take long for the Pitocin to kick in and mom's contractions quickly escalated to pretty darn miserable (I know, I know.. who's aren't miserable?). We all worked tirelessly for hours and hours trying to help her body relax so that her cervix could open.  When it finally got to where she just couldn't take it anymore we asked if we could get her into the shower.  Negative.  Major bummer.  They decided to check her cervix hoping that her progress would give her some drive to continue.  Now I have to say, from my personal experience watching cervical checks: whenever I see a care provider feel around in there for a REALLY good while before saying ANYTHING looking as though they're up to their elbows trying to even find the darned thing, I always know the dilation is going to be lower than we want to hear... but when I heard, "she's 1.5cm" I just about lost it and mom really did. HOW could this mother be contracting this strongly for SO long (5 hours on Pitocin at this point) and not be progressing at all??? She could no longer physically relax and Kim and I looked at each other and quietly nodded: "Epidural".  So against mom's original hopes for her birth she adamantly requested an epidural and was finally able to let her body go.  Once it began to take effect at about 6:45am Kim and I curled up on either end of the little hospital couch and dad half-dozed in a chair.  We cat napped for a bit and woke to the nurse coming in to give mom a check.  Within 2 hours she was 4cm dilated and 80% effaced!!!  The OB came in only 10 minutes later and said "she's 5-6cm and 100% effaced!". IN 10 MINUTES??? HOLY PITOCIN BATMAN!  We all felt like dancing!  Progress was being made and a chance was being given... we were thrilled.  Exhausted but thrilled.

Sure enough, a few more hours into the epidural phase, mom developed a fever.  We weren't sure if it was a side effect of the epidural or if she was developing an infection from having ruptured membranes for so long.  Again:  perfect time for Dr. to throw in the towel and intervene with a cesarean.  Nope... she treated mom with antibiotics and let her continue!  Kim and I just looked at each other with "well ok then!" faces as each of these surprising moments came and went.  

As the hours passed our team grew closer.  When it finally came time to push, our nurse allowed Kim to use hot compresses, perform perineal massage AND check mom's progress vaginally.  SERIOUSLY?!  This was awesome. We knew we were on their turf when we walked through those hospital doors and thought we knew what we'd signed up for, but this nurse graciously allowed Kim to maintain her role as this mother had originally hoped.  Next thing we knew the Dr. unexpectedly popped in and there stood Kim in her purple sterile gloves..... our hearts raced for a second as we thought "uh oh" and the doc just smiled and waved us on to continue as we were.  Again, SERIOUSLY?  Was this a dream???  So mom pushed as we massaged, rotated legs, hips and changed positions and a few hours later it was finally time for this baby to be born.  Nurses scrambled in assembling tables and disassembling the bed in the usual baby's-crowning-fashion.  [side note: Hours prior when explaining to the nurses some of the hopes that the parents had for their birth, dad expressed wanting to help catch the baby.  The nurse doubted that this would 'fly' but said she would speak to the OB.]  So during said scramble, in walked the Dr. and said to dad, "Would you like to help catch?"  REALLY??!  All eyes bulged and mouths dropped (including every nurse in that room)! "YESSSS!!!" Dad said as they quickly suited him up to look like the finest of Dr's.  What amazed us most was when baby's head emerged, the Dr. wasn't the one guiding it while playing the "you rest your hands on top of mine and pretend like you're doing the work" game.  DAD had his own hands on his sweet baby's head and the Dr. calmly rested hers on top of his [tears are streaming down my face as I write this].  This precious baby girl entered into this world in her father's very hands... in a hospital no less!  HOT DOG!!! (as my grandfather used to always say when excited)... We laughed and cried as we cheered this little one into this out-of-belly-world.

This birth was amazing in so many respects.  I've never been an "anti-hospital" doula at all, but when a couple wants a home birth you just know it's going to be a VERY different story when you have to transfer to a hospital.  It's a different ballgame and you just have to be willing to play it when you step onto their court.  This hospital staff proved otherwise.  They did their very best to preserve this mothers birth wishes despite the ever so many ways they could have intervened.  This gave me hope... if only more hospitals, nurses and doctors would be willing to welcome us with open arms and to truly play as a team.. utilizing all of our collective talents and knowledge TOGETHER to create a positive birth environment for everyone... just take a moment and imagine what we could accomplish!  Upon leaving, Kim put it very well: had any ONE single element of that birth been missing, then it would have gone SO differently.  Many OB's would have sectioned this mom weeks ago upon seeing her blood pressure alone!  Every single person on this journey was essential, and every path we took was perfect in every way.  God has a much greater plan and coordinated everything so that this baby would come into the world in the perfect way that she did; which really taught me... when you think you know exactly what will happen in life because the cards are stacked HIGH against you, something Greater laughs in your face and proves you wrong. And by golly I had no idea being wrong could feel soooo good!