A Tranquil, Natural Birth

The phone rang around 8am, "I think my water is leaking..."At 38weeks, 4 days, we had been waiting for signs of labor to start, regular contractions every 4-5 minutes for several hours, or leaking of fluid from the vagina that could not be stopped with Kegal contractions.  Since she was Group B strep positive and would need to receive antibiotics in labor to protect her unborn from Group B Strep illness, we decided to have her pack her bags, eat a light breakfast, and head to the hospital in another 2 hours.  Oh, did I forget to mention she was 3-4 centimeters dilated at her last exam in the office?!  Needing to leave their 4 year old daughter with relatives, the time passed quickly. 

Upon arriving at the hospital, she was noted to be grossly ruptured, which only between 2.7-17% of women are prior to regular contractions.  After interviewing questions were answered, the electronic fetal monitoring was on and found to be reassuring, blood was drawn, an IV of Lactated Ringers solution was started along with the first  dose of Penicillin. Low dose Pitocin was started to bring the contractions to a regular interval of every 2-3 minutes.  Mom and dad had accomplished natural childbirth 4 years earlier and were anxious to have an unmedicated birth with this baby too.  A calm labor room with low lighting, position changes from rocking chair to standing to birthing ball to standing and leaning over the birthing ball while receiving very warm wet towels on her low back and buttocks helped this mother to move gracefully through the active stage of labor.  Her Nurse-Midwife and husband encouraged her in her relaxing and conserving her energy for the second stage of labor (10 cm to delivery of the baby). 

A little frown came across mom's forehead as she said, "I think I'm going to need something to help ease the pain."  Before making a decision on pain relief I asked to check her.  "You're 9+ centimeters now, Soon you'll be able to push the baby out."  That was all mom needed to hear.  With the next contraction came that unmistakable urge to push.  The room was prepared to receive the new baby and 11 minutes from the first urge to push, a sweet baby girl with lots of black hair was born, handed to her mother, and let us all hear thast she was an unmedicated infant...with great lungs!

Natural childbirth is almost a lost art now, with the modern advances of epidurals, but on occasion I am still privileged to witness the event, and am always honored and blessed by being part of this miracle of life.

Welcome to the world, baby girl!

When the Laboring Process Takes a Team

She was almost one week past her due date, that magical date arrived at by adding 40 weeks to the last menstrual period, when she awoke to a feeling of her bag of waters leaking.  Still feeling her baby move and not noticing any unusual color to the leaking, she waited for labor to start and called her Nurse-Midwife to discuss how long to wait at home before going to the hospital.  Having had an uneventful pregnancy course, we decided to give a few hours and see if nature would take it's course. 

A few hours later the contractions were only about 20 minutes apart, so it was time to head to the hospital to get labor picked up, first by walking around, then with the addition of low dose Pitocin through an IV drip.  Walking, rocking back and forth, and sitting on the birthing ball passed the time of early labor moving into the active stage of labor. 

Her husband was very attentive and encouraging as labor contractions began to come closer together.  Lite kisses on her forehead gave her that sense of being cared for and feeling his strength and safety.  The Nurse-Midwife offered suggestions for position changes and later a little rest in the bed.  The RN and student nurse offered their support with breathing and relaxation too, bringing an additional freshness into the room.

Soft classical music had been selected by the patient and brought from home to create a more home like environment for labor....and we waited...now nearly 4 centimeters dilated and 90% effaced, the contractions became stronger and harder to deal with.  With mom becoming tired from being up most of the night before, a decision was made to have an epidural for pain relief. 

Most of the time epidurals provide fairly quick pain relief to the laboring mother, but this time relief would not come.  Breathing and relaxation techniques were called into play as we encouraged and supported our patient and requested the epidural to be placed a second time an hour later. 

As pain relief came the mother-to-be continued to dilate to 10 centimeters and labor down.  The second stage of labor (from 10 centimeters to delivery of the baby) often takes an hour or two or a little longer in a first time mother and is usually well tolerated by the fetus.  This little fellow, however gave interesting signs of slowing his heart rate in response to contractions when on mother's right side or in a mid sitting up position. 

Having passed meconium earlier in the evening, an amnioinfusion had been started to thin the meconium and help protect the baby from trying to swallow the fluid after birth.  Mother was encouraged in gentle bearing down efforts or mild pushing as we watched baby's response to the final leg of his journey.  As baby continued to show signs of mild stress with labor it was decided to be in the best interest of mother and baby to stop the Pitocin, rest mom, and request the physician to come and assist the birth with a vacuum.

A little while later and two pulls, a vigorous baby boy entered the world, wide eyed and very unhappy about being removed from his safe place for the past 9 months.

Yes, I witnessed a miracle of a team effort in the birth of a baby boy on Mother's Day, May 9, 2010 with proud grandparents in Korea and Romania, all celebrating a new life on the same day in different countries.  Welcome to the world, little man.  You are so loved!