Tuesday, July 14, 2009

Commit

I had another wonderful birth recently with a woman who I had been seeing regularly in the office. She very much wanted to have her baby and not go past her due date due to some extenuating circumstances. I had told her that if her cervix was 'ripe' (ready for labor and not thick, closed and high) I would accomadte her. Turns out her cervix was definitely ready at 3-4/80/-1. I scheduled her for a few days later but just before her due date for an AROM induction (breaking the bag of water in the hopes of labor starting). Of course I had discussed the risks of doing this with her and possible pitfalls. She was also thinking about trying to have natural childbirth with this baby as she had epidurals with her two previous babies.

Shortly after she arrived, I checked her...she was now a solid 4/90/-1 with just occasional painless contractions. I ruptured the bag to find clear fluid and sent her off to start walking. She gradually started to contract more, reporting that they were initially about every 15 minutes, then ten, then five. It was a nice, steady buildup for her. She was starting to get a little uncomfortable with them but breathing well through them. She was alternating between walking and resting in the bed. I had advised holding off on the tub until she was a little more active.

I had to go into the OR to do a scheduled primary C/S on a patient of mine who had an IUGR and breech baby. I told my lady that I would be done in about 45 minutes. She told me that she thought she would be ok for 30 minutes. :) I told her to walk for half an hour, then get in the tub. She agreed to that plan.

While we were almost done in the OR, the nurse comes in and says she's 6-7/100/-1 and asking for an epidural. She wanted to know if she could go ahead and start the IV. I was a little frustrated because I wasn't a point yet where I could leave the OR, but was close. I told her to just put her in the tub and start the IV there. The CRNA couldn't come anyway until the c/s was over. I was able to leave once the skin incision was the only thing left to do.

She was just getting in the tub as I arrived and no IV had been started yet. She was really starting to go into a 'zone'. I gave her a choice...I told her she could either commit now to doing this natural or we could start the IV and try to get her an epidural but that I didn't think she would make it long enough for that. She never answered me so I told the nurse to not worry about the IV. I sat with her while she labored in the tub. She really was coping well - humming loudly, rocking a bit. The dad (this was his first), who had earlier informed me that he spoke three languages - spanish, english, and stupid, kept asking her if she needed to push, did she want an epidural, etc. I told him to quit speaking stupid at her, that she was in a 'zone', and it was better to not distract her from her work. I had that kind of relationship with them :) He finally quit pestering her.
He was supposed to catch but decided that his mother would catch instead. I was a little disappointed as it's an opportunity that only comes around rarely but whatever.

My patient started to get up on her knees and push so we moved back to the bed (we are not supposed to do waterbirth at this hospital). She made herself comfy and pushed her baby out with fabulous control over an intact perineum, into the hands of the grandmother. It was amazing to watch her and I had goosebumps! She felt tired but proud afterwards. I was very proud of her as well :)

5 comments:

womantowomancbe said...

LOL at the "third language" -- I'll have to remember that!

Great story, too. I always feel a twinge at the "need" for an unnecessary induction, because I imagine it to be due to perhaps a previous term stillbirth or something like that. My heart goes out to couples in this situation -- or any other situation in which they feel it necessary for their peace of mind to speed up the birth process.

-Kathy

Ciarin said...

Don't get too twingy :) It was related to a physical problem and mobility :p

mitchsmom said...

Awesome!!!!!!

Joy said...

Very beautiful story!

Kim said...

Love the story...I got scared in the middle there but everything worked out beautifully :)