Post Dates Baby Finally Born!

Despite my best efforts, I must admit I've been a little edgy this past week. I had a mama past her due date, quite a bit past her due date, and I found myself caught between trusting the natural process of gestation taking the time it needed, and then having panic attacks of worse-case-scenarios and our modern obstetrical world that thrives on fear and early inductions (and c-sections) as a result.
I had a 2 weeks late mama last year who didn't want to try an herbal induction for fear they'd cause problems for the baby. When we went for the BPP, she chose to stay for a pit induction. She had an otherwise great birth without drugs (other than the pit), just in the hospital.
During that client's BPP, the physician and tech were calmly explaining the higher incidence of meconium staining, meconium aspiration, placental failure, stillbirth and babies dying in labor because they're post-mature and can't deal with the stress of labor. "But it's up to you if you want to go home and see if labor starts on its own."

On Friday this current post dates client was 42w 1d. I offered to go with her for a BPP that day, or we could wait til Monday to see if she didn't have the baby over the weekend. I was honest about the possible concerns with a post-dates baby and then we started talking about induction. She wanted to try herbs. She had been doing EPO capsules vaginally for a week already. Those had helped bring her from a soft, but closed very posterior cervix to a midline 1-2 cm cervix. We opted to do 2 doses of blue cohosh followed by half hour doses of cotton root bark ala Anne Frye. She tried this for 4 hours, only got crampy and called it a night.
I came out to listen the next morning. Baby sounded great. Great beat-to-beat variability. She decided to have another go at the herbs. With breast pump nipple stim. Crampy, but nothing more.
Came out Sunday morning to listen to baby. Sounded great once again. Checked cervix, 2-3 centimeters and very stretchy. Gently swept them, nothing super invasive, and then did some accupressure on the cervix, again, ala Anne Frye.
Client asked about castor oil. The Big Gun. She knew that meant explosive shits, intestinal cramping, and hopefully uterine contractions. I think we were all ready for a good go at it.
I told her to take 2 tablespoons. She did so around 4pm. At 8pm she called me at a birthday party I was attending to say she hadn't pooped much and wasn't feeling cramping any stronger than usual.
Another midwife at the party informed that it's usually 2 ounces, not tablespoons. We measured how many tablespoons are in 2 ounces and found it was about 4 1/2.
Damn. I called my client back and told her to take another 2 ounces if she felt up to it. She said she was ready to have this baby and would take more castor oil.

I got a call at 9pm from client saying she wanted me to listen to the baby. So I drove out and did another long stretch of listening with stimulation and baby's own movements. Baby was great. Client felt relieved and told me to go home.

At 2am I got a call saying she'd been contracting for 2 hours and that i should come. (We already had it planned that I would come in early labor to make sure this post dates baby was coping well with labor.)
I arrived by 2:30, with my client contracting every 3-4 minutes, but only for 20-30 seconds. Thought to myself: this is gonna take some time....
By 4:30, she was involuntarily grunting at the peak of contractions. Hmm, so soon? By this time, contractions were longer, 60 seconds, and coming every 2-3 minutes.
I called an assistant to come and then listened for baby. This client had a very anterior placenta with what must have been a 3cm window above her pubis where I could hear the baby. This proved to be incredibly stressful during pushing when we tried to locate FHTs quickly while trying to discern if that slow 80bpm was the mom's or the baby's. You'd hear the 80bpm for 6 seconds while wiggling the doppler just so to find that magic spot where you'd suddenly hear FHTs in the 140s. Ahh, sigh of relief. Or, was that decels. We ended up feeling mom's pulse every time we checked heart tones to rule out decels.
At any rate, labor went quickly for this first time mom. She was completely dilated by 6am. By 7 we were seeing a quarter size of baby's scalp.
Exciting and encouraging.
And then hours started to pass and while we were seeing more scalp, I couldn't be sure it wasn't just caput and not real descent.
We changed positions frequently, which seemed to help. Every time progress stopped, we'd change again and get just a little more head.
I had to keep sticking my fingers into the mom's vagina to really assess descent. I had to feel for the skull bones behind the increasing caput. Every time I thought to myself, this is crazy, it's gonna take a vacuum extractor to get this baby out, it'd make the smalled increment of progress down. FHTs were great all the while. No mec fluid. In fact, the baby's head quite a bit of vernix on it when pushing first started.
What finally helped rock the baby under the pubis was McRobert's position, which is the natural birth junkie's hated hospital-slamming position: flat on your back, chin to chest, knees pulled up by your boobs while you push like hell. (We had tried this same position earlier and it worked for a little bit and then stopped.) In this position I could see the switch in baby's hair pattern. Realized this kid was trying to come in a military position, that's what was holding him up.
Seeing more scalp, and knowing there was certainly a lot more caput, I could also tell the head bones was there, it was getting through the mom's bones and McRoberts was helping.
All the while that little window for heart tones. Good God! That was stressful. I remember thinking, *THIS is when they'd screw in that stupid fetal scalp electrode if we were at the hospital!*
But actually, by that point she'd been pushing for 5 hours and 45 minutes. "They" would've done a section 3 hours ago.

With a lot of encouraging progress, the progress halted. We had the mom eat a few spoonfuls of applesauce for instant sugar power surge. Then I made her get off the bed with half that baby head hanging out of her. Poor thing. I felt so bad but we needed to just be done by that point. I held her in a complete supported squat and my assistant said, "Oh yeah, lots more head, this is working."
I really hoped she wasn't imagining things. Or just being encouraging.
I switched places with a family member and let him support her through the next squat. What do you know? There WAS more head! Tried to get heart tones. Heard 80 bpm. At this point it doesn't matter who they belong to. the mom's partner switches out the family member to support his partner. Another squat, and POP! Out comes that completely stubborn, military head. All in one POP!
I tell her I want her to push her baby out with the next contraction. And she does. He poops this massive amount of meconium on his way out and I gently catch him, laying him on the floor to look up at all 5 of us. To get his bearings. Those wonderful newborn eyes full of wonder. He doesn't cry, he just scans the 5 of us. He takes a breath, then another and another. Then he cries. I hand him to his mama, who is this exhausted, ecstatic woman who just pushed like hell for 6 straight hours without ever crying out in despair, or fatigue, or disbelief that this baby would ever come out. She held strong throughout and so did this baby.
Simply amazing.
This baby had vernix in his folds, his amniotic fluid remained clear, he had lanugo all over his body. Was he post dates? Yeah, he was a little over-cooked, but no worse for the wear. I think he shed his first layer of skin within 1 hour on the outside. He was so super peely! I hadn't seen a baby like that since my sister had her son at 43 weeks 23 years ago. His nails were quite long and peely too. But he was healthy and vigorous and continues to be.
So there you are. A little one coaxed out at 42 w 4 days.
Mom and baby are doing great today. His head has almost completely gone done to normal, just the slightest molding at the back of his head. No visible bruising. We had given both mom and baby Arnica 200C immediately after birth and doses over the immediate postpartum hours.
I'm so thankful this baby has finally come out to join his parents on the outside. I'm so thankful everyone is healthy and happy.
I'm so thankful for all my friends and midwives who reminded me that it's not crazy to go to 43 weeks. Mainstream medicine used to let women do so without question not all that long ago.
It's hard to remain focused on the natural order of things when we're constantly being bombarded by all the possible theoretical "threats" of just being alive in this world.
I'm going to bed now. I'm always so much more tired the second day after a birth.

The Birth Project #5

The newest issue of The Birth Project is finally out! If you subscribe and have been wondering where in the heck your issue is, well, it's in my dining room waiting for postage.
There are 3 of us that put TBP together, along with a lot of great contributors. We had everything pretty much ready to go by the first week of January... but between going to births, being sick, our kids being sick and just the general day to day of prenatals and post partum visits, we got behind. I suppose it's to be expected when 3 birth workers try to adhere to a deadline. :)

If you haven't checked us out, do so now!

And thanks to the bloggers who submitted pieces for publication. We love you!

Night Shift

G is back to the afternoon shift. He hasn't worked this 2:30pm-11pm shift since S was 3 1/2. I was actively apprenticing and going to a lot of births then. Finding childcare was tough.
I like this shift though. We get to see him in the morning/early afternoon. Then I can do dinner, homework, watch AFV rerun at 7pm and get the kids into bed at 8 without there being another adult to mess up our mojo. Or, another adult around for the kids to stall/plead with.
I admit, I'm not on top of it tonight. It's 8:15 and S is playing dolls in her room and E is playing his Leapster. I only got on to check my email and then decided to blah blah blog.

Nothing terribly exciting. I have a first time mom who is 41+ weeks. She and baby are doing great. She has total faith in her body to go into labor when ready. I love this about her. I always have to call my sister when I get someone very post dates. My sister had a hospital birth 23 years ago (when OBs were far more laid back about EDDs). She had her son at 42w6days. Spontaneous, 4 hour labor. Healthy mom, healthy baby. I attended (or rather, just missed) a birth in November of a woman who was nearly 43 weeks. She went 2weeks+ over for each of her 3 pregnancies. And that baby had so much vernix on it!

I would love it though, if this mama of mine went into labor tonight or tomorrow. I've got February clients coming up who could really go at any time.
Trust the process.
Oh, and there's a beautiful full moon on this cold, clear night. Maybe that will work some belly contracting mojo. ;)

Hey Ladies...

Funny, but I've realized that going to the library at story time is the way to pick up the ladies. That is, the pregnant ladies. Or, ladies in their childbearing years.
Yesterday I went to story time with a friend and saw two old clients, and met a pregnant mom. Today we went to the other library to pick up a book I ordered on loan, met an old client with a brief hello and oohs and aahs over her beautiful children.
A few minutes later and she's quickly and quietly asking me over bookshelves if I do well woman care too. It kinda felt After-School-Special-ish. Very clandestine discussion about Pap tests.

On the way home my sister called and I told her I had just left the library. She laughed because nearly every time she calls me I'm at the library. I told her about all the mamas I met up with and how I have to be in Good Mom mode out in public in case an old client hears me bribing my kids with chocolate or some computer time once we're home. And I can't raise my voice and be THAT mom who is threatening to leave her whiney children right where they are as I go to the checkout.

Another blog of mine

Right, because I have so much spare time to waste on the computer...

but I started another blog called The Urban Homesteader. You can read it by going to my profile.
I hope to document this new year of trying to grow as much of our own food as possible without appearing the least bit crunchy-granola-girl. I am out to prove that one can be hip and self-sustaining all at the same time.
Just as one does not need long braids to be a lay midwife. :)

Complete Placenta Previa

At the end of summer I had a couple call me for prenatal care only. They were planning on moving in 3 months or so. So I agreed to meet them for 3 prenatals. At 18 weeks she had a find-out-the-gender ultrasound and found that she had complete placenta previa.
Not good. If you don't know, previa is when the placenta covers the cervix, sometimes completely, sometimes partially, or sometimes only marginally. We hoped that it would grow up and out of the way (they often do that, especially when partial) and I told her that her new midwife would have her get another ultrasound to check on it as she got closer to her due date.
Well this couple never moved away. As she progressed through pregnancy she made it known that she was afraid of labor pain and really wanted an epidural. Her husband was very against being in the hospital and I told them that I needed them both to be on board, etc. I also kept encouraging her to get some kind of insurance coverage for her and the baby, which she never did. Until today.

At 5:30 this morning my phone rang. It was my client telling me that she woke up with a lot of blood in the bed and in the toilet. I told her to go to the ER asap. She was worried about the cost of going to the hospital. I told her not to worry about it and to GO! She's almost 34 weeks and I figured that good old placenta hadn't moved much.

Fortunately, she made it just fine (the hospital is only 1/2 mile from their apartment) and the bleeding stopped. Baby is fine, but the placenta is completely covering the cervix and that smart baby who has been breech for the last two months continues to be. Amazing. So they're giving her steroids to prepare the baby's lungs for a possible early-early birth.

I seem to have a thing for placenta issues. An abruption last August, a complete previa now, and a LOT of anterior placentas that make it nearly impossible to hear with a fetoscope and usually delivers with a fast, bloody plop very soon after birth because they seem to detach so much quicker. I've got 3 clients with very anterior placentas right now. That abruption in August was a completely anterior placenta. When I saw it on ultrasound I could not believe my eyes. The darn thing went from pubis to rib cage and was fairly wide too.

At any rate, home now. It's my husband's and sister's birthday. Me and the kids are taking him out for pizza dinner.