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.