That week of babies- #1

I've been wanting to write about this for a while now. Of course, after I caught up sleep, hung out with my family, caught up with the postpartum visits and the regular prenatals, I was just ready for bed again.

But I wanted to recap that week of births, it was a long, but wonderful week.

On Saturday the 9th, I got a call in the morning hours from a first time mom who was
having contractions every ten minutes and felt like she was leaking water. I got up and checked on her and the baby and we discussed what more active labor might be like, telling her to call me when she needed me. I checked in again in the early afternoon and by 5pm my assistant and I were there. The woman was in early/active labor, but seemed like she wanted us there. She's a very quiet woman. One of those kinds that never makes a sound during the entire labor, even while pushing (which wouldn't come for a while yet)!
We tried to stay out of her way and encouraged her to rest, eat, etc.
After midnight, her labor really got kicking. She continued to trickle water and baby continued to sound great. By 4am she had thrown up a few times. She was getting tired, it was hard for her to drink much, and her contractions started to space out. I checked her around 5am and she was 6cm. I had her drink as much as she could and then encouraged her to rest. It was now Sunday morning, and her family was beginning to wake up and get breakfast going. I slept for about a half hour. Contractions were still spaced out, and the mama was getting some rest. Around 11am I went back home (which fortunately was VERY close), leaving them instructions to check the mom's temp every couple hours since her water had been leaking 24 hours and she was exhausted.

Once home, I tried to eat breakfast, washed (without showering) "my dirty bits" as my husband would joke, then took my daughter to a birthday party with her friend. I came back home and slept for two hours. I went back to the woman's house around 4pm. She was having closer contractions, but somewhat irregular and less strong. She felt a bit more rested and was able to eat a little. Her temp was 97. An hour later, 98.9. Another hour latter 99.5. Contractions were still all over the place irregular and not as strong as they had been in the night. (She had also tried homeopathic caullophyllum and cotton root bark tincture during the day to make things more regular.)
I was concerned about possible infection, dehydration and exhaustion. We discussed going to the hospital for these concerns. She was so disappointed and we were all sad about the decision to go in, but felt like it was the best. Her mother was there and she said this amazing prayer over her daughter, the baby, the situation, and basically for acceptance and surrender for whatever lay on the path ahead. We cried a few tears at the beauty and truth of the prayer and packed up to go.
The weather was freezing. Little House on the Prairie cold. Seriously -20 below zero with a strong, howling wind. The hospital is only 5 minutes away, so the cars never even warmed up.
It was nearly 8pm.
I had called ahead to triage to tell them we were coming in and explained my concerns about maternal dehydration and a small, yet creeping temperature. Once we were in the hospital, we were met by an amazingly sweet and gloriously NOT condescending nurse. We got the feeling straight away that she was on "our side". Once in a triage room, my client's temp was taken and it was normal. 98 degrees. WTF? I was thrilled, but she just drink a little and we did just come in from the prairies of Ypsiville. Her urine was checked and it was crazy high with ketones, a sure sign of dehydration and no recent nourishment. The nurse was optimistic. She said off the bat that maybe with "a bag or two of fluids, labor will get going again and you can go home and have your baby!"
Say what?! Never have I encountered such sweetness at the hospital. Not as a mama myself, nor as a doula and certainly never as a homebirth midwife.
The nurse sets her up with a fabulously fast-dripping IV bag, that makes my client very cold but gets contractions going immediately. Regular, strong, 4-minute-apart contractions. YES!
Soon a resident comes in and checks my client. They ask why I haven't checked her since early that morning. I explain because she's not really had regular-enough, nor strong enough contractions to warrant another check. She had trickled some fluid on an off and I didn't want to introduce any more bacteria than I needed to.

So the resident does an exam and states my client is still 6cm. Then she looks at me and asks, "Is this baby head down?" While she's got her hand in there! I felt a rush of adrenalin and then just as quickly a Wait...She's-Fucking-With-Me epiphany.
"Yes the baby is head down. I felt the suture lines, can't you? I mean, there's a bulgy forebag there, but that's definitely a head."
See it's a good thing I waste time reading medical student blogs and learn all about their strange hierarchy and nasty ways of climbing up the ladder by belittling others. (Only partly kidding, I also know of a lot of fabulous, big-hearted, sincere medical folks whom I love and respect.)
The resident agrees with the nurse that we can probably go back home after we finish the fluids and get another urine check. They're also not concerned about leaking fluid since there's still a big forebag. At the "Other" big hospital in town, I've seen them freak out about hind leaks and going over 24 hours, etc. So that was nice to hear.
Soon a second year and then a third year intern come in and they're happier to use scare tactics in soft, soothing tones. Like late night radio hosts they smoothly say, "Well, we have to wonder WHY you've not dilated in 12 hours. That's not normal. Why isn't this baby coming down? (Baby was +1 !!) If you stay, we'll likely keep you on IV's, maybe augment with a little pitocin and see how it goes. If you're not fully dilated by 11 or midnight, we'd have to discuss other options, like a cesarian..."

My beautiful, calm, intelligent client says with no sass whatsoever, "I appreciate your concerns. I really appreciate the IV fluids and I feel much better. My contractions are regular and as strong as they were last night. I'd like to finish up this second IV bag and go home. Thank you so much for your help."

Intern in a not-so-soothing tone, "Well I don't know. You'll have to sign out AMA. Against medical advice. Let me go get the doctor. Huff."

The doctor comes in (got to see every rung of the hierarchy in 30 minutes). He was great. Honestly, maybe in his 50s. He said all the same things the interns said, but one got the feeling it was because he HAD to. He also said that if she chose to stay, then I could stay, not just as a doula, but as her midwife. "I'll be in the room, but she can still catch your baby." We were stunned.
"Not all doctors are as bad as we're made out to be, you know." (I guess he knew what ACOG had just said about MY camp a couple weeks ago.)
My client explained she'd really love to go back home. The doctor was gracious to me, asked me what my plan was at home, I told him and he nodded his sage, gray head.
"All right. We'll have the nurse get the AMA forms. Go home and have your baby."
Then he looked at me and said, "Now I want you to call me at 11:30 and tell me she had that baby, okay?"
I laughed and said, "I'd be thrilled to call you at 11:30 with that news!"
"No, I mean it," he said. "If you have any problems, call us back. I'll be here all night. Ask for me."

Everyone left us alone. My client, her partner, her mother and I were incredulous to say the least. The client's mother is very spiritual and had been saying very calming, solid-rock prayers that helped ground us all. I felt she had some direct connection with God. I loved her presence as much as her daughter did.
My client got up to pee again and to catch it in a cup so that they could do one more ketone check before we finished the fluids. She and her husband came back from the bathroom with big eyes. Apparently, as soon as she waddled down the hall and sat on the toilet, her water broke with a bang (she caught it in the pee cup)! As soon as she sat back on the bed it was clear she was in transition. Strong contractions every 2 minutes.
We sped up the already fast IV so we could get home. We had a good laugh about how amazing it was she made it to the toilet for her water to break. Had it happened in the hall, everyone's Go Home tone may have changed. I told the client's mother that now I firmly believed she's got a direct line to God!

We managed to get the AMA forms and everything taken care rather quickly. I think we were back home again by 10pm. I called my assistant and told her to come quick to the house, we were coming back and things were moving quick. She was awesome and was there super fast and we scurried to re-set up the birth tray and other supplies.

Just after 11pm my client was pushing in earnest with great progress. A few minutes after midnight, she pushed out her gorgeous baby, who came with fairly sticky shoulders that only required the running-start position and turning baby into the oblique to free up the shoulders. Pink and crying and healthy! 40 hours from beginning to end, with only a 50 minute 2nd stage!

I called the hospital back a few hours after the birth and wasn't able to talk to the doctor or the nurse themselves, but I did leave a message saying, "Please tell Dr. X that the woman planning the homebirth had her baby and everyone is healthy. Tell him he was a 1/2 hour off though. Baby came at midnight. And tell him thank you for the respect."