A Disappointing Day

I had a hard day at my hospital clinicals yesterday.

We had a patient that wanted a natural, unmedicated birth.  With her previous birth, she was induced with pitocin, had a very difficult labor, and subsequently has a very negative image ingrained in her memory about her birth experience.  This time she wanted to have a simple, serene birth - the one we all dream of.  She presented to the hospital already dilated to a 7 as a G2P1.  My midwife and I thought that this would be perfect for her, and that she'd easily give birth in the next few hours.

After 5 hours of hands and knees, walking, birth ball, rocking, squatting, in and out of the bath tub, lighting candles, and listening to soothing music there was relatively little change in her cervical dilation, and yet she was experiencing increasingly worse contraction pain.  She was beginning to give up; thinking she would not be able to carry on with her plan.  We were not checking her, so I was encouraging her to continue - telling her soothingly that she was almost there, that she could surely make it.  At the 6 hour point, we finally checked her to see if she was close.

Nope.

She was the same.

Upon further inspection, her baby's posterior fontanel was extremely posterior, which is not typical, and we could not 100% decipher what the presenting part was.  It felt like a face.  We had the attending come and confirm for us, and she said it was definitely a face presentation with mentum transverse (MT).

MA or mentum anterior is the only one able to delivered vaginally.  It is done by placing a finger in the woman's rectum and flexing (or tucking) the head forward so the baby can still go through the cardinal movements of delivery.  Unfortunately, this is not possible for MT or MP (mentum posterior) presentation.

Oh sigh.  It was a such a heart wrenching moment to tell her she was not going to be able to physically birth from below.

When I came to get her husband to bring him back for the cesarean section, I asked him if he wanted to bring his camera and he said quietly, "No, I think we'd rather not remember this part."  My eyes welled up with tears and I had to look away.  How absolutely crushing.

Thankfully the baby was born easily and did not need any resuscitation efforts.  Both of the baby's eyes were swollen shut, but there was only minimal bruising over the right brow.  The mom, dad and baby spent the rest of the surgery time trying to bond with their new baby in the OR.  The mother was shaking uncontrollably (due to the spinal anesthesia) and despondent.  The father was quite sad.  It was a bittersweet moment for them.

The attending ensured a triple layer closure so that should they decide to have another baby they could attempt again to have the birth they so desperately desired.  She made sure they knew this, but I am not sure how much comfort it provided in the moment.

I am sure the healing both physically and emotionally will take some time, but my hope for today is that they are enjoying their baby much more and are able to let go of their negative perception of this birth bit by bit over time.

First Catch!

Most of this blog has been consumed with our attempts with trying to conceive.  It might make one wonder if I do anything else!  Trying to conceive does seem to overtake almost every waking thought I have, but I am still pursuing my dream of becoming a nurse-midwife.  I am doing about 36-40 clinical hours each week now - 2 clinic days and 1 hospital day.  This past week was my first week in the hospital AND my first official catch!  Wahoo!

As a labor & delivery nurse there have been a handful of times where I have caught a baby due to a precipitous birth where the physician did not make it in time, but those times were usually more of a surprise and panic type situation where I was wondering when the physician was going to arrive while catching the baby and simultaneously calling other nurses and techs into help me.  In contrast, my first official catch happened in a very serene, calm, controlled and beautiful way.  We had a patient who was a G2P1 having a natural birth at 40.4 weeks gestation.  She had a doula and did amazing throughout the whole labor.  She walked and rocked, sat on the birthing ball and tried a variety of positions until she found what worked for her.  But at 0300 and 8 cm she wanted to give up.  She started crying and saying she just could not go on, and that she wanted an epidural or something to make the pain go away.  I encouraged her to get in the bath tub and she did.  She sat in the warm water, pelvis open, rocking side to side and moaning with eyes closed breathing through every contraction.  In 15 minutes time she said she felt like she needed to push.  She walked back to the bed and began her delivery.  Half a dozen pushes later she welcomed her healthy, beautiful baby boy into the world.

For my part, I protected the perineum during the crowning and then supported the head as it birthed.  I then gently pulled traction down to release the anterior shoulder and then the posterior shoulder slid right out along with the rest of the baby.  It was quite easy as the mother did all the work, but I still need more practice with my hand placement and coordination of catching the entire baby with both hands and then placing on mom's tummy.  I am sure though that will all come together in due time with practise.

The birth though was just so magical and beautiful.  I know I have said beautiful several times now, but it really was a picture perfect birth experience. The baby needed a bit of transitional support and the nurse even gave the baby oxygen on the mom's belly.  In the end, the mother got all that she wished for - a natural birth with no interventions, no lacerations and she was not separated from her baby after the delivery.  A perfect birth for the mother and baby, and a wonderful first birthing experience for me!