Monday, July 16, 2012

9cm for 6 hours!?!?......

This birth recently happened, and I love how it points out some differences between the midwifery model and the medical model..... A client, Sara, called, she was having her first baby and had been in early labor for several hours. She was one week past her due date. Sara reported regular contractions every 3-4 minutes, good fetal movement and did not think her water had broken, but had had some bloody show. Excellent! I tell them to head on in. In the meantime, it got busy! I had to call in my back up midwife. She is fantastic, I love working with her and her presence in labor. She is also a brand new "baby midwife". When Sara arrived, she walked in the door and my first thought was "Oh darn, it is too early for her to be here!" She was calm, smiling and talkative and her contractions were now every 8-10 minutes and "mild". I took her back to the birth room, checked her vital signs, listened to baby and checked her cervix. She was 9cm/100%effaced/+1 station!!! I had another Mama who also very close to birthing, so I went to be with her while my midwife-partner stayed with Sara. Four hours later, the other Mama had birthed and Sara was still pregnant. Her contractions were still mild and spaced out. Her vital signs were good, the baby was doing great, so there seemed no reason to rush things. About an hour later, Sara got frustrated and asked for an exam. We discussed AROM (artificial rupture of membranes) and Sara and her husband asked for that as well. My midwife-partner checked her and found the exam un-changed from the previous one. However, this time she noted that the baby was in the OP (posterior)position, which can make birth more difficult. So, we did not AROM, instead we did lots of good positions and activities to help turn the baby to the anterior position. About an hour later, Sara's contractions changed dramatically. They became stronger and very regular, she began to have the urge to push. A while later, while standing next to the birth pool, Sara and her husband welcomed their beautiful son to the world. Would this birth have progressed so "naturally" in a hospital setting? Of course, it is impossible to say for sure, but it seems unlikely. Most likely, she would have had her waters ruptured, which may have "locked" the babe in that tough position, leading to a much harder birth. In the midwifery model, there was nothing wrong, so no reason to intervene until the Mother desired it. The interventions to turn the baby were appropriate and very successful. All in all it was a grand birth!

6 comments:

  1. Hi Aubre! I'm a (relatively new) L&D nurse and studying to be a CNM (long story). If you don't mind me asking, what are some of your favorite positions to help turn an OP babe?

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    1. Karyn, one of my favorites is called "shaking the apples" and I learned about it at an AABC conference. The Mama gets on her hands and knees and during the contraction rocks back and forth. Place yourself behind her at her bottom, when she comes back to you, using the palms of your hands, you bump her butt. It is hard to describe, but when you do it it makes sense. Good luck to you on your journey!

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  2. Hey Aubre, I am currently working on my doula certification and hope to one day be a midwife :) I love your blog posts. This reminds of a post I just read on another midwife's blog, http://midwifethinking.com/2012/04/25/asynclitism-a-well-aligned-baby-or-a-tilted-head/. It's births like these that make me so thankful for the midwifery model of care!

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    1. I love her blog and am honored to have been thought of with her!

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  3. Hi Aubre,

    I was wondering if you accepted any guest posting on your site. I couldn’t manage to find your email on the site. If you could get a hold of me at jeff@drugwatch.com, I would greatly appreciate it!

    Thanks,
    -Jeff

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  4. Hi Aube! Would you mind if we talked via email? My email is justinapolvere@hotmail.com . I am a nurse preparing to attend school to be a CNM and id love to ask a few things if possible.

    Thank you :)

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