Putting yourself out there is very difficult. I think it is important, but hard none the less. As a birth worker...one who often struggles with the apparent lack of accountability in US maternity care, I feel that it is a duty to be open and transparent with my own stats. In publicly posting my stats I knew full well that I was opening myself up to criticism. My hope was the the criticism would be constructive, aid in my own introspection and help me to improve the care that I give. For the most part this has been true. I participate in a forum that is closed to the public and made up only of other birth workers, particularly but not solely, out of hospital workers. I shared my stats blog post with the group. I felt that I was prepared for some good discussion and mostly that is what I got. Many of my numbers were questioned and "called out". At first, it felt constructive and the discussion was valuable to me. The very numbers that had troubled me, were the same ones that caused questions from the group. Then, after a while it started to feel less and less productive and little more...hostile is not quite the right word but the closest that I can come up with. This was most likely not the intent, and I am trying not to be overly sensitive about it all. But it is not easy...I have a tendency toward being over sensitive and I know this about myself, so am constantly trying to balance my reactions. I do not regret putting myself out there and am ultimately gratefull for the discussion.
One of the things that surprised me in the discussions was that most of the participants have never done their own stats. I found this to be true with other people also, ones that I discussed my "project" with in person. This surprises me. How can we maintain standards and improve outcomes if we do not objectively look at our stats? Before doing my numbers, I would have thought many outcomes were different. Looking at them in black and white really puts things into perspective and has been invaluable to me. As I said, this process is not necessarily comfortable and more than a little intimidating.
So, to further my process, I will delve into the "number" that caused the most concern in the forum group, postpartum hemorrhage (PPH);
Initially, I listed 33 PPH's, which worked out to be 16.5%. That is a high rate! I went back to really analyze the data. After doing this, the number of PPH's that required intervention (medication) and/or caused symptoms (low BP, dizziness, etc) in the women was 12 which equals 6%. Better, but still high! Where would this high rate come from? The vast majority of our ladies are well nourished and healthy. Our practice recommends nutritive herbs and 65-75grams of protien per day. For the most part, births are physiologic with woman directed pushing, I practice immediate skin to skin care and baby led breastfeeding, third stage is physiologic and the cord is clamped after the birth of the placenta. All of these factors should help to decrease the rate of PPH. All throughout my training, I was taught that providers routinely underestimate the amount of blood loss. Perhaps, I have over compensated for this and now over estimate. Sometimes, especially when there appears to be a lot of blood loss, I will weigh the chux pads. So for those cases I do know the actual amount. I have two thoughts now; 1. if providers do routinely understimate blood loss, then it seems possible that the actual rate of PPH my be higher, and 2. is the current accepted definition of PPH (loss greater than or equal to 500cc) appropriate? I have been very particular about noting any EBL over 500 as a PPH, the majority of my 33 were 600-800cc and caused no problems for the mother. So, what is a midwife to do? Well, it appears that this midwife will begin weighing ALL the chux after ALL the births and attempting to get a handle on the actual number of blood loss. Stay tuned for results of my experiences in chux weighing..........
Finally, I would like to throw out a challenge; please keep records, please compile them on a regular basis, please use them to improve and strengthen your practice!!
Saturday, November 24, 2012
Monday, November 12, 2012
Stats...200 Babies!
I can hardly believe that I have been blessed to catch 200 babies. As I sit here writing this, I am overcome with gratitude. Gratitude for all the families that have shared their births with me, gratitude for all of my teachers along the way, gratitude for my own amazing family and gratitude for the birth center itself. Back in April of 2011, I reached the milestone of 100 babies and decided to calculate some personal stats. It was very informative and I decided to go through the same process every 100 births. The stats that I list are not for the birth center as a whole, but only the stats for the births I personally attended. I have combined the results from 1-100 with the new 101-200 to give a total. Here goes;
100 boys and 100 girls (what are the chances of that?!?), 5 of these were born en caul (2 girls and 3 boys)
There were 33 cases of PPH (16.5%), the vast majority being less than 1,000cc
There were 10 Shoulder Dystocia's (5%), however 3 were very mild and easily relieved by 1 position change
I performed AROM in 34 labors (17%), primarily this was done for augmentation of labor.
I had 5 cases of retained placenta. (At our center, per state regulations, the cut off for retained placenta is 30min.)
I performed 1 manual removal of a placenta at the center secondary to hemorrhage, also for that birth I performed bi-manual compression while en route to hospital. I had 1 cord evulsion, found 1 true knot in a cord and had 1 labial hematoma. The hematoma was not severe and resolved on its own.
I have performed 7 episiotomies (3.5%). Two of which extended to fourth degree lacerations. All were done for significant fetal heart rate decelerations during crowning.
Intact perineums = 75, first degree lacs = 59 (about half requiring repair), second degree lacs = 56, third degree lacs = 7 and fourth degree lacs = 3
8 newborns were transferred to the hospital; 6 for TTN, 1 for congenital pneumonia and 1 with severe anomolies.
17 women were transferred PP; 5 for retained placenta's, 3 related to PPH's and 9 for repairs of extensive lacerations.
My water birth rate is 36.3% (for 21 of my catches, water birth was not an option per the site)
Birth positions: semi-reclining = 35, hands and knees = 58, birth stool = 36, McRobert's = 29, squatting = 21, side lying = 18, standing = 3
Additionally, something that I did not keep track of for the first 100 births, was my rate of intrapartum transfer. I have since started keeping track of those numbers. Since April of 2011 through November 8 of this year, I have transferred 24 Mama's that were in labor, none of them were emergent. (These 24 are not included in the above numbers.) Of those ladies transferred, 11 required a cesarean section.
So, there it is in a little nutshell. It really is an experience to go back and look through these numbers. In reviewing my birth logs, I get to re-visit these births and families. Overall, I feel good about my outcomes and am glad to share them.
100 boys and 100 girls (what are the chances of that?!?), 5 of these were born en caul (2 girls and 3 boys)
There were 33 cases of PPH (16.5%), the vast majority being less than 1,000cc
There were 10 Shoulder Dystocia's (5%), however 3 were very mild and easily relieved by 1 position change
I performed AROM in 34 labors (17%), primarily this was done for augmentation of labor.
I had 5 cases of retained placenta. (At our center, per state regulations, the cut off for retained placenta is 30min.)
I performed 1 manual removal of a placenta at the center secondary to hemorrhage, also for that birth I performed bi-manual compression while en route to hospital. I had 1 cord evulsion, found 1 true knot in a cord and had 1 labial hematoma. The hematoma was not severe and resolved on its own.
I have performed 7 episiotomies (3.5%). Two of which extended to fourth degree lacerations. All were done for significant fetal heart rate decelerations during crowning.
Intact perineums = 75, first degree lacs = 59 (about half requiring repair), second degree lacs = 56, third degree lacs = 7 and fourth degree lacs = 3
8 newborns were transferred to the hospital; 6 for TTN, 1 for congenital pneumonia and 1 with severe anomolies.
17 women were transferred PP; 5 for retained placenta's, 3 related to PPH's and 9 for repairs of extensive lacerations.
My water birth rate is 36.3% (for 21 of my catches, water birth was not an option per the site)
Birth positions: semi-reclining = 35, hands and knees = 58, birth stool = 36, McRobert's = 29, squatting = 21, side lying = 18, standing = 3
Additionally, something that I did not keep track of for the first 100 births, was my rate of intrapartum transfer. I have since started keeping track of those numbers. Since April of 2011 through November 8 of this year, I have transferred 24 Mama's that were in labor, none of them were emergent. (These 24 are not included in the above numbers.) Of those ladies transferred, 11 required a cesarean section.
So, there it is in a little nutshell. It really is an experience to go back and look through these numbers. In reviewing my birth logs, I get to re-visit these births and families. Overall, I feel good about my outcomes and am glad to share them.
Sitting on My Hands
Right now, literally, I am precepting a wonderful new midwife. She is guiding a lovely first time Mom through second stage. I am down the hall, well within hearing distance (don't worry though, the Mom cannot hear my typing ;)), trying very hard not to be over her shoulder. We have worked together for years, we both started here at the birth center as nurses. She is more than capable, she is fantastic, she is doing a great job. I am going crazy out here. I have precepted many students by now, and find that role easier and easier. With a student, I am still ultimately "in charge" and am always present in the birth room. This is different and new for me. She is a midwife, on her orientation and needs to be completely independent...she need to know that I am here, but that she can do this all on her own. Wish me luck on my process of sitting on my hands.....
Saturday, October 13, 2012
And what is this?.....placenta?!?....
So, as I work at an out of hospital setting, it is logical to assume that I believe in natural, physiologic birth. I believe strongly, that most of the time, if well supported a woman and her baby will safely navigate the birth process together. However, sometimes this is not the case. If you are a reader of this blog, you will have already read some of my stories that discuss less than optimal situations. Fortunately, by the grace of the divine, my learned skill, years of training, the amazing nurses, our healthy low risk population and a sprinkling of luck I have not had a "bad outcome". I also know that, if one works in this realm long enough, it is more and more likely to happen. My reasons for sharing this story are complex and I have thought long and hard about whether or not to do so. In the end, I have decided to share it. Not to tout the "crazy" things that may happen in an out of hospital setting. But to highlight that even in an out of hospital setting, when a trained and skilled provider is present, many unexpected high risk scenarios can be handled safely and well.
At our center, we do not require that Mama's get any ultrasounds. We believe that ultrasound is a tool, to be utilized thoughtfully. I will say that a majority of our clients do get one ultrasound, the traditional 20 week anatomy scan, but it is optional. If something comes up during the course of a clients care, for example: bleeding, her fundal height measuring too big or too small, we will request that she get an ultrasound. Other clients may get an early ultrasound to establish a due date if we don't have accurate menstrual or ovulation information. And if a Mama goes into her 41st week we will use the ultrasound to get an AFI (amniotic fluid index) level. ***I do realize that there is controversy around the use of AFI to assess fetal and placental status, but in our community it is the standard of care so we include it our assessment.*** Recently, I attended a birth that caused me to seriously question my stance on ultrasound...
Sue and her husband are open, intelligent people with a beautiful family. She is very involved in the local birth community as a doula and educator. They are preparing to welcome a new child to their family. She has been rumbly for a day or so and we decide to have her come in and check things out. She arrives with her husband, children and a friend/doula. She is in labor, but it is still a little early. My student checks her cervix and finds it to be about 3cm. We all decide that Sue and her family will go home and return when her labor has picked up. My student goes home to sleep and I go lay down in our midwife sleep room. About two hours later my phone rings and it is Sue's husband, I can hear Sue in the background and tell him that they should just head in.
When they arrive, it is clear that Sue is ready to begin pushing. The family gets settled and I listen to the baby's heartbeat, a strong and steady 140bpm. Many times when a multiparous woman starts to push, I will not check her cervix, however, this time I felt that I should. Sue layed down on the bed and I checked her cervix, which was completely dilated and effaced, the baby head was at 0 station. However, there was also something else presenting, a soft, spongy, "tissuey" something from about 12 o'clock to 3 o'clock. It takes me a moment to realize what this is that I am feeling.....placenta!!!! Everything that happened next seemed to take forever, but in reality happened extremely quickly. I looked at Sue and calmly (hopefully) told her the situation and that she would need to pull out her inner Mama Bear and birth her babe quickly. I called for help and then set up one of our birth stools. I had calculated in my head the time it would take to get Sue to the hospital v. how long it would take her as a multip to just push out her babe and decided it would be quicker to just do it. (Had she been a primip I never would have attempted this!)
Sue got on the birth stool with her husband behind her, I will never forget the look on her face. She was preparing to fight for her baby and would not accept anything other than winning. It was powerful and exactly what we needed. With the next contraction, she pushed the babe to +2, the waters broke and the baby had a low heart rate. We all breathed, gathered our focus and prepared for the next contraction. Thankfully, it came quickly and with one more mighty push the babe was born! She was beautiful and still, had a good heart rate but needed some resuscitation. I worked on her, Mama and Daddy talked to her and she came around to join us in the world. The placenta was birthed very soon after that, with a chunk sheared off but still attached to the membranes, and otherwise normal. I helped Sue, her husband and the new babe get into bed and settled. Then my help arrived! Basically, as soon as I saw my nurses I left the room and collapsed in the hallway, my legs just buckled out under me and I started to cry. I remember repeating over and over again that they were both well and thanking the creator.
During the course of her prenatal care, Sue had declined any ultrasounds. Her pregnancy had progressed normally and was a healthy one. She never had any signs, like vaginal bleeding, that would suggest she had a partial placental previa. In the initial days after this birth, I felt strongly that as a center, we needed to change our policy on ultrasound and begin requiring them. Then, through talking with other midwives, processing the birth and visiting with Sue and her family, I began to slowly shift back to my original thinking. Birth work will continually keep you on your toes, will cause you to question your beliefs and require that you are always learning and adapting. Each birth will give you new insights into the process...information to gain and information to discard.
At our center, we do not require that Mama's get any ultrasounds. We believe that ultrasound is a tool, to be utilized thoughtfully. I will say that a majority of our clients do get one ultrasound, the traditional 20 week anatomy scan, but it is optional. If something comes up during the course of a clients care, for example: bleeding, her fundal height measuring too big or too small, we will request that she get an ultrasound. Other clients may get an early ultrasound to establish a due date if we don't have accurate menstrual or ovulation information. And if a Mama goes into her 41st week we will use the ultrasound to get an AFI (amniotic fluid index) level. ***I do realize that there is controversy around the use of AFI to assess fetal and placental status, but in our community it is the standard of care so we include it our assessment.*** Recently, I attended a birth that caused me to seriously question my stance on ultrasound...
Sue and her husband are open, intelligent people with a beautiful family. She is very involved in the local birth community as a doula and educator. They are preparing to welcome a new child to their family. She has been rumbly for a day or so and we decide to have her come in and check things out. She arrives with her husband, children and a friend/doula. She is in labor, but it is still a little early. My student checks her cervix and finds it to be about 3cm. We all decide that Sue and her family will go home and return when her labor has picked up. My student goes home to sleep and I go lay down in our midwife sleep room. About two hours later my phone rings and it is Sue's husband, I can hear Sue in the background and tell him that they should just head in.
When they arrive, it is clear that Sue is ready to begin pushing. The family gets settled and I listen to the baby's heartbeat, a strong and steady 140bpm. Many times when a multiparous woman starts to push, I will not check her cervix, however, this time I felt that I should. Sue layed down on the bed and I checked her cervix, which was completely dilated and effaced, the baby head was at 0 station. However, there was also something else presenting, a soft, spongy, "tissuey" something from about 12 o'clock to 3 o'clock. It takes me a moment to realize what this is that I am feeling.....placenta!!!! Everything that happened next seemed to take forever, but in reality happened extremely quickly. I looked at Sue and calmly (hopefully) told her the situation and that she would need to pull out her inner Mama Bear and birth her babe quickly. I called for help and then set up one of our birth stools. I had calculated in my head the time it would take to get Sue to the hospital v. how long it would take her as a multip to just push out her babe and decided it would be quicker to just do it. (Had she been a primip I never would have attempted this!)
Sue got on the birth stool with her husband behind her, I will never forget the look on her face. She was preparing to fight for her baby and would not accept anything other than winning. It was powerful and exactly what we needed. With the next contraction, she pushed the babe to +2, the waters broke and the baby had a low heart rate. We all breathed, gathered our focus and prepared for the next contraction. Thankfully, it came quickly and with one more mighty push the babe was born! She was beautiful and still, had a good heart rate but needed some resuscitation. I worked on her, Mama and Daddy talked to her and she came around to join us in the world. The placenta was birthed very soon after that, with a chunk sheared off but still attached to the membranes, and otherwise normal. I helped Sue, her husband and the new babe get into bed and settled. Then my help arrived! Basically, as soon as I saw my nurses I left the room and collapsed in the hallway, my legs just buckled out under me and I started to cry. I remember repeating over and over again that they were both well and thanking the creator.
During the course of her prenatal care, Sue had declined any ultrasounds. Her pregnancy had progressed normally and was a healthy one. She never had any signs, like vaginal bleeding, that would suggest she had a partial placental previa. In the initial days after this birth, I felt strongly that as a center, we needed to change our policy on ultrasound and begin requiring them. Then, through talking with other midwives, processing the birth and visiting with Sue and her family, I began to slowly shift back to my original thinking. Birth work will continually keep you on your toes, will cause you to question your beliefs and require that you are always learning and adapting. Each birth will give you new insights into the process...information to gain and information to discard.
Monday, September 24, 2012
Tidbits and Snippets
Just some tidbits and snippets from recent births.....
In case you were ever wondering....an AquaDoula birth pool will in fact hold a 5'11" full term pregnant Mama and her 6'6" husband! It will look like a soup of belly and long legs but it will work.
It is possible for a woman, experiencing a shoulder dystopia in the pool, to levitate herself out of the water and onto the floor.
Being blessed to catch the little brother or sister for a soon to be big sibling who you also caught is pretty fantastic.
Giving birth to your baby on the same day as your wedding anniversary is sweet.
When your answering service calls you at 2am and tells you that Ryan Reynolds in on the phone for you, it is probably just a soon to be Daddy who has similar name and not actually Ryan Reynolds.
Most of the time, nuchal cords are not a problem, but when they are they are a BIG problem.
A Mama can have an extremely difficult second stage, work and work and work for hours, require an episiotomy and then look at you afterward and say "That wasn't as bad as I thought it was gonna be" with a huge smile on her face.
Birth...never dull around here!
In case you were ever wondering....an AquaDoula birth pool will in fact hold a 5'11" full term pregnant Mama and her 6'6" husband! It will look like a soup of belly and long legs but it will work.
It is possible for a woman, experiencing a shoulder dystopia in the pool, to levitate herself out of the water and onto the floor.
Being blessed to catch the little brother or sister for a soon to be big sibling who you also caught is pretty fantastic.
Giving birth to your baby on the same day as your wedding anniversary is sweet.
When your answering service calls you at 2am and tells you that Ryan Reynolds in on the phone for you, it is probably just a soon to be Daddy who has similar name and not actually Ryan Reynolds.
Most of the time, nuchal cords are not a problem, but when they are they are a BIG problem.
A Mama can have an extremely difficult second stage, work and work and work for hours, require an episiotomy and then look at you afterward and say "That wasn't as bad as I thought it was gonna be" with a huge smile on her face.
Birth...never dull around here!
Saturday, September 1, 2012
A Banner Crop
Wow, all I can say is wow! This past week at the birth center, we had a record setting amount of births. One day, we had 5 babes in seven hours, then just one day later we had 5 babes in six hours, another baby was born a few hours later and the next night 3 babes were born back to back! It was intense and sometimes a blur of activity. However, it served to highlight the amazing group of people that make up the birth center and I am so proud to be part of it! It was all hands on deck and the hands worked beautifully together. Members of our administrative team were scrubbing toilets and doing laundry, staff members came in on their day off, it was a fantastic display of teamwork. Every Mama had a birth room and no-one was turned away.
Here is a snippet of these births. I was pretty tired if I do say so myself. We had just had the two big 5 baby days and I was hoping for a little lull in activity....but, we had two Mama's who were almost 42 weeks. The first one was pregnant with her second babe, she was so tired and ready to have her little one. We had used a cervical balloon earlier in the week, and it had done some good and started some labor but the it stalled out. She had decided to try castor oil and it was working. She arrived to the center with contractions and was 5cm. The contractions were sporadic and could have been more intense. We had a long discussion about options and she and her husband opted to do some herbs and then AROM (artificial rupture of membranes). These interventions worked and her labor picked up. Then things stalled again, her contractions were in a coupling pattern, Mama was becoming frustrated. Additionally, the location of the babes heart beat was unusual......an OP presentation was happening. I did what I refer to as "labor acrobatics"......rebozo shaking, the hands and knees bump and duck walking, just twenty minutes later her babe turned and she gave birth very shortly after that. We were all enjoying this new little one when I got another call.....
Mama #2, she was having her second baby, her water had just broken and she was cranking out labor. Of course, I said "get on over here!". She came in, labored beautifully in the water and not long after started to push. Her babes beautiful head emerged....and then stopped, a shoulder dystocia was occurring. I told her to get out of the pool, which she did in amazingly fast speed, we got her on her hands and knees and with a little help the babe was born. Then we settled everyone in the bed, gave them lots of TLC after the stress of the birth and they were recovering nicely. And then...my phone rang.....
It was the other Mama who was almost 42 weeks. She had been doing some herbs and was now in good labor and ready to head in. She arrived with her husband and Mother, they made a great team. It was her first baby and she labored so gracefully. In a very short time, she was ready to push. She was in the pool, and soon the babe was almost crowning. Then, she started to have some bleeding, at the same time, Mama said she felt something happen. The blood kept coming, the heart tones were strong and steady. I had her get out of the pool, as the baby crowned the bleeding stopped and shortly she gave birth to her gorgeous little one. We placed babe skin to skin, Dad curled up next to them and we waited for the placenta. She had some more bleeding but no placenta, so we gave her a shot of pitocin. Then her placenta came....along with a huge 500cc blood clot! I think that at the very end she had a small placental abruption. Thank goodness, baby didn't have any trouble and both were well.
So, that was just one snippet from this week. Of the 14 births that happened, I was blessed to be present for 8 of them. I am still processing them and looking forward to seeing the families in their postpartum visits. And now I am ready for a HUGE nap!
Here is a snippet of these births. I was pretty tired if I do say so myself. We had just had the two big 5 baby days and I was hoping for a little lull in activity....but, we had two Mama's who were almost 42 weeks. The first one was pregnant with her second babe, she was so tired and ready to have her little one. We had used a cervical balloon earlier in the week, and it had done some good and started some labor but the it stalled out. She had decided to try castor oil and it was working. She arrived to the center with contractions and was 5cm. The contractions were sporadic and could have been more intense. We had a long discussion about options and she and her husband opted to do some herbs and then AROM (artificial rupture of membranes). These interventions worked and her labor picked up. Then things stalled again, her contractions were in a coupling pattern, Mama was becoming frustrated. Additionally, the location of the babes heart beat was unusual......an OP presentation was happening. I did what I refer to as "labor acrobatics"......rebozo shaking, the hands and knees bump and duck walking, just twenty minutes later her babe turned and she gave birth very shortly after that. We were all enjoying this new little one when I got another call.....
Mama #2, she was having her second baby, her water had just broken and she was cranking out labor. Of course, I said "get on over here!". She came in, labored beautifully in the water and not long after started to push. Her babes beautiful head emerged....and then stopped, a shoulder dystocia was occurring. I told her to get out of the pool, which she did in amazingly fast speed, we got her on her hands and knees and with a little help the babe was born. Then we settled everyone in the bed, gave them lots of TLC after the stress of the birth and they were recovering nicely. And then...my phone rang.....
It was the other Mama who was almost 42 weeks. She had been doing some herbs and was now in good labor and ready to head in. She arrived with her husband and Mother, they made a great team. It was her first baby and she labored so gracefully. In a very short time, she was ready to push. She was in the pool, and soon the babe was almost crowning. Then, she started to have some bleeding, at the same time, Mama said she felt something happen. The blood kept coming, the heart tones were strong and steady. I had her get out of the pool, as the baby crowned the bleeding stopped and shortly she gave birth to her gorgeous little one. We placed babe skin to skin, Dad curled up next to them and we waited for the placenta. She had some more bleeding but no placenta, so we gave her a shot of pitocin. Then her placenta came....along with a huge 500cc blood clot! I think that at the very end she had a small placental abruption. Thank goodness, baby didn't have any trouble and both were well.
So, that was just one snippet from this week. Of the 14 births that happened, I was blessed to be present for 8 of them. I am still processing them and looking forward to seeing the families in their postpartum visits. And now I am ready for a HUGE nap!
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!
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