HomeBirth Transfer~ Doc says NO to C/S~
I wrote a few stories a few weeks ago because I was proud of my hospital that week– sorry I didn’t finish the stories until now……
~She lived about 8 -10 miles outside of town. “Ellie” was having her first baby at age 32. First baby, first pregnancy, no risk factors…. an easy uncomplicated pregnancy. She had done some research, not extensively, judging from some of my conversations with her and her husband…but she knew what she wanted. She had made a beautiful plan with a CPM for a water tub home birth. This particular midwife has been doing home-births in my area for a long time.. (She was the one cowering in the L&D hallway in this story…). The story of how things progressed up to transfer to the hospital was told to us by both the mother, father and midwife.
~Her labor started with regular contractions at 39 weeks. They progressed from early labor which lasted around 6 hours to a more active labor with contractions about every 2- 3 minutes. Her cervix had dilated to 6-7 cm. This pattern of contractions continued for hours. Ellie was in and out of the tub, walking, dozing, in and out of the shower, squatting, doing many different position changes throughout the next 6 to 8 hours. When she was re-examined by her midwife, she had made no cervical change in all that time. This can happen sometimes, things can stall out and pick back up again. Ellie reported that the contractions may not have been as strong at that, so she wanted to wait it out, maybe nap. The baby’s heart rate checks were all good.
~Everyone rested about 2 hours … Ellie’s water broke (clear fluid) about 1 am and her contractions got more intense. The CPM checked her cervix about 3 am and felt no change. She still was 6 -7 cm dilated and the head was at about -2 station. The midwife then brought up the idea of possibly transferring to the hospital. Ellie said NO! Is my baby alright? “Yes….” said her midwife.. “Then No..I’m staying here, — I can do this.”
~Back to the tub… In and out of the shower, total body massages.. contraction pattern the same with increased intensity…next cervix check at 730 am… still 6-7 cm. Now Ellie was tired. Really tired. Exhausted! The baby was great on all checks. Her midwife again brought up the transfer to hospital idea, talked to her about the possibilities of pitocin, epidural etc… Ellie was now wanting anything, agreeing with anything–to get this over with.
~She arrived at the hospital around 8- 830 am very upset. Her husband and midwife were with her and her CPM had all her prenatal care info. Some of the first words out of Ellie’s mouth were that she wanted an epidural and a Cesarean! The nurses on duty this morning were awesome! They calmed her down, had her hooked up to the fetal monitor and observed her contraction pattern and the fetal heart rate pattern response. The baby looked excellent! The midwife and hubby coached her through the contractions while the nurses gathered their admission data. The doctor checked her and she was still about 6-7, swelling of the cervix noted, about -1 station. Ellie asked him if he would please do a C/S and he said no… (yeah!). He said that he felt the best option at this time was to do the epidural she was asking for and observe her contraction pattern… possibly add Pitocin. He talked to her so nicely and non-judgmentally. Many of the other docs would have taken her right into the OR with very little discussion of options. She had been 6-7 cm dilated for some approximate 16 hours.
~After the epidural, Ellie and her husband and midwife all slept. The doc did NOT start pitocin right away, he said that she may need to rest and the contraction pattern couldstart to become of better quality once she rested and was better relaxed. WOW! Where did this guy come from? I’m so amazed and happy and quite frankly, shocked. This was a newer OB here.. I wanted to ask him where he’d been all my life! I went in to talk to Ellie and introduced myself. I told her I was so sorry thingsweren’t progressing the way she had hoped and sorry she didn’t get to stay home. She thanked me and said at this point, she was ready for it to be over! I told her she was really quite fortunate to have this particular doctor on duty today. Except for one bad apple from the night shift just leaving when Ellie arrived, everyone was wonderfully supportive and accommodating. Ellie’s contractions indeed did start up in a better intensity pattern on their own….. however their continued to be a lack of progress. Once again, she asked the doctor to get it over with now and please do a C/S.
~The doctor said NO again! He explained that her uterus was probably tired and the quality/intensity of contractions just may not be what was needed for the job to get done. He explained that the fetal heart rate tracing was beautiful and her membranes had been ruptured less than 12 hours. No baby risks… He felt it possible the baby merely needed to get in better position and the contraction quality needed to improve.. and then he would re-evaluate. Ellie agreed with renewed optimism. The pitocin drip was started. She didn’t need much before the contraction pattern got much stronger, longer and better quality. He came to re-evaluate her only after these better contractions had been consistent for 2 hours. The vaginal exam revealed the cervix was the same ..still the same and possibly more swollen. He said he felt the head was not as well applied to the cervix as it had been.. but still at -1 station. He examined her with and without a contraction. Same in his opinion. Ellie lost all her fight. Her support people rallied to help her, but she was now insistent.
~This time the doctor said she certainly had reason to feel this way, had given this a great try. He told her he still felt she could try longer… that we could alter positions with the pitocin, keep her comfortable with the epidural and keep going… the baby was handling all this just fine. He did say that there was a possibility the baby had his head in a tilted position making it difficult to descend the birth canal. He then let it up to her and told her if she wanted the C/S, he would do it at this point.
~YES I want a C/S! Ellie exclaimed. We did the C/S about 3 pm… some 7 hours after transfer and approximatelyclose to 24 hours of being 6-7cm dilated. Her gorgeous 7 lb baby boy was delivered operatively with apgar scores of 9 and 9. Pink and vigorous! Beautiful. I was able to get him skin to skin in the OR.. that was one of the first times all the players didn’t object and I went with it! (It won’t be the last….and next I’m trying for breastfeeding on the OR table!) Upon delivery, the OB noted the baby had been acynclitic . This is when the head is tilted to the side, ear towards the shoulder. It is probably responsible for her long stall in labor. The OB still felt she could have delivered vaginally given time and good management. I am just so happy he was there. I am proud of this mom, her partner and midwife and of our whole team! This mom was able to make good educated choices about her care despite dealing with the stress of a transfer.. and was able to feel so very very proud of how hard she tried.
In the end it was her…… who gave in to the C/S … not her doctor.
Of that we can be proud