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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……

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~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

🙂

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16 Comments Post a comment
  1. Thank you , thank you, thank you, for a positive hospital birth story. I am sorry the mom did not get the birth she truly wanted though. The OB sounds like a very up to date and patient provider. Hopefully he will influence some of his peers.

    July 19, 2009
    • Birth_Lactation #

      Thanks RR. yes I do hope he will be a positive influence! Thanks for stopping in!

      July 20, 2009
  2. Gayle #

    That is great. So nice that he did not scare her and took the time to really evaluate where things were.

    July 19, 2009
    • Birth_Lactation #

      Thanks Gayle..yes! you are so right! That’s the main point…. the whole point. thank you!

      July 20, 2009
  3. That sounds like a great doctor! I’m sorry the birth didn’t go the way that the mom planned, but it sounds like as positive a C/S as possible. And I’m really glad that you got to do skin-to-skin in the OR. I think one of the worst parts of the C/S is when mom and baby are separated for long stretches and don’t get to bond. I’m glad you’re working to change that. 🙂

    July 19, 2009
    • Birth_Lactation #

      Thanks Amber! I’ll be working on these things till I no longer work!

      July 20, 2009
  4. Question: One of our great docs is being “evaluated” for his (supposedly) long decisions to incisions. While this doc doesn’t seem to have had that issue exactly, might mom have a postpartum fit about not having the cesarean sooner? If she’d have had a vaginal birth, I could see she might be ecstatic, but since she had a cesarean anyway, might that be an issue? And didn’t the midwife or doc *feel* the baby’s acyncliticism? (I am a Licensed (homebirth) Midwife, so am not asking meanly, but just really wondering.) It would be good to know the position changes the midwife tried at home, especially since the head was so high and before ROM.

    Just some thoughts.

    July 20, 2009
    • Birth_Lactation #

      Hi and thanks for stopping here. Very good questions… I am not sure exactly the position changes used at home. The OB was so very unassuming when speaking to Ellie. Although he said no… I wasn’t a forceful “No”.. more like, that’s not needed now, here are options and Ellie did want to try to wait after the discussions, openly stated her desires to continue laboring with renewed optimisim. I don’t know how much better any doc or midwife could have handled the situation. Perhaps I inadvertantly made it sound like he said a flat out NO..like a refusal. This was not the case. He really listened and talked to her. The point was that he didn’t rush her to the OR. Because of this and my conversations with her support people, she felt like everthing possible had been tried. I think it’s always an issue for a mom to possibly be having feelings of depression or grief over the loss of their “expected vaginal birth”. Anytime~…. so I don’t know. She was ecstatic when it was all over.
      As far as him feeling the acynclitic presentation… I suspect he may have when he told them the head may be tilted. he never said anything to me until after. I didn’t ask. Good question..
      Thanks so much!

      July 20, 2009
  5. I don’t think I have ever seen a woman with a swollen cervix at 7cm deliver vaginally. For the exception of pushing with a lip. Which I never made that mistake again.

    Yes, very different for the Doctor to say No C-section.

    July 20, 2009
    • Birth_Lactation #

      From the deep resources of my mind.. I can think of a few…It has been seen… of course many variables– Baby position, management of labor positions/ interventions/ para / degree of swelling etc.. and more… all factor in. Thanks so much for stopping by!

      July 20, 2009
  6. yes, he sounded very wise. I want to give him a doughnut.

    July 20, 2009
    • Birth_Lactation #

      How bout me too? I like glazed! Thanks!

      July 20, 2009
  7. Hi Navelgazing ~ I wondered too what positions were tried. What immediately came to mind was hands and knees if not chest to floor. I’ve also heard of, but never seen it done myself, of successful care of a swollen cervix through the use of ice packs.

    I had a good OB myself who encouraged me to VBAC naturally and told me I could do it, was totally confident I could ‘handle’ natural birth, etc.

    I know there are very good OBs out there. I just have to sprinkle a little salt here and acknowledge this OB used the main tools obstetrics have always had at their disposal: epidurals and pitocin.

    Just wondering as well as to the limitations of the information gleaned from the VEs and the limitation of the more practical application of position changes that might have been employed.

    July 25, 2009
  8. I don’t want to sound like I’m blaming the mother here, but it sounds to me like her labor stopped because she wanted it to. I truly believe that we can will ourselves to do just about anything. I certainly did. In my experience, the women who really, REALLY don’t want cesareans, and know exactly how to go about avoiding them, rarely end up having them. The women who walk into the hospital asking for one will get one.

    It’s too bad she wasn’t more educated about her options.

    Speaking of this – my friend’s sister was trying for a homebirth just today. Got “stuck” (I hate that word) at 8 cm for 7 hours. They got scared and went to the hospital where she got the epidural. It took her another 5 or 6 hours, but last I heard she was pushing (finally.) She was also a FTM. I see women get “stuck” at a certain phase all the time (like I did) even with a swollen cervix (like I had) and then go on to deliver vaginally (like I did), IF they give it time.

    So much of this is how much we believe in ourselves, or don’t.

    September 21, 2009
    • StorkStories #

      I don’t take your thoughts as blaming the mom.. I think you are on target, esp having personally experiencing a lull in labor with no ill effects on the health of mom or baby. She made her own choices, true, but the main point of this piece was “The OB still felt she could have delivered vaginally given time and good management.” So different from what we usually experience. He did try to let her know she could do it..but everyone reaches their point I guess. I happened to run in to her a couple weeks ago. I asked her a lot of questions about how she felt now…. She feels very happy with her birth experience and said having the baby at home was a nice idea but she never did have herself truly invested or her heart set on it. I had already gotten that feeling from her thru different conversations while in the hospital. Just not fully educated on her options. Each women is different. Love what you are doing with ICAN!

      September 22, 2009
  9. This is a wonderful hospital birth story! I’m so glad everything went well and that the doc was able to help the mom stay calm and make educated choices. It’s wonderful to hear a homebirth transfer story where the staff was helpful, accomodating, and patient.

    December 27, 2010

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