A two baby weekend

Baby #1 was actually due a few days after Baby #2 but babies don't really check out the calendar much before deciding to be born.  Momma was late in pregnancy to decide she really wanted a home birth, so I took her under my care at around 35 weeks.  Mom called me on Thursday to report contractions and when I decided it was time to go check, she was around 4 cm.  Baby turned to an OP position and then we had a painful and sporadic contraction pattern that didn't produce much dilation.  On Friday morning we got the baby to finally turn around to an anterior position and then the contraction pattern slowed to a stop and allowed momma to rest for a good portion of the day.

Late in the evening contractions began again with a vengeance.  I arrived around 11 PM to find mom deep into active labor and progress with dilation.  Baby's heart tones were great.  We got mom in the tub for comfort and I listened again and heard a long sustained deceleration in the heart tones.  We flipped mom over to hands and knees and got her on oxygen and the heart tones recovered fairly quickly.  This happens sometimes in labor, you treat it and then it either never happens again or it happens again and bites you in the rear.  This mom got into some serious fear and requested a transfer to the hospital.  So we called ahead to let them know the situation and to expect us.  Records went in with her.  We had a good respectful transfer, at least with the physicians.  One nurse had an attitude, but the doctors couldn't have been more pleasant and helpful.  The first one just asked questions about why we transported, the second one who actually was assigned to the case said he had trained with midwives and actually said if it wouldn't get him into trouble, he would just send us home!  Then he said if he was still on the case when she delivered, I could just continue as her midwife and catch the baby.  That's what I call a good reception.  However, he got called into emergency surgery and we ended up having another OB who just happened to be there for another patient do the delivery.  Funny thing was, he was her original OB and he had to gloat just a bit at getting his patient returned to him at the end.  Mom had a natural, unmedicated birth and healthy baby when it was all over.

My favorite picture of this couple working through contractions together.

Momma/baby #2 was a second child for this family.  I was only there a couple of hours when we had a nice natural peaceful birth of a baby girl.  Two grandmothers were present and came into the birth room just after baby arrived.  Mom had started to feel just a little pushy for a bit and gave a little effort to one of the contractions.  Mom had just checked herself and said she couldn't feel the head yet.  Next thing I knew she kind of gasped and baby had dropped right down on the perineum.  Beautiful peaceful birth with mom picking her baby up out of the water and onto herself just perfectly.  No tears.  Great APGAR scores for baby.

Mother and new baby, along with Jill my interim apprentice and daughter #1 for birth mom.

Two in the wings

Waiting on a baby girl who was "due" on Valentine's Day but obviously has another day all picked out and I have another mom expecting a little boy who is "due" on Sunday.

In the mean time, the Georgia Birth Network has planned a workshop for the public on Sunday afternoon on Midwifery Options in Georgia and I have been asked to sit on a discussion panel.  Praying both babies will choose another day other than Sunday for their birthday.

Mommas have been keeping me busy though.  The life of a midwife includes so much more than just catching a baby.  There are the phone calls and emails from those curious about home birth and wanting to schedule a consult.  There are current clients who may be suffering from nausea, backache, urinary tract infection or a bad case of the sniffles and they call wanting to know how to make it go away.  They call for advise about doulas and childbirth classes and recommendations for chiropractors.  They call to say they "think" they might be in labor.....but no, the contractions went away.  They call postpartum with breastfeeding concerns, worries about whether their baby's umbilical cord looks normal or not, and to report that an older sibling is sick and what should they do?  They call when they are concerned about wet or poopy diapers, whether they can go up and down their stairs, if they can start exercising again.  They call to reschedule appointments and to say their check is in the mail.  They call to let me know they got their labs done and do I have the results yet?  They call for a referral for an ultrasound or worries that the baby isn't moving as much today as yesterday. Sometimes if I send them in for a trip to the emergency room I also have to make arrangements to get records into the hands of those who are evaluating my client.

A lot of this is covered in their birth notebook that I give them at the beginning of providing their care.  But there is something about the sound of a reassuring voice at an appointment or over the phone that lets them know this is all normal.  That's why my phone is never very far from me and why I walk around Whole Foods trying to discretely talk about breastfeeding issues while picking fruits and vegetables. I mean, sometimes when discussing breastfeeding issues, you just gotta use the term nipple, folks!   It's why my husband and son (who live with me) are quite familiar with all the names of body parts that get openly discussed when they are eating a meal with me while I'm trying to Q and A with a client over the phone.  Poor guys!

Today, my heart is pulled towards my youngest daughter who is under my care for this pregnancy.  She's just past 28 weeks and has a history of premature labor but she never actually delivers prematurely, just seems to have episodes of painful frequent contractions.  She has had this twice in the last week.  The first time it stopped but last night they did not and so far this morning, they still haven't.  I asked them to head to the hospital for evaluation.  Even though she is still contracting, it is not producing any changes in the cervix.  All of her tests are normal and they are giving her meds, but so far she is still contracting.

Those are the phone calls that pull at you.

Another little girl

It seems the weekends were made for babies lately.  That's both good and bad.  Good, in that I don't have to rearrange prenatal appointments during the week but bad in that sometimes the weekends are my only time off from appointments to run errands or rest.

This expectant momma has six other children and one of them arrived by cesarean, making her a VBAC client.  She lives two hours away and had originally seen a nurse midwife who does home births but about half way through her pregnancy, the other midwife got a lot of pressure from her malpractice provider to quit doing VBACs at home so the mom had to look for another provider.  Normally I don't drive that far but I agreed for this situation.  (Sound like the story of my life?  I'm a softie)

So she made the trip up here to me every month and took really good care of herself.  She had a history of quick deliveries, in fact her husband had to catch a couple of her previous babies as her midwife didn't make it in time.  We were hoping to avoid a repeat of that scenario.  So the plan was for me to be notified as soon as she knew contractions were forming a pattern.  Problem was, she had lots of prodromal labor that fooled her many times and left her still without delivery.

But Saturday evening, I was just checking out at a grocery store, not yet having eaten dinner yet and she called.  She felt this time the contractions weren't going away, so I rushed home and handed off the grocery bags to my two guys (hubby and son) and grabbed my birth bags and got on the road.  I think I did get to grab a granola bar or something as I ran.

Arrived several hours later and checked mom.  About three centimeters and still just slightly posterior.  I had a sneaking suspicion as a grand multip she had probably been that dilated for several weeks.  Contractions eventually subsided and mom and dad went to bed to rest and so did I in their guest room.

The next morning I lay wondering if this was going to go ahead and kick into high gear that day and I should stay or whether it was going to just keep starting and stopping for a few more days.  Should I go home or stay?  I tiptoed down the hall to find mom and dad up and reporting progress.  It seemed that things might be a "go" after all.  I headed to Waffle House for some breakfast after listening to baby and making sure all was well.  When I got back, full of breakfast and caffeine, mom wanted to be checked.  She was 8.5 cms!  Serious progress!  But I was about to have another lesson in emotional dystocia.

That was about 10:30 AM.  All the children were home and up and busy.  The oldest child was 12 and she was trying to handle her siblings alone.  Friends from church were supposed to come pick them up but because it was Sunday morning, but she felt guilty pulling them away from church.  So, she did not disturb them until after lunch and her cervix cooperated.   A mom who has delivered this many children and usually delivers fast, you would think that last little bit of dilation and pushing would just zoom by, right?

Apparently not when mom didn't feel safe to be herself and all her biddies were not yet being looked after.  The children left just before 2 PM, her water broke on its own at 2 and we had a baby girl at 2:28.

That is the power the mind has over birth.