Let me tell you a little story about this client. About how she navigated a difficult birth as a first time mom. About how you can utilize intervention judiciously *WITHOUT* losing freedom of movement and giving up your entire birth plan.
Her water broke first, without immediate contractions — also known as PROM (or, premature rupture of membranes). Not only that, but this occurred on the even of the biggest snowstorm of the year in Western Wisconsin.
Almost 24 hours later, labor had not yet begun. This is not uncommon in PROM situations, but can be incredibly stressful. Read more about PROM here.
Anticipating inclement weather, Sara and her partner, Travis, were faced with a difficult decision about whether to stay in the hospital for induction, or head home to wait for contractions and risk later having to drive back later through hazardous road conditions.
Sara elected to take one dose of oral misoprostol (also known as cytotec) and quickly found herself in labor with no additional medication needed.
When I arrived (after driving through the snowstorm), she was soaking in a huge tub with her attentive husband pouring water gently over her belly. Her amazing midwife & nurse whispered words of encouragement and occasionally asked permission to monitor baby. The lights were low. The only noises were her low moans through contractions and her hypnobirthing meditations in the background.
Importantly, electing to take a single dose of miso did not turn her birth into your typical induction.
Other than very occasional antibiotics for the prolonged ruptured membranes, she didn’t have to drag around an IV pole the entire time. She was able to use the tub freely despite her water having been broken more than 24 hours. She was not strapped up to a continuous monitoring device or even lugging around a portable telemetry unit, despite having taken cytotec — because her labor kicked in and maintained without need for further medication. She was monitored intermittently with a handheld doppler, just like at a home birth with spontaneous labor.
She got out of the tub and moved into the bathroom, swaying with her hands planted on the sink. Her labor intensified, as it often does in the dark and privacy of that space. It became apparent that she was beginning to push.
As the midwives prepared to catch her baby (while she was standing!), they discovered she was not yet fully dilated, but rather about 7cm. She was encouraged to stop pushing as best as one can do such a thing.
This news can be devastating to take in and very difficult to achieve, especially for a first time mother.
We regrouped emotionally, and did some targeted stretches and position changes to encourage baby into a more optimal position — VERY difficult to do while involuntarily bearing down, and also trying to stop yourself. She was so strong during this time of emotional uncertainty and physical challenge.
Sara spent another couple hours working through her contractions while resisting that urge to push. Grounded, mindful, determined.
Hovering at about 8cm, she elected to get an epidural to help her stop pushing with each contraction. This allowed her to get some rest and then wake up fully dilated and ready to push!
She pushed in every conceivable position! Sara was able to *hoist herself* up onto the squat bar and support herself with her own legs, with very little help from her nurse, partner and me. She was also able to turn onto her hands & knees *on her own* and push in a modified version of that position. I honestly wondered if she would have been able to stand up if she tried!
This is just a small sampling of the many position changes we did during the second stage of labor.
For this client, the epidural was a tool in her toolbox that solved a very specific and very difficult problem other than pain — premature urge to push — *without* sacrificing labor progress or freedom of movement.
While we are often hired to support unmedicated births, it is so important to celebrate births like this. This birth was awesome! One of the coolest I’ve ever supported.
This client was so thoughtful in using interventions when it made sense, in just enough capacity to address the present issue without creating others.
In the end, her baby was born into her husband’s hands, after the midwives asked him if he wanted to “catch” as causally as they typically ask about cutting the cord. She had a minor 1st degree tear, and when I asked her, “how blissed out are you?!” as she held her little one on her chest, she told me later at our postpartum visit that was the PERFECT description for how she was feeling in that moment.
Congratulations Sara and Travis, you were amazing!
PROM and premature urge to push are two of the hardest scenarios you can be dealt in birth, and you navigated them BOTH (on the eve of a trecherous blizzard, no less) with smarts and grace. Respect!
This birth took place at HSHS Sacred Heart Hospital in Eau Claire, Wisconsin, with the former Prevea midwives. Read more about how doulas can support clients birthing with an epidural here.