The healthier and low risk a woman remains during her pregnancy, the more choices she has when exploring where and with whom she brings forth life. An out of hospital birth is not for everyone, however, for those who have a healthy baby and healthy pregnancy, more and more are finding the out of hospital birth experience to grant them the best of both worlds. A low intervention birth, focusing on the normality of the natural process, is once again being researched and desired by more and more couples who in understanding there will always be inherent risks involved in birthing, also understand the labor and birth process has worked for countless generations who do not need to be quote "saved by their doctor". If mom and baby are fine, the process continues until otherwise a need presents that would warrant extra help for either mom or baby. Likewise, variations of normal or what Dr. Robert A. Bradley called the whammies of birthing, such as longer than average labor, back labor, high pain levels, longer push phase, etc. do not necessarily constitute a medical emergency or transport. The couple, must acknowledge and take responsibility for their choices of where they decide to birth, as well as, giving informed consent throughout. The mother should also feel she is supported, continuing to be supported and understand that if at any time the baby is not handling the labor process well, or mom has a reason for medical intervention such as a need for mechanical assistance for stuck baby, etc. a transport takes often takes place. Each labor and push phase should be individually assessed as normal labor has a multitude of variations and / or possible variations.
Allow me to introduce power couple, Angie & Mark. They contacted me seeking labor support for their out of hospital birth planned to take place at Baby & Co. Charlotte. I explained the necessity of proper training to manage contractions and her pain level in an out of hospital center. In fact, considering normal pain management that unprepared couples often utilize such as the epidural not being an option at all is reason enough to make preparation and gain valuable skills to relax during contractions. Angie and Mark understood those skills were necessary to be successful in an out of hospital birth experience. Therefore, they willingly signed up for a #YourBirthHelper training workshop to gain confidence and enhance their level of education on the natural process and boy did it pay off big. It also gave them an opportunity to establish a relationship with our #CharlotteDoulaDreamTeam. As support to our couples, we always offer 24/7 access to call, text, face time to receive assistance through all the I'm not sure's, should I go to work, should I be timing contractions, what if I feel crampy, what position should I assume, how can I get my own body into labor and avoid induction? Just to name some of the most popular for a first time mom. And then before you know it, it's go time...
Friday morning, the phone rang all bright and early Angie had experienced her first bloody show and was curious if she should head into work or stay home. We stand by following your normal daily routine unless a danger sign presents. Otherwise, if we stand idle by and time every single contraction, we would be timing them for days. Three days to be exact for Angie and Mark. Which by the way is not unusual for a first labor. No one likes the sound of it but its often the case. She went to work on Friday and rocked her workday like a champ with only loose bowels and some light cramping.
Friday came and went with no other signs of progressing labor. On Saturday, she and Mark did some things they had learned to speed labor along and spent the day between visiting family and working toward bringing on stronger contractions. By early afternoon things seem to be trucking along. Our YBH team was notified and standing by if needed. All of a sudden Mark called to say her contractions had jumped over active labor and were now around 90 seconds in length. I immediately jumped in the car to drive to Charlotte. Within an hour and half, Mark had observed some definitive signs of progress such as contractions which had settled into a pattern, but also much closer together and lasting longer, and Angie was having lots of pressure. They contacted their birth center midwife and were advised to come over to get checked. To everyone's shock she was only maybe 1 cm dilated, -1 station but fully effaced. By this time, taking mom out of her relaxing environment had most likely produced some adrenaline and sadly adrenaline whether we want it to be released or not happens. It typically causes labor to slow and sometimes even stop completely. The pattern of 90 sec long contractions every few minutes had totally spaced back out.
Angie was very tired and understandably so, as the contractions had kept her awake through the night and fatigue of labor was setting in. This is why women must maintain a level of physical fitness going into labor that allows them to have the stamina the staying power to overcome and push through fatigue. Some laboring moms are also capable of sleeping in between contractions, few sleep through them at this point. We recommendation at least thirty minutes of regular physical exercise a day for stamina. Angie was a champ, overcoming a multitude of stumbling blocks to birth naturally and out of hospital including slower than normal labor, slow dilation and long strong contractions to move baby down. It is important to understand that Natural Alignment Plateau is a normal part of many labors, as well. This is a time when mom's uterus continues to contract as normal but the cervix is not showing signs of increased dilation. In a hospital setting this is what is often deemed, "Failure to Progress" and the staff simply appear to give up on mom, her body, the normal process or mom gives up on herself and is ready for someone to escort the baby out via surgery, help baby out with vacuum, etc. but there are no other apparent reasons to intervene, no medical reasons such as a baby in fetal distress, etc. In these situations, it is important one understands the definition of progress. Progress is NOT JUST DILATION ONLY. If one's station changes (the downward decent of baby in relation to the ischial spines), if mom has been effacing, if contractions are continuing to grow longer and stronger, those are ALL SIGNS OF PROGRESSION. Many women will experience the slow to dilate cervix, even myself. But, what we know about the cervix is when it is time to expel a baby, often the woman's cervix goes from whatever number to complete in a matter of minutes. This is a trait of a healthy, un-medicated and yet unpredictable uterus! It simply does what it wants to do and doesn't ask us permission. Every woman does NOT dilate a cm an hour, heck some of us women don't dilate a cm in hours of labor but there are many other things that may be taking place during Natural Alignment Plateau than just dilation.
Angie was no doubt starved at this point, Doula Apprentice Allison Termeer, went to pick up food them. We know labor can often slow or stop allowing mom time to take care of necessaries such as rest, food & hydration. Preventing a laboring mom from eating or drinking during labor is NOT evidence based. Even if a medical situations arises, we do not have the same anesthesia as we did in 1955 when that was first established as routine. The couple, along with their midwife made the decision to return home, try to sleep Saturday evening and return when labor picked back up. She said SLEEP during labor is clearly overrated #NOT...lol however, she continued a horizontal position, resting in between contractions and only getting up through the night to empty her bladder every hour. And, then once again the contractions started picking up and then a text came in at 2:57 am Sunday morning that Angie had once again experienced bloody show and contractions seem to be settled in a pattern again.
It wasn't long after that Mark asked me to join them at Baby & Co birth center. Together, actively, the three of us continued to work through each contraction, utilizing good positioning, deep abdominal breathing exercises, visualization, peanut ball, birth affirmations, etc. we don't focus on the how much longer, how many more contractions, we just take them one at a time and overcome any obstacles that present along the way. If mom & baby are okay, we continue the labor journey as planned. No doubt Angie was in her head, discouragement from the fatigue of labor, her lack of cervical dilation coupled by back pain and an overwhelming urge to bear down during contractions didn't help her stay positive either, but her ever present husband coach was ever attentive to her! Reassuring her all the way!
Even after being up for days, we had to completely twist his arm to take a break and get horizontal for a few minutes. I told him I wouldn't let him miss anything and finally he agreed to take a cat nap while we had mom in the tub. Angie kept saying she did not want to be in the water. The shower or tub just didn't appeal to her mind. Here is what we know about water/ shower/ tub & the toilet, women naturally relax the right muscles there. It comes instinctive to relax your pelvic floor on the toilet (which we need to do to progress labor). Also, we are conditioned to relax in water. Water has been used for countless generations for pain relief and relaxation and despite whether you desire to push a baby out in a tub (which Angie did!!!!!) it is still a great position to rock late first stage labor, transition phase and labor down!
Around 7:30am there was talk of encouraging Angie to transport to Presby Main due to her slow labor. She was fully effaced, zero station but only around 5cm dilated. Once again, we got Angie moving, we walked around the center, even throwing in some full squats too! The urge to bear down was consuming Angie and we began using low register noises. At 7:51 a.m., I text team member Nancy Cook to come in and assist for additional encouragement for the couple. I reassured Mark and Angie that no one on our team would jeopardize health of mom or baby to simply have a baby in an out of hospital location, but also if there were no medical complications, she could continue normal labor. Nancy arrived around 8:33 a.m. and considering all we had already tried to get baby to drop down put pressure on cervix to open, inversion positions to help baby readjust head, including the midwife and I sifting with the rebozo, Nancy suggested maybe a side lie position without the peanut ball and we continued the process of working through her contractions. Angie was also able to sleep in between. Then after successful dilation, correcting the asynclitic head position, we were able to get her up to use gravity to bring the head down with use of pilates bar,
more deep squats, more sitting on toilet (although the pressure was intense) and hands & knees, but most of all we were able to convince her that her body was made for this work, that is new what it was doing and to surrender to the process. Let go and let her baby come out. What was beating her down was right between her ears.
Truly, Angie would tell you how very difficult and extremely painful at times her first labor was, she would also tell you once we did coax her into the tub, but that she most definitely did NOT like GETTING OUT. In a tub or pool we have weightlessness! Out of the water, we do not. It is important to keep mom moving and Angie did just that. She made the first labor, the long first labor process look easy. We salute Angie for staying focused and letting go of the right muscles during contractions. With numerous change of positions, also came the news of a finally completely dilated cervix and the green light to bear down with her contractions. She was a rock-star at push phase and literally push her baby out in less than 33 minutes giving birth in the water. Prior to the baby exiting her body, I had Angie reach down and touch her baby's head. She wept in light of the finish line. Dad couldn't help but to sneak a peek while the head was descending and he also took advantage of touching his sweet baby's head as she was crowning. You go DADDY! Ifeona (midwife) caught her in the water and placed baby in her arms. As you can imagine, Angie was not only thrilled to have given birth naturally, but also thrilled against the odds baby's heart tones were great throughout. Angie was great throughout and her first glimpse of her baby out of her body a precious moment indeed! The birth climax is a rush of hormones that floods moms body after birth. These amazing hormones are what allows a tired momma like Angie to interact with their new baby even though the birth process is quite exhausting .
The baby also passed meconium during the act of pushing/birth. It is estimated, around 85% of the time its a normal occurrence, approximately 15% of the time it can lead to a medical complication if baby inhales into its lungs. And, last who do you think cut the cord? MOM DID! I'm so proud of both of you! Thank you Angie and Mark for entrusting YourBirthHelper for your happy "birth"day party!
Congratulations to big sister ❤️
Oh happy day MISS SCARLETT MAE ~ 7lb 7 oz, 19.5 inches long