Couple confidently executes an unexpected induction without pitocin or epidural.



First things first, Carlie and I first met just a few shorts weeks before she had a baby. She had found herself near her due date and her sister Kelsey (whom I had the pleasure to train a few years back) had suggested she at least attend one of Your Birth Helper's Labor Workshops. In fact, Kelsey now expecting #2 and her husband attended also. The weather was perfect and we had both Labor positioning practice on the deck complimented with natural Vitamin D shining upon us, but also inside taught the girls how to assume a variety of pushing positions and the how to's of timing contractions, what position can help with variations of normal labor.


At the end of two hours, her husband Brett was like, "Hey is it too late to hire you to help us?" Then Carlie followed with, I don't think I am in the right place for me to have my wishes supported, can we discuss my options as you help us make PLANS for our baby's birth... to which I said, of course, we got this don't stress. First, take a tour of another hospital and simply see how you feel. Did the tour make you feel more comfortable or less comfortable, did you have your questions properly answered and do the answers better align with your target birth. Does the other hospital/birth place have the amenities you are seeking, does the practice you have your second consult with more accommodating or supportive of your wishes for your birth? I made a few quick notes and upon arriving back home sent a few messages to confirm transfer care options for her. It wasn't long before Brett and Carlie called to share they LOVED Carolinas Medical Center Pineville location and couldn't wait to meet the midwives. This may have been the second best decision she made, the first was listening to her sister and attending the workshop...lol. And, the couple quickly realized just a few short weeks later, good thing they did not delay their decision making because unfortunately Carlie found herself in a preeclampsic scenario and a medically necessary induction was imminent .


Carlie was to report at 12 midnight to admit for induction prep. Later that morning, I checked in to see how things were going. Carlie asked if I would go ahead and make my way to Charlotte from Athens, Ga to be available if things picked up quickly. You see we had no idea what to expect because she actually had a bout of premature labor a few weeks earlier which made the induction a little more unpredictable. I packed up my things, cleared my schedule and headed to NC. Upon arriving, I stopped by the hospital to get an update on how things were progressing. Definitely, still in early labor phase, still wearing a smile and capable of carrying on conversation. Carlie had the support of her husband, Brett and her mother present. I reminded her to give her body credit for every contraction and just focus on relaxing and good positioning.


Meanwhile, I headed down the street to Amelie's bakery to get some computer work done and have a lovely coffee with Ms. Nancy before she headed into work for her shift. She was so excited that at least the stars had aligned for her to be at work during Carlie's induction. I mean if you have to be induced, how perfect Nancy Cook goes on duty 7pm to 7am. I can hear Carlie now, "I want Nancy to be my nurse PRETTY PLEASE!"

Sarah, YBH Doula Apprentice checked in on the couple shortly before 6pm. Sarah reported back, definitely still obvious early labor, that Carlie was still giddy and smiling no trouble walking or talking through her contractions. That was, until they inserted the Cooks Device. To better explain, the cervix needs to be pliable and open enough to insert the device but typically not beyond 3cm to be considered a candidate for use. The first of two balloons is inflated on the uterine side of cervix and the second is then inflated in the vaginal side of the cervix helps stimulate labor by gradually dilating the cervix. It typically is known to fall out around 4cm dilated. Keep in mind, if an early induction (prior to due date) is taking place, there is most likely not much going on downstairs. Carlie had chose the foley catheter and cytotec as a means to stay mobile, prep her cervix and hopefully kick labor in while avoid pitocin and other interventions such as epidura which would take away her ability to work with her body and challenge her during late labor/ push phase.


Carlie managed to hold it together despite the balloons trying to force her cervix apart. She experienced a very painful sensation as you can imagine, but managed to get calmed down shortly after. "The insertion of the device and the inflation of the balloons caused Carlie an extreme amount of pain, it was clearly difficult for her to recover after." Music seemed to work best to help Carlie get back into a relaxed state to allow her labor to progress. Sarah Neri

Shortly after, the contractions began to intensify. Brett had retrieved some dinner and Mom decided probably her last chance to eat before contractions made eating unlikely. She got back to focusing on her relaxation around 9pm and added a peanut ball while resting. Around 10pm she decided to utilize the bath to prepare for the evening and focus on letting go and letting her uterus do its work. Later they walked, did squats and changed positions frequently. Carlie had the pleasure of being in the hospital one of the few days Nancy Cook was on the schedule.


I, Nancy, had the pleasure to be Carlie and Brett's nurse for the night 7mp to 7am. It was a pleasure to assist the couple the second evening of their medically necessary induction. The couple was:

-Calm

-Focused

-Always willing to move, turn, walk, dance, squat, bathe, use hands and knees, use the peanut ball

Basically, Carlie was willing to try anything. Her biggest obstacles were the hip pain and being tired. I shared with her last night that she drank over a gallon! That’s before even pushing. She had crackers, popsicles, juice, a healthy salmon and potato dinner and bites of protein bars all through labor! It was especially important with preeclampsia as her admission diagnosis, not to be overloaded with IV fluids. We saved those for the last few hours when baby showed off a little. Hubby was always, I mean always putting her needs first. They were a great synchronized team! A few times she said quietly, "I can’t do this." When that doubt set in, we would just move or change positions. We reminded her to keep control of her breathing! Their determination in spite of exhaustion, was evident, Having the cooks catheter inserted at 1 cm ( she never knew the number) wasn’t fun. Nancy Cook

Carlie's Induction Timeline / Labor Notes: We started induction on Friday, April 6th at 12 am with Cytotec, I had 5 doses.


Cooks balloon inserted around 6:30 pm Friday (kept it in for the next 12 hours). Between 4-6am Carlie started losing control of her breathing and as she put it losing herself. Prior to doula support, she allowed Brett and her mom time to doze off and rest a little. She wanted them to sleep as long as possible and this was her time to labor independently. Her family had remained with her all night catering to her every need. In her mind, (because she had been told on average the device falls out around 4cm dilated) her mind began to work on defeating her. This is a perfect example of why we tell women you DON'T NEED TO KNOW YOUR DILATION NUMBER. In her mind she was telling herself it hasn't fallen out OMG I am Not even 4CM DILATED there is NO WAY I CAN DO THIS... at this point she is doing the math in her head and thinking this cooks device has already been in for twelve hours. At 6am Carlie looked at her mom and said, "What do you think they will do now?" Neither her mom or Brett knew how close she was to ordering an epidural, she said she felt as if I was at the end of my rope and couldn't take much more. At 6:30am the Cooks Device was removed. Carlie shared, "I could tell by the look on the Doctor's face that she was surprised." She immediately responded with, "I have to know the number"... the reply was a breath of fresh air, I can't believe this hasn't fallen out yet bc you are 7cm! At this point, the decision was made to opt for an amniotomy to hopefully avoid pitocin use and get this baby here! Carlie cried tears of Relief and JOY! It was exactly what she needed to hear to remain epidural free. Now here is the irony... we do a lot of hard work from 7cm to complete and that is the typical time most women ask for medication. But, NO, not Carlie she had Brett text me to come and upon my arrival as Doula #3 tag teaming in upon my arrival I found this beautiful site! Nancy smiling, Dad tired but still smiling and Carlie resting with oxygen. Not sure of the exact time frame, but it appeared there was some varations of normal heart tones and Carlie blood pressure had spiked so she was lying on her left side to get her blood pressure down. Being in the bed she found the least helpful for pain management. It made her so much more uncomfortable. She literally said before I arrived she literally wanted to JUMP out of the bed her levels of discomfort intensified while lying down. This is when she asked for Nitrous Oxide as shown above Dad held the mask to her face during a contraction and then it was removed after. Carlie knew the gas would NOT take away the pain of the contraction, however, she said it did help her not fight the baby moving down. As the gas seemed to make it easier for her to relax at peak of the contraction. As she put it, "It made me not care about the pain just while I was breathing it, the effects fade so quickly after the mask is removed. During the time she had the nitrous she was able to slightly doze in between the contractions and she definitely needed some kind of rest. We would take even a few seconds or minutes of dozing off. When she had completed her time on the nitrous oxide it was removed and she shared, "Thats when Pam put me to work!"


Things that Carlie found most helpful to avoid epidural:

Sitting on Toilet with dad in front of her

Getting in the TUB (she called it medicine!) lol

Her husband giving her positive feedback (every few minutes!)

Having Cold Wash cloth to her face

Essential Oils to both relax and breathe during push phase

Relaxing music, meditation and hypnotherapy

~The Couple Labored for 37 hours total


Dad's ten adjectives to describe Labor:

Intense!

Its A Marathon for sure!

Emotional!

Tiresome!

It takes Endurance!

Exciting!

Stressful!

Bonding experience between the couple! Amazing!

Miracle!


The most important tip for other Coaches that I took away from our YourBirthHelper Labor Workshop:

Change Positions every 30m (if mom is not sleeping). Frequent position changes and my physically holding her up using the blanket both protected my back and allowed her the ability to sink down into her contractions to finish off the cervix and that was key to our success. If Carlie had remained in the bed 7cm and beyond, she never would've made it without an epidural.

Brett Helms



I could've never gotten through it with out my husband, Brett. He stayed by me the entire time, putting cold cloths on my face, heat packs on my legs and hips and when using nitrous he helped hold the mask for me. He was constantly encouraging me telling me how great I was doing. Between Brett and my mom, they kept me comfortable by heating and reheating towels/ rice heat packs constantly for those hard 18 hours of labor. Carlie


My mom, Your Birth Helper team, my nurses and my midwife were fantastic! Encouraging me throughout, offering me food and drink the entire time, even between contractions, assisting me with positioning, breath control/ deep abdominal breathing, relaxation techniques to progress labor and even reminding me to empty my bladder. The only thing I couldn't quite get the hang of was not tensing up my face during pushing contractions. I knew I needed to relax my face and push out my bottom, but just found it hard to do it. Also, the use of a hand held mirror at the end suggested by my Doula Pam, was a big help seeing exactly where I needed to direct my energy and occasionally being able to open my eyes and see when I was pushing correctly. I never would've thought that would've been so helpful. I couldn't have had a happier happy "BIRTH" day and induction. It is true what Pam says, you really can have unexpected situations and with knowledge, the right medical professionals, the right birth place, with a trained coach, Doula assistance long before your labor begins to help guide you and navigate, you can experience JOY! The best thing I did was transfer care to CMC Pineville. Pam describes the labor marathon as the "John 16:21 journey" to clients who are believers, And, she uses the term #SymbioticBirth to describe the best of the medical world/ medically necessary interventions combined with the best of the normality in birthing. The blending of two mindsets working in harmony to support my birth wishes. For that, I am so grateful. Carlie Helms


Total push phase was around 1.5 hours

Welcome to the world Mr. Maverick Brett!

If you turn out to be half the labor coach as your father, your future laboring wife one day will be in real good hands!

It was our utmost pleasure to assist The Helms family!

Congrats Mom and Dad on your John 16:21 Journey - may the life of your little one bless you and your marriage in immeasurable ways!


Special thanks to the entire CMC Pineville LDR staff, Piedmont OBGYN and their wonderful care and especially Tina Moreno, CNM for her amazing work! More specifically: First Baby - yet NO tear = Awesome Perineum Support!!!


As always, I remain super proud of my Your Birth Helper teamwork to best serve our clients. Congrats also to Lena May for hosting Carlie & Brett's Labor Workshop and for completing her first Labor & Birth from the other side of the table!

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