48 Hours at 42 Weeks
A few months back I answered my phone and on the other end was a bubbly voice telling me about how more and more research has led her to wanting to search for a doula. She told me about how my business name, Mama Warrior Doula, had spoken to her. How the strength in the word warrior, was exactly how she wanted to feel during this process.
At the end of the week, I met with her and her partner Matt. While most partners, have some questions, they defer to the pregnant person when making the choice for a doula. Matt was very involved. He had lots of questions, including ones he had written down. He told me that he wanted for Laura Beth to be respected and safe and as they get deeper into the process the choices and decisions are overwhelming. He wanted to insure that I would be there for them through the entire process.
Every meeting with them, went over the scheduled length, and they kept me laughing the entire time. Laura Beth and Matt, are very special people who have faced a million challenges through out their lives. Their positive attitude, their joy, and their playful relationship was so refreshing.
Laura Beth had a pretty textbook pregnancy. From a physical standpoint it truly couldn’t have been better. However, Laura Beth and her provider often had differences to work out and she was feeling like she wasn’t being heard. After every appointment with her obgyn, Laura Beth would call me feeling negative, feeling like they were against her or dismissing her feelings, and needed for me to get her back to a positive place. I hated that for her, but when I would check in with her later on, she would seem perfectly happy.
At 36 weeks pregnant, Laura Beth called me one afternoon crying. Her provider had crossed a line. Her provider had not only disrespected and offended her, but belittled her in the process. We chatted and disconnected. Later that evening Laura Beth phoned me again to talk about what had happened. At this point, I decided it was time to suggest a provider change. Laura Beth was shocked that this was even an option. I told her that while I couldn’t make any guarantees, I could probably find a provider to take her on regardless of her gestation week.
Laura Beth and Matt, live about 15 minutes east of Middletown, CT. We targeted providers that deliver at Manchester Memorial Hospital first, as this was the closest hospital I thought would respect her wishes. After being turned down, I crossed my fingers and sent a message to one of my absolute favorite CNM’s, Erin Morelli, with the Center for Women’s Health and Midwifery, delivering at Vidone Birth Center, part of Yale’s St. Raphael campus. Laura Beth was 36 weeks and 3 days along at this point. Erin was in the Westport, CT office that week and said that as long as Laura Beth was willing to make the drive to that office for her first initial appointment, they would fit her into the New Haven schedule after that.
Laura Beth and Matt, I think thought I might have been a bit crazy for suggesting that they deliver somewhere that was 50 minutes away. However, I suggested that they take the initial appointment and if it didn’t feel like a good fit, they didn’t have to switch. They had nothing to lose by meeting with Erin.
All day Monday, the day of their appointment, I waited anxiously by the phone for a text or phone call from Laura Beth, but nothing came. Oh no! Had I been wrong? Were they not the patient and midwife soul mates I thought that they would be?!?! I decided to reach out to Laura Beth myself and she apologized for not telling me. She said that she immediately felt comfortable and since I thought the drive wasn’t too far, they were going to switch. YAY! I knew that they would be getting the experience that they had wanted.
Laura Beth’s due date, came an went. Laura Beth would call and text me telling me that everyone was driving her absolutely bonkers asking her why she was still pregnant. Friends and family were insinuating that maybe something was wrong with the baby or pregnancy. I reassured her every time and told her to stop answering their messages.
For anyone reading this, 40 weeks aka “due date”, pretty much means nothing. Most babies come between 37 weeks and 42 weeks gestation. Not all babies, and not all bodies, make babies in the same exact time frame. Stop asking people when the baby is coming!!! No provider would risk anyones health by letting them go farther than they thought was appropriate.
At Laura Beth’s last midwifery appointment, Nancy, another fabulous and loving midwife in the practice, discussed an induction with Laura Beth. They decided on 41 weeks and 5 days and after discussing a few options, they made decisions that everyone was comfortable with, for how to start this process as gently as possible.
On Wednesday, at 41 weeks and 4 days, Matt called me. He wanted some reassurance that every thing was truly ok with Laura Beth and the baby. We chatted for awhile and I decided to go see them that evening. Laura Beth had been having some contractions on and off for the last two days and I was hoping some doula tricks, might help to encourage them along.
At 5:15pm on Wednesday, April 25th,
I arrived at their home and it was obvious, they needed a person. They weren’t falling apart by any means, but the contractions overnight for the last two night and the waiting to meet their baby, was starting to get to them. Matt said, “What can we do? Let’s throw everything at this!” After a bit of discussion they decided to try a castor oil float, clary sage, and some pressure points. I also confirmed (via info from their last ultrasound) that baby was not in the proper position and would do some rebozo work to get baby into a better position. (sometimes an on and off contraction pattern can signify a baby in and OP position)
We started the shakes and decided to play some cards while we waited. We shared stories from our pasts, we came up with additional plans, and we laughed so hard, that someone may have even peed their pants.
At 7:45pm Laura Beth started feeling some contractions. I was making sure to keep her hydrated, and change her positions every 30 minutes or so. It was a cold and rainy night, and while Laura Beth was sitting on a birth ball, she said, “Oh my gosh! Is that thunder?” Matt and I both started dying laughing. Laura Beth had rolled the ball under the coffee table and when it pulled back, it made a small noise. He said, “No, it’s you!”.
We had a late dinner and 4 hours after the first shake, Laura Beth had another. Matt reminded me about the clary sage oil, and we placed some pads on her chest. At 11pm, her contractions started to slip into a pattern. I did some more pressure point work and within the hour, she was having contractions about 4 minutes apart. Matt was sitting next to her, encouraging her through every contraction with tears in his eyes. I asked if he was ok and he said, "When is an appropriate time to cry? Now? Ok good". My heart melted. He’s truly an exceptional partner and father.
I encouraged them to try to rest. Laura Beth and Matt climbed into bed and she fell asleep for the small intervals in between the contractions. At 4am after 3 hours of contractions of 3-4 minutes apart, Laura Beth was really uncomfortable. We decided to call Vidone and tell them we were going to head their way. On the drive down, Laura Beth’s contractions began to pitter out. I actually contemplated turning around, however, her induction was scheduled for this day anyways. She was now 3 nights in of contractions, and was 41 weeks and 5 days. We all agreed it was time.
It was now Thursday, April 26th at 5:40am. Upon arrival they checked Laura Beth and while she wasn’t very dilated she had made huge changes in effacement. It was decided at that point to start the induction with the way they had planned in the office earlier in the week. They decided to use a cook catheter. This is a small tube that’s placed inside of the cervix with a balloon that gets filled up with saline solution on each side of the cervix, applying pressure and assisting the cervix in dilation. This is called “mechanical dilation”.
The shift change for both nurses and midwives was at 7am. Laura Beth was happy to see midwife Sarah come on. We had done a very good job of being peaceful and jovial in this scenario, but then there was a bit of a change in energy. A nurse came on shift and her and Laura Beth clashed right away. Matt then also began to become very protective of Laura Beth. The nurse did not handle this interaction very well. They could never manage to gel, even with both of them trying, and every single time the nurse entered the room, Laura Beth’s contractions would slow or even stop during her presence. I say it all of the time, but we are animals, and if we don’t feel safe in our birthing environment, our bodies will fend off labor.
The nurse took longer breaks from us and Laura Beth began to cruise into a contraction pattern again.
The nurse came in for a vitals check at 11:50am and during that time Laura Beth pulled Matt towards her and said, “Your energy helps me to relax. It’s calming and makes me feel secure.” I watched the nurse roll her eyes. It was the first time, I had a true negative feeling about the nurse. Why would that cause anyone to eye roll? There was something else going on here.
At 1:21pm through a shut bathroom door, Laura Beth yelled, “Melissa! Balloon!”. I buzzed for the nurse and told her that Laura Beth had thought the catheter had shifted. This would signal dilation of the cervix to about 4 or 5 centimeters. The nurse came in and asked if it fell out. I told her no, but that Laura Beth had felt it shift into her vagina. She said something that made me feel as though she didn’t believe Laura Beth, but that she would grab a midwife to “just check it out”. Laura Beth was right. The catheter had done it’s job and she was dilated to 4 centimeters.
Toward the end of the nurses shift, it continued to get more and more uncomfortable. Laura Beth had asked her multiple times to relay information through myself or Matt and asked her not to touch or guide her through labor. I think it’s important to say, that Laura Beth at this stage didn’t want any of us to touch her, but the nurse struggled to maintain boundaries and not follow Laura Beth’s instructions.
I suggested that Laura Beth get in the tub to help her relax and cope with contractions. After she was comfortable, I ran out for dinner. When I came back, I was informed that there had been another intense verbal moment between the nurse and Laura Beth. Matt asked her to please leave, and the nurse lashed out. It was 6:50pm and I let them know that there would be a shift in nursing staff again. We needed something new. We needed someone else. It was perfect timing.
The next nurse walked in. Laura Beth was in the middle of a contraction and she stayed quiet until it was complete. While any labor and delivery nurse reading this is like, “well, duh”, the previous nurse did not let Laura Beth work through the contractions before talking or giving information. This new nurse was named Anna, and we couldn’t have been matched up with a better one for what would be another intense series of things.
At 7pm Laura Beth was describing a lot of pressure. We kept her in the tub for the next two hours or so. When Laura Beth got out, she was exhausted and tired. She at one point had said, “I’m done”. She asked for a cervical check. She was still 5cm and this was defeating for her. Laura Beth began to cry and tell me she was done. With every surge, it was the same words.
While I very rarely have to have firm conversations, it was time for one. The next time Laura Beth told me she was done, I asked her what that meant. She repeated it. I asked her if she wanted them to wheel her down to the OR and she said no. She got herself together for a bit and asked me what we should do. I said, “now we cry”, and we did. I held her and we cried. In my time of getting to know Laura Beth, we had discussed how sometimes a good sobbing cry, brought us both back to being centered and in control. Matt also cried. We all got it out if you will.
Now it was time for a change of plans. Laura Beth for the last few days had done an absolutely beautiful job of listening to her body. I didn’t want any of that to change now. Her body was tired. Her body needed a break. She was past the point of being able to rest in between contractions. I whispered to her quietly. In the last 3 days, Laura Beth had slept less than one nights worth of sleep. Her body was working so hard, she had maintained a great attitude, and it was time to grieve the plan she had decided on at the start of pregnancy, and start a new one. We talked about the benefits an epidural could give her now. I reminded her of how the one thing she had told me throughout the months of this relationship, was that she wanted to trust her body. I asked her what her body was telling her and she just nodded.
Anna, the nurse, popped back in, and basically repeated everything I had just said to Laura Beth. Laura Beth agreed. I think that she trusted us both and knew we were helping her to make the best decisions. Nancy, a midwife that Laura Beth also loved, than also walked in and began the epidural conversation. Laura Beth stopped her and told her she was in agreement.
At 10:30pm Laura Beth received an epidural. I had left my vehicle at Laura Beth’s and Matt’s home. I decided now would be a good time to retrieve it, and take a few hours of sleep myself. I tucked them in and headed off.
At 4am I checked in with Matt, and Laura Beth called me right back. They had checked her and she was still 5cm dilated. She didn’t sound defeated this time though. She sounded positive and ready to meet her baby once again. We discussed next step options and came up with a plan.
At 5am, the midwives at Vidone broke her water and started her on the very lowest dose pitocin. Please note, that while some hospitals have policies on how long your water can be broken for, Vidone does not. They monitor you and baby and as long as everything is fine, they will let you keep chugging along.
I arrived to the hospital at 7am, and on came a new nurse and a new midwife. I knew that today was going to be an amazing day. Laura Beth and Matt had gotten back their playful personalities with the bit of sleep they got, and in walked Erin, that midwife I mentioned at the beginning of the story and one of the absolute best nurses, an absolutely perfect match for Laura Beth and Matt, Helen.
They had the “dream team” as Matt would later refer to us. A cervical check at 8:30 am and after 18 hours of no cervical change, we had hit 6cm and were now in active labor. We all cheered! Erin told me that the right side of the cervix was a bit swollen and that baby had gone back into an odd position. She suggested that I do some more rebozo work and try to work my magic applying pressure to that side of the cervix.
Laura Beth’s epidural was starting to wear off a bit. She could feel her contractions and let me know as they were coming. She was also capable of moving herself around in the bed. We rolled her to the right and placed a peanut ball in between her legs in hopes that babies head would apply some pressure to that side of the cervix. I then began to “shake the apple tree” as they call it and attempt to get the baby back into a better position.
At 12:30pm Laura Beth quietly begged Quinn to come. Matt told her they were ready. Another cervical check and she had dilated to 7cm. The anesthesiologist gave her another dose of medication so that she could sleep for a little bit.
I decided to step out for lunch and as I walked into the cafeteria, Matt called me. He told me Laura Beth was once again napping and wanted to know if we could talk for a bit. He sat across the table from me, eyes welled up, and asked me if everyone was hiding that there was something wrong with the baby or Laura Beth. I eased his mind. This is just sometimes how inductions go. They are a slow, and often a painful process. The baby was beautiful on the monitor and Laura Beth wasn’t showing any signs of any complications.
He then asked, “Why is the heartbeat dipping low then during contractions? It’s making me so nervous.” I told him that’s why I decided to eat now. I told him that the dip in heart rate was very normal as babies started to get lower into the canal. That the rebozo work, seemed to have put baby in a better position and while I couldn’t make any promises, I believed that their baby would be here around dinner time. I assured him that no one was concerned because all of this was normal, and everything we wanted to see. We both returned back to the room.
At 3:42pm a student midwife came in, and also mentioned the dips in heart rate. They had been seeing for the last little bit (they had gotten a little bit lower and a little closer together) and asked if she could please check Laura Beth. Laura Beth was hesitant. I think after all of this time, she didn’t believe that she was close. She didn’t believe that she could have gone 3 centimeters more, in less time than it took her to gain once centimeter previously.
The student midwife checked and then said, “I think I’m going to grab Erin and have her to do a check.” Oh my face beamed! I knew that we had made it! We were there!
Laura Beth and Matt though had no idea what was going on. Laura Beth says, “I don’t want to many checks. If I’m not close let’s just wait.” The student midwife stutters for a bit, and I say, “She wants Erin to check you, because you’re better than close.” and the midwife laughed and said, “I think you’re 10cm, but I don’t want to be wrong. You deserve an absolute positive answer after all of this.”
Laura Beth, in the absolute best tone of voice ever says, “If I delivered in the next 20 minutes, that’d be great.” Matt, Helen, and I die laughing. No part of this had been a sprint. It had certainly been a marathon, but I was hopeful for Laura Beth, that it would be quicker than the previous stages.
Erin came in and confirmed that baby was now in an awesome position and that Laura Beth had indeed reached the 10cm mark and stepped out. I suggest that before we start pushing they order dinner. The kitchen was going to close, and Laura Beth had been throwing up all day. I was hopeful that after birth she would have her appetite back.
We then had th