Kamishia: A Home Birth Induction

I met Kamishia later in her pregnancy, than most of my clients. As we sat in the office she shared her story with me. It was complicated, heartbreaking, and certainly deserving of a Birth Tribe scholarship.  

 

Besides Mama Warrior, I also run a doula collective called Birth Tribe. It's a group of 27 independent doula businesses, who have all come together, to help make finding the perfect doula, easier for the families we serve.  This group of doulas has created a scholarship program, that allows for a portion of each of our contracts, to go into a fund to help support a doulas out of pocket expenses, when they choose to support a family for free.  These scholarships are primarily held for woman of color, due to horrendous birth statistics in our country. 

 

Kamishia was planning a homebirth.  She is a single, black, lesbian woman. She falls into quite a few categories, that would make her at risk for some unwanted birth outcomes. However, after a few pregnancy complications, and then an ultrasound that determined intrauterine growth restriction, a hospital would now have to be her path.   

 

At 4:35pm on Thursday evening, I received a text that said "I'm getting induced".  I picked up the phone and called her. We talked about what would happen next and I assured her that she was safe. I could hear in her voice that she was very disappointed, but certainly knew this was a necessary move at this point.

 

After she arrived, they placed a foley balloon into her cervix that would be left overnight and then Kamishia went to sleep. A foley balloon is also known as a form of mechanical dilation and can help to ready a cervix in preparation for an induction. 

 

I headed down to Kamishia the next morning. They had decided to leave the balloon in for 24 hours, so we just hung out, chatted, and played games. We talked about all of the possible outcomes of this birth.  This was going to be very different than the home birth that she had planned, and I wanted to make sure she felt educated and aware. The more we talked about things, the better I could see her feeling. 

 

There was one issue though that was difficult to overcome. Kamishia would need to be continuously monitored, which meant that we could also hear Kamishia's baby's heart decel more often than what would be considered normal. This was another reason that she was in the hospital having an induction.  We talked about all of the "why's" surrounding what could be happening, but it was mostly just speculation. Every time the heartbeat went very low, Kamishia would watch the monitor to see what the number was and to be honest so was I, every time her face would be one of concern. 

 

When the heart rate would dip I would start having Kamishia move, and remind her to breath in deeply, to help oxygenate her babe as well as calm herself. 

 

24 hours after the balloon placement, Kamishia was 4cm dilated and 90% effaced. The plan was to start pitocin, but Kamishia had begun to contract on her own. The nurse and I had also discussed the baby maybe not being able to tolerate pitocin. The heart rate was dipping with each contraction, especially when Kamishia tried to lay down for rest. It was going to be a long road ahead, not only physically, but mentally for Kamishia. 

 

Around 11:40pm Kamishia started to kick into active labor. She was on all fours moaning and rocking through contractions. With each one I watched her tense up. She was having a battle of wanting to bring her baby earth side, but also not wanting to contract, knowing that she would hear her baby in distress. 

 

Throughout the labor Kamishia would say, "I don't feel like my baby is safe." We would reassure her that midwives and OB's on staff wouldn't put her baby in danger, and that while a lot of her dips were very low, she always sprung back with great variability.  The head OB also came in to explain what they were seeing on the monitors and why they felt like pushing ahead was still safe. I was in the presence of two very strong and determined females, one was just super pint sized, and still in the other one's womb. 

 

At 2:45am, Kamishia wasn't dilating anymore. She couldn't let go, she couldn't get herself to feel safe, and because we are animals who need safety to birth, her body was following her brains lead. I eventually discussed an epidural with her. While this was the farthest thing from her original plan, I was hopeful that it could help her to relax and in turn allow for dilation to start again.

 

Kamishia agreed that she needed rest. I was slightly concerned about the effects of an epidural on the baby's heart rate as well, but was hopeful we could manage it. 

 

Kamishia was able to move her body even with an epidural placed.  It allowed for her to get a bit of rest, relax, but still allow for enough movement to keep her babies heart rate at an acceptable baseline. 

 

I went and got a little bit of shut eye in my car, myself and returned a hour later at 5am. When I went back to the floor,  her mother was sitting in the waiting area reading a book. I assumed all was quiet until I opened the door to Kamishia's birthing room and it was packed full of people and chaos. 

 

Kamishia looked at me wide eyed, wearing an oxygen mask and said, "I was just looking for my phone, you have perfect timing."  The baby's heart rate was in the 50's.  A normal heart rate for a baby is between 120-160, for reference. 

 

I rubbed Kamishia's leg and told her that I thought she was probably close to fully dilated. I watched nurses and an OB start to gather things for an internal fetal heart rate monitor. This is a small electronic tranduscer that is slid under the baby's skin. It doesn't hurt the baby, it's sort of like passing a needle through the top layer of the skin on your finger.  While this is an intervention that is usually unnecessary, this type of situation is why they exist.

 

I explained to Kamishia the procedure, as the nurses and doctors were moving at a panic style pace and not explaining things.  This scenario happens quite often, and I think it is probably one of the most underrated reasons for having an experienced doula (and also a reason for OB's to really want and accept a doulas presence, but that's for another blog!)  Things can happen so fast, that a birthing person is often watching things happen to them without any explanation.  Kamishia's best friend, Eric, was in the room with us and I could also tell in need of explanation, by the look of fear on his face. 

 

While informed consent should be the norm, often times OB's and nurses have to make what could be life saving decisions without it. I was able to explain things to Kamishia and she was able to consent to them, prior to them being done. This helps medical professionals operate in a way that protects everyone, while allowing for the parents to experience less trauma by receiving education and being able to consent and remain part of their child's birth. 

 

The electrode was placed and the baby's heart rate was a bit higher than previous.  After 20 minutes or so there was another significant dip in the heart rate and two OB's entered the space.  After another cervical check, Kamishia was fully dilated.  It was 5:48am. I again heard conversation and the statement, "I can pull the baby out" from an OB. 

 

I leaned down into Kamishia's face and said, "Do you understand what they are saying?" She shook her head no. I explained that she was fully dilated and safe to push with her next contraction, but they were considering using a vacuum to help assist the baby in making her arrival earth side. 

 

Her eyes got wide, "When can I push?! How do I push?!" I explained active pushing in hopes that Kamishia could get her baby out, prior to a vacuum needing to be used. While this isn't usually my approach, in this situation it would make the most sense. I wasn't sure where we would end up, as this was Kamishia's first time pushing.  

 

I helped Kamishia pull back her leg, due to odd positioning needed for baby's heart rate, and said, "Big deep breath in!" and began to push with her. Let me tell you, it was the most magical, unicorn, fairy dust sparkling in the air, pushing that I have witnessed! 

 

Kamishia pushed her baby's head half way out with the first breath, big deep breath in and another push, the full head was out, and one more breath and push, and Braelynn took her first breath earth side, as her mama screamed with joy, at 5:52am. The entire room exploded with cheering. The noises were in disbelief and absolute awe. 

 

 

She was a teeny little peanut weighing in at 4lbs 14oz (which was expected due to the IUGR), but she was a tough cookie! Great apgar scores and those decels were not due to anything wrong with her.

 

The cord from the placenta was the shortest cord I had ever seen. Probably 8 inches or so, it was a 2 vessel cord, and was so thin and scrawny.  It was also wrapped around her torso! This was the explanation for all of the heart rate stress and I was glad to see that it was over.  The team kept the baby low on Kamishia'ss abdomen to still allow for delayed cord clamping.

 

Kamishia's mother was invited to cut the cord, and her friend Eric, stood by her side while Kamishia sobbed and welcomed her baby with very sweet words.  

 

 

This birth had great potential to have a very different outcome. I am very thankful to Dr. Jessica Illuzzi, for guiding the entire team, to what ended up being an absolutely empowering birth for my client.  Her placenta tour was one that puts midwives tours to shame! 

 

As 6 birth workers stood around gazing at Kamishia kissing her baby's head she said, "I had such a wonderful team and I'm very thankful."  

 

Then Eric, so very sweetly began to give his friend loving parental advice and helped her to latch her little babe. It melted my heart. 

 

 

It was a honor to be invited into someone's birth so late in the game and to feel so quickly connected them. I can't wait to see their little family continue to grow and succeed. I will never forget that little but mighty cry. I hope you keep your fighting spirit forever little one. 

 

And for all of the birth nerds still reading along, it appears as though she might have been breech at some point as well! (Lots of poop in the womb and immediately outside of it too!) 

 

 

 

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