Saturday, January 28, 2006

Birth debrief

The induction ended. Well. I don't know which was more significant. The ending or the ending well! Of course I'm kidding, but I suspect the mother, at least in the moments after delivery, shared those sentiments.

Actually the labor itself wasn't so bad. It was the preceeding 14 hours of chemical induction that set the tone for the whole experience. For some reason they start inductions at night at this particular hospital. So at 9 p.m. the mother was tucked into bed with prostaglandins on her cervix and told to rest. Like that's gonna happen.

But she gave it her best shot and got maybe 2-3 hours of sleep. In the morning she had made no cervical change, so they switched to pitocin. After six hours on pitocin, again with no cervical change, she asked for a break. She asked them to stop the pitocin so she could sleep.

At that point, however, her body had taken over and her contractions continued with the same frequency and intensity. Over the next six hours she made steady progress, working so amazingly patiently with each contraction. Finally she asked to have her water broken and the caregivers complied. Twenty minutes later her son arrived, robust and healthy, after three pushes.

Every birth is a learning experience and this birth gave me more insight into why some midwives never induce labor. For though this baby was technically 10 days overdue, he did not have signs of being a late baby. He has some vernix on him. His placenta was very healthy looking (I even asked the midwife to show me what calcification looked like, since I haven't seen many "old" placentas, and she couldn't find any). And after watching hour after hour of exhaustion and pain that the mother went through with the induction, it was pretty clear that her body could have used some more time to get ready for labor. She endured it so well, and without an epidural, which was her goal, but much of it seemed unnecessary; given another few days or a week, how much more quickly would it have gone?

I don't feel like I'm making myself clear. Let me try again. I am extremely proud of this woman and the effort she gave. I am in awe of her determination. Knowing what she has inside her, I wish she could have been allowed to get a better labor, which I believe would have happened if she wasn't induced.

The other thing I learned at this labor was just how quickly a mother can go from transition to birth. She was seven centimeters when the midwife broke her water. After watching a few contractions, the midwife left to check on another patient. Then the nurse left to run down the hall for a second. And no sooner was the room empty than the mother had a contraction where she said, "I'm pushing. I can't help it." I said "O.K. I'll call for the nurse." I pushed the call button and said we needed the nurse. The mother pushed again, this time a hard whole-body push. She said, "The head is right there!" And it was. At least three centimeters of scalp.

I pressed the call button again and said, "We need the midwife in here!" The midwife walked in during the next push and was able to talk the mother through a slow delivery of the head, followed by the rest of his body. It was so fast. In one picture you can see the nurse arriving and putting a glove on, but the baby's already resting on the mother's belly.

Quite a nice, memorable ending to a grueling 26-hour induction.


Anonymous susie said...

Thanks for sharing the outcome of the induction. I am glad the mother was able to go without an epidural since that's what she wanted -- but man, induction sure doesn't sound like fun.

I am being induced on Tuesday at 39 weeks due to gestational diabetes and I've been reading induction stories all weekend. I sure wish I didn't have to go this way. I'm still hoping that labor will begin on its own before then.

If not for the GD I would never have agreed to induction, but I have had a lot of pregnancy losses in the past and I am terrified of going too long and the placenta deteriorating.

Anyway thanks for sharing the story, I found it interesting.

2:54 PM  
Blogger Dr. Deborah Serani said...

Wow, what a story.

11:10 AM  
Blogger I am a Milliner's Dream, a woman of many "hats"... said...

I call that "supernatural" birth--pitocin induction with no analgesics or epidural.

I rarely see induction births that go this well...glad it did and you were there for her.

11:10 AM  
Blogger Connie Banack said...

My sister is currently one week postdates with her second child. Her first was fully three weeks post-term ending in a spontaneous labour resulting in a "term" baby (no postdates symptoms at all, just like your client). I am so thankful her midwife is patient and trusting, very rare today. Induction is not fun, what an amazing woman to have a "supernatural" birth (way to go Hh!).

5:19 PM  
Blogger Jyn said...

Natural birth tends to be defined as a labor without pain medication or C-section, and honestly I think there is a little more to it.

Although the main goal is to have a healthy baby, I also believe the goal is to have a healthy birth experience. A lot of women dont truely understand the ramifications of the seemingly "more convenient" medical opportunities there are for the pregnant and birthing mother. I have heard women say "I would rather be cut than tear!" , "If I had the choice, i would be induced...", "Oh, if only I could just have a c-section, everything would be perfect..." .
Induction is NOT natural when Pitocin is concerned, and depriving yourself of an epidural when being induced via Pitocin just because you want to 'keep it natural' just shows a little ignorance, in my eyes. I've been there- Im jsut more informed and wise, now.

You have harder closer, unatural contractions that your body isnt ready for. Under normal terms, your body has a process of pain inhibitors and a rhythm of hard contractions as well as different contractions to go with them.

I have had 3 induced births, one with an epidural, two without, and 1 completely natural, med free birth. My last birth I happened to be induced without my permission, DENIED a perfectly fine epidural and endured 9 hours of UNATURAL labor when the previouse uninduced, natural, med free labor 13 mos prior was an hour and a half long.

I also was forced to have an IV while being induced and I had severe water retention afterwards, as well as continued contractions, even after I delivered baby and placenta. If I ever have to be induced again, it's epidural all the way, baby.

I have been having those awful non-productive contractions at 38 1/2 weeks with my 5th, and I am in a hurry to have something happen just as most pregnant women are in my position, but I still choose the natral method because it was the epitomy of the perfect birth. Induction was the worst, and Ive had it both ways- with and without pain meds. Both were not the best possible situation for me.


8:39 PM  

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