I got to attend a birth last night/this morning…what day is it anyway?!? It was a great experience! The couple (who for privacy purposes shall remain nameless) was hoping for a VBAC (Vaginal Birth After Cesarean). This was their 4th baby – their 2nd and 3rd were delivered by Cesarean. They decided to go to Dr. Tate at Emory Midtown who specializes in VBACs – he’s delivered thousands of babies and is willing to take on cases that many other OB’s simply will not. It was a joy and pleasure to be a part of his team!
So, here’s the birth essay that briefly outlines the progression of labor that I will submit to DONA as part of my certification. Enjoy (if you’re into that sort of thing)!
VBAC on February 4, 2011; Emory University Hospital–Midtown; Atlanta, GA
Mom and Dad were hoping for a VBAC for their 4th baby, after 2 Cesarean births. I met them at the hospital at 3:50 am, February 3 (40+3 gestation). Mom’s contractions had been coming every 5 minutes for an hour, then increased to every 2-3 minutes on their way to the hospital. Once they were checked into triage and given a cervical exam (2cm, 50%, -2 station) the contractions became less frequent. After walking for 1 hour, no progress had been made so we left the hospital. Mom labored at home, with mild contractions coming sporadically – they did not need my help at this point. At 11:00 pm on February 4, contractions began increasing in regularity, frequency and intensity. At 12:30 am, they headed to the hospital again and asked me to meet them there. I arrived at the hospital around 1:30 am. Mom’s contractions were about 5 minutes apart, lasting about 1 minute. Her contractions soon became more intense and closer together. She rated her pain level at 10 and quickly asked for pain medication. During her contractions, I helped her with rhythmic breathing and encouraged her to relax her legs, arms and belly, not tensing up against the pain. At 1:45, Dr. Tate administered a paracervical block. Within 5 minutes Mom rated her pain at 4. I continued to help her with rhythmic breathing during contractions, massaging her hands, keeping her cool with wet cloths, and feeding her ice chips. At 2:15, a cervical exam revealed that she was 9 cm, 100%, 0 station. Dr. Tate ruptured the membranes in hopes that the baby would descend further. He then encouraged her to begin pushing with each contraction to help with the baby’s descent (Mom did not feel any urge to push, but Dr. Tate felt that this effort was needed to bring the baby down). Dr. Tate instructed me and Dad to hold Mom’s legs up and back while she curled into each push. She managed 3 10-second pushes per contraction, but was very fatigued and having doubts that she could keep it up. I praised her efforts and encouraged her to give it everything she had for each push (Dr. Tate also encouraged her progress by letting her know that the baby was steadily moving further down the pelvis with each contraction). Mom repeatedly asked if we could see the baby’s head. Once we reported that her head was visible, she seemed encouraged and strengthened. She felt a lot of pain as the baby’s head emerged, but was soon amazed at how quickly she arrived, after only 25 minutes of pushing. She repeatedly exclaimed, “I can’t believe it’s already over”! Her 8 lb., 12 oz. daughter was born at 2:40am. Mom required a few stitches for 2nd degree lacerations. The baby was a bit blue, so the nurses rubbed her down and got her to “pink up”, but soon realized that her oxygen levels were low. They moved her to the warming bed and administered oxygen. She responded well but could not maintain proper levels on her own. Mom nursed her briefly (the baby latched on immediately and nursed well) and the baby’s oxygen level improved. However, the levels kept fluctuating so the decision was made to take her to the Intermediate Nursery. Dad stayed with the baby while I remained with Mom. She was exhausted and worried about her baby. I helped to get her comfortable and warm and stayed by her side as she waited for news. After several hours, she was relieved to be transported to the nursery so that she could hold and nurse her baby.
Dr. Tate is a very experienced, dedicated supporter of VBACs. It was wonderful to watch him at work. He was extremely attentive and engaged with Mom and the entire team. I learned that, as a doula, sometimes you have to “take charge” to help mom through, but sometimes you have to just do what the experienced, trustworthy, wise doctor tells you. For this labor and delivery, my main focus was to help Mom stay in control and as comfortable as possible while Dr. Tate instructed her (and me and Dad) on his proven techniques to insure a successful VBAC and a healthy mom and baby.