Midwife Mondays 137: Birth Centre, Water Birth and Working Hard for Normality!

So, after weeks of sitting at my desk and swatting up over my dissertation, this week I was finally back in the hospital – yay!

I had one week scheduled on the Midwife Led Birth Unit, to get my head back into low risk care and try a few confidence cases where I led the care (after all, just a few months and I will be the only midwife in the room!)

My first shift of the week was absolutely lovely – we were handed over the care of a couple who were using hypnobirthing (which is particularly topical given that I have just done my hypnobirthing training!) After half an hour or so of breathing through each contraction, we ran the pool and she got in.
She was completely in control throughout, using her hypnobirthing to keep herself calm. Only a couple of hours later, I started seeing some signs that she might be progressing, despite her only having used gas and air, and on checking with a mirror in the water, I saw the top of the baby’s head. Her waters broke as she used her down-breathing to bring her baby downwards and in just 20 minutes, her little boy was born in the pool – perfectly controlled and calm.
It was so lovely to see the hypnobirthing really helping the couple; she was completely in control and he had all the tools to be able to support her however she needed. It wasn’t about it being the most quiet birth, it was about her being in control and empowered – exactly what hypnobirthing should be!

I passed her little boy between her legs under the water and she was able to lift him up, out of the water and onto her chest.

I spent the next few hours with the couple, helping with feeding and tidying everything up – it was so lovely to talk to them afterwards, having had very little casual conversation in the room in labour, to hear more about them and even find out that we had a lot of things in common including a real love for good food (and she’s a blogger too – what a small world!)

It was a really special day, getting back onto the Birth Centre with a beautiful baby boy welcomed into the world safe & sound, and my 28th official solo “catch”! Yay!

My second shift was a little bit less “low-risk” care. As we took over, the lady’s waters broke, showing meconium (baby poo) in the fluid. As this can be an indicator that the baby is in a bit of distress, we needed to transfer to the labour ward and start continuous monitoring with a CTG.

Within a few hours she was requesting an epidural and so we got that sited and soon she was much more comfortable. On examination she was making good progress and her cervix had got to 8cm. She slept for a bit and we all had a nice chat, keeping an eye on the trace the whole time. Only a couple of hours later we started to see small decelerations on the trace with the contractions, which can be a good sign of being fully dilated, which, on examination, she was.

She started pushing and we saw really good descent and caught a glimpse of the top of the baby’s head, however by this point there were a few more decelerations and the amniotic fluid had quite suddenly turned from a green yellow (meconium) to dark red, so we needed to get an urgent doctors review. The doctors decided that delivery needed to be expedited as they didn’t know exactly where the bleeding was coming from. They carried out a ventouse (suction cup) delivery and her baby boy was born. The paediatrician was in the room due to the meconium, however she wasn’t needed, the baby was born in really good condition and cried immediately.

The placenta came very quickly after delivery, which raised the question as to whether it had already partially separated causing the bleed, and which led to a heavy bleed. We pulled the emergency buzzer and after a few minutes of following emergency protocol to control the bleeding, it was all under control again and her baby was snuggled up in her arms.
It always amazes me how quickly everyone comes together and works as a team to help in emergencies – and does whatever is needed to solve whatever the problem is.

I saw her again the next day and she was feeling so much better and was absolutely smitten with her little boy too. πŸ™‚

My final shift of the week the whole hospital was stretched, there were no beds anywhere and staff were being pulled to different areas, so we were pulled to work on the labour ward.

Initially, we were assigned to the care of a lady who was in early labour and hoping for a VBAC (vaginal birth after caesarean), however as she wasn’t yet in active labour, I was moved to the care of another woman who had just come across to the labour ward undergoing an induction – and was fully dilated.

Cards on the table right now, this case was the hardest I’ve ever had to work for a “catch” ever. And it wasn’t just because I was hoping for the “catch” (although the illusive 40 births is still looking a little far away!) but it was because I knew how much the woman wanted a normal delivery. Her birth plan had obviously been well thought through and in it she quite pragmatically had said that she didn’t want interventions such as ventouse or forceps unless absolutely clinically necessary (which hopefully would be the case anyway!) and that she desperately wanted a vaginal delivery, even stating that she would prefer a natural tear than an episiotomy – although birth plans are just that, a “plan” they can give the midwife an idea of how a woman feels about the options available to her, and the plan can be altered accordingly (provided the baby is ok etc).

In this case, she was absolutely exhausted, and was almost completely shut off communication-wise – she just wanted to push with her contractions and then rest between. She didn’t acknowledge any questions, or even that we were there….but starting off it was fine.

After a short while of pushing I suggested changing her position to help the baby descend, but she was so “out of it” she didn’t respond other than a soft nod. Her partner and I helped her into another position, with no physical assistance from her. She wasn’t resisting, she was just too exhausted to move or respond. But as she was pushing well, it was manageable.

After an hour or so of pushing, we changed positions again, this time the only option being for me to resist against her legs to stop her sliding down the bed, as she wasn’t holding herself up at all. The doctors came in to review, as she had been pushing for an hour, but as the baby was fine, they left again. I was encouraging her to lengthen her pushes, to bear down, because I knew that the doctors would be back again shortly and would want to make a plan for the wellbeing of mother and baby if the baby wasn’t born by then. She didn’t want interventions, so I spent that half hour encouraging and coaching her pushing with every ounce of my will. It was exhausting but I knew how much she wanted to have tried her very best for the delivery she wanted so I was going to give her that.

When the doctors came back there was more of the head visible and as the baby was still showing on the trace as being well, they went away again, giving her a bit more time but mentioning to her that an episiotomy and ventouse delivery might be better for both mum and baby if the baby wasn’t born soon.

A little while later, after even more encouragement with each contraction, the doctors came back and although the baby was even closer to being born, they needed to start thinking about intervening – it’s just not kind to let someone push for that long, and the baby was starting to show signs of distress too. I was giving her everything, so much encouragement and physically holding her legs for her so she could push with all her might, but it looked like she might just need that extra bit of help from the doctors to bring her baby safely into the world.

She gave consent for an episiotomy; the doctors were getting ready to carry out a ventouse delivery but I carried on encouraging her to push as hard as she could in the meantime – I knew how much she wanted a normal delivery.
We administered the local anaesthetic but before we could give her an episiotomy, she gave one more long, hard push, encouraged by her partner and I, and her baby’s head was born! With the next contraction her baby boy was born, without any intervention, and I passed him onto her chest with tears in my eyes – both of the thrill of helping her achieve the delivery she wanted, and of physical and mental exhaustion from the now 2 hours and 25 minutes of pushing I’d been encouraging and helping her through.

I was exhausted, but happy, and seeing the relief on her face and the ecstasy at having had her normal vaginal delivery was wonderful – she did it, and I helped.

It’s been a good week, and nice to be back on the Birth Centre (even if it was just for one of the three shifts!) and catch another beautiful water birth baby too. Two beautiful “catches” this week – so that’s 29 of the 40 I need to qualify! Getting there! πŸ™‚

To read more of Midwife Mondays posts, click here:

Lead image by Rainer Maiores.
Image by David Schwarzenberg.
Image by RitaE.

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