Clinic day #24

A short clinic day today... home by 4:30!

Clinic day #23

Uneventful, but for one woman who had a previous c-section with another pregnancy. She has since had a vaginal birth with midwives, but it was complicated (requiring surgery afterward), and I think she is wanting the social ease of scheduling a surgical birth, despite the numerous risks to herself and baby with a scheduled c-section. [Scheduling a c-section is not an option for most women, but women who have had a c-section before can request them]. I have conflicted feelings about this. First, why did she come to midwifery care if she is going to choose a section and I can't deliver her? She should have gone right to an Obstetrician. In her defense, she hadn't made a decision in early pregnancy, but still. On the other hand, midwifery care is so much more than the birth - it is education in pregnancy, it is support with home visits postpartum, it is breastfeeding support and 24-hour availability. Does she deserve less than that because she doesn't want a vaginal birth? I am inclined to declare "no!"

VBACs

Lately we have had quite a few women in care who have had a c-section for their previous birth. They were wanting to attempt a vaginal birth for this labour (also known as Vaginal Birth After Caesarean, or VBAC). I attended a birth (for my neighbour midwife, who was on her weekend off) a bit ago for a woman who went did this just wonderfully, with no pain medication even! Then a few days later, I assisted neighbour woman with another VBAC at home, which went so very smoothly as well.

Then there was my client. For her first delivery, she had a c-section for failure to progress beyond an anterior lip [definition: a little bit of cervix right in front of the baby's head, more than 9cm, but not yet 10cm]. Despite the fact that she was morbidly obese, as well as having blood sugar issues in this pregnancy, I was hoping that since things tend to come in batches, that she was going to fit nicely into this spell of beautiful VBACs that we've been having. She paged around 3am with her water breaking and regular contractions. I checked her at 4:30 at home and she was a lovely 5cm, fully effaced, with the head nicely in the pelvis - excellent! So we headed to the hospital.

I was optimistic that she was going to do it beautifully too, but slightly nervous due to her other issues (mostly the blood sugar issue, which tends to make for bigger babies).

She progressed steadily, medication free, until the dreaded anterior lip, where she stayed for 2+ hours. After two hours, I tried to push the lip up with my fingers (very painful for mom), but that didn't work, so I talked to the OB, who recommended another position change and more waiting. Did so, and after 30 minutes, lo and behold, the lip disappeared! Thank the Lord for patient Obstetricians! So pushing began and she was giving it her all and doing well, as she was un-anaesthetized. But two hours later, the baby had not descended AT ALL and she was getting truly exhausted, and so I reconsulted and a decision was made for a caesarean section.

The mom was ready for a section by that point, so there was no argument from her, but the usual tears were there as she had worked SO hard to get to that point with no success. But as I told her, she did her very best, and this was NOT failure, it was just not meant to be. I so admired this mom's bravery, her determination for a vaginal birth despite not having the most ideal situation, and her valiance during a very difficult labour. I hope that I have the courage that she had when I have my children. What a trooper!

Clinic day #22

I did a home visit for the home birth mum in the morning, and she is doing wonderfully - staying in the bed resting, nursing on demand. She is positively glowing!

On my way back, a great big snowstorm came up, and while I was doing my afternoon clinic it turned to freezing rain. Despite the bad weather, all but one of my appointments showed up.

AND.... my first repeat client!!! Her babe is only four months old (a beautiful home birth), and she is expecting again! She is a little shell shocked, but happy, and I am thrilled to have her back in care!