I met Hannah and Casey a little later in her pregnancy than most of my clients which meant that we saw a lot of each other in the weeks before Crosby's birth to make up for lost time. Her daughter's birth had been an induction and Hannah was set on doing everything in her power to make this an entirely different experience. After a pretty uneventful pregnancy, Hannah's doctor started noticing that she was measuring a few weeks smaller than expected and suggested that she have an additional ultrasound to check on the baby and make sure all his measurements were on target. At this ultrasound, they diagnosed Hannah with oligohydramnios, meaning that the amniotic fluid level was lower than they liked to see it. Her doctor suggested that she go be admitted to the hospital overnight for IV fluids but also made it sound like if the fluid levels hadn't improved the following day that they would push for an induction. Hannah and Casey discussed their options and stayed for a non-stress test which showed a spectacular looking baby so they chose to go home for the evening and attempt to hydrate on their own before returning the following day for another ultrasound. They did a lot of their own research on low fluid levels to prepare themselves for future doctor's visits. I accompanied Hannah to her follow-up ultrasound appointment which showed even lower fluid levels and her doctor started pulling out lots of scare tactics. It was the first time I'd ever actually heard a doctor pull the “dead baby card” with my own ears and I was so impressed with the way Hannah handled herself throughout the entire ordeal. Despite only being 36 weeks along, her doctor even said he would induce her if she'd entertain the idea (which she would not!) She agreed to stay overnight for IV hydration and thankfully, the ultrasound the following day showed increased fluid levels, though the baby had flipped and was now breech, so while one worry was taken away, another one was added.
Hannah started doing everything she could to get him to flip back around, including some chiropractic work and thankfully, he cooperated quite nicely. Once he was back head down, the focus started to be back on the birth and avoiding an induction. It was difficult to shift back out of scarey medical mode after how much her doctor and the entire experience with the low fluid levels had really undercut her confidence.
She was worried about going past her due date and having to fight an induction so she was taken by surprise when her water broke around 2pm, Saturday, the 24th, a few days after she hit 39 weeks. She and Casey had already had a big date night planned so they just kept their plans, enjoying what they thought would be their last night before meeting their son. She went to bed expecting to be woken up by labor by morning but Crosby had other plans. They continued to stay home, hoping that labor would start on it's own, and while Hannah was having some contractions, they were very irregular and never fell into a pattern.
She made an appointment with her doctor's office for Monday at 2pm with a plan to tell them that her water had broken that morning. They confirmed her water had indeed broken and found that she was 2cm dilated and 80% effaced. The doctor gave them some grief about not coming into the hospital right away and wheeled her over to be admitted at the hospital. I arrived around 3:45pm, just as she was getting settled into her room. They got her hooked up to the monitors and confirmed that she was indeed having contractions, even if she wasn't really feeling them very much. She was fearful of the Pitocin since it was used during her first labor and there hadn't been any build up, only what she remembered to be excruciating pain right from the start, so she made sure she got them to agree to start low and raise it as slowly as possible. Around 5pm they got the Pitocin going through her IV, starting at the lowest possible dose of 2 units/minute and slowly moving up to 6 over the next 2 hours. Hannah was checked again at 7:10pm and was still 2cm dilated, though she was now 90% effaced. The baby was still really high in her pelvis so we started working on positions to try and get him to move down. We made sure she was going to the bathroom about once an hour and during one of the bathroom trips, she noted that she felt like something had “popped” while she was in there, which I suggested was likely the baby moving down into a better position. The Pitocin was slowly increased to 12 units for two hours and at 9pm, Hannah had progressed to 2.5cm dilated, 90% effaced, and the baby had moved down quite a bit. The nurse came in and checked her 45 minutes later and nothing had changed so Dr. Pappas relayed that he wanted to up the Pitocin again to 20 units/min but Hannah declined and asked that it be pushed back an hour. Around this time, Casey left for a bit to pick up some caffeine for he & I since we figured it was going to be a long night. Dr. Pappas came in at 11:15pm to check her again and Hannah was still 2.5cm dilated. The Pitocin was then upped to 20 where it would remain “until sunrise” with an understood deal that if she made progress by then, the doctor would consider lowering it back down.
The contractions slowly started picking up in intensity and frequency after midnight. We spent much of the night chatting about our lives, remembering to go to the bathroom, making guesses about when Crosby would arrive, and laughing about how the room (& the blood pressure cuff) seemed to be jinxed, with everything needing to be held just right. I french braided her hair and we fit in a couple episodes of The Office before Hannah's contractions started requiring a little more focus. The heating pad seemed to be helpful when she was sitting in bed and we learned that it didn't matter how many time Casey or I suggested it, she had no interest in doing any sort of leaning. She managed to get a little rest in between contractions and Casey tried to do the same.
The doctor came back in at 5am and Hannah was completely effaced, 5cm dilated, and the baby had moved down a lot more! He was so happy with this progress that he agreed to start lowering the Pitocin back down. He told her that she held up her end of the deal, so now it was time for him to hold up his. I was incredibly impressed! The baby was at +2 when he checked her, and since +3 is crowning, I knew that if she wasn't already feeling a lot of extra pressure, she was about to. Almost as soon as the doctor left the room, labor really kicked into high gear. Because of all the pressure that she was feeling, she didn't really have much interest in getting up and out of bed but she gave it a shot for a few minutes. I tried to prepare her as best as I could that she was going to have to fight the urge to push. I told her that was her going to be her new mission for the next few hours. This meant developing new ways to get through each contraction as she cycled through different breathing, noises, and moans as her will was tested. Casey and I held her hands through each contraction as she buried her face in this soft little pillow or in Casey's shoulder. During the more intense contractions, she would cry out a bit before they would start to subside and she could regain some sense of composure. It was beautiful to watch the way Casey held her and marveled at her strength through these increasingly tough contractions. Throughout this time, the Pitocin kept being lowered every half hour and sometimes sooner.
The nurse came in at 6am to check her again and in just under an hour she had progressed to 8cm. Every contraction remained just as intense as the one before but with more and more of an urge to push during the next hour. Shortly before 7am, her body took over and started pushing on it's own. She still wasn't completely dilated, lacking only about half a centimeter which meant almost another full hour of having to fight against her body. At this point there wasn't really much of a break between contractions because she was feeling so much constant pressure. There were a few times when a contraction would really get to her but Casey would tell her she only had a couple more to fight through, brush some hair out of her face, and she would go barreling into another one.
At 7:30, the doctor came in and checked her, noting that she really only had one little lip of the cervix remaining. During her next contraction, he told her to give in and push just a little bit so that he could push that lip out of the way. At this point, he left to go try to get some paperwork done and Hannah got to start pushing with the nurse. She pushed on her back for a little while but the baby wasn't making his way down very well so the nurse suggested some hands & knees pushing to help him descend. After pushing on her hands and knees for about half an hour, they got her to flip back over and start pushing while pulling her legs back. Once she got in this position, the baby started making his way down very quickly! The doctor was called, as well as a back up nurse just in case the doctor didn't make it, and Hannah continued to push, despite them urging her not to. The nurses shoved Hannah's legs back at this point, I assume mostly because that's what they're used to, which she later said was incredibly painful.
Dr. Pappas barely had time to get his gloves on as Crosby sat right on her perineum, waiting for one last push to bring him earthside. Crosby made his way into our world at 8:12am, a little over 66 hours after Hannah's water broke. Dr. Pappas was very respectful of their wishes for delayed cord clamping and held Crosby level with the placenta for 60 seconds before handing Casey scissors to cut the cord. Crosby was then brought up to Hannah's chest where he let us all know he was less than thrilled with the change in environment. After a few minutes on her chest, staring at him in amazement, Casey accompanied the baby over to the warmer to be dried off and weighed while Hannah had a small tear repaired. He had beautiful blonde hair like Hannah and though it looked curly in all his newborn cheesiness, after his bath it was obvious it was straight. Hannah had him attempting to breastfeed by 9am and though he latched on and off a couple times, he was still mostly uninterested. Since they believed it had been almost 24 hours since her water broke, they kept them an extra night in the hospital (but oh, if they only knew!)
The confidence she had in her body that enabled her to stay home as long as she did, the strength it took to endure 15+ hours on Pitocin without so much as a tylenol, having the opportunity to push in a position other than on her back (in a hospital!!!), and last but definitely not least, talking them into turning the Pitocin almost completely off, are all thing that you don't get to witness every day. There were so many amazing aspects of Crosby's birth that I had never had the privilege to see before, making it an even more unique experience than I'm used to.
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(I'm one birth story behind since I forgot to bring my release form to the postpartum visit but I'm putting it in the mail Monday so hopefully my October birth will be up here soon!)
