Fantastic VBAC!!! Welcome sweet Emzey!

Laura and I met by chance after I switched shifts with another employee up at Terra Tots one Saturday morning. She came in to see what we carried that might help prepare her body for labor. She told me she was anxious because she was planning a VBAC and didn't want to face an induction. I asked who her care provider was and when she told me it was Dr. Hannah, I assured her that she was in fantastic hands. It was easy to see that she was relieved when she heard this and even came back into the store a little later to thank me again. Our interaction stuck with me though, and when she emailed me a few weeks later I remembered her clearly. Everything fell into place nicely and we met just a few days before her due date for a really long prenatal visit, wondering if it might be our only one. I really enjoyed our visit and meeting her husband, Howard, and their other beautiful daughter. Laura had been losing her mucus plug, having sporadic contractions, and feeling just generally under the weather off and on during the week following her due date. The contractions would get stronger from time to time but never got regular. She saw Dr. Hannah at 41 weeks and the decision was made to plan an induction the next day on the 25th. Laura had contractions throughout the rest of the day of her appointment and into the evening. They were about 10-15 minutes apart on that Thursday, the 25th and she was starting to see some bloody show so we knew some kind of progress was being made. The contractions continued to get stronger throughout the day and the decision was made to just keep the induction appointment at 8pm. We met at the hospital around 7:45pm and started to get checked in. Laura was having contractions this entire time, around 4-5 minutes apart. The staff was a bit confused that she was there for an induction but in labor and we finally got settled into a room upstairs about 25 minutes later. Laura changed into a gown and got hooked up to the monitors. She did not want to be sitting down for any of this as that made the contractions more painful. The nurse, Susan, did an exam at 8:50pm and Laura was 3cm dilated and her cervix was about 80% thinned out. Once she was on the monitor it was easy to see that the baby liked certain positions more than others and her heart rate would dip down some from time to time. The nurse said that she was pretty sure there was a nuchal cord (the cord around the baby's neck) but that it seemed to be relieved with position so it wasn't a concern. Laura was leaning over the bed a lot but eventually her legs were getting really tired. She tried to find a comfortable position on the bed with the heating pad on her lower back. Susan came in and said she'd spoken with Dr. Hannah who agreed to leave things be for two hours before they discussed starting the pitocin. Laura spent a lot of the next two hours pacing the area around the bed and leaning on the bed (or sometimes Howard) during contractions. Around 11:30pm the intensity starting picking up and the contractions were lasting sometimes up to 2 minutes long. She was really having to use her breath a lot to stay on top of the contractions and beginning to think about getting an epidural. When the nurse came in around 12:25am to do another vaginal exam and found little cervical change, she said that she was going to need to begin the pitocin now. Though she was doing a fantastic job, hearing this was a big disappointment and really solidified her decision to go ahead and get the epidural. She got up to use the restroom about half an hour later and saw a lot more bloody show which was very encouraging. Once she got into bed again, Susan decided to check her again while we waited on the anesthesiologist to arrive and were all thrilled to find that she was 4cm dilated and completely thinned out. It was farther along that she'd ever been before! At 1:20am Dr. Barlow came in to place her epidural and while she was sitting straight up, the baby's heart rate was dropping down around 100bpm so as soon as he was done, the nurse was quick to get her to turn on her side. By 1:45am, he was finished and Howard came back in as Laura was starting to feel the epidural take the edge off of her contractions. He got settled in on the sorry excuse for a bed in the room (once we figured out how it worked) and managed to get a few hours sleep while Laura and I chatted. She was flipped to her other side around 2am in the hopes that it would help her feel the epidural more fully since she still had a lot of pain with her contractions. It was also to help Emzey's heart rate to stabilize, taking pressure off of the cord. Laura was still experiencing a lot of back labor and had almost full control of her legs. Within an hour, her pain level was right back up to where is was before the epidural and she was needing full support again from me and a slightly groggy Howard. Susan called Dr. Barlow back and he replaced her epidural, hoping this one would bring her more lasting relief while reminding her it wouldn't really do much for the back labor. About 10 minutes later, the relief was really visible and Laura was feeling a lot better. Her contractions continued to be around 2 minutes apart and she was 6.5cm dilated. Susan checked in one more time before shift change when she introduced the day nurse, Becky (whom we were much less impressed with.) Dr. Hannah came in with the nurse around 7:30am and asked to break Laura's water. There was some light meconium in the water and they chose to insert an internal contraction monitor at this time too so that they could get a more precise idea of just how strong her contractions were. They tried to put on an internal heart rate monitor but Emzey shook it off within a few minutes. Laura was 7cm but Emzey's heart rate began to dip down lower and stay down longer than it had earlier. Dr. Hannah explained that if it got more concerning that he would probably do an amnioinfusion, putting water back inside Laura's uterus to take that pressure off of the cord, never once jumping to or even mentioning a c-section. By 10:30am, Laura had progressed beautifully to 8cm and we'd fallen into quite the pattern with each contraction. As the contraction would begin, Howard would start rubbing one side of Laura's belly while she sand and I, with hands cupped to her belly, talked to Emzey. We told her about all the people who were waiting to meet her and all the fun things that awaited her. We promised her all kinds of amazing things if she would continue to bring her heart rate back up. I may have even promised her a pony at one point. Howard had his phone out and would jokingly put it under the gown with the flashlight on, doing some Morse code and trying to coax her towards the light. We all just tried to share our love for her through Laura's belly, explaining just how much we needed her to behave so that she could be born vaginally. At noon, another exam revealed that Emzey had moved down some but Laura remained at 8cm, which meant an increase in the pitocin. Not long after this, she was starting to feel more pressure than she had previously and had made it to 9cm. Everyone was beginning to get excited, though the nurse kept being somewhat of a bummer trying to talk about the possibility of a c-section but Laura was steadfast in her optimism and pointedly told her to leave at one point. The nurse came back in with Dr. Hannah around 1:50pm and said that there was only a small little big of her cervix left. They left to go perform a surgery on another patient and said that she'd be ready to start pushing by the time they were done. While they were gone another nurse that I had worked with previously came in and said that she was going to help Laura to have a vaginal birth. She said she was going to “chicken wing” her one way and then the other before having her get on her hands and knees. This involved Laura being on her side with a leg pretty high up in the air in a stirrup and then getting flipped over half an hour later. At 2:30pm she was pushing while laying on her back on the bed but not making very much progress. Everyone had suspected that Emzey was posterior, meaning she was facing up instead of towards Laura's back, and so another round of position changes was suggested to try and get her to flip around. At 4pm, after many contractions on her hands and knees, we helped her switch back around to the “chicken wing” position on her left side and the pain switched from being more in her back to being more in the front down low which we all hoped meant that Emzey had decided to flip. Dr. Hannah came back in at this point and Laura began pushing again. He used a vacuum to help bring Emzey down under Laura's pubic bone and after a half hour of pushing, she was almost here! Emzey Mae made her way into our world at 4:36pm on Friday, July 25th and many tears of pure joy were shed. I was so proud of Laura!! All her hard work and determination had paid off and she had proven that her body was not broken. Emzey was born with a really tight nuchal cord and so they took her immediately over to the warm. She needed a lot of stimulation and Laura continued to sing to her while we all told her how much we wanted to hear about her journey. Within a few minutes she let out a sweet little cry that exponentially grew in the following seconds. She was absolutely beautiful, weighing 7lb 12oz and looking a lot like her big sister! After about 5 minutes she was able to be placed on Laura's chest and for about a minute, every thing was so peaceful as they showered this sweet baby in so much love. She was taken to the nursery for observation and sadly it was many hours before she got to hold her again. By the time I visited the next day they'd started working on their breastfeeding relationship and Laura was getting around really well. I feel so fortunate that our paths crossed, that I was able to witness her amazing strength and perseverance, and so humbled that she allowed me to be a part of their incredible journey. This is one family that will always have a place in my heart.

Welcoming Finley!

Welcoming Finley! Born May 5^th, 2013

         Erika and Luke first met me early in their third trimester and we spent quite a while chatting and getting to know one another. I felt a fairly instant connection with them and was thrilled when they made the decision to have me as their doula for the birth of their son. After a previous miscarriage, it had taken them a while to accept that this pregnancy would indeed result in a take-home baby. They had waited until she was more than halfway through this pregnancy to let their families know and being aware of just how private they were made it that much more special to be a part of their journey.

        We spent our prenatals discussing which aspects of their birth were the most important to them, her health history, as well as the flexibility of birth and the importance of not having rigid expectations. Erika's mother had a traumatic experience during the birth of her youngest child where she damaged her back and was stuck in a wheelchair for a few months postpartum. Erika had experience with throwing her back out in the past which had made it temporarily impossible to get around. We knew that the fear of this happening again, or having an experience similar to her mother's was going to be a very real concern for her during labor. We spent more time than usual discussing the type of back pain that can accompany labor and the possibility that this could be a normal part of her labor, all the while knowing that if and when this happened, large amounts of anxiety would accompany it.

        Erika still wanted to labor at home as long as possible, though since they lived about 45 minutes from the hospital, they knew they would have to time their trip really well. They lived a few miles off a main road and we all joked at their home visit that they may be some of the only folks who had to pack a chainsaw as part of their hospital bag in case any downed trees attempted to delay them. Their last prenatal appointment was Wednesday, May 1^st and the doctor confirmed that very little cervical change had been made. Thankfully, no one seemed to be in any hurry to rush things along and we all knew that Fin would make his appearance when he was ready, though we didn't anticipate that it would be so soon after.

        Erika sent me a text message around 6:30am on Saturday, May 4^th to let me know she was pretty sure her water had broken earlier that morning around 2am and that she had been having sporadic contractions since then, around every 15-20 minutes but she still managed to get some sleep that night. I was finishing up at another birth when I got her message so I knew I was in for another long day. She made herself a plan to stay home until things intensified, to stay super hydrated, and to go for a walk if contractions started to taper off. Shortly after we exchanged messages, she started getting some bloody show and I assured her that would likely increase as the day went on.
        As Erika labored throughout the day, they found ways to keep themselves busy, though I think Luke did most the nesting for both of them. He kept himself occupied by vacuuming, cleaning the toilets in the house, ironing all of his work shirts, and even baking a sweet potato pie! Erika was thankful he had found such a productive outlet for his excitement and anxious energy.

        I was incredibly thankful to get to sleep for about 6 hours before checking in with them again. It was now almost 6pm and her contractions had started to become more painful, though they were still 6-10 minutes apart. She was still feeling pretty good and getting some rest in between the contractions. They decided to go ahead and make some dinner and if contractions continued to get closer together, they would start to plan their trip into town. By 7:30pm, her contractions were getting more and more painful, requiring some focus to get through them, but still about 5-10 minutes apart so they decided to go ahead and get ready to come to the hospital.

       They called me at 8:30pm to let me know they'd made it into town and were walking around the hospital grounds trying to decide what they're next move was going to be. There was talk about walking around the mall, even potentially getting a hotel room, though by 8:45, the decision was made to go ahead and check in. We made sure that everyone was on the same page about when we would say that her water had broken so that she could avoid the unnecessary interventions that would have been implemented if they'd know how long it had actually been.

        Erika and Luke arrived in the labor and delivery triage around 9pm. She changed into a gown and her first cervical check revealed that she was between 1-2cm dilated, the baby was really low at -1 station, and she was about 60% effaced. She really felt like this was where she'd be when she arrived so she wasn't too surprised. I arrived about half an hour later and her contractions were becoming consistently 5 minutes apart and quickly increasing in intensity and frequency. While in the little triage room, she started having to stand and sway during the contractions, sometimes crouching on her hands and knees until it was over.

        Luke was incredibly attentive, staying very close, ready to help her with the next contraction. We finally got moved into room 1310 where we sat for over half an hour before anyone came in to check on us. They got her saline lock IV put in and gave her a quick run down of their monitoring protocols before we were alone in the room again. We started trying to make things a little cozy and get Erika as comfortable as possible but it was getting increasingly more difficult to relax and focus her way through each contraction. It was easy to tell from an observer standpoint that she was making quick progress and that where all this extra intensity was coming into play.

        Around midnight, it was just getting to be too much and no amount of position changes, heat, or massage seemed to be making a difference. Erika had been feeling nauseated since arriving at the hospital and had been throwing up quite a bit in the hour and a half we'd been in the room. Luke and I struggled to find a way to help Erika not feel so tense and every contraction brought more and more concern about the pain she was starting to feel in her lower back. The nurse came in to check her and she was between 3-4cm dilated already, completely effaced, and little Fin had made his way down even farther! We discussed pain medication options at this point and she decided to try some IV Stadol and Phenergen to take the edge off and to help with the nausea. This allowed her to relax, especially in between contractions and make a concerted effort to build up for strength for what was to come. Not long after receiving the IV meds, her contractions were about 2-3 minutes apart and head compression started to be evident on the monitoring strip, meaning that Finn was really starting to move down into her pelvis even more. The medication only last about an hour and had almost entirely worn off when the nurse came in to let Erika know that their anesthesiologist was about to head home for the day, meaning that if she was going to want an epidural at any point, she had to make that decision now.

           The intensity of the contractions and the fear that her back was going to be damaged was overwhelming at this point, really causing a lot of extra tension and pain so she made the decision to go ahead and get the epidural so that she could get some more long term relief. I left the room around 1:45am for them to prepare her for the epidural and while I was gone, she had another cervical exam. She had already made it to 7cm and it looked like the epidural wasn't going to slow any of that progress down. I arrived back in the room at 2:40am and Erika was laying on her side to help Finn's heart rate stay stable. She was in much better spirits and feeling good about the decision she had made. We discussed the fluidity of labor and birth and the fact that plans frequently change. We all felt that she had made exactly the right decision for their situation and started to bring the focus back in on how quickly we'd be meeting this sweet baby.

             Only twenty minutes after I got back in there, she was checked again and was between 9-10cm dilated, with just a little bit of cervix remaining before she could start pushing. By 3:30am, she was starting to feel her contractions enough to know when she was wanting to push and within 15 minutes, she was really starting to give pushing all she had. Finn was incredibly active during her entire pushing phase, which is fairly unusual. It was so crazy to see Erika's belly move in between the contractions with such big movements even while she was pushing. We could see about a half dollar size part of Finn's little head which was also wiggling around a ton! The nurse joked that he was going to be the first baby to be diagnosed with ADHD in the womb. We maintained a lighthearted casual conversation throughout all her pushing phase, dreaming of the little boy that Finn will one day be, running naked through their land chasing wild animals and all the joy he was going to bring to their lives.

               With each push, Erika would make a little progress but then Finn would just sink right back in. After 2 hours of pushing, Finn still couldn't make it under her pubic bone so the nurse went ahead and called in Dr. Merkell. The doctor suggested that they try a vacuum to help pull him under the pubic bone and went over the potential risks. I was super thankful that she went over the procedure in detail, reassuring everyone that the vacuum was meant to pop off when it hit a certain level of pressure and that this was entirely normal. The first time the vacuum popped off, I could tell that the sound was pretty alarming for Luke and Erika, and honestly, I felt the same way. The second time that it popped off, we were all a little less worried, though knowing that there was a 3 pop-off limit, we knew this next push was going to be the game changer. Erika pushed with absolutely every bit of strength and power she had within her and at 5:47am, their son was finally born!
              All the anticipation that filled the room was quickly replaced with an overwhelming amount of joy and love felt by everyone involved. Finn looked great and was instantly showing signs that he was ready to try nursing, licking his little lips and looking around. Erika had a small 2^nd degree tear that the doctor quickly repaired and while the nurse got her all cleaned up, they weighed Finn and found that he was 6 pounds and 6 ounces. We got Erika more comfortable in the bed and finally got Finn to latch for the first time around 6:15am. He would latch for a few minutes and then pop himself off as they both got the hang of this new relationship. Once they were all comfortable and preparing to call their families around 7:30am, I headed home, checking in via text message later that day.

           They stayed in the hospital for two nights, getting lots of assistance from the lactation consultants to help them get the hang of breastfeeding and after some initial soreness and a little bleeding, nursing started getting easier and easier, especially once Finn got the latch down and they were settled in at home. Erika's strength through the insane intensity of going from 1cm to complete in that short amount of time was incredibly humbling and Luke's consistent love and support was a joy and privilege to witness. No matter how many births I attend, every single one of them leaves me so absolutely impressed with these fabulous mamas and their partners, and I know that the amazing partnership that they built upon throughout labor will continue to flourish and grow as they continue in their parenting journey. 

Welcoming Judson!

Welcoming Judson to the world!
Born on December 28th, 2012 at 11:47am

  I first met Matt and Ashley at a local Meet the Doulas event about half-way through her pregnancy. We quickly hit it off and established a relaxed, comfortable relationship with one another. Our prenatal visits frequently lasted longer than we'd anticipated and were never complete without us all exchanging warm hugs. Ashley was fairly convinced that her body would take its sweet time going into labor and that she would end up going past her due date, so we didn't really expect Judson to make his arrival in 2012 at all.
They decided to eat some Indian food for dinner on Thursday the 27th, which seemed to be what got things started. Ashley started having some stomach pain, accompanied by frequent trips to the bathroom, which she just attributed to her dinner choice. In hindsight, all of this was clearly early labor. Ashley had a small burst of water around 9:30pm that was likely when her water broke. Even after that happened, she still wasn't convinced she was in labor. She stayed mostly in bed until around 4am when Matt got up with her. They labored together throughout the house and gave me a call around 6am. We spoke about a half an hour later and I gathered up my things and headed out the door.
I arrived shortly before 8am and stood at their front door long enough to listen to Ashley working through a contraction before going inside. She was in the living room on her hands and knees, supported by pillows, with Matt sitting in front of her. Going only off of her intense focus and the moans that were getting her through each contraction, I knew we should start thinking about heading toward the hospital sooner rather than later. I heated up a rice pack that I'd brought and applied to to her lower back as she continued laboring in the living room. I recommended that she get up and go use the bathroom, noticing that she had a couple contractions on the way there. She walked around the kitchen a bit, leaning over whatever was closest when a contraction started coming on.  She made her way over to the couch, which happened to be covered in clean clothes, propping up pillows to try and get comfortable. We moved the birth ball up onto the couch for her to lean over and she rearranged herself after each contraction. We used a flat sheet to try a bit of rebozo-like shifting but it wasn't helpful at combating the back pain so we just kept using the rice sock. She called her sister to let her know what was going on and it was during this call that I realized her contractions were only about 3 minutes apart. Shortly after getting off the phone, Ashley also started to feel nauseous, once again making me think she was much farther into labor than I had previously thought.
I started mentioning that we should probably think about heading to the hospital soon, having Matt show me what needed to be loaded into their car. Once everything was packed, it took us about 10 minutes to get Ashley to the car and another 5 to get her inside. We headed toward the hospital at 9:25, driving well over the speed limit the entire time. We arrived at the hospital at 9:45 and Ashley was wheeled into a triage bed. I went in with her while Matt parked the car. At this stage it was taking a lot of moaning to get through each contraction. When Matt came in, I confidently handed her over to him as I went to go wait in the hallway - and later a waiting room, since they had a one person per patient rule. At one point, I sneaked back in to get my birth ball & peek in on them and Ashley was entirely in her own world, not wanting anyone to touch her. When the nurse came in, Matt immediately went to their birth plan, making sure the nurse knew that they didn't want to use Pitocin and that Ashley was ready for the epidural. At this point, none of us knew just how far along she was and that we didn't have time for either of those things.
I was pacing out in the waiting room when, all at once, nurses began loudly telling people to move out of the way. Ashley was being pushed down the hallway on a bed, practically at a run, with Matt in tow. I quickly learned that she was already 9cm dilated and feeling like she wanted to push. They wouldn't let me in until they had her all set up on the bed and the longer it took, the shorter my fingernails got. I was so happy when I got inside, quickly going to Ashley and telling her what an amazing job she was doing. She started pushing at 10:20am, barely half an hour after we arrived!
The baby hadn't made his way under her pelvic bone just yet so we knew there was the possibility of a long pushing phase. Ashley started to push with each contraction, learning to push through the pain. Before long, she had a really amazing feel for each contraction as it started to build, waiting until it was at its most powerful to really start to push. As we started to see more and more of the baby's head, we encouraged Ashley to reach down and touch his head. Matt and I continued to cheer her on, totally amazed at her composure and strength. After almost an hour an a half of pushing, Judson was losing patience and his heart rate started to show some signs of distress, decreasing and increasing a little more than normal so the doctor decided to cut a small episiotomy. With the next push, Judson made his way into this world at 11:47am, quickly letting us know that he wasn't thrilled with the change in environment.
After the long wait, he was finally here, weighing 7 pounds, 5 ounces with dark hair and eyebrows. Matt and Ashley were in love with every little thing about him, completely overwhelmed that he was actually here. Judson got to enjoy some skin to skin with Ashley before we attempted breastfeeding for the first time. It didn't take much effort at all to get him to latch on and he was an instant pro. Those first few hours always seem so surreal for new parents, like they expect that, at any moment, they'll wake up from this incredible dream. I love getting to be a part of it. The pure love on their faces as they stared down at their son brought tears to my eyes and was a beautiful reminder of what an amazing privilege I'm given.