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.