I have been struggling a little bit to get my birth observations done. I understand that this is a very personal and private event and am not surprised that this has proved to be a challenge. After offering support to the families in the childbirth class I observed and having no takers, I contacted a small hospital which uses the midwifery model of care. It also happens to have some of the nicest employees around. I had been in contact with a nurse/childbirth educator who put me in contact with her nurse manager. After getting cleared with volunteer services, I was set to observe.
The phone rang at about 7:30 the morning after I was medically cleared to observe. The nurse manager said she had a mom who was willing to let me observe. She was 3 cm dilated and having her third baby. I thought this had the potential to move quickly, so I hopped in the car and headed north. I arrived a little bit after 8, changed into scrubs and met up with L, the nurse I would be shadowing. She led me into the room, introduced me to the mom and dad and gave me a chair. I would sit in that chair until about 1:35.
The family was pleasant and easy to get along with. I should note that this experience was at times awkward. I was unsure as to when/if to leave the room, speak, look away, etc. Thankfully, the pace of the nurses and the family were easy to follow. Mom's water had broken the night before. She came to the hospital having contractions that weren't really helping her to make any progress. At the time that I arrived, Mom had been in the jacuzzi and was back in bed having an IV started in anticipation of her epidural. Mom had been 3cm dilated for at least a week before her water broke and after several hours of contractions, that's where she stayed. Mom was using a relatively slow paced breathing and doing a great job staying on top of her contractions. She changed positions when she felt the need, used the bathroom, and was monitored intermittently until she received her epidural at about 10:30AM. L was doing a great job of providing support as well as nursing care.
Mom wanted to have a natural birth, but hadn't slept and wasn't making progress. She opted for the epidural to get the rest she needed for the hard work ahead. Not long after feeling relief, Mom was snoring away. Dad also got a much needed breather, using the time to take a walk and have some breakfast. While Mom was resting, her blood pressure dropped and contractions spread out a great deal. There were also some fluctuations with the baby's heart rate that the nurses were keeping an eye on.
During this time, I couldn't help but think that this would end in a section. Then I remembered where I was and the track record of this facility. The nurses had Mom change positions which would resolve the issues for a few minutes. The gave her a whole bunch of fluid as well. The baby was VERY active making it difficult to monitor effectively. After a good stretch of time with low blood pressure, the midwife made the decision to wake Mom up and start pitocin to augment her labor. Dad was clearly very uneasy about all that was going on, asking lots of questions. The nurses were great at putting him at ease and explaining that the best way to assess what was going on was with their hands, not the machines. After pitocin was started, Mom's blood pressure was good, the baby looked great and contractions began coming more regularly. I would estimate that this all happened at about 12:30.
Mom continued to change positions, even with the epidural. She had good relief from the epidural until a little bit before 1. She said she could feel pain on her lower right hip which she guessed was her cervix. The nurses believe that she had a patchy epidural, leaving her an area where she could still feel everything. I vividly remember Mom having a contraction which she had to breath through and make a bit of noise. It caught my attention because it was different from the past few hours with the epidural. I checked the clock. It was 1:07PM. I watched the clock and Mom's contractions were coming less than 3 minutes apart and they were good ones! Mom got more and more uncomfortable and the nurse began to ask if she had the urge to push. Mom did not, but the nurses later said they thought they could feel her making small, involuntary pushes. The decision was made to call anesthesia to see if they could get Mom some relief. In the meantime, the midwife was called in to check Mom's progress. The midwife said she had a small lip and should try to push. This was after 1:35PM. Mom was surprised, as she still didn't have the urge to push. She gave a push while semi-reclined and sort of on her right side. She decided what position to be in and wasn't afraid to tell anyone when she wasn't comfortable. The midwife announced that she moved the head quite a bit and the nurses should get everything ready.
At this time, I attempted to move myself as far out of the way as possible. I really wanted to get a good look at what was about to happen, but also didn't want to interfere with anything. Mom proceeded to "scream the baby out." She pushed, without direction, for what I think was three contractions. She had moments of "I can't do it," "I don't want to," and "GET HIM OUT!" I couldn't believe when I suddenly saw an adorable little face. His body quickly followed. Baby went right to Mom, making very little noise, but doing ok. Mom pushed for less than 6 minutes and once the baby was born, she was like a different person. The pain ended abruptly. She of course had new pain, but it didn't seem so bad. It was probably an hour before the baby boy was taken from Mom. All assessments were done in her arms. I was amazed at how quickly this little boy was interested in nursing. He was giving very clear cues within minutes of his birth. He nursed as soon as he was ready.
I stayed with the family long enough to see how much the baby weighed and decided it was best to let the family enjoy this time. This is the first baby I have ever seen born and I will never forget it. Although there was a time during Mom's yelling when I was glad I had never done it, the overall feeling I had was that it just made sense. What I watched was the way nature intended it to happen. It was amazing. I am forever grateful to this family for allowing me to be a part of the birth of their baby. I am honored to have been a witness to his birth and will never forget this experience. What a great job these nurses have to witness such an amazing event so often in their lives.
