I've had some time to process this and I'd love some input.
Recently (within the past couple months), I spent the evening on the phone on and off with a woman in early labor, trying to help her decide when to come in to the birth center. She had had a prenatal appointment earlier that day and was a tight 2cm, 50% and minus 2. G1P0, in her early 30s. At first when she called that evening, her contractions were mild, and coming "every 45 minutes." (NOT every four to five.) She waited a while, called again, we chatted again, and she waited a couple more hours. Her husband called back and said that her water had just broken, and things were picking up, so I had them come in.
When she arrived, she was clammy and acting desperate. Her eyes had a wild look. I tried to get her to pee, but she had a monster contraction trying to sit on the toilet and was unable to pee. I was thinking I would check her and she would be at least 8cm. I managed to get her on the exam table to do a quick vaginal, and let me tell you, SHE WAS 3 CM. A tight 3 cm.
I do not always feel 100% confident of my vaginal exams. I almost never actually give the mom a number, because I'm afraid she'll have another exam by another midwife, and she'll be told a smaller number and be disheartened. So I try to say something vague but encouraging, like, "Oh, you're making progress!" or "Well, it seems like everything is going well." Then the midwife will check her and give an actual number and record it in the chart. But in this particular case, it was so totally completely not mistakable that she was 3 cm, that I had no reservation whatsoever recording it in the chart, calling the midwife and telling her, and making decisions based on my exam. I was also reasonably confident that the baby had moved waaaaay down to at least plus one if not plus two. (remember that earlier in the day the baby was at minus 2 according to the chart.) I could feel hair, no bag. I did not feel a suture line, but at 3cm I never really can.
So I tell her that we have got to get her calmed down, so she's going to get in the bath and relax. I tell her husband, privately, to please not call all the family yet, because it was going to be hours and hours, and they could get a good night's sleep and come in the morning in time for the birth. And a watched pot never boils, she's already all worked up, etc. etc. He informed me that there would be hell to pay if the relatives missed the birth. (Not in a threatening way, but to let me know it was serious.) I told him I was confident that we would have plenty of time to summon them and the best idea was not to call them yet.
Meanwhile, we get her into a room, start the tub, and I try my best to do the required vitals and all that while she has pretty strong-seeming contractions and says, "I'm in a lot of pain" (in a creepily calm voice) over and over again. I'm in wonder at how she can be in so much pain at 3 cm. I'm trying to make her comfortable and get the initial filled out. I have another student w/ me who is running around to get everything set up before the midwife comes over.
About 30-45 minutes after I checked her, the midwife comes over. The mom is in the tub, and loving the water. She feels much better in the water. The midwife checks her... AND INFORMS ME SHE HAS AN ANTERIOR LIP.
You can imagine that my chin hit the floor. Then I checked her at that point, there was no mistaking it, she was almost fully dilated.
After the birth when we had a minute, the midwife told me that when she first checked her, she thought she was at 4, but then she realized that it was the fontanelle she was feeling.
I wanted to accept that, but I just cannot accept that I was feeling a fontanelle. What I felt (and yes, I have second-guessed myself a million times now) was a dead-on 3cm dilated cervix with a head very well applied. And when I went in and she had the lip, there was no obvious 3cm or 4cm fontanelle that my fingers ran into; it felt very, very different in there.
But IME, anyone who is dilating uncommonly quickly has a lot of bloody show, and she had very, very little.
The rest of the story was great... nice water birth, family arrived right after the birth, no one was upset about that, and the family was very pleased with the whole experience. The mom even told me a few days later that "it was so wonderful, and it was all because of you." And I wanted to ask her, "How is that possible, seeing as I was totally wrong about everything I told you?" But of course I just kept my mouth shut. I'm THRILLED that she has processed everything as such a positive experience, but I feel like I messed up so bad!
At this point I could really use any insight as far as what you all think probably happened, what is possible etc. In my head I haven't ruled out an insanely fast dilation, nor have I totally ruled out that what I felt was really a fontanelle. I wish more than anything I could go back in time and do that first exam again, with the other midwife standing there beside me to do one right after!
Recently (within the past couple months), I spent the evening on the phone on and off with a woman in early labor, trying to help her decide when to come in to the birth center. She had had a prenatal appointment earlier that day and was a tight 2cm, 50% and minus 2. G1P0, in her early 30s. At first when she called that evening, her contractions were mild, and coming "every 45 minutes." (NOT every four to five.) She waited a while, called again, we chatted again, and she waited a couple more hours. Her husband called back and said that her water had just broken, and things were picking up, so I had them come in.
When she arrived, she was clammy and acting desperate. Her eyes had a wild look. I tried to get her to pee, but she had a monster contraction trying to sit on the toilet and was unable to pee. I was thinking I would check her and she would be at least 8cm. I managed to get her on the exam table to do a quick vaginal, and let me tell you, SHE WAS 3 CM. A tight 3 cm.
I do not always feel 100% confident of my vaginal exams. I almost never actually give the mom a number, because I'm afraid she'll have another exam by another midwife, and she'll be told a smaller number and be disheartened. So I try to say something vague but encouraging, like, "Oh, you're making progress!" or "Well, it seems like everything is going well." Then the midwife will check her and give an actual number and record it in the chart. But in this particular case, it was so totally completely not mistakable that she was 3 cm, that I had no reservation whatsoever recording it in the chart, calling the midwife and telling her, and making decisions based on my exam. I was also reasonably confident that the baby had moved waaaaay down to at least plus one if not plus two. (remember that earlier in the day the baby was at minus 2 according to the chart.) I could feel hair, no bag. I did not feel a suture line, but at 3cm I never really can.
So I tell her that we have got to get her calmed down, so she's going to get in the bath and relax. I tell her husband, privately, to please not call all the family yet, because it was going to be hours and hours, and they could get a good night's sleep and come in the morning in time for the birth. And a watched pot never boils, she's already all worked up, etc. etc. He informed me that there would be hell to pay if the relatives missed the birth. (Not in a threatening way, but to let me know it was serious.) I told him I was confident that we would have plenty of time to summon them and the best idea was not to call them yet.
Meanwhile, we get her into a room, start the tub, and I try my best to do the required vitals and all that while she has pretty strong-seeming contractions and says, "I'm in a lot of pain" (in a creepily calm voice) over and over again. I'm in wonder at how she can be in so much pain at 3 cm. I'm trying to make her comfortable and get the initial filled out. I have another student w/ me who is running around to get everything set up before the midwife comes over.
About 30-45 minutes after I checked her, the midwife comes over. The mom is in the tub, and loving the water. She feels much better in the water. The midwife checks her... AND INFORMS ME SHE HAS AN ANTERIOR LIP.
You can imagine that my chin hit the floor. Then I checked her at that point, there was no mistaking it, she was almost fully dilated.
After the birth when we had a minute, the midwife told me that when she first checked her, she thought she was at 4, but then she realized that it was the fontanelle she was feeling.
I wanted to accept that, but I just cannot accept that I was feeling a fontanelle. What I felt (and yes, I have second-guessed myself a million times now) was a dead-on 3cm dilated cervix with a head very well applied. And when I went in and she had the lip, there was no obvious 3cm or 4cm fontanelle that my fingers ran into; it felt very, very different in there.
But IME, anyone who is dilating uncommonly quickly has a lot of bloody show, and she had very, very little.
The rest of the story was great... nice water birth, family arrived right after the birth, no one was upset about that, and the family was very pleased with the whole experience. The mom even told me a few days later that "it was so wonderful, and it was all because of you." And I wanted to ask her, "How is that possible, seeing as I was totally wrong about everything I told you?" But of course I just kept my mouth shut. I'm THRILLED that she has processed everything as such a positive experience, but I feel like I messed up so bad!
At this point I could really use any insight as far as what you all think probably happened, what is possible etc. In my head I haven't ruled out an insanely fast dilation, nor have I totally ruled out that what I felt was really a fontanelle. I wish more than anything I could go back in time and do that first exam again, with the other midwife standing there beside me to do one right after!
About 20 minutes later she called back: "you need to get over here, apparently she took some castor oil". She was only 38 or 39 weeks. She didn't discuss it with us. We would advised her against it, but at least we would have told her the proper dosage. Apparently she got anxious that her baby might get to big and downed an entire bottle.
(I'd rather not get a concussion though. Wow!)
: reading these stories.
