Join Date: Dec 2002
Location: The Garden City
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1. Description of the labor
W call me around 8 am on the morning of Friday the 27th of February to let me know that she had been kept awake by contractions the following night and had some show. She had a Doctors Appointment later that morning and would call to let me know what the doctor reported. At 1pm she called to let me know that she was 1cm dilated with show. I told her to try and get some rest and to eat and hydrate herself like normal. At 6 pm she called to let me know that she was experiencing contractions from 5-10 minutes apart and that she was worried that things would progress too fast so would I please come . I arrived at her home just after 7:30 pm to find her pausing to breathe through contractions that were about 5 minutes apart with the help of her mother timing them. She had been laboring with her mother for several hours. Her mother left and for about half an hour the contractions stopped altogether. Within an hour the contractions resumed and over the next four hours they progressed from 5 minutes apart and lasting 1 minute in length to 2-3 minutes apart and lasting 45-85 seconds. W decided it was time to go to the hospital. We arrived at the hospital at 11:30 and W was 2-3 cm dilated and fully effaced. She received at shot of Morphine. She was spilling ketones in her urine and was hooked up to an IV for rehydration. Within three hours she was 4-5 cm dilated. Between 2:30 am and 11:15 am W worked through her contractions without further medication and appeared to progress to 9-10 cm with an anterior lip. Her contractions maintained a spacing of 4-5 minutes throughout but as she appeared to be progressing no augmentation was recommended. Her doctor was called again (she had come at 7 am and confirmed a dilation of 7cm) and checked W only to discover that the intern who had been doing the checks had reported incorrectly. W’s cervix was soft and could easily stretch to 10 cm but the baby’s head had not descended into the cervix in order for her to be ‘dilated’ to 10 cm. She was still only 7cm and the baby was still not coming down. Options were discussed with the clients and it was decided that a therapeutic epidural might help W to relax and the baby to descend. She received an epidural at 2:25 pm with the intent to augment her contractions with oxytocin. Once the epidural was in place W’s contractions increased in frequency without the use of Oxytocin however the baby began to experience several decelerations. W’s doctor was again called in to check progress. At 3:50 pm W was now dilated to 8cm but her cervix had started to swell and stiffen. The doctor did not think the state of the cervix and the babies intolerance of the increased contractions were conducive to a continuing the labor and a cesarean section was recommended. The baby was born at 4:35 by cesarean section due to Relative Cephalopelvic Disproportion and Failure to progress. The baby aspirated blood during the section but pinked up well. The baby was allowed to stay and nurse with W in recovery for an hour before being reassessed by the pediatrician. She was transferred to the Special Care Nursery for a chest X-ray and Observation as her respirations were increased.
2. My role as a doula
My role in this birth was to assist both O and W in whatever capacity they desired. I suggested comfort strategies, changing postions, and massage and acupressure techniques. At home I focused on calming and hydrating W and getting her to think about how her body was built to birth a baby and that what she was experiencing was her body telling her it was working hard to bring her baby out into the world. Once in the hospital O and I worked together over the following 17 hours to keep W coping well through the contractions, using the toilet, hydrated, and changing position regularly.
3. Mother's Reaction to Labor and Birth
W was afraid of labor from the first time I met her. She was terrified that she wouldn’t be able to cope with the pain and wouldn’t be able to get through labor without medication. She had realized in her Childbirth Education Class that an unmedicated birth was best and had decided to make the attempt while leaving the options open. She was absolutely terrified of having her legs frozen so did not want an epidural and voiced that a shot of morphine or fentanyl would be preferred. During early labor W was suffering more than she should have been constantly down talking herself and ability to cope while at the same time riding through each contraction reasonably well. Once we arrived at the hospital she immediately requested something for the pain and reacted ‘extremely well’ to the morphine/gravol cocktail that she was given. In fact she did not realize that the morphine had worn off several hours later and continued to cope very well through the contractions for several more hours. When her doctor came in to check her in the morning and reported a dilation of 7cm W’s fear of not coping well switched to a fear of pushing. She coped well with contractions for the next 7 hours right up until the doctor reported that after 7 hours of misinformation she had actually made no progress at all. W was exhausted and defeated. She told her doctor to knock her out and get the baby out now because she couldn’t do it anymore. Her doctor recommended augmenting the contractions (which had been 4-5 minutes apart throughout the entire labor in hospital) with oxytocin and recommended W get an epidural to help her relax through the increased contractions instead of jumping onto the Operating room table right away. W was terrified of the epidural but once in place she was extremely relieved. When things progressed as they did from there W was quite ok with it. She felt she had done everything she could to get her baby out vaginally and that a Cesarean Section was her best option.
4. What I learned as the Doula
I learned several big things through this birth. The first is that the mind body connection is bigger than I gave it credit. It was really apparent at several points that it was W’s fear of the process that was holding things back. Especially when the morphine began to wear off and there was no change in her ability to cope. So long as she thought she was being assisted the placebo effect kept her going. The effect of her own fear on her body was also evident when the epidural resulted in increased instead of decreased contractions and increased dilation and fetal descent without any augmentation. It had been W’s fear of labor and pushing that had been holding her 7.5 lb baby back for so many hours. I also saw first hand the effect of ‘multiple hands’ doing the vaginal exams. The interns mistakes cost W and her baby at least 5 hours of laboring energy without progress. Combining the fear and mistakes resulted in what may have been an unnecessary Cesarean Section.
I came home knowing two things for sure. First I did the best I could for W given the circumstances. It was extremely difficult to get her to past the ‘suffering’ that she was experiencing. Labor was an absolutely awful experience for her.. As far as she was concerned the outcome was wonderful and I was a great help to both her and O. Second I realize that when things do not go the way I believe they should I am going to have difficulty separating what I wanted for my clients from what they wanted for themselves. It won’t be impossible for me but I am going to have to shed more than a few tears.
tireless sewer of teeny little clothes for Bamboletta dolls ...
tireless sewer of teeny little clothes for Bamboletta dolls ...