Meet Steph and Ethan! Aren't they cuties? I had the pleasure of having this lovely couple in birthED class and got to know them quite well. Their doula and Chiropractor sent them my way (*ahem* Holly is awesome). They were funny, educated, and so connected. In the beginning of their pregnancy they started with an OB group but quickly realized that they felt more at home in a midwife practice. By the time they started my class they were already enjoying their prenatal care through a local hospital midwifery group.
As the weeks of class went on they went through all of the activities and discussions to help them write their birth preferences letter. They ended up with their top three priorities. You can see that they had a full menu of things that they dreamed and envisioned happening in their 'best birth scenario', but through the process of asking themselves 'what's REALLY important', they landed on the items in pink, with the items in purple squares as their TOP THREE most important elements.
As the final weeks of their pregnancy inched a long, Steph's blood pressure began elevating, which was noticed by her midwife at prenatal visits. They began keeping a close eye on it and did some extra testing to be sure that Steph wasn't heading in the direction of pre-eclampsia. After another week or so sure enough Steph's blood pressure and other tests were all pointing toward needing baby to be born sooner rather than later in order to keep Steph as healthy as possible and avoid pre-eclampsia. It was decided that an induction was the best plan of action. The decision is not one that most families want to make. Most families I serve are first to say "I just don't want pitocin" or "I DO NOT want to be induced." Of course not! I get it!
The induction started with cervidil which was placed overnight, while Steph attempted to sleep in the hospital. After 12-hours not much change was noted in the location, softness, or opening of her cervix. Her blood pressures continued to climb and her midwives were able to collaborate with OBs to come up with a recommendation for the best plan of action. It was recommended to Steph that she needed some magnesium and also pitocin to hopefully get this baby out vaginally before she got too sick. Luckily the collaboration allowed her to KEEP her midwife for the birth with the OBs off in the wings monitoring her rising blood pressure.
This shift in her dream birth meant she had to say goodbye to a few other items on her list like freedom of movement, due to continuous monitoring, IVs and the recommendation that she lie flat in the bed while on magnesium. She also lost access to the tub, which thankfully she got to use the day before to relax and she felt that she did get to experience some parts of labor with the help of hydrotherapy.
When her doula arrived active labor was just picking up. She was feeling nauseous and stuck in the bed with the magnesium treatment for her ever climbing blood pressure. After about 2 hours of good strong labor, Steph decided due to her lack of ability to move from the magnesium protocol and the fact that she was getting increasingly stronger labor with a blood pressure that remained high she would opt for an epidural. Was this in the original plan? No! However, she was already quite dilated (her midwife guessed at least 6-7 cm) and she knew her top three goals were not solely about these elements, so she kept her eye on the goals and continued forward.
Steph's labor was cruising along and her epidural was placed. Soon after her baby had a bit of deceleration in his heart rate. The team came in and quickly remedied the situation with body movement for Steph plus some meds in her IV. Baby boy's heart rate had dropped because Steph's blood pressure had dropped (a side effect of an epidural), but came back up and we discovered that sure enough, she was 10cm and could begin pushing whenever she felt like it. Steph pushed for about 45 minutes and although she hadn't wanted to be on her back they were able to hold to their original dream of having her husband, Ethan, catch their baby boy with the support of the midwife (DING! Top 3!). Her baby boy was placed immediately on her skin (DING DING! Top 3!)
We cannot PLAN for birth, but we CAN identify our values, educate ourselves, and hone in on our top goals for birth. Her midwife team was able to identify when she was no longer low risk and because of their professional collaborations they were able to negotiate on her behalf to continue her care, while the OB team managed her pre-eclampsia and blood pressure. She kept her team, her location, AND her baby.