birth day indeed

Yesterday was my birthday. I'm 28.  I had no idea that my twenties would fly by the way they have... the whole decade has been an apprenticeship, in something or other!  The best birthday gift I received was a love letter from my husband.

Fittingly, I came home from a birth yesterday at about 11am.  It was a sweet, perfect, glorious birth.  I had received a call from my preceptor the morning before (Feb 24th), when I was two hours' drive north of the birth centre where I work. I was getting my paperwork/biometrics sorted out with US Customs and Immigration, since I am now married to an American.  My preceptor told me we had a mama who looked like she was getting into a really nice labour pattern, and that I should come straight to the birth centre when I returned from my USCIS errand.  I did, and by 4pm, the mama (G4P2) was fully in transition, shaking, quivering her bottom lip, throwing up her egg-and-toast breakfast - in other words, doing some really hard work. The baby's papa was naked in the tub with her, and he was the most amazing birth doula I had ever seen. She was getting sleepy in the warm water of the tub, and it was making her lose focus as it came time to push. She said her urge to push wasn't really overwhelming (even though I knew she was almost complete, if not already 10cm).  She got out of the tub on our suggestion, and we dried her off and helped her get into LSL position in bed, with a chux-covered pillow between her legs to help keep her pelvis open.

She lay there for about twenty minutes and I suggested to check her (which I normally do not do) - only because her urge to push wasn't quite there and she told me she didn't really know where to push towards or how much force to apply.  She said that when she did push, it didn't feel good.  (Note: she'd had an epidural for each of her two previous births.)  That made me think she might have an anterior lip.  She was doing incredible work, breathing and moaning softly through each of her contractions, and between the next set I checked her gently and found the lip.  Her cervix was buttery and soft, baby's head +1 station, so we figured it was best to hold the lip back for a few contractions and see if she'd push the baby's head right past it and out.  Indeed, within 3 contractions, the lip had completely melted away and baby was almost crowning.  So, we called the mama's eldest daughter (age 15) into the room and I helped get papa into position for catching his own baby, which he had really wanted to do.  The mama was propped up with some pillows, and she said it really felt good to push now. A gorgeous, round head emerged with her next great effort, and the head breathed and gurgled immediately!  I nudged some chux underneath his chin, against mama's perineum, to keep him from suffocating in the fluid (he was completely OA). He restituted and I told papa, just gently put your hands on either side of his head, no need to tug, his body will come out with the next contraction and your hands will be supporting him.  He slid out, and papa held him up in his hands.  We all heard the baby's lusty cries right away. I gently swabbed away the mucus from his mouth and nose with some gauze (we avoid bulb syringes as much as we can around here - they're pretty horrifying, especially if your face is only about twice the size of the bulb, and a gloved hand is drilling a hard plastic probe deep into your tiny nostils and heretofore-unprodded mouth). He pinked up, yelled, and we all greeted him with expressions of love and delight.

He was handed immediately over to mama, who cuddled him with glee.  I helped her deliver her placenta with only the tiniest, slightest bit of cord traction, 350cc total EBL (that's all!).  We inspected it together, and papa was in awe - he took pictures of the tree of vessels on the fetal side, and asked me all kinds of questions. Then, the placenta was whisked away to be encapsulated for mama to take as her 'happy medicine' over the first few weeks postpartum.  I examined her yoni - no tears, just two tiny splits on the labia and a single small skid mark on the perineum.  I said to her, if I didn't have this bloody glove on right now, I would high-five you!  She laughed and cheered and kissed her baby.  He was a champ, and latched on within 40 minutes of his birth. He nursed for a little, and then lost interest, so I grabbed my opportunity for the newborn exam.  I got papa to talk to him and cuddle him throughout, but he still cried for the first part of the exam until I figured out that if I jiggled his tummy gently with my hand, he would stop, and look at me intently. 8lb 3oz, 19 inches long. Cute, mellow, perfect - not a single thing odd or untoward about him. So with that done, he went back to the warm envelopment of his mother.  I waited to administer his eye ointment (which his parents wanted him to get) until he'd had a good, long nursing session. I think it's better if the baby can see mama's face clearly while forming those early attachments. He nursed for 45 minutes, and he got his vit K and erythromycin while in her arms.  So much gentler that way!

We talked through all the postpartum and newborn stuff; what to expect re. bleeding, poop/pee, jaundice, nursing on demand, etc. The parents were awesome; we had a sweet connection and I felt that they trusted me, which is the best compliment I could receive. When they said they were so glad I was there, I said, you know, you could've done this without any of the birth team here - this baby was going to come out just fine!  And now you can say, you did it yourself, on your own steam, no medication, just love and faith and mama strength.  She smiled at me triumphantly.

I stayed at the birth centre all night as the weather had been freezing all week, and they lived some distance away. We all figured the roads would be terribly icy and it'd be best if they stayed overnight and got some good rest, too.  I checked in on them every so often for vitals, etc, and all was well. They bundled him up in his car seat in the morning and he looked so beautiful, all sleepy and tiny and content.

What a great Birth Day!

I'm Back...!

Back to the birth centre today! I'm back to full-time work as an 'advanced midwifery student' (how my preceptor describes me to clients), and back to being on call full-time for births between now and the end of July. It was a good day; not too busy, two third-trimester prenatal appointments, and two postpartum visits. I handled it all with ease and completed my charting long before day's end.  It feels good to be back, although I admit it's a little terrifying... as I take on more responsibility as midwife, I must face my 'demons' and try to remember why I wanted to do this in the first place. As a good friend of mine would remind me: Remember, that what you have now was once among the things you only dreamed of...

Count on more regular blog updates from now on, and also - once I get to it - a couple huge 'review' posts to fill in my blogging gap since December 2008. <gulp>