Birth Center Transfer | C-Section | Cary, NC
I had the privilege of attending Ashley’s birth. Ashley and Brett decided to hire a birth doula to help support them through labor. They were having their first child, and were planning on having a natural birth at Baby +Co, a birth center, in Cary, NC. They did everything possible to prepare for a natural birth. They took two different classes, chose great care providers, hired a doula, and did a lot of research.
On July 2nd, 2016 at 4:23pm, Ashley sent me a text to let me know that she was having cramping and bloody show, but no regular contractions yet. I told her bloody show was a great sign. I suggested Ashley take a warm bath and sleep some if she could. I also reminded her to make sure to get a good meal in and to be sure to stay hydrated. Around 9:00pm, I checked in with Ashley to see how things were going. She said she just took a warm bath that felt great. She was still having bloody show and contractions, but nothing regular. She said she was going to time a few just to see, but that it was nothing unbearable at all, and she could easily talk through them. I told her it still sounded like early labor, and to definitely try to get some sleep in before things pick up. She said she was going to go to bed soon, and would call me if things changed.
Around 1:00am, I got a call from Ashley. She said contractions were getting pretty intense and closer together. She said she was feeling them mostly in her back, but some in the front too. She would have to stop and breathe through them. I told her I would get ready and head to her house. I suggested she try laboring some on hands and knees and have Brett apply heat to her back until I got there. I arrived at their house a little after 2:00am. Brett answered the door, and walked me to Ashley. Ashley was in the living room on hands and knees leaning on the couch. I talked to her for a few minutes, and then watched her through a contraction. She took deep breaths and moaned through each one. She said she was still feeling it mostly in her back. I heated up the heating pack and applied counter pressure to her back during each contraction. Brett said they had called the birth center already and spoke with Jualeah, one of the midwives. Jualeah said to come in whenever they were ready. We waited through a few more contractions. They were about 3-4 minutes apart, and about a minute long. I told Ashley and Brett that I didn’t think it was a huge rush, but that we could definitely think about heading to the birth center soon. Brett started grabbing all the bags and loading up the car.
We arrived at Baby+Co around 3:00am. Jualeah had just arrived. She hadn’t set up any of the birthing suites yet, so she had Ashley go into an exam room to check her and see if she was ready to be admitted. She checked Ashley’s cervix. Ashley was 4 cm dilated and paper thin. The baby’s head was still very high and wasn’t quite hitting the cervix. It was a little posterior, so Jualeah suggested Ashley lean back on the exam table while she got a dose of IV antibiotics. Ashley was GBS +, so she would need to have these administered every four hours during labor. Ashley’s labor continued to intensify during this time, and she seemed to be progressing fairly quickly. By 3:30am, all was ready, and we walked back to the birth room.
While in the birth room, Ashley started doing squats and lunges with the pilates bar. We were hoping this would help bring the baby down some. Around 4:00am, as things continued to intensify, Ashley decided to try getting in the shower. She labored in the shower for a while alternating between hands and knees and leaning on Brett. I continued to apply counter pressure to her back during the contractions. She stayed in the shower for about 20 minutes, and then decided she’d like to get in the bath for a while. The bath helped a lot with the intensity. Ashley worked through each contraction beautifully. She listened to her body and breathed and moaned through each one. She got in different positions in the bath. Brett sat by her side, supporting her through each one. He would make sure she was drinking and her water was staying full. I applied cool cloths to her neck and face.
Around 5:00am, Ashley decided to get out of the bath to use the bathroom. Ashley’s back was still bothering her a lot, so I suggested she try getting on hands and knees on the bed. She did this for a while, and then her knees would get tired, and she would rest side lying. During this time, Brett would massage Ashley’s back and encourage her, and he and I would alternate between applying heat and counter pressure to her back and hips. At 5:30am, it started storming outside. The rain was coming down really hard. Also, about this time things really began to get intense for Ashley. Her contractions were about 2-3 minutes apart now, and she was involuntarily bearing down at the peak of the contractions. Jualeah asked Ashley if she could check her to see if it was time to push yet. Ashley agreed. Jualeah checked her cervix. She was 9 cm dilated, 100% effaced, and the baby had come down some. After this Ashley went to the bathroom and sat on the toilet through a few contractions. Her urge to push really began to intensify.
Jualeah still felt that the baby’s head wasn’t fully on the cervix, so she had Ashley get into a new position for a while to help with this, and also hopefully to allow Ashley and Brett to rest some. Jualeah had Brett sit in a chair, and put the birth ball in front of him. She then had Ashley sit on the birth ball and lean back on Brett. We put pillows behind both of them. Brett continued to apply heat and pressure to Ashley’s back during contractions, and they would both doze and rest in between. They stayed in this position for about 20 minutes. The urge to push was continuing to intensify for Ashley. She decided she’d like to get in the tub. Ashley got back in the tub and sat leaning against the end of the tub. Brett, once again, sat beside her head, comforting and encouraging her. I sat behind her.
Around 6:50am, the urge to push was continuing to intensify for Ashley, and it was now lasting throughout the entire contraction. Jualeah thought it might be good to do another cervical check to see if she thought Ashley would have time for another round of IV antibiotics. She checked Ashley’s cervix, and she was almost completely dilated. There was just a small cervical lip there. Jualeah felt like Ashley could probably push past that, so she suggested that Ashley just continue listening to her body and push when she felt like she needed to. Ashley pushed long and hard during each contraction. She listened to her body so beautifully. She did this until a little after 8:00am. At this time, Jualeah noticed not much progress had been made, so she suggested that it might help if Ashley got out of the tub, and try pushing on the bed for a little while. Jualeah thought that if she could hold the lip back, until baby’s head got past that point that it might help.
Ashley lay on the bed and pushed for a while on her back. During this time, you could actually see a little bit of baby’s head when Ashley was pushing, and Jualeah showed Brett. He held a flash light down there for several contractions while Ashley pushed. Tracey, the nurse, and I sat by Ashley’s head. We applied cool cloths, massaged her, and encouraged her. Finally, the cervical lip was gone, and we encouraged Ashley to try another position to see if it might be more effective. At 8:50am, Ashley got out of the bed and moved over to the pilates bar. She did squats and lunges while pushing with each contraction. She was so incredible during this time. She was so strong and powerful. Brett and I would tell her, “you can do this.” She would always respond with, “I know”. It was amazing to watch. She knew how strong she was.
After about 20 minutes of doing squats and lunges, Ashley’s legs began to get tired. Jualeah brought in the birthing stool. She had Ashley sit on that while Brett sat on the chair behind her. Ashley would lean back on Brett and push. Jualeah was sitting on the floor beneath Ashley, checking progress. At 9:35am, after about 30 minutes in this position, Ashley changed positions again. She got on hands and knees on the bed again. She pushed this way for a while, then Tracey brought in something for Ashley and Brett to basically play tug a war with. Brett would pull one end, and Ashley would pull the other, hopefully making her pushes more effective.
At 10:10am, Ashley was beginning to get really exhausted, and the baby wasn’t making much descent at all. She had been pushing for about four hours, with so much strength and determination. Jualeah felt that Ashley really needed to rest. Jualeah also wanted to see if maybe the baby would come down some with contractions alone. Ashley couldn’t resist her body’s urge to push during contractions, so Jualeah suggested using nitrous to help her relax. Tracey set up the nitrous. Ashley still needed help being reminded to resist the urge to push during contractions, but she was able to rest for a while. While she was resting I strongly encouraged Brett to take a small break and get some breakfast. He had been up all night, and hadn’t had much to eat. I wanted to make sure he could keep his energy up. He went out and grabbed breakfast at Whole Food’s with Ashley’s mom, who had been in the waiting room. With the help of the nitrous, Ashley was able to sleep and relax some. She was having a lot of pain in her sciatic nerve, so Tracey and I massaged her back. I applied some clary sage mixed with a labor oil the birth center had. After Brett returned, I switched off with him and took a quick break.
Ashley labored down with the nitrous for about an hour and a half. She was able to get some rest, and she actually looked much more refreshed afterwards. She tried pushing on the toilet some, and in a few other positions. I tried belly sifting with the rebozo, in hopes that baby would get in a better position to come down. Finally, around 12:00pm, Ashley and Brett, on Jualeah’s recommendation, made the decision to transfer to the hospital for an epidural. Ashley was so exhausted, and had done just about everything possible to push the baby down, but he wasn’t budging. Besides being exhausted, Ashley was able to continue handling contractions just fine. She was a rockstar. The hope was that the epidural would help Ashley relax completely and maybe make more progress.
We all went to the hospital. Jualeah used her hospital privileges for the first time and accompanied Ashley and Brett. Ashley’s mom also came back to the hospital room with us. Ashley asked her mom to pray. Everyone placed a hand on Ashley, as her mom prayed. At 1:00pm, Ashley received her epidural. At first, Jualeah, suggested that Ashley rest and take a nap, but then the baby’s heart rate started showing late decels on the monitors. It’s normal for a baby’s heart rate to dip during the peak of the contraction, but Evan’s was dipping at the end of the contraction, and taking longer than normal to recover. This can often be a sign that the placenta or cord is compromised. Jualeah talked to the OB on call to see her thoughts. She told Ashley she’d like to have her push through two or three contractions to see if she could make any progress at all, and if not, she recommended Ashley have a cesarean section. Ashley pushed with all her might during those three contractions. The OB could tell that Ashley was definitely pushing in the right place, but the baby was not coming down at all. Ashley and Brett agreed that a cesarean would be the best thing at that point.
At 2:25pm, they took Ashley back to the OR for the c section. Jualeah and Brett were able to go with her. I was not allowed in the OR, so I waited in the recovery room for Ashley. About an hour later, they pushed Ashley back into the recovery room. She was holding her baby on her chest, and she said, ‘we have a boy”! She was just glowing and so excited to finally be holding her sweet baby. You could just take one look at her eyes, and tell how madly in love she was with him already. Brett came in shortly after and just talked all about him. They were so happy to have him here.
It really was such an honor to stand by Ashley’s side as she labored. She is one of the strongest, most powerful laboring women I have ever seen. She was truly a birth warrior. She was nothing short of amazing during her birth. Brett was so supportive of her, and was there every step of the way. You could tell his support was priceless to her.
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