birth stories. (long)

[Mary Murphy]

Just to change the subject slightly...   Recently I had two clients call me with premature rupture of membranes, no labour.  Just great! thinks I.  How can I manage this as they live at each end of the freeway (almost)?  Well two other colleagues helped me to monitor them when in turn I was with the other.  Thanks friends, you know who you are.  Number One client, due in 9 days, G5P4, wandering B/P (essential hypertension), clear liquor pouring out. No labour. Really wanted a homebirth as she had birthed before with midwives in South Africa (a waterbirth) and NZ.  (Domino).  5 days before baby had been in Transverse (similar story for 2 other pregnancies) and now Cephalic but ballotable.  2am  I checked her out, left the Doppler for her to check baby and strict instructions to call if any mec liquor etc. Take temperature regularly.  Client number two. Primip, Cephalic, all other parameters normal except for being only just 36 weeks by u/s dating.  (felt good size abdominally).  Called by  her at 9am after 8 hrs of leaking liquor, no labour. Left her partner a Pinnards to check heartbeat, take temperature, call if anything changes as above.  I then went on my way doing postnatals and organising my car boot for two births.   Well, neither of them went into labour!  both definitely resisting the thought that they may have to go to hospital, have antibiotics, be induced etc. as per hospital protocol. OUTCOMES Client No 1.  B/P climbing, no labour, so we went to hospital at 36 hrs post rupture.  V.E done by RMO... 3cm, bulge of forewaters, head 4/5ths, ARM, low vaginal swab, insert IV "bung" and iv antibiotics, leave alone to get going herself. (Subsequently no growth on the LVS) We walked the stairs and the corridors all day until 4pm when contractions were 2-3 mins  Lovely!.  She stood at the end of the bed swaying with that characteristic knees bent stance,  with low moans during contractions. I put a mattress at her feet as she requested. Outside the window in a large whitegum tree were a flock of grey and pink Galahs, raucously fighting over nuts and territory and then the  rain started (very welcome).  I had closed over the net curtains thinking to minimise distractions  and she walked over and opened them so she could focus on the scene. When the head was coming very low she knelt down and the very discreet attending midwife caught her baby and passed it between her legs for her to pick up.  It was a really lovely birth.  After 6 hrs (2 of these with IVI Syntocinon as per hospital protocol for G5s) she went home at midnight to her family with her new baby boy.  She told me that it was the first birth where no-one told her how to birth the baby.  No instructions how or when  to push etc.  She really appreciated it and felt that this was truly HER birth, even tho it wasn't the homebirth she planned.   Meanwhile, client No 2 STILL was not in labour.  During the day, my colleague had taken her to another hospital for CTG and  Low vaginal swab & assessment of cervix (speculum). Cervix 1cm, very posterior os.  Definitely did not want to stay, have antibiotics or be induced so signed herself out and went home.  She and her partner with the help of my colleague intermittently monitored events.  Next morning,after 1/2 hrly contractions overnight stimulated by wild flower therapy, (now 56 hrs rupt membranes no labour.) I advised them that I thought it time to go to hospital and  encourage this baby to be born before everyone got too tired.  Very reluctantly they agreed that if I supported them for a few more hours at home and still no labour, they would go to hospital at midday.   They sadly packed the hospital bag and on my suggestion included personal items like her own special pillow and pictures etc and bunnyrugs and hat for baby as well as clothes to return home in.  They chose a little purple crocheted  beanie with a feather on the top.  We turned up at the hospital at 60hrs post ruptured membranes, no labour!  The medical staff felt they had fully informed her of the risks of no iv antibiotics etc (her LVS was NAD) and at 2pm put up Syntocinon , 1/2hr CTG trace.  She has a very good friend who is a W.A. Wild Flower Therapist and all through the day dropped remedies on her head , annointed her with creams and encouraged her to squat and intensify the pressure on the cervix.  She walked, squatted on the mattress we had put on the floor and sat on the toilet for a little privacy and elimination.  The hospital midwives were very respectful of her wishes of minimal interuptions and low level lighting.  When she said "Isn't it nearly time yet?" and "come on baby" I thought Aha! and took her to the bath tub filled with warm water and sprinkled with remedies.  She moaned and groaned her way through the next two hrs, pushed instinctively and without instruciton until crowning when I reminded her to be gentle on herself and the baby and ... out slid a 3kg baby Apgars 7, 9, 10.  over an intact perineum.  After 4 hrs she was on her way home with her little baby with his purple feathered hat.    She is delighted and says while she didn't labour in her ideal place, but she had the birth she dreamed of.  Thank you to those midwives who supported her (and me) through what was a stressful time with  wonderful outcomes.