Ep 24: Leah's Midwife Handles a Serious Complication

Show Notes:

• Leah is a registered nurse engaged to a UFC fighter, Brandon Davis. They have just grown their family with a new baby!
• She had a homebirth with her first baby. When asked how she decided to have a homebirth, she said she’s always been fascinated with it, but she doesn’t have any friends or family members who had had homebirths previously.  That being the case, it took a large amount of research on her part to come to the decision and know for certain she wanted to give birth at home.
• As a registered nurse, she did have some negative reactions from coworkers and friends about her decision.
• “I think that labor is best left untouched.”
• Leah’s fiancé was very uncomfortable with the idea of a homebirth. Early on, she asked him to visit several care providers, and he quickly disagreed, saying she needed to give birth in the hospital like every other “normal” mom!
• Not wanting to argue, Leah began seeing an OB. She continued with this care provider up until week 26, when she began feeling very uncomfortable with the idea that she was now going to be having a hospital birth.
• She decided to set up a quiet little meeting with a local midwife without involving her fiancé until afterwards. She immediately felt connected with this midwife and said, “This is it.  I know that whatever my birth story is going to be, you are going to be a part of it.”
• Leah continued to see both her OB and her midwife up until week 36, where she completely transferred care over to her midwife.  Though she liked her OB, Leah began feeling pushed to do things she didn’t want to do, including a  3rd trimester ultrasound and weekly cervical checks after 35 weeks.
• She felt that her prenatals were far more in depth with her midwife; they discussed issues like nutrition, which never happened with her OB- not because she didn’t care, but simply because there was just not enough time.
• In fact, her OB was so busy, that she had a patient due every single day of the month that Leah was due. She had warned Leah that she would likely not be the person delivering her baby anyway.
• Leah’s midwife was able to discern that her baby was posterior, and explained how that had the potential to complicate, or at least prolong, labor. She recommended chiropractic care and yoga to help get baby in a more optimal position. 
• She appreciated how much more hands-on her care was with her midwife. The OB pushed for a 3rd trimester ultrasound to see baby’s position, but her midwife already knew baby’s position by consistent belly palpation.  “I felt like she was almost a sister or a mom to me, as well as a care provider.”
• Leah decided to work up until the day that she gave birth.  She was healthy and her baby was healthy, so she decided to continue.
• During her 39th week, she got up on a Friday to go to work and noticed some bloody show. She let her midwife know, and asked her what that meant in relation to when labor would start.  Her midwife responded that it could be any time between the next 24 hours and week!
• Leah went to work and worked the full 12 hour shift. She was on her feet all day, and by the time she got home, she was feeling crampy and “not good,” but she hadn’t realized at that point that she was on the cusp of labor.
• Leah tried to go to sleep early, but couldn’t sleep. Although she was feeling crampy, she thought that maybe she was just experiencing Braxton Hicks contractions.  At about 3:30 in the morning, the discomfort was feeling less tolerable.  She thought that maybe she should start timing them to see if they were actually contractions.  At this point, she was having contractions every five minutes. 
• At 4:30, she called her best friend who lives hours away and let her know that she thought today was going to be the day, so get in the car and head her way whenever she was up and ready.
• At 5, Leah called her midwife and let her know what she was feeling.
• An hour later, she called her midwife back and let her know that she was still consistently contracting.
• At 8:30, Leah’s midwife arrived. Leah says, “I remember walking to the door and saying, ‘Hey…I feel like crap.’”
• Her midwife checked her and said, “Strong work, girl! You’re a 6!”  Leah was very happy to know that her contractions were doing something!
• Leah’s midwife had an assistant with her, who also acted similar to a doula during the experience.
• In the late afternoon/evening, she was checked again and was at 9cm with her bag of waters still intact. Her midwife gave her the option of continuing with labor uninterrupted or breaking her water.  Leah decided to wait and see and did not want her water broken at that time.
• She labored on for another hour and began feeling exhausted. At that point, she decided to have her water broken.  She as laboring on the bed at this time, but her midwife told her she should try to decide where she wanted to be when they had the baby since they were getting close.  She labored for about 26 hours total, but only spent about 45 minutes in the pool.  She decided she wanted to go back to the labor pool.
• Leah’s midwife told her that would be fine… but she was worried that they wouldn’t actually have time to get the birth pool set back up before baby arrived.
• Leah decided to go for the next best thing- her shower! At this time, she was already feeling pushy.  With her next contraction, she made a clear pushing sound, so her midwife came back into the room…. Only to realize that Leah had already birthed the baby’s head!
• Her midwife came behind her and provided perineal support to help prevent tearing. After a few pushes, Leah’s midwife that the baby wasn’t coming out.  She asked Leah to give her everything she had during the next push.  At this point, Leah was doing all that she could, and wondered what was happening.  Her midwife told her that she would need to get out of the shower if baby didn’t come with the next push.
• Baby still did not come, so Leah stepped out of the shower/tub and her midwife had her get onto her hands and knees on the bathroom floor. Her midwife had her alternate lifting one knee into a runner’s lunge, and then the other knee.  Back and forth, back and forth.  Baby still was not coming, though Leah’s midwife did free a nuchal cord that was wrapped twice around his neck.
• At this point, about 5 minutes had passed. Leah’s midwife had her lie down on her back and lift her knees up as high as possible (this is called the McRoberts maneuver).  Baby came at this point!!
• Leah’s baby was not crying or vigorous when he was born- he was absolutely exhausted. It took a bit of stimulating him to finally get a solid response.  Of course, he was attached to the cord this entire time, so he was still receiving oxygen via the placenta. 
• Even after this entire situation, Leah did not tear at all during her birth.
• She and her midwives spoke after everyone had calmed down. Leah was curious to hear how this situation would have played out in the hospital.  She learned that she certainly would have received an episiotomy, which she mentions is not a very helpful intervention because a shoulder dystocia is not a skin-on-skin issue, but rather a bone-on-bone issue. 
• Leah says that she felt so good postpartum that she probably didn’t take it quite as easy as she should have. Postpartum bleeding ended up being somewhat of an issue. She had a hard time just lying in, so she admits that she ended up doing too much and being on her feet too much!
• She felt such a sense of empowerment after the experience, and so did her fiance. He was very upfront that he didn’t want her to give birth at home, but after the experience, he couldn’t stop bragging about her. He was so happy with their birthing experience.

Episode Roundup

1. This is an amazing example of a rather large complication being handled at home. Notice how calmly and skillfully Leah’s midwife managed the shoulder dystocia.  She had her get up, then hands and knees, then alternating lunges, and finally had her move onto her back with her legs pulled up.  She also knew the importance of course of keeping the cord attached so that Leah’s baby still had a direct flow to oxygenated blood, even if he wasn’t quite breathing yet.
2. Just because you’re feeling empowered and strong doesn’t mean you should go make dinner! Once again, make sure you are taking care of your body and recovering appropriately after birth. 
3. If your gut is telling you to go with a certain care provider, please be in tune with that.