Amber’s story is an example of what a non-emergent transport can look like with a planned birth center birth. Here at NBBC, the most common reason for transport is maternal exhaustion after slow progress in labor. This can happen after a long labor where mom has been unable to sleep for an extended amount of time. This story is an example of how our care continues if you need to transport from birth center to hospital.
My due date had come and gone (May 23) and I was content in knowing that our little boy was safe, healthy and still tucked away inside of the safest place on earth. As much as I was over the back and hip aches, heart burn, constant exhaustion and frequent bathroom trips, I truly enjoyed my pregnancy and I was soaking in as much as I could the last few days of it. Every little kick and movement shared just between my baby and I was priceless and savored as I knew the journey of pregnancy was ending and the unknown adventure of motherhood was soon to begin. My husband and I did everything that we possibly could in preparing for the birth of our first child. We attended 12 weeks of Bradley method classes, went through books, watched countless videos and documentaries on the natural birth process and we chose a birth center with midwives to deliver E at. I felt empowered, encouraged and educated throughout my entire pregnancy as I surrounded myself with an incredible birth team!
At around 10:30 AM on Wednesday morning, I got out of bed to make breakfast and felt a significant gush of fluid. I immediately thought “DID MY WATER JUST BREAK?”
About 10 percent of women will experience spontaneous rupture of membranes(SROM) before contractions begin. At NBBC, the midwife remains in contact with patients when this happens to monitor progress and make sure no symptoms of infection or complications are present. For most women, labor will begin spontaneously within 24 hours. For patients who are GBS negative, we wait up to 72 hours for labor to begin spontaneously.
I went about my business of bed-making, breakfast eating and experienced a sudden burst of energy which made me start cleaning like a mad person. I was scrubbing floors, walls, counter tops and making sure my birth center bag was packed with everything I needed (even though I had packed it 3 weeks prior), our birth plan was typed neatly and I ensured that we had multiple copies JUST IN CASE today happened to be BIRTH day. Soon after my cleaning craze began, I felt another gush of fluid. I tested positive for GBS (group b streptococcus) during my pregnancy which is a bacteria found in about 25% of healthy, adult women and can be passed to the baby through delivery. So at At 1:20 PM, Ben and I packed our birth bag and birth essentials and started off to Natural Beginnings Birth Center. I was having minor contractions that were spread out, I could talk through them and I was all smiles so it was very apparent that we were in the early 1st stage of labor. We stopped and grabbed a bite on the way and I was chugging water like a champ! I kept remembering the “eat, drink, sleep, shower and walk” routine and I was definitely killing the eat and drink portion!
About 1 in 4 women test positive for Group B Strep during pregnancy. We also offer the option of receiving antibiotics at our birth center for those who desire it. Amber was able to come and and receive a dose of antibiotics, then go back home to eat, stay hydrated, rest and wait for labor to begin. The midwives at NBBC encourage eating and hydrating in labor! In order to follow birth center protocol, labor must begin within 24 hours of membranes rupturing in GBS positive patients to avoid transport so we also gave Amber some information on alternative ways to stimulate labor to try if she wanted to do that. Amber’s contractions began soon after she got back home and she chose some alternative ways to augment her contractions to encourage more active labor to begin.
I labored on our birth ball some, laid down to rest and walked a little bit. I lost more of my (mucous)plug soon after. I was feeling more tired at this point and my contractions were becoming a little more frequent (3-4 mins apart) and I just KNEW I was approaching “active labor” and that I HAD to be dilating.
At 10:00 PM, Ben and I left our house to go back to the birth center for my second round of antibiotics as I had to have them administered every 8 hours during labor. We decided that instead of coming back home if I was not in “active labor that we would get a hotel room in Statesville to be close. I was hoping that I was at least 4-5 cm dilated and that I could just stay and labor at the birth center. I had to be.
We arrived at Natural Beginnings at 10:50 PM and they began the second dose of IV antibiotics and my midwife checked my cervix. I was only 1 cm dilated. I was starting to feel really discouraged at this point, my contractions were still intensifying and I felt a lot of pressure in my pelvis. How could I only be ONE CENTIMETER?
Dilation is as unique as the woman in labor. Sometimes contractions are strong but dilation is slow. We do not know all of the reasons for this. Sometimes it is the baby trying to find just the right position which is why we encourage mobility combined with resting positions that keep the pelvis open. The most important thing to do during this time as long as vitals are normal and baby sounds good is to stay hydrated, nourished and well rested. We are happy to have a relationship with local hotels who will give parents a discount if they wish to do this but also remain close by. Not admitting a patient to the birth center until they are in an active labor pattern reduces the chance of transport.
Nicole (my midwife) was super sweet and encouraging and told us to go to the Holiday Inn Express nearby and tell them we were laboring and they would give us a discount. She told us to call her and keep her updated. We left the birth center and arrived at about 12:00 AM. At this point, I was unable to talk through my contractions, I was VERY focused, serious and did lots of moaning and groaning to get though each one. I tried to lay on my side but was very uncomfortable so I got on the birth ball on the edge of the bed and pretty much stayed there ALL night. My contractions were about 2-3 mins apart and were lasting 60-90 seconds. I was feeling exhausted and just kept wanting to sleep but there was no way I could sleep through them. Ben put pressure on my back, squeezed my hips and coached me beautifully through each one. We had an app on his phone to monitor them and he talked me through every one. He was so encouraging and kept telling me how amazing I was doing and how exciting it was that we were going to be holding our baby so soon!
We ended up leaving the hotel at around 5:50 AM to go back to the birth center. I could barely walk out of the room and found myself stopping in the halls and lobby to moan and get through the contractions. I know people were looking at me funny but I didn’t care AT ALL. Ben helped me into the car and we started back to the birth center. I just knew that this was active labor and that we would be staying there! We arrived and Nicole started the IV drip and checked me and I was only TWO cm dilated. At this point, I don’t even think discouragement is the right word to describe how I felt. I was utterly disappointed and so upset. I cried and kept asking “is my body broken?”. I was so sad because I knew that this meant my beautiful water birth experience was not going to happen as we would have to go to the hospital and they would start pitocin soon.
It is never easy for us to have the transport discussion with a patient that we know strongly desired and prepared for a birth center birth. We understand the disappointment that comes with a change in birth plan/vision. We do our best to give strong emotional support at that point then make the transition to the hospital as seamless as possible. We typically go to the hospital at the same time as the patient and help them get settled and comfortable. We continue to manage care for our patients at Davis Regional Medical Center where the staff is sensitive to the needs of patients who are transported. It is hard to watch your vision of your birth change, but we hope our continued presence throughout the process can provide the consistency needed to help a mom through such an emotional time.
The ride there felt like an eternal mile and a half. My husband was so precious and kept encouraging me and telling me how proud he was of me and that soon I would have our perfect baby in my arms. We arrived at Davis Regional Medical Center at 7:30 AM and I could still barely walk and talk but I made it to the room and we got settled in. They started the pitocin drip at 8:45 AM and man oh man, did things REALLY start to intensify.
Ben and Nicole were excellent at talking me through them. They kept saying “that is one more(contraction) you don’t have to have and one closer to having your baby!”. Some were 1 min apart and others were 30-45 seconds apart. At 10:30 AM, I got in the tub to labor. The water was my friend. I wanted to stay there. I got an urge to push and they made me get out. I started to labor on the birth ball again and my midwife put heat and counter pressure on my lower back during contractions and it definitely helped! I got back into the tub at around 11:45 PM and got another urge to push. I remember wanting to just stay in the water so bad and I was so upset that they kept making me get out when I wanted to push!
My midwife arrived at at 12:50 PM and she checked me and informed me that I was actually only 3 cm. Hello, Natural Alignment Plateau. Within the Bradley Method, we learned of this. It is sometime during labor when there is a ‘stall’ in cervical dilation. Sometimes this occurs just before transition, but can happen at any time when it looks like nothing is happening!
I am SO thankful that Ben and I educated ourselves and that we had a midwife who was PATIENT, believed in natural birth, encouraging and allowed me to continue to labor. Also, dilation is measured differently by most everyone. It is so tricky to gauge true dilation. I won’t lie to you and say that I didn’t feel discouraged and totally defeated at this point in my labor. Again, I can’t say enough how tremendous my husband was during this phase. He knew what was happening and he kept reminding me that my body was doing what it needed to do for me and for the baby and that I was a champ. These words and reminders were powerful to me during this stage.
In the absence of abnormalities, we understand that labor can be tricky and unpredictable and we do our best to allow time for the process to unfold. We help by suggesting position changes and other comfort measure to help encourage progress and cervical change. We are happy that at Davis Regional Medical Center, we have access to wireless, waterproof fetal monitors. Hydrotherapy can be very helpful to moms having long labors and can provide welcome relief especially when progress is slow. Sometimes, at this point, pain relief through epidural or narcotics can also provide much needed rest and that is also available. But Amber had been able to eat and hydrate well during her labor which we encourage so she was able to keep going.
My midwife suggested that I start trying some other positions and let gravity work with me. From 1:00 PM- 2:00 PM, I labored in many different positions such as hands and knees, the birth ball, squatting, side lying. At this point, I started to majorly doubt myself. I started saying things like “I can’t do this anymore”, “I need relief” and “I think I want the epidural now”. I was crying and really started wanting drugs at this point. Ben and Nicole kept talking me through each contraction and were so sweet and supportive.
At 2:00 PM I asked to get into the tub again and after about 15 minutes, I felt an overwhelming urge to push. I couldn’t not push. It was impossible. This baby was coming whether I was 10 cm or not! I knew it. The pressure was intense and the urge would not subside. I got out of the tub at 2:15 PM and sat on the toilet. This is when I hit transition. It was intense. I was shaking, throwing up and crying. Nicole and Ben kept saying, “remember this is the shortest part- you’re doing amazing!”. It felt like I couldn’t go on. Where was I going to find the energy to push? Nicole had me get on hands and knees on the bed again and I pushed a couple of times. I had an intense need to bear down through each contraction. I stayed on hands and knees for about 15 mins and then I wanted to change to the classic pushing position (sitting up with knees back). This detail is funny to me because during our labor rehearsals, I thought for sure I would HATE that position for pushing but sure enough, it’s what I wanted. I started pushing in classic position at 2:45 and pushed through each contraction for a little over an hour. My pushing contractions were way more spread out and I was talking, joking and laughing through them. When they came though, I HAD to push with my body. I remember wanting to groan really loud when I pushed but my midwife kept telling me to focus all of my energy on pushing. She massaged my perineum with oil between and during my pushes to keep me from tearing. I remember feeling the “ring of fire” as the head was crowning and they kept saying “He has hair!”. This was so motivating to me, I wanted my baby in my arms. I pushed through the burning a few times and at 3:56 PM on May 29, 2014, E was born! They placed him on my chest immediately and the most overwhelming sense of joy, love, relief, excitement, happiness and pure peace came crashing over me. Never in my life have I experienced a rush like that. Ben and I couldn’t take our eyes off of him as he nuzzled into me and let out the most precious cries I have ever heard in my life.
Sometimes a mom will make quick change after what seems to be a long time of “failure to progress.” We monitor mom and baby closely and dialogue with parents about their wishes and desires during long, difficult labors. We make every effort to work with parents wishes when it is within the realm of safety to do so. We do not have set time limits or standard protocols pertaining to length of labor. It is a continuous discussion and interaction between us and our patients and we determine together what is the best path for mom and for baby. We do believe that a moms experience of her labor has value and influences breastfeeding, postpartum healing and postpartum emotions so we do our best to focus on a healthy baby AND a healthy mom…..physically and emotionally.
We did it! We had birthed our baby as a team and I was so shocked and in disbelief that I made it through without ANY pain meds. I felt like I could literally do ANYTHING. The moments after his birth were precious and I will never forget how amazing the skin-to-skin contact and the first time breastfeeding was. It was surely love at first sight- this child whom we had prayed for, prepared for and had already grown to love on the inside came into our world and radically changed our lives in an instant. We were a family.
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If this experience taught me anything at all, it surely was a beautiful lesson in trust. Trusting the Lord, my husband, my midwife, my body and my baby. I realized that my “plans” were surely secondary and I learned to “roll with the punches” per se. We didn’t get to have the water birth at a birth center that we so desired and planned for but our birth story is beautiful in every way, filled with adventure and is a journey that I would absolutely change nothing about.
We are so excited that Amber is expecting AGAIN. E will enjoy being a big brother and we will try to share her next journey with you too!