Posts tagged EVMS
The Birth of Josiah Emerson 8/22/22

Alex and Josh’s first journey to parenthood ended in preterm loss that was difficult, but also only intensified their desire for a child. Her second pregnancy progressed well, but in consideration of her previous loss, if she didn’t go into labor on her own at a certain point, her providers felt it best to induce labor and keep a close eye on the baby. Alex advocated to move the induction a week later and her providers obliged. Her hope was that labor would happen on its own. And that’s what happened!

On August 18, Alex noticed her body gearing up with contractions. They came and went for a couple of days until the middle of the night on Sunday, August 21. They were every 4-5 minutes and lasting a minute, some coming closer than that. Alex and Josh remained at home laboring another six hours before heading to the hospital. Their timing was so wise because once they arrived, Alex was dilated 4-5 cm, 80% effaced, and her baby was nice and low at 0 station. 

When I entered the room, Alex was still smiling and had the NOVII monitor on her belly. It glowed kind of like ET, except blue. It was the tool that allowed for freedom of movement and hydrotherapy even though her baby was monitored for the duration. Alex breathed calmly through her contractions that had quickly moved to 2-3 minutes apart, some drifted to 5 minutes. “Ooooh,” she exhaled confidently with each surge.

Alex moved through many positions. She labored on hands and knees, then sat upright on the bed like a throne, using gravity to her advantage. She stood beside the bed and leaned forward as relaxing and inspiring music played in the background. Her contractions spaced apart during this time, which had us wondering if there might be a positional issue with baby. Just before 2:00 pm her doctor did an exam and confirmed she was dilated to 6 cm, however baby felt higher. Alex was not discouraged and continued her active laboring.  

She stepped it up and did lunges and dangled with the rebozo, squatting back onto Josh, her loving and steadfast partner through it all. She did hip swirls on the birth ball and posterior pelvic tilts. She labored on her hands and knees over the CUB again, this time incorporating lunges. The nurses changed shifts into the evening and a popsicle was a gift from Heaven for Alex at just the right time. She indulged in a second one.

Alex continued her labor cycle with hands and knees on the bed and even labored laying on her side for some rest. She stood and swayed beside the bed and just past 8:00 pm had another exam and agreed to have her water broken. Alex was dilated 8 cm (at 8pm!), but baby still felt high at -3 station. There was also light meconium. Alex returned to the rebozo tied over the door and dangled through contractions to encourage her baby to move deeper into her pelvis. We also did a side-lying release to see if that might create more space.

Next Alex labored in the shower and stood strategically to allow the water to bring on stronger contractions via nipple stimulation. I placed votives in the shower and some essential oil on a washcloth to create a calming environment where she could really tune into her body and tune out everything else. The baby had a dip in heart rate during the shower and since they had trouble getting a steady connection with the fetal heart rate, Alex exited the shower and labored on land.

At 10:00 that night she was dilated 8 cm, or perhaps only 6-7 cm. Baby was a little lower at -1 station. We shook the apple tree with the rebozo (to loosen and relax her pelvis and perineum), and she returned to lunges. After the rebozo work, Alex’s contractions were closer again. But she was getting tired, so she lay back down on the bed with the peanut ball between her legs for some rest. It wasn’t easy but it did allow for some “rest.” The contractions spaced again but felt stronger. So just before midnight since her cervix was the same and the contractions had drifted apart to 9 minutes, Alex agreed to some Pitocin. They began at the lowest dose. Alex labored in the flying cowgirl position, and then felt some new pain in her right hip. We wondered if her baby might be trying to figure himself out in there. A heating pad helped relieve the pain in her right hip.

It didn’t take long for the contractions to jump back to the 3 – 3 ½ minutes range and some even closer. So, Alex got back up and did some lunges and then walked her hip out. We then used the bed to mimic a throne so Alex could use gravity again and she felt a difference in the pain—it was more in the front and back rather than on her right side. This was encouraging. The Pitocin was increased again, and we dabbed Alex’s face and neck with a cold cloth.

Then she had the feeling like she had to poop, which told us perhaps things had changed! It was just before 3:00 am and it prompted an exam. And Alex was 8-9 cm and her baby had moved down to -1/0 station. She continued to breathe calmly through each contraction and resumed her circuit of movement. Josh was an emotional and spiritual support to Alex, telling her to “breathe in Jesus and breathe out Josiah.” He also prayed over her. I found Josh on more than one occasion reading Scripture or praying throughout labor.

An ultrasound was used to try to figure out baby’s position since labor had been so gradual, and he was looking somewhat transverse to Alex’s right. So we did some belly sifting. The baby’s heart rate started to show some dips that were concerning so the Pitocin was also turned down by half. Since labor had been so gradual and Alex was getting very tired, she took the recommendation to get an epidural. The hope was that she would get solid sleep and perhaps something would relax in her pelvis and allow her baby to make the adjustments needed.

There was a delay in getting the epidural since the anesthesiologist was in the OR for a c-section. But eventually, after 2 hours and 2 different people trying, Alex got the epidural and hoped for some relief next. But that isn’t exactly what happened. Not too long after, her baby’s heart rate dipped. They shifted her position to improve his heart rate and it helped, but it dipped again. A constellation of concerns all came together that brought the medical team in to speak with Alex and Josh about next steps. She had been dilated 8 cm for close to 10 hours without progression, and her baby’s heart rate was displaying some signs that perhaps he didn’t have the stamina to withstand labor much longer. The recommendation was made for Alex to have a c-section.

This is never an easy decision. Alex asked the questions and sorted through the answers. There was no doubt she worked with her body and did all the things to coax her baby out. The flow of staff constantly complimented her on her control and how calm she was through her entire labor, but for some reason her baby wasn’t descending. Alex decided to move forward with the c-section with Josh’s full support. She cried, not tears of disappointment, but grateful tears knowing she had assembled a team that did everything to help her baby to be born vaginally. It didn’t take long before she and Josh were in the OR meeting their baby.

Josiah was born August 22, 2022 (8/22/22!) at 9:45 am, weighing 6 lb. 11 oz. and measuring 20 ¼ in. long. He was perfect and worth every bit of the journey. He is a gift from God, their sweet rainbow baby. Alex’s postpartum wasn’t without its complications, but at the time of our postpartum visit she was doing well and sorting through the early newborn issues of reflux and colic with Josh. Once again, they have assembled themselves a team of support to find the answers they need. It takes a village, that’s for sure.  

The Birth of Levi Marshall 2/2/22

Lindy and Leland welcomed their first child, a son, on February 22, 2022. (That’s 2-22-22!) These first-time parents were also students in my 7-week childbirth class and had chosen providers who were known for their support of natural birth. However, as the pregnancy progressed, there were some concerns that came up at 28 weeks. It became clear that their care would be referred out to the high-risk OB practice in the area to ensure Lindy and Leland’s baby got the level of care he would need. There were several concerns that added up to a heart problem that would need to be addressed with surgery in their baby’s first days of life.

This was a big pill to swallow but swallow it they did. Lindy and Leland gracefully followed the new direction their journey had taken them, and with strong faith in the Lord, they prayed fervently and adjusted their plans, surrounding them with loving friends and family to help.

In the last weeks, their baby was confirmed breech. This was an added complication as it would mean a c-section birth if baby did not turn. With the heart issues looming, and some concerning slow growth in their baby, Lindy’s doctors strongly recommended a c-section sooner rather than later. They even put a date on the calendar to insure they had the OR reserved. Lindy and Leland struggled to balance the potential for a c-section with the benefits of more time in utero for their baby to develop. Lindy went in for regular BPPS and NSTs to check on baby and make sure he was doing fine. And for a while he was. Until he wasn’t.

All was well on February 14. Then on February 17, baby checked out fine. But four days later, the ultrasound showed some reduced amniotic fluid volume that made a c-section as soon as possible the safest option. Originally it was going to be 6:00pm that night, but then it was shifted, and Lindy was admitted overnight so they could do the c-section in the morning when the full cardiac team was available. This was par for the course at this point. Their expectations were in constant flux.

We had a powwow phone call that night to check-in on emotions and review details, and I planned to arrive the following morning. When I entered the room, I saw Leland laying in Lindy’s hospital bed with her. It was such a sweet image and hit home just how united and how in love these young parents are!

We passed the time talking, and I answered questions as needed and encouraged the both of them. A parade of nurses and doctors came in to explain why things were delayed. Yes, they were delayed again. But Lindy and Leland were patient and took refuge in the fact that their baby was holding and wasn’t in such urgent need of a c-section that they couldn’t wait a little longer. Time was a gift, every day, to every hour, and in the end every minute. They played worship music to bring peace and love to the space. And with minutes remaining before Lindy was to get wheeled to the OR, a prayer was said for wisdom and skill of surgeons, and for a safe birth for their son. Lindy was taken back at 11:44 am. And Leland worked on getting dressed in his paper suit.

Leland was taken back to join Lindy at 12:08 pm. And their son was born at 12:25 am. Leland texted me the good news and mentioned there was a beautiful story to share. Lindy had worship music playing over her phone during the birth. She and Leland sang as the c-section began. Soon they heard another voice singing on the other side of the curtain, followed by another, and another until a chorus of people were singing and worshipping together. There were tears and softened hearts and a definite feeling of God with Us during the birth.

Their sweet baby, Levi Marshall, was born breathing well. And in answer to a prayer by his parents that he be born weighing more than 5 lbs. (in spite of the most recent ultrasound that had him estimated at 4 lb. 10 oz.). And Levi weighed 5 lb. 1 oz.! While still small, this was a huge victory as it was a safer weight for surgery. Hugs came from the doctor, who happened to recognize Leland from a previous encounter, and she told Lindy she brought the good energy that day.

Leland went with Levi while I stayed with Lindy. She mostly rested. She had had a whirlwind 24 hours and it was just the beginning of their crazy ride as parents. Soon they would have surgery and recovery for their baby, and eventually skin to skin, breastfeeding, and bringing him home.

In the meantime, they drive to the hospital daily, bringing Lindy’s pumped milk and taking notes to update loved ones. At the time of this writing, Levi is still at the hospital but on the road to recovery. They encountered a few little hiccups but in general things are looking good. And mom and dad even got some skin-to-skin time with their sweet boy!

Birth can be so different. And while there were not many surprises with the scheduled c-section, Lindy and Leland still went through the gamut of emotions that accompany any birth, but to an even greater degree. They are taking things day by day and clinging to each other in the process. They have loving friends and family to keep them connected, and they are covered in prayer. Their faith continues to carry them through this difficult journey, but they believe in God’s goodness and look forward to when they can bring Levi home and really feel like things are “normal”.

(UPDATE: Levi is home and doing well. He was in the hospital for 79 days total, not that his parents are counting. He’s been home about 6 weeks at the time of this writing, and his parents are ecstatic to be sleep deprived and have an uncanny understanding of breastfeeding and pumping. Levi is growing and he is getting caught up on his milestones too. He does have another surgery, but the future looks very bright!)

The Birth of Kai Jian Hui 2/28/22

Leslie and Jeremy welcomed Kai Jian Hui, son #2 on February 28, 2022, in a much hoped for and prepared for VBAC! I first met Leslie at an ICAN meeting in which I was a member of a panel of doulas. I had just showed up after a birth and not at all dressed for a social engagement, but I somehow gave her a good impression and reached out to me for a doula interview. Jeremy was at the meeting, and they made it very clear how important it was that Leslie have a voice this time. She had some high-risk issues that required care from high-risk OBs, but Leslie believed in her heart that she need not be treated as a high-risk patient.

She educated herself on her own as well as through my classes, and she and Jeremy were ready for whatever came their way. An induction because the recommendation, even though Leslie’s providers were hesitant. They recommended a repeat c-section, but Leslie stood her ground and asked simply “for a chance”. They waited for an available bed and then made their way to the hospital. As is the case with most inductions, there was a lot of waiting around initially. There were also words of caution and concern, sprinkled between the options and plans that were laid. A wireless monitor was brought to the room so Leslie would have every opportunity to move freely with her labor.

They waited through most of the day as the Pitocin was bumped up gradually. It was nearly maxed out, but Leslie’s perception of the pain was still mild. There was a recommendation to break her water to intensify contractions and change her cervix, but Leslie had a strong desire to hold off and let her body have a chance. She was effective in advocating for more time, and a phone conversation with me did her good. Several more hours into the night had her contractions coming closer than 5 minutes and longer than before, so I headed in. I arrived at her room around 10:45 that night.

Leslie was in good spirits, considering she had been staring at the same 4 walls all day. She had one excellent nurse after another and that would continue for the duration of her labor. Nurses work so hard and good ones are priceless! (And I rarely meet a nurse who doesn’t want the best for her patients.) Leslie’s doctor came in and did a cervical exam shortly after I arrived and she was dilated to 4 cm, 50% effaced, and baby was still high at -3. This was the third check that was the same. It was time for some Spinning Babies. Pitocin had been shut off which gave Leslie a nice break from the annoying and unproductive contractions.

We did the Three Balances that Jeremy and Leslie had learned from the Spinning Babies® Parent Class. Once completed, Leslie tried to rest. Two hours later they did another cervical exam and Leslie’s cervix was still unchanged. Once talking through the risks and benefits, Leslie and Jeremy felt comfortable with breaking her water. Her baby’s head was tight against the membrane, and they hoped once broken the head would move down nicely to help dilate the cervix. But it was too difficult to break at that time because there was not much give. So, they started up the Pitocin again to see.

Two hours later at 4:00 am, her cervix had made change! She was dilated to 5cm, 50% effaced (still), and baby was a smidge lower at -2 station. Her doctor tried again to break her water and this time it worked! Clear fluid flowed which brought reassurance to everyone that baby was doing just fine. Leslie lay on her right side with the peanut ball between her legs, and soon she was breathing through intensifying contractions. (She was still able to text between them though, so it wasn’t too active yet.)

She draped herself over the cub birthing chair just before 5:00 am to help her baby continue to navigate downward. But she didn’t rest there. She got up and labored on the toilet some and swirled her hips on the birth ball. And she even did lunges. Jeremy applied counter pressure to her lower back as the pain escalated, and Leslie drew strength from his steadfast support. He was all in the entire time, encouraging her with words, pressing on her hips, or literally holding her up when she was spent. Their love shone brightly through labor and was such a sight to see.

By 6:30 the morning of day two, Leslie was dilated 6 cm, 80% effaced, and vocalizing loudly with contractions. It was hard for Jeremy to see his wife in such pain that she cried out, and it brought tears to his eyes. It wasn’t soon after that Leslie requested an epidural. Her road had already been long, and active labor had only just taken hold. She wanted to preserve her energy for pushing, something she wanted so much in her heart to do! 

Peace and calming essential oil helped her to cope and she liked the feeling of the peanut ball between her legs to keep things open. She had to wait a bit but by 8:00 am the epidural was placed, and Leslie was comfortable. She tried hard to sleep and so did Jeremy. About 90 minutes later they started the Pitocin back up to see how labor would unfold. We helped Leslie onto her left side with the peanut and moved her to the right when her baby’s heart rate showed some variables from likely cord compression.

But they stayed the course, walking the balancing act between progress and safety.  Leslie “feasted” on an orange popsicle, but truth be told she really wasn’t very hungry, so it hit the spot. An hour later at 11:00 an exam revealed Leslie was dilated 8 cm! Her baby’s head was the lowest so far at -1 station too, so we were all very excited. Leslie was overwhelmed with emotion as tears spilled out of her eyes. She had not progressed to 8 cm in her previous birth, so this was a very significant labor landmark! She confessed that she didn’t think she’d get that far so her heart dared to hope for even more progress. I wanted her VBAC for her so bad, and she wanted it too. It broke my heart a little how tentatively she held her VBAC dreams, but I understood why.

Leslie slept, but after some rest she got busy being active. She lunged on her side with the peanut, we did side-lying releases to help encourage her baby’s passage down, down down, and she even rolled onto her hands and knees to labor over the cub with that epidural. And just over 2 hours later she was dilated to 8.5 cm. It was a small change, but her baby had moved down to 0 station, an even more significant change! She labored upright in bed in the throne position, and we placed the peanut strategically to keep her pelvis asymmetric. And just before 7:00 am she was dilated 9.5! Her cervix was 90% effaced and her baby was solidly at 0 station with some caput. It was back to hands and knees over the cub to get that last lip of cervix to melt away. Leslie felt more pressure in that position which made us hopeful it was working.

Leslie tried to relax as the pressure grew but by 8:00 that night she was pushing into the pressure. She had a lip that remained, but the doctor was able to push it aside, so her baby was no longer impeded by a thing. Leslie pushed with courage and persistence. She dug deep and pushed for nearly two hours, including with closed knees, and even using the tug of war push/pull with the rebozo. By 9:45 pm it was time to call the team! The room swirled with people and at 9:53 Leslie pushed her son out of her body!

She cried, Jeremy cried, baby Kai cried! It was a celebration by everyone, and Leslie savored the feeling of her baby on her chest from the very first moment. This was something she didn’t have with her first and it set the stage for such a healing start. They noticed his hairy shoulders and how alert he was, staring up at mommy. And once the crowd left and the room was once again quiet, Leslie brought Kai to the breast. And he latched in the first hour of life; another wish of Leslie’s fulfilled.

Leslie’s VBAC required a lot of patience, persistence, advocacy, communication, and belief in the process. Leslie was met with resistance, then cautious optimism, and finally a rousing congratulations. I hope everyone who was part of her care team learned something that day. I hope they learned that even risky birth can be approached with options and careful considerations. Communication is the key and does so much for a mom’s heart. I am so grateful Leslie was able to have the VBAC she prepared for and hoped for. And I am also grateful to have been by her side when it happened.

Photos in the gallery above taken by professional photographer, Stephanie Dunn. Follow her on Instagram: @stellar_photography _757