Every birth is different, and Kristin and Justin have learned this firsthand with the birth of their second child, Daniel Justin, on May 25, 2021. They welcomed their first child in a spontaneous labor free of interventions and had plans to do the same with baby #2. But in the last weeks of Kristin’s pregnancy, her blood pressure crept up to concerning levels. In fact, it rose so high at her 36-week prenatal appointment, that her midwife recommended she head to the hospital for induction that day. This unforeseen development had Kristin and Justin scrambling to adjust their plans for the birth as well as big sister’s care. But they made it work and were able to check-in to the hospital as directed.

Kristin and her providers talked a lot about options and various ways to get labor going. Since it was still early, her cervix was dilated just 1 cm, and not showing signs of imminent labor, they would need to ripen her cervix first. But with her blood pressure remaining alarmingly high, it was also important to make certain it remained in safe levels before any sign of contractions, let alone active labor contractions. Magnesium sulfate was the chosen medication to treat her high blood pressure, but it brought with it certain complications that made labor more of a challenge than expected. 

Contractions had hardly begun when Kristin did some soul searching. She was already feeling awful from the magnesium and was bed-ridden from it, not to mention the catheter and leg cuffs that were part of the package deal. She was in pain from the bed and felt sick from the blood pressure medicine and the contractions hadn’t even really started yet. The road ahead was most certainly a long one and she would remain on the magnesium sulfate for at least 24 hours after the birth. And there was also the question of whether her son would have the stamina for labor. Taking everything into consideration, and after a birth team pow pow, Kristin decided she would prefer to have a c-section knowing her son would be born, her blood pressure would have the opportunity to improve sooner, and she would be of the mag asap. It was by no means a decision she would have imagined making, but in this situation, there was empowerment for her in the choice. Her providers were diligent in detailing the risks, and just as thoroughly reviewed the process and how it would go. And sooner than expected, there was an OR ready. Justin and I waited while Kristin was wheeled back, but he was summoned soon after. Daniel Justin was born at 9:59 pm, less than 30 minutes from when Kristin left the room.

Sweet Daniel Justin was born very small, likely due to the blood pressure issues and the strained placenta. He weighed 4 lb. 11 oz. and was 18.5 in. long. And best of all, he was born with very strong Apgar’s of 8/9, showing everyone in the room that he might be small, but he was strong and ready. (Kind of like his mom!) Daniel’s birth just goes to show that every birth is different because every baby is different. Even Kristin’s pregnancies were different, and her babies needed different births. At the time of this writing, Daniel is getting chunkier by the day and is loved on by big sister. And Kristin is also doing much better. Hindsight only helps bring clarity to this as the best decision and there are no regrets. Kristin made the best decision for herself and her baby and I am so proud of her for it. I was honored to accompany them on this journey of birth, but also the journey of self-discovery through self-advocacy.

Christina and Brian met their sweet baby girl, Gianna May (Gia) on May 6, 2021. It was a love-filled labor and birth and I wasn’t surprised in the least. The first time I met them over a virtual interview, I could feel their love. This was a baby wanted and desired for a long time and through the gift of IVF they were finally expecting. We were excited for the day they would welcome their baby for it would be the closing of a chapter and the first page of an incredibly different one.

Christina reached out at 8:00 am on May 5 to tell me about the contractions that had been keeping her up since 4:00 am. They were surprisingly painful which threw her off since things had only just begun. She had a hard time keeping anything down, even water, so after several hours she called the midwife to see about going in to get fluids.

She was dilated 5-6 cm upon arrival which was quite remarkable, but she was also dehydrated. The fluid would help her uterus and hopefully give her a little boost as well. She was shown to her room after admission and once she got through the initial questions and procedures, she decided on an epidural and that along with some Zofran helped with her comfort and rest immensely. She was well on her way to rest around 5:00 that evening. And she was dilated 6 ½ cm and 100% effaced too.

We rotated Christina into a variety of positions. There was a pesky window of pain that was managed with position changes and the PCA button. But the only true relief would be delivery. Christina was grateful for the relief the epidural provided, even if it wasn’t 100%. The midwife came in around 7:00 pm and confirmed on exam that Christina was dilated to 9 ½ cm! It wouldn’t be long, or so we thought. She tried to rest but it was hard to sleep when you are excited to meet your baby!

The position changes continued and we all waited for Christina to feel the landmark “pressure in her bottom” that would signal full dilation and descent and a reasonable time to start pushing. She developed some signs of transition that were actually a low grade fever. But that lip of cervix while reducible, persisted. Her doctor preferred not to mess with it and rather let nature run its course. So Christina continued to rest and we continued to rotate her into various side-lying positions using a peanut ball and stirrups, and the runners position. At 11:30 pm the lip was still there and since it had been several hours at that point, the doctor recommended a little bit of pitocin in the hopes the contractions would move baby’s head against the cervix and melt it away.

Her baby’s heart rate dipped, but it was always manageable and partially due to the head compression that signaled it would soon be time to push. And just prior to 2:00 am, Christina’s cervix was fully dilated. Pushing began around 2:15 am and because her baby was already so low (she had been at +2 station for hours), we saw hair almost immediately! The doctor joined us thirty minutes later and Christina even reached down and felt her baby’s head herself at 2:52 am. And that touch inspired some great pushes because the nursery staff was called in for delivery with the next push!

Christina managed to allow her baby’s head to crown gradually in spite of the epidural, and her patient doctor applied oil and counter pressure to encourage everything to stretch. And the diligence and patience paid off because Gia was born at 3:13 am! Christina and Brian cried at the sight of their daughter and she was gripping her daddy’s finger within minutes. Although I think Brian was the one wrapped around her finger in that moment!

Christina and Brian immediately searched for family resemblances in their daughter’s features and fell in love with every bit of her. Christina propped her baby girl on her legs and marveled at her, really taking her in. Daddy got some skin-to-skin time too and eventually the official stats were recorded: 7 lb. 7.8 oz. and 20 in. long. Yes, Gia was perfect.

This birth was encircled in such love. The way Christina and Brian care for each other is evident, and labor was such a beautiful picture of that. And their love for Gia is inspiring and I couldn’t help but be touched by their gratefulness of finally holding their baby in their arms. Their birth and their path to become pregnant, was an example of patience, something that is a good reminder for those of us working in birth. I’m so glad their providers were patient as well.

Moriah and Desmond met their son face to face on April 15, 2021 in a surprising and beautiful birth. Dorian Prince was well named as he entered the world the prince of his mother’s heart. I got a phone call from Desmond just past 9:00 am on April 14 that Moriah thought her water had broken. The plan was to rest until she felt notable contractions and since she had a midwife appointment later that morning she would plan to go if labor hadn’t really taken hold.

At her appointment she was dilated 3 cm. The midwife confirmed that her water had begun to break and since she had tested positive for Group B strep, she was sent to the hospital to be admitted. Desmond called to keep me up to date and to share that Moriah was given space and time at the hospital to see if she would naturally go into active labor. Her midwife broke the forebag, then Moriah used a breast pump to bring on contractions and walked the halls of the unit. But by 9:40 that night just dilated 4 cm, Pitocin was recommended to bring stronger contractions. They started slowly and raised it gradually. Moriah rested initially but within two hours she was in active labor. She breathed in sighs through her contractions and nausea overcame her, making her vomit at midnight. 

The wireless monitor gave much freedom as Moriah moved her way through labor. And she was dilated to 5 cm by 1:00 am. She labored on her hands and knees over the peanut ball, and then labored sitting upright in the bed. By 2:00 am there were late decels in her baby’s heart rate but fluids leveled it out just fine.

Her next go-to was the shower at 3:00. But it was difficult to trace her baby’s heart rate, and Moriah had to return to the bed for a better strip. She hit a wall there and confessed to us that she wasn’t sure how much longer she could take it. She was tired and labor was painful. We recommended she get an exam to see if perhaps she might be in transition and sure enough, she was dilated 7 cm at 3:45 am. Moriah found encouragement knowing her labor had taken off and she was able to refocus her efforts.

She flipped back to her hands and knees and we cooled her with wet cloths. And just a few minutes later, Moriah felt like she had to push. I reminded her to continue laboring down, breathing through the pressure as it grew. Desmond applied counter pressure to her lower back since the sensations grew larger and she felt like she had to have a bowel movement. (She actually didn’t. It was her baby coming!) But when Desmond heard that he said, “We’re gonna check it!” And he was right on the money because Moriah was 9.5 cm dilated at 4:30 am. 

Moriah continued to breathe through the growing urge to push until she couldn’t stop it anymore. And she was officially pushing at 4:45 am. She zoomed from 7 to 10 cm in an hour! Moriah moved her baby quickly and in no time we saw his hair. I will never grow tired of the reaction of parents upon seeing the first glimpse of their baby! And at 5:12 am Dorian Prince was born! Moriah was able to reach down and help grab her baby as he entered the world! He weighed 8 lb. 5 oz. and measured 20 in. long, although those stats wouldn’t be determined until after the magic hour. Snuggling was first on the agenda and then breastfeeding! There was plenty of time to statistics.

These first-time parents navigated the unchartered waters of labor with confidence and open minds, which brought their son to them with as little intervention as possible. It was a joy to get to know them and to accompany them as they traversed such a significant phase in their lives together, from couple to parents. Welcome to the club! And welcome to the world, Dorian!

Courtney and Nathan are parents again! And in somewhat of a déjà vu, they welcomed a second son after a surprisingly long labor. Courtney was motivated and driven to welcome this baby in an unmedicated birth just as she had the first time. But the emotional challenge a second prodromal labor brings can be unexpected. Life was busy as it tends to be with a young child. But add in the sale and purchase of a home and the subsequent home improvement projects, and busy was escalated to a whole new level this time. Pile on top of that the unique challenges of giving birth in a pandemic, and you’ve got a totally new and different experience. But Courtney and Nathan were up for the challenge.

Courtney sensed that her son had shifted in utero, feeling as though he was somewhat sideways. I gave some suggestions of positions to encourage her baby to realign himself and the following night, April 12, she texted to say she had been contracting since 4:00 am overnight. They were inconsistent but persistent. She attempted rest for the second night, but with contractions that were escalating she found it difficult to sleep much with contractions ranging from 10-20 minutes apart all night. By the following morning, and after rounds of positions, Courtney was still contracting. They called the midwife and were heading in that morning for some answers. Courtney was 4 cm dilated and 100% effaced but she was not in active labor. Not technically. Her uterus was trying hard to be. Her baby had shifted downward from -3 to -1 station, a testament to all her hard work with positions. It was midday when they got admitted. 

The plan was to eat a meal and then see about getting contractions to be more consistent. After lunch, Courtney and Nathan walked two laps on the labor and delivery unit and then Courtney used a breast pump to bring on stronger contractions. And it worked! Courtney’s contractions were steady at 5-6 minutes apart by 3:30 pm and had her heading to the shower to the relaxation and pain maintenance it promised. Thirty minutes later, Courtney was out of the shower and dilated to 8 cm.

Courtney labored on hands and knees through transition and was still self-aware enough to comment to us how annoyed she was with the process and how anyone who told her second babies are easier was wrong! We positioned the peanut ball in front of her so she could “rest” between contractions. And her midwife told her to push when she felt she was ready and see what happened. A lunge was the next position in the hopes it would solidify that urge to push that Courtney was ready for. She felt pressure like she needed to have a bowel movement but the pushing part she wasn’t so sure about. She remembered it was a challenge her first birth. She lay upon her side for a bit and then we shifted the bed into a throne so she could see if gravity might move her into second stage.

And an hour later she was dilated 9 cm. She was ready for a change and that change was to break her water. Surely that last barrier cleared would bring her baby down for birth. Her water was broken at 5:12 pm and she returned to her hands and knees over the peanut ball, her preferred labor position. She lunged without hesitation, and then stood with her husband to lunge while she stood. She tried the bathroom again, where the familiarity of softening and letting go might yield her baby. And sure, enough when she returned to the bed at 5:52 her midwife had nursery called. Courtney was pushing! She pushed in lunges, and we could see a baby’s head shortly thereafter. And after 24 minutes of pushing, Courtney welcomed her second son, Ford Callum into the world! He was born at 6:19 pm on April 13, 2021, weighing 8 lb. 1.8 oz. and measuring 20.5 in. long.

Ford made his mom work hard right up to the end, when a suspected shoulder dystocia that wasn’t, elevated the tension for a minute. Ford cried immediately after her was born, adjusting to life with the strength and vigor his mom had displayed through the entire labor. He had a head of dark hair and a smear of vernix across his forehead, and once his daddy cut the cord, he lay against his mom’s chest as they both adjusted to being born. Ford was born as Courtney’s son, and Courtney was born as Ford’s mother.  Ford was breastfeeding at 20 minutes-old and Courtney’s phone was already blowing up with all the well-wishes.

Although Courtney’s labor was slow to start, once it was active, I was just three hours long. She was tired and over it by the time those strong and close contractions came, but she was a warrior all the way to the very last push. Nathan was her stronghold, always there believing in her. Thank goodness for a patient midwife who presented options and did not push, and for the opportunity to choose the path that felt right. You showed once again that women are resilient and strong and will stop at nothing to meet their babies. Congratulations again!

Ezra Mendel entered the world on April 4, 2021, perfectly timed on the last day of Passoover, promoting Jessica and Marc to parents! Marc sent me a text one minute before midnight of Jessica’s due date, to say that contractions had been coming for 40 minutes of varying intensities. It was just a heads up sort of text as they were still trying to sort out whether it was labor. After I reminded them to hydrate, get in a warm bath, rest and not to pay too close attention, we waited to see what the night would hold. Just two hours later, the contractions were stronger and closer and Jessica was feeling nauseous. This seemed to be labor! Her contractions were closer than 5 minutes apart and escalated quickly in a short time. 

When Jessica threw up, we thought a call to the midwife was in order. And with the blessing to head in, they were out the door. Just before 4:30 am, Jessica was confirmed 2 cm dilated and her baby’s head was at -1 station. Her blood pressure was high so there were tests to run, but Jessica continued to move along in her labor. Just 90 minutes later she was dilated 3-4 cm and definitely being admitted to have a baby. Some iv medication aided relaxation as Jessica waited for a room. It was a busy birth-day!

Shortly before 7:00 am, right during shift change, Jessica’s medication was wearing off and her contractions were growing in intensity. Her baby was in the OP position and the pain in her back was intense. An epidural was the plan since it would help with the pain and also lower Jessica’s blood pressure. She was brave as she sat through the procedure, and it was quick and effective. An hour later she was dilated 5 cm. 

The midwives changed shift as the nurses did, bringing someone new. And it happened to be Jessica’s favorite midwife of the group! Ezra’s heart rate dipped a bit lower than normal ranges, so some oxygen and position changes helped in the interim. Jessica moved side to side, but since she had pretty good leg control, we had her labor on her hands and knees for a period of time. And just two minutes later her water broke with a splash! There was some meconium, which would bring a few extra people to the birth. And it might be sooner than later since Jessica was dilated 7-8 cm! Since her baby looked good on the monitor, the midwife assured Jessica and Marc that they were comfortable with everything and had no plans to change “the plan”. 

Continued position changes using the stirrups for a time and then the peanut ball, laying down and sitting up, really helped to complete Jessica’s dilation. And just before 5:00, feeling lots of pressure, Jessica began to push. Her baby’s heart rate was reacting to the intensity of labor as well, so pushing was a good idea for him too. Jessica was an excellent pusher and her baby’s heart rate rebounded between contractions like a champ. Jessica smiled as she pushed from behind the oxygen mask, overcome with the joy and excitement of meeting her son in a few short minutes.

At 5:12, she reached down and felt her baby’s head with her own hand. She had moved her baby down so quickly, from 0 station to +3 station in just two pushes! Jessica stayed the course and the nursery staff was called in shortly. And just 3 minutes later, Jessica and Marc welcomed their son, Ezra Mendel at 5:25 pm! When Ezra came out, a fountain of fluid followed him, spraying out in a dramatic way that left its mark on the floor and the midwife’s scrubs. He was pink from head to toe (literally) and rest against his mom’s chest before taking a quick trip at the warmer. He was returned to his mother’s arms soon after and Jessica didn’t let him go for over an hour. And for the record, he did manage to rotate into the OA position for birth, thanks to his mother maintaining her mobility even with an epidural. 

Ezra weighed 8 lb. 7 oz. and was so completely loved. Jessica and Marc noticed hairy shoulders, long fingernails, and even a dimple. He stuck his tongue out like a lizard and his parents were completely taken by him. When he was ready he latched and had his first feed as his mother looked adoringly on. This couple were beautiful partners and I am so proud of how they navigated the strong, choppy waves of labor. Welcome to the world, Ezra!

Megan and Gokhan welcomed their son, Aslan Yusuf, before the sunrise on April 2, 2021. When I first met Megan, I was struck by her youth. She was the same age as my oldest child and the reality really hit me. I jumped to conclusions based on this and was so humbled and enlightened as I got to know her. She was bubbly and eager, and extremely motivated to welcome her son in the unmedicated birth she envisioned. She was also a student in my in-depth childbirth class, further building upon the innate knowledge of her body. Megan’s cervix made some changes late in pregnancy, thinning and opening before the first labor contraction, so that by her 39-week appointment she was 3 cm and 80% effaced. Her midwife sent her home with the compliment of being the most ready for labor of the many 39-week moms she had seen that day. Still, Megan realized this had no bearing on when she would welcome her son, so she remained open to whatever may come.

And just a few hours later I got a text. Megan was having “cramps” every 6 minutes or so, painful enough to give her pause. Were these from her exam? Or maybe for some other reason? They couldn’t possibly be labor just like that, could they? And of course, we all know that yes, they can. Six hours later, just past midnight Megan reached out with an update. The contractions were 5 minutes apart and very long and painful. It was so quick! So I recommended she call her midwife to get the recommendation of whether it was a good time to head in. The midwife confirned it was, and we met up at the hospital a short time later.

Megan breathed very calmly through her surges and her midwife was pleased to say she was dilated 5-6 cm with a bulging amniotic sac. This was a good place to be, for it meant that the longest most painstaking part of labor was already done. The more intense phase was coming. Megan received some iv fluids to help stabilize her baby’s heart rate and we applied some heat to her lower back as she sat through it. After the midwife checked in and left, Megan asked me about her pain medication options. But she did so with a slight smile. This was Megan’s transition. I assured her that by asking the question we could see she was very soon going to meet her baby. She never spoke another word of it. And neither did we.

The shower was the next stop but it didn’t last long. Megan needed to take a stop on the toilet as she felt some strong rectal pressure. And sitting right there her water broke! She retuned to the bed for a quick cervical update and her midwife declared her to be 9 ½ cm dilated at 4:07 am. Megan reclined in the bed because that felt right to her. And she gracefully allowed her body’s transition contractions wash over her as she started to feel the urge to bear down at the peaks. A fan (HER fan that she directed us to) and a cold washcloth were about all she needed in that moment. And by 4:45 she was full-on pushing side-lying.

Megan rolled over to her hands and knees and pushed over the birth ball. Her midwife leaned in closely to tell her that her baby was in the OP position and would need a bit more oomph in each push to descend and rotate. And Megan delivered. Literally. Megan pushed in a lunge and we could see her son’s dark hair shortly after. The midwife reached for the delivery cart, parking it at the foot of the bed. Then she donned her paper suit and took a seat.

Megan’s pushes were instinctive and strong and effective. Her son come tumbling into the world (and even rotated into the OA position) at 5:56 am! Daddy cut the cord and a quick workup confirmed he was just fine in spite of meconium in the fluid. Megan pulled her son to her and locked into his face. Then she looked about the room at each one of us to express her glee. She had done it! Just like she knew she could. Like we all knew she could. Aslan weighed 8 lb. 3 oz. and measured 21 in. long. He was wide awake, basking in his mother’s smell and sound, peering into her face, the one he already knew.

Watching Megan embrace her labor, actually relish it, was a beautiful reminder of the gift of birthing. It is an act of courage, strength, letting go, and ultimately of love. Megan may be young, but she is already so wise. She trusts her body and believes in herself. And it is no accident those same qualities make a marvelous mother. She taught all of us some things that night. And we will be forever blessed by those lessons. No matter what is happening in the world, babies are born and mothers are strong.

Repeat clients, Ashley and Stephen, welcomed their second baby in the most beautiful healing, family-centered cesarean, the likes of which are sadly still hard to come by in our area. Ashley’s first baby was in the breech position late in pregnancy, and given her provider’s protocols, welcomed that baby in a scheduled c-section. It wasn’t bad, as c-sections go, except it left her feeling like she missed out on something. And the separation from her baby initially did not help her to feel bonded and like she birthed her child. So, when she saw the positive pregnancy test, she was on a mission to do all she could to have a very different birth experience. This began with securing her best chance for a VBAC. Her unicornuate uterus was a potential challenge, as it would make her second baby more likely to settle in the breech position. But she was not swayed from her goal and did her part with optimal fetal positioning.

But her baby was confirmed breech late in the pregnancy and since she had the previous uterine scar, her providers were not comfortable doing an external cephalic version (rotating baby to head down by manipulating the mom’s belly). Ashley was extremely disappointed and at a loss for options. She studied Spinning Babies and even invested in an inversion table, but to no avail. Her son was still breech. So before completely consigning herself to a repeat c-section, Ashley sought a second opinion. Enter West End Midwifery. This second opinion would turn out to be the single more important thing she did to impact her birth. In one visit just a few weeks from her due date, Ashley felt listened to and the skilled obgyn was able to successfully rotate her baby to the head down position in an ECV. She and her husband drove the 90-minutes home with a renewed fervor and desire for the VBAC they had originally hoped for. Ashley planned to stay with her original providers but as her blood pressure trended higher that week, there was strong talk of admission to the hospital and induction. So, Ashley officially switched care to West End Midwifery in Richmond, making the weekly drive and keeping close tabs on her blood pressure at home. The trust her new providers had in her was illuminating and really helped her to feel supported to follow her intuition regarding the birth.

Then Ashley was thrown another curve ball. Her water broke. I got the text at 8:30 that morning. She called her new providers who recommended she make her way up to Richmond to be seen in the office. Her water was confirmed broken so the doctor recommended she drink a castor oil shake, get something to eat, and walk around. It didn’t take long for Ashley’s uterus to start contracting and by late that afternoon, Ashley’s contractions were steady at 5 minutes apart. She could still talk through them so they would keep me posted. A couple of hours later, hooked to the monitor and admitted to the hospital, it was time to join them. Ashley’s contractions were relentless at 5 minutes apart and stopping her in her tracks—no walking or talking. I arrived by 9:00 that night.

I was immediately amazed and impressed by what I saw. There were twinkle lights strung from the ceiling and a diffuser with essential oils filling the room with lavender. The diffuser was plainly marked as hospital property, which was an amazing addition. In the corner were various birth balls, a peanut ball, and even a cub inflatable birthing chair. The room was abundantly equipped for labor, and aside from the hospital bed, might have been mistaken for a birth center. The shower and tub were one, and included jets and two shower heads, one removable for more focused hydrotherapy. Perhaps most intriguing was the trio of lights that could glow in virtually any color imaginable. Ashley could truly make that space her own and could envision welcoming her baby in that space. It goes without saying that they had multiple wireless options for monitoring—the telemetry unit, but also the Monika which is a sticker monitor that allows excellent contact with baby and laboring freedom for mom.

Ashley had some scar tissue from a previous LEEP that her doctor tried to break up. She was laboring hard but her cervix was not opening. She was left to labor freely as she wished, while her nurse checked on her blood pressure regularly. It did creep up but following hospital protocols, Ashley was given some oral medication before any talk of magnesium. Thankfully, it lowered her blood pressure and secured her freedom to continue laboring without an epidural.

Ashley spent most of the night doing every possible thing. She labored on her hands and knees, sitting on the birth ball and birthing chair, walking the hallways, all while waves of nausea came and went. Peppermint essential oil was a permanent fixture whether in the diffuser or close by on a cotton ball, a much more pleasant and effective tool for battling nausea. She took a walk on the unit as well but returned to her room shortly thereafter. She was do drawn into her labor to be out and about. This was a good sign of progress, it seemed. I did the Three Sisters of Balance to bring Ashley’s pelvis into balance and she had an emotional release in the process, a very healthy thing for her to do! I hoped in the letting go of her tears she might also be able to let go within to birth her baby. 

And as expected, Ashley was growing weary. So, we positioned the bed into a throne to allow her to lean back against a pillow between contractions, and labor upright and forward without having to fully support her weight on her knees and legs. The doctor came in to do an exam and despite 10 hours of regular contractions, Ashley was still not dilated. He suspected the scar tissue was the culprit but to break it up he would need to be more invasive than previous attempts. To preserve her energy, provide complete pelvic relaxation, and to help maintain a lower blood pressure, Ashley opted for an epidural. She felt safe and supported in her choice, knowing her doctor was trying valiantly to give her every chance at a VBAC. This was one in many steps toward that end. Once comfortable, the obgyn broke up the scar tissue and inserted a foley catheter to hold the cervix open until it dilated on its own. Pitocin was also added to the mix at 6:30 to bring stronger contractions than before. They had also spaced out as Ashley rested, so it would bring them closer. Her water had been broken for 22 hours at this point.

Shift change at 7:00 am brought a new nurse and a new doctor and midwife. Before the original obgyn left, he removed the foley and was pleased to confirm that Ashley was dilated 6 cm. His strategy seemed to be working. With pitocin at 8.0 mu, we were hopeful for an active labor pattern and continued cervical change soon. Ashley breathed more deeply into each contraction, a clue to us that they were intensifying. She continued her laboring most of the day, just as she had overnight. We changed her position in the bed from side-lying with a peanut ball, to side-lying with a stirrup, and even to hands and knees. But by that afternoon, even after position changes and steady pitocin and consistent contractions, Ashley was dilated to 4 cm. But more significant than that was the fact that her baby had not moved down at all. This was very telling and it was time to have a frank conversation. 

The midwife recommended a c-section but one very different than her previous. She would have both the obgyn and the midwife participate in the birth. And here is how it went. The obgyn did the surgical part of the birth and their baby was birthed into the midwife’s hands and passed directly to Ashley. There was no stop at the warmer. Instead, he went straight to his mother for instant skin-to-skin. He cleared her fluids well with crying and some bulb suction, and Stephen cut his son’s cord as he rested on Ashley. They were never separated at any point during the c-section. Benton Leopold was born at 4:18 pm on March 31, 2021 in a very healing birth.

Ashley was returned to her labor and delivery room for her recovery period and Benton latched well for her, especially after his uninterrupted skin-to-skin time. He weighed 6 lb. 6 oz. and spent his first hour of life in his mom’s arms. Ashley emerged from the birth with the most peaceful smile on her face. She was thrilled to have a healthy baby but just as excited to feel the healing that comes from feeling heard. Ashley was met at every turn in Richmond with open minds and hearts. And when her baby was born 32 hours after her water broke, there was not an alarmist response. Instead, she was met with patience, reasonable diligence, and open communication. Ashley was beaming! In welcoming her son, she also welcomed her own motherhood, a stronger, more self-assured mother. She found her voice and listened to it this time, doing the hard things like driving far, and using every possible comfort measure and position to make it happen. She can do hard things. And in doing the hard things, she found herself. And I couldn’t be happier for her or more honored to have watched it happen. Welcome to the world, Benton Leopold! 

Sabrina and Chris welcomed their third child together, Bodi King Ro, on March 12, 2021, much to the excitement of his big sisters! This birth was completely different than the others, including being their only son whose gender was a surprise until birth. As you can surmise, this pregnancy occurred during the pandemic and Sabrina felt strongly that she wanted to have her chosen support people in attendance. She was not interested in the limitations of the hospital and also preferred to have her own babies nearby. This was achieved at her previous birth in the hospital for she had them asleep on a blowup mattress beside her birthing bed. However, this was not an option during COVID. Sabrina decided to welcome this baby in her own home where she felt safest and where her babies would be close.

Things proceeded without incident until the final weeks in which at an appointment her homebirth midwife noticed the baby’s heartbeat was less reactive than desired. She recommended an immediate NST at the hospital to determine next steps. Sabrina’s baby was tired, as they described it, and at 41 weeks they recommended induction. She was told to return that evening. However, when she returned there were no available beds. A call to another hospital yielded the same predicament, no beds. Her baby was cleared with a good NST and so she was sent home. Sabrina’s midwife came the very next day to monitor baby and Sabrina also had another NST at the hospital. That would be the plan—very close monitoring and a call to the hospital (or induction) if anything wasn’t right. This was a roller coaster of a ride for Sabrina who went from a homebirth to a hospital induction, and then to a possible homebirth, depending on baby. It was a challenge but she perfected the art of letting go and seeing what her baby had in store. It was all she could do and it would be the secret to being able to roll with her labor.

Just three days later, Chris texted me at 12:40 am to say that Sabrina was having regular contractions at 3-4 minutes apart already lasting over a minute. They started 45 minutes earlier and they were already going like gangbusters. Since this was Sabrina’s third birth and I had been at her previous births, I knew that she had a high pain tolerance and would be calm through pretty much all of it. Subtle signs would mean big progress so when Chris said she was stopping and bracing for her contractions I knew I’d be heading to their house soon.

Then about 10 minutes later, Chris texted to say that Sabrina’s water broke “all the way” and the labor was “getting really fast.” That’s all I needed and I was out the door. Things were escalating quickly and they had also contacted the midwives who were on their way to the house. I arrived about 20 minutes later at 1:15 am to find Sabrina on her hands and knees leaning against the bed. The midwives arrived one by one soon after, setting up their things and seamlessly drifting into Sabrina’s birth. They listened to the baby’s heartbeat regularly and it stayed strong, even better than the previous days as if baby wanted to show everyone that all was well.

Within the hour Sabrina felt a lot more pressure in her bottom and she required steady counter pressure from me and Chris. But no matter how deeply her labor drew her in, there was always a part of her that was tuned in to the monitor on the bed. The moment there was a peep from one of the girls Chris disappeared upstairs to calm them. Sabrina was surrounded in support so when Chris had daddy responsibilities, she was never alone. In fact, having him available to soothe the restless sleepers helped Sabrina to let go and labor.

By 2:22 we could hear Sabrina become more vocal with her contractions, and within 10 minutes we heard her familiar mantra of “okay, okay, okay,” which had been her landmark transition sign in previous births. We stayed close and applied steady pressure to her sacrum, reassuring her she was strong and capable and her baby was almost here. And in three minutes she said, “I feel the baby coming.” Her breath changed in that moment from a deep inhale and exhale to the catch in breath the precedes the urge to bear down. Sabrina pushed for maybe 10 minutes as her midwife sat at her bottom encouraging her, Chris lay beside her, and I sat nearby. Her other two midwives were attentive and saying words that uplifted and empowered her and in the midst of the support Sabrina opened and birthed her baby. First the head, and then the rest tumbled out at 2:41 am, just 2 ½ hours after her first contraction. The baby’s cord was wrapped around the leg twice and the ankle once but did not slow down descent. It might have explained the low heart rate detected a few days earlier but we will never know.

He cried robustly and was soon declared a boy and greeted with tears from his mother as she grabbed him upon her chest. Tears of love, elation, relief, and ultimate release that comes with giving birth. This journey had been rife with drama, the likes of which Sabrina never would have wanted. But even when she had resigned herself to an induction in the hospital, her baby’s journey to birth took a U-turn and had her meet him right at home where she had planned from the beginning. 

Bodi weighed 7 lb. 9 oz. and was nursing shortly after birth. One of his sisters woke up as well, sending Chris bounding back upstairs to settle her before coming back down to cut the cord. There was no rush to cut it though. Once delivered, the placenta remained in a bowl nearby in the meantime. It stopped pulsing naturally when Bodi was through with it. The first hour was magical and reserved for exclusive skin-to-skin between mom and baby. And even after the first couple of hours passed and it was time for the newborn exam, Bodi hardly cried as the midwife gently assessed him with a tender touch and soft-spoken words. It’s really beautiful how serene the newborn exam is at a homebirth. And it inspired some thought-provoking discussion about homebirth and what normal birth looks like when it is left alone, undisturbed.

Sabrina was challenged to let go of the reins in this birth. And that is not something that comes easily for her. But she was ready to do anything to insure her baby’s safe passage earthside, even if it meant an induction and interventions. But in the span of a few days, she had her baby safely in her arms, born at home in the unmedicated birth she had envisioned all along. In the midst of a pandemic and so much uncertainty, I’m so thrilled this couple was able to welcome their newest baby in the comfort and sanctuary of their own home. There is no better time for a homebirth, I say. Welcome to the world, Bodi King Ro! You are the prince in your family and the king of your mom’s heart.

Rachel and Bruce became parents on March 9, 2021 as they welcomed their daughter, Eliza Mae, in a most surprising and keep-you-on-your-toes-guessing-all-the-while sort of birth. They were educated and ready, having attended my in-depth childbirth classes. And Rachel was the oldest of 8 children so she had some insight into becoming a mother. But this would be her first go. And if we know anything about birth it is that we cannot ever know for sure how it will unfold.

Rachel’s guess date of March 1 came and went and she tried to remain calm and patient. I didn’t hear from her really until she was 41 weeks and looking at an induction in a few days if labor did not happen first. She wanted any tips for starting things up and I reminded her that nothing would do it if her body wasn’t ready, and encouraged the relaxation benefit of massage and discouraged the pressure of the massage starting labor. Exercises to optimize her baby’s position were wise as was going for walks and spending time with Bruce in the final days. Labor would start if it was time and it wouldn’t if it wasn’t. And all of the trying to get it to start wouldn’t help and would actually possibly delay labor even further from all of the stress. Rachel took the advice with plans to wait.

But less than 24 hours later the text came to my phone. It was 6:55 am on March 9 and Rachel had been feeling contractions for 3-4 hours that were finally regular, just not consistent. They were mostly not too strong so I encouraged her to rest as long as possible and only do the minimum to get through them until her body required more. She had an appointment at 2:30 for an NST and ultrasound and wondered whether she should go in. Meanwhile, the plan was to do the Miles Circuit to help baby settle into position, and use comfort measures as needed. Several more hours of inconsistent and not too strong contractions, and a call to her midwife confirmed she was to report to her appointment. Turns out she was dilated 4 cm, 80-90% effaced, and her baby was in the OP position. The ob also swept her membranes in the hopes it would get her labor into a more productive pattern. Rachel returned home and her contractions quickly escalated.

Even with steady and strong contractions, Rachel attempted another round of the Miles Circuit in the hopes her baby would move from OP to OA. She had been contracting all day and was ready to meet her baby. But with contractions only 2 ½ minutes apart, lasting a minute, there was not a lot of rest time between and Rachel still wasn’t sure. I recommended she call the midwife again and possibly head back to the hospital. After an hour of contractions at that interval, they spoke with the midwife who said to head back in.

The car ride was awful, but it always is awful in labor. And since Rachel had been laboring so intently over the phone, her midwife arranged for them to go straight to a room bypassing triage. Rachel was seen to her room and climbed upon the bed for an exam. Her midwife did the exam and said, “Well you’ll be glad to know you are fully dilated.” Talk about a shock! It was about 7:15 pm and Rachel had been there a few hours earlier dilated just 4 cm! 

Her nurse worked on admitting her into the system and preparing the delivery cart and everything else that needs to happen beforehand, while Rachel worked through very intense contractions all while laying for the requisite initial monitoring. Her water broke 10 minutes later at 7:27 pm and she was pushing a few minutes after that. A few minutes later Bruce texted me back to confirm I should come to the hospital. I left quickly and was there in 10 minutes but it would prove to be just a smidge too late…

Rachel was a great pusher and moved her baby quickly down to birth. The heart rate dipped too low for comfort and there was talk of maybe having to take measures to encourage a more rapid birth. Rachel wanted none of that and so instead she pushed like never before and her baby was crowning in no time. She pushed with such strength and brought her daughter into the world at 8:10 pm! She was born strong and vigorous after that initial cry, and I walked in the room one minute later to find Rachel clutching her newborn baby girl and trying to catch her breath. She was happy and relieved, I could tell that even from behind her mask. (Yes, she wore her mask while pushing. Amazing.) Eliza weighed 7 lb. 15 oz. and measured a lanky 22.5 in. long.

It was remarkable how much her labor changed in so short a time, bringing Rachel from 4 cm to birthed in just under 3 hours. But make no mistake, shorter is not easier. Not in childbirth. Rachel was a champion at stepping up to the task as her contractions ratcheted higher. And we’ll never know how Eliza managed to rotate in the end after being persistently OP, (Rachel’s erratic and slow to progress labor had OP written all over them), but we suspect Rachel’s diligence with the Miles Circuit had something to do with it. Or maybe it was the membrane sweep that intensified the contractions right when Rachel (and Eliza) needed it most. Perhaps it was the feeling and listening to her body that helped Rachel welcome Eliza far more than the knowing and doing that had led her up to that point. All of the red raspberry tea, pineapple, eggplant, spicy food, dates, etc in the world won’t coax out a baby who simply isn’t ready. It was patience and diligence that made all the difference. Congratulations on the surprising and wonderful birth of Eliza Mae! You rode the waves of your labor like a pro.

I’m sharing a birth experience that is quite different from the ones you see here. The mother has requested it be shared because her son has a story, just like every baby. And as his mother, she would like their journey acknowledged, however heartbreaking it may be. Megan and Dan’s journey to parenthood was not easy. Through the gift of medical advancements, they were able to conceive through IVF. After the very real awareness that birth doesn’t always just happen, Megan waited with reserved excitement for the confirmation that her pregnancy “took” and she was indeed on her way. She reached out to me on the earlier side, dotting her I’s and crossing her t’s to insure a healthy pregnancy and birth. She had done her research and selected midwifes are her primary care providers, with the goal of minimizing interventions during her birth. She and Dan attended my childbirth class at the height of the COVID-19 pandemic, virtually, and would also welcome their baby in the midst of protocols to insure safety and limit the spread of the virus. We had our prenatal visit in their home, and discussed everything from logistical details to comfort measures, and even deviated to plants. When we parted we were looking eagerly forward to Megan’s birthing time and the fulfillment of her longtime dream of having children of her own.

Megan sent weekly updates following her prenatal appointments. All was well, meaning baby’s heart rate was good and he was growing fine. Her cervix was making subtle changes, but it was looking like her baby would push the envelope and gestate on the longer side. An induction was scheduled for February 24, but we hoped it wouldn’t be necessary. Then the phone call came, not a text like the weekly updates that final month telling me all was well and mom and baby were healthy. This was different. I could hear it in Megan’s voice. She had been crying. “They couldn’t find his heartbeat.” I couldn’t believe what I was hearing and I fell silent. A pit formed in my stomach and I held it together with an “I’m sorry.” This was devastating and I began to hold Megan’s space. Dan was on his way to her and details would be hammered out regarding support. But they were soon heading to the hospital for an induction a day sooner than expected.

Megan wrapped her head around the drastic shift in her reality and her thoughts of a natural birth suddenly felt impossible. “How can I honor Theo with the birth I have been preparing for when I know he won’t be coming home with us?” She was not afraid to ask the hard questions. She did her research and communicated openly and I answered her difficult questions as well as I was able. I responded with the reassurance that there was no wrong answer and she would find the best path for laboring her baby into the world. She would know the best thing to do and I would support her unconditionally in that. And Dan would love her the whole way through as they walked that devastating journey together.

The induction process was slow, as is often the case. But there was no cadence of a heartbeat to break up the monotony and remind her of why she was doing the work. It was a means to an end and one that she knew would be difficult and so very different than the meeting she had been envisioning for so many months. Years really. The first step was a foley bulb to encourage Megan’s cervix to open a bit more so it would be more receptive to pitocin. Megan tried to sleep that first night but it’s hard to sleep when your heart is broken and your mind is reeling. But she needed rest more than ever and she still had labor coming. Pitocin was incorporated and with it came stronger contractions. Megan accepted iv medication to help her rest and relax, as well as take the edge off the labor pain that had already begun. It could not touch the emotional pain though. An epidural soon followed, but it was not effective and Megan had several hours of intense labor even so.

Once her labor picked up it took off, which was a small mercy in the midst of such a task. Megan was dilated 8-9 cm by midday and the realization began to hit that Theo would be coming soon. We reminded Dan to eat and both of them to rest but self-care is especially difficult in grief. Megan’s body came through in amazing fashion, dilating rapidly and moving her baby down to +2 station in a short couple of hours. She continued to feel break through pain, the physical kind. But the emotional pain was just as acute. Megan began pushing sooner than expected and moved through that phase with a courage that I cannot fathom. It was a challenge she knew she had to face, and she did so without the reliable aid of the pain medication button. She relied on the physical pain to cue her to push. Megan used immense strength and powerful emotion and brought Theo out of her body with a tearful roar. He was born at 3:09 pm on February 23, 2021. And in his birth he was also gone.

The midwife gently placed Theo on Megan’s chest and she grabbed hold of him. There was no vigorous rubbing to elicit a cry. Just a gentle stroking to wipe away some blood. Dan reached out to touch his son and immediately noted all of his perfect parts. “He has ten perfect fingers and ten perfect toes,” Dan whispered. Then he laughed to see the same “mean mugging face” that Megan’s dad had. Her father was Theo’s namesake and had passed away just two years ago. Seeing his expression was heartwarming and heartwrenching at the same time. He was in that room though. Megan and Dan had a lot to get to know in a short amount of time and they relished the opportunity to become familiar with their son. They were given a cuddle cot so he could spend some extended time with them before their final goodbyes. Theo was perfect. He just looked like he was asleep and I suppose he was. The cause of his sudden passing was clear at the birth and something that could not have been prevented or foreseen. It is also a very rare circumstance. But those words don’t bring comfort when your son is the rare case.

I held their space and took pictures. Megan’s nurse was kind and compassionate. She gently bathed and dressed Theo in the outfit of his parents’ choosing. It fit perfectly, although we initially had out doubts. Theo weighed 9 lb. and was 22 ¼ in. long. He had chubby cheeks and substantial shoulders and a head full of dark hair. His parents memorized those details along with so many other things none of us could begin to imagine.

There was palpable love in that room. There was sadness, yes. There was great sorrow. But there was also talk of family and stories told. Megan and Dan laughed over memories from their wedding that were ridiculous and endearing, and only made their experience more precious. I could see how much Megan and Dan valued family and how much they loved each other. I could see how much they loved their son. They modeled patience and courage as they walked through the most difficult thing a human can. They will continue that walk lifelong. I also saw yielding and openness and hope as the mention of children entered the conversation. And spring was a promise just a few weeks away, hinted by the first color growing from the ground and the first buds of the trees. I will always cherish the hours spent with Megan and Dan and the beautiful reminder it was of the strength of parents’ love and how it transcends space and time. And knowing how fleeting life can be, remembering to savor every little thing. For you just don’t know. Holding space for this sweet couple today and every day. Thank you for your lessons to us about love and loss, and for wanting to share Theo’s story.