I received a text from Michelle at 4:30 that Kanika and Fidel were on their way to the hospital. I got to the hospital at 6:30 and met them and Fidel’s mother, Savannah in the triage room. Kanika was sitting in the bed, breathing deeply and calmly through her contractions. Fidel had some meditation recordings that he played that really relaxed Kanika as she focused on them and breathed with them.
The nurse, Kari, came in at 7:00 to check Kanika’s cervix. She said that her cervix was paper thin, but had 0 dilation. Kari said she tried to get her fingertip into the dimple she felt in the center of the cervix but couldn’t. Keri said that it was unusual for a 1st time mom to be fully effaced without any dilation, and asked if Kanika had ever had any cervical procedures done. Kanika said she had a colposcopy and biopsy some time ago. The nurse said Kanika could go home and return in a few hours, since it wasn’t considered true labor until the contractions produced dilation or they could stay and have Dr. Tanner, the resident on duty come in and try to open the cervix a bit by removing any scar tissue. After Keri left we discussed the options. Kanika was a bit discouraged that she had been having contractions regularly for some time, and being told she wasn’t in clinical labor. I explained that the cervical procedure was important since it could cause a scar that didn’t allow stretching without some manipulation, and the four ways to progress in labor: station (how low the baby was), rotation (moving the cervix in line with the birth canal), effacing (thinning of the cervix) and dilation) opening of the cervix. If they went home for a couple of hours, we knew she would be returning shortly, but she could eat something. But if she stayed, they wouldn’t have the hassle of loading everything back in the car and Kanika wasn’t sure she wanted to be moving home just to return. They decided to wait for a half hour and then decide. Keri then returned and said that Dr. Lawrence, was coming to the hospital to discharge a patient and would come herself to assess Kanika’s cervix. Keri brought in a birthing ball and Kanika was laboring on it for a while.
Meanwhile, Kanika was continuing to labor nicely, but with some back pain. She decided to try a knee chest position to make room for the baby to shift her head and take the pressure off her back. She had some blood dripping during contractions and when she went to the bathroom. Dr. Lawrence came at 8:30 and found Kanika to be at 4-5 cm and 0 station.
We moved from the triage room to room 16 for birthing. Keri said the room had a lot of good karma, since it was where she delivered her last child naturally. She said it was the biggest of the rooms, and it didn’t have any windows which made it nice and dim for natural child birthing. She also said it was the nurses favorite room, and they usually chose it when they birthed their children. As soon as we got everything in the room, Keri started filling the tub. Kanika was able to have just intermittent fetal monitoring, so it allowed for much freedom of movement.
Kanika labored in the tub for about ½ hour – 45 minutes. Being on her back wasn’t very comfortable, so she floated on her side most of the time. At 9:30 she began to vomit, and Keri and I encouraged her that it was good to get it out and was a good sign of labor progressing and the baby moving down.
She got out of the tub at 9:40 and sat on the birthing ball, leaning on the bed. We used tennis balls on her back for some counter pressure as well as back massage. Savanah, Fidel and I all took turns rubbing Kanika’s back. At 10:30 she was checked and the nurse said she was a good 6 cm with a bulging bag. Kanika and Fidel did some slow dancing around 10:45 and at 11:00 Keri introduced Christina, the new nurse.
At 11:00. Kanika went back to bed, and labored on her side for most of the remainder of labor, except for a short time when she walked with Fidel. She went to the bathroom at 1:00, after which Christina checked her cervix and found her to be at 8 cm. Kanika’s contractions began to space out more at this time, coming only every 3-5 minutes, so Kanika was able to get some sleep. She continued to labor very well, using deep calming breaths and listening to the meditation recordings. She liked having someone hold her hands, and rub her back during contractions.
We laughed that we knew when a contraction was coming because Kanika would begin breathing a bit faster and hold out her arms and begin squeezing air with her hands. At 2:00, when Christina checked her, she was still at 8 cm, but there was part of the bag hanging out. At 2:20, Dr. Lawrence checked her and determined that the baby’s head was fully engaged, she was at 9 cm with just a slight lip, and what we were seeing was some of the inner bag, since when her membranes ruptured spontaneously earlier, only the outer bag broke. She ruptured the inner bag, found it slightly stained with meconium and told Kanika she could begin to push, but encouraged her to lay on her left side to help remove the last bit of lip. At 3:30, Jerilyn came in as her new nurse, and they decided to use a scalp monitor since the external monitor was so annoying for Kanika.
Dr. Lawrence suggested a knee chest position to push to help bring the baby down. During these pushing contractions, Dr. Lawrence and Jerilyn both noticed the baby’s head begin to rotate. After about 20 minutes, Kanika returned to her back and pushed on her back.
Kali Maa was born at 4:02, weighed 7# 11 oz. and was 20 ½ “ long. Her Apgars were 8/9 which was very good for a baby needing to be suctioned at birth due to meconium staining. The nurses were laughing because during suctioning and wiping her down, she also pooped again.
Kanika had some slight tearing needing 2 stitches. She was given a pitocin shot to help with bleeding, The placenta was delivered at 4:10. After the stitching was completed, Kanika was able to breast feed for about 15 minutes on each side. It only took Kali Maa a couple of minutes to figure out how this eating thing worked.
Kanika’s dad arrived around 5:30 and I left the hospital at 6:00. The plan was for Kanika to stay in the delivery room for a couple of hours before moving to her regular room.
Kanika showed incredible control throughout the entire labor. She was completely in her “zone” and stayed in it throughout. Fidel was a great source of encouragement and comfort. It was a true pleasure to participate in this special time in this new family’s life!
Doula - Diane Nelson
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