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Positive Induction - Baby R's Birth

Writer's picture: thewillowtreedoulathewillowtreedoula

(The Doula Perspective)

After a few days of on and off contractions which H was managing well, H became concerned for Baby R’s well-being on December 23rd. She had noticed movements had reduced and was concerned that labour wasn’t going to start itself. Having an induction booked for the 24th at 10am, H reached out to see if we could support during this appointment as she felt this would be necessary. Being concerned about reduced movements, H was encouraged to go in for monitoring to get some reassurance around Baby R’s health. As H had been having early signs of progress towards labour, we suggested that she take some time to consider all options after this monitoring, including going home to digest the information in her own space. Upon attending hospital and seeing an episode of bradycardia on baby R’s trace, H considered the offer of bringing the induction forward and opted to stay in hospital, despite having driven herself to hospital without her bag, having been expecting to come home after. H felt that her concerns for baby R’s well-being were not alleviated by further monitoring, as I had suggested, and that it was in hers and baby R’s best interests to accept an induction. 

H told me she was provided information for pessary and balloon method induction and took time to consider these options, favouring the pessary. After being admitted to the ward, H’s mum went to collect her belongings from home, I drove her back to meet H at the induction suite and we chatted. H’s instinct was telling her that baby R was needing to be born and she had spoken to the midwives about continuing with the rest of her birth plan around the induction, which they stated was achievable. We discussed her concerns and what she considered to be the risks vs benefits of waiting or continuing with the induction and H felt strongly that the induction was the right path for them. She had accepted a vaginal examination before my arrival which stated she was 1cm and H said this frustrated her but confirmed that she felt an induction of labour would be beneficial.

The midwives made H aware that continuous monitoring was advised due to the bradycardia episode plus induction to monitor how baby R was coping with labour. She was happy with this as they could offer wireless monitoring and that this could be used in the pool also. H was happy to explore this option and had the pessary inserted shortly after 10pm. I had left by this point and H messaged me at 11.40pm saying she had decided to try and sleep as all was well. 

H contacted me and I(mum) around 3am saying that contractions had started and was managing but concerned that she was on her own. She suspected waters had broken and called the midwife to check. She told me that things had ramped up in the last 30 minutes, baby R had given a really big kick that had felt scary and contractions were happening relatively quickly (H was telling me when each one was happening and they seemed to be 2 minutes apart!). At this point, I went to pick up I and we made our way to hospital as H was requesting support.

On our arrival, H had accepted a vaginal examination and was being advised about going to delivery suite. We met her on the way to the room and settled in. H was managing well with contractions, feeling most comfortable standing and leaning through them, using gas and air, the comb and midwives started the pool. We tried counter pressure (hip squeezes) during contractions and H said this was helpful. The obstetrician spoke to H regarding fibroids and risk factors. She recommended a cannula be cited pre-emptively to provide an oxytocin infusion following delivery of baby R, in addition to the syntocin injection to assist with delivery and reduce risk of bleeding. H was struggling to consent to this initially due to discomfort of contractions during discussion. I requested that the Dr inform me of the options being presented so I could assist in explaining these recommendations. H consented to the cannula, infusion and injection but confidently stated that the oxytocin was only to be used following baby R’s arrival and not before. 

H was also advised that she could labour in the pool but delivery was recommended on land due to bleeding risk. H accepted this, but myself and midwife Cheryl discussed with H throughout that it was her choice to deliver in the pool or not, these were only the hospital’s recommendations.

The pool was going to take a while to fill so we suggested using the TENS machine, however it was becoming difficult for midwives to find a successful trace of baby R’s heart rate using the CTG, so applying the TENS didn’t happen. The CTG continued to slip down and off baby’s heart beat for around 40 minutes. In this time, H attempted multiple positions to help it stay in place and did continue to consent to them trying to place it. I suggested that a Doppler be used to check in on baby whilst H got comfortable as there hadn’t been a reading for a while and the CTG was restricting movement. Shift leader Jen came in shortly after and also suggested this to help cite the CTG. H found a comfortable position on the bed that clearly facilitated rest but it was understandably difficult to remain still for the monitor. Other options were presented such as using additional pain relief such as opioids or epidural to help H lay still or foetal scalp electrode, both of which were clearly stated in the birth plan as either being last resorts or declined completely. We prompted H that CTG could be declined if it was disruptive but H consented to this continuing. From this point, a CTG reading was gained with assistance from midwives holding the monitor and was agreed that at least a 10 minute reading would be sufficient to determine if baby R was coping well. Midwife Cheryl held the monitor in positions H found comfortable while she concentrated on breathing through her contractions and using gas and air to assist. We offered H to get in the pool whenever she felt it was needed to but H decided to stay on the bed. Using a peanut ball on her side seemed comfortable for a while, although then H seemed to be holding a lot of tension through her legs and pelvis during contractions and contractions were coming very frequently. During this time, a cannula was cited in preparation for the infusion. We tried different positions of the peanut ball to facilitate H’s pelvis opening to allow baby R some more room. We also tried some “shaking” motions to release tension during contractions, but H fed back that this was neither helping nor hindering. 

Midwife Keira then announced that there were external signs of baby R descending into the birth canal. Midwife Cheryl asked H which position she wanted to deliver in but she was unsure at this stage. The obstetrician came in to offer examination, which H accepted and this determined she was fully dilated and baby was descending well with pushes. 

I recommended H try to empty her bladder and trying a hands and knees position to assist with delivering baby R. She managed to get on to hands and knees but didn’t manage to pass urine at this point, which was anticipated due to baby R’s descent but H told us she felt much more comfortable in this position. Contractions became more spaced and allowed H to manage the flow of labour really well. Midwives and the obstetrician responded positively to the progress H began to make at this stage. To assist further, I suggested using the head of the bed to get into a further upright position and baby R began to descend earthside. We briefly discussed if H wanted to catch baby R as stated in her birth plan but she didn’t feel capable of doing this at the time and preferred to concentrate on delivering. Using gas and air for contractions and being supported beautifully by I, H went with prompts to follow the urge to push and delivered baby R in just over 25 minutes. I told H that baby R was beautiful as her face was now fully visible and H became so excited to see her and meet her, she delivered baby R with love and power at 07.31. She was born with her hand next to her face and with a lovely layer of vernix on her back. H said she came out like a fighter and brought her immediately skin to skin and said how relieved she felt, looking emotional and wonderfully elated. 

H immediately took this time together and was eager to get her on the breast. This was difficult at first, but H was observing baby R’s behaviour as she was learning how to latch and was aware that positioning wasn’t going to be optimal during management of placenta, delivery, needing to re-cite the cannula and suturing. Baby R managed some lovely latches during this time and H was learning what felt right for her and what didn’t. 

Once suturing had been completed, bleeding managed and H’s bladder was empty, she was able to rest while mum had cuddles with baby R and H began to process the incredible experience she just had with her beautiful baby girl. Baby R was weighed at 3360g. Midwife Robyn showed H her placenta and stated that it was showing signs of calcification which, although normal for term pregnancies, may have explained the bradycardia and reduced movements, highlighting that following her instincts, knowledge and guidance from those around her getting checked over to make informed decisions that were right for her was absolutely the right call. 

While H spent some time recovering and mum was updating everyone with the gorgeous news, I put together a bag for H to freshen up with, ensured she had things in reach on the table and offered further assistance. While things were quieter and calm and H had eaten, I left them to enjoy some time just the 3 of them while awaiting a discharge plan. 

It was an absolute privilege to be a part of this birth team, being completely in awe from the start of H’s courage, determination and overwhelming love for her baby. I look forward to seeing H settle and flourish into parenthood. 

 



 

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