Summer and Anthony were hoping to have a VBAC after the birth of your BIG brother…(The Little Tiger) they chose Dr. Swensen this time who supported their wishes, and asked that I come as their doula again to offer labor support. Here is your birth day story from my perspective.

As the weeks went by, Summer’s body made all the right changes indicating labor was getting close. You remained “high” but her cervix got all the way to 4cm before she even went into labor! Dr. Swensen said she would allow Summer to go all the way to 42 weeks and a day before scheduling a repeat cesarean… which was scheduled for Friday, Oct 5th at noon. (Dr. Swensen’s birthday!)

Summer went into labor on Wednesday night the 3rd around 9pm. She had mild to moderate contractions which progressed over the evening. “Don’t get too excited Shelley”…They got consistent enough that she called the doctor around 2am– she called me too. It didn’t sound like Summer was working hard enough to go in, so I helped her re-evaluate things. They decided to “take their time” which meant wait til morning to go.

They arrived at 6:30am at Seton Medical Center and were admitted. We had talked about doing a breastpump induction today anyway, but Summer was already having contractions! Upon admission, Summer was 5cm dilated. They were coming every 4-10 minutes, so still irregular, but seemed to be making some change. I checked in with them around 8am and she said they were fine, they were getting another exam around 9:30 and would check in then.

At 10am, Summer texted me she was “almost 7cm, 90% and -2″… so I said I was on my way! Anthony was still sleeping through most of it– so different from their last labor!

I arrived at 10:45am with Summer mobile and still smiling. She was enjoying moving around, using the ball, changing positions. Our nurse Sara was super encouraging and helpful. We started augmenting labor with the breastpump- to help the contractions come a little more regularly and stronger. (In my opinion, Summer was still way too comfortable!) As Summer pumped each time, the contractions immediately got much stronger and closer… in fact, enough for her to say “I think I want to stop this”.

By 11:30am, Summer was getting sensitive to sounds and distractions. She needed to focus. She also did not want touch during the contraction, so different from her last labor! The pumping got the contractions 2-3 minutes apart, so it seemed like the “real deal”. She kept moving, changing things up. Anthony went out to grab “breakfast” and brought me back a slice of pizza! (Need to keep the doula’s strength up!)

As the contractions settled down, we started pumping again- about every hour. Summer was feeling more pressure on her bladder, so we hoped that was a good sign you were moving down! Dr. Swensen came in around 1pm, wanting to check on progress. She called Summer about the same as earlier- 6-7cm- and agreed we needed more regular contractions. We also talked about techniques to help the baby descend into the pelvis- using the rebozo to hold her belly in and tilt the baby’s body more vertically (Summer’s belly went straight out!)

More breast pumping… each time we did it the contractions literally were one on top of the other. Summer began to vocalize… that was more like it. I reminded her those were the type of contractions that got a baby here! I recommended some sidelying to help the baby move down in a more gravity neutral space– plus it allowed Summer to rest between the contractions. She had a restless night’s sleep the previous evening. The contractions spaced to 5-7 minutes apart but we allowed them to so Summer could rest.

Around 3pm Summer was up again and ready to pump- it only took a few minutes and those contractions were strong and close once again! More vocalizing- Anthony rubbed her back between the contractions, and even crawled in bed with her to snuggle and nap.

As the afternoon progressed, we moved around a lot, changing things up. Summer liked the “throne” position, the ball, and walking around. Frequent bathroom trips kept us on the move! I encouraged her to stay there for a while– a good quiet place to labor and bring the baby down. Anthony stepped out for another bite to eat. Summer was feeling “kinda crappy all over” which told me things had to be moving along! We expected to see Dr. Swensen soon and thought another exam seemed appropriate.

Dr. Swensen arrived around 5:40pm and did suggest an exam. She reported Summer was now a very stretchy 7cm. While it was progress, she had only gone 2 cm in almost 11 hrs of labor. She asked Summer what she thought about some gentle augmentation to get this ball rolling. We all agreed more consistent contractions is what it would take to make the kind of progress we were hoping for. Summer did not want another whole night of contractions without some change! She was not ready to break the water yet– so we decided to do some light Pitocin to bring the contractions together. Dr. Swensen said goodbye and said Dr. Oliver would be on call tonight.

Summer was a little fearful about what pitocin contractions would feel like– so she asked about getting in the shower. It was perfect timing. As the contractions gently became closer and stronger, Summer had the warm water helping her stay relaxed. Anthony put on his swimsuit and stayed nearby– Summer was in heaven. The contractions felt way less intense. “Screw the epidural… I say that now”. I told her to stay in there til she felt pushy!

At 7pm Dr. Oliver came in to give us the “hard nose pep talk”. She felt we were on the same path as last time– and was ready to get a little more aggressive with the pitocin. We were only bumping it up 1 ml every 30 minutes, so she suggested 1 ml every 15 minutes. Summer was open to that. She too wanted to make progress and not be doing this all night! Dr. Oliver suggested another exam around 8pm and re-evaluate at that point.

I encouraged Summer to just stay in the shower as long as she could and not come out til it was absolutely necessary. She was really doing great. Anthony asked how the contractions felt compared to outside the shower and she said “I’m not going out there to find out!” We were seeing a much better pattern now- 3-4 minutes apart and steady. Summer reported some light rectal pressure, so I was sure we were making change and bringing the baby down. We talked about what might be next, the sensations, and cues for pushing. Our nurse Sara said goodbye and we welcomed Olivia.

At 8pm Dr. Oliver returned and we got Summer out of the shower (relunctantly) for an exam. She was 8cm now and -1 station- not bad! Dr. Oliver was happy and said she felt good about the progress now- no need to change things. We’d re-evaluate in another hour. She offerred Summer a popsicle- Summer said yes- grape!

Around 8:30pm, during a contraction, Summer suddenly said “water broke”. Sure enough, there was a large gush of clear fluid! That was great news- a sign things were progressing! I warned Summer the next few contractions would feel more intense both with pain and pressure, and it was all good. Sure enough, she was working hard now– lots of deep vocalizing. We offered to go back to the shower, but it sounded like too much work, so she stayed where she was, in her “throne” position.

Summer started getting pressure sensations so Dr. Oliver returned around 9pm to check- she was 9 ½ cm at that point- the baby was 0 station! Hooray! She was confident Summer would need to start pushing within the hour, and gave lots of praise. She would be close by. Within 20 minutes those pressure sensations moved to pushy sensations– at 9:30pm Summer was officially complete! The baby had come down nicely but she didn’t feel the strong urge to push, so we just let her rest.

Within 30 minutes, I suggested a visit to the bathroom- it had been a while since she emptied her bladder, and I was hoping the change in position would bring on that urge to bear down. Summer was not real pleased with the move, but I asked her to “trust me”. Sure enough, she sat on that toilet and we heard good groaning/pushing sounds. Olivia and I gave each other a “high five”. She was comfortable letting Summer stay there a while, which was great. Summer leaned on Anthony for support and pushed away!

She was ready for change by 10:30pm, so we headed back to bed. We tried the squat bar for a while. Summer was pretty tired, but liked “hanging” on it– she was really getting her rhythm now. That was tiring her out, so we tried side lying for a bit to help her rest completely between the contractions. At 10:45pm Dr. Oliver came to check on progress and said she had moved the baby down to +1 station now, so he was on the move. It was great news!

Summer was getting exhausted, but kept listening to her body. We alternated various positions, even tried hands and knees. We ended up back on the squat bar, hoping to utilize gravity and open up Summer’s pelvis. We knew you she would need all the room we could make! By 11:45 Summer was ready to rest again. There had been some decelerations of your heart rate off and on, so Anthony continued to offer oxygen between the contractions. I realized you would not be a “10/4” baby after all!

Dr. Oliver came in again around 12:15am– to check on progress. She said the baby was still about the same- +1 station. There was not a lot of molding going on, and she felt, with Summer’s effective pushing, she should have made more progress by now. The baby was still really high up- not even close to consider a vacuum or forceps assist. In fact, he was so high up, she could not even tell if he was face up or face down– she could not reach around Summer’s pubic bone to feel the baby’s head.

Dr. Oliver was open to letting Summer continue to push– there was no hurry– but she was thinking the baby was “stuck” and was probably too large to fit through.

Summer didn’t need long to make her decision– she was pretty tapped out and not sure if she had much left in her to push anyway. She felt she had given it as much as she could- it was time to get you here. So Summer decided to do another cesarean at 12:30am. Because you were doing fine, there was no reason to “rush” so while the nurses got things ready, we talked about our options. Summer really wanted to hold you right away, since she had not done so with your brother. And there had been separation last time too. I pleaded with the staff to allow you to be held, and for your family to stay together, unless it was clearly medically indicated for you to go to nursery. They said they would do their best… it was not the norm, but they were open minded.

Summer was wheeled away and Anthony walked along with her. It didn’t take them long to get her anesthesia in place and start the surgery– at 1:12am on 10/5/12 you were born! They took you immediately to your mama, where she welcomed you on her warm chest. They let you stay there, skin to skin, with Anthony nearby. Your parents welcomed you with love and joy – all 9 lbs, 6 oz of you! They were delighted to meet you finally, and so happy to be able to hold you and snuggle together. They remained together as a family all the way into recovery where I joined them. Summer glowing (even though she was exhausted)– so happy. I helped her get you positioned for breastfeeding, and guess what– you latched on without hardly any help, and Summer breathed a sigh of relief. “This was what it was all for”. She was so happy to be holding you, nursing you less than an hour after you were born. Every contraction, every part of the day culminated in this one moment– I felt such peace, and joy, as we sat and watched you eagerly nurse for the first time.

(Note: Immediate skin to skin in the OR after a cesarean is not currently the norm. Special thank you to Dr. Oliver for being open minded and to the rest of the Seton staff who supported Summer and Anthony’s wishes. We know babies benefit greatly from immediate and uninterrupted skin to skin contact – whether it’s a vaginal or cesarean birth. I hope this story is the beginning of many where hospital routines change to help families have more family centered cesarean births. sls)

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Families report having a postpartum doula improved breastfeeding outcomes, increased their confidence as parents, helped them get better sleep, and improved their emotions, including reducing symptoms of depression and anxiety.