Teresa had an uncomplicated vaginal delivery with first child Joe (which I had attended), but had ended up with a cesarean with second Issac- who was a full 2 pounds bigger. Most involved thought “he was just too big for her”. She consulted with her doctor who advised her to attempt a Vaginal Birth After Cesarean this time, being a safer option for both her and the baby. Teresa knew she’d need extra help and support, so hired me to be her doula again.

 

Her due date came and went- and Teresa began to get a little worried about approaching the Thanksgiving holidays, and going too far past her due date. We knew she was already 3 cm dilated, so hoped labor would start soon!

 

Monday night the 19th she noticed some light contractions, but went to bed. They were mild and not enough to keep her awake. Around 1:30 or 2am she awoke with contractions close- 2-4 minutes apart, and much stronger. She called me at 2:30am and said they were headed in. I reminded her to call and let Dr. Mingea know and I’d meet them there.

 

I arrived at St Davids Medical Center around 3:30am. Our nurse, Shelly had gotten Teresa settled in bed, and on monitors. Teresa was still smiling between the contractions, but when they came, she was having to work through them. I encouraged her to relax and breathe. Shelly did an exam at 3:40am and said she was already 6cm, 100% effaced, and the baby was -2 station. That was a great start! Contractions were 2-3 minutes apart. Teresa indicated she did want an epidural. Shelly said as soon as they could get her admitted and fluids in her they could do that.

 

In the meantime, Shelly notified Dr. Mileur, who was on call for Dr. Mingea. We started consent forms, and drew blood work and set up an IV. Shelly notified us that the hospital required an internal monitor for VBAC patients, indicating Dr. Mileur was on her way to break her water and insert that.

 

At 4am, Dr. Mileur came in, broke Teresa’s water and inserted the scalp electrode. She also checked her cervix, and called her 7cm– wow, things were progressing! Now that her water was broke we knew things had the potential to move fast, so Shelly made sure fluids were going in quickly, and called the lab to get her results as soon as possible. In the meantime, I helped Teresa stay calm and focused on getting through the now more intense contractions.

 

Teresa had had an epidural with both of her previous labors, and had issues with her blood pressure dropping each time. This was a concern again. We re-iterated we needed to get a whole bag of IV fluids in her before getting an epidural on board to try to prevent that. We got forms signed, and waited. Teresa began to ask “how much longer” and both of us reassured her it was coming. She needed to continue to do what she was doing– she was managing her contractions beautifully.

 

Anesthesia came in around 4:20am and the epidural was in place by 4:35am. We helped get Teresa comfortable laying down and waited for the medication to take effect. Teresa said the contractions were beginning to feel less intense already. Travis had been watching all this from the corner!

 

By 4:45am Shelly insisted on getting a catheter in place– Teresa had a lot of fluids and they needed to keep her bladder empty. While she did that, she also checked her cervix– 8-9 cm now and the baby was lower at 0 station. We couldn’t believe things were moving along so well! It looked like we’d have a baby before the night shift was even over!

 

 

 

Once things settled down, I dimmed the lights and encouraged Teresa to rest. She was not completely comfortable from the epidural yet, still having to breathe through the contractions. We tried rolling her to her side to see if that would help. She had been battling nausea off and on- could have been part of labor, also a common side effect from the epidural. Peppermint oil seemed to help. Her blood pressure was lower, but not low enough to be worried, and the baby looked great. Both Shelly and I assured her things looked fine, but she still felt crummy. We helped her with cool washcloths, and gently fanning her as she got hot flashes.

 

Travis headed out to grab a coffee. He had been a quiet observer during all this! We asked about names– they had a few in the works, but nothing confirmed. Waiting to see what the baby looked like!

 

By a little after 5am, Teresa was still having “too much pain” so we pressed her bolus button and rolled her over again. It was possible getting an epidural so late in labor that it would not have time to take effect completely– I encouraged her to close her eyes and rest, at least in between the contractions. Her being worried about her blood pressure and the epidural wasn’t helping things!

 

By 5:25am, Teresa stated she had “constant pain” and wanted to be checked. Shelly said she was completely dilated now, and the baby was even lower at +1 station. She felt it would be a good idea to wait til the baby moved down even farther, so suggested “laboring down” for a while. Baby looked good- and it gave Teresa a chance to rest.

 

Teresa’s blood pressure continued to drop slightly but the baby was never affected. We tried to keep her comfortable with peppermint, cool washcloths, and fanning. She felt very uncomfortable and a little scared. Shelly even stayed with us to reassure her that all was well. I helped her visualize welcoming the baby, or a safe wonderful place in her head– trying to help her get her mind off the epidural side effects.  Her pain levels seemed to diminish and she rested finally.

 

Travis hung out in the rocking chair. I encouraged him to take a quick nap too- he was too wired at this point to sleep, enjoying his hospital coffee which was “not as bad as he thought it would be”!

 

By 6am Shelly checked again– The baby had shown signs on the monitor that she was getting some head compression, a good sign. She had moved down nicely and we could start pushing! She notified Dr. Mileur.

 

At 6:10am we took our first “test push”. Within a couple pushes we could see quite a bit of the baby’s head! Shelly called Dr. Mileur in, who arrived at 6:20am. “Show her what you’ve got!”. Teresa got the hang of pushing quickly– she was really moving that baby down. Things were looking great! Staff quickly got ready for delivery– Lots of cheering and encouragement as Teresa brought that baby right on down. Helen Grace was born at 6:44am on Tuesday, November 20, 2012, after only 30 minutes of good pushing! She was placed immediately onto Teresa’s chest skin to skin, where she settled down. We covered her with warm blankets and let mother welcome her daughter. Travis was close by– we were so happy to have her here already!

 

We all started making bets on her weight– she looked like a good size baby. Would she be as big as her brother? She had 8/9 Apgar scores– she looked perfect. Dr. Mileur reported that Teresa had some tears that would require some stitching, so we just hung out skin to skin for a while. Teresa enjoyed snuggling with her new baby girl– announcing her name officially. The nursery nurse came in and offered to weigh her– we were all curious. She was 8 lbs 14 oz– exactly the same size as Issac who was born by cesarean!! Teresa had done an amazing job of bringing Helen into the world with love, joy and gentleness. Congratulations on a successful and beautiful birth!

 

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How does a doula really make a difference?
Results from different studies have all suggested that having a doula reduces the overall cesarean rate by 50%, Pitocin use by 40% and requests for epidurals by 60%. The use of a doula also showed a major reduction in the length of labor due to fewer stress hormones being produced in the laboring woman’s body.

The Doula Book © 2002; Klaus, Marshall, Klaus and Kennell.