The expectant mother received prenatal care from February to August and she had a normal course of pregnancy, with pre-labor starting on August 9th. We had several conversations of varying length during her last week of pregnancy regarding her intermittent and irregular labor. From my estimation, she went into active labor at 8 am on August 9th. It was light and regular. I was notified and an assisting midwife (her sister) was in attendance. I received a call from the assisting midwife at 5 am on August 10th notifying me that the mother was dilated to a pliable 8 cm. I immediately went to their home.

Mom working through contractions. This was a planned homebirth, that ended up being completed in a nearby hospital.

Upon arrival at 6:30 am, contractions were 5 minutes apart and lasting 90 seconds but dilation was at 6 cm. By 9:30 am, the contractions were becoming irregular and sporadic. The baby's head appeared to be asynclitic in an anterior position with a possibility of nuchal fetal hand(s) preventing adequate cervical pressure and pelvic engagement. We used several position changes to encourage the baby to assume a more favorable position and we used other techniques to encourage a stronger labor patter. The birth mom experienced spontaneous rupture of membranes (SROM) at 10 am. By 11 am the contractions slowed and stopped altogether.

The mom rested and slept until 2:30 pm. At this time, methods and techniques were performed to stimulate contractions and labor began again. The mom was dilated to 7 cm. For the next 15 hours, we continued to work with the mom using position changes, relaxation methods and other techniques to keep her labor in motion and working. She dilated to 10 cm about 5-6 am on the morning of August 11th, but the baby still was not deeply engaged in the pelvis and mild pushing did not move the baby's head down. Her labor stopped again.

At 10 am, the mom was still not having contractions. We discussed with her and her husband the possibility of having to do a non-emergency transport to the hospital due to the rupture of the membranes and the absence of labor. The mother refused transport and stated that she wanted to continue trying to stimulate the contractions and birth the baby at home as planned. We continued to work with her for another 24 hours. Her labor continued to be sporadic and intermittent in spite of our efforts.

By the morning of August 12th, the mother began to seriously consider a non-emergency transport to the nearby hospital for pitocin augmentation to stimulate the needed contractions. Her contractions continued to be intermittent and sporadic. At about 5 pm, the mother and her husband decided to go to the hospital. After pre-arranging the transport with the hospital, my midwife assistant and myself joined the mother at the hospital to continue to assist her during her labor. As is standard for hospital transports, both myself and my midwife assistant attended her during her hospital stay, continuing with her labor support and providing comfort measures to her throughout her labor, delivery and immediately postpartum. Her daughter, Ella, was born at 9:30 pm on August 12th. I remained with the mother for an extra 3 hours after the delivery to provide lactation consultation. The total time I attended Jennifer's labor at home, her transport to the hospital, her labor and birth in the hospital and her immediate postpartum was 67 hours. This is significantly more time than the average for a routine birth.

We discovered that the baby would stop the labor when it came time to move into the birth canal because of baby arms and hands were along side her head and prevented her from comfortably entering and moving down the vagina to be born. The augmentation gave the mother enough push to finally get the baby to move down and in the process her arms and hands were moved out of the way allowing her to be born. She received no medications other than the pitocin and gave birth naturally and without incidence. We had a very nice, very cooperative nurse midwife that allowed us to continue to work with the mother during her labor, the birth, and the immediate postpartum period. The nurse midwife and the baby's dad were "catchers" during the birth and I became the photographer.

After such a long, tiring labor, augmented with pitocin to stimulate contractions pushing finally begins.

Crowning of the head.

Perineal support.

More perineal support.

The head is born.

Head rotation to the right leg begins and shoulders deliver.

The baby is born.

Dad catches his daughter (the person in white).

Baby is placed on mom's belly. Dad gives mom a kiss.

Happy dad.

The mom and dad finally getting a good look at their new daughter.

Happy parents with their new daughter.

Mom, dad, daughter and the homebirth midwife (me).

Myself with my midwifery assistant (the mom's sister) and Ella. We were all happy to see a great outcome for such a long labor.

Ella weighs in at 7 lbs 5 oz.

Ella dressed and ready to go home.

Ella meets her big brother.

The mom and dad preferred to minimize their time in the hospital and so went home the next day. I continued to provide postpartum and newborn care in their home to the mother and her daughter, Ella, in place of having to remain in the hospital. I normally provide in-home postpartum and newborn care as part of my service for my clients.

I was in phone contact with the mother during her first few days home. I saw both mother and daughter in their home at a 3-day visit and performed a PKU test as requested by the mother along with the standard check-up for both mother and infant, including lactation consultation. Visits were also made at 3 weeks postpartum with phone and email conversations in between until 6 weeks postpartum.

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