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BIRTH OF ALISHA
The birthing mom was the niece to my birthing assistant. The mom had been to a local osteopath for the first part of her prenatal care until she heard about and discussed homebirth through her family. The expectant dad was against the idea of homebirth to begin with, because he came from a very medical-hospital oriented family as an orderly for the x-ray department and his mother also worked there as a therapist. The dad's mother was extremely set against homebirth having heard horror stories regarding the outcomes of non-hospital deliveries from ER attendants and the local doctors.
However, the expectant mom did not like her health care provider because he was vague with her and she felt manipulated by him, as well as her husband's mother (who had intended to be at the hospital birth). The birthing mom and her family are Jehovah's Witnesses and did not want blood transfusions because of their religious beliefs. The health care provider and her mother-in-law wanted to totally disregard her feelings on the matter. The birthing mom said that they had given her the impression that she would possibly need one and she would HAVE to have one, if the need arose.
Lorie had periods of nausea and vomiting, possibly due to the summer heat and the emotional conflicts with her in-laws.
After our first meeting, the expectant dad decided to go with the homebirth. I explained to him that he would have to stand his ground with his mother and because of his hospital job. It would be rough for both of them. The couple continued to stand firm on their decision.
The birthing mom's prenatal care and well-being was good. She took her nutritional herbs and supplements and walked regularly. Her diet was very good. She had a glucose reading in her urine at 31.5 weeks, but her blood level was normal. Possible food consumption that day had caused an abnormal reading. It did not reoccur. The FHTs stayed fairly high (possibly a girl baby) and were good, strong and regular.
On July 17th, I did a pelvic check on her and she was 3 to 4 cm dilated and 50 percent effaced. She had not been having any noticeable contractions, that she could remember, so we were both, pleasantly, a little surprised that she was showing so much preparation for her forthcoming birth. The fetal head was firmly in the pelvis and immovable, but still fairly high at station -1. We all left my house together and attended a surprise baby shower that her family was giving her at a local park. We had lunch at the shower. The birthing mom was quiet and uncomfortable during the shower. I thought she looked like she might be in light labor. After the shower, I followed her home to do a home prep check on her supplies and I stayed around a few hours to observe her. She was having contractions off and on, but not regularly. I felt the birth was beginning.
I left the couple for about an hour, to drop off my kids with the expectant mom's mother, who had quickly arranged childcare for me. I called my assistant to let her know her niece's condition and she should go to her niece's house to keep an eye on her labor, to keep the mom relaxed and keep her company.
I went home and picked up my birth bag and supplies, settled a few domestic things and returned to the birthing mom's house.
The birthing mom had passed globs of cervical mucus four times since coming home from the baby shower indicating she was losing her mucus plug. I got our supplies ready and performed an initial labor exam at 9:30 pm to determine labor progress. Her contractions were irregular and mild, dilation was 4 to 5 cm with 75 percent effacement and the fetal head had dropped to a station 1+, indicating the firm engagement of the fetal head into the pelvis. The uterine height had dropped from 35 cm to 32 cm. The fetal position was LOA and the fetus was active. The FHTs were 152 and strong. The birthing mom's blood pressure was normal. She felt stinging on urination and a lot of lower pelvic pressure.
At 11:55 pm, she had considerable bloody show seen in active labor with contractions about 5 minutes apart. Dilation was 6 cm, 90 percent effaced. The FHTs stayed between 152 and 140 throughout the labor and contractions.
Dad coaching and offering support with birthing mother during transitional contractions. Mom is breathing through a contraction.
We had to get a tummy shot. I have a great fondness of pregnant tummys.
We did another check at 1:00 am. The birthing mom had more blood-tinged mucus. She was still 6 cm until 3:30 am. At this point, we got her up and moving around and finally settled her on sitting on two chairs allowing the baby's head to put more pressure on the cervix. By 4:00 am, she was 9 cm dilation and spontaneous rupture of membranes (SROM) occurred. I caught the amniotic fluid in a small bowl to observe it, and it was clear except for a little amount of blood tinge.
The birthing mom immediately went into intense labor and having been experiencing nausea over the last few hours, vomited the contents of her stomach. We got her moved to the bed and got her as comfortable as possible. Her husband was her labor support.
The mom is dilated to 10 cm. Transition stage moves into pushing stage. Mom is doing well.
We got her to pushing and while the head descended, I massaged the perineum. At one point the head seemed to have tight squeeze, so I carefully and firmly pressed out on the vaginal wall against the pubic bone and on the sides to allow the head to move through with the next contraction. As the head came up on the perineum, the tissue was rigid and would not stretch. The vaginal opening was small and tight (this was her first birth and she had not practiced perineal massage and relaxation like she was supposed to do the last 6 weeks of her pregnancy).
As the color of the baby's scalp darkened to a bluish purple color, the decision was made to do a VERY small episiotomy (no more than a small clip), since the head refused to move any further. I continued to massage and stretch the tissue around the baby's head with my finger tips stretching the perineal tissue while doing so. The tissue gave a little more and I was able to lift and guide the head out at the same time.
Once the baby's head fully crowned, there were no more problems. The baby's face swept the perineum and we suctioned. I checked for a cord around the neck. No cord. The head rotated to the mother's right leg and with the next contraction, the shoulders were born producing a very slight tear with the episiotomy.
5:25 am - Alisha is born. Apgar 9/10.
Blood is from mom's small perineal episiotomy-tear. It took 5 small sutures after all was done.
I lifted the baby up and laid her on her mom's tummy. We suctioned again. The baby immediately breathed and was pinking up. It was 5:25 am. Her Apgar was 9/10. She gave a little cry and opened her eyes while looking up at her mother. Everyone massaged her and she did fine. The blood from the birthing mom's small episiotomy-tear was wiped off the baby and she was wrapped in warm blankets. After about 10 minutes, we clamped the cord and the dad cut it.
Birth of infant girl, named Alisha. Suctioning was done to remove the blood and mucus from mouth and nose.
Baby was placed on mom's tummy.
Doing some more suctioning.
Mom and dad are massaging Alisha.
Alisha opens her eyes for the first time to gaze at her mom.
Congratulations and praise for a job well done.
Seeing if Alisha can be persuaded into nursing.
Clamping off cord. Dad is cutting cord.
We got the baby to nurse and contractions started again. We got the birthing mom up into a sitting-squatting position on the edge of the bed and she delivered the placenta. The placenta was complete.
Grandma holds new granddaughter for the first time.
Getting Alisha to nurse to help deliver the placenta.
Alisha having her first meal. Very happy and contented.
Alisha is holding her aunt's finger. Placenta delivered within minutes after this.
Mom is showered, sutured, and in fresh, clean clothing. Alisha is settled in with her mom for a well-deserved rest.
We quickly cleaned the birthing mom up and changed the bed pads. I examined her episiotomy and saw it had torn slightly along the line of incision. It was a small second degree tear and required 5 sutures to repair. One on the inside, 4 on the outside. There was some bruising and edema for a few days afterward. After the repair, the birthing mom took a shower while we changed her bedding and cleaned up baby Alisha. The birthing mom returned to her bed for a well deserved rest.
I gave the birthing mom and her partner instructions about bed rest for the next 24 hours except for the bathroom. Although the labor was not a long one, it was intense on the birthing mom and she was very tired and sore. She was instructed to drink lots of liquids during the next day or two.
Mom and daughter.
Giving mom nursing instructions and taking Alisha to have a home neonatal examination.
We took Alisha and did a neonatal check on her. She weighted in at 6 lbs even and was a healthy, pretty little girl. We found a slight "click" in her left hip. The new dad and I took Alisha to a health clinic and had her re-examined for a well-baby check at 3:15 pm that day. The health care provider did a PKU test. The health care provider confirmed the hip "click" and simply told us to keep an eye on it. Other than that, Alisha received a clean bill of health.
Alisha's length is 20 inches.
Alisha is 6 lbs even.
Everything checks out fine. There is a fine "click" in her left hip. Mother has same left hip "click".
The birthing mom's mother and sister were present at the birth. Her sister was in charge of photography and helping to take care of my month-old infant son and other small children present at the birth. The birthing mom's family assisted the couple over the next few days with care for the baby and made sure the birthing mom was eating and hydrated well. I continued to see the mom over the next several days, to help as needed, and to check on her sutures and the baby. I continued care until her 6 week postpartum check. All was fine and well.
The dad's mother visited with her new granddaughter within a few hours of the birth and was greatly relieved and pleased that all went well. I had no further problems with the dad's mother after Alisha's birth.
Mom with her sister for family hugs.
Grandma and Alisha.
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