Friday, January 15, 2010

Failure to progress or reason to be patient? A birth story

My sister-in-law "Mary" had her baby a few days ago! You might remember her from our post-screening conversation about Orgasmic Birth. She had a really amazing birth, I think. Although she had to deviate from her original plan toward the end, she was able to use certain interventions to positively affect the outcome of the birth. A few highlights from her birth:
  • She was in labor for over 36 hours
  • She was stalled at 8 cms for 12 hours
  • Her birth plan was followed to a T; the only deviations were ones she chose
  • She had a spontaneous vaginal birth, with total support from her midwives, despite the attending physicians wanting to move to cesarean during her long period of "failure to progress." 
I am thoroughly impressed with her caregivers--the midwife practice at UNC.

So here's the story, reposted with her permission. I call it a SBP birth: Successfully Being Patient!


Thanks everyone for the prayers, support, and congratulations. It has been a pretty intense few days and while I am a little sore, I have never been so incredibly happy.

Warning: I am going to tell about the details of Isaac's birth, so if you don't feel comfortable with technical birth terms like "mucus plug" or "cervix", you might want to skip the story to the pictures below.

As Kent mentioned, the entire labor period was rather long. Sunday night [I think she meant Saturday night] I was really achy, so I moved to the couch in the study which is a little firmer than our bed. Around 7:30 am, I noticed a little gush of liquid from my vagina. A few hours later I called the midwife and she agreed with me that it was probably the mucus plug (I know it sounds gross, but this is the real technical term used to describe the material that keeps the cervix sealed so that the baby in the uterus is protected during pregnancy) which usually comes out 2-3 days before people start having contractions.

I clearly was NOT having contractions, so Kent and I went to Church. Since I looked like I had a beach ball in my stomach and people know my due date was on the 17th, we got lots of good luck wishes from people. One of my 8 year old students from the church class I taught last year was so excited about the pending birth, she had announced to her class at school that her church teacher was about to have a baby--she is pretty cute. I now teach the 6-year-old class at church and part of the lesson was playing "Follow the Leader" which invariable involved several variations of hopping. Although a little uncomfortable, I joined in with the hopping but still experienced no contractions.

Later that I night, I had the intense urge to tidy the living room, bake chocolate chip cookies, cook a nice/huge stew for dinner, and finish up some research that I had been working on in the past week and was planning on meeting with my adviser to discuss the next day. I ended up staying up until 1 am to get this done, and noticed some irregular twinges of discomfort in my lower abdomen.

Monday 3:00 am to 7:00 am: I only slept for about 2 hours because around 3 am, I began to have constant contractions, about 8 to 10 minutes apart. I moved to the couch in the living room because I didn't want to wake Kent (which I didn't--he sleeps like a rock). The rest of the night was spent pacing around the living room and trying to rest on the couch between contractions. It felt like just as I was about to drift into a real sleep, the next contraction would hit. I mostly remember that the house was very cold, noticing that the high school students waiting on the sidewalk in the dark for the school bus in the freezing cold at what seemed a horribly early hour, and watching the progress of dawn through the curtain cracks.

Monday 7:00 am- 6:30 pm: Kent finally woke up and agreed that I probably was in the early stages of labor and should cancel my meeting. I felt the strong need to go to Target to get a bathrobe and other things so we went early in the morning before the contractions got stronger. The rest of the day was a blur of pacing around our little house, grabbing on to desks/door frames/sinks, and moving my hips like a hula dancer to help with the discomfort. Because of the age of the house, the floorboards are a little unstable and squeaky in parts, so I am sure our neighbors in the other units were wondering why their floors were wobbling so much. I ate a bowl of cereal in the morning and a 1/4 cup of tomato soup around lunch, but mostly just drank tons of water. As the day progressed the time between contraction decreased and by 6:30 pm, they were occurring about 3 minutes apart and I was having a hard time talking through them so we decided to head over to the UNC hospital!

Monday 6:30 p.m. - Tuesday 1:00 a.m: We got the the hospital and found out I was only dilated to 4 centimeters (full dilation is 10 centimeters) and I was a little disappointed because I thought I would be further along that that. As we walked toward our delivery room, we passed a group of people touring the maternity ward. (Of course a guy said, "Get a chair for the lady!" when they noticed I was in the middle of a contraction. Obviously he has never been in labor because it is much worse sitting still -- or at least it was for me). The irony of seeing the tour group was that we had been signed up to take our tour of the maternity ward that night at 7pm, but instead we came in for the real deal.

We got situated in the room, talked to the midwife on duty and meet the wonderful nurse who would be periodically monitoring the baby and helping us through the night. My goal was to have a natural childbirth with no medication. The nurse and midwife were very wonderful and supportive of my goal and allowed me to not have an IV, agreed not to ask me to rate my pain (I wanted to focus on the positive), and agreed not to ask me if I wanted pain medication as I outlined in my Birth Plan. And then I began my pacing and swaying-it involved a lot of movement which probably used up a lot of my energy, but it was the only thing that really helped me. I tried to sit and rest when I could, but it was only for a few minutes at a time. I found vocalization to also be a good way to deal with the pain--singing parts of songs, saying random vowel sounds, etc. I sounded really weird, but I didn't care about anything other than getting through the contractions. As the night progressed, I stopped vocalizing and was just really really intense and quiet as I focused on getting through one more contraction.

Around 1 am, the midwife checked and found I was dilated to an eight. I upchucked after one contraction They were all sure that I would probably have my baby within the next few hours.

Tuesday 1:00 am - 7:00 am: Kent was so amazing in letting me hold his hand in a death grip, helping me get out of the seat and onto my feet when a contraction hit, and giving me constant positive encouragement letting me know that I was doing well, etc.

Tuesday 7:00 am -11:00 am: At 7 am, there was a shift change which brought in two new midwives and a new nurse. They were really nice and helped me a lot in getting through the contractions. Their help was even more appreciated because the past night had been really draining on Kent. I don't think he realized how hard it would be to see me in pain, but he really did a great job. To make sure he kept up his energy, he quickly ran down to the cafeteria for breakfast. Unfortunately, the exhaustion and stress hit him hard and his stomach rebelled around 30 minutes after getting back to the room. Luckily, the midwives were so involved in helping me cope with the contractions that this allowed Kent to rest a little on the couch to make sure his stomach could get settled. Around 9 am, my dilation was checked again and it STILL was only at 8 centimeters. 8 hours and no progress! Grrrrrrrr.

I decided that it was time to try some of our options and decided to get an IV to make sure I had enough fluid in my body and have my bag of waters broken in hopes of strengthening the contractions.

After two hours, we checked again and no progress. At this point, I was literally falling asleep standing up. I still felt relatively optimistic, but I knew I was exhausted and my body was physically drained. I talked to the midwives and I decided that I would get an epidural so I could sleep and then get some pitocin to help strengthen the contractions and get this baby out!

Tuesday 11:00 am- 5:31 pm: Getting the epidural was fine and in 20 minutes, the contractions were numbed, I could still feel the sensations but not to the point of pain. I fell asleep almost instantaneously. Kent also got some sleep on the pull out bed. The nurse and midwife let me sleep for 3 or 4 hours (I think) and I woke up with so much energy and feeling so happy and ready for the next part. We checked and the pitocin had helped me dilate to 9 centimeters--everyone cheered. Everything started moving quickly at this point and the next thing I knew was it was time to push! The epidural allowed me to feel when I needed to push and how much the baby was progressing, but the pain was minimal. It seemed like we had to wait a long time between each push, but after about an hour of pushing, Isaac came out. We did it! It was so miraculous. They let me hold him immediately and I remember thinking that he felt so soft and warm. I can't describe the awe and wonder of the moment.

The midwives told me after that the doctors all thought I wouldn't make it and were really pushing for me to have a c-section, but the midwives knew I didn't want this and backed me up 100 percent. Apparently there are many places that tend to perform a c-section after 2 hours of no progression in dilation and that letting it go 4 hours is considered liberal. During my labor, I knew it was taking a while, but I had no idea how long it was actually taking because I was focused on each contraction. There was no past, no future, just now. So it wasn't too bad and I am glad I didn't have people telling me they thought I was taking "too long." I took just the right amount of time for me and was very happy with how things worked out.

During the whole birth process and after, I have felt great peace and a deep happiness. We love Isaac so much. I have loved spending this past day with him watching his squashed newborn eyes open and peer around with a look of bafflement, his soft dark hair, being able to comfort him when he cries, and all the other many little things that make him special. He has a talent for sneaking his hand out of his swaddle blanket--like a baby Houdini.

Thank you for all your love and support!

Kent was about to take a picture of me, but a contraction hit so I stopped smiling and he got this instead. You can't see, but I was wearing Kent's huge green boy scout socks because they were so warm. I really know how to dress stylishly.
A few minutes after birth. That is my hand on the left.

He was so perfect.
Isaac's reaction to life outside the womb.

Isaac loves being snuggled by his papa.

Our little Buddha baby almost 19 hours old


  1. Congrats to her! Sometimes it's really hard to have patience in those situations!

  2. MAny congrats to Mary! How big was Isaac? He looks like a pretty hefty baby! :)

  3. This is Kent here - Isaac was a hefty baby - 8lbs 11oz at birth. We were so happy with the midwives operation at the UNC hospital. One of the primary reasons we chose them was the c-section rate (7% versus over 30% at Duke, where we attend graduate school).

  4. A beautiful story and a beautiful baby.

    I had something similar happen during my labor where I was "stuck" at 6 cm for five or six hours. I'm sure if I'd been seeing an OB I would have wound up with a c-section but the midwife just suggested that it was time to consider breaking my bag of waters, pit, or an epidural. I went with the epidural because after talking with her I realized I was tensing up during the contractions and that was keeping me from dilating.

  5. Congratulations!!!!

    I was a "failure to progress" too. Two days of active labor and six hours of hard pushing, and I still birthed vaginally and drug-free.

  6. Congratulations! What a wonderful story of patience, for all involved. I wish we had more patient people as care providers in the hospital!

  7. What a wonderful, wonderful, and beautiful birth story! I have been reading so many negative comments lately about L&D nurses, that it was refreshing to hear about good nurses for a change. Many blessings to the new family.

  8. Fantastic that she was able to have a vaginal birth! I can definitely say that in the hospital where I work, mom would have been coerced into a c-section within a few hours of remaining at 8cm. Thank GOODNESS for excellent and patient midwives!!!!

  9. That is a great story - I especially like how she chose interventions that would help assist her to her ultimate goal. So many people get caught up on "NO INTERVENTIONS" and then they end up having more problems than they might have had. Thanks for posting, and congratulations to the new mama!

  10. Lovely story! Congratulations to her!

  11. Great birth story. Nice to read a birth story where a women has a good birth at a hospital. Sometimes an epidural really helps after a long labor. Where I used to work, none of the Obs would section a patient for failure to progress unless they had rupture of membranes and pitocin augmentation. They wanted to make sure there were adequate contractions for progress. Waiting eight hours is a little extreme but as long as the mom is afebrile and the heart tones are o.k. they would probably wait.

  12. Rixa-

    So glad that they liked to UNC! I went to college there and it is really a lovely place- glad the midwives are lovely.

    As a North Carolinian, I have 2 questions for the couple-

    How did they found out the c sec rate at duke v. UNC?

    What made them pick the UNC hospital system over the birthing center in Chapel Hill?

    Rixa, I know you just won the Lamaze award- I can't remember if you've ever discussed the lamaze birth networks on your blog. Triangle Birth Network ( lists both the UNC midwives and the free-standing birth center.

  13. Really beautiful story. Do you think she might be willing to share this story for the book? It would be a great one to include in the waiting section! Congrats on the new nephew!

  14. Natalie
    We found out the c-section rate by asking the midwives about their rate and then asking the instructor of a birthing class about Duke. So the numbers are better viewed as rough estimates. The Duke statistic that Kent gave maybe be a little high- but we do know that the rate is substantially higher at Duke- this is due in part to the larger number of high risk cases that Duke deals with.

    We chose the hospital over the birthing center because of insurance and because I liked the hospital. I felt more comfortable having immediate access to specialists if an emergency did arise. And I was impressed by the setup after taking a tour of the facilities at the beginning of my pregnancy.

  15. Yay, this is good to hear. I'm planning on using the UNC midwives the next time around!

  16. I also had "failure to progress" - stuck at 7 cm for eight hours or so. Happily I was in the hands of an excellent midwife. She recommended at a certain point that I get an epidural and pitocin, but she never pushed it. Because the baby was doing fine, she said we could wait a few more hours. But I was really in bad shape - dehydrated and caught up in the fear-pain cycle, plus I had an anterior lip and too-early urge to push. So the epidural really helped preserve my vaginal birth (though next time I'm hoping to go med-free). My midwife was so great - she never made me feel like there was anything "wrong" about my labor.

    (In case you have an OH readers, I birthed at the birth center in Miami Valley Hospital in Dayton - had to travel quite a distance to get there, but it was worth it!)

  17. I work with UNC BirthPartners as a doula at the hospital and I LOVE LOVE LOVE the midwives and nurses there. Your sister-in-law made a great choice!! I think the atmosphere is enhanced b/c many of the nurses also work at the freestanding birth center in Chapel Hill and understand what low-intervention really looks like. They're very supportive and positive - some have even done doula training.

    Cesarean-wise, in 2008 (most recent year state statistics are available), UNC overall had a 32.1% section rate, Duke a 39.1%. Both attract high-risk cases. Hard to know if the midwifery practice at UNC, with their very low section rate, lowers the overall numbers there, but it can't hurt.

    Congrats on your birth and your super cute baby!!

  18. That is wonderful! Congrats to your SIL and all of you!

    My labor was that long, too, and I am quite certain that if I hadn't educated myself about birth, I would have ended up with a c/s. Instead, I had an amazing homebirth. I'm so glad she had midwives on her side!

  19. Thank you (and your SIL) for sharing! Such an encouraging story. I always need to be reminded that birth is natural and we are each individuals. There is no such thing as a text book birth.

    Thanks for writing such a great blog! It's been a great encouragement!

  20. Wonderful, it shows how crucial choosing your care providers is in the outcome of a birth!


  21. What a beautiful story, and what a beautiful family. Thanks so much for sharing!

  22. It's amazing the difference that being surrounded by supportive, positive people can make in your perspective on birth while in labor. It's so wonderful that she was able to stay positive and present while stalled for 8 hours. I know that during my (not nearly as long, but slow to dilate) birth, I was profoundly influenced by the attitudes of the people around me and one negative word may have made everything seem terrible and dangerous. It's great that you were "sheltered" from the docs who saw your body as failing and were able to get over that hump feeling empowered. Isaac is a beautiful boy!

  23. I love the part, "There was no past, no future, just now." That just about sums up the beauty of labor to me!

  24. What a beautiful story -- and baby! :) Congrats to them!!!!!!

    I VBAC'd w/ the midwives about 18 months ago and LOVED them!! Can't wait to do it again this August! :)

  25. wow that sounds amazing.
    unforunately, I ended with a c-section, i was already 10 cm dilared but didnt even get a chance t oush, it had been 26 hours after induction. my son s name is also Isaac. I suffered great infections after which took 3 months to heal and finally close up. I struggled with depression thinking things could have gone different... G-dwiling next time I will know better wth G-d s help.

  26. Great story. I also had a long labour, but since it was a homebirth (and since I requested it), I didn't have any vaginal exams, so I wouldn't have known how far along I was. I think this helped psychologically, and knowing that dilation is not linear - you can progress from 4 to 10 in minutes and even regress in some cases, so those numbers are not really helpful (according to Ina May Gaskin). My midwife assumed I was still in early established labour when suddenly I felt a strong urge to push and she checked my dilation at that point and saw the head was already descending. Prior to that, she highly encouraged me to preserve my strength by resting as much as possible. For me, the most comfortable position was kneeling on the floor with my bottom up supported by pillows under it and under my legs and resting me head on the seat of a couch. The horizontal position took the pressure off my lower back and cervix a bit. This (as well as hypnobirthing techniques) allowed me to rest between contractions over the many hours. I think were it not for my midwife's insistence that I rest, I may have moved around more in an attempt to get things going faster and exhausted myself. Having said that, if the labour had gone much longer than mine did, I probably would have gone to hospital for an epidural just to get some rest, like this mama needed to.


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