I worked the loveliest labor recently. Marisol and Carlos* arrived on our unit early in my 7AM to 7PM shift, the first patients of my day. I'd woken up that morning hoping for a sweet couple with one of my favorite midwives and to steer clear of the operating room. One never knows what's going to happen on any shift. I could be assigned to anyone: the 7:30 scheduled c-section, an induction, three postpartum mother-baby couplets, the 10AM D&C for miscarriage, outpatients, or any one of a number of labor scenarios. When you walk on the floor, you'd best have already had your coffee because, anything can happen.
Marisol started contracting at 10PM the previous night and dozed off and on until 3AM when they really intensified. She woke up Carlos who ran a warm bath for her, made her toast and tea and called his brother to care for their 2-year-old daughter. By the time they came to me, Marisol was contracting every four minutes and was 4 centimeters dilated. We did a little bit of fetal heart monitoring and found the baby to be "perfect." She went for a walk and we did a little more monitoring. She took another bath where we used a Doppler to listen to the baby's heart tones. Everyone was calm, focused, and quiet. Carlos stayed right at Marisol's side, acting as her interpreter, freshening her water and keeping her company. My Spanish is serviceable but poor. I can talk about contractions, dilation, children, food and enough about parenting to get through the day but if you stray into other topics, I'm lost. Carlos did a great job translating. We chatted about sibling rivalry and how his brother would do caring for their 2-year-old, Elisa. Marisol said Carlos' brother would pamper Elisa. Carlos said he'd spoil her.
Eventually, the bath no longer provided the amount of pain control Marisol wanted and we moved on to an epidural. The procedure went like a dream and within 15 minutes, Marisol was comfortable and content. Carlos had a little lunch while I fluffed Marisol's pillows and tucked her in for a nap. Within a few hours, Marisol was completely dilated and felt the urge to push. Our midwife and an obstetrician who was standing by "just in case" sipped tea, read the paper and knitted while Marisol pushed. Carlos and I took turns counting to ten and coaching her pushing efforts. She pushed for almost two hours before the hair was born—long wisps of silky black hair emerging before the rest of the baby. Carlos joked about more snarls to comb out. Pretty soon, the baby crowned and moments later another daughter was born—looking straight up instead of the easier face-down position. When we explained the difference to Carlos and Marisol, Carlos said, "ah, una optimista"—an optimist. Their daughter went straight to the breast. Marisol had no tears and needed no repairs. We tucked her in with warm blankets and the two of them happily nursed away.
What made this delivery particularly special? It was a VBAC—a vaginal birth after cesarean. Marisol's first baby had been delivered by emergency cesarean section when the heart tones had dropped and stayed down. Marisol was very clear that her next baby would be born vaginally and fortunately, found a midwife practice that supported her. It was just the loveliest day and everything I'd hoped for that morning.
*Names are changed to protect privacy
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