A difficult birth

When I come back to this blog, I know I am more of a midwife than a writer. I make time in my life to be a midwife, but rarely make time to write. So many things have happened since I last wrote and I'm mad at myself for not making the time to write about it. So here I am now to give an update.
I'm at home today listening to NPR on the radio with my cat lying in a basket nearby. it's wonderful to have some time to write. I helped deliver two babies yesterday. It always amazes me how babies are born in little groups. The babies yesterday were at 6:16 am (after a long night for us all), and 5:09 pm. The mother of the second baby is a woman I am close to. I helped her with her first baby as well and have also helped with some of her friends babies. I like her family because it reminds me of my own. She called me yesterday morning to let me know she was in labor. I was already at the birth center with my first client, so she said she would be there in a little while. In the meantime, my other client went home and I got the birth room cleaned and ready to use again.
When she got there, she was doing great- really working well with each strong contraction- breathing and walking and not complaining- just working hard. She is in good health and had a perfectly sized baby- three days past her due date. I checked her vital signs and listened to her baby- everything sounded great. At 1:00, I checked and she was 8 cm with bulging membranes and we were all so excited to know her baby would be here soon. Her first labor had been kind of long. We were all hoping this one would not take so long.
So she got in the birth tub to relax. She continued working well with her contractions. But time went on , and she did not have an urge to push. After about two hours she got out of the tub to lie on the bed because she was getting very tired. I checked again and she was 9 cm, but the front part of her cervix was swollen. Her water broke when I did that exam and it was clear. I felt confident that the baby would come right on down and out with the water out of the way. So she went on with her labor working really hard. I was surprised that her completely normal pregnancy and labor so far had not resulted in birth. During all this time, I was checking her vital signs and listening to her baby with the dopler intermittantly. He always sounded fine. She would occasionally get an urge to push, but it would not last. I knew something was blocking his way. I checked again and her cervix was swollen even more. I was worried now, because there isn't much I can do to stop the swelling except change the mom's position frequently and put ice on the cervix. She was already moving all over the place, so I decided to try to put some ice on the cervix to reduce it. From that time on, I was very busy working with her with every contraction. The ice definitely helped. She got on her hands and knees to put pressure on the front part of her cervix and soon had a true urge to push. The baby's heartbeat went down to the 120's, but still in the normal range. I think it was because his head was being molded.
Finally, we could see his head as she pushed. He certainly didn't glide out. She had to push hard every time to make a little progress. The baby's heart rate remained in the normal range. And now he was crowning. I waited for the next contraction and his head came halfway out. Ok, push him out- but she couldn't she didn't have another contraction or an urge to push. I rubbed her uterus vigorously to stimulate another contraction-I asked her husband to rub her nipples to release some oxytocin. Still no contraction- just push anyway!!!So she pushed with all her might and he came on through. There was a cord around his neck and I quickly looped it off. He came out limp and white and not moving. It is my worst nightmare to see a baby like that.
I immediately rubbed him and suctioned him with the bulb syringe and he moved and coughed a little. My assistant got the oxygen. It took a minute to get the o2 going, but we gave him some. He had a good heartbeat, but still not breathing on his own. I gave him a few puffs with the ambu bag, and finally he started breathing on his own. His color improved and he opened his eyes. His life came back to him! He was so precious and we were all so thankful for him to be alive. His apgars were 4, 9, and 10. Now today he is at home with his parents and big brother and grandparents.