Monday, March 14, 2016

Midwifery Is Like A Box Of Chocolates

As a midwife I love it when we get "butter" babies. Those are the ones that they literally just slide right out like butter running down a hot cinnamon roll. They are yummy! It is those births that the oxytocin is just flowing through our bodies. A butter birth might even make you question why you are there at all. Anyone, and yes I mean anyone, including a five year old can "catch" a baby. It is just not that hard, until....... it's not!

So before I tell you the story, please know that this type of birth I am going to tell you about is pretty rare. Before this birth I had only seen one "sticky shoulder" challenge and that was probably birth #5 or #6 in my training. I have read many midwifery books and studied positions and theories but never had the dreaded "shoulder dystocia".

A shoulder dystocia is a midwifes worst nightmare. It is a true emergency. You HAVE to get the baby out because the baby's shoulders are stuck behind the pubic bone like concrete. That is the best way I can describe it. Shoulders that are both hung up and stuck in cement, while the head is out but turning all different weird shades that never, ever look good on anyone, especially a baby.

So the call came that I had been expecting. Katie* and I have been developing a relationship over the past six months. She is a delightful Amish Mama with two little ones happily playing outside when I come to visit. The children are not told who this strange "English" woman who comes to visit frequently is.  Apparently the little four year old boy asked his Mama after one of my visits why a doctor kept coming to their house. Unbeknown to both Katie and I, he had peered into the window during the last visit and saw me taking her blood pressure. In fact, one little six year old Amish boy told his little cousin to run when "the lady with the big bag comes, because there is a baby in that bag!" Even the prenatal appointments are before the older children come home from school so that no explanation is needed.

When I got that phone call I dashed out the door. Midwives have to take special training for many things, and one of those is how to go from a deep sleep to dressed, teeth brushed and out the door in the blink of an eye! It's called "Departure Practices 101"This Mama had her last birth from start to finish in only two hours and she was one hour and 15 minutes away! So like all births, when I fly down the road I pray for God's protection over this new wee one. I pray that all will go well and Mama and baby are doing great. I might on occasion specifically pray for a butter baby but usually just to ask for God's protection. I was ready to walk calmly in with my arms opened wide ready to catch this new one.

That's how I picture it sometimes but that is not quite accurate in this case. When I arrived I could tell that I had indeed got there in plenty of time. I even slowly set up everything I would need. I had time to take vitals on Mama and listen to the baby. Everything was perfect. At some point I decided to sit down and realized an hour had already gone by. It was apparent once again that birth was not imminent. I started analyzing why the contractions were not one on top of the other at this point. After checking her I realized baby was not in an optimal position to birth smoothly and baby was still very high. I remembered the time a Mama who was probably on her 8th or 9th baby was in active labor and almost completely dilated but baby was high. This particular Mama delivered her baby shortly afterwards, with the baby practically shooting herself out of the birth canal. Sometimes thats the way it is. So, I assured myself that baby could remain high and suddenly descend right before birth.

As the hours drug on I knew we could have a problem on our hands. I continued to monitor baby who was doing great through this long labor. Mama was starting to get tired. All of the sudden her water broke with a huge gush while working through a contraction. I checked baby's heart rate and it was still in the normal range. 15 minutes later she started to push while getting up on the bed. I had already figured out that baby was on the larger size. Because of that, I had her get in the hands and knees position, figuring she needed all the help she could get in the diameter of the pelvis. With in two pushes the baby's head was out. Sounds great right? Wrong! Babies are supposed to turn their heads and shoulders either to the right or the left after the head is out, its called restitution. Not with this little pumpkin. It was as if the shoulders had landed in quick set concrete. The baby immediately puked out a fair amount of fluid which was great. I wiped the baby's face and the color immediately started to change. First light blue, then dark blue, then light purple, then dark purple. I jumped up on the bed trying to maneuver the baby to no avail. I think at some point I prayed out loud, "please Jesus help us". I was able to get right behind Mama and finally get a hand inside on the right. Sure enough, the right hand was tucked under the chin which I swept down to the side. That gave me a little more room to put two fingers under the right shoulder and one finger under the left. I started rocking the baby back and forth and up and down all the while the face is almost black. When you get to this point you realize you would rather have a broken color bone or a broken arm then a dead baby. I was done being gentle, there was no more time so I started rocking back and forth faster and finally got enough momentum to pull the baby to safety. That was only half the battle.

When I finally got the baby's body free it was totally white and zero tone which means the baby was as floppy as a rag doll. I put the baby down, felt for the heart which thank you GOD was beating rapidly in the little baby's chest. But baby had not taken a breath. I jumped off the bed and started mouth to mouth. First the standard 5 initial inflation breaths with zero response. Later Dad said he was amazed that every time I breathed for the baby his little chest rose, which means I was doing it correctly. I continued to give breaths over and over again. Early in the process I asked Dad and Mama to talk to their baby. All I could hear in the moment was beautiful and gently German words flowing out of their mouths, encouraging baby to breathe. Mama was still on hands and knees and couldn't see a thing which was probably good. Dad stood right there at the foot of the bed time being suspended. I remembered later that at some point I told this baby it was NOT his time to go, that he needed to breathe. What seemed like an eternity baby finally showed signs of life and he let out a little feeble cry. In less than a minute later he was wailing! By this point my knees began to shake and my heart was pounding out of my chest. I had Dad run to the head of the bed and pull the baby from under Mama by his feet. Once the baby passed through we rolled over Mama and put baby on her chest. Mama spoke such tender words to her baby boy. Over and over again in beautiful German she assured her baby that he was indeed going to be okay.

When I stood up after getting baby situated on Mama I stood back. Dad quietly walked out of the room and balled his eyes out. It occurred to me that was a really wise thing to do after all the trauma we had been through the past 10 minutes. Unfortunately as their midwife I didn't get to cry. I had to be the brave one on the outside while shaking on the inside. I still had another 3 or 4 hours to monitor this precious little one. One thing I knew at that moment was the three of us had wrestled with death itself and came out victors!

It is so hard to describe the feelings of breathing life into a lifeless little baby. To watch a face go from black to blue to pink again is truly a miracle.  If you have read my blog for a long time you know that not every baby I have resuscitated has come back. I don't get to decide, I just get to serve to the very best of my ability. All of my training has paid off more than once. I would not trade this job for almost anything. I love what I do. I also know that this work really is like a box of chocolates. You just never know what you are going to get.

A dear and wise friend of mine prayed over me today after sharing this story. This is what she left me with. Dear Father God, please be with Jill as she catches these babies. Help her to know that she is not alone. Help her to remember that it is you God who catches her. I'm thankful for my perfect Father to carry me because I sure could not do this without Him.

Speaking of Father's, my next post will be about another kind of father.

Till then

Be the kind of woman that when your feet hit the ground each morning Satan says, "Oh crud, she's up".

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