Read our 4 part story about long labor scenarios, posted every Wednesday.

Part 3

Where are the home-birth friendly hospital providers? Why don’t the labor and delivery hospitalists get to know their home birth counterparts to effectively improve the outcomes for home birth clients?

Midwife360 was recently faced with this scenario. Our client had prodromal labor (early labor contractions with little or no cervical change, usually the ripening phase of labor for some women) for several days. When she came into the office for an exam she was found to be 4 cm dilated and very effaced or thinned out. The next time she started contracting, we believed she would then kick into the active phase and be in actual labor. We recommended an acupuncture treatment which often helps women who are past their due date to go into active labor. This seemed to work and several hours later her contractions were fairly consistently 5 min apart and her water broke with a gush of clear fluid.

When I arrived, she was found to be 5 cm, which is nearly the definition of active labor, so I considered her in labor and began monitoring and encouraging her. After several hours I needed to decide if I should call in my assistant, so I checked her again and found her to be 7 cm. Alright! She’s moving along, slowly, but still making progress. About 4 hours later, when we weren’t getting a strong pushing urge, I asked to check her again, and found her to be 9cm – nearly there! At this point, though, she had been deprived of sleep for about 5 days and been in active labor all night and she was exhausted. She didn’t want to eat anything and just had very low energy. About 5 hours after that, she was still with an anterior lip (considered 9-10 cm, just a small part of the cervix remains and can be manually pushed back while the client pushes the baby down – as long as the baby does move down when she pushes. Alternatively, it will resolve on its own as the baby moves down with the labor.)

By now, she was so exhausted that her contractions had stopped coming regularly and were likely not adequate by definition. She would have benefitted from Pitocin labor augmentation, but that was not an option. So we attempted to use the breast pump to help naturally increase her oxytocin levels, but she did not like that idea and didn’t want to do that. Our only hope was to try to get her to push the baby past the lip. During one of the pushing attempts, a copious amount of thick, greenish-brown fluid came out and that made the decision to transport urgent and obvious. She had some disturbing decelerations once she was hooked up to the monitor that we had not detected at home and due to her exhaustion she just wanted to have a cesarean at that point – even though they offered her the possibility of Pitocin and an epidural. I do not consider a hospital delivery a bad outcome if both mommy and baby are whole and healthy.

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