Bobbi's labor started early on Sunday Sept 16th with some mild to moderate contractions and the gradual loosing of the mucus plug. Jack called me at 8:00 a.m. that morning to report Bobbi's condition and we discussed some early comfort measures. While Jack went off to church Bobbi and I kept in touch by phone. By mid-day the contractions had stopped and Bobbi was able to rest and await the start of the rest of labor.

Labor started again Monday morning at 4:00 a.m. Jack called me at 8:00 a.m. to tell me that Bobbi was having contractions that were becoming increasingly more intense. We agreed to be in touch by phone while Bobbi and Jack tried some comfort measures at home. I checked in with Jack and Bobbie at 8:45 a.m. Bobbie was comfortable in the tub with candles and music playing, her contractions were 8-10 minutes apart. At 9:40 a.m. Jack paged me while I was dropping my kids off. When I finally reached him at 10:00 a.m. he said that Bobbi was not okay and they were on their way to the hospital. It turns out that Fairview Ridges was full and they were being sent to Methodist. We agreed to meet at the hospital.

When Bobbi and Jack arrived at Methodist Hospital at 11:10 a.m. Bobbi seemed to be doing a lot better handling the intensity of her contractions. They were admitted to the triage area and Bobbi's cervix was checked, she was 2 cm dilated. Shortly after that we were taken to room 348 for the duration of the birth. Patti, the labor nurse, put the fetal monitor on Bobbi to get a reactive strip of the baby's heart rate. We got Bobbi to sit on the birth ball so she could stay mobile during contractions. Unfortunately while Bobbi rocked on the birth ball the monitor moved with each contraction and the reactive strip of the baby's heart rate was harder than usual to obtain. Finally after an hour on the fetal monitor the sub-nurse, Nissa, decided that the strip looked reassuring and let Bobbi remain completely mobile. It was now 12:40 p.m.

Bobbi felt best when she could be up and moving during contractions. When a contraction came on Jack got into position at Bobbi's back and gave her a very intense pressure massage on her sacrum for the duration of the contraction. I stayed close by and made sure Bobbi drank plenty of fluids and suggested position chances. At 1:10 p.m. Bobbi had a bout of nausea and vomiting during some particularly strong contractions. During this phase of the labor Bobbi seemed to feel most comfortable while standing and leaning on the birth ball. It was about this time that Bobbi first asked for pain medication. I was quick to suggest that Bobbi try the shower or bathtub.

Bobbi got into the shower at 1:40 p.m. and spent the next 20 minutes relaxing while listening to Jack sing. I held the hand-held showerhead during contractions while Jack massaged Bobbi's back. Contractions were now 45 seconds long and were 3-5 minutes apart.

When Patti, the regular labor nurse, returned from her lunch break she encouraged Bobbi back into bed to get a more accurate read of the baby's heart rate. She also explained that she wanted to a speculum exam to confirm if Bobbi's water had broken or not. This required Bobbi to be almost flat on her back in bed, which proved to be the most painful position for her. The entire procedure took 40 minutes. Bobbi was 4 cm dilated, 100% effaced and the baby was at 0 station. Despite Bobbi's disappointment, good progress had been made.

Bobbi got back into the shower for the next two hours. We developed quite a lovely rhythm in the shower. Jack sang and massaged, I ran for water, juice and candies and held the showerhead on Bobbi's back and belly and Bobbi labored beautifully. She got out of the shower at 4:00 p.m. to get checked and have the baby monitored. It was at this junction that she became very discouraged and felt like she really needed medication.

Patti checked Bobbi's cervix and she was 4+ cm dilated and 100% effaced. Since Bobbi didn't perceive adequate progress she opted for the epidural. Despite her disappointment she did a wonderful job laboring for 12 hours without any pain medication. An IV was started and bolus of fluid put into the IV. Dr. Swanlund, the anesthesiologist, arrived and inserted the epidural at 4:45 p.m. Later, OB, Dr. Schaffer checked Bobbi's cervix at 5:20 p.m. and she was 5 cm dilated, 100% effaced and baby at 0 station.

By 6:10 p.m. the Dr. noted a few decelerations in the baby's heart rate following some of the contractions and suggested breaking the bag of water to move things along. Jack and Bobbi wanted some time to think about the consequences of this procedure and decided to wait. The Dr. ultimately broke the bag of water at 7:00 p.m. and reported some light meconium staining. We were a little bit past the 12-hour mark for length of labor and Bobbi was starting to feel discouraged. She was unable to sleep for any significant period of time and was questioning the decision she made to get the epidural.

Paula, the new labor nurse, arrived at 7:00 p.m. She inserted a catheter to empty Bobbi's bladder. We all rested and waited for the hard work ahead. Bobbi's cervix was checked at 8:00 p.m. Instead of progress, Bobbi's cervix at this measurement seemed to be thicker. Paula believed the cervix to be only 80% effaced and still 5 cm dilated. We did some positioning in bed getting Bobbi in a half-nelson in order to widen her pelvic outlet. By 9:00 p.m. the new OB, Dr. Brown, came in to check on Bobbi's progress. Still 5 cm, 80% effaced and baby at +1 station. A permanent folly catheter was inserted at this point and Bobbi was turned to her right side.

The reliability of an epidural is always unpredictable and in this case it was no different. At 9:50 p.m. Bobbi was feeling a lot of pain in her back and the front of her abdomen. We moved her on to her back lay her flat. The anesthesiologist on call, Dr. Boyd, came and administered more medication into the epidural and upped the rate of flow.

Ever since the epidural had been inserted, the talk of augmenting the labor with pitocin was on the table. Jack and Bobbi were clear about the preferences for the birth of their baby and were leery of an augmentation. They were concerned about how another intervention would affect them and their baby? The pressure became to great and at 10:50 p.m., Bobbi and Jack decided to augment the labor with pitocin. The pitocin was started at 11:20 p.m. By 12:00a.m, only 40 minutes later, the baby was experiencing some late decelerations in its heart rate following a contraction. It was decided to turn the pitocin off at 12:15 a.m. About the same time Bobbi started to run a low fever and was give two different antibiotics. At this time Dr. Brown ordered an internal fetal monitor and an intrauterine pressure catheter be inserted so they could more accurately the baby's heart rate and the intensity of the contractions.

With each passing hour and little or no progress in Bobbi's cervix, Jack and Bobbi got more and more discouraged. Jack held out the most hope for a normal vaginal birth but the odds were becoming stacked against them. At 1:00 a.m. a cervical check revealed 6 cm dilation, 80% effacement and baby at 0 station. The baby's heart rate had returned to normal and the pitocin was turned on again. We all lay down and tried to sleep.

Between 1:00 a.m. and 3:00 a.m. the baby showed quite a few 'lates' related to the pitocin induced contractions. Paula checked Bobbie cervix and found no change since the last check. No progress had been made. Dr Brown was called in to discuss with Jack and Bobbi the possibility of a C-section. Jack remained optimistic while Bobbi got emotionally ready for a surgical birth.

The process of finally making the decision to have their baby by cesarean section was one fraught with much emotion and angst. Ultimately Bobbi and Jack had their baby's best interest in mind but they came to their own decision in very different ways and in different time frames. What they needed most to do was to pull together and celebrate the sacredness of their baby's birth day and be joyous in the birth whichever way it happened. I spoke to them about what I was seeing and hearing in both of them and then gave them the space they needed to come together for their baby's birth.

Jack and Bobbi made the decision to birth their baby by cesarean section at 4:30 a.m. The pre OP preparation was done swiftly and Bobbi was wheeled to the OR at 4:55 a.m.

Jack and I were escorted into the OR at about 5:05 a.m. just as the surgery was starting. The birth was swift and relatively uncomplicated. Kara Mae Conrad was born at 5:35 a.m. on Tuesday September 18th, 2001 after 25 1/2 hours of labor. She was 8#, 3oz, 20 inches long and had a 14-inch head. Her APGARS test measurements were 1 and 8 at 1 and 5 minutes. She was kept in the level two nurseries for a period of time after the birth because of meconium staining in the fluid and labored breathing. Kara Mae lay in an oxygen tent at 28% saturation. She was brought to Bobbi's room at 12:00 pm when her breathing was stable and she had been weaned off the oxygen.

Joyfully Submitted,

Emme Corbeil CD (DONA)