Ryland James

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                                   Before Ryland was born, we had moved to the Dubuque area. This meant deciding if we would                                         drive 80 miles to continue with the same midwife who had cared for us during my previous births                                       or transfer care to a local provider. Hospital-based midwifery care had been a great fit for me in                                       the past, so I looked into options in Dubuque. Unfortunately, access to this type of care was very                                         limited. There was only one CNM offering prenatal care, but she was, understandably, limited in                                       on-call hours and client-load. Ultimately, we chose to travel to seek care 80 miles away.

 

On Thursday, January 10th I had my 39-week appointment. My midwife palpated and told us that baby was head down, but might be “hung up” on my pubic bone. Later that afternoon I began having contractions. I was trying all the things to determine if they were the real deal – these were unique in that they were the most intense when I was laying down. I called my midwife that evening to give her a heads up and let her know what my body was doing. She thought the way contractions were going was likely due to baby’s positioning, and I agreed – deciding to work through Miles Circuit. The pattern continued with contractions getting to be 4-5 minutes apart and intense enough to require concentration. The signposts we knew to watch for from our Bradley Method classes were not there, so we decided to go to bed. I didn’t sleep much that night, as contractions were too intense to settle into a good sleep. They eventually went away at around 2:00 a.m. Friday morning.

I had agreed to provide an update, so Friday morning I called my midwife and agreed to go in and evaluate how things were going. With the long drive, and impending winter weather, as well as the fact that I was a multigravida, we both wanted to assess my body's progress. At the appointment, my midwife palpated and determined that baby was likely, as we thought, still hung up on my pubic bone, unable to put appropriate pressure on my cervix. Because of this, my contractions were likely not productive in dilating or effacing my cervix. Instead my body was trying to encourage baby into position.

Around 10:30 p.m. Saturday night I was experiencing a contraction pattern of low intensity contractions every 5 minutes. Contractions subsided around 3:00 a.m., and I was able to sleep. I did not return to a pattern on Sunday, but did have a few mild contractions here and there throughout the day. I was able to sleep Sunday night!

4:20 a.m. Monday morning I woke up with a contraction every 20-30 minutes until around 7:00 a.m. Throughout all of this, contractions came more when I was laying down. Then contractions subsided. With the knowledge of baby’s position, I tried some rebozo techniques on the birth ball. Around 11:00 a.m. we decided to drive again to see the midwife. She palpated and I consented to a vaginal exam. Not much had changed. Monday night contractions picked up again. This time, they were more intense. Around 10:30 that night they had settled into a pattern of being 1 minute long, an average of 3 ½ minutes apart, and had been doing this for a little over an hour. 

It was an icy night. We called Jason’s mom to come stay with the girls. She got to our house around 2:30 a.m., and we started our drive. Contractions spaced out to coming every 4-6 minutes on the drive. I was uncomfortable, but managing. We arrived around 4:00 a.m. and they took us right to our room.  My contractions were now every 3-4 minutes. As the nurse was trying to get initial readings I requested that she not “check me in”, as we might be going home based on my contractions spacing out. At this point there was a “pop!” and my water broke.  

 

Around 7:00 a.m. contractions started to become unpredictable – over the next 6 hours I’d have some 4-5 minutes apart, and sometimes I’d have 20 minutes or an hour with no contractions. During this time we were walking, bouncing on the birth ball, using the breast pump, and trying to get contractions going. A partnering midwife came in to try side-lying release and some rebozo techniques to move baby off my pelvis. My midwife came in around noon and was concerned about my lack of contraction pattern and progress. She suggested that we may need to try Pitocin. We asked for more time and she left for a while. She came back with an idea to use a rebozo tied to the hospital bed rails to lift my belly as I sat upright - an energy-conserving way to do an abdominal lift. This seemed to get contractions going a bit better. I hung onto this position for a LONG time, even though my butt was numb, because it was giving me some contractions. Our midwife left while we tried the abdominal lift, but later came back and suggested again that we needed Pitocin. At this point I had been laboring off and on for days, not sleeping, and in labor for 16 hours (9 of those being at the hospital). She was concerned that I was fatigued and explained that she needed me to have energy for second stage. At this point around 2 p.m., we consented to prepping Pitocin. I was upset, but calling on my relaxation skills I had learned in our Bradley classes and willing my body to contract.

As the nurses were prepping the Pitocin bags and setting up the wireless monitor, I noticed a couple contractions in a row. At this point I felt strongly we needed to ask for more time. We again leaned on our Bradley training, asking the nurses if we got contractions going again, could we hold off. They said, “Sure, if you’ve got contractions, we’ll leave you alone.” They abandoned the IV pole, Pitocin, monitor, and supplies and left the room. From then on, my contractions were all a minute+ and coming every 3-5 minutes. I was SO exhausted, but SO happy to have contractions. At some point we finally felt confident enough in my contraction pattern to move out of the abdominal lift rebozo position. I labored on the bed using a birth ball and a peanut, and I spent time laboring on the toilet.

 

I remember laboring on the toilet and feeling so exhausted and a little bit bitchy. I remember asking our midwife if baby boys were usually this ornery in labor. I remember her reassuring me that baby was safe, and I was safe. She reminded me that every baby’s journey is different and this was the labor he needed. These were the words I needed to hear. At some point I walked out of the bathroom and stood, leaning on the tall bedside table. I remember my legs shaking and feeling really cold. I knew from our training that this was transition!

 

In second stage I wanted to try pushing on hands and knees. I tried for a bit, but my legs were too tired to be comfortable. I turned on to my left side for pushing. I remember communicating that I was having some pain with pushing. At my request, my midwife checked, and I had a lip of cervix. I consented to her manual manipulation to allow the lip to move back. Contractions spaced out to 8 minutes apart. After a little push or two, I remember hearing his heart rate dip really low. My midwife said, "OK, now is when I need a good strong push." I pushed with the peak of my contraction and Ryland James was born at 8:18 p.m. on January 15 at 7lbs. 15oz. Ryland was placed on my chest where he snuggled in and began nursing. 

 

(Ryland was born with a nuchal cord and pressure on the cord was likely the cause of the drop in heart rate. I remember as he was born the nurse exclaiming with alarm, “There’s a cord!” and Jason tells me that the midwife shot her a look while already calmly slipping the cord over his head. Nuchal cords are common, and only rarely cause for concern.)