FOREMOST--this had absolutely nothing to do with the fact that she was delivered by a midwife, or that she wasn't born in the hospital but at a birthing center. The center itself had everything that a standard delivery area would have, with the exception of more specialized equipment like ultrasound. And the center is literally just a few minutes to the hospital by ambulance. Christina is a nurse midwife, and as most of us who gave birth in a hospital can attest to, it's
the nurses who do most of the labor and delivery, even in a hospital. Heck, I never even saw the physician who caught Holly, and even with Savanna, Dr. Joe merely swooped into his gloves and caught her.
So what happened is this...
Holly and Emma had a lovely pregnancy, with no real problems outside Holly having a bit too much glucose in her urine. She watched her sugar intake through the pregnancy, and she never had high blood glucose, so no diabetes. Her ultrasound at about 4 months showed nothing unusual, and she gained about 40 pounds--a bit much, but not terrible.
Although she had a long bout with off-and-on labor (even going to about 90% effaced), she didn't go into "real" labor until she was 12 days past her due date. She was very antsy about the possibility of having to be induced, and said she just had this gut feeling that doing that would be a bad, bad thing. When her water broke, there was no big gush, but it was quite a relief in a way, because we knew that she'd made it before the 2-week mark, after which Christina wouldn't be allowed to deliver Emma.
Labor went extremely well, and with Nicky's help, Holly was able to ride out almost all of the active phase of labor at home--you can not imagine how much easier this is to do with a doula. I highly, HIGHLY recommend them, and I truly believe that staying at home where she was more comfortable made the labor go much faster. Big pains started at around 6 pm on the 27th, and by 2 am, she was having to try hard not to push, so off we went to the birthing center.
When we got to the birthing center, we had just enough time to get the water into the tub while Christina examined Holly, and it was really time to push. All went pretty well, but near the end, Holly felt a strong sense that she needed to get this done, like...NOW. Emma was born at 4:55 on September 28, 2009. By the way I (GRAMMA) cut the cord. A bit of wow, a bit of ICK. Special, nonetheless.
Emma was a bit gurgly, and when Christina aspirated some of the fluid, it was lightly stained with meconium--which meant that pretty late in the birth process, she had a bit of distress. This is what ultimately led to Emma being put in the NICU for a week. With swine flu being so prevalent here, pediatricians and hospitals are being extra cautious with any patients with respiratory issues, so even though she was much better after 24 hours, they kept her in for the full 7 days.
The placenta was stubborn. 30 minutes of nursing Emma, good strong "ejection" contractions, but still no placenta, and Christina was getting concerned because when she tugged lightly on the cord, it appeared not to be too strong--so she couldn't do that anymore. She started pitocin to help it along and help slow the bleeding. And finally the placenta was
delivered, but it was obvious that there were still some membranes hanging on in there. After getting her somewhat stable, she took some time while fluids were going in by IV to give us a little show and tell on the placenta and the cord.
Turns out that Holly had a "battledore placenta" and a "partially velamentous cord." I'll explain.
This is what a normal placenta looks like compared with a battledore placenta. See how in a normal placenta, the cord inserts in or near the middle? Notice that in the battledore placenta, the cord inserts at the side. This is generally not much of a problem by itself. (These images were taken from the Frontiers in Bioscience Journal and Virtual Library in a subsection under Encyclopedia: Reproduction called "An Atlas of Xenopus Embryogenesis".)
The problem here was that "partially velamentous" cord. Normal umbilical cords contain veins and arteries surrounded by a thick tissue called Wharton's jelly--this is the tough stuff that normally protects those blood vessels from pressure and keeps them intact. In velamentous cord insertion, as you can see above, the blood vessels emerge from under the Wharton's jelly and snake through the membranes until the reach the placenta. I've made a red line in this picture to show you approximately where the edge of the placenta is. These exposed veins and arteries are risky because they can rupture. According to all the professional, medically-sound sources I've found (and not just on the web), the highest incidence of these vessels rupturing is during amniotomy--the artificial rupturing of the amniotic sac--which is routinely done during artificial induction in the hospital. It is said that it only takes a few minutes for a baby to exsanguinate (that is, lose all her blood) in these cases. It is a bit eerie to think that this would have been entirely possible if Holly would've had to be induced.
As it turned out, natural birth led to perhaps more maternal hemorrhage, but perhaps not. And in any case, Holly's recovery was better in the long run for having natural childbirth because she didn't have the complications associated with emergency C-section. Emma may literally owe her life to her mother's decision to go the natural childbirth route (and the courage to go through with it!)
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