At Home with Kelly + Tiffany
At Home with Kelly + Tiffany
Ep 184. Birth Story: She Pushed for How Long?!
Join us as we discuss an intense, yet victorious birth story from our midwifery practice in San Diego, navigating gestational diabetes management, labor challenges, our longest pushing phase we have supported as midwives, and the journey of a firmly committed and focused first-time mom.
01:09 Diving into Birth Stories
02:04 Reflecting on Midwifery Practices
08:59 Client's Journey to Midwifery Care
10:10 Managing Blood Glucose Issues
17:44 The Birth Story Begins
23:05 Navigating Early Labor Challenges
23:22 Rest and Reassurance
23:54 The Importance of Patience
24:13 Encouraging Progress
24:41 The Power of Support
24:56 Midwives' Tools and Techniques
25:35 A Critical Nap
26:00 Reassessing and Adapting
26:41 Pushing Through Obstacles
27:26 Facing Position Challenges
29:01 The Final Push
30:44 A Hard-Earned Victory
32:10 Reflecting on the Birth Experience
40:41 Postpartum Reflections
42:58 Empowering Future Births
46:40 Community and Support
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Welcome to at Home with Kelly and Tiffany, where we share powerful tools, exciting education, and relatable views about holistic health, physiological birth, and thriving in the female body. We are home birth midwives in sunny San Diego. Passionate about the alternatives that give women control and confidence in health, in birth and in life. We've poured a lot of love into creating very in depth and high value offerings. A monthly membership, a physiological birth course, and holistic guides for the women who really want to dive all the way in. But this podcast. We want to bring zero cost information about health and natural birth and make these important topics accessible always. Your support of the show is also zero cost and means everything to us. When you leave a review, share an episode and join our newsletter. It really helps us keep this space open, ad free and full of honest, valuable conversations. Now let's dive into today's show.
kelly_1_07-31-2025_092847:Welcome back to the podcast at home with Kelly and Tiffany, and we have a great one for you today. One of our favorite things to do are share birth stories. So we have a wonderful birth story to jump back into. We're just excited to be here with you. I'm so happy that we started incorporating these birth stories into this space. We love sharing them on Instagram and always get feedback of wow, I love seeing birth from this different perspective as we are sharing what we are seeing and things like that. And so this is another just cool way both. Professionally to share some things and to educate and to, you know, just give some ideas to women of oh, that happened in my pregnancy. Oh, so interesting. That's how they handled it. But also just personally because it's a little bit of a walkthrough memory lane of what was going on at the time and our own lives and things like that. So, excited to jump into this one.
tiffany_1_07-31-2025_092846:I know I could do birth stories every single episode. It would be my greatest desire. I recognize that. Women want well-rounded information. And the I it, I feel responsible to share information about other health pieces for women. But the birth, I mean, even just compiling the research, quote unquote, reminding myself what happened at this birth. I was like, I love this. I love this. And this was one of those births that. Groom me as a midwife tremendously. And I love the, I love how birth does that. I just, it's so good for everyone who's around it. It is just the ultimate. The ultimate, like leveler, the ultimate, ah, it's just so good.
kelly_1_07-31-2025_092847:Oh yeah, absolutely. I'm excited to get into some of the details, both even prenatally, but especially the birth itself. I remember thinking like, wow, her decision to choose this type of care, like at the different points along the way, changed so much of the outcome, right? And not oh, look how great we are, but just. Just the fact, like her choices that she made months prior to her birth itself absolutely impacted how the birth itself was supported and seen and all of it. And so it's it's just cool to consider.
tiffany_1_07-31-2025_092846:I know I love it. I can't wait to share with everybody first. I'm gonna read a review, okay? This is from Isabel Beach. She says, best podcast ever. Five stars. Off to a good start. Then she says, the friendliest, funniest, most educational podcast on women's health, pregnancy, postpartum, et cetera. From a holistic perspective, I've learned so much from Kelly and Tiffany and laughed a lot along the way. They have obviously put so much work into making an awesome resource for the world. Great job ladies, and thank you. A must
kelly_1_07-31-2025_092847:The world. The world. I love it.
tiffany_1_07-31-2025_092846:The entire world friendly and funny. I mean,
kelly_1_07-31-2025_092847:you want?
tiffany_1_07-31-2025_092846:thank you everyone obviously have put a lot of time into this resource. Thank, I'm glad that shows, I can imagine a world in which it might not show.
kelly_1_07-31-2025_092847:Yeah. It feels good to be seen and encouraged in this as we work diligently behind the scenes.
tiffany_1_07-31-2025_092846:Okay. Getting into this birth story, the last one we shared, we were like, honestly, the birth was uneventful and here's a couple of interesting things that like happened along the way, but birth can just be really simple and straightforward and I don't know, un noteworthy. But this birth,
kelly_1_07-31-2025_092847:Vy.
tiffany_1_07-31-2025_092846:birth is noteworthy. This birth was. It was crazy. This birth to me was crazy. And I recognized while I was going through this chart there's things I remember about this birth that we did not chart. And I'm wondering why were we very busy? Did we not want a permanent record of it, did we, am I remembering it wrong? About the.
kelly_1_07-31-2025_092847:Yeah, that's an interesting thing too. There's been a couple of those times where I've gone back and be like, oh that's how we thought about it. But in my brain, I thought about it differently and. You know, we've talked about like people getting their medical records from their births, you know, from like the hospital and being like, oh, I'm like underwhelmed.'cause I remember all this extra stuff that wasn't put in there. We're usually, look, we're very diligent in what we add and a lot of mom said, this mom moves to toilet, you know, whatever. It is just interesting what might have been in there or what might have been missed.
tiffany_1_07-31-2025_092846:Yeah, so we're always doing our best, that's for sure. There's some things that I like had questions about, so as a more seasoned midwife now versus looking back, this was, this birth was the very beginning of our second year of practice, I think. Oh. Second, maybe
kelly_1_07-31-2025_092847:Probably second.
tiffany_1_07-31-2025_092846:I don't remember.
kelly_1_07-31-2025_092847:I don't remember exactly, but.
tiffany_1_07-31-2025_092846:Maybe second. so, it was hard to say'cause the first year we only had a few, the second year is when we really got going. So I think this might have technically been the third. Third, technically the third year. Nope, second. Sorry. I
kelly_1_07-31-2025_092847:Oh.
tiffany_1_07-31-2025_092846:date on it. Second year of practice. Very passionate, very skilled, very highly trained, very ready, totally competent. But there was things that now grownup midwife Tiffany,'cause I was responsible for the charting at this birth that I would look at now and say. What is, what are you trying to say here in the chart? What do you This no. Tiffany, what? What do you mean that's not enough information? How, in what way? So that's good because I also noticed that there's things that we chart, which is a funny thing about using these charts in order to create these episode outlines. There's things that we would chart better now, and then there's things that we just have really let go. don't know if we're throwing ourselves under the bus here as providers, but as you start to get more comfortable, and we're not doing 36 births a year anymore. So what was funny is we have a entire call log of information of when we talk to this client on the phone in pregnancy or an important email or something like, we documented all of that. And it's just inter, that was interesting to me where I'm like, wow, that is really thorough. Really thorough to have all of that documented and responsible and good, right? Yeah. But just not something we would take the time to do anymore. Un you know, unfortunately, we just
kelly_1_07-31-2025_092847:Yeah when you're busy too, you have a lot of systems and when you be, when you take some of those pieces off your plate, not that like it's all helped or skelter or whatever, but there's just not the same. Systems, I guess, in place. And the, our ability to communicate, because we're dealing with so few clients clinically right now, our ability to communicate together is just much simpler and straightforward, rather than needing to go back and do that over, you know, so many clients at once.
tiffany_1_07-31-2025_092846:Yes, and especially when there was three midwives working in the same practice, there was things happening that we were not a part of but needed to catch up on, or there needed to be a record of it for the benefit of the other provider. And so, yes, there's a time and place for that, but how nice that I can remember most of the conversations I have with our clients now. I can tell you about them instead of writing a really detailed note and you can be like, okay, cool. Thanks for letting me know. Which is just interesting to see how things evolve over time and are constantly, you know, in flux and changing. I hope that. Younger midwives or midwifery students hear that and think, oh, okay, so there isn't one way to go. There isn't just my preceptor's way and the best way to document and chart and take care of people that way. Okay, so the history of this particular client, she actually didn't come to us until she was over halfway through her pregnancy. She was 23 weeks pregnant with her first baby. She spent her first pregnancy getting care through Kaiser, and we didn't chart why she wanted a home birth. We didn't chart why she decided to come from exclusively Kaiser care into midwifery care planning a home birth. Do you remember?
kelly_1_07-31-2025_092847:I don't actually remember what her words are, but I do know that was an important aspect at this point in our practice of asking about that. And I recognize that. I don't necessarily remember her reasons. They must have been compelling enough that we were like. Yes. I have a feeling it has to do a bit with how medicalized her pregnancy had become over time. You know, just with the different issues that she was dealing with.
tiffany_1_07-31-2025_092846:Yeah, and so she had been in the medical system a little bit already. She had a history of PCOS. She was on some medications for blood glucose control. She had an early pregnancy blood glucose test that was totally normal. She had an A1C that was totally normal. But we ended up dealing with a lot of blood glucose instability in her pregnancy and quickly we do our normal like gestational diabetes screening with our clients around 28 weeks. So within this first month of us just getting to know each other, maybe we only had one or two appointments before we had to tackle some really. Serious discussions and conversations about keeping her as low risk as possible in order to stay in our care. But with that PCOS, polycystic ovarian syndrome, it's really common for blood glucose issues to go hand in hand. It's really common for fertility issues. There's just like a whole entire symptom picture there that. We can't go into, but one of those things was really long cycles, and so I think she would go like four or five months without having a period. And so as she was. Working on getting pregnant. We used or she used early ultrasound as her dating at six weeks or something, which is super accurate. We were able to establish an accurate due date with that. We talk with our clients a lot about having multiple factors of information when establishing a due date, and sometimes that early ultrasound is part of it. Sometimes your own knowledge about your cycle and ovulation and fertility and potential conception is a part of it. How long your pregnancies have been in the past or pregnancies in your family history, like all of that can get thrown into dating stuff. And so she had this she had the glucose tolerance test with Kaiser and I had to remind myself.
kelly_1_07-31-2025_092847:why that?
tiffany_1_07-31-2025_092846:Why that ended up being a part of it, because very few of our clients actually choose the glucose tolerance test, which is standard in medical care. But most of our clients do some other type of gestational diabetes screening just because you can collect more information with other methods and stuff.
kelly_1_07-31-2025_092847:Yeah, what was interesting is because her, you know, her care had been through Kaiser and it made sense lab wise that she was like, I'm just gonna go make this kind of as easy and straightforward as possible. Or so she thought maybe for herself. But she did that GTT test and failed, and I remember her calling about that. And being really stressed out about it and saying, okay, they're telling me I need to take the three hour test. And she was like, I'm gonna do it. That's what I want to do. And I want to go, you know, continue to follow through what Kaiser is recommending. So she did the three hour test as well. Failed that one as well. So on, on our minds we have very spec, like specific parameters limitations. And so, you know, it's just in her heads, what exactly is going on here? What is she, you know, what kind of feedback is she gonna get? What is she going to need to help potentially stabilize some of her numbers? And so she was freaking out as well. And Kaiser basically is oh yeah, it's fine. Here's some information about some nutritional counseling, which was. Poor, from what I remember the nutritional counseling she was given was very different than what we had to eventually like work, you know, her towards, but they didn't provide her a glucose monitor. They basically said, here you go. Here's some nutritional counseling. We'll deal with this later, basically. And so again, we are like we care about the outcome of this. We care about how your body is responding. We care that you want this home birth. We want to be able to do this together as long as it is safe, as long as we can get some of these things stabilized. Through lifestyle things, right? That's our parameter here. And I remember a lot of back and forth on that nutritional counseling piece, how in depth we were with providing that for her, how in depth it was to get the feedback from her. But food really was a hard,, it's like a sticking point in this pregnancy. It was a hard. Aspect to nail down. It was a hard aspect to stabilize. She would swing quite a bit from what I remember from this, like hyperglycemic. Space to this hypoglycemic space. And she would come in and just be like I feel terrible, right? And so I'm doing these things, but then we would be like, Ooh, yeah, but that thing that you're doing isn't within these, parameters. Let's try to take that out, really work on this piece. And so at some point she was up to four, glucometer readings a day. And a food diary. So we know okay, you're taking this seriously, right? You're really working hard at this. And we just continued to tweak, Hey, we're seeing this. Let's just take that out completely. Let's swap these things out. Let's make sure we're considering these things. Here are all the supplements we recommend. Here are the lifestyle things we recommend for you to get that stubborn fasting number,, more in control and eventually. W again, with a lot of work on her part, it did start to stabilize. And I remember being like, oh, thank you. We could see that it had the possibility, but we had to work very hard. But on both ends, I mean, she had to work so hard for, food and lifestyle stuff, but we did too in order to partner together to make this not only just outcome happen, but just a an opportunity for her to feel better and for her to have. The healthiest pregnancy that she could.
tiffany_1_07-31-2025_092846:Yeah. And in our call logs, we were touching base with her every two days. She was sharing her food diary and her blood glucose readings and we were troubleshooting with her like, okay, that was a little bit too much of this. Let's try to back this off a little bit, add in some more fat maybe not that first thing in the morning. And it was just. So much tweaking. And that can be really overwhelming for women. It becomes a total part-time job. Food is really mental for women and emotional. And when you're pregnant, there's just an extra sensitivity to blood glucose screens and just, or swings. And wanting to just do the best thing for your body and your pregnancy and for your midwives to have to say, I know that your Kaiser doctor doesn't care about this because. To them, you're borderline. But to us, we have to care about it. We have to put these things in place. We have to keep you as stable as possible. Our limitations are different. Our parameters are different. The way that we're, our resources are different. We're gonna have a your baby at home. It's lower resource. We need to be sure that this pregnancy is. As tight as we can be on some of these things. And so that's the beauty of midwifery care, but also can just be tedious and more of more responsibility too, and a lot to a lot to take in stride. And it's your first baby. So your first baby, you're already having some of these complications. You're, it already feels like a miracle that you're pregnant at all. And just ha just having a lot. But what it did is it strengthened our communication. It gave us a lot of touch points with this particular client who came into care late. It gave us a lot of opportunity to establish relationship and communication and expectations and figure out how to work together and how to communicate. So before the birth even starts, we're laying this groundwork, we're laying this foundation of, are you in? I'm in. How In Are You? Okay, I will match that. And that piece, that thread really carried in to her birth. And so I'll get into it because do you see how many notes I wrote about the bird?
kelly_1_07-31-2025_092847:Oh, and then there was this, but also this, but don't forget this. And also this thing happened and this went on for this long. Yeah.
tiffany_1_07-31-2025_092846:I know because I'm just like, this was a, it wasn't the longest birth we've ever been to, but it was really, it was long. It was really long. So it started out actually crazily optimistic. It was like too good to be true. Because I think on her due date or the day before, her due date, the night before her active labor started, she was starting to have contractions and they went into the evening and the next morning around 5:00 AM I think we may have not even known that she was in labor. May, maybe we did. Maybe we had the heads up.
kelly_1_07-31-2025_092847:I remember getting I was the one who got the call at 5:00 AM and I was like, oh, bless you for not telling me at 10:00 PM like, Hey, I might be in labor'cause I would be up all night thinking about it. But yes. Yeah, continue.
tiffany_1_07-31-2025_092846:Yep.. So it's actually her doula who calls and her doula was a, is, was, is still a great friend of ours and someone that was easy to recommend.'Cause we like working with them and we know that they'll do really well with our client. She calls us herself and she says, Hey, I've been here for a while. This person has been laboring all night. Her contractions are strong. This is a very experienced doula. Her contractions are really strong. Her water just broke. And she's saying she has a lot of pressure, so I think you need to come here right now. And we're like, whoa. Maybe this'll be one of those primates, one of those first time moms that just has a really straightforward, quick labor. And so we're trying, we, we know that might not be the case, but we have lots of signs that everything is going really quickly, and so we're like, okay. Let's be cautiously optimistic and I remember we rushed to her house. We got there around 6:00 AM We observe with our own eyes. Oh, she is very active. Oh, while we're setting up our equipment, she's starting to grunt at the peak of every contraction. We do our normal intake and assessment. We always offer a vaginal exam. But we. We don't recommend it necessarily. It's just this is information. If you'd like to have it, it's available to you. It usually doesn't help at this point. But she declines it and we're like, yeah, who needs to know what's going on in there? All your external signs are absolutely beautiful and amazing. We are so good. To just hang out and wait and see what happens. Even if you don't have a baby for a few hours from now, everything's progressing so smoothly for you. She was coping really well when the midwife team arrives, it always makes everyone excited oh, this is actually happening. And so there was like a lot of that going on too. Kelly, you mentioned that you got the call'cause you were the primary, so that means that you were like in charge of the birth. I'm sure we've explained our roles before. To our audience as we're describing Bruce, but
kelly_1_07-31-2025_092847:at the time, I forget if it was like by week or something, but I was the one who was like first call basically. But from the information I was given, I was like, I'm not going to just show up by myself'cause it sounds like we're about to have a baby. So I called you and we came and I I remember thinking, oh wow. Like she's. It seems like she's going to have a baby soon, but we don't we don't say that, right? We say trust your body, listen to your body, all of those things. And we were there for a couple hours at the time when we were like, okay, like we're not really. We're not really going forward. We're not necessarily going backwards, but we're just in this same space here, right? And we're like, okay, all of this pressure that you're feeling like that is, that's a normal thing. Your baby is, coming down, coming through and here's how we best can support you in that. So she was grunting and almost bearing down. We were like, Hey, you can blow that out if that feels right too. She began doing that for a while. And then. Eventually, again, a couple hours later after that, she's oh, the pressure is like more intense when it's there, but it's not there all the time either. And so I rem I remember at the time being like, oh, I wonder what position her baby's in. I wonder, what we're up to. And her doula was thinking the same exact thing. Her doula is incredibly skilled on positioning stuff, so she's we're just gonna go ahead and work on some of these things. I'm not gonna tell her that she's working on pushing her baby out. We're just gonna get into these different positions. But already around 11 or so, she's already getting tired, right? The mom is, she's been up all night working so hard. We've been there for right, like six hours, five hours, whatever. At this point, she's I really, I thought I was gonna have my baby. I really want to just like, can I just push really hard? We offer another vaginal exam, which she declines. But visually, I remember being like, we were able to see, she was laying down or something, or I forget if she was feeling it, but she felt, or we saw some labial parting, so we were like, oh. So maybe this is what we think it is, maybe this is what we're working on here. Maybe we are having a baby and we're just, working slowly. And I remember that specifically being like, okay, great. I guess, a vaginal exam really wouldn't like what exactly,, what exact information are we going to get when we're seeing some of these signs, hearing some of these signs outwardly. But as you can imagine. A woman in that position when she's just oh my gosh, I'm exhausted. I am, I'm ready just to have my baby. She's starting to feel really discouraged because she's dude, my, the intensity that is happening right now and the amount of pressure and my bearing down,, this is around, this is like afternoon already. And she's just feeling really discouraged. She's I don't want a vaginal exam. I don't want your fingers in there. My water has already broken. I'm trying to, decrease the potential for infection. Having that be another thing that's, on my list of things that I'm considering. And, she had been working really hard. So eventually, like around 1230 or so, we were like, here's what we're gonna do. Get into bed, be as comfortable as possible. Setting her up with as many pillows, and obviously contractions are waking her up, but she really does start to fall asleep during that time, which I remember stepping outside of, the room with you and being like, I'm so thankful that she is that she's asleep at this point. I'm so thankful that hopefully this is. Like us not being in there, us not talking about anything. Her just being able to rest and focus on that important part of the work of labor will be helpful.
tiffany_1_07-31-2025_092846:Yeah, and I, because we had charted so many times that she declined a vaginal exam every couple hours that was being offered to her. I'm sure that we were giving her counseling like. Everything you're doing is completely fine. We're totally patient. You're good. Your baby's good. You don't need this right now. But if you want us to try to understand what is happening, we have to get that information. I mean, we, because we're looking at, we now, we've been supporting all the external signs of the being it looking like you're getting towards the end of your labor. All that looks really positive. But now we're starting to get into the zone, especially with you saying that you're really tired. Where we might be, we might really be able to utilize that information. So I just imagine. I just imagine how much it takes for her to say, no, I actually want to trust my body. I wanna really feel and lean into what's happening in my body. I'm saying I'm tired because I am, but I'm frustrated. It really means I just need more support. It doesn't mean that I wanna give up. It's like this dance between all of those things and the, and honestly we can offer those tools and we can bring those resources in, but the most supportive thing we can do is wait. Especially for a first time mom, it's really common for that last bit of dilation to take some time just because the cervix is open. Just because she's feeling pressure doesn't mean that it's time to start pushing. There's so much going on in there that we're not trying to define an experience by what the cervix is doing at all, but this is definitely the point where we're starting to wonder if there's something more we can do to support her to prevent her from burning out later. In the labor, right? So she sleeps for a half an hour, which was probably so incredible. I'll just, I'll leave a teaser in here. This is not the last time we sent her to bed before she had a baby. But it was definitely needed. It's a, it's one of the tools that we use as midwives. Let's not always just be pushing things forward. There's your body's saying it wants rest, it needs something more. So she wakes up at 1:00 PM from her nap. Things are about the same, and she. Finally asks for a vaginal exam, and what we discover in the vaginal exam is actually really encouraging it. She was nine and a half centimeters. She had an internal or a, an anterior lip, which is part of the cervix in the front was not finished dilating, but while your hand was in there for the exam, Kelly, she pushed a little bit and that cervix moved out of the way. All in that. All in that one step. And then the baby moved down. You felt the baby move. Once the cervix moved out of the way, you felt the baby move down into her birth canal while you were in there. And so then she starts pushing with that and.
kelly_1_07-31-2025_092847:Try
tiffany_1_07-31-2025_092846:We try to be really accurate with our charting because it just, it matters. It's a medical record, but we wanna be really careful that we don't say something is happening that actually isn't. And so, even though she's feeling gruy, even though she was giving some bearing down effort, we did not chart that she started pushing until this point. It's one o'clock in the afternoon. Because now we know that her cervix is fully out of the way. Now we know that her baby's moved down a little bit. And that's when we charted that she officially started pushing at 1:00 PM And so Kelly, what happens an hour and a half later?
kelly_1_07-31-2025_092847:It was not a baby. I will say that she's continuing to push At this point, we're keeping our fingers out because the effort that she was giving, when my fingers were in, I was like, you are moving your baby. You're not necessarily pushing your baby right out with this one push, but like I can feel movement happening, right? And so about an hour and a half after that she's still pushing, she's resting, we're doing a ton of spinning baby stuff, right? Just trying to work with what she is doing. But we notice that her contractions start to space out a little bit. And so that like when she's laying down in particular, she starts to get a lot of rest. That is not necessarily a bad thing, right? That can be a very good sign that hey, we're getting closer. Your body's saying, Hey, I need to rest'cause I'm about to have a baby. And so we were like, let's just go with that. Let's try to get you as nourished as possible. Drink some water, eat some food. And yes, go back and take a little nap for a little bit because there's no, we don't need to force this. We don't need, like your baby is doing well, you are doing well. Again, a nap together with your husband cuddling in bed because your body's already wanting to give you some space in between these contractions is a good option here. So we just sort of were like, let's you two go ahead and do that. And she was able to do that for a couple hours. And I think we also probably took naps at this point, or, we're chilling, hanging out in a room right side, right outside of their room. But it was a good couple hours for her to start to rest and reset and the hope was that she would hope, wake up and push a baby out.
tiffany_1_07-31-2025_092846:I know we're just like looking for these, we're looking for this big switch, right? We're looking for this big ah, there we go. Applying time, applying patience, applying nourishment. That really is just gonna fill your tank up and then you're gonna just pop into. It being more obvious and straightforward, but it's four 30 in the afternoon. Again, she's getting to that place of I don't know how long I can do this for. It was, is what I'm doing even helpful? And so she asked for another vaginal exam. During your exam, you suspect that. There, the baby's head is just in a wonky position that like the neck is not, that the baby's chin is not flexed all the way down. Creating the most like aerodynamic space. And then feeling the suture lines on the baby's head. You. Think that what you're feeling is that the baby is ROP, which is facing towards mom's right side, but also sunny side up, which is a very difficult position to push a baby out in, especially for the first time, but also common. It's like one of the most. Common things that can make labor take a long time. So at this point in the labor, we've already been prophylactically supporting positional things, suspecting that's the most likely thing that's holding things up. But now we have it as like almost an official diagnosis. And so you're like, okay, we need to figure out how to work with this. We have already been sort of working to turn the baby and we will continue to do that, but I remember the doula who can love her to death, but she can be bossy and she did have this moment in this labor where she whispered to us. This is the way that this baby has to come out. We, if we could have turned this baby, we would've done it by now. She has to push this baby out op. And I remember thinking, I think you're right actually. I think you're actually right. We do. This is what we're working with and this is just gonna be hard and we need to be in it with her for that. So you actually kept your fingers in at this point and you were applying pressure and this, it turned into a whole, it turned into like a whole, we're gonna do whatever we can to just try to get some movement on this now. Like we just have to be working every single time. Every single contraction we're just in it and the hanging out and just waiting to see what the body does on its own. We're like, we're trading that out for now. We just need to try to preserve you having your baby at home because that window is narrowing so much because now we have some things stacked up against this whole thing. So you're applying pressure on where she should push like Totally. What we, have only learned from the medical model, right? Like somebody's finger staying in there and saying, here, push right here. Do you see I'm putting all this pressure on your rectum. Push against that. And she actually found that really helpful. So. I hope that women who are hearing this story can see how sometimes it's absolutely necessary to pivot, change directions, use a different set of tools. It's not gonna look like what we thought it was anymore. We have to almost let that dream die and just try to preserve the overarching goal.
kelly_1_07-31-2025_092847:And I remember having my fingers in there and saying can you feel this push against this, try to move my fingers, kind of thing. Again, things that I had heard in midwifery school at certain births that I was at was certain preceptors and midwifery school, but thinking, oh, this is really funny that I'm doing this. But they, the couple was so like. No, you, I want you guys to do all the things now. I know I declined everything, but now I'm going to say yes to anything, everything. I just wanna move forward in this. And I remember her saying yes, this is really helpful. But there wasn't really much change in how baby was coming down. And so I was like, well, I don't need to keep my fingers in here for, a long time or anything. And so basically what we did again was the doula took control of some spinning baby stuff and was still doing that, just given the information that I had gotten with. The vaginal exam. And she does that for a while, right? Probably, I mean, at this point at time, right? That was around four 30 where all of that was happening. And then around six 15. She asked for a vaginal exam again. She was like, please, will you just see if anything that I'm doing is working? And it was working in a specific way. So when I went in to do the vaginal exam, I was mostly interested because i'm like, your cervix is out of the way. I'm mostly interested in what your baby's, position is, where they're at, where their, head is. And this baby was directly op, meaning like directly Sunnyside up now. So that pushing and that movement had shifted baby a bit from that more. Position. But that was the moment where I was like, yes, okay, we are gonna have an op baby. We just have to work with what we're working with here. She, was. She wanted the information. So we spoke about that. We talked about that. And then she was still feeling this overwhelming kind of urge to push and all of that. So around 7:00 PM we're still working together, but then we start hearing a little bit of deceleration in babies. Heart rate comes right back up to baseline, quickly. But we're just noting that and we're like, Hey, we might listen more often. Hey, we're like being aware of this. And then, but we decided because she was so tired, because we were hearing these things, we're like, let's just give a little bit of a break for a little bit. Let's try to blow through your contractions for the next like half hour, the next hour. Potentially. Maybe that's what you need, right? To just relax your body, blow through that. We're not saying don't. Do what your body is wanting to do, but basically just blow through that rather than bring all of that energy down in like a pushing situation. And so she does that for half an hour or so, and at eight o'clock that night, she was like, I not push. And we're like, we are not going to, stop you from that. If you, if that's the overwhelming thing. But then, that's all going normal for the next like hour. Again, I'm just thinking of 5:00 AM us. So, so idealistic and all of that, but around 9 45 ish. So mom's been pushing for this hour and a half. She's I can't stop. Around 9:00 PM she's I am putting everything I possibly have into pushing. She's doing like the purple pushing that we often talk about Hey, you don't necessarily need to do that again. The pivots that we are making and this mom's willing to make, and the mom feels like she needs to make, and we're just,, throwing everything that we have at it at this point. But baby's heart rate is still doing a little bit of a thing. She's baby is, decelerating, but then coming back up to baseline, having a good recovery. And so we're like, okay, I think baby's doing okay, but also we may need to like mix. This purple pushing that you started doing in with a little bit more breathing, But thankfully we had a baby who was returning back, to baselines. And so we were listening pretty consistently at this point and telling her like, Hey, how about every other contraction? Will you push, breathe through the other ones and let's. Give baby a little bit of a moment because your baby's struggling too. They've had a long day as well. They're working very hard as well. But I do remember the moment where we discovered as we were looking at mom, laboring and all of that. It was around 9 45 that night that we could see the top of the baby's head. And so this baby was finally down far enough for us to be able to see what was going on. And that just felt so encouraging. But even seeing it, I remember looking at the suture lines and being like, okay, we're having an op baby, and we're just doing that. Obviously we still had some time to get to the end point, but that was around 9 45 and there was a little bit of a celebration that happened in the room, and then we all were like. And now we actually have, still have to get this baby out, so we gotta get back to work, right? And so we're listening a bunch, and then finally about a half an hour later, so this mom had worked for hours and hours to get her baby down. At 10 15, she birthed the baby's head and then the baby came out completely at 10 16. And I remember being like every ounce of things that was in my body was like, oh my goodness. I'm so thankful, not just like for how hard it was, but I'm just so thankful that this baby came out and this baby came out at home and this baby is okay. I do remember though, the baby being slower to transition and question, not a questioning that happens sometimes. We like to give baby as much time as they need to transition, but I remember being like, this looks like a baby who's been working hard all day as well.
tiffany_1_07-31-2025_092846:Yeah, and baby came out with meconium. It took a few minutes for this baby to like really come around. Clearly the baby was stressed. Clearly the mom was stressed. Clearly we were really riding the edge here. We were fully informed. I don't think that we were, I don't think we were playing. Too riskily with the situation. We were constantly in communication with each other, with the parents. They had full, appraisal and consent of everything that we were noticing and seeing. And we were just barely getting enough progress, barely keeping things stable, that it was appropriate to stay home. She was still appropriate for midwifery care. It was just like, we just need to get this baby out and. If things had changed in a different way or something had destabilized, I remember feeling very much on the edge of calling this birth for a transfer. Not because it was an, not because it was potentially turning into an emergency at all, but just whoa, how long? How far? How much can we stretch before? We're just giving a little here, giving little here, giving a little here. I think other midwives. Absolutely would have transferred. I don't think that would've been the wrong call either to transfer at this point. But that is not what the mom wanted, and we were willing to hang in there with her and see. And even though the baby was showing some signs of distress, the baby was not showing signs of being. Dangerously distressed. It was a normal amount of, Hey, my head's been compressed in the vagina for a while. Every time you pushed, I'm not getting the oxygen I want. It's taking me time to come around. But the baby came out, man. The baby came out. That was such a victory for everybody. It ended up being really important to the mom. So even though we have to reflect on these pieces in our care and the clinical aspect of it, and we have to take responsibility for places where we were riding the line on some things at the end of the day. The ultimate piece to me. And I mean, safety is important and of course that's what we're there for. But the ultimate piece for me is that mom saying. I would've, if I would've transferred, if we wouldn't have seen that through at home, my experience, my story would have been completely different. Completely changed, completely. She needed us to be in it there with her, and I think that was one of the strengths that you really brought Kelly to the team. Just in reflecting on my own, I remember feeling I'm not sure if we should keep doing this at home. And you believed in her. You saw enough progress that you felt like things were moving forward enough to just keep pushing and keep believing in her. And I mean, that was incredible. Really incredible experience. I was stretched a lot. Our skills were stretched and challenged a lot, and it ended up making a huge impact on this mom and her family,
kelly_1_07-31-2025_092847:And I think it's probably different having your fingers in and seeing some of those, you know, like some of those. Pieces. Not to say that there weren't moments where I was like I don't, I will never say nothing's something's impossible, but you're just like, how long or how long can we do this? How long can both of them like be okay? So she had an eight hour active labor, which is great. She had a nine hour second stage, which is a long long long time. And that's just something to note that like Absolutely. If she was not at home. There would not be an option for that to have happened. And then that third stage though, like the excitement was not over because her placenta took a while to detach. Also not surprising with how long her labor was and everything that her body was going through and how exhausted she was. But almost an hour and a half between when the baby was born to when the placenta, came out. There were no signs of concern, no excessive bleeding or anything. But we did give her some herbs to help encourage. That was around minute 45 after the baby was born that we were like, Hey, let. Let's just try to encourage something. And she eventually started moving some positions. We got our birth stool out and she actually delivered her placenta over that with no concern. She had about 400 ccs of blood loss throughout her entire immediate postpartum, which is a decent amount, but not necessarily concerning. And she was feeling good minus the fact that she was. Exhausted from the entire experience. We checked her for tears as well. She had a first degree tear, but she, as we were looking at it and counseling and given her feedback she declined to repair it and it actually healed wonderfully. Her baby was only seven pounds, zero ounces, so, I think that there was a lot of concern about her. Glucose readings and potential GDM status with gestational diabetes. And she produced a very normal sized baby. So there was a lot that was like, Ooh, that was abnormal. And then there was a lot that we were like, oh, look at how this storyline ended here which was an interesting thing to consider as well.
tiffany_1_07-31-2025_092846:Yeah, there's like a lot for her to process obviously like that is, was a tremendous, a really cr crazy thing to have to experience. Especially, as your only experience, you're very. First experience with birth, having it be that hard. I think that there's a lot of women who can relate to that. A lot of women who are thinking right now wow, I pushed for four hours and then I was offered a cesarean. I wonder what it would've been like if somebody would've given me more time, given me more support, taken me, had I been in an environment that I would've had more options. And I think there's some really important pieces here in that. Of course who her team was, the setting, the care model that she chose. She had a lot of support with her partner. She had a lot of support with her doula. All of that, she was really well prepared for a potentially super hard birth. And that is, that was the goal in preparing all of those things. But she was also really committed and I think. That just impacted us the most is her commitment, and I had no idea that she was prepared to work so hard and for so long, and to want to give up but not give up, which like, as we've already said in another setting, it would have been all too easy to have that story changed with the inpatient provider. Her choices up to that point afforded her options in labor afforded her time. And even though the birth was like a lot she said that she wouldn't have changed it because she knows that how the odds were stacked against her and how that would have turned out in another environment. And so even going through that really hard, long thing was better for her to have the outcome that she wanted and the type of birth experience for her own baby and her own family. And. Like we need to hold on to those pieces too. That is just as important as some of the other pieces. We need to, like women need to have some context for what things really matter, what things don't matter. Preparing for long or hard labors totally owning your experience for the good. Pieces and the vision and the beauty, and then the challenge and the victory that comes with walking through that challenge. It is usually an accumulation of many informed choices and really. We wanna help women prepare for birth in a way that gives them the best chance for staying in the driver's seat. And so I hope that is what comes through in this story for listeners, that you can apply these concepts. The Midwifery model template is available for your birth plan too. And that is just every, that's every bit of passion that we share in our childbirth education class too. So visit the link in our show notes to check out that course if you haven't already. We have applied birth prep to every single stage of pregnancy. So your vision has a chance to like build and spiral and layer in the ways that just make your birth yours and keep you in the driver's seat. And that is, that's midwifery care. That is really good midwifery care in a nutshell. And having those strategies and learning that nuance and being able to. To have that as a part of your story. I hope that is an encouragement
kelly_1_07-31-2025_092847:I mean, there's so many pieces here, right? If you're somebody who has struggled with blood glucose levels in previous pregnancies or positions of babies in previous labors, things like that, there's so many pieces here that I think can be gleaned And learned from, and just hopefully again, even if you're somebody who hasn't given birth yet, that maybe, yeah, this sounds intense, but there's also the, there's births that go so straightforward and smooth and babies just like. It flies out on a cloud and everything is, easy and wonderful. There's no moral, good or bad right here. This is a hard earned experience for these parents, and that is good and worthy too, and I think impacted her. Awareness of herself as a mom and built her confidence too as she entered into motherhood. Which like would she have preferred an easier labor of course. But did that labor teach her and grow her and build her confidence in other ways like that probably were surprising to her. Have Absolutely. And so that is encouraging to me. As well as just the own personal reflection as a midwife all of those years ago when when this baby was born. So, this was a great one to come back and consider and continue listening.'cause every so often we will keep sharing these birth stories and we love the conversations that we're having with you outside of the episodes about them as well. So you can hop on over to Instagram and DM us and chat about this too, if you have any thoughts and feelings about this. And we will catch you next week.
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