Before we begin, please know that some episodes include language that may be sensitive for some people. Thank you for joining me for another episode of the Birth Portal. My name is Connie. Today's true story is about a first time mum I'll call Beth. She had the softest voice I have ever heard. Her mannerisms were gentle and slow. She and her husband Ben were just such soft and sweet people to be around, the kind of people you want to drink in their wholesomeness. Beth always came to her clinic appointments with questions and wanted to be as prepared as possible to be the best mum. Ben was also very excited and was doing renovations in their old home, one of which was the nursery or bedroom for the baby. Beth knew before she got pregnant she would want to have her baby at home. She was born at home, and hearing the stories from her mother that all her children were born at home instilled a strong desire to do the same. Ben was on board a hundred percent. Her pregnancy was healthy, but there was one area of concern that would not support a home birth. At Beth's twenty week ultrasound, which looks at the overall development of the baby, was great. There were no abnormalities identified. There is one other reason ultrasounds are done in the middle of the pregnancy or around 20 weeks, and that is to see where the placenta is attached within the uterus. Whether it is attached to the front, the back, the top, doesn't matter, and that's where it's most commonly seen. However, if the placenta attaches to the bottom of the uterine area, we need to measure how close it attaches in relation to the cervix, which will open to let the baby out during labor. There are four levels of concern. Low lying is the least concerning and often resolves. Imagine a uterus in the pelvis, and it is in the shape of an upside-down pair, so the lower part of the uterus is more narrow compared to the middle and upper portions of the uterus. And the cervix is at the very bottom of the narrow part of the uterus. As the pregnancy progresses and the baby grows, the lower narrow area of the uterus stretches too and becomes longer. If the placenta is attached to the lower segment of the uterus but not touching the cervix, we would order another ultrasound around 30 weeks gestational age to see if the narrow section of the uterus where the placenta is attached has grown or elongated to become further away from the cervix. This in fact is most often the case. Sometimes people say the placenta has moved. The placenta can't move positions in the uterus. Once attached, it's attached. It's the muscle fibers of the uterus that stretch and move. Marginal placenta previa is the second level. This is where the placenta is near the edge of the cervix. An ultrasound is done again in the third trimester of pregnancy around 30 weeks gestational age to see how elongated the lower section of the uterus has become and to measure the distance from the placental edge to the cervix. A reassuring measurement would be greater than two centimeters from the cervix. Partial placenta previa is the next level. This is when the placenta partially covers the cervix, which increases the risk of painless, bright red vaginal bleeding during the second or third trimester of pregnancy. An ultrasound is done in the third trimester, and if it appears on ultrasound to still be partially covering the cervix, a cesarean section would be planned, reasonably close to the woman's due date, perhaps around thirty-eight or thirty-nine weeks gestational age, because there's a risk of severe bleeding at the site of the placental attachment. And when the cervix begins to soften and open, that can stimulate the bleeding. A complete placenta previa is when the placenta completely covers the cervix with the same risks as a partial placenta previa, and therefore a planned caesarean section is organized before but close to the woman's due date. And sometimes the delivery date is changed if vaginal bleeding begins sooner. For Beth, she has marginal placenta previa, and so all we could do is wait until her third trimester ultrasound results came in. When we got the results of Beth's ultrasound sent to the clinic, it was the best news, and I called her at home to say the placenta is more than two centimeters away from the cervix, and we could now plan for her home birth. At thirty-six weeks gestational age, I went to her home to assess the layout. The master bedroom was upstairs, with about more than twelve steps to climb. She did have a washroom off the bedroom. It was the middle of the summer and they had no air conditioning. Their bed was a thin mattress on the floor. They had an electrical outlet with an extension cord in their room, and Beth thought she would deliver in the bedroom. I left her a copy of her records, and we had a good plan in place. At forty one weeks gestational age, Beth paged in the morning to say her contraction started through the night. But it was still early, she just wanted me to be aware. By around lunchtime, things were progressing, and she paged wanting me to come to her home. When I arrived, Beth was puttering around the kitchen, and she would lean on the counter, rocking back and forth on her heels with every contraction. She had been snacking and drinking herbal teas. She reported having several bowel movements already that day. It is not uncommon for women to have several bowel movements before labor is well established. The body is releasing a hormone called prostaglandin, which softens and ripens the cervix, but also stimulates the gut and relaxes muscles. The baby can drop into the pelvis and cause increased pressure on the rectum. Some will say it's the body's way of making room for the baby to be born. It is very common for women to pass stool during the pushing stage. The baby's head will push out any remaining stool, and we just clear it away. But if the mother is passing stool as the baby is being born, there is no concern. When I check Beth cervix, she's well on her way. She's five centimeters dilated. I inform the backup midwife who is at a birth at the hospital. She continues to labor and calls her mum to come to be with her, and Ben is working around the house. There is a storm brewing and the winds are picking up outside. The windows are open and we welcome the breeze inside the house. I set up my equipment upstairs in their bedroom. By 9 p.m. that night, Beth no longer has a quiet, tiny voice. She lets out a roar like a lion during a contraction. She was eight centimeters on her last cervical check two hours before. So I say to Beth, let's head upstairs to your bedroom if you still want to have your baby there. Beth doesn't say anything. She just starts moving towards the stairs with her mother and husband at her side. I call my backup midwife, who's still at the hospital doing her paperwork following the delivery of her client. Beth is hit with another contraction as she starts to climb the stairs and roars again throughout the contraction. The storm is closer and the house is getting darker. A flash of lightning hits and lights up the stairs. Beth is leaning forward, hands on the stairs, slowly climbing up, as the contractions are so close now she barely has time to catch her breath between them. She finally makes it to her bed and collapses on her side. When I check her cervix, I feel the baby's head is very low in her pelvis. Beth, you're fully dilated. You can push now with each contraction. I call my backup midwife to come. Beth chooses to roar with each contraction instead of actively pushing and letting her body do it naturally. I'm thinking, she's gonna have such a sore throat tomorrow. After almost two hours, we're seeing lots of the baby's head. And we are moments from the birth now. I have my gloves on and I say, Beth, the baby's head will be born with the next contraction. Suddenly there's a loud crack of lightning, and the power goes off. We're now completely in the dark. I ask Ben to quickly bring me some candles, and he is back lighting them before the next contraction. With the next contraction, Beth delivers the head and is reaching down, rubbing the baby's head, crying, saying, Come on, baby, come on! I encourage her to wait for the next contraction to push, and she relaxes in her husband's arms, breathing heavily. Her mother offers her a sip of water, but she pushes away and says, grunting, here it comes, and pushes out this huge baby, reaching down to pull him up to her chest. Just then the power is restored and the lights come back on. Beth looks up towards Ben and says, We did it! Ben, we did it. Thank you for joining me for another episode of the Birth Portal.