Before we begin, please know that some episodes include language that may be sensitive for some people. Welcome to another episode of the Birth Portal. My name is Connie. Today's true story is about a woman I'll call Renata, who was pregnant with her third child. Renata's previous pregnancies were normal, and she had two previous vaginal deliveries without any complications. Renata had reached a part of her pregnancy where she was coming to the midifree clinic appointments every two weeks. As part of a clinic appointment, a woman's fundal measurement is done, which helps determine appropriate fetal growth. This can be done in different ways, but in Ontario, we are taught to measure from the top of the woman's pubic bone to the top of the uterus. And after about 20 weeks' gestational age, however many weeks pregnant the woman is, that's how many centimeters she should measure, plus or minus three centimeters. If they measure more than three centimeters greater than what they are in weeks, then that could indicate a large baby, multiple gestation like twins, excess amniotic fluid. These are just some of the more common reasons for a woman to measure LGA or large for gestational age. So for example, if one was 30 weeks and she measured 34 centimeters, that would be called LGA. If a woman measures less than 3 centimeters from her gestational age, so for example, if she's measuring 26 centimeters at 30 weeks gestational age, that would indicate small for gestational age or SGA. If the baby is small or there is low amniotic fluid levels, or perhaps incorrect dating of the pregnancy, we might get these findings during an assessment. For Renata, she was measuring small for gestational age, and after no growth in her fundal height, after a couple of weeks, an ultrasound was ordered. The ultrasound gave measurements of both a small fragestational age baby and low amniotic fluid, which now gave us the suspicion of IUGR or intrauterine growth restriction. This can be caused by several things, some of which include poor placental functioning, maternal blood pressure issues, abnormalities within the fetus, suboptimal maternal nutritional needs, maternal gestational diabetes. Again, these are just some of the possibilities. Renata was just over 37 weeks gestational age when she had her ultrasound, and the hospital where she had the ultrasound paged me to inform me of the results and that they were sending her to the triage unit on labor and delivery. I met her there where a consultation was done with the on-call obstetrician. The obstetrician reviewed the ultrasound findings with Renata and her husband, who came as soon as he found out that she had to meet the doctors. The estimated fetal weight of the baby was 2100 grams, which is less than the tenth percentile. The doctor was recommending an induction of labor immediately, which they agreed to. They checked Renata's cervix, and it was two centimeters dilated, but it had not begun to thin or efface, and so the doctor inserted a folicatheter into the cervix to ripen it. A foly catheter is a small deflated balloon that is placed into the cervix, and then it is filled with normal saline fluid to about the size of a golf ball. This puts pressure on the inner walls of the cervix, which stimulates the body to release a hormone prostaglandin to thin and ripen the cervix. Renata had not had one before and wasn't impressed, saying, For sure it must have been a man who invented this contraption. She was moved to a room on the labor and delivery unit where she was admitted. Her blood pressure was also a bit high, but she did not need medications for that. We explained that her care would be transferred to the obstetrician due to the concerns now classifying her pregnancy as high risk, but that I would come back and be with her for the birth. And I went home heading to bed early as I was expecting to be called back sooner rather than later as this was not her first delivery. It didn't take long for that Foley catheter to come out, and the oxytocin meds to induce her were working well. Renata and her husband Daniel rode the wave of labor together, Dad doing everything he could to absorb her pain. Their love was palpable, and as part of why I love my job, seeing people real, raw, vulnerable yet strong. The nurse that was assigned to them was so bubbly and stated she no longer needed to work, but she just chose to because she enjoys it, and she's not ready to hang her hat up just yet. The nurse stayed in the room continuously except for two breaks and had them laughing throughout labor. Renata never had an epidural before and was not planning one for this labor. So I came back for labor support about four hours later. And as I walked in the room, she says, I can't do it anymore, standing and leaning on the bed. Her husband has his arm around her and he says, Yes, you can. You're doing a great job. Her cousin is on the other side also giving her support. The doctor is called in to check her dilation, and she's seven centimeters dilated. We call this the transition phase of labor. Some would call it the gates to hell. It's often the hardest part of labor, but if you had a baby before, it can be the fastest part. The nurse and I suggest she move on to her left side, lying down, to give her legs a bit of a rest, knowing this position can complete the dilation process quickly. Renata suddenly becomes vocal with each contraction. I step in and look into her eyes and say, Look at me, Renata. Let that energy out deep and low. And I demonstrate to her our eyes are locked. And then the primal grunting starts. The nurse calls for the doctor to come now, as well as the neonatal intensive care unit in case the baby needs extra support. To my surprise, the doctor says to me, These are your clients, you deliver the baby. I'll be right here. With only three pushes, this tiny peanut is born, screaming and crying, weighing 2,500 grams, and I placed her upon mom's chest. The doctor transferred care back to me, and the nurses and doctor leave the room. The siblings were waiting in the waiting room and come in with their auntie. As I examine the placenta, which we do after every birth, I ask the kids if they want to see the house their sister was living in. Their eyes widen as big as pancakes. I explain, they will see blood, but none of it was in their baby's house. I wipe away as much blood as possible and ask, do you want to touch the house your sister lived in? The look on the big brother's face was priceless, all in his eyebrows. But they both touched it, and then Dad says, he wants a turn to see what it feels like. Thank you for joining me for another episode of the Birth Portal.