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 woman I'll call Phoenix, who's a first-time mum planning a hospital birth. This was a planned pregnancy that took four rounds of IVF or in vitro fertilization to result in a successful pregnancy. IVF can be a long and difficult process of reproductive assistance, both physically and emotionally. Phoenix paged at 4 a.m., around 38 weeks' gestational age, to say she lost her mucus plug when she got up to go to the bathroom and that there was a tiny bit of blood. She was wondering what should she do. I replied that this is normal and that she will likely go into labor within a couple of weeks. I discussed normal bleeding and when to page back. The mucus plug resides within the cervix, and at the end of pregnancy, when the cervix starts to move and change and open up, this mucus plug can come out. It can come out in one piece or it can continue to come out as long strings of mucus that can be pink tinged, bright red tinged, clear, or old blood, or brown blood tinged. All is normal. About four hours later, Phoenix Page back again to say that the contractions have started, but they were irregular, mild, and no more bloody show. I had a day of home visits to do, and so I informed the on-call team of midwives what was up and headed out to do as many home visits as I could before hearing back from Phoenix. Phoenix was anxious and paged back an hour later to say her contractions were getting intense, and as I was close to her home, I stopped by for an assessment. When I checked her cervix, she was two centimeters dilated, and her cervix was paper thin or a hundred percent effaced. The baby's head was at zero station, and I feel a bag of water intact. When I spread my two examining fingers apart in the cervix, to my surprise, she easily opens up to three to four centimeters dilated. The station is the term we use to describe how high or low the baby's head is in the pelvis. So at zero station, we call that an engaged head. The numbers from zero either go up higher in the pelvis, so minus one, minus two, minus three, or belottable, which is a head not even in the pelvis. And then if the head is moving lower than zero station, we say the head is at plus one, plus two, plus three, plus four to visible at the vaginal opening. Each number is equal to one centimeter up or down. So a head that was at zero and then is felt to be at plus one has moved down the pelvis one centimeter. Phoenix is managing well with the contractions, and after discussing her options, she chooses to stay at home a while longer and understands when to page me back. And I head out to do another home visit. After that home visit, I stopped to get a bite to eat when Phoenix paged again to say that the contractions are very intense, but she wanted another home assessment as she was enjoying being able to move around her home. The weather was good, she lived about twenty five minutes from the hospital, so I was fine with another home assessment. Phoenix was six centimeters dilated and working hard, but coping well, and she wanted to labor at home as long as possible, so I stayed with her. We discussed the option of a home birth, as I carry all the equipment and medications required for home births in my vehicle. She decided she would now aim for a home birth, so I set up my equipment and notified the midwives. By 6 p.m., Phoenix asked me to check her cervix again, and unfortunately, she was still six centimeters. We discussed her options, and she wanted me to break her water with the understanding that if there's meconium stained fluid, we would head to the hospital. Miconium stained fluid just means that the baby has passed stool that is mixed with the amniotic fluid. This is not an emergency, but a reason to go to the hospital for the birth. When I break her water, the fluid is clear, the baby's heart rate is fine, and so Phoenix can carry on at home. Phoenix was laboring on the toilet, letting gravity do its work, and by 8 p.m. she starts to give us the primal grunt. So I check her cervix while sitting on the toilet and confirm she's fully dilated. I feel the head is low in the pelvis, and so I call my backup midwife to come. About forty minutes after pushing well on the toilet, I ask Phoenix if I can recheck her while lying on the bed. The baby's head is starting to mold and form capet, which is swelling of the skin of the baby's head, and a normal finding. After an hour or more of pushing really well, I suddenly feel a bit of cervix sticking out like a tiny tongue, something I had not felt before. And the baby's heart rate was also starting to increase to 170 to 190 beats per minute, and a normal heart rate would be 110 to 160 beats per minute. So we talk about moving to the hospital now by ambulance. And I encourage her to say house, house, house during the contraction to help her from the uncontrollable urge to push. I call 911 and notify the hospital we're on our way, and then start an IV and bolus her fluids, which means we let the fluids run as fast as possible through the IV line. As we ride in the ambulance, Phoenix continues to say house over and over through each contraction. And one of the paramedics asks, Why are you saying house over and over? I pipe up an answer for her. And he says, just don't push. This from a 27-year-old male. I remind him as he left the hospital, remember the word house. I promise you'll need it someday. Within 10 minutes of arriving at the hospital, the baby's heart rate was normal again. Despite Phoenix drinking throughout labor, she became dehydrated, which increased the baby's heart rate. Phoenix now wanted an epidural, so I rechecked her cervix, and I could see dark hair, but I could still feel that tongue-like cervix, so she had time to get the epidural. After an hour, the cervix was finally gone, and Phoenix could begin to push again. But there was the concern that Phoenix's uterus was forming a bandel's ring, and therefore forceps or vacuum are not a safe option. A bandal's ring is where the uterus becomes kind of like an hourglass shape, where a ring of tissue forms a tight ring around part of the uterus. And therefore, an emergency caesarean section is done. Now, because the baby's head is so low in the pelvis, someone has to put their hand into the vagina and push the head back up under the guidance of the surgeon. It took three different doctors trying to reach into the uterine incision to get the baby out because of the constriction of the bandal's ring. The baby needed some support from the neonatal team who was present at the birth. But after 90 seconds, he was pink, alert, and now looking at the team around him. Thank you for joining me for another episode of the Birth Portal.