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 Katie, who paged me as I just tucked one woman in following the birth of her first child, happy yet sore. Katie said her water just broke and she's contracting every four minutes. I'm exhausted from the previous twelve hour labor in birth. I'm hungry. I really want to shower and especially need to brush my teeth. But Katie's on her way to the hospital, and I'm thinking to myself as I review her records, this is her second baby. Her previous labor was nine hours long, so we should be done in approximately seven hours if all goes as we can expect for a second birth, just four years since her last delivery. I can do this and grab a cup of coffee and brush my teeth with my fingers. Kitty arrives thirty minutes later to the labor and delivery unit, and when I check her cervix, she's only three centimeters dilated, and her cervix is so long, but she's definitely ruptured, so she's not going home. While I examined her cervix, I gave her a good stretch and sweep to try and encourage labor along. And then I sent Katie walking the halls, returning to the room every thirty minutes so I could listen to the baby's heart. Round and round she goes as I begin my paperwork. Katie's cheeks become redder with each lap she does. Yes, I'm thinking she's going into labor spontaneously, and she won't need any oxytocin to encourage active labor. For women whose water breaks and there's no labor, oxytocin is given through an IV in small amounts, increasing the dose in increments until labor is well established. She asked me to check her cervix an hour and a half later as she's reporting rectal pressure a little bit. Katie's made great progress. She's now five centimeters, and the cervix is half as long as it was with the initial exam. As well, we have bloody show. These are all great signs. Quickly, she starts to contract every two minutes and is rocking through this labor on the exercise ball, bouncing like she's riding a horse, moving her pelvis forward and back. Only 30 minutes later, Katie says, I feel more pressure. Connie, please check me to see if I can push now. And her cervix is six centimeters dilated. Another 30 minutes pass, and Katie says, I have to push. But unfortunately, her cervix is the same. Another 30 minutes pass, and she says again, I have to push. And her cervix has not changed. Still six centimeters dilated. Katie is crying now and says, I want an epidural. Okay, I'll get you an epidural, but I have to start an ivy and get half a bag of fluid into you so your blood pressure doesn't drop too low and affect the baby negatively. The ivy is in and the fluids are flowing nicely. I page the anesthetist who calls back quickly, but is just heading into an emergency caesarean section, so it'll be about forty minutes before they can come. Oh God, no, Katie's not going to be happy when I tell her this. I walk into the room, dreading to tell her she has to wait forty minutes at least to get her epidural. Katie's looking very upset at the end of the bed, with a look of determination and glaze at the same time. With the next contraction, she makes the primal sound that I know so well, and I say, Are you pushing? Oh crap, she is. Thank goodness my brand new student of three weeks into her first placement is doing a great job supporting her through the pain of each contraction, asking her to breathe through the pain and not push. I do a quick cervical check, and she is in fact fully dilated this time, and there's no way my backup midwife that I've called will make it in time for the birth. And the nurses and doctors, they're all in an emergency caesarean section. I have to clear the room of the epidural cart, pull the cart out with the labor and delivery equipment, set it up, turn on the warmer where the baby is placed if needing extra support following the delivery. Thankfully, there is a midwife from another practice on the labor and delivery unit whose client is nowhere near delivering, who comes in to help out as the second midwife, just as the baby is quickly and easily born into the hands of my student midwife and I. A few minutes later, I hand the phone to Katie to speak directly to the backup midwife who's still on her way to say the baby is born and all is well. The midwife who she called is a friend of hers and is why I did this. I would not dream of doing that just for anyone. In the end, what was looking to be a long night ended with two healthy babies born and me crawling into bed at six in the morning. Not bad for a day's work. Two very happy families, and a big smile on my face as I laid down to sleep with my cat Theo curled around my head. Thank you for joining me for another episode of the Birth Portal.