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 Rose, who's having her first baby. Rose was in for her last weekly antenatal clinic appointment before she would have an induction of labor if she didn't go into labor by 41 weeks and five days. At that appointment, we did a cervical exam to see if she needed cervical ripening before the induction of labor. Cervical ripening used at the time of her pregnancy was with a product called cervadil, which is like a tampon that is placed within the cervix rather than the vagina, and it has prostaglandin in it that slowly releases, causing the cervix to thin and ripen. Rose did not need it, as she was already three centimeters dilated, and her cervix was thinning out nicely and was already half a centimeter thick and very stretchy. We offer women a stretch and sweep to help stimulate the body to release the hormone prostaglandin naturally. I discussed the risks and benefits with Rose of a stretch and sweep, and she chose to have one done. Her cervix responded well to the stretch and sweep with lots of bloody show when it was done. We talked about what's normal bleeding and when to page, and off she went. Shortly after leaving the clinic, Rose Page to say she felt a pop in her uterus, but no water came after the pop sound. And she was already having mild contractions. Rose paged back early evening to report regular strong contractions and wanted a home assessment. I arrived about thirty minutes later, and she seemed very calm. When she had a contraction, she just closed her eyes and seemed very focused. Then after the contraction was over, she was very smiley and talkative. When I checked her cervix, she was already seven centimeters dilated. We call this transition, and usually women are quite vocal and animated due to the pain. I talked to her about the option of a home birth, or we could go to the hospital as she originally planned. Rose quickly said she wanted this baby to be born in the hospital just in case. Research is very clear that home birth is just as safe as a hospital birth if the pregnancy is normal, you are within a reasonable distance to the hospital, the weather is good, and you have two midwives with all the equipment and meds required. Rose and her husband drive in their vehicle and I follow behind them to the hospital. En route I notify the labor and delivery unit that we are on our way to directly admit Rose. And I notify the backup midwife to be ready and on standby. Rose continued to be calm and then said she wanted her headphones to listen to her hypnobirthing recording. Hypnobirthing is a recording saying positive affirmations about your body and its ability to labor and birth your baby. It is very calming to listen to. By 10 PM, Rose calmly says, Okay, I think it's time. She was lying on her side, and the lights were off, except one so we could see our way around the room. You couldn't tell when she was even having a contraction, and she was completely unmedicated. To my complete surprise, Rose was fully dilated, but had no urge to push. So we waited about thirty minutes to start pushing when Rose felt ready. She was pushing very well, but the head wasn't descending or moving down at all. I spoke to the obstetrician who recommended we try augmenting the contractions with oxytocin to get the contractions closer together and stronger. The baby's head was not properly aligned, so when examining the position of the baby's head, you want to feel the top and the back of the head, but in this case it was the side portion of the head that we could feel. And so the hope was that the oxytocin would produce strong enough contractions to force the head to correct its position within the pelvis so it could be borne vaginally, otherwise she was looking at a cesarean section. An hour and a half later, Rose tried pushing again, but unfortunately the baby wasn't budging. The doctor came in again to assess and felt that we should move to the operating room to try a vacuum for the delivery. The OR began to fill with people. A team for the baby and a team for the mum. Rose now gets an epidural in the event we needed to do a cesarean section. The doctor carefully applies the vacuum, and as Rose pushes, the doctor pulls on the handle attached to the vacuum, trying to get the baby's head in the right position. But the vacuum pops off. The doctor applies it again, and with the next contraction, Rose pushes and the doctor pulls. Pop, off it comes again. The doctor wants to try the forceps now. A vacuum is a small cap that is calibrated to section to the back of the baby's head with a stretchy tube and handle to pull on. Forceps are metal-like hollow spoons that cup the baby's head, and the arms of the spoon are pulled carefully by the doctor. Thankfully, the forceps work and the baby is born. After a little tender loving care by the neonatal team, the baby is handed to daddy with a bruised face and nose from the ride out, facing up all the way out. Approximately only 5% of babies come out facing up. Thank you for joining me for another episode of the Birth Portal.