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 Michaela, having her fifth child. Michaela's previous births included three vaginal deliveries and a caesarean section. Michaela and her family were so excited that God had blessed them with another child. And the plan was to try for another home birth, despite having a cesarean section, the previous birth. They had the recommended two years since their last child was born, and there were no other contraindications to trying for a vaginal delivery at home. For women planning a trial of labor following a cesarean section, the recommendation is to continuously monitor the baby's heart with the electronic fetal monitor and have an IV in situ with. An IV in situ simply means an IV catheter is in the woman's vein, but it is not hooked up to the bag of fluids necessarily. After a proper and complete discussion with Michaela and her husband Jeremiah about the advantages and disadvantages of a home birth following a cesarean section, a good plan was put in place to aim for a home birth, but with the flexibility to move into the hospital if needed. Michaela and Jeremiah also felt it might be a good idea if their twelve year old daughter be present for the birth, and possibly help with the delivery. Their daughter was present for this discussion and seemed to be happy about the whole idea. It was a Saturday morning when Michaela called, and was complaining of cramping heavily off and on for two days, but nothing now, and wanted to know if I could help get things going in any way. So I recommended that she have a good breakfast, and I'll be there by noon to see if I can stimulate labor. Michaela was thirty-eight weeks and three days gestational age, and her last baby that delivered at home was thirty-eight weeks and three days as well. And that baby weighed nine pounds. So I didn't want this baby to get too much bigger, so I was happy with the request. As I walked into their home, I can see the floors are drying, and I look at Michaela and say, What have you been doing this morning? Her daughter's there smiling quietly and excited. Her brother's ready to go outside to make a house for the bug he has in a cup, while the others are outside with dad playing basketball. Michaela and I go to the bedroom and talk about the options to try to get labor started, and we start with the famous stretch and sweep. I'm able to stretch her cervix from two centimeters to four centimeters dilated. But it is still thick, and the baby's head is quite high, not putting any pressure on the cervix. What she needs is strong contractions to get the uterus to push the baby's head down. I set up my equipment and I need to go back to the clinic to pick up some extra supplies. I suggest to Michaela to try using her breast pump while I'm gone, to see if she can get some endogenous oxytocin flowing to start labor, although the stretch and sweep seems to have started things. As I leave for the clinic, I'm thinking, maybe she'll have the baby today. When I return approximately 40 minutes later, I see Michaela is working hard through some contractions using her breast pump. Her daughter is watching closely. About two hours from the first cervical exam, I check again, and Michaela's cervix has opened more. She's now four to five centimeters dilated, but the cervix is still thick and the head is still high. Michaela asks about homeopathics and if that would be a safe option to try. I say she could definitely try, starting with Simusifuga, to see if that would help thin out the cervix. She puts three pellets under her tongue, and I start an IV and give Michaela her first dose of antibiotics as she swabbed positive for GBS or group B streptococci. GBS is a bacteria we all have in our gut. It's a transient bacteria that can also be in the rectum and vagina. It is not an infection when a woman has it present in the vagina or rectum, as her immune system will keep it under control. However, if a baby is exposed to the bacteria during the birth and the baby has a weakened immune system, it could then develop into an infection in the baby. For women who have GBS present at the time of labor, the recommendation is that they receive a dose of antibiotics through an IV every four hours. The antibiotics cross the placenta and get to the baby, which can then treat them before they're exposed to the GBS bacteria and should prevent the infection from occurring. Michaela soon begins to work harder through the contractions and says her contractions are now starting in her back, just like all previous labors. She says to her husband, It's time for the boys to go to their grandparents, and please come right back. But Dad needs to keep busy and takes the boys to the toy store first. Michaela calls him and says, Come home now, please, I need you. Jeremiah returns, but not before stopping to get pizza. Michaela moves to soak in the bathtub, so we move the pizza party to the bathroom, and her contractions are every three minutes. I say to myself, Okay, she's doing this today. She's rocking it. I inform my backup midwife and her student about the progress, and say it shouldn't be long before I ask them to come. Michaela moves to lean on the banister down the hall as the back pain continues. Jeremiah knows exactly what to do and puts pressure on her sacrum as she sways to and fro. By this time I've shown their daughter all the equipment and medications, which she appears to be interested in. I think maybe this may spark interest in being a midwife someday. The best job in the world as far as I'm concerned. Four hours after the first cervical exam, Michaela is now six to seven centimeters dilated, with a bulging bag of water felt, and the baby's head has come down somewhat. I call for my backup to come now. Michaela sits on the birthing stool, and suddenly we see clear fluid draining as her water spontaneously ruptures. Then she becomes quite vocal with each contraction. She says, I feel pressure in my bum, but no urge to push, and is crying through the contractions due to the back pain. I check her cervix again and she's not fully dilated. I feel a bag of water which we call four waters when the baby's head is well applied to the cervix. Ideally, we need one more hour for the antibiotics to get to the baby, Michaela. Forty-five minutes later, she begs me to break her waters. She sits on the birthing stool as I examine and break the bag of four waters. Michaela's six centimeters dilated. I encourage her to keep moving. The baby should be born within the hour. Back to the banister she goes. Then the toilet, then the birthing stool, then just standing, leaning into my arms. I can tell she's close to being ready to deliver as we move back and forth. My hand is on her belly on the right side, and I feel the baby kick my hand. Great! The baby turned, I think. Michaela suddenly starts to bear down, and we encourage her to listen and do what her body wants to do. She moves to her hands and knees on the bed and pushes hard. Another contraction and she bears down again. I don't see the progress from below that I would expect for the fifth child and ask if I can check her cervix. Unfortunately, I still feel a tiny bit of cervix, Michaela. I can try with the next contraction to push the cervix over the baby's head. Yes, do it, she screams. The cervix moved easily away, and the baby moved down the vaginal canal quickly. Michaela moves back onto her hands and knees, and her daughter is beside me with her gloves on. Dad is also gloved and ready to catch together with their daughter. With the next contraction, we shine a flashlight, and I say, See that loony-sized black hairy inside the vagina? That's the baby's head. Dad looks at me and says, Are you sure? Then the next push he says, Wow, as he touches his daughter's shoulder, who has hands open ready for instruction. I move my hands to cup hers as the baby's head emerges and is born. I feel for a cord and it's around the baby's neck, but not too tight. So as the baby is being born, I keep the head close to Mom's upper thigh and let the baby somersault out without causing too much tension on the cord. Okay, Michaela, roll over onto your back, and we hand her the baby. Their daughter suddenly wants the gloves off due to the blood on them, then moves up to Mom's side with a big smile. Michaela's body was obviously ready, or none of these interventions would have helped get her into labor. Michaela and Jeremiah pull out their Bible and begin reading to their newborn. Thank you for joining me for another episode of the Birth Portal.