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 June, having her third child. Her previous pregnancies were normal and the labor and births uncomplicated. June's last labor was quick, lasting only four hours from start to finish. Being this was her third child, we say it's a wild card, guessing how long the labor will be, but hopefully as fast and efficient as her first and second labor and births. At 39 weeks and two days gestational age, June paged to say she was having regular contractions now, and was awake off and on through the night with her regular contractions. Some were quite strong. And there was a little bit of bloody show now in the last hour. She didn't have any fluid leaking indicating that her water broke. June wanted a hospital berth, so we made a plan to meet at the hospital after she had dropped her kids off to a family member who lived close by and on the way. I was waiting at the hospital looking at my watch, wondering, where is June? It's been an hour and a half since we spoke. I hope she's not delivering on the side of the road. So I called her cell, and she says, They're just pulling into the parking lot. When I watch June walking down the hall through the security camera, she stops to lean against the wall as a contraction begins. I quickly head to meet her to see if she is pushing, and she tells me there's no urge to push yet. We walk to the triage area, and June gets another contraction, so I let her know I'm going to feel the abdomen to assess the strength of the contraction. When I try to give a squeeze to the uterus, it's not really firm, but still hard enough to feel the uterus is working hard. June's facial expression during the contraction is another indicator of the strength of the contractions. I ask her to try and void and change into a hospital gown and will check your cervix to see where you're at. Well, June, your five centimeters dilated. I feel a big bag of water, but your baby's not low enough in the pelvis yet. Once that bag of water is ruptured, the baby's head will hopefully put pressure on the cervix and give you some good strong contractions. June wants to wait to break the water, hoping it will happen naturally, like the last two births. After 30 minutes of walking, June says, I'm tired and I want to get this over and done with, so please break my water. When I check her to make sure I feel it's safe to rupture, she's still five centimeters. I don't feel a cord floating in front of the head or pulsing in the membranes. But the head is still a bit too high for me to rupture without putting some pressure on the top of the uterus. So I consulted with the obstetrician on call to do a controlled rupture, which she feels is safe after an assessment. As June laid on her back, I put pressure down on the top of her uterus, and the doctor easily ruptures the water, which causes a big gush of warm, clear fluid, and the baby's head is still high, but it's well applied to the cervix. June is wanting to do this unmedicated and starts to pace around the room. Four hours later, it's time to reassess her progress, and the cervix has only open one more centimeter. She's six centimeters dilated, and the baby's head is still high in the pelvis. The next step is to try augmenting the labor with oxytocin through an IV to see if stronger contractions will bring the baby down in the pelvis. June wants an epidural before starting the oxytocin as she is exhausted now. Forty minutes later, June is smiling and in love with the anesthetist who took all her pain away. So we start the oxytocin through the pump and put the electronic fetal monitor on to ensure the baby's okay. Finally, five hours of oxytocin and June was fully dilated, so I call for my backup midwife to come. Women with epidurals don't necessarily have an urge to push when fully dilated, but often feel lots of rectal pressure, but June didn't feel that. And so normally we would wait for that sensation to develop, but the baby's heart was starting to increase from the 140s to the 160s, and therefore I recommended to June to start pushing, and boy did she push well, so well that I immediately saw black hair and called for the nurse to come, as my backup midwife wouldn't make it. When I touched the top of the baby's head, it felt hot. So I also called for the neonatal intensive care unit team to come to be ready in case the baby needed support after the birth. With the next contraction, the baby's head delivered, and I checked to feel for a cord around the neck, and there was one. I tried to loop the cord over the head, but it was too tight, and at the same time, more of the baby's neck became visible and revealed not one loop around the neck, not two, not three loops, but four loops around the baby's neck. June, stop pushing. I need to clamp and cut the cord now. June listened, and I quickly clamped two sections of one loop. And when I cut the cord, there was so much pressure between the clamps that the blood squirted right in my face. I could feel it hit my chin, up across, in my mouth, up my nose, in one eye, and up my forehead. My one eye began to burn instantly, but I couldn't stop, so I kept blinking as I unwound the four loops. Okay, June, push, push hard, and the baby was born quickly. The baby's face was blue and wasn't moving enough, so I brought her to the warmer where the NICU team was, and they gave her a good rub, and soon she was pink and crying, which put a big smile on everyone's face. Just then the backup midwife walks in the room, surprised to see it filled with people, and then looks at me and says, You know you have blood on your face. What was a surprise besides the four loops of cord around the baby's neck was that there were no dips in the baby's heart rate during a contraction, which we would often see. This baby's cord was extra long, thankfully. Soon she was cuddling with her mom, breastfeeding. All was well. Thank you for joining me for another episode of the Birth Portal.