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 Quinn who was having her second child. Her first labor in birth was in a hospital setting, and she had an epidural for pain management. Quinn had a baby that was nine and a half pounds, and she needed help for delivering him with a vacuum after pushing for three hours, as she was too tired to push effectively anymore. And unfortunately, Quinn sustained a third-degree tear after getting an episiotomy. A third degree tear is when the tissue damage extends to the rectal area. An episiotomy is not routinely done nowadays, rather, only if there's an indication to do so. Those indications can include a fetal heart that is not reassuring, if the baby's shoulders are stuck and other maneuvers are not working, or if the perineum is just too tight and not thinning out. These are just a few reasons when an epesiotomy is indicated. Quinn obviously didn't want a repeat scenario for this birth. We had several informed choice discussions along the way, one of which was screening for diabetes and what good diet and exercise can do to influence the size of the baby. Quinn realized there were some changes in her diet that she would make, like only drinking one glass of juice a day, as opposed to three to four large glasses she was used to. She craved chocolate chip cookies and ice cream her last pregnancy and indulged almost daily. As for exercise, a brisk walk three to four times weekly for 20 to 30 minutes is fantastic in helping the body deal with glucose. Quinn felt that with her busy toddler, that could easily be attained. Another informed choice discussion was about the choice of birthplace. Midwives are the only healthcare providers that offer home birth as an option, and Quinn was very keen to try to have this baby at home. As part of the discussion, she was aware we don't have the option of vacuum deliveries at home, and if she sustained another third degree tear, we would need to transfer to the hospital for the repair to be done by an obstetrician, as midwives only repair tissue that involved the vaginal area and not the rectal tissue. After a complete and thorough discussion on the advantages and disadvantages of a home birth, she felt it was a good option to aim for. When we came to Quinn's home at 36 weeks gestational age to assess it for sustainability for a home birth, the only recommendation was to have an extension cord plugged in to the only electrical outlet behind the big dresser in her bedroom, and to clear the stairway leading to the bedroom in the event we needed paramedics to get her out on a stretcher. At Quinn's 38-week gestational age at regular clinic appointment, she asked if a stretch and sweep could be done, as she wanted this baby born before Christmas Day, which was in two weeks. When I checked her cervix, it was very hard to reach, and I could only get one finger inside, so I was not able to do a thorough stretch and sweep. I recommended that she have lots of intercourse with ejaculation if she's comfortable with that. Sperm in ejaculate is loaded with the hormone prostaglandin, and prostaglandin helps thin and ripen the cervix in preparation for labor. Quinn said, Well, my husband will be happy to hear that. Five days later, Quinn paged at 11 30 p.m. to say she was having strong contractions every ten minutes. I asked if she had had intercourse by chance, and she said, Yes, every night and was cramping after each time, but this time it felt different. I lived close by and said to have a bath and if she's still contracting in an hour or the contractions increase in frequency to page me back. I tossed and turned all night, expecting to hear back foom Quinn, but it was not until 6 30 in the morning that she paged back saying her water just broke and the contractions immediately started again and are coming quickly now. I asked if she had the urge to push, which she didn't, and the fluid was clear. I arrived to Quinn's home 30 minutes later, and she was very vocal, reporting starting to feel rectal pressure on the last contraction, but thinks she just needs to have a bowel movement. Let's have a quick listen to your baby's heart, Quinn, before you go to the washroom. 120 beats per minute, that's great. I'll set up my equipment while you're in the washroom, but let me know if you have the urge to push. I hear Quinn in the bathroom, and although she's not pushing, she sounds like she's close to being ready, so I call for my backup to come now. Quinn comes out of the bathroom and says, I can't do this, I need an epidural. I say to her, Quinn, you're strong, you're healthy. Let's check your cervix and see where you're at and see if we have time to get to the hospital. Wow, Quinn, you're nine centimeters dilated. I don't think we can get you to the hospital in time to get an epidural. I think you're going to have this baby very soon. And she is hit with another contraction and says in a high-pitched voice, I can't do it. I start making low, deep groans and say, Do this with me, it'll help. And she does, and she seems to relax up a bit. Twenty minutes later, my backup walks in the door and has time to wash her hands and quickly introduce herself when Quinn is back to her high-pitched voice saying, I have to push, I can't, I can't, and is standing straight up, squeezing her butt cheeks tight on her tiptoes. She does this for two more contractions as we help her take her pajama bottoms off. And I say, Before the next contraction starts, Quinn, why don't you try getting on your bed on your hands and knees? No, no, she says. But as soon as the next contraction begins, she leans forward, and as she kneels and puts her hands on the bed, she screams and the baby is born in one big kapow of a contraction. And the baby's also screaming and pink. We help Quinn on her back, and she is crying for joy, reaching for her baby. I did it, I did it. Her husband, who was quiet as a mouse all along, calls up and sits beside and gently kisses her shoulder and says, You're amazing, Quinn. I can't believe you did that unmedicated. She only needed a couple of stitches, and then we left the family alone for a while as we sat at the kitchen table to complete our paperwork. Thank you for joining me for another episode of the Birth Portal.