Jenny and Billy were expecting their second baby around November 5, 2016. They were followed by a family doctor, Dr. Millar, and planned to try for a VBAC at the Civic with additional support from their doula, Victoria.
Early in the pregnancy, Dr. Millar sent Jenny for a consult with an obstetrician, Dr. Lamensa, because the surgical report indicated an extension in the incision on her uterus. Dr. Lamensa supported a trial of labour. Jenny and Billy prepared for a vaginal birth.
Early Labour
Around noon on November 7, Jenny felt a small gush of fluid. She called Victoria. Because it sounded like her water broke, Victoria recommended that Jenny and Billy head in to triage to be assessed, and to keep her posted. At this point Jenny was having sporadic mild cramps. She and Billy arranged for Jenny’s father to come to look after Colby, and they left for the Civic. Once in triage, there was no longer any fluid leaking, so Jenny had a sterile speculum exam to confirm the rupture of membranes. The staff felt that her membranes were still intact. However, while still in triage, Jenny had a much bigger gush of fluid, which was unquestionably her membranes rupturing. A vaginal exam showed that her cervix was already 3cm dilated and 50% effaced. She was admitted to room 10. Her nurses were Natasha and Larissa.
Active Labour
When Victoria arrived about 4:30 PM, Jenny’s contractions were getting stronger. She tried various positions, and coped very well. At first she preferred standing upright, with Billy holding her belly. As each contraction was stronger than the last, Jenny had to keep trying new strategies including leaning over the bed, or standing and leaning on Billy. She began to wonder how she was going to get through it all. Eventually, at about 5:15 PM, she got into the tub.
In the tub, Jenny seemed better able to rest in between contractions. She stayed in there as long as she could. Her labour became more intense and there were signs that she was close to pushing. Jenny eventually requested to examined, with a view to having an epidural if the birth was not imminent. She got out of the tub and on to the bed. At 5:50 PM Larissa checked her cervix and said it was 4cm dilated and paper thin. Jenny asked for an epidural.
While waiting for the anaesthesiologist, Jenny laboured on the bed with the nitrous oxide gas. She managed to stay still enough for the epidural insertion. However, as soon as it was complete and before any medication was given, Jenny felt a strong urge to push. She lay down on the bed and Larissa checked her cervix. It was fully dilated and the baby was very low. It was 6:22 PM; only half an hour since she was 4cm.
Pushing and Birth
Jenny began pushing with the next contraction, at 6:25 PM. By this time both Larissa and Natasha were in the room. The anaesthesiologist injected the test dose of medication into her epidural catheter, and informed her it would take about 20 minutes to take effect. Meanwhile, the baby’s heart rate was dropping with each contraction and was taking longer to recover. Since Dr. Millar had not yet arrived, the staff OB, Dr. Pascali, was called in along with the OB resident, Dr. Zee, a med student, and the pediatrician, Dr. Tirado. After observing the next few contractions, Dr. Pascali recommended helping the baby out with a vacuum. Jenny and Billy consented. Dr. Zee applied the vacuum. Jenny still had to push with all her might.
Scotlyn was born at 6:41 PM on Monday, November 7, 2016.
She was placed on Jenny’s abdomen. After a delay, Billy cut the cord. Dr. Millar arrived at this time. Scotlyn was taken to the warmer for assessment by the pediatrician, which was standard procedure after a vacuum-assisted birth. In all the bustle of pushing, Jenny’s IV had come out. She was given a shot of oxytocin intramuscularly, and delivered her placenta at 7:12 PM. She had a small second degree tear, which Dr. Millar sutured. Scotlyn weighed in at 2994g (6 pounds, 9 ounces). After being examined by both Dr. Tirado and Dr. Millar, she was returned to Jenny.
By 8:00 PM, Jenny was finally comfortable. She breastfed Scotlyn on both sides. Eventually she was able to get up to take a shower, and enjoy a visit from her mother and stepfather. At 9:30 PM Jenny, Billy and Scotlyn were taken to their postpartum room, and Victoria left.
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