Labor is like life. Sometimes it goes smoothly and as hoped for, and other times it is touch and go with the ultimate outcome in doubt until the very end. Her labor was anything but smooth. She was past her due date, the fetal monitor repeatedly indicated the baby was under stress, and progress was excruciatingly slow, making for a long and difficult afternoon for both patient and doctor, as the outcome was anything but certain.
I had made arrangements for her to arrive in the hospital that morning. She was 41 weeks pregnant with her first child, a week overdue. Within an hour of her being admitted, the nurse started an IV drip of oxytocin, the hormone that causes uterine contractions.
Inducing labor typically follows a pattern- The medication is gradually increased with the goal of contractions every 3-5 minutes. Once that happens, it is a matter of waiting for the cervix to shorten and open and the baby's head to come down. Progress is usually slow early on, but once the cervix reaches 4-5 cm the bag of waters can be broken and labor accelerates. From that point delivery is usually 5-8 hours a way. Usually. This baby did not get the memo and had other plans.
It took four hours for the contractions to fall into a reasonable pattern and then, after just a few minutes of strong contractions, the baby voiced its displeasure. Almost every contraction was associated with an ominous slowing of the fetal heart rate, a sign that oxygen supply to the baby might not be enough to withstand the stress of labor. Worried, the nurse decreased the dose of the oxytocin to slow the rate of contractions. The heart rate tracing quickly returned to normal but was unfortunately coupled with an arrest of progress. After about an hour the nurse again increased the medication and the contractions increased. After 30 minutes there was minimal progress but also a return of the worrisome heart slowing. The nurse again decreased the oxytocin and called me.
"I do not feel comfortable continuing the oxytocin as the baby is not tolerating it. If you want it continued you will have to come in," was her report.
I canceled the rest of my patients for that day and hurried to the hospital. I examined the mother and inserted a pressure monitor to allow for better monitoring of the contractions. The nurse increased the medication again. Within 30 minutes the heart rate dropped again. I rechecked the mom and discovered that she had made slight progress but had a long way to go.
I debated what to do. I did not want to give up and do a c-section, but I was not sure the baby cold withstand several hours of labor. I called an obstetrician friend whose office was next to the hospital, asking him to be ready to come at a moments notice should things take a turn for the worse. I them settled in for a long afternoon.
I spent much of my time in the room with mom and dad, and we talked about the baby and their plans. They shared their daughter's name and told me how they had painted her room pink. She was their first and they were truly excited. I assured them that we were going to monitor the baby closely to make sure that she was okay. We hoped for a vaginal delivery but were ready to do a c-section if necessary.
The pattern from the morning continued and my concern increased. Around four in the afternoon the mom's temperature started to rise, yet another worrisome sign. I called the obstetrician again and we made arrangements for the c-section to be done around 5:30. I performed the necessary physical exam and dictated the pre-operative note into the hospital system.
At 5 pm, 5 hours after I had arrived back at the hospital, I went back into the room to perform one final exam before taking her back to the operating room. To my surprise, she was completely dilated! To my disdain, her temperature had climbed further. Since it was now apparent that a vaginal delivery was possible, I put the surgery on hold. Over the next nerve racking hour I remained in the room as we instructed the mom how to push and continued to monitor the baby's disconcerting heart tracing. I called the neonatologist (specialist in small and sick newborns) and asked if he could be present in the delivery room. I was worried that the baby might not be totally healthy immediately after birth.
When the time for delivery came, I focused on getting the baby out and handed over to the neonatologist as quickly as possible. As soon as the cord was cut I turned and gave the baby to the specialist, who began to examine and stabilize the child. After about 30 seconds he turned to the father who still was standing at his wife's side.
"Dad, you can come over here and see your baby if you like," he said.
The father came order to the baby warmer and looked down at his newborn child. In a perplexed tone he said, "Um... Honey?"
The mom started laughing, "Are you going to tease me and tell me it's not a girl?"
The neonatologist looked up, "You didn't know you were having a boy?"
I started laughing, "I sure hope he likes pink!"
In that moment all of our worries and concerns faded away into laughing, as we celebrated their healthy little BOY!
They had planned and prepared for parenthood, attended classes, and painted a room. Yet, in spite of their best plans, they were not prepared for the surprise the future held. Isn't that how life works?
It was no different with the birth of Jesus. The knew a baby boy was coming but there was no way that Mary and Joseph were fully prepared for what was in store. They knew Mary was having a boy, but how could they comprehend the truth of incarnation? Recipients of angelic visits, I doubt they were prepared for the shepherds' tale or the testimony of the wise men. They assuredly expected people to question their morality, but were they prepared for that stigma to follow them so intensely for the rest of their lives
Their experience foreshadows what we all experience in our journeys of faith. God reveals a small amount of what he Has in store for us, just enough for us to be confident in His promises and calling, but our walk of faith will certainly contain surprises.
This is the 6th and final Amazing Childbirth story, leading up to the Greatest Childbirth Story, the birth of Jesus Christ. (for the other stories click here, here, here, here or here)Please consider sharing these stories with your friends as a way to bring a new perspective on the Savior's birth. Merry Christmas!
