Processing

She'd been "doing stuff" for weeks.  Little twinges here and there; sometimes a good one that would make her stop and contemplate.  At each of our meetings she'd ask us to "check" though there were no changes.  She was ever hopeful that "today would be the day".

There were two dates.  The LMP date came and went.  That magic number 42...here today, gone tomorrow.  The second EDD, according to a 16 week ultrasound, assured us that she was only 40 weeks, so we agreed to wait.  NST on the baby showed lots of wonderful healthful activity.

Wait
Wait
Wait

41 weeks, my phone rings.  I'm just getting dinner on the stove; hardworking, hungry husband prowling the kitchen.  I reach into the refrigerator after taking the call, crack open an ice cold beer and hand it to my man. "Sorry Honey, but I gotta go.  These potatoes will be done in 10 minutes.  Do what you will with the steaks."  Kiss, Kiss...I'm out the door.

I get to the birth center and find Mama getting into the tub.  She's 7-8 cm. and things seem to be rockin' and rollin'.  Sr. midwife tells me baby's floating at -2 or -3, not engaging in the pelvis.  This has been our "problem" all along with this little one.  Mama is a large woman, pendulous belly, lots of room for baby to play; no need to put her head in the right place.

Later...9.5 cm (ish) with anterior lip.  Baby still floating, no engagement.  "Why don't you give a little push with this next wave? Lets see if we can get this little pumpkin to get her head down here."

Nothing...but FHT's are good.  Baby's tolerating labor really well.

This continues for about 1 1/2 hrs.  Baby's head still isn't where it should be.  Mom is getting tired.  We've tried our bag of tricks to get baby down.  FHT's are o.k. but not as great as they were.  O2 seems to be in order.  Baby likes the oxygen.  We put Mama on the toilet to push for a few contractions; "Let's see what that does."

In the meantime, the Sr. midwife is getting the chart together and copied as this mom is a VBAC (vaginal birth after cesarean) and our state regs. will only allow her to push for two hours before we have to transport.  Baby is still at -2 station (which means she is still high in the uterus and hasn't fully engaged in the bony pelvis of the mother).  I stay in the bathroom with Mama, encouraging her.  She has another powerful contraction and pushes to the point that her water breaks.

Oh Good Lord!!!  Particulate Mec!!  Lots of it.  Shit!!! Literally.  I plaster a smile on my face, "Oh look.  You're water broke.  Let me just jump downstairs and get the midwife.  Good Job!"   I calmly walk out of the bathroom and as soon as I'm outta sight, I haul ass to find the midwife.  She's with the grandparents who I don't want to freak out so I say, "Hey (insert midwife's name) we've got SROM with particulate mec."   Normal grandparents wouldn't know that this is not a good sign but the midwife did.  She nonchalantly leaves the presence of the grandparents and together WE haul ass back to the birthing woman.

You know how toothpaste looks when it's squeezed from the tube?  Thick and pasty?  That's what was coming out of this woman's vagina.  Black/green, thick, pasty, meconium.  I've seen lots of meconium stained amniotic fluid, but I've never seen anything like this.

We try to get heart tones on the baby, but its not easy because of Mom's size.  I literally have to lift her pendulous belly, sink a shoulder into it to hold it up, so I can get the doppler underneath the pannus and find the baby.   Yeah, after we find the heart tones, we are off that toilet and  onto the bed in a hands and knees position.  That baby still hasn't descended into the pelvis, now we have a mess o' mec and heart tones are starting to dip.  Sr. Midwife calls the EMT's for an ambulance transport as there isn't anyway we can get this woman into her vehicle (or ours for that matter) in this hands and knee position.

Fast forward to KMC in the labor and delivery area.  Sr.midwife is getting her ass chewed by the doc on call.  He's livid with the situation and accusing Sr. Midwife of all kinds of atrocities.  I am in shock as I stand there listening.  Sr. Midwife keeps her cool, respects the doc while in "his house" and as soon as he's done with his tyraid, she calmly and collectively defends herself, her craft and her client.  I will give mention that by the time we'd left the hospital, the doc was not hostile toward us any longer, and was in fact, quite complimentary of our practice, our records and the stellar job we'd done with this client.

Regardless, Mama has another cesarean section and the baby is compromised.  Baby had the worst case of meconium aspiration that this particular doc had ever seen.  The baby was rushed to NICU then life-flighted to Portland.  As of yesterday, "they" don't know if she will survive.

It's all so surreal - the labor, the transport, the hospital scene, the bad news, the weeping parents and grandparents, the "looks" from the hospital staff, that feeling of unwarranted guilt.

Oh the questions...What did we miss?  How could a baby be so happy and healthy sounding in the womb to  come out like this?  The doc thinks she was swimming in the mec for quite awhile - she was stained green, stinky/smelly and there was poop under her fingernails.  How would her NST sound so great two days before she was born if she was living in pea soup?  I didn't think fetuses "breathed" in utero.  I know they make breathing motions, but actual breathing?

I've done some research since this train wreck, because I'm confused regarding this breathing thing.  I've found that mec aspiration once was assumed to only occur primarily at birth in conjunction with the onset of respiration.  Now it is felt to happen most often with intrauterine mec passage associated with periods of fetal asphyxia (lack of O2) sufficient to promote gasping.  So, I wonder and remember and think... did the baby's heart rate ever drop that low?  No!  It didn't.  Couldn't it be possible that when the c section incision was made and baby was pulled out, that she could have aspirated then?  But what about the pediatrician saying that the mec in the lungs had been there a long time?  I have so many questions.

I'm still processing.

I'm still praying.