Meet Brianna, an eager 38-year-old, now 38.2 weeks pregnant with her first baby. During her clinic appointment that morning, she was informed that it would be wise to head to the hospital due to low amniotic fluid, a condition known as oligohydramnios.
Uncertain about what to expect, Brianna and her husband prepared for their trip to the hospital. As they walked in, Brianna was filled with a mix of emotions—excitement and anxiety intertwined.
The nurse ushered her into triage, where they confirmed her condition of low amniotic fluid. Considering her weight and gestational age, the medical team decided to admit her for delivery.
Initially, Brianna had planned for a natural delivery and opted against an epidural. The doctors reviewed all the admission information with her and allowed the nurses to get her settled before commencing her induction.
They decided to begin with a dose of Cytotec, a medication used to stimulate contractions, which was administered around 5 p.m. Brianna patiently awaited the onset of labor, with the nurse periodically checking on her and confirming her desire to manage the pain without medication.
Around the change of shift, approximately at 7:30/8 p.m., Brianna's contractions intensified. She realized she needed pain relief and also noticed fluid trickling down her leg. Concerned, considering her already low amniotic fluid, she promptly informed the nurse, who then alerted the doctors about the potential rupture of her amniotic sac.
After a quick vaginal examination and amniotic fluid analysis, it was confirmed that her water had indeed broken. The examination also revealed that her cervix was dilated to about 1cm, with 90% effacement, and positioned at -3. The doctors explained, "Your cervix is thinning faster than it is opening. While you're at 1cm, we still have 9cm to go, but you're already 90% effaced. We've confirmed your water has broken, and we'll continue to monitor you."
As the doctor spoke, Brianna winced in pain from the repetitive contractions. Taking a momentary break from the pain, she breathlessly requested pain medication.
The nurse calmly replied, "Let me discuss this with the doctors."
Returning shortly after, the nurse appeared disappointed. "Unfortunately, Brianna, I can't administer any pain medication through the IV because your baby's heart rate isn't tolerating the contractions well, especially since your water has broken. We can start fluids for an epidural, or we can wait until the baby's heart rate stabilizes."
Dismayed by the news, Brianna decided it was time for an epidural. In excruciating pain, she felt the intensity of each contraction as the fluids flowed into her IV in preparation for the epidural.
Within an hour, Brianna had received the epidural, and her body relaxed.
Around 11 p.m., she continued to experience consistent contractions every 2 to 3 minutes, but her baby's heart rate was showing fluctuations. These two factors prompted the doctors to check the progress of her cervix. During the examination, Brianna was found to be 5cm dilated, with 90% effacement and at -2 station. For a first-time mother, she was progressing rapidly.
Brianna continued to labor, with nurses and doctors coming in periodically to reposition her. Each time she thought she was getting comfortable, a member of her medical team would adjust her position. This continued for what felt like hours.
Her devoted husband remained by her side throughout, shifting his chair from one side of the bed to the other each time they repositioned her.
Around 2 a.m., her nurse decided to try applying oxygen to see if it would help stabilize the baby's heart rate. While it didn't hurt, Brianna wasn't certain how much it helped, as the medical team continued to come in and out of her room.
Within 30 minutes of applying the oxygen, Brianna's doctor arrived for an examination, just before 3 a.m.
During the check, Brianna was found to be fully dilated at 10cm, with 100% effacement and a +3 station. This meant it was time to meet her baby.
As the medical team set up around her, Brianna focused intently. Her husband stood by her side, offering words of encouragement.
The doctor leaned in and said, "Okay, we're going to do a practice push. When the next contraction comes, give me a good push."
There was a pause until the next contraction arrived.
Brianna sat up, tucked her chin to her chest, and pushed.
"Wow, okay. Stop," the doctor said. "That was a fantastic push. Let's get everything ready and call NICU."
"Keep pushing like that, and you'll be meeting your baby in no time," her doctor exclaimed enthusiastically.