2.3.b Labour and the Transfer into Hospital

 

Geeta’s labour begins when she is 41 weeks + 3 days gestation. She has been labouring well at home with her mother and doula. Her contractions began at 06:00. Carol arrives at noon and assesses all to be normal: vital signs, contraction pattern, cervical changes and the fetal heart rate. Carol calls the birthing unit to notify the Charge Nurse, Eleanor, that she is providing care to Geeta for a planned home birth. Eleanor pulls Geeta’s antenatal records so that the medical staff is prepared if a transfer occurs. Having records in place at the local maternity hospital ensures swift and efficient communication among the team if they transfer.

Around 14:00, Geeta begins to make grunting sounds and says: “I feel like I need to push”. Carol does a vaginal exam and feels a small amount of cervix left, so she calls her second attendant, Sasha, to request her attendance. By the time Sasha arrives Geeta’s contractions become less frequent and milder. A vaginal exam shows a similar finding as the previous exam. Her vital signs have been stable throughout, and the baby’s heart rate has been normal.

Over the next few hours, Carol, along with the help of Jillian, supports Geeta through some techniques to facilitate rotation of the baby and to increase the frequency and strength of contractions. They recommend position changes, emptying her bladder frequently and encouraging Geeta to hydrate and eat.  Sasha has done advanced certification training and offers acupuncture treatments.  They also attempt to manually reduce the cervical lip. Unfortunately, none of these techniques seem to be effective. There has been a little rotation of the baby, but the baby is no lower in the pelvis, and the cervix has not changed. Geeta is exhausted and her mother Parvati seems concerned.

Carol believes that Geeta is experiencing labour dystocia or prolonged active phase of labour. Carol considers the options for care, the changing clinical situation, and how they may affect birth site selection. Carol begins a conversation with Geeta and discusses her concerns and the potential benefits and risks of home versus hospital birth in this situation.  During the decision making process some key communication skills are used.

Geeta decides to transfer into the hospital and is received by the hospital team. Geeta is settling into her room and her mother and her doula have accompanied her. She is struggling with the contractions and is quite exhausted. The transport was uncomfortable for her. Aleya is the assigned nurse for the room. She is very supportive and empathetic. She asks Geeta what she needs and goes to get her a cup of cold water.  Eleanor is the charge nurse on the floor and she is waiting to see what she can do. Dr. Liz Chen is the obstetrician on call. Geeta has never met any of these providers.

Sasha stays in the home to pack up the home birth supplies and make the home ready for the family's eventual return. Carol travelled separately in her own car and had a few moments in the car ride to gather her thoughts about the situation. She has prepared what she will say when she arrives at the hospital’s maternity unit.