Family Centered Birth During Quarantine: The Birth of Ruby

Some seasons of life bring love and joy, some bring discomfort and growth, and others bring it ALL. Molly and Greg had to navigate more than they anticipated during this pregnancy. It seems that there was something new to consider at every twist and turn. Everybody was elated to find out Molly and Greg were adding to their family. Their families were a key pillar in their support team throughout their pregnancy. One of their biggest cheerleaders was their three year old son, Rory! They started easing him into the idea of becoming a big brother very early on. He spent many weeks talking about his baby sister and practicing his baby care skills.  

With this being Molly’s second pregnancy and being a nurse in labor and delivery, she knew something was off fairly early on. She took notice of her extreme nausea, vomiting, fatigue, and dehydration. There wasn’t any relief as the first trimester progressed into the second or second into third. Molly struggled with a pregnancy related condition known as Hyperemesis Gravidarum. 

This condition takes a huge toll on the pregnant body both physically and emotionally, some people see drastic weight loss, some are in and out of the clinic for IV fluids, there may be several attempts at medications, nausea and vomiting, increased risk for depression, etc. In Molly’s case, she opted for a picc line in order to make IV fluids easier to receive since they were becoming a routine part of her care. Unfortunately, one of the risks associated with them are blood clots and Molly experienced this complication. 

Molly now had a whole new set of things to monitor and manage on top of the exhaustion and medical needs that come along with Hyperemesis Gravidarum. This meant monitoring with extra care providers- Maternal Fetal Medicine, in addition to her OB. This meant taking blood thinners, it meant weighing the options of waiting for labor to occur on its own versus induction. It meant seriously considering her pain management options and preferences in advance. 

Her health triggered waves that crashed into all aspects of life. Getting through each day was a task in itself, she was far too sick to work, taking care of their toddler was an incredible challenge. This is where Molly and Greg’s family really stepped in and provided so much love and support. They played such a huge role that both of their moms were invited to be in the birthing space.   

Molly and Greg actively envisioned this labor and felt like an induction was the best course . Molly’s labor with Rory was pretty smooth and moved quickly after her water broke. She felt like her body would respond well this time around too.. She also knew that inductions can be intense, she’s seen the variation of outcomes. Molly searched for a provider who was willing to work with her on planning a gentle induction. She switched providers and hospital systems midway and felt confident in her choice until about 3 weeks before her scheduled induction. 

This is when we started preparing for COVID-19 to hit our communities. The hospitals in the area quickly shifted visitor policies, placing limits on the amount of visitors and support patients are able to bring with them. Some hospitals included doulas as visitors and some viewed them as an essential part of the birth team and welcomed them into the birth space. It appeared that Waukesha Memorial wasn’t going to budge on their policy despite Molly’s fierce advocacy work. She values the support and care that doulas bring into the birth space and hoped that her advocacy would help others facing the same sorts of heartbreaking decisions.

Once again, Molly and Greg consulted with new providers in a different system whose policy was still welcoming doulas into the birth space. They found themselves working with a clinic in Madison and started to prepare for birthing at Meriter Hospital.

At around 5am on Thursday, April 2nd Molly and Greg arrived at the hospital in Madison to settle in and begin the induction process. They began by doing a cervical check, Molly wasn’t too far into the dilation process but trusted that her body only needed a few nudges to get labor going. She opted to set things in motion with an oral dose of Cytotec and a Foley Bulb Catheter. The Foley Bulb is placed into the cervix and slowly filled with a saline solution. As the Foley slowly fills it aids in softening and dilating the cervix and falls out around 3-4cm. The Cytotec is used to help facilitate uterine contractions. 

I was able to pass through the hospital screening station and join them just before 9am. They were relaxing in their hospital room, Molly was pacing her room since walking through the halls wasn’t ideal. Her contractions were regular but fairly mild. We used this time to reconnect, we talked about the challenges she faced and how relieved we were to be there. 

After checking in with her care team they decided the next step was to introduce a low dose of Pitocin and to discontinue the Cytotec. Molly was put on the lowest level since her body kept showing positive labor patterns. After about an hour or so Molly’s Foley bulb fell out which meant that she was at least 3cm dilated. At this point Molly felt that it was time to break her waters, her doctor agreed and tossed out the idea of having an epidural placed since it was a part of Molly’s plan. Molly didn’t think it was time yet, they moved on and broke her water. 

From there Molly’s contractions picked up rather swiftly. She found herself laboring in the bathroom, alternating between sitting on the toilet and standing and swaying.Greg held her hand, coaching her through each one.  After about 30 minutes of fiercely working through contractions Molly signaled her nurse who turned off the pitocin, then called in the anesthesiologist for an epidural. She found it next to impossible to sit still, she felt a lot of pressure so Molly’s doctor checked her again, she was only about 7-8cm. Molly really tried to persevere and focus on Greg while sitting as still as possible. 

She just couldn’t do it. Molly leaned over to the side and said “SHE’S COMING!” Within moments her nurse had hands near the baby's head until the doctor could finish getting her gloves on. Everybody cheered Molly on as she pushed about two more times before her daughter was being passed up to her chest. 

Molly and Greg erupted with emotion, still in shock with how sudden things changed. After the first hour mark they were ecstatic to announce Ruby’s debut to their parents and son Rory. Molly shared with everybody that there was only an hour between having her water broken and having Ruby in arms and how there wasn’t enough time for an epidural like she was originally planning for.

Early postpartum recovery has been mostly smooth. They were hoping to have a short hospital stay and were aiming to go home around 24 hours postpartum, however that didn’t work out. Ruby needed to stay. Her bilirubin levels were a bit higher than they wanted, but that didn’t last long with the help of frequently nursing, using donor milk, and photo-light therapy. Once they were home Molly and Greg were able to introduce Rory to his baby sister Ruby. He’s adjusting to being a big brother but isn’t a fan of her making noise. The hardest part has been the isolation that comes with quarantine, they have only been able to interact with their friends and family through screens and windows. Molly says this experience was completely different than her first, but they are so happy!