Ep 158. Birth Story: PROM and Hypertension

In this episode, the midwife duo reflects on a particularly memorable home birth experience. The case involved a client with premature rupture of membranes (PROM) and hypertension, as well as sensitivity to various treatments, leading to a complex and challenging birth scenario. Throughout the episode, they discuss handling unexpected complications, the significance of communication and trust between midwives and their clients, the management of medical risks in a home birth setting, and the learning curve of midwifery practice. The episode also highlights the value of midwife partnerships in providing balanced and effective patient care, as well as the importance of being prepared for a range of outcomes and scenarios in home births. 

00:00 Welcome to At Home with Kelly and Tiffany: A Midwifery Journey

00:26 Diving Into Birth Stories: The Joy of Revisiting Memories

01:32 Understanding PROM and Hypertension in Birth

02:04 Navigating Home Birth Criteria and Challenges

05:45 A Deep Dive into a Complex Home Birth Story

06:29 The Importance of Preparation and Teamwork in Midwifery

13:34 Addressing Complications and Embracing Collaboration

18:21 The Unfolding of a Prolonged Labor: Day One to Three

22:05 The Challenge of Home Induction

22:36 Unexpected Hurdles and Late Start

23:51 Rapid Progress and Blood Pressure Concerns

25:18 Addressing High Blood Pressure and Labor Management

28:57 Revealing the Coffee Enema Incident

31:19 Navigating Trust and Communication Breakdown

34:56 Reflections and Lessons Learned

39:57 The Value of Teamwork in Midwifery

41:06 Launching a Childbirth Class: A New Venture

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Transcript

0:00

Welcome to At Home with Kelly and Tiffany, where naturally minded women gather together as we pursue simplicity and confidence in health alternatives, so we can show up better in our busy lives and feel more at home in our bodies. Join your favorite home birth midwife duo for conversation, candor, and community. Welcome back to at-home with Kelly and Tiffany. I'm Kelly and I'm Tiffany. Today we get to talk about. Another bird story. I'm really enjoying this series. I have to say. I can do an entire podcast. Line up. Like I can just do episode after episode of just revisiting views. Birth stories because I mean, this was happening. Five years ago, these bursts that were starting to come through. And I remember many pieces of probably every single birth, but once I get into the notes and stuff, I'm just like remembering. So many other little gems that it is just. It's birth nostalgia to like the best. The best degree ever. Yeah, for real, after we did the last one, I was like, let's, let's like we listen more. Like, it's just, it's just so fun to be able to share. I think for us just personally, but also for the benefit of our listeners, we hope you feel the same benefit. I have a feeling this is landing as well as it feels like it is for us. But I'm excited to chat about this one in particular. Yes. So this one's called prom and hypertension and prom stands for premature rupture of membranes. That's when your water breaks before contractions begin and hypertension is just stuff, fancy little word for high blood pressure. Two things we don't like to see in. I, when we pulled this up, I was like, oh yeah, yeah. Those are two words I don't like to see when we're talking about birth. No, slightly complicated. And there's more, there's more that did not fit into the title of this. Of this story. And so to start us off Kelly, one of the FAQ's about home birth that we get quite often, which I think some of our listeners are going to be like, gosh, I wonder where do they draw the line? What conditions, risk women out of care? I mean, it kind of runs through so many things. There are certain issues in different states as well, depending on where you. Live right in California. We have certain stipulations for who we can treat and who we can serve in a home birth capacity. So that would be right. A mom who has between 37 and a 42 weeks pregnant. And she has one baby who has head down. As of last time we assessed her kind of situation. But there's other things that come up too, depending just previous medical history stuff that throws a wrench in things. It doesn't necessarily mean there's no hope for you, but it means that. We ourselves. Can't be the main provider without the support or supervision or signing off of a, of an OB. Yeah. So like some specific men, maternal disease processes, like. Diabetes, preeclampsia. Other health things that, you know, can come up. Like maybe we don't, we're not sure if your baby's growing appropriately anymore, or there's some kind of anatomical abnormality or your baby has a heart condition or, right. So there's many things that would not make home the most appropriate place anymore where you want to be near more intervention. Those are the things that will risk you out of care. But there are midwives out there who will risk women out of care. Which means essentially transferring you to medical care in pregnancy or in your birth for some kind of. I don't know. What do you call it? Like subjective things that like don't have research or risk status attached to it. Like. Limits on. How long you can be in labor limits on how long your water can be broken, how long you're pushing or yeah. And while everyone is Certainly allowed to find where those boundaries are for themselves and their care. There's no, there's no rule about that. You have to feel comfortable with things that you don't. But you need to be able to communicate those things to your client so that they know, oh, a part of birthing with this practice or with this midwife includes. Her comfortability or her. You know, plan of care with this type of situation. Yeah, everybody needs to figure out their own level of comfort as a provider. And I think that can shift over time also, but being able to ask questions when you're consulting with a midwife in particular about some of these things is really important. So that comes back to, we did an episode recently about Asking questions or like questions to ask in an interview that can help kind of start to piece some of those pieces out. So there are like the really big, like, this is not going to happen. You know, issues, right. But then there's those smaller things that can also sort of pile up on each other to be like, you know what, like it is not home birth at all costs here. And from what we are seeing, the wisest thing to do is be somewhere where there's extra support, whether that's for you or for baby after they're born. So it's not necessarily It's not a bad thing to be risked out necessarily. It can be disappointing, but it's not. Some. Bad. It doesn't mean you did anything wrong, right? Yeah. Exactly. Okay. So jumping into this story. This must be our third birth that we ever did together. If I'm like counting it correctly. Right. And we're about six months into practice at this point. And I think in our first year of practice, we did seven births together. And so that was feeling really. That was feeling perfectly fine that we had this kind of slow build while we were figuring everything out. You still had like a one-year-old. At home with you? I was recovering, I didn't know it was going to take seven more years, but I was still recovering from being a midwifery student kind of recently I had broken my arm and that just like threw a dang wrench in a lot of things like those handful of months while I was recovering. Yep. And so this particular client came to us as a referral from my old preceptor and it was kind of fun because it was like the first family that we didn't know there wasn't like another, there wasn't another relationship or association with this family. And so we were excited to serve them. And really just like, kind of play midwife from beginning to end. It was, I remember specifically we had our like official consultation kind of thing, and we walked outside together and like high five and we're like, I think they're going to hire us. Like somebody wants to. Something that we don't know personally, like wants to hire us. So we, I remember really feeling like we're doing a thing that we said we were going to do. It felt good. Yeah. And like, there were many pieces of this story that helped to refine what we. Put in place after. After taking care of this family. So we came across a lot of challenges that would have just happened inevitably, as you're forming all your different, you know, things, especially working with another midwife for the first time, you just have to walk through some things together where you're like, oh, how did that feel for you? Not good. All right. How do we want to make sure, how can we try to avoid that from happening in the future? So lots of those little pieces kind of came up with this. Particular family. And so this lady was having her third baby, but it was her first home birth and the older kids and their family had some medical problems. And so they had so much experience. In that space being in hospitals, being with doctors, being with specialists over these. Serious medical issues that they're like, we do not want to spend any more time there if it's not absolutely necessary. And so they were really excited for their first home birth. Yeah. That was like a sweet part and reminder of what we're able to do with midwifery care. Like it's not always just people who are like, I've just always dreamed of having my baby at home. It was like, that was a, that was a desire to have this healing family experience, which was really sweet. Looking back on it. It totally was. And so Kelly mentioned that like her arm was still healing from her broken femur and surgery. So we brought Christina again, our happy little. Happy little, little midwifery student bless her for like hopping. And I think this is the last one she did with us in this. While she was a student. I think so, too. But having her there ended up being super helpful because Kelly and I are like all completely wrapped up in just managing the midwifery part of this, that Christina was able to really like think on her feet and think critically and help us like come up with, you know, some information. And it just reminded me that. Students are just so much more creative, so much more knowledgeable in a, not in an experience way, but just in a, oh, well, I was just reading about this yesterday, you know, it's like, it's just so fresh for them. Like little sponges, you know, and they're more up to date on research and you know, didactic topics because they're in it, you know, several, several hours a week. And so that's one of the things that we've kind of lost a little bit of touch with is that as we become more and more familiar with the way we like to do midwifery and how we like our practice to run we're we miss out a little bit on that, like fresh perspective. Yeah. I can a hundred. Percent. See why providers get in that space of like, well, this is just what we've always done or how it takes, you know, what 10, 15 years or something for like new evidence to show up in, you know, a hospital maternity word. Well, it makes sense because everyone's just like, I gotta just keep going on this conveyor belt. I guy, like I have to put my head down and just keep focusing. And so it really, it gives you some, I'm not saying it's right, but it gives you some context as to why it takes so long. So yeah, for some things to change. So initially there were, like I said, there was a lot of pieces of working with this family that helped us to just like refine our own practices. But one thing that I remembered that I did not chart. Is how, like dead, we were at the way that this family was preparing for their home birds, because Kelly they're like pretty laid back about most things. We're like we're in your home. You're going to have running water and electricity, and you're going to gather the birth supplies that we asked you to. And we're going to bring our stuff too. And like, it's gonna, it's gonna be fine. Let's not overdo it. But this family was the absolutely most prepared for their home birth and they were thinking through. Every little detail in a way that was like, oh wow. I I actually, I can't, I can't tell you what. A structural engineer would say about having the weight of a birth tub up on the second floor. You might have to contact. And I'm 91. I'm sure he actually did. Yeah. He's like, well, if we put it, if we put it as close to the fireplace as possible, it's the most structurally sound place on the second floor. So that's our plan. And I'm like, I will just. Put it in a place where your wife wants to give birth. That's probably fine if you're also not living in like you know shanty cabin out in the mountains, like a very new. You know, area that they were living in home that they had, they were going to be just fine, no matter where they set that tub up. But I never thought about it before. I'm like, I wonder how much, what do you think that is Kelly a hundred gallons of water? How much does that weigh? I don't know. Oh, that's a lot. I wonder. Are we putting everybody at risk every single time we have a baby on the second floor? I don't know. What about, what about people who have babies in apartment buildings that are maybe 10 or 20 stores up? I'm concerned now. Yep. It was a lot. But then also this family had contact paper. Clear clear contact. Clear plastic contact paper on every single carpeted surface upstairs. And that was well before labor started that they had to deal with that for weeks. And someone thought this is needed. And we're would, there's no way we're going to let our carpet get ruined. I'm pretty sure they anticipated, even though we always say like, it's not like blood is splattering everywhere. I think they really anticipated like a blood bath. Just things just getting totally splashed everywhere. We didn't make a mess at that birth. Sometimes we do. I mean, we really try not to, we always clean up the mess, but I don't think that was a messy birth. I think it was perfectly fine. Anyway, we were dying at some of these things. We were just like, this is going to be really interesting. Sticking to the plastic and that was great. Yeah. You ha you must wear socks. To this birth. Anyway, looking back in this chart, I was reminded that this pregnancy was somewhat complicated to, I mean, we were working on some liver stuff with this Mon, she had some itchy skin stuff that we ended up, you know, doing the liver panel on and found that like, she was really kind of borderline teetering into. Son. Livered issues that we successfully treated with herbs. That was really wonderful, but she was very sensitive to a lot of things in her environment. So it was really difficult to sort out what was causing what and how to, you know, take care of her. And so that was just a part of, that was a part of her care. It's just knowing that she was really sensitive to a lot of things. Yeah. We, that was the first time we ever really like consulted with somebody else as well. We connected with another. Other newer ish midwife who had done a bunch of research on this particular issue that she was having, that we were seeing with her lab work that I did some student stuff with years before. And so. We're able to actually like connect with her, let her look at the labs. Also just make sure that we weren't missing anything. And that was a cool experience just to be like, oh yeah, we can, we can collaborate. Yes. Like we don't have to have all the answers, but it did feel good to know. Yes. We're on the right track. To have the affirmation of, you know, seeing the results of that. That was really gratifying as we were just getting started taking care of women and that we were, you know, getting some of it right. I will also say that Kelly and I had so, so, so much communication about this client, just because of some of those pieces that were happening. But then as the birth started unfolding, I mean, Kelly estimated that we probably spent like at least a dozen hours, Talking to each other, through all of the different pieces of how we wanted to communicate with this particular client. Us just working through midwife to midwife on different things that we were comfortable with. And that grew us a ton in practice because we had the opportunity to really hash out some things. But there was also just personality pieces between the two of us that we ended up, you know, kind of working through with that too, of like, where am I at in my comfort level? Where are you at? How are we going to defer to each person's. Comfort levels and things. And. Really just getting to like work out and process those pieces. I attribute a lot of those early foundational communication tools that we developed to working on this client together. Yeah. I mean, some smaller pieces from this labor have played themselves out in other ways since then. And we still communicate on things, but this was one of those defining moments of like, Oh, yeah. Okay. Not everything is always smooth and easy and as low risk as humanly possible. What do we, what do we actually do with that at that point? Because that's part of midwifery care too. It's not just. These other birth stories that we share where things are just beautiful and physiological and wonderful. It also is. Can we bring something back into normal when it starts to, you know, starts to creep outside of it. And how comfortable outside of that normal are we. Yeah. Yeah, totally. And it reminds me when Christina became licensed, we invited her to come on to our team as a three midwife team. And so she was a new midwife after we'd been practicing for a few years already. And she would just apologize constantly for needing to process and talk out through everything. And we were like, do not even worry about it. We so understand what that's like to be a brand new midwife and just feeling. The pressure and the responsibility and the am I missing anything? And how do I feel about this and what else can we do to support? And am I doing the right thing? And so that. That was J it's a part of it. It's just a part of it. And it's, it's a good part of it. And it's unfortunate sometimes. I mean, You don't want to be as mentally wrapped up in every little detail, always, but there is a piece of it that's lost as you continue to do it that you're like, oh no, it actually is good to continue to go back and like, Emotionally check yourself and clinically check yourself as well. Yeah. I mean, Kelly and I are so used to knowing what the other person feels about certain situations that there's very little, that we actually have to touch base on. Sometimes there's, there's so many things that I feel like I don't even have to run past her if I'm providing face-to-face midwifery care, because I already know. How she's going to respond or what she's going to want. And there's a part of that that just makes. Taking care of people so easy. But it was a lot of work to get there. Yes. Yeah. And, and hard work on this one in particular. Yep. Okay. So this mom, she is two days past her due date. And her water breaks. And I'm calling this day one, her water breaks in the evening. If this shows you where we're at, where we're headed, this is day one day one, her water breaks. In the evening she calls us and lets us know that. And that is not a particular anything to us we're like, okay, well, you're definitely having a baby in the next few days, but we're not like, well, we're going to need to see active labor pattern within the next 24 hours. And. Duh, duh, duh. I will say that this particular mom was GBS positive. She opted to know her. Group beta strep. And status at the end of her pregnancy. And that was a piece of her care. And so there is a little bit of like, oh, let's pay attention to somebody who's GBS positive who has their water broken. And we gave her consent for all of those pieces that, you know, she was at a higher risk for infection potentially. And we gave her really strict parameters for vaginal hygiene and. Prophylactic immune boosting. And all of that. Yeah. So she had the option to have Ivy antibiotics because of that and opted. Like declined them and have that. That conversation again, just making sure, like, this is what you still agree to. She was like, yep. I want to avoid that as much as humanly possible, which is great because we could not have collected antibiotics in the entire county. Yes of home birth midwives in order to give her appropriate dosing every four hours while we waited for baby to come. Cause we're on day one, still. Okay. So day two, we're still feeling pretty calm and cool Kelly and I have like a very a very relaxed. Viewpoint on the, on the premature rupture of membranes. It's like, if everything is looking great, your tent, you. You know, your temperature is still normal. Baby's moving normally the fluid coming out of you as normal. It's really just a waiting game there. And of course we're always bringing in the informed consent piece of like, well, now we don't, we don't have that barrier anymore. That is protecting, you know, you and your baby, but we do have all of these other positive signs and tools at our disposal. And so. Up until 24 hours. We really like, we don't expect anything if you don't ha if you're a contractions, don't start. If, you know, if we don't have any big pieces coming around at 24 hours, it's not a big deal. But around that 24 hour, mark is statistically. When 95% of labors should have got going on their own and women always have the option to decline our recommendation to start to. You know, push labor forward a little bit. And so that's what this client did. We visited her on D two. We kind of gave her just like a prenatal appointment basically. And we counseled her on her rupture status and the GBS component. And we talked about doing some home induction stuff and she wasn't comfortable with doing anything at that point. And so we kind of talked about what that would look like for her. What would make her feel comfortable? What that timeline could look like so that we could. You know, collaborate and come up with a plan to get there. And we decided that the very next morning, the beginning of day three is when they would follow our recommendation for inducing labor. Yeah. So we hadn't given them sort of a, we have this handout of exactly what they need. I think we all, we gave them a couple of those things that we had on hand already as part of that. And then they needed to go to like a health store, you know, to grab another tincture or something like that. And. I don't know if we discussed the fact that she didn't have a breast pump already. But that ended up being. Thing cause breast pump or pumping is a part of this home induction protocol that we gave them this on and off pumping experience. And so I think maybe it was an assumption part or maybe it was a. I'm not running the details are sort of shaky for me on if they thought they could just borrow one from a friend or what the, what the actual plan was. To get started the following morning. Yes. And so while we were in contact with them on day three, trying to determine. How we could support them in the follow through of the plan. They did not actually gather all of the supplies until evening time in. That's exactly what we did not want to do is. We wasted an entire day. To just start stimulating things at nighttime when everyone should be sleeping. But at this point it was worth it just to move forward more. So just. There's so many pieces there, there were so many pieces, so they finally began their induction protocol, their home induction protocol at six o'clock at night. Yeah. And, and again, usually we're recommending doing that in the morning so that it has some time to kick in. And if it does kick in you're laboring during the day, and again, not in the middle of the night. So at 6:00 PM, when she started. We were like, okay, well, you know, she's had babies before her water is broken. We're hopeful, but also, I don't think I was as like I was aware of the fact that it would work as, you know, Well, as it did. Yes. At 30 minutes after she started her induction protocol, she called us saying that her contractions were every five minutes. And could we please come? She felt like this is definitely getting going and I'm ready for some help already. And so we did, we arrived about an hour and a half later, and her contractions were about every two to three minutes. But her blood pressure on her intake vitals was 140 over 80. And Kelly, maybe you can just like review really quickly. Like what is, what is the blood pressure that is concerning? What's a blood pressure. That's too high. I mean, where's our cutoff. This is like a textbook high blood pressure. It's not like overwhelmingly like, oh my gosh, red flag everywhere. But when you look in like a textbook. They would be like, you know, one 20 over 60, over 70, something like that. But once you start getting into the one forties and especially that bottom number being 80 is sort of that beginning sign of like, okay, where. We're higher than we would like to see this. And so there's not necessarily a number that's like, you need to get out of here right now, but it is something that we need to look in the overall picture of what is going on. For this family or for this mom in particular. And so it was, I mean, especially the liver stuff she had already had going on. I think we were just already like, oh boy, what, what, what exactly is going on here? So usually we would come in and take a blood pressure. It's normal four hours later. We're retaking vitals, unless there's some reason to do so earlier, but we decided okay, there's a lot going on here right now. Right? Like let's do some calming stuff and just, we'll take it again in an hour and kind of see where we're. We're where we're at. So we're still feeling like, yeah, this you're fine here, but we need to keep an eye on this. Yes. It's not so normal that we can just be like, ah, yeah. Okay. Get that blood pressure cuff out of here. That's annoying. And we'll check it again in four hours or whatever. We're thinking like, oh, this is the beginning of your labor. That is already, everything is already feeling like it's taking forever. And we did take her blood pressure again an hour later and it was even higher. It was one 40 over 96, which is like, oh, well that's just telling us something, right. Like something's not quite right here. It's not just that. You are reactive to labor, and you're just going to sit kind of higher, which is, can be really normal for does blood pressure to be elevated in labor in general, but also it's, it's common for blood pressure to continue to elevate throughout the labor process, just because of what is happening, you know, metabolically and physically to your system. In a labor situation, but not that high. Yeah. And if we're planning for it to get higher, I think that was when we were like, Okay. I think we had to step outside the room and be like, Okay. We need to Palau again. What exactly are we going to do about this? And if we don't see resolution we're gun. We can't stay here if we're not, if we're, if we don't have a plan and we're not seeing any kind of resolution here. Yeah. So we talked to them about that a little bit. Your blood pressure is higher than we would like it to be. We need it to actually lower. And so here's our plan for helping you, you. You know, at least work with your nervous system a little bit to try to circumvent that. And then we're going to take your blood pressure every 30 minutes to continue to monitor that. And so half an hour later, we took her blood pressure and it was 150 over 100. And that was after we had already implemented some of these like more relaxation techniques. So this is stressing me out. It was stressful to, it was stressful to review. Also because she is definitely in very active labor at this point. And, you know, we're like, are you going to have your baby? Right now, or where are we at? Kind of, we don't like to like really assess. Necessarily that situation, but also there's a big difference in if you're a centimeter right now. Or. You're complete and about to start pushing kind of thing. Not that those. You know, you could be one and have your baby and a half an hour also, but just generally looking at that realizing, okay, are we. Are we in this space where we're going to have a baby really soon, and we can. Expect your blood pressure to potentially resolve. Are you becoming preeclamptic right before our eyes? So we were screening for preeclampsia. She had no other signs or symptoms. It was just this hypertensive piece. But we pulled or no, we decided to do a vaginal exam on her so that we could see what are, what are we looking at here? That's going to give us information about like how much tolerance we can have for the blood pressure piece. And she was six centimeters, which was like, okay, you've been in labor for. Three and a half hours. That's wonderful. You're doing great. But we took the dad out of the room because she was, she was really focused and I think she had asked to not be a part of any. Yes. We wanted the dad to have the main source of conversation. And then he could sort of communicate slash make some decisions like for her. So she could sort of say in her space, So we respected that and we brought him out of the room and we had a really serious talk with him because we had already. Recognized that there was some communication breakdown in between what we needed to see happen and the response to that. And so we were really. Serious about how, what we needed to see happen next. And so we told him, you know, the blood pressure is too high. It needs to come down. If it comes up any more than where it's at, we're going to need to transfer. And so then he took that opportunity to let us in on some additional information and our clients. I'm sorry, I don't mean to laugh. It's funny. Looking back in the moment. We were not laughing. It was not funny. I was like this. This is rude. This is rude to not disclose this. So this is what I wrote in the chart. I charted this. Father of baby stated without midwife knowledge, mom took a coffee enema before her home induction protocol this evening. Which is maybe what she was doing with all that time before she started. Well, it makes a lot of sense that they were working on the coffee enema instead of getting the birth pump yes. Or breast pump. So we discussed earlier, she was really sensitive to like, Everything. And so she couldn't take a lot of supplements. She couldn't take certain herbs that we recommended as we're working on different things. And just trying to like support her system. And so we were like, huh? You added something in to somebody who's a very, very sensitive. And now we're seeing this crazy hike in blood pressure that we would not have anticipated because everything was very normal with that beforehand. Yep. So we're like, does coffee enema cause high blood pressure? Huh? Let's look that up 100%. It does. It can be that that association is relatively common. Yep. And, and, but we don't have a way of saying this is for sure. The reason you have high blood pressure and no matter the cause of your blood. Blood pressure. Having high blood pressure is unsafe for you. It's unsafe for your baby. It's just. It just is we hadn't, we had many feelings. At that point. So we, we discussed transport. We said, we're going to keep an eye on this. And if it goes any higher than where it's at, then we absolutely have to transport. And he, he said something like, so what does that mean? And we were like, If the blood pressure increases, which we'll be continuing to check on, then we have to transport. And I remember talking to Kelly through this for, you know, a whole lot more. Time, unpacking and processing this. Like, if we suggest the transport are these. Client's going to. Cooperate. Are they going to cooperate? And if they do. I think there was a piece of it also that we were like, oh man, like we just w. The tr the full trust or something just didn't feel quite right. And especially in that moment. And I think it was sort of disappointing. Yeah. It was like, I understand that you. Wanted to make some different decisions than what our suggestion was. That would have been helpful. Two. To, you know, at least disco, I don't know. Anyway. But I do remember praying over her. After we came back inside and because that is what she asked for. And so we prayed that her blood pressure would be lowered and that we would just have wisdom and navigating the next steps. And the very next time we took the blood pressure, it was already lowering, it was 1 44 over 90 half an hour later. It was 1 44 over 82. And so then we thought, okay, we're trending in the right direction. Your coffee and a mum must be wearing off. This residual side effects. Great. So then we moved to taking her blood pressure every hour, but just, you know, half an hour after we decided to do that, it's 1130 at night. So she started her induction protocol at six, we got there at eight. She's she, you know, had only been in labor since like six 30 and she got in her birth tub at 1130. She started pushing about 20 minutes after that. And then she had a baby eight minutes after that. So by midnight, she had a baby in her arms. She had normal. A normal blood pressure. She had no signs of. Any type of infection happening, you know, with her uterus or systemically babies did not show any signs of like infection or anything, smallest baby that we've had. You had tiny little thing. Oh, not the smallest. Oh really? No. The absolute smallest was the Bri the surprise breech. Oh, wait for that one. Yes. Oh, okay. And this one is a, this one was like a few ounces. Okay. He was tiny little thing for being 40 weeks. That's a whole nother. That was a whole nother but her placenta came 15 minutes on its own. She had 250 estimated blood loss, which is like a cup of blood, super regular amount of bleeding. She had six hours of labor, total. She had 53 hours of ruptured membranes, which that's a long time. That's 53 hours is. It's pretty long time. The longest we've grown since then. The longest problem that we've ever had. I think as far as my memory serves me was 59 hours. And that was like two years later with the client that we had a lot of trust and communication and relationship with. And it felt very, very, very different. Yeah. And that just goes to show you right. That relationship. The shift does matter, but also we were at a different place. And our midwifery career also in terms of our comfort levels and how we were, how we were communicating with each other and all of that. Yep, absolutely. So what a fascinating little journey, we talked a little bit about like the lessons that we learned there were so, so, so many, it refined our expectations of communication with our clients and how we wanted to communicate that to them. What our expectations were of communication. And we learned that we can push boundaries with some clients, but not all clients can we push boundaries with. And that was a really interesting lesson to learn that a part of the individualized care that we give is really assessing. How much responsibility, how much trust, how much communication, how much collaboration. Makes us feel comfortable with giving a more and more individualized experience. Yeah, for sure. It definitely was probably the most uncomfortable. I've been. Us. And midwife maybe. Yeah. I can think of a couple other ones where I've been really uncomfortable, but this, this piece of discomfort was more relational than medical, I think for me. Yes. Yeah, absolutely. And I think that that part really plays into it and I think was. Hard for us to peace out as we were sorting through next options and like praise the Lord, we didn't have to make. Any, big changes to birth plans at that point. But it did, it did put us in a position where we were like, oh man, It really does matter this mutual fit idea and that mutual trust. Idea, but we also, you know, I learned some things learned about coffee enemas. Hypertension. And we always now carry what's called Hawthorne in our birth bags. Never once used it since then, but that was the one that we were like, yes, this is helpful for blood pressure. We were like, this is so important for us to have literally, I mean, I've taken it out and given it to my husband because. Mike, somebody's got to use it at this point, right? Yeah. Yeah. But it's nice to know that we have it. So if we encounter any blood pressure issues and we have a tool because I hated knowing that there was a tool that we could have used for that situation and not having it. And yup. I even remember thinking, I even remember looking up like store like health food stores in the area, if anything was still open. So we could just go grab that one herb that we knew was gonna help. But we also learned about boundaries. I mean, I learned a lot personally about what, what it feels like when I am up against my limit and not feeling flexible at all. And that's just like an interpersonal thing for me, but. I also learned that like you Kelly, just balanced that out a bit and I can think of a couple circumstances. Where I have felt that way, like I'm up against my limit. And like, in that particular situation, I think if I was the only one making calls, I would have just transferred. Like I was upset that the trust and communication part was broken. And I just thought, what am I going to put, like my butt on the line for this, you know, scenario, but you, you had more. A little more compassion, a little more reasoning, a little, you were a little more cool-headed about it. And you made a plan with them. And it worked out. Yeah, I'm thankful that it worked out. It certainly, it would have been, it felt like a good conversation to have, and to be like, here's the plan, but you have to hear us that like, We have to be in this plan together. Right. And if the, if we, I mean, it could've gone the other way. Right. Oh, totally. We don't have control over any of those pieces. Right. But just really trying to create the best possible scenario for our clients in weighing all of those pieces out and taking it, you know, heavy and serious. You know, there are a few little random things that can paint outside of normal like this, and it's important to pay attention to. And I think that we did a lot of due diligence in paying attention to those pieces, but it's good to remember that some of those things can be, be a little bit outside of normal. And that we can bring them back into normal or we can support resolution into normal. And that usually turned out okay. And there's some things that you just don't gamble with. And it's really clear that like, this is not happening in this particular space, but it's so important. And we have such an opportunity in the way that we get to autonomously, provide care that we get to look at each situation uniquely and really figure out what some of those, you know, different care. Pieces look like for the person who's right in front of us. Yeah, for sure. And looking back on this birth also in like some of the vitals and just the, how things played out and like, Dang. I wonder if midwife mean now would like what that would look like and how that would actually play out. And if similar decisions would be made and all of that, it's, this is actually a very helpful thing. And I think more providers should. I mean, they don't necessarily need to get on a podcast and do this, but this is so like clinically helpful also. On our end. Yeah. Like all of those different pieces as a provider. And I guess like one of the things of course that I, that I'm continually saying about this birth is the value in having you be a part of that with me. Me and having somebody that you can call, especially if they have a different approach to problem solving, especially if they have a different approach to communication. And there's just so much value in us being able to practice together because of that, because personality wise. We're a little bit different and it just compliments each other. And so that's another big plug for practicing on a team, practicing in a partnership. Because when you just have these, these one sided viewpoints, and you're just out there doing it on your own, you have to make all the calls. You have to hold all the responsibility. You, you know, it's just a lot, you would make different decisions. If you were practicing solo than you would. If you had another, if you had a partner. I a hundred percent agree with that. So hopefully this was like a helpful at all. Peek into this experience for us. We are enjoying our time right now. We're like halfway ish through our very first beta childbirth class that we launched. We're just having so much fun. We get to talk about some of these things that we even talked about here just in different ways, as women are experiencing different things in their pregnancy and planning for their births and just so much fun leading that group of women through. Through just preparation for a connected, peaceful birth experience. It's been really, really sweet to watch it all play out. We would love. As we open the doors and launched this officially out into the world this summer. We'd love to get you on the wait list for that, so that you can stay up to date with all of the announcements. You'll be the first to know what our plans are, what is coming what's ahead. And you'll also get access to a bunch of exclusive. Content about pregnancy, about birth, all that good stuff. And so hop on there. The link is in the show notes. Yep. And you can also find it a beautiful one, midwifery that calm. It has been a pleasure to process and unpack this one. I mean, Wu, I guess there was a lot there that I was not expecting to remember all the feelings I'm going to need to go like sauna bag after the sun, just releasing things. I agree. Next week. Bye.