“Pelvis in which you can turn a Mercedes”

Beautiful home birth on Curaçao

In one of my last internships during my midwifery training, I went to a maternity visit, the baby was almost 5 kg at birth, Mrs. Had a smooth and smooth delivery without any problems. The midwife who accompanied me then said: "This Mrs. has a pelvis in which you could turn a Mercedes." It made me laugh out loud and I have never forgotten this statement.

Switched from Gyneacologist to Midwife

One of my clients came to the practice for a check-up, her due date just passed. She switched from the gynecologist to me from 37 weeks onwards because she wanted to give birth at home. We had been in touch about this for some time, she went to our birth course with her partner and she thinks a home birth would be much nicer, or suit them better. She's doing well, but she's getting a bit fed up at this point with the pregnancy and is starting to have trouble sleeping. The baby is still having a great time, and decides to pose very nicely during the ultrasound at 40 weeks! Beautiful pictures!

We discuss the different options, wait or perhaps strip her membranes. After careful consultation, she indicates that she wants to try stripping. When examined internally, she already has 2-3 cm, her cervix feels very favorable and can be stripped very well. Yes, this could be the push she needs to get the birth started. They go home with the advice to just mess around a bit at home and get some rest in case the birth starts.

---

What exactly is stripping the membranes?

The midwife does an internal examination to check whether the cervix is already flexible and whether thre is dilation. If that is the case, you can be stripped. During stripping, the midwife loosens the membranes of the cervix with her fingers. This releases hormones (prostaglandins) that are necessary to initiate labor. Some women find stripping annoying or unpleasant. Other women don't feel it that much. Stripping accelerates the ripening of the cervix. If stripping has the desired effect, you can have contractions within 20 hours. The midwife can strip you a second time if it had no effect the first time.

---

Just after midnight I get a call from her partner

"Her water just broke in the shower!" The amniotic fluid is clear, she was already experiencing some cramping, which has now increased slightly but is still irregular. I consult with them that they will call again if the contractions increase and are regular.

A little over an hour later I get a call again, the contractions have increased considerably, she indicates that she would like me to come and have a look. When I get there it is clear that she is having intense contractions, she finds it tough and did not expect this. After half an hour she indicates that she would like to know how far along she is, because she doesn't feel like giving birth at home if this is just the beginning... She already has 6-7cm! This gives her good strength.

In the birthing pool

In the meantime, we are busy preparing the birthing pool. Once in the pool, she notices that it helps support the contractions, but it is also clear that they are getting stronger quickly. After more than an hour she indicates that she feels pressure during a contraction. At the peak she gently pushes a little, this helps to absorb the contraction. In the meantime, maternity care is also underway.

After about an hour I do an internal exam; an edge of the cervix can still be felt. I slowly see some panic developing, she is tired and having a hard time. I indicate that I can try to gently massage the edge away, which she is willing to try.

She moves to bed, which allows me to feel a little better and I feel that the baby is not conveniently positioned. The head is not lying straight in the pelvis and his chin is not neatly on his chest. During the contraction I try to slide the edge of the cervix over the head, with no success... I advise her to lie on her left side in the hope that the baby will lie a little more favorably. About half an hour later she has a reflexive urge to push, sighing away is no longer possible.

---

What exactly is reflective pressure?

During the contraction you have the feeling that you can no longer sigh it away, your abdominal muscles contract as a reflex and you have the feeling that you have no choice but to push along. If dilation is indeed complete, this is the ideal time to start pushing (expulsion).

---

Because the baby was lying in an unfavorable position with an edge over the head, I still want to feel once more before pushing. The edge has become very thin and with one press from Mrs. this has completely disappeared and the head is a lot deeper, the position is the same but there is progression.

Starting to push

We start pushing on the birthing stool, then switch to squatting, but unfortunately not a lot happens. I notice that fatigue is starting to set in with her. The head remains in an unfavorable position. After about 40 minutes I suggest going back to bed so that I can help a bit. We roll up a towel to place under her pelvis (prevents pressure on the tail bone), her partner sits behind her so that she sits slightly upright and he can support her.

I immediately notice a difference, the head drops steadily down with each push, little by little it gets deeper. I notice that the atmosphere in the room changes, more excitement, everyone realizes that this is going to work! After half an hour, a part of the head remains visible for the first time outside of the contraction. A few contractions later I suddenly see the head make a large turn from the crown position to the "normal" position (back of head in front).

I can't remember ever seeing a baby make such a big turn at this point in labor!

A beautiful son is born

4 minutes later a beautiful son is born. But that head!!! This little man's head is completely shaped after his mother's birth canal, and where the tute normally sits on the back of his head, his tute is completely on top of his head. It is very clear to see how he has been lying. In total, Mrs. pushed for 74 minutes , which is super impressive at with this babies position! Just for comparison, in a normal occipital position the diameter of the head is approximately 10 cm, in a crown position this is about 12 cm!

My supervisor's statement immediately came back: "You have a pelvis in which you could turn a Mercedes!"