Alternate Title: nuchal cord, 2 nuchal hands and a non-optimal fetal position makes for a doozy of a birth (but alas, that is a little wordy for a title)

At 11pm on August 1st, I was woken up by a strong and forceful contraction that jolted me out of bed. It wasn't like the gentle contractions in my lower abdomen I had leading up to this moment. It was more of a "jump out of bed faster than you knew you could at 40+4 days" kinda contraction. Being the third baby I thought, "welp, tonight's the night." I went back to sleep and about 10 minutes later I was woken up by the same pain. I thought, “Mmm...kkkkayyy. So this is it.”  I called my doula, Tunisia, to put her on alert so she knew to be ready but I wasn't ready for her to come yet. At that point I just wanted space, privacy and to be left alone.

I hopped into the shower to see if I could get more comfortable. After 30 minutes of being on hands and knees in the shower the contractions picked up intensity and were anywhere between 5-10 minutes. I called for my husband, Marcus, to let him know that contractions were getting more intense. I was tired and knew it could still be a long labor so I tried to lay on the couch and rest in between contractions. I felt like the time between contractions was restful- each contraction I felt refreshed from my 5-10 minute nap. The contraction itself was a different story. I would naturally shoot up during contractions to move - sometimes hanging onto Marcus's shoulders, sometimes on all fours, never on the exercise ball because I tried that once and immediately dropped the f-bomb. It hurt - a lot. This was a lot more intense than I remembered early labor being with the girls. Finally around 1:50 I called Tunisia and told her to head over in 20 or 30 minutes for support. 

20-30 minutes probably would have been fine if I didn't go to the bathroom. As soon as my bladder was relieved, the baby found its new space and couldn't wait to shimmy down. Contraction intensity picked up and they were now 1-3 minutes apart. About 10 minutes after I called Tunisia I called the midwives because moving and talking during contractions was no longer happening. Claire was on duty that night and after hearing me through a contraction she recommended we start heading over soon. I started walking back to tell my oldest we were leaving and felt the baby shift to the point I thought, "oh crap, we gotta go now or this baby may accidentally be born at home." I had an intense shooting pain in the perineum that felt like the baby had just dropped into my crotch. I remember reaching down and feeling down there just to make sure a head wasn’t on it's way. Ha...luckily he was still on the inside! We made our way to the car, called Tunisia to say we were throwing a curveball and would meet her at the hospital instead.

On the way to the hospital contractions initially picked up and were steady at 3 minutes apart. About half way there I moved and the contraction intensity increased but timing slowed and were now 7-10 minutes apart again. When we made our way up to L&D, the contractions were by the best description I could find- wonky. This was my third labor but it was nothing like either of the girls. It was nothing like I expected. It was all just….wonky.

My contractions were strong but they felt lopsided and weird...like only half of my body was doing the work. It felt like someone was taking my right hip/pelvis and right lower abdomen and had it held in a vise grip squeezing it together while twisting it in circles and pulling it further and further away from my body. It was intense. And sporadic. And just wonky. 

I consented to a vaginal exam because of how I was feeling. The baby was high (+2) and I was dilated 3cm. THREE whole freaking centimeters. I was frustrated because the intensity of this labor was already stronger than the entire delivery of my 2nd. Claire asked how I was feeling - weird and I said "I don't know what this baby is doing but it is wonky" was my description. After going for a walk, Claire watched me move and she wanted to do a quick positional ultrasound to make sure that the wonky feeling I had wasn't actually a breech feeling. <<<insert more f-bombs>>> On ultrasound we learned the baby was head down (woot woot) but was ROT and we saw two nuchal hands. This means his hands were lodged into my pelvis along with his head and they wanted to come out that way.

This was definitely one of those moments where I didn't want to know what I know. As much as I love Spinning Babies, all I could think of in that moment was f-bombs because I know what they say about ROT babies (and nuchal hands) and it isn't pretty...  "if labor is treated with typical habits (resting in bed, semi-sitting, lack of food or lack of movement), that labor is often longer, and babies can turn posterior easily. Instruments, medications or even a cesarean is more likely than when the baby STARTS labor on the left." Thanks for the confidence boost….

So, great, we have a double whammy. Right Occiput Transverse position AND a nuchal hand. Admittedly, I started to get annoyed and my inner Negative Nancy and Temper-Tantrum Terry were making their way into labor. My inner dialogue wasn't pretty, "I'm ONLY 3cm...The baby doesn't want to stay engaged...There's a hand there AND the baby is posterior...fantastic, Real. Freaking. Fantastic."

Thankfully, Claire is amazing and could see the frustration on my face. She looked at me and said, "Well, great news. There's nothing on the ultrasound to say you CAN'T give birth vaginally." Honestly, those words were exactly what I needed at that moment. Sure, there was a lot of stuff adding up against a vaginal delivery but there was nothing to say I couldn't. Nothing to say it wasn't safe.

The next couple of hours were honestly a bit of a blur-- I just remember the contractions being intense on the right - like someone was stabbing me in the right low back and abdomen and trying to tear apart from front to back. I couldn't get comfortable in any of the normal rest positions for labor...side-lying felt like torture, the exercise ball was still a no-go, sitting in thrones position left me gasping for air the second a contraction started. When I tried the resting position it felt like I had a burning sword going through my body…slowly twisting it and my body apart.

I found myself on all-fours, supported by a bean bag or in open-knee-chest with my husband shifting my hips and low back, applying pressure to my low back or lifting my belly so I didn't have to do the work myself. Marcus was a comfort measure champion. Tunisia helped with positions, pressure and was able to get a heating pad for my groin since it felt like the baby was trying to make its way out through my hip/groin instead of vaginally. It felt like every contraction was centered on my right pubic bone, quickly ripping it further and further away from my body with each contraction.

After a little bit of “rest” the contractions were still 5-10 minutes apart, still wonky and annoying the crap out of me (uh, yeah...literally and figuratively...everybody poops, especially in labor, it's okay). Tunisia recommended a walk and I'm pretty sure the glare I gave her is still reflecting in her soul. I didn'twant to move. I was having a hard enough time just breathing.

A little bit later I wanted to get in the shower to see if the warmth would help. I stood up but quickly found myself hanging by Marcus's shoulders navigating a contraction. The next two contractions were intense and I never did move to the shower...instead I followed my body's natural instincts in a move that, if it had been filmed, would be a perfect example of an exorcism. My hips tilted to the left, my body to the right, I shifted forward and backward, tilted my pelvis and wiggled and eventually dropped into a deep squat. But even the squat wasn't normal. The only position I wanted to be in was a squat with my body tilted and rotated to the right, dangling over the bed. By almost every birth book ever written, I was doing it wrong. But it was the only position that felt right. 

After a few contractions I asked for help back on the bed. The contractions were still super intense and they were still 5-10 minutes apart...never getting closer. Negative Nancy's voice was starting to creep back into my head, "Am I even dilating? Why aren't the contractions getting closer?" Finally, I assumed my favorite position for this labor which was hands and knees. Tunisia was doing Rebozo Manteada when my water broke...ALL. OVER. HER. It was like something out of a sitcom, Tunisia covered in my amniotic fluid while I panicked for a minute because the water bursting felt identical to when #2 was physically born but this time I didn't hear a baby screaming and I panicked the baby wasn'tokay. I asked Tunisia where the baby was and she calmly told me it was just the bags breaking...I still had work to do.

The midwives came in and since it was a shift change, I now had Lacey. Lacey was a peaceful presence in a moment when I felt anything but peace. She told me everything looked great. I could feel the baby shifting in my abdomen. It felt like the baby was rotating, rolling and moving my intestines from one side to the other. It delt like the baby was in the washign machine, forcefully tumbling side-to-side and it nearly took my breath away.

Thankfully, my team didn't let me get distracted. "Breathe. Relax your shoulders. Relax your jaw." I started to run from the pain and pull away from it during the contraction. Not only was the contraction itself intense, I was struggling to get sturdy ground because my leg kept slipping in my amniotic fluid. I yelled in frustration and Lacey calmly reminded me to lean into the contraction rather than run away from it. I was still on all-fours so I pulled my right leg forward a bit, took a breath and naturally pushed with the next few contractions. All said and done I think I pushed 3-4x but I can’t really tell you because it was all a blur. 

When the baby came out, he came out with both hands up at his face as if he was ready to fight and Marcus was there to catch him. I jokingly said he came out knowing he needed to protect himself from his feisty big sisters. Lacey was there to resolve the baby’s nuchal cords as we welcomed our sweet boy, Carmen, Earthside and to our family. He was healthy, screaming and absolutely perfect...even if he was born from the ROT position, with nuchal cords and two nuchal hands.