The Point of No Return

It seems to me there inevitably comes a time during the course of a natural birth that the woman finds herself at the end of her rope, convinced that she cannot go on. For some delightful folks (usually those who considered themselves too smart to attend Prenatal Classes, or believed that their Internet education would suffice), this point is shortly after they walk in the door. For the more hardier women than myself, those who choose not to have an epidural, the point still comes.

Today was the perfect example. My patient was a quiet woman, having her fourth child. She wanted as natural a delivery as possible while being induced. No pitocin (to give more contractions) and no epidural... she just wanted an amniotomy (to have her water broken). Ok. That's fine. I'd like for her to have the delivery she wants. So I shift into Natural Labor mode and start to wait.

Two hours after the Obstetrician broke her water, she was still not contracting any more than when she'd arrived. We sat down and discussed starting pitocin to give her a bit of a boost. She agreed that that would be a good idea, so I started pitocin. Very slowly... we were still aiming for a delivery without an epidural, which is significantly harder with pitocin.

Four hours later the patient was really beginning to hurt and requested that I examine her. She still had not changed. Tears filled her eyes. Before getting discouraged, though, I reminded her that this was not her first baby and that it could, and probably would, speed up significantly in the next few hours. She agreed that she could continue for another hour.

The next hour, I examined her and she had progressed a dramatic amount to 6 cm. She was clearly going very fast, but the pain was too much. She'd reached the point of no return. It's when the patient wants the epidural but in reality she's in the end stretch and very capable of achieving the delivery that she wanted! My patient wanted the epidural and no encouragement I could give was going to change that. I called the Anesthesiologist.

When he walked in the room, I thought I'm going to examine her one more time, just on a hunch. Sure enough was 10cm. Complete. Her entire labor was 1.5 hours. Incredible. Now tears of joy were running down her face.