False Alarms

Written by Sarah Davis CPM

            Most mothers eventually ask the midwife - “What happens if I have a false alarm?  What if I think labor is happening, I call you and you come out, and then my labor goes away?” Nobody wants to be the client who calls her birth team out and then becomes the “watched pot.”    The answer to the question about false alarms is simple:  if labor quits, mother and baby are doing well, and there isn’t any reason for us to encourage labor (like a broken bag of waters), then we go home!
 
            This scenario happens more frequently than you might think, and it truly doesn’t bother midwives.  We would always rather you call if you think you are in labor than wait until it’s too late for us to arrive before the baby.  This summer I had several false alarms, one that included a lovely walk with Kim on a not-too-hot afternoon, and a pleasant visit to a bookstore, but my favorite false alarm story happened a number of years ago.
 
            June of 2008 was very, very busy.  Some May clients ended up having their babies in June, some July clients did the same, and June had plenty of due dates, too.  It was a hot, but otherwise very nice month in the middle of the country - not too humid, and enough rain to keep my garden growing well (which was handy, because I had no time to water it!).
 
            One of my clients, “Mary,” was having her 7th baby.  An Amish woman, she lived in a community about 45 minutes away from me, along with the majority of my clients.  This was her first homebirth, and she asked several times about when to call me about labor.  We talked it through - she had managed to get to the hospital *before* the baby’s arrival 6 times previously, so it was clear that she recognized active labor when it happened, but with at least two of her children, she had arrived at the hospital only to have her contractions stop.  In both cases, the OB staff had induced her labor to start up again, as she was already admitted to the hospital, and it would have been a hardship to go back and forth a number of times.
 
            One of the issues that Amish families deal with when staying at a hospital outside of their community is transportation.  Most families hire a driver, who is simply an English (non-Amish) person with a vehicle who acts as a taxi, to drive them to places they otherwise couldn’t go.  This isn’t a hard thing to set up if you are planning a trip to a regional center for the day - you know ahead of time which day you want to go, you invite your sisters or neighbors to go along, and everybody can get their special shopping and appointments done and split the fare.  But if you are in labor and need a ride to the hospital RIGHT NOW, it can be hard to get a driver!  Drivers are well aware that sometimes babies come more quickly than expected, perhaps in the 45 minutes between your house and the hospital.  And drivers like to schedule trips ahead of time, and your favorite driver might just not be available when your labor begins.  These were good reasons for my client to have her labors induced, but there was also the cost of a taxi, which could be $100 or more for each trip back and forth from the hospital.
 
            But Mary didn’t like to be induced, and this was one of the reasons she wanted to have this baby at home.  She was also looking forward to having postpartum visits at her house, but she was especially looking forward to not being stuck in a hospital with no contractions.
 
            Mary’s due date was right in the middle of June.  The first two weeks of the month were full of other client’s labors and babies, and Mary warmed up for labor, with bouts of mild contractions every couple of days.  The night before her due date, her husband called me at 2:30 in the morning. 
 
            “Mary says ‘this is it’ - she was awake for a little while before she got me up to call you, and these look like the real thing.”  I told Mary’s husband that I was on the way, and dashed off into the night.  Driving at night to a birth is always a little bit surreal; I usually have the road to myself, and I am WIDE awake, anticipating a labor and birth.  I ate my snack (I always have a snack packed) while I drove, and enjoyed the cool night air coming in the windows. 
 
            When I pulled into Mary’s driveway at 3:20, I could see the lamp lit in the living room.  Her husband met me at the door, and helped me carry my equipment into the house.  I checked Mary’s vitals and listened to her baby’s heartbeat - all normal.  I unpacked some equipment and settled into a rocker to observe Mary’s labor.  She leaned over the counter in her nightgown, breathing quietly through contractions about 4 minutes apart.  Despite the cool night temperatures, her face was a little sweaty.  Her labor looked active, and seemed to have progressed since her husband had called me.
 
            I rocked and pretended to read an Amish family periodical while quietly observing. Mary’s husband read a German-language Amish newsletter, dozing in his recliner.  Mary walked slowly around the living room and kitchen between contractions, stopping to lean on the counter and breath deeply with every contraction. 
 
            Thirty minutes later I listened to Mary’s baby again - he or she sounded fine.  I settled back into the rocker and timed a few contractions.  Hmmm…6 minutes, then 8 between contractions. Mary went to the bathroom, then settled into her own recliner when she returned.  Twelve minutes went by before another contraction, and soon Mary was snoozing along with her husband.  My eyes closed, too, and an hour went by. Mary and I opened our eyes at the same time, and she smiled, a little embarrassed.
 
            “Well, I really thought this day was going to start with a baby, but I don’t seem to be having contractions anymore.  Dawn will be here soon.”
 
            “This happens pretty frequently,” I assured her, “it’s not a problem at all - why don’t you go to bed and get another hour of sleep?  I’ll sleep out here, and if labor hasn’t picked up again by breakfast time, I’ll head home.”
 
            Mary slept from 5-6 a.m. in her own bed.  I claimed the couch, and Mary’s husband slept on in the recliner.
 
            At 6 a.m., Mary came out to the living room in her day dress.  She told me that she was determined to “be grateful for this day, even if my labor isn’t ready to start.”  We discussed the need to call ASAP if labor seemed to kick in again, as she had almost certainly done some dilating overnight, and she was feeling lots of pressure.  I listened to the baby one more time, gratefully accepted a cup of coffee and a fried-egg sandwich, and headed off home.  The road was just beginning to fill with commuters as I arrived home at 7a.m.  I was a little tired, but it was a beautiful day, and my belly was full.
 
            That evening, a different mother called me at 10 p.m.  She had her baby at 2 a.m., and I got home at 5 a.m.  I slept in until noon. No word from Mary.  The afternoon was full of laundry and supper preparation, and my family went to bed early.  At 2:30 in the morning, Mary’s husband called me.
 
            “Mary says labor has come back, and it really feels strong.  She didn’t want to call, but then she had a couple of hard ones and we both thought you’d better come.”  I grabbed my snack and my bags and headed out.  The evening was just as pleasant and cool as the first time, and the scene at Mary’s house was just about identical, except that her husband was in the rocker.  Mary’s baby’s heart rate was normal, her vitals were normal, and she was having close, strong contractions.  I quietly timed a few, and they were 4 minutes apart, and lasting more than one minute.  Thirty minutes later when I went to listen to the baby again, contractions were 5, then 6, then 8 minutes apart.  Hmmm…
 
            Thirty minutes later Mary was sleeping in her recliner, and I was one the couch.  Mary’s husband woke up and headed for his bed.
 
            At 6 a.m., Mary woke up with a start, and gave me a very sheepish look. 
 
            “I’m so sorry, I really, really thought that I was far into labor this time.  I was even a little afraid that you wouldn’t make it before the baby.”
 
            “I truly don’t mind, Mary - this isn’t that unusual, and you and your baby are doing fine.  Just don’t wait to call me the next time labor begins because you’re worried it will go away!”
 
            Mary made me a cup of coffee and a fried egg sandwich and I headed home, arriving at 7 a.m.
 
            That afternoon, another mother began labor, and had her baby at 10 p.m. that evening.  I headed home and went immediately to sleep, fully anticipating a call from Mary.  I woke the next morning and checked the phone, to make sure I hadn’t missed a call, and I hadn’t.
 
            The day passed with a trip to the library and the grocery store, and choir practice that evening.  It was pretty hot, and I was glad for the sun to go down and a breeze to cool off the house.
 
            At 2:30 in the morning, Mary’s husband called me.
 
            “I just hate to call you, after the last two times, but if I didn’t call now, I just don’t know when I would call at all.  Mary’s up and about with contractions, and they are strong.  She was trying not to wake me up, but she couldn’t stay still in the bed, and now she’s pacing around the kitchen.”
 
            “I’m glad you called,” I replied, “I’ll be on my way.”
 
            The scene was very familiar at Mary’s house  Mary and her baby were doing well, labor seemed to be well-established, and Mary was determined to have a baby!  She was walking briskly up and down the living room between contractions, and even went up and down the cellar stairs several times to encourage labor progression.  Mary’s husband was back to his recliner.    But despite all the walking, labor slowed and stopped by 4:30 a.m., just like the previous nights.  Mary and I slept until 6, then got up and talked the situation through over a fried-egg sandwich and coffee.  Mary was starting to feel frustrated and a little silly - how could these contractions feel so convincing and yet peter out?  I asked if she would like a cervical check, or wanted to try any gentle methods to encourage labor to keep going.  After some thought, she said that she didn’t.  She had hated having her water broken previously, and didn’t think there was any point in checking her cervix if she wasn’t having any contractions anyway.  She was sure (and I agreed) that it had done some opening already, but without contractions, she wasn’t going to get very far.  As it was my regular prenatal visit day, I did my regular check-up:  urinalysis, blood pressure and pulse, listening to the baby’s heartbeat, checking the baby’s position, measuring fundal height, and talking to the mother about everything from swelling to heartburn and digestion.  All was well, and Mary’s baby was in a great position:  LOA, back on Mary’s left, towards the front of the belly, with head very low in the pelvis (engaged) and central.  Baby was moving very well.  I headed off for a full day of visiting clients.  I arrived back home at suppertime and was glad to get everyone to bed early.
 
            I slept all night - no babies!
 
            The next day, I enjoyed meeting up with other families at the park, and caught up on some yard work.  That evening, like clockwork, Mary’s husband called at 2:30 a.m.
 
            “I don’t know what to say, except that it seems to be time.”
 
            “I’m on the way.”
 
            This time was different as Mary’s 2 yr old woke up about the time I arrived.  Mary’s husband tried to help her go back to sleep while Mary labored, but by 4 a.m., he needed some help.  The little girl was teething and had been sleeping poorly, and really wanted her mom.  Mary went in to snuggle her daughter, and when I peeked into the room 30 minutes later, I found them both asleep in the tiny child’s bed. 
 
            Being quite familiar with the couch, I got comfortable until the sun came up and my stomach growled for a fried-egg sandwich.  Mary was tired and decidedly grouchy (what mother wouldn’t be???).  She cried a little.
 
            “I just don’t think I’ll ever have this baby! I know all my other babies came eventually, but I just can’t believe this!  It’s ridiculous, and I’m so sorry that you've come here four times now with no baby.”
 
            “I truly don’t mind, Mary, and you and your baby are doing well, so I don’t see that there’s anything we need to do differently unless you’d like to try something to encourage labor.”
 
            “No, I really don’t want to do that.  I know if I can be patient this baby will come, I’m just having a really hard time staying patient.”
 
            I left after breakfast, with Mary determined to go about her day.  She had decided to invite her elderly neighbor for supper in hopes that it would keep her mind off the lack of labor.
 
            That night, I woke up to a call from Mary’s husband at 3 a.m. 
            “It’s time, again,”  he said dryly.
 
            “I’m on the way.”
 
            I snacked and listened to the radio on the way down, wondering what would happen, and if Mary would change her mind about encouraging labor.  At home we don’t use pitocin or other oxytocic medications to induce labor, but we do have some tricks.  Of course, they won’t really start labor if labor isn’t pretty close anyway, but a mother having her 7th baby, with lots of contractions softening and opening her cervix, usually isn’t that hard to encourage!
 
            I arrived at 4:20 a.m., noting the light in the living room window.  I didn’t see Mary or her husband inside as I struggled with the door, so I quietly let myself in. 
 
            “Mary?”  I called, quietly.
 
            Mary’s husband stuck his head out of the bathroom door. 
 
            “We’re in here! I can’t get her off the toilet!”
 
            This sounded promising!  I grabbed gloves, a doppler (for listening to babies in utero), and some towels from the shelf as I dashed into the bathroom, just in time to hear Mary push.  I darted over to her, pulling on gloves, and noted her perineum bulging.  With the passing of the contraction, I was able to maneuver my doppler under her belly and listen to her baby - he or she was chugging right along. 
 
            “I’m definitely having this baby today!”  Mary huffed, as she caught her breath.  I had to agree.
 
            Two more pushes with the next contraction, and Mary was snuggling her baby daughter in her arms, smiling and crooning to the baby.  Mary’s husband was looking a little shocked.  As he told me later, Mary’s labor had proceeded in the same way as the other nights, with the difference that Mary wouldn’t let her husband call me until 3 a.m., when he announced that he was calling me no matter what she said.  Contractions continued like all the other nights until about 10 minutes before I arrived, when Mary’s water broke while she was sitting on the toilet.  With the next contraction, they both knew the baby was very close, and Mary’s husband began to get very, very nervous that I wouldn’t arrive before the baby.  When he expressed this to Mary, she let him know that while she would prefer that I get there first, she certainly wasn’t going to try and delay the birth of the baby just because I wasn’t there yet!  Luckily, I made it with five minutes to spare.
 
            After Mary delivered her placenta, I walked her back to her bedroom.  She nursed her baby in bed and nibbled on some cookies.  In between checking on Mary and the new baby, I cleaned up after the birth and charted.  Mary’s husband cuddled his wife and baby, and smiled with relief.  Eventually, Mary was ready to urinate and take a shower.  She was VERY happy to finally put on her postpartum nightgown, which had been waiting for her in her box of birth supplies for weeks.  I weighed and measured the new baby and did my normal newborn exam.  Mother and baby were both well. 
 
            At 6:30 a.m., I packed up my supplies and did a final assessment of mother and baby:  both doing just fine, and getting ready for a nap.  I headed to the kitchen and made fried-egg sandwiches for everybody.  Mary laughed when I brought her her sandwich in bed.
 
            “I thought I would just keep making these for you forever!  I do like them for breakfast, but I think I’m going to like this sandwich even better than normal, because I didn’t make it.”