In midwifery school I had learned all about shoulder dystocia. After personally experiencing one with my first born, I constantly wanted to learn more about them, I practiced drills on resolving them, and have taken workshops to dive even deeper into understanding them… But, in the 150 ish births I had attended as a student midwife/ primary midwife after my own I had never had to manage or assist in a shoulder dystocia. And to be quite honest, I just really wanted to get one over with! I would practice the steps to resolving a shoulder dystocia in my head before any birth where I was expecting a “big” baby and all of the births with the “big babies” (9 1/2 lbs+) were smooth as butter.

Once the COVID-19 birth storm started in March 2020, I have been dealt with quite a few difficult birth situations and some emergencies that, thankfully, all ended well & have made me feel much more confident in my skills as a midwife. Some hemorrhages, some meconium, some decelerated heart tones, etc. But, alas, not one shoulder dystocia or resuscitation. Until…

6/14/2020- A mama, who has become a dear friend of mine, calls me in the middle of the night.

(A little background) Her first babe was born 5 weeks early, her water broke at 35 weeks and her baby was born just a few hours later weighing 5lbs 5oz. It was a planned homebirth transferred to the hospital because he was premature. When she found out she was pregnant again she still had high hopes of having a homebirth.

This mama had hired me going into her 3rd trimester. She had thought a lot about having a free birth (completely unassisted), but considered that if she could find the right connection with a midwife it would be worth having one there. & through the community she found me and chose me to be her midwife (& I’m so incredibly honored she did!) Anyways, with this pregnancy she became a bit anxious as she hit the 34/35 week window hoping she would make it to at least 37 weeks so she could finally give birth at home. After 37 weeks she started to feel relief! She made it to full term! The prenatal visits leading up to her due date she would bring her son over to my house for a play date and we would have her prenatal in my living room as our sons played in the sun outside and it was pure bliss. (This is a huge part of what community midwifery care means to me!)

At 38 weeks and 4 days, she calls around 2:00am to let me know her water broke. Clear fluid, baby was moving well, she would call once contractions picked up. An hour later she lets me know it’s time to come. I didn’t waste any time since I knew her first birth went quickly and anticipated a quick and easy birth this time around.

I made it there around 3:45am hoping she didn’t give birth before I made it there. We had talked about having a second midwife to assist me there during her pregnancy, but since she had wanted something as close to a free birth as possible we decided that if things were moving as quickly as they did with her first then I probably wouldn’t call in an assistant.

She was sitting on the toilet, roaring through her contractions. Her son and partner gently watching her in the hallway. I could tell she was close to meeting this baby!

I quickly bring my things upstairs and listen to baby. The heart tones sound a bit low, but still totally within normal limits, and something I would expect to hear as she pushes. I ask her if I can check her to see where baby is at and sure enough that baby’s head is so close, no cervix at all. I call Hayden (birth photographer) and tell her she better hurry over!

She’s sitting on the toilet pushing. I remember that her 4 (almost 5) year old son wants to help catch the baby! “Your mama is doing so amazing!” I look and tell him. “Mama is singing the birth song to get the baby out” -He tells me. Baby continues to sound good as I listen to heart tones.

I tell her to try and feel her babies head and she reaches in, “I don’t feel anything.” I promise her that it’s there and her baby will be in her arms so soon!

At 4:39am Hayden comes in quietly and starts to photograph this beautiful mama in the throws of labor.

A few minutes later Eden gets into hands and knees, she can feel herself opening. I get my gloves ready and tell Ellis to come sit by me if he wants to help catch this baby.

The head emerges and it’s purple, there’s no restitution (external rotation). I give it a minute or a few seconds, who really knows since time just feels like another dimension during births, I’m thinking maybe the shoulders are just a little “sticky”. But, I know what this is. I know what’s happening here- it’s a damn shoulder dystocia…& I’m just thinking to myself really?! She had ZERO risk factors. I get behind her and feel around baby’s head, a TIGHT nuchal cord.

I want to be clear that nuchal cords are generally harmless and happen quite often.

But, I feel a bit deeper, these shoulders are also stuck too. There’s no way to loop this cord over the baby’s head, so I begin to try and “unlatch” the shoulders. I don’t want to immediately cut the cord because I have no idea how long the shoulder dystocia will take to resolve. I have her put one leg up in a runners lunge, then the other leg as I try to dislodge the shoulder. Just like that, 3 minutes have gone by. My heart is pounding. I’m trying to remain as calm as possible on the outside, just like Karen did for me.

I make the decision to clamp and cut the cord & then continue to try and maneuver the shoulders out. I am replaying all the things I learned in my head. Nothing feels like its working. I can hear one of my favorite teachers saying “Shoulder dystocia sounds scary, but you know that you will eventually get the baby out.” I don’t feel like this baby is ever going to come out. I have her flip onto her back and shortly after the baby is finally born, 5 minutes total. A sigh of relief. But, this baby is FLOPPY with no respiratory effort. I have Hayden grab my resuscitation equipment and then begin to give inflation breaths.

“Your baby is great mama, they just need some breaths.” I try to remain as calm as possible for her. I hand her my stethoscope so she can hear that his heart rate is normal (she’s a nurse), “Listen to your baby’s heartbeat, it’s so strong. He is okay!”

He starts to come around and become pink. 2 minutes later he lets out a weak cry and slowly starts to come into his body. His heart rate remains strong and he continues to transition earthside.

She discovers she has given birth to another boy!

Holy shit! After her placenta finally comes out and she gets snuggled into bed with all of her boys. She holds this little babe closely as the sun rises and everyone is just overjoyed he’s safely here!

I stare at this baby’s conehead and wonder how big he is. He doesn’t seem too huge. (7lbs 13 oz)

I wonder what he got hung up on and cannot wait to debrief this birth with some of my midwifery sisters. I have about 30 new silver hairs on my head, but I am proud of myself. I feel like I have level’d up. I may not have 30 years of experience under my belt, but I do feel confident in my skills. Everything that I had learned over the past 5 years is stored somewhere in my body and somehow my hands intuitively know what to do (while still staying calm apparently!)

It’s been a year since I started practicing & I think about how much I have already grown as a midwife. The wildness & uncertainty of birth is what leaves me craving more.

'“I am so happy that the stars aligned and I found Samm for my second pregnancy! We instantly clicked and even though she was technically the “expert”, she always made me feel and know that I was in the driver’s seat, which supported the autonomous and empowered pregnancy and birth I strived for. Any questions or anxieties were met immediately via text or call, and always left me feeling calm and in control again.

During labor, she gave me the space to follow my own instincts, her quiet yet steadfast presence and gentle reminders enough to keep my head in the game. My son’s birth quickly went from smooth to baby needing help and Samm jumped into action quickly and confidently and relieved a tight nuchal chord and shoulder dystocia while also managing to not break my birth trance or scare me. Afterwards, we all basked in the joy of his arrival, as a team. Samm is amazing.