In September 2023, Melissa Nelson, MSN, CNM, WHNP-BC , became the chief of the Midwifery Service within the Department of Obstetrics and Gynecology at Massachusetts General Hospital.
During the summer of 2021, Caroline and her husband, Ryan, found out they were expecting a daughter, due on St. Patrick’s Day. “This was very poetic, because Ryan is Irish and we met in Ireland, and now our baby was going to be born on St. Patty's Day,” says Caroline. “Little did we know how things would all turn out!”
From the beginning of their parenting journey, a few key factors were important to the couple: they wanted a convenient location for the prenatal appointments and eventual delivery, they hoped for a vaginal delivery, and after doing some research, Caroline knew she wanted a midwife to lead her pregnancy care. “It was the perfect balance for me,” Caroline says, “I appreciate the midwives' holistic, natural approach to pregnancy and childbirth, and with the midwifery program part of the OB team if anything goes wrong, there are doctors in the hall on standby at the hospital.”
Choosing a Midwife and a Birthing Facility
Caroline selected the Charlestown HealthCare Center for her prenatal care where Velvet Baker, CNM, MSN, was the midwife. The location was close enough to her home that she could walk to her prenatal appointments, and the facilities were comprehensive and robust, serving as a one-stop-shop for all her prenatal care needs, including regular bloodwork and ultrasounds. The Charlestown HealthCare Center offers outpatient services, including pediatric primary care, for the whole family so the couple also appreciated that her daughter’s pediatrician could eventually be in the same building.
“I enjoyed working with Caroline and her partner Ryan in our Charlestown clinic during their pregnancy,” says Velvet Baker, CNM, MSN. “Mass General midwives specialize in low- to moderate-risk pregnancies, with a focus on trying to provide the birth experience each patient is hoping for. While we are independent providers, we also work closely with our physician colleagues, and if any emergency arises, an obstetrician is immediately available.”
As St. Patrick’s Day approached, Caroline went for what she hoped would be her last prenatal appointment with her midwife. She had a cervical membrane sweep which involves loosening the amniotic sac from the uterus and can sometimes help induce labor. As St. Patrick’s Day passed, Caroline and Velvet began to discuss induction.
“Velvet let me go as far overdue as was safe, knowing it was important to me to try to have a vaginal birth, but we did have to eventually schedule the induction,” Caroline says.
A Long Labor of Love
On the morning of her scheduled induction, Caroline woke up with what she thought were contractions, and noticed some spotting of blood. She called the hospital, and they told her to come in. After she arrived, and despite the early contractions, progress slowed. She had multiple rounds of a cervical ripening drug called Cytotec over the course of the day, but still that didn’t move things along as hoped.
Labor was long for Caroline, without much progress for quite a while. “I finally went into active labor late into the night, and it was brutal, but I had the most amazing labor & delivery nurse and midwife,” Caroline remembers. “I had been planning to get an epidural, and I decided to get one a few hours into active labor so that I could rest and save some of my energy.”
At one point, a caesarean section was mentioned, and Caroline prepared for that possibility. While that was outside of her initial list of birth preferences, Caroline appreciated being part of the conversation around all her birthing options. Her team advocated that she continue to push for the vaginal birth she envisioned, as long as the baby and mom remained unstressed.
After many hours of pushing, Caroline delivered baby Makenzie, just 15 minutes shy of being officially two weeks overdue.
A Bespoke Birth: A Mother’s Plans Honored
Reflecting on the experience, Caroline was particularly impressed at how her team reacted to and respected the birth plan she created, listing out all of her birthing preferences, down to the type of music she wanted playing in the room. “We brought a bunch of copies with us and gave them out. What I appreciated was that the team actually read them. They would come in, they would look at it and read it,” Caroline remembers. “In my head, I thought, ‘Because they do this every day, they're not going to read this.’ But they did, and I appreciated that commitment to honoring my wishes around the birth experience.”
Caroline has a lot of gratitude for the labor, delivery, and postpartum care team members she interacted with over the course of her birth experience, recalling how they worked with her to keep her informed and calm during her long labor. “The delivery and recovery nurses—I could cry thinking about the women who took care of me during my stay,” recalls Caroline. “They are angels on earth.”
Now, when Caroline and Ryan take Makenzie to see her pediatrician, Ariadna Burgos-Chaves, MD, at the same Charlestown clinic where they went for prenatal appointments, they sometimes stop by OBYGN to say hello. Caroline adds, “I have sent three of my girlfriends to the Mass General midwives since my daughter was born. I just could not have asked for a better experience.”
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