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Leo’s mother seemed to be a naturally anxious person, so I was not surprised when she reached out to me early one evening describing contractions that were consistent with a latent labor pattern. First time mothers often need reassurance during this phase of the labor, even though they are not ready to head to the hospital and do not “need” to call. However, Leo’s mother seemed more uncomfortable than most and I worried that I was missing something, but I gave her some precautions and went about my evening. She called again around 1 am, now very uncomfortable with contractions, but still without a regular pattern to the labor. I told her to try a bath or a shower to ease her discomfort and wait and see if the contractions became more regular. If so, she was to head to the hospital.

No further call came that night, but by morning my phone was ringing again and Leo’s mother was now sounding desperate, though the contractions were still not regular. I instructed her to meet me in the office in a few hours when we opened. I hoped she was far enough along to be admitted, because she was obviously having a difficult time. When she arrived, I knew at once she was not really in active labor. She was exhausted and miserable, but not breathing through contractions or showing any other signs of active labor. When I examined her, she was only two centimeters and the baby was still high in the pelvis. I saw the frustration on both her and her husband’s face. I sent them back home with instructions to rest.

No further calls came that day, but at 2 am my phone was ringing again and she now was having mostly regular contractions. I sent her to the hospital and tried to go back to sleep, while awaiting word of her exam. Two hours later the call came in and the laborist had examined and found her to be four centimeters dilated. I hoped she would continue to progress and gave the orders for admission. By morning she was six centimeters, but still with a strange contraction pattern, where contractions would group up together and then space out sometimes for as many as ten minutes. She felt a lot of pressure with contractions, even though the baby was still high. She described it mostly as “front pressure” versus “back pressure.” She continued to work through the labor for several more hours, walking, trying different positions, and using the shower. However, nothing seemed to bring the baby down and she remained six to seven centimeters until the afternoon. We decided to try breaking her water. That seemed to increase the intensity of the contractions and improved the pattern, but the dilation did not progress. I could tell Leo’s head was not positioned correctly when I examined her, but she was so uncomfortable, it was difficult to ...

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