Real-Life Decision Making
You have worked closely with a patient for over eight months now. Through meeting with her and her family on a regular basis over the past few months, you have developed a bond of trust. You have heard her reasons for wanting a home birth and shared your feelings about why you chose a career as a midwife.
You have trained both her and her coach in Lamaze and massage, and everyone is anticipating a smooth and safe birth. The idea of a calm and friendly home situation, as opposed to the cold and sterility of a hospital, was one of the many reasons why this couple chose you to come to their home and deliver their first child.
The due date was three days ago, so you are expecting to hear from this patient any time. Everything is in order; you have arranged all your personal duties so that you can be away for as long as may be necessary. For a labor, midwife Anne Sommers makes sure she has packed all of the "herbs, tinctures, and nutrition" that she thinks might be required.
The phone rings -- it's the mother saying that her contractions are consistent, and it looks like it's time.
The labor starts out well and her contractions stay consistent for the first five hours. However, things begin to change when you notice there hasn't been any significant dilation. Your patient has tried walking, massage, stretching, and everything else you can think of to help increase the dilation, but nothing seems to be working.
The mother is getting exhausted and you see that she could require a caesarean section. If your patient does require a c-section, then she must be at a hospital where a surgeon is ready to perform the operation.
What do you do?