Real-Life Decision Making -- Solution
You stay at home, continue with the labor massaging, and try to increase dilation.
Anne Sommers says that to be a good midwife, one of the many skills required is patience. "Definitely patience is a main quality, since babies and labor do not go like clockwork. There is a lot of waiting at births."
You can spend the time explaining to the family the pros and cons of waiting for a home birth, and be really clear on what the outcome could possibly be if they decide to forgo the hospital.
You have to use the level of trust you have built up with this patient and her family to decide what would be best for the child. You can also use this time to reassure them that you, a person who they have grown to know and trust, will be with them either at home or in the hospital.
You can continue with the labor, using massage, relaxation techniques, or whatever you have available. But if the mother does not continue to dilate, then you run the risk of her getting exhausted.
Your intuition as a midwife is telling you that the time is getting critical. Since dilation does not seem to be increasing, and the mother is getting more and more exhausted, it would be best for all concerned to go to the hospital where a safe birth will be imminent.
Midwives must be decisive. Kathy Wethy is a midwife. She says good decision-making skills are crucial in her field. A decision can mean life or death in her field, she says. "Obviously, you have to be able to assess a situation, and within your parameters and guidelines, make a decision," she says.