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Midwife's care eases Zachary into world

THE BALTIMORE SUN

When Claudia Kunkos learned she was pregnant last fall, she also knew she wanted to have her baby delivered by a midwife.

She wanted to follow the common practice in her native Germany of having a midwife for childbirth.

"In Germany, midwives deliver almost all babies. It's considered a natural thing," she said.

At first unaware that such services are available here, the Millersville resident considered bringing in a German midwife or flying to Germany to have the baby.

Her husband, Jeff, concurred in her plans because Claudia, a midwife in Germany, had been made fearful of U.S. medical practices by "horror stories" she had heard about excessive intervention in childbirth.

But, scanning a newspaper, she saw an advertisement for Bay Area Midwives in Severna Park.

She arranged to meet Judy Parsley, a certified nurse midwife who is director of Bay Area Midwifery Center in Severna Park, and became her patient.

On June 17, she delivered a healthy baby boy at St. Agnes Hospital in Baltimore, with Jeff and Judy by her side.

This is Claudia's birth story, as described by Sun staff writer Deidre Nerreau McCabe.

*

2 a.m. Claudia wakes from a brief sleep. Her pain is getting worse. The baby is five days late, and she's been having contractions for more than a week. She wants to call Judy but Jeff says to wait. Finally, she can't stand it any more.

"Call Judy!" she commands as it approaches 3 a.m.

"I don't care if we wake her up. I need to talk to her."

6 a.m. Judy arrives. Judging from Claudia's description of her contractions at 3 a.m., she knew it would be a while before they had to leave for the hospital.

She examines Claudia and decides it's time.

6:45 a.m. Claudia and Jeff check in to St. Agnes.

Nurses roll her down the hall in a hospital bed. Jeff wears a stopwatch around his neck to time contactions, but is too distracted to use it.

8 a.m. Claudia's contractions are getting more painful; her complaints more vocal.

'I can't take it'

"I can't take it anymore. Really, Judy, I can't take it," she whines. Judy talks her through each contraction in a soothing voice.

8:15 a.m. Judy does another examination. Claudia has dilated to 7 centimeters -- good progress. But Judy worries the baby's head is too far up in the birth canal.

Throughout the pregnancy, Claudia knew she might have a hard time delivering because of her pelvic structure.

Judy says Claudia must get up and walk. Motion and gravity will help bring the baby's head down. But Claudia wants no part of it.

"I'm so tired. I can't walk," she says.

"I need that baby down. Come on, Claudia. Let's go," Judy says, this time with considerable force.

8:30 a.m. Claudia and Jeff aren't talking. He seems lost, unsure of what to do for his wife.

Although Claudia delivered more than 200 babies in Germany, it didn't prepare her for this, she says. But she doesn't ask for pain medication; she wanted natural childbirth and is still committed.

Unbearable pain

Suddenly, the pain becomes unbearable. Claudia feels nauseous and vomits.

"I don't want this baby anymore," she screams at Judy. "I can't go further."

8:38 a.m. Judy does another exam. The baby's head is not moving down. Judy is worried and expresses concern about a Caesarean section.

Claudia asks for pain medication for the first time. Judy advises against it, explaining that this late in her labor it might slow the contractions. With less effective contractions, a C-section could become more likely.

"I'd like you to get to the pushing stage without it," she says.

"Will you try, Claudia? Really, this is important. Will you try?"

After a few seconds, Claudia nods yes.

9 a.m. Judy does one last pelvic exam. The baby's head has finally shifted down some. But everyone is tense.

"We're going to do some serious pushing," Judy tells her. "We've got to get this baby out."

9:05 a.m. The pushing begins. Jeff takes a baby outfit from the overnight bag to inspire Claudia. "Come on, honey. Fill it up," he says playfully. Claudia is too preoccupied to notice.

With each contraction, she is pushing in earnest. The exertion makes her sweat. Jeff wipes her brow.

"It burns. Oh, it burns," Claudia wails, and asks again about pain medication.

Judy tells her the pushing will soon be over.

9:20 a.m. The baby's head is crowning. For the first time, his dark hair is visible with each push. Suddenly, his heartbeat begins to plumment. The monitor Claudia is wearing flashes numbers that are lower and lower. The baby is showing distress.

"Let's get this baby out," Judy commands. "If you can get this baby out in the next few minutes, we'll deliver here.

"If not, we're going to the delivery room."

Heartbeat dipping

Claudia pushes through two more contractions, then Judy says they can't wait any longer. "That's it. We've got to go. The heartbeat is dipping down to 70."

9:25 a.m. Chaos.

The doctor is called. Everyone must change into scrubs.

Claudia is wheeled, wailing, down the hall to the delivery room. Her dream of natural child birth is slipping away.

Judy tries to comfort her, saying she can push another few minutes when they get there. But they have to be ready in case she needs a C-section or the baby needs to be resuscitated.

9:27 a.m. The delivery room is cold and clinical. Medical equipment dominates. It is a far cry from Claudia's labor and delivery room, with its pink wallpaper and tasteful prints on the wall.

Judy's voice has become increasingly urgent.

"We have to bring this baby right down, Claudia, right now. Come on, Claudia. Baby wants out. Push it out. Come on. Let's go."

9:29 a.m. The baby's heartbeat has dipped precariously low. Judy fears he may need to be resuscitated.

"I want a break," Claudia shouts.

"No," Judy says. "The baby's got to come out. No breaks."

9:35 a.m. Frenzy. Jeff, Judy, the nurse and doctor bark orders at Claudia. She wails. Judy makes a snap decision. She has to do an episiotomy to get the baby out.

"I'm sorry, Claudia. I have to do this," she says, as she makes a small incision.

"Oh, gosh. It hurts so bad," Claudia cries.

9:38 a.m. The baby is almost out. Judy suddenly sees his umbilical cord is wrapped around his arm.

"Come on, Claudia, give me one more good push," she barks.

9:40 a.m. With one final push, Zachary is born.

He's breathing, but his right arm looks grayish blue.

'He's OK'

"He's OK," exclaims Judy, handing the 6 1/2 -pound infant to the nurse.

Everyone sighs in relief.

"He's sooooo little," Claudia gushes.

"That's OK," Judy laughs. "You didn't need him to be any bigger."

*

It's an hour before Claudia, Jeff and Zachary are ready to go back to their room. Claudia is still in pain, but much less tense.

She tries to nurse Zachary, but has little luck.

Jeff's mother is allowed in and immediately takes Zachary to cuddle. Claudia leans back in bed to rest.

She and Jeff plan to go home in six hours, the minimum amount of time a new mother must stay in the hospital.

Judy, who was scheduled to depart for a trip to Ohio, is in no hurry to leave. She sits next to Claudia on the bed, talking about the delivery, assuring her she did a wonderful job.

"You did it, Claudia," she coos.

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