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Narrator: Samiyyah is the owner of a day spa in Philadelphia. She is 38 weeks pregnant with her second child.
Samiyyah: With the first pregnancy, I delivered in a hospital, and it was very restricting, you know, being confined to the bed, not being able to, you know, move when I felt my body wanted me to do certain things.
Narrator: For her son Safi's birth, she was given pitocin to speed up labor, an epidural for pain management, and an episiotomy (a surgical cut to widen the vaginal opening).
This time, she's planning a natural delivery -- without pain medication and other medical interventions -- at a birth center.
Samiyyah: Yes, I've been told that I am completely crazy for being, you know, for not having the drugs, but I've been there and I didn't like it, so I figured I would try this. It's healthier for the baby; it's healthier for me. So why not? I mean, women, we were designed to do this.
Narrator: Seven days after her due date, Samiyyah's labor kicks into gear. At the birth center in Bryn Mawr, Pennsylvania, Julia Rasch, a licensed nurse/midwife, performs an internal exam and starts an IV line to give Samiyyah a dose of antibiotics, since she's positive for Group B strep.
Samiyyah is 3 centimeters dilated, 100 percent effaced, and her water hasn't broken yet, which is common in the first stage of labor.
Birth centers offer a more relaxed and intimate alternative to hospitals for women expecting uncomplicated births.
It's important to choose a birth center with nearby hospital privileges in case of an emergency.
Helping her through her first natural birth is her husband, Arvan. Her mother-in-law, Irena, and 6-year-old son Safi are there for support.
Samiyyah: We've talked about, you know, what he's gonna see, we've shown him pictures, and I think he'll be okay.
Narrator: As Samiyyah's labor progresses, her baby's heart rate is monitored every 15 minutes.
Samiyyah: My goal is to remain calm and try to stay level-headed.
Narrator: As her contractions pick up, she starts experiencing painful back labor, typically caused by the baby's head pressing against the lower spine.
Samiyyah finds some relief by trying a combination of slow steady breathing, constant deep massaging and counterpressure, spending lots of time in a heated Jacuzzi, and trying different labor positions.
Arvan: She's doing great. She's doing great. She's really pushing through.
Narrator: Her midwife feels it's time to break her water with an amni hook, since she can feel the amniotic sac bulging. This is a common procedure and usually helps speed up the labor process.
Samiyyah: I thought it would be painful, but it wasn't at all. Actually it was like a relief of pressure.
Midwife Julia Rasch: Large amount of clear fluid. Beautiful.
Narrator: Her contractions now intensify as she starts to feel the urge to push. This is called hard labor or transition. The muscles your body uses to contract are transitioning from dilating the cervix to pushing the baby down and out.
Midwife: The intensity of the contractions is increasing, and just a certain force is now really behind that baby coming.
Narrator: Transition can be the most painful part of labor -- but usually the shortest phase.
Narrator: Though most mothers dilate nearly 8 to 10 centimeters before transitioning, Samiyyah is only 5 centimeters dilated and is having trouble resisting the urge to push.
Arvan: Sam, do not push. Fight it. Fight it.
Samiyyah: I'm trying!
Narrator: Her midwife agrees her body is ready to deliver. Pushing before being fully dilated is uncommon. This is why each caregiver has to manage her patient's labor on an individual basis.
Midwife: Okay now, take a breath and do it again.
Narrator: Her midwife uses her fingers to pull back her cervical opening as Samiyyah pushes.
The midwife made the right decision, listening to her body. With just 11 minutes of pushing, Arvan and Samiyyah's baby emerges.
Arvan: Good job! Good job!
Midwife: There's your baby!
Narrator: Sami Sarrajj, a healthy boy, is placed immediately on his mother's chest.
Midwife: You did it! You did it!
Narrator: Dad cuts the umbilical cord, and the midwife collects some of the cord blood for routine testing.
It's not over yet. The midwife helps deliver the placenta, and a nurse presses on the fundus -- the upper part of the uterus -- to check how much the uterus has contracted.
Applying pressure is a common practice used by caregivers to help expel excess blood.
Samiyyah tore along her previous episiotomy line, and her midwife repairs it with stitches, which takes 15 minutes to complete.
Arvan: You did a hell of a job... Yeah!
Narrator: Samiyyah is now breastfeeding and bonding with her baby. Incredibly, in an hour, she is showered up and savoring some well-deserved fettucini Alfredo.
It was a fast delivery, with just four hours and 11 minutes of labor. Samiyyah's natural birth is a success, and she's ready to try it again.
Samiyyah: One more. We're going to try for a girl. (laughs)
Narrator: Everyone played a supportive part on the birth team… Even big brother Safi got to announce the news that his brother was born.