I had a lovely, young first time mom-to-be last evening. When I arrived for my shift, she was just getting an epidural. I got her all settled after her epidural, and she progressed very nicely as the evening progressed.
After feeling lots of pressure, I checked her, and she was 10cm/+2 station! YEAH! She started pushing (gently directed, no counting, going with what her body was telling her to do), and she progressed initially nicely. Started seeing baby's head.
Then, no further progress of seeing the head. Hmmm. I checked position - baby felt to be ROP (right occiput posterior). Time to change positions. We did fully upright, semi to low fowlers. Not much progress with that. Also made her reflux horrible. I suggested to her that since the baby is feeling to be posterior, let's try all the way on her right side. She was very open to the position change. Got her on her far right, and she pushed magnificently! Baby rotated into more of an OA (occiput anterior) position, and within 10 minutes, we were able to get the doc to come in and catch.
For a first time mom, with a good epidural, she did an awesome job of pushing, and delivered her beautiful baby girl over an intact perineum. YEAH!!
Kudos to the doc too. We discussed ahead of time about laboring down until she felt pressure, which he agreed was best. He also stayed out of the room most of the time while I had her pushing, and let me do the 2nd stage management on my own. Which I love doing! This mom was also very shy about exposing herself for pushing and delivery - not even wanting her boyfriend to see the baby coming out. We talked ahead of time about who would be in the room at the time of birth, keeping staffing to a minimum and her dignity to a maximum. She was agreeable and understanding of who would be there during birth.
All in all, a fantastic birth. A very empowering, positive experience for the mom!