!Not-knowing --- agk's diary 27 July 2022 @ 18:18 UTC --- written on GPD Win 1 lying on floor while my kid plays with a pencil --- "I'm not dilating. I'm not going to dilate," the woman told me. I had sanitized my hands, knocked, and was meeting her as night shift turned to day. > I invent composite patients based on details > from enough individuals none can be identified. Her oxytocin ran fast at 23 ffter being titrated up over 36 hours since her post-term induction. It did what it was supposed to do. She had a 60-90 second contraction every 2-3 minutes with relaxed uterine tone between them. The midwife ruptured her membranes late the night before. Her amniotic fluid had been nice and clear. At an 0500 vaginal exam , her cervix was only dilated 4-5 cm (of a possible 10), effaced 70%, and her son's head hadn't moved down from 0 station, right between the ischial spines of her pelvis. She can't push her baby out til her cervix ripens to 10cm dilated and 100% effaced. The baby's head's pressure on the cervix causes the hormonal changes that ripen it, but he's occiput posterior, eyes front, leading with the flat top of his head, not the pointy apex at the back of his skull. It would be so nice if he would spin to face her spine and ram her cervix with the apex of his skull with every contraction. It probably would have been easier when he still had an amniotic fluid cushion. "I never should have induced. My body doesn't work. Something's wrong with my baby. Something's wrong with me. Something's wrong. My body doesn't work." She was so exhausted, so dispirited, so anxious. Her husband, a factory worker, had left to get breakfast. Her mother had her and her siblings so easily at home in Africa. Why was her body unable to do as her mother's had? Every few contractions for the last day and a half electronic fetal monitoring showed variable decel- erations of the fetal heart rate---quick drops more than 15 bpm that quick returned to baseline. Vari- ables indicate transient cord compression, breaks in fetal oxygenation. Her baby had good reserve so weathered them well, and bounced back to his base- line heart rate. Cord compression wasn't surprising with such a big baby in such a little lady. We helped her sit up in bed to labor, eat clear liquids, (lemon ice, clear broth), turn radically to her right with a calf in the stirrup and the peanut ball betweenn her legs. I sat, listened, breathed with her, encouraged, learned about her life, her job, her family, her rethinking of small decisions in light of the enormity of subsequent events. I encouraged her to press the button under the flashing green light to deliver epidural pain control with her PCA pump. "It doesn't work any- more," she said, and cried. I called the anesthesi- ologist, who asked her consent to replace it. She said, "It won't work. There's no point." She'd been awake and in labor for 40 hours. I met her mother, baby brother, church friend, as each visited and left again. We breathed through contractions. I showed her the fetal heart rate, assured her: her son was definitely not dead. We talked about what happens in a c-section and what would lead her midwife to recommend one. My shift neared its end. She reported increasing, almost unbearable pain. We helped her change pos- ition but it didn't help. I messaged the midwife, who checked her cervix. Still 4-5 cm, 70% effaced, 0 station. "Oh, God!" shr cried in despair, then suddenly "Oh, God!" in sharp pain. We all heard her son's heart rate on the ultrasound drop from 150 BPM to 70 and stay there. Her husband arrived. "I think the ultrasound slipped," I said. "That's her heartrate." "No," said the midwife. "No, that's the baby's heartrate." Suddenly we were all in motion. Oxy- tocin off, oxygen mask on, midwife got consent, reached in her vagina and screwed a spiral elect- rode into baby's scalp. The muffled lub-dub of the ultrasound fetal heart rate was replaced with sharp beep beep as midwife and nurse got the woman onto knees and elbows in bed, ungowned bottom up in the air. I encouraged her husband to hold her hand, got him water, told him she got some sleep when he was gone and he'd come back at exactly the right time. A nurse gave her a shot. My shift ended. That's all I know.