My first official catch as a qualified midwife came a few days after the breech birth. I was called in the morning by Jim(actual names will not be used in any of my posts)He and his wife Mary were Americans living in Barcelona. She became pregnant and initially went to an American gynecologist at a big high tech hospital in Barcelona. They wanted to have a natural birth, no interventions. They also wanted to have a doula present for support during their labor.http://www.dona.org/mothers/index.php
This was all agreed by the doctor, but later the couple found that what was agreed was never intended to be honored. In short they had been lied to. This is not unusual in Barcelona with the doctors working in obstetrics. Angry and afraid, the couple went on a journey to find some one who would look after them and give them care with respect for their wishes and someone who could speak English. After searching around Barcelona they found my group of midwives and our lovely gynecologist who agreed to give them care and deliver them with their doula and even at home if wanted. Unfortunately they only found us late in their pregnancy and we did not have much time to develop a relationship with them, which is a very important aspect of the care we give.
Around 8 months into her pregnancy Mary was diagnosed as having group B strep. She was told by an outside gynecologist the this meant she could not deliver her baby at home as she would need 2 doses of a broad spectrum antibiotic during her labor or her baby could get an infection and die.http://www.homebirth.org.uk/leighann.htm Mary and her husband were understandably frightened by this ‘fact’ and agreed to have their baby in a private hospital where we could still attend her.
I met Mary and Jim tow weeks before their due date and assured them I would be there to support them as their plan was to dilate at home and go into hospital for the antibiotic treatment at 6cm.
Her waters broke early in the morning and an hour after I was called I arrived at their piso. The environment was dark and chilled with trance music floating in the air. Mary was contracting beautifully and Sarah the doula was there working her magic. It was a lovely space to enter. My first exam of Mary told me that she was 4cm dilated and doing well. Baby was happily working his way down to the identified exit and all was well. Mary went on contracting beautifully and strongly for 2 hours and on my following exam she was 6-7cm,and going strong, it was time to go to the hospital, so I rang all concerned and let them know we were on our way in.
It is important to note here that Mary was my, as I said, my first client and I was on my own. This was the first time I had been on my own with a client in labor with out any back up and I have to say I was a bit anxious. I had pushed my anxiety to the back of my mind but it was there. Although my outside persona was laid back and self assured, on the inside I was full of self doubt and was constantly hoping that my exams were correct and that nothing went wrong with mother or baby because I was afraid I would not know what to do, not to mention my Spanish is not what I would like it to be and communicating with midwives and doctors in the hospital was daunting. In short I was scared, which was interesting, because so were Mary and Jim.
We caught a taxi to the hospital. Fortunately for me and all,Sarah,although American, had lived in Spain for over 20 years and spoke fluent Spanish, so was able to explain to the taxi driver where to go and what was going on. Mary was vocalizing through her contractions beautifully and loudly, but the taxi driver was super cool, with us all as we vocalized with her and gave her encouragement.
Arriving at the hospital we were met at the front desk by a rude and uninterested receptionist who gestured for us to go ant wait for the midwife in charge. The midwife who met us was known by one of my colleague as a kind woman who was comfortable with parto natural or natural birth. She greeted us with warmth and even spoke English. She took us up to our room, put in the line for Mary’s IV antibiotics, (with no gloves on mind you, and no concept of using an aseptic technique to do this) but she was efficient and before I knew it the drugs were running and she was out of the room. She only came back to give me the supply’s I needed and offer us a drink. This was very different from the reception we received at the very super posh hospital where our breech baby was delivered. We were just left to it and Mary got on with the job ahead of her.
By 3:30pm she was nearly fully dilated and was feeling the urge to push, I rang my colleague and our doctor to let them know as they were coming in for the birth, which was a relief for me as our lovely midwife was soon to finish her shift and I had no idea who would replace her. Also I was still struggling with my own doubt.
By the time my colleague arrived Mary was pushing well and it seemed baby was shortly to arrive, but birth is a sensitive thing and on the arrival of the doctor something changed. Our doctor is very trusting of the midwives and was happy to let me take the lead with this birth. She did not come into the room for an hour as it seemed all was going smoothly and she knew she did not need to be there. But I had let Mary and Jim know that she was there. After this I began to notice that Mary was now fighting her contractions and although she was pushing strongly, she was also holding her baby in. She was becoming terrified of the pain and sensation of her baby coming down the birth canal. This continued for a couple of hours and although I felt this was happening I did not vocalize my observations, instead I questioned my exams an racked my brain with what I was doing wrong.
An hour later and with an exhausted Mary feeling she was unable to birth her baby, out doctor examined Mary and confirmed my observations. She spoke to Mary who responded by saying she was trying and she did not understand why she could not have her baby. I heard in her voice the tone of a woman on the verge of giving up. She was being encouraged by; her husband, doula, myself, the doctor and my colleague, that she could do it, but this actually was working against her. I knew there were to many people involved in this birth and the most important person was being left to the side. I mustered my courage and asked everyone to leave the room, even the doctor, I had decided to be the midwife I’d always wanted to be and fear be damned. I decide to finally trust my abilities, so that Mary could trust hers.
I believe that there can be a deep connection between a midwife and the woman she supports, even if neither is aware of it. This connection can work for or against a birth and I realized that my own fear was affecting Mary as well as her own. Once everyone had left the room, I sat on Mary’s bed and told her what I though was happening. I spoke with her about her fear and how she could and in fact was birthing her baby and I explained to her that she could not do this with her head. She, like me was searching for solace in her head instead of allowing her instincts to take over. I told her that I would stay with her in the room while everyone else left. I showed her how to breath through her contractions and encouraged her to keep all of her attention on her breathing and allow her body to give birth on her baby. Mary and I breathed through her contractions for nearly 2 hours, and during that time she allowed her body to move her baby down the birth canal considerably.http://hypnobabies.wordpress.com/2009/05/29/breathing-your-baby-out/
After this time Mary was reexamined by our doctor who confirmed that baby had come down a lot form the last exam. We encouraged Mary to push again, although I did not feel that this was necessary as the breathing was working well for her but I understood that in the end Mary was our doctors patient and not really my client, so the doctor had the last word. The doctor also felt Mary needed some pharmaceutical help and she and my colleague put up syntocinon in her fluid IV to help her contractions work more efficiently. I did not agree with this but I knew we were against a clock as well, we were after all in a hospital, and Mary had the noted risk factors of group B strep and had been fully dilated and pushing for over 3 hours. She had only been pushing for one hour and breathing for the other two, but I understood the situation form the doctors point of view. The synto was put up, but Mary was not asked is she wanted it. I am sure she would have said yes, as the doctor was, but for me, giving her this medication with out her permission seemed very wrong. She was told after the fact and did not complain but I feel that perhaps later or possibly for her next pregnancy, she may feel she was unable to birth her baby with out our intervention. This could cause some deep seeded suffering and self doubt. .
Things progressed slowly and with everyone back in the room, Mary started to fight her contractions once again, but this time baby was not coping as well. Could it have been the introduction of the syntocinon? Regardless of the cause, we all decided it was time to deliver this baby and we moved through to the delivery room, where with the aid of fundal pressure(I am not sure about that either)Mary pushed out her beautiful baby boy and I was able to catch him. He took beautifully to the breast and a happy ending was had by all.
On reflection of this experience, I have the deepest gratitude to all present at the birth, each person taught me something worthy of learning specially Mary and Jim. Every birth is an opportunity to learn something about ourselves and our practice,this birth was full of lessons for me. I now know I am capable as a midwife and that my instincts are sharp. I also know that the beliefs that I have held for years,from my own experience in my own births and the ones I have supported are showing themselves to be true. This is a real validation for me as a new midwife.