I think we all get to a place, as midwives, where we feel we are pushing the limits to keep a woman within normality. Or maybe we don’t, but I have had experience of other midwives working extremely hard to try to keep their clients experience of pregnancy and birth as normal as possible. In this particular case our client came to us very normal. On paper there were no concerns, but there was a feeling among all of us in the collective that this client would be ‘a lot of work’. Of course that phrase in itself can be taken as derogatory but it is not meant in that way. It is a fact that some clients need more support than others and sometimes you can see them coming. This lady was one of those clients.
She and her husband worked in the alternative therapies field and were both very intense people. Our client had heard of us through a relative who gave birth at home with us. The relatives birth was joyful and straight forward and this is what our client wanted for the birth of her first child. To be honest, I did not have very much contact with her until a few weeks before her birth as she was cared for primarily by another midwife on our team, but we had met and I knew I would second at her birth.
Her pregnancy was uneventful until around 32 weeks when a routine scan had flagged up to her doctors that her baby appeared to small for gestational age. My colleague had not felt, on palpation, that this woman’s baby had felt unusually small when considering she was a small woman herself. This became a point if issue with our woman, who was very anti hospital along with her partner who was hospital phobic. They were thrown into a few weeks of upset and battle as they did not trust the scan data and did not want to comply with what the hospital suggested (strongly in fact) that they induce and deliver their baby early, for fear that her placenta was not functioning well.
I was told by my colleague that this was going on with our client and 5 weeks later went on a home visit to her house, as she had decided to go through with her plan of having a home birth. At this time she was now 37 weeks with babies head well engaged in the pelvis and on palpation and measurement baby appeared a normal healthy size. Now, it has to be said that, here in Spain, hospitals are known to be questionable in their care of pregnant and laboring women. There is little to know evidence based practice here in the public and private sector and both sectors routinely scare monger women into lucrative caesarian sections. Many women in Spain suffer sever physical and emotional trauma around pregnancy and child birth, so the reaction of our client and her husband to suggestions of interventions based solely on early scan results with are worked out on a mean graph basis with no consideration of deviations which could occur based on physical differences from woman to woman can be understood.
At 37 weeks, our lady had decided to stay home and await for nature to take its course and birth her baby at home with us. I felt comfortable with this decision as at this point all was normal, with exception of one scan done earlier in her pregnancy that was now obviously not an issue. Our clients baby was now well grown and our measurements and observations assured us of her normalcy. But these observations said nothing of her ability to birth successfully at home and this is where our limits were truly stretched.
5 days before our client gave birth she rang to let us know that she was leaking clear fluid. I saw her in the clinic with my colleague and confirmed ruptured membranes, not fully but a small leak. We were all very excited as she was experiencing signs of early labour, http://www.nhs.uk/Planners/pregnancycareplanner/pages/Laboursigns.aspx, so she was sent home to await events. But the event did not take place. Forty eight hours later, a plan was set in place to see our client each day to monitor baby and take bloods and do full observations to ensure she was not developing any infection. Our client was deeply convinced she would not go to the hospital as she knew she would be induced and she did not want this. Each day, we would talk with her at the clinic to give her support and possibly ascertain any fears or worries that could be holding her back from laboring fully. She was given, acupuncture, homeopathy to encourage her body into labour as well as some good old castor oil, as not only was she unable to labour she was also uncomfortably constipated. From a holistic point of view, she was holding something very powerful inside her and she could not let it go to birth her baby.
From our point of view, we had tried every trick in the book, but on the 4th day she revealed to us that she felt detached from the entire experience. This had been suggested to her by our homeopathic doctor, as she was spending much of her time and energy trying to find something outside of herself to push her body into labour. But on this day, she admitted this herself. She said she felt no connection to her baby or body and was afraid to be a mother. This was a hard realization for her but something she had to face. Later that same day, which was by chance her birthday, I paid her a visit in her home. I had felt from her a deep need to be held and supported and I thought that I would try to give her this support through touch. So as a birthday present to her (no pressure to labour, on her part, just to relax and enjoy) I would give her an aromatherapy massage. I felt that somehow if I could pass her some of my own energy while supporting her to relax and accept it, she just might be able to open and allow her labour to happen.
My experience of this moment was very different than what I had thought it would be. I found it very difficult to connect with her at all and felt completely unable to share my energy with her. Although her body appeared willing to relax and accept the supportive touch that I was endeavoring to give, I felt a massive energy barrier (which I know sounds very hippy dippy) from her. I left her appearing to be very relaxed and grateful, but I felt awkward and uncomfortable with what I felt was my failure to reach or truly support her. Then later that evening I just felt very angry. Angry that with all we had given her, she just would not GO INTO LABOUR AND HAVE A NICE BABY LIKE ALL OUR OTHER WOMEN DID!!! I felt angry she was such a challenge and that I could not, with all I had to give, help her or at that point my self to move forward.
The following day, we got the call that her labour had started. It was my colleagues birthday and we were hopeful and in high spirits, FINALLY!!! But it was not to be and 20 hours after we arrived at her home, we were preparing to take her in to hospital for ‘failure to progress’. These words, hav always struck a deep cord of cynicism in me. I always secretly thought that if a women was supported in the right way, then failure to progress would never happen. Yet here I was, having given my all and knowing that everyone in our clinic had also given their all to her but it was not enough.
Leaving her at that hospital was one on the most difficult moments of my practice. Not because I felt she or we had failed, but because I had arrived at that same hospital 8 years ago after over 30 hours of hard labour and was diagnosed as ‘failure to progress’. I knew how she felt or at least I thought I did, and it broke my heart to leave her there, remembering how I had felt all those years ago.
Ten hours later our client gave birth to a lovely baby boy, 3,001kg. She managed to push him out and although she had the standard episiotomy, she had done it and done it herself. She did need a few hours of syntocinon and an epidural, but she escaped a caesarian section and that was her worst nightmare. She was home 2 days later and despite of a few new mother jitters with breast feeding, she has done really well. She now feels that she was trying to give birth with her mind, and that throughout her labour she could not let go because she could not understand what was happening to her. She felt a bit bad she could not do it at home but I shared my birth experience with her and let her know how proud she could feel of herself if she wanted to. She was touched by this and I feel that the real birth here was the birth of the mother, of the family, the ones that needed that much more help to get to a place where they could simply enjoy the feelings and emotions, with out understanding everything. This experience really taught our client and her husband and the people who card for her, most of all me, I think, that ultimate lesson, no matter how hard we try, we just cant control life.
The Barcelona Midwife 