My laptop died at the start of this month and much had happened to write about, but unfortunately its all in there, so I will do my best to recap. This month started with a bit of a logistical nightmare for me. A birth in a different city is never easy to get to when you have no car, but as this birth did not progress we had to transfer to hospital which was in different city again!
This birth was of particular interest, as although the clients were lovely and really beautiful together, family problems with her family caused them to decide to birth at home in secret. Both my colleagues felt this would have a strong effect on the birth and they were absolutely right. In the end, after she had been fully and pushing for some time with no decent, we decided to transfer. She was given an epidural and baby was born with forceps rotation vaginally, but all was well. My reflection of this birth was that I really believe now more than ever, that it is ideal for clarity to be there if we want our bodies to open and progress. Birth is not just about the 3 powers ( the power or uterine activity,the passage and the passenger) as we are taught in university, but there is also the 4th p, which I feel should be routinely taught as well. This is the power of the psyche. Where’s your head at? is a good question for all women who want to birth well and one a midwife should not be afraid to ask so that she can give the best holistic care and be aware of issues that might hinder progress.
Our next three clients, of which two had birthed with us previously, were second time mothers. They each had had some problem in their first birth, the two who had birthed with us had both had to transfer to hospital, and the other had sever post natal depression. For these three ladies I deeply wanted them to succeed in their births at home and really feel transformed from it. These ladies all birthed at home and did so amazingly well. One in the pool and with our postnatal support was able to overcome initial feeding issues and did not repeat her postnatal depression. In fact she shone and was joyful and confident.
A second was deeply fearful as her first baby was large over 4kilos and she had pushed with out progress for many hours. On her arrival to hospital she was traumatized by the ridicule of the midwives and doctors on duty as they were cold and intimidating, and actually told her she was stupid for trying to give birth at home. It took 4 years for her to recover from this experience, and after much emotional and body work she had determined to give birth to her second child at home. This she did, with our support and hours of massage from me. This second child was a whopping 4550grams! and she delivered him with only a small tear! It was a joy to behold.
Our third lady had also transferred for failure to progress. There was much emotional baggage attached to her experience which hindered her progress, but 4 years later again, she was able to have a beautiful birth at home. Here birth was intimate and beautiful. Just what she had wanted. These births are always special, because you see a real transformation with these women. They are able to regain a personal power and knowing of their bodies that was lost in their first birth or maybe that they had never had until this birth.
Our last lady of the month came just yesterday, two days before the short month of February. She had started her labour the evening before but she was in a village close to my colleagues home then me and as it was 10pm when I was told, I declined to go. The next morning I sent a text to see how things had gone and found that she was still in labour and my colleague needed to leave so I took the train along the cost and was her fresh and positive replacement.
This labour had been going on for over 20 hours and everyone was exhausted. Its good to work in a team for just this reason. At times labours can go on a bit and a tag team approach is helpful. A fresh set of hands and eyes can do wonders to reinvigorate an exhausted home birth environment. Please don’t get me wrong, its not the same as a change of shift in a hospital when a women can be confronted by a midwife she has never met and may well not like. All of our women meet us and trust in our team. As midwives we work well together and are aware of how the others work, so we can make a seamless transition from one to the other but at the same time we bring new energy.
I arrived while our client was in the bath, her labour had slowed for a few hours but had now picked up. As my colleague left she told me she felt our client was in transition, that point where a woman is becoming fully dilated and can become overwhelmed with it all. She was right. I suggested we get her out of the bath, as she had been there for a good while and I felt the movement would be good. She was contracting well, but movement helps rotation and decent of baby which is what we wanted. Time went by and after many contractions I began to feel the need to know just what position this baby was in. My colleague who had been with our client from the start was feeling the same. She decided to do an exam and found our client was fully but baby was very high in the pelvis, but came down well with pushing. Unfortunately our client had no idea how to push and was holding back with her pushing because she felt she had to control herself. We only found this out an hour later. Normally my colleagues don’t like to direct a woman’s pushing. I agree with this but sometimes a woman needs a bit of help. First baby or subsequent babies, sometimes a woman can get lost and just need a guide.
My colleague began instructing our client in how to push and baby was coming down well, but baby was not happy and its heart beat began to show signs of this. Actually, this became a really stressful birth. With each contraction, baby was showing signs of possible distress. I thought to myself that we needed to change our clients position as possibly babies cord was in the way and being squashed. We got our lady off the birthing stool and onto the bed in a semi recumbent position. Baby took a bit of time to recover so we encouraged our lady to breath through a few of her contractions. Seconds felt like hours as we monitored babies heart over the next few contractions, but finally babies heart beat became normal after 3 contractions with no pushing. We then instructed our lady to push and in this new position baby dealt with the pushing well.
After some very strongly directed pushing baby was out an all was well. With the exception of a placenta that took 3 hours, a syntocinon injection and 3 doses of Arnica to come out! Placenta smoothies for the happy parents were served. All was well but my colleague and myself really felt we had been fortunate that all went well, as it could have so easily not. We were so grateful to have had each other there and I felt absolutely justified in my decision to never work on my own.