So much has happened since my last blog that I cant write it all. But one experience was interesting and challenging. This client was not my client but that of my colleague. This woman had not decided on a home birth until a week before she gave birth. She had many family issues and was fighting her family, who were against her choice of home birth. Her husband was also very negative about her choice. Her first birth ended with a hemorrhage and was very traumatizing for her and her family. My other colleague and I knew very little about this woman or her previous birth experience. But we work as a team and I am always available to work as a support or second midwife to my colleagues.
A few days before the birth my colleague told me a bit about her lady. I was called to her home in the early morning and I arrived before my colleague. On my arrival to her house I could see that the woman was pushing with her contractions. She was in the bathroom and in a very awkward position. I found it difficult to hear baby with the doppler as her bathroom was small and her contractions were coming thick and fast. I finally got a good fetal heart sound, 5 min after I had arrived and seconds before my colleague arrived.
My colleague suggested I catch this babe as it had been a while since I’d had my hands on. I was happy to do this, but quickly realized that I knew nothing about this woman and had not created any relationship with her. Now in hospital, this can be the case and often is, but in our circumstances, developing a relationship with our clients is really key to supporting a tranquil and genital birth. But now that I was there and struggling to connect with this woman verbally and to get into a good deliver position, It was clear that our lack of knowledge of each other was a problem.
The woman either could not or refused to speak with me in Spanish and as I do not speak Catala, I found it very difficult to understand her and to communicate with her and to her that her. Her chosen position was not optimum for my delivering her and the situation was quickly feeling a bit out of control. Baby was coming and I could see nothing, but fortunately, my relationship with my colleague is brilliant or so I thought. I knew her well and had witnessed many of her deliveries which were always beautiful. I had delivered with her and we always seemed to work well together. But we had never encountered a problem together, with me as the lead midwife so this experience was completely new.
Although I was in a bad position to see, my colleague was able to get a mirror behind our lady so that I could see babies head deliver. This was my usual hands off delivery but it felt wrong in some un nameable way. I was un able to communicate with the woman and though I do hands off deliveries most of the time, I use my voice and words to support women to deliver the head in a slow and gentle way. But in this experience I could not. Her position also made things difficult for me. I told this to my colleague and her help and translation we were able to get our lady onto the birthing stool after babies head was out to finish the delivery.
But the delivery of babies body proved a bit difficult. Babies head did restitute but its body did not deliver with the following contractions. My colleague, who is more experienced then I, was happy to continue with a hands off birth and encouraged me to await a few more contractions before intervening. I felt very uncomfortable with this as I watched babies head turn dark purple as two contractions passed. Feeling very nervous as the third contraction came I gently inserted two fingers to feel for cord or what ever was blocking this babies way. I felt nothing but a chunky shoulder so I felt through and released babies arm and she was born and passed to her mother for immediate skin to skin.. She was floppy and did not cry. My colleague told our lady, in Catala to cuddle and speak to her baby while I tried to dry and stimulate baby.
Our lady appeared oblivious to the fact that her baby was barely breathing. She also seemed to ignore my colleagues instructions, to stimulate her baby. She was more concerned with getting her husband to ring her parents. As I tried to stimulate baby with a bit of vigorous drying and chatting to baby my colleague told to feel the cord and check for a bradychardia. I had never done this before in hospital or in a home setting. I felt the cord and it was slow, but not brady slow, but as the seconds ticked past, I felt the pulse slowing to brady levels. I was very uncomfortable in this situation.
Through out this time my colleague was remarkably laid back, while I was silently freaking out. But I trusted her experience and tried to work in rhythm with her. Although, this was my catch, she was not my client and there was clearly no space for me to interact with the woman or her baby, or this is what I had felt at the time. In the end and within a minute, babies breathing began to normalize and within 2 minutes baby began to cry and pinken up. All was well and mother and baby were fine, but for me this birth was a bit of a trauma and I learned some very clear lessons.
Primarily I realized that I will never again deliver a woman whom I can not communicate with, if I can avoid it. In that situation I felt very much out of my depth and unable to ive the care I wanted to give.
Secondly I realized that, regardless of my colleagues experience or skill, If I do not feel the situation is all together safe and I am delivering, I need to either change places with my colleague or proceed in a way that feels right and safe to me and our client.
Thirdly I also learned about feeling the cord for a bradychardia. I had never thought of this happening in a home birth situation, but I now have another tool of understanding in my mental midwifery tool box.
Finally I have learned that, with this colleague and anyone I work with, I need to clarify, before a birth, who’s rhythm we will be following. I am happy to support her but if I take the lead, I need her to support me. This is a real big thing for me. It symbolizes me coming into my own as a midwife. I now feel much more confidence in my own decisions, skills and experience as a midwife. Which feels good as step by step I am becoming more confident in myself as a midwife.
The Barcelona Midwife 