I have been an independent midwife here in Barcelona for 4 and a 1/2 years now and in that time I have learned many things but the most important things are these;
birth works and women can birth naturally and normally when they are given the time and space to do so.
there is not one woman in the world who is in a text book and that birth has its own individual flow with each mother birthing.
hospitals can be amazing places for normality if the staff know what normality actually is and they are confident in their skill and their patients.
and no matter where she births or how, as long as a woman feels respected and involved in her care she will have a good birth experience. It may not be to her ‘ideal plan’ but she will feel she was able to do her best.
These last few births I have attended have brought home to me how important it is to be very present and in the moment with your ladies. How intuition can be the best tool in your midwifery kit and how your heart can see more clearly than your head at times when it comes to discerning a productive labour.
In my last two birth I supported two very different multips. One with a lot of fear from a previous birth trauma and one with one hundred percent confidence in her ability to birth and her babies ability to do well in birth although she was not ‘text book’ normal.
This mother of two had delivered her first in hospital and second at home with a doctor and a midwife. She was mother with known IgG antibodies in her blood and was Rh-. Regardless of this she was set on her home birth and did all she could to insure she could have this. At the time of labour the antibodies in her blood were at an all time low and we were sure of babies blood type, which was positive so anti D was on stand by at home.
She laboured at home with her her husband and two young children. She amazed me because she laboured completely in her own rhythm. She laboured in silence for two hours and thirty five minutes after we arrived but her contractions never come closer together than 10 minutes. Finally five minutes before baby was born she had 3 contractions one after the other and baby was out. It was made all the more beautiful as her children aged six and eight were both quietly sitting on the sofa watching intently, both with head lights on to see in the pool when baby came out.
On arrival I noted that her contractions had slowed, which I took as normal, because the dynamic had changed with our entering her home. The children became very excited and we busied ourselves preparing the pool and other little things needed for the birth. Once the energy in the space settled, down although the children never really did, I began to observe her and her labour. Her contractions were rhythmic but she was so controlled and silent it was very difficult to tell how strong or effective they were.
I make it a rule to not do a vaginal exams (V.E.) in home births unless they are requested by the mum or if I feel unsure about progress. As the years have passed here I tend to do less and less because there are so many other ways to determine how a birth is progressing and having been on the other end of a v.e. I know they can be very uncomfortable and even painful or traumatic for the labouring mum no matter how gentle you try to be. I feel now that if I wait and watch I can, 9 times out of 10, see, hear and even feel in myself how the mother is progressing. I have seen amazing purple, silver and even brown lines that have been spot on in telling me dilation but more than that I have seen women go from zero to ten centimeters in minutes more times than I can count. These experiences have instilled in me a confidence in the women I care for and made me question our obsession with V.E.’s as birth professionals. But I digress.
One hour into this labour I understood clearly that this mama was in her own zone and I was happy to simply sit and observe her beauty and listening to baby when it felt timely. I knew somehow deep inside me that, although her contractions were only ten minutes apart she was doing the work she needed to do. An hour and a half into her birth she and her husband really began to connect and in between lovely moment with her beautiful children in the kitchen, drawing and chatting about birth and life I knew we were close. By the completion of her second hour with contraction still every ten minutes I had a feeling that I should be near and I sat quietly behind the pool and closed my eyes. I felt the need to be visible and yet invisible. This happens often in birth and is a great skill I have learned. The mother s aware you are present and with her but you do not break her concentration or disturb her energy. It os easier than it sounds I promise you.
Ten minutes before baby was born her beautiful children and my lovely doula joined us in the front room and with the fire glowing in the fire place a magical hush came across us all. Still labouring in silence she sat up and began to push. Hand in hand with her husband she leaned forward and baby delivered gently into the water and then into my hands. Yet another powerful birth moment when that door of life swings open and we behold the light of life. A birth so gentle and yet so powerful, just a part of normal life in this family, the new baby greeted by her siblings and parents immediately and with such awe and love. Birth, a normal part of life in a family, but such a great gift to us all. This is why I love home birth so much.
This woman was not text book ‘normal’ at the start but working with her doctor and believing her and her baby it was possible for her to birth in her way, in her time and with her family. It was a great gift and lesson to me, this lesson is taught to me over and over again.
The second birth was with a mother who had attempted a home birth with her first baby. Her baby was un diagnosed hypotinia and after hours of pushing she was transferred to hospital and delivered by forceps.Her baby was weak and floppy and they were deeply traumatised by the news of babies illness. She and her husband spent the past two years striving to help their baby have a normal life and grow as well as possible.
When she became pregnant again of course she had her worries that they could have another unwell child but they persevered. This woman understandably needed a lot of emotional support and private midwifery was the best choice for her with out a doubt. I did my best to support her and encourage her that she could have this baby well and at home, which was her wish.
The interesting thing about this birth for me was how we all assume that birth must take place in an intimate space. How we think, and this is really true for us home birth midwives, that a mother needs few people and a dark corner to birth in. This is true for some women but no woman is the same and in this birth this mother assembled everyone she felt she needed to safely deliver her baby and support her across the sea of fear she needed to cross to do so.
Two midwives, one osteopath, one acupuncturist, one doula, her husband, mother and sister in law were present as well as her little daughter. The house was full and we all took our turns giving this mother the support and energy she needed to make her birth happen. Although thi was a second baby this labour took its time considering that she was fully dilated with in three hours with her first baby. But this did not surprise me. I felt she was a bit like the VABAC (vaginal birth after section) mums that I support at home. I feel they need to recover the births they feel they were unable to achieve the first time around and their births really take their time. It is not in any text book but I have seen this time and time again, This birth took thirteen hours from start to finish but the journey was really about breaking trough the fear and doubt she had inside.
With the love and support of all those around her she was able to move, one contraction at a time, through a dark place where she later told me she feared she or her baby would die.But what power and determination!She knew the only way to heal the trauma of her previous birth was to make that journey and how wise she was to bring together the right people to help her through.
The mind can be your worst enemy in labour. It can stop contractions and cause them to be unbearably painful. A woman’s emotional state in labour is so very important and those around her must be sensitive to this if not they can create an environment where normal or natural birth becomes impossible. This happens because our energy can either support her hormones to do their amazing job or hinder them. Women can read our stress levels out doubt and fear. Like all other mammals, they pick up on the energy in their space and its effects are powerful.
I feel as a midwife I must always be open to all possibilities. I think its something more than just hoping that it all goes well. I feel like the mother we as midwives must surrender to birth in away. Of course we carry our skill and obstetric mind into birth with us, but there comes a time when we have to accept that it is really bigger than us and that life is working through us as it is the mother. Once we do this we cam allow the deep wisdom within us to guide us to support a mother in the way she really needs us to and we open to the possibility that although all may not appear normal, life is making its way and birth is progressing. Of course I am not saying we should practice in a dangerous manner, but we have to cultivate eyes that see beyond text books and protocols. Maybe we see with our deeper wisdom. I find it difficult to explain but I feel it so much when I am in a birth. It it’s about finding that balance between medical professional and the spiritual self. I am once again digressing.
This birth progressed in its way, with contractions getting closer and stronger as the night wore on. The mother was well supported by so many that I took a very back seat and really watched as she moved along in her journey calling on the help of whom ever she needed at a specific point along the way.
About an hour before baby was born I felt it was time for her to really dive into her birth and bring her baby to the light. I do not know why I felt this but it just seemed time to move toward the end. I spoke with her and her husband and explained that I wanted her to leave the pool for awhile and do a bit of dancing and have some intimate time with her lovely man. I told her in no uncertain terms that it was time to go where she feared to go. I explained that I knew she was afraid but that only he could tread her path and we would be there beside her but it was time to move on.
She understood and the three of us spent the next half hour dancing and moving. Things got very intense and her contractions were coming thick, strong and fast. I suggested she lie in left lateral for twenty minutes to help baby down and have a rest fror the pushing phase, I knew she had a large baby on board. I left the two of them to have some romantic time and twenty minutes later I was called because she needed to push. At that point the room was once again ful and with the help of her husband and osteopath she took a position that opened her pelvis wide and in 5 five controlled pushes baby was out weighing 4280g. She had only the smallest tear that did not need suturing and this baby was the strongest little boy I had ever seen. Eyes wide ope with the strength to life and hold his head up for over one minute. He was like Bam Bam from the Flintstones.
She had concurred her deep fears and delivered a healthy strong massive baby boy. Once again the family entered the room and birth was just a normal occurrence.
As a side note, she did retain her placenta for some reason. We tried all we had in our power to deliver it, from an alternative medicine point of view but nothing worked. In the end as she was not happy to go to hospital I performed a manual removal and delivered her placenta at home. This was very much ‘text book’ and I was amazed as how it was really just like we were taught to do it. I had once preformed one of these on a woman in hospital with an epidural but never at home and with out anesthesia, but that is home birth and after all these years I had the skill and confidence to do it.
The funny thing is after all this time and all the experience I have gained I still worry that I am not a well rounded midwife. I have yet to truly feel comfortable and confident working in a hospital setting and because of this I feel I am lacking. In the NMC code it says that we should be well rounded in our profession as midwives and I worry about this a lot. I have applied for a few hospital jobs in the UK feeling that I really must get in there and overcome my fear and doubts but each time I interview I feel an over whelming urge to run out of the hospital screaming because deep inside I know its not for me. I value and admire my hospital colleagues. I know how important and vital the service they provide is and I know they reach so many more women than I ever could. Its the women who are un well and have very little chance at a normal birth who really need midwives, I tell myself, and I believe this to be true. I also feel that the midwifery I practice is really valuable but I struggle with the fact that it is private and leaves many women outside of my care. Over the next year I must find a balance, away to reconcile this situation because I am moving home to the UK and leaving this life behind.
I guess like my last mum I must find the courage to walk my path of fear and doubt to bring my new working life to light.
The Barcelona Midwife 