the midwife`s journal <
9. a special partnership
The woman gave birth to her first child late Friday night, in the bathroom of her home at Kinglake.
It was a cold and wet afternoon when I received the call, asking me to come. The waters had broken, and labour had progressed well since early morning. When I arrived the man greeted me, and told me that she was working very hard, in her own world.
The whole world was still. The tall eucalypt forest that surrounded the house was sodden and quiet. There was fine rain, and a light mist blanketed the tree-tops. There were no people noises, and no sound of traffic on the road. The still quietness was interrupted from time to time by the grating honk of a duck; the mournful wail of a pet peacock; or the thumping sound of the house water-pump.
The man was totally attentive to his woman. He seemed intuitively to know her need for space. He quietly went about assisting her when she occasionally surfaced.
When I enter a partnership with a woman for birthing her child I need to know her, and work with her within her world. The trust that she and her man put in me must be reciprocated by my trusting her. That relationship of trust is likely to be tested from time to time, as the birth journey gradually unfolds.
There was no second midwife available at the time, and Roslyn would come as soon as she could be free from the hospital. The sounds of early second stage made me think that we would have a baby a long time before Roslyn could be present. However, after a couple of hours of spontaneous expulsive effort, when I expected at least to see signs of an imminent birth, the woman was becoming tired and there was no baby to be seen or felt.
The woman agreed to an internal assessment, and this confirmed the full dilatation of the cervix. However the head had not begun its descent. Was this baby able to find a way through the birth canal? It was obvious to me that whatever the woman had been doing was less than effective, so I suggested a total change.
I believe that active birth will often include resting. Women are sometimes able to move into a sleep-state, putting their labour on hold for a little while, and allowing their bodies to rest. This is what the woman did. Contractions became less intense, and she slept on her side for about an hour, working with each contraction as it came.
The second intervention I attempted was the manipulation of the pelvic bones by lifting the sacrum at the same time as I pressed the ilium downwards. Following this the woman got up and sat with her legs widely stretched open, on the big exercise ball. At this time the urge to bear down returned, and the labour was re-invigorated. The woman stayed on the ball for about 20 minutes, tilting and rotating her pelvis consciously after each contraction. She then found the shower comfortable.
I hoped that we had turned a corner. Baby's heart sounds were strong and steady each time I listened. Mother was working well, definitely refreshed by her brief rest.
The woman stood in the shower, and we waited. Her man kept the wood fire burning strongly - the hot water system was connected to the fire. As I reviewed the progress and made a few notes in my records I was conscious that two hours had passed since I had recorded full dilation, and the cervix had probably been fully dilated two hours before the examination. The home is about an hour's drive from the nearest hospital suitable for transfer. I explained to the couple that I was concerned about the lack of progress. I said that if after another 30 minutes we had not seen progress we should seriously consider transferring to hospital.
The woman had appeared to me, on the surface, to be very timid. We experienced the other side of her personality that evening - stubborn determination. Just as the half-hour time test passed I thought I could detect a slight stretching and bulging. Yes! We had progress. I was not imagining it! The baby's head came down well onto the perineum.
But the baby wasn't born yet. The head was well on view, with the vaginal opening stretched about half way, and that's where it stopped. Contraction after contraction, push after push, and no change. I brought the woman out of the shower, and made various attempts at assisting progress, to no avail. The perineum seemed thick, rigid, and a little oedematous.
"I really think I need to cut." I could hardly believe I was saying it.
"OK. I won't do anything without your permission."
Another contraction came and went. This state of affairs continued, and I again asked permission to cut. I held the scissors in my hand.
"Just give me one more try."
And suddenly, after about 20 minutes of nothing, something happened. A long, moulded head moved gently forward, and passed over the perineal barrier.
With grateful heart and willing hands I received the little one, who blinked, looked around, and drew in a good strong breath.
By this stage I had heavy sweat dripping from my face. I was emotionally spent. We waited to complete the third stage as the happy new parents marvelled at their beautiful little daughter.
My partnership with this woman took me to places which I would have preferred to avoid. In being "with woman" I do not enjoy having to demand achievement within pre-determined times. Yet my professional commitment demands that I be fully answerable. I cannot sit back and ignore a situation that is clearly outside commonly accepted limits. Yet in this case I am very glad that the woman has a stubborn streak. She trusted herself, and me, enough to say "No".
The woman who has emerged from this birthing has an air of confidence about her. Perhaps she has learnt to trust me more; perhaps she has moved to a new relationship with herself, and the world. Empowerment. I have not, since the birth, seen shyness or timidity. I have seen a woman who has become mother-nurturer.
The act of giving birth is a wonderful climax. The process of becoming a mother is an on-going challenge which continually opens up new levels of experience.
The birth of this little girl is an experience which we will all remember: the woman who gave birth; and the man who husbanded his woman in a gentle and appropriate way. And Roslyn, attending homebirth for the first time - I wonder what was most memorable to you? And me, as I try to commit to a written form some of the lessons I have learned. I am again grateful to have been able to enter the world of a woman, and partner her within her own world. I have learnt a little more about trust, and I have become more convinced of the importance of midwifery interventions which can be called upon to empower a woman and enhance her labour.