When I was asked me to be her midwife I was aware that this was a woman with very special needs. She openly discussed her anxiety, and seemed to reach out to me to provide some security in a very insecure world.

The woman's previous birth experience had been, on the surface at least, positive. She had employed a skilled midwife to be with her at home in early labour, and to continue as her special support person in hospital. She reconsidered her options, discussed with me the possibility of a different doctor or a different hospital, and decided that there was no need to change. The one private hospital to which I had visiting rights for midwife-doctor shared care at the time was too far from her home to be practical.

The anxieties which seemed to plague the woman related a great deal to her experience of Hodgkins Lymphoma about seven years ago. Although she had not had any recurrence of symptoms, she was afraid that the chemotherapy may have damaged her eggs in some way. The woman viewed her little daughter as a wonderful gift from God - could she hope for another strong, healthy baby?

As the pregnancy progressed there were several obstacles for the woman to overcome. We discussed prenatal testing at length. She decided to have an ultrasound scan, although she was sure that she would not consider rejection of the pregnancy. She told me that she had found the scan reassuring with her first child, and she was looking for reassurance. It was important that we had talked about the scan, because as it happened there was an abnormality noted. The baby had only two, not the usual three vessels in his umbilical cord. The woman was told that this may mean that the baby would be small at birth, it may mean that labour would need to be induced early, it may be linked to other problems - and it may not make any difference at all! The woman who craved security was confronted with big question marks.

Later in the pregnancy, as the baby grew nicely, another test brought more questions. Blood glucose levels were marginally high - resulting in more questions, more fears and anxieties.

During the past couple of years there has been a movement in the midwifery profession in Victoria to have independent midwives accepted in hospitals, providing midwifery care for their clients. Progress has been slow. It was therefore very encouraging to me that the hospital which the woman chose agreed to give me visiting rights, and this happened just a few days before the baby was born. We were the first to take up the new access. Prior to the admission hospital staff seemed a little unsure about the change. I understand that change brings uncertainty, and I did what I could to reassure the hospital midwives, emphasising the importance of good communication.

The woman's labour progressed well.

We went to the hospital and were admitted to a room with a lovely deep bath. The woman used the bath, and the shower to help her cope with the strong labour. Her man gave quiet, matter-of-fact support, and she looked to me for reassurance, stability and security.

There came a time when the woman's doubts about her ability to birth her baby almost seemed to overwhelm her. I explained and encouraged, and eventually the change took place. New energy and empowerment worked through her body as she felt the baby open the way through her birth canal.

The doctor came for the birth. He assumed the role of coach: "Don't waste the contraction; take a deep breath; push down; don't make that noise, it's wasting your energy. At the same time I was saying: "You're doing well; let your baby come down; listen to your body; let your body stretch and open." I do not need to coach as an outsider; I am 'with woman', and to a small degree we engaged in the birth process together. The woman was listening to me - she told me later that my voice and touch were very important to her. There was no confrontation between the medical model which controls, and the midwifery model which empowers. The woman went ahead and birthed her healthy baby boy.

I am truly grateful for the trust of a woman, working with her so that she feels secure and free to make her own choices.