the midwife`s journal <
Part 1: Preparation for birth
How can I hope to understand the complexities of a woman's life? The more I get to know her, the more there is to be known. This partnership that we enter into, culminating in the birth of her baby, is limited in so many ways. We find points of commonality as we share aspects of our lives, only to reach the place where the partnership must end. There is much in my life that I do not share with the woman - she does not need to be burdened with the complexities of my life. We each retain the memories, but we move out of the relationship.
Many of the stories in my Journal are simple. I have chosen a specific memory to ponder on, to develop and to treasure. My reflections on the woman today must go beyond my comfortable pattern. This woman has drawn out from me a level of trust and partnership that many women would not know about.
In developing the partnership with this woman I was aware that one of the complexities of her situation is her partnership with her husband. I have asked the man to write his thoughts, and I hope he will, and that he will feel free to share them. This man is the experienced home-birther. His two older children from a previous relationship were born at home, with well-known midwives. The man is knowledgable, caring, and more than willing to be involved. A concern that I had for the woman as we prepared for the birth was that she would be empowered to take the lead.
I had met this family a few years ago, after the birth of their first child. Adam seemed to represent high ideals that had not been achieved, disappointment with a body that did not perform; frustration with midwifery care that did not satisfy, and the confusing fragmentation of transfer from home to hospital care. I cannot go into details - my view is only second hand. Mother and child needed help with breastfeeding, and I was called in.
I do not believe in the super-midwife. I do not believe that the advice and care I give at a time of uncertainty or difficulty is necessarily better than that of a colleague. Empowerment of the woman to work with her body and respond to intuitive cues is achieved through trust. It is an on-going dynamic relationship. Trust is not achieved through fragmented care; it grows and is nurtured in an environment of consistent face-to-face discussion, and working through the issues that are presenting.
The complexities of the woman's experience in this pregnancy included an early threatened miscarriage; the severe illness and death of her father; and the long trip from Melbourne to California for the funeral. As the pregnancy drew to term the woman described a sense of sadness that the pregnancy must soon end. I am looking forward to whatever the woman chooses to write and share with me.
A few weeks ago we met at their home for the homebirth planning meeting. It was a hot, oppressive evening, one of Melbourne's worst. Adam was very demanding, and his father seemed to struggle to keep him within reasonable limits. My colleague Annie came to meet them in preparation for her role as second midwife.
After a couple of hours we were all exhausted. We had talked a lot, in a disjointed and frustrating way, and not achieved much. We had another session the following week to complete the planning. The woman had been unsure of what role she wanted for her little boy in the impending birth. During the process of planning it became clear to her that she needed to give the new baby the time and space for birthing. The woman decided that she, her man, and her midwife were the right team in this situation, with the second midwife to be called if needed for the birth. A friend agreed to care for Adam. Having completed preparations, the woman told me that she was ready. Her baby was born a few days later.
Part 2: Giving birth
Labour progressed well. When I arrived, late at night, the woman's contractions were strong and regular and her sounds were consistent with effective labour. As I always do I prayed that God would grant me wisdom, and that all would be well. My fear was that this woman who wanted the intimacy of birthing in her own place, under her own power, would face difficult physical or psychological obstacles. We had prepared to the best of our abilities. Now the test had come. I am conscious that I must remain objective at all times. My personal desires, my sense of caring about the woman and her wishes, must not block my critical thinking processes.
The midwifery skills that seemed appropriate in this labour included measures that I have learned and refined over many years, as well as some developed more recently. The woman had used the exercise ball to achieve good positioning of the baby. I encouraged her to gently rotate and tilt her pelvis after contractions, releasing muscle tension that may have built up, and keeping movement between the baby and the pelvic structures. The woman found kneeling a good position, leaning forward, supported by the ball. Her man was there, in front of her. I was able to apply strong pressure with my thumbs on the points on either side of her sacrum, and the woman asked me to continue this pressure. She said it helped.
Another of the complexities of the woman's birthing was her difficulty with staying mentally focused. After a strong contraction her alert mind sought answers to how? -When? -Why?.
'Talk to your baby, not to me' I said.
Some questions can't be answered at such a time. This is the first time I have responded in such a way to a labouring woman.
Labour did not last long. A huge contraction, accompanied by the woman's long, primal scream, and the baby's head was crowning. There was no pushing, no second stage.
Through the next contraction the woman was able to catch up with herself, and her perineum was given time to adjust to the stretching. A couple of minutes' rest, and the little one slipped into my waiting hands.
It seemed to me that the woman may not have recognised the sensations of the descent of her baby's head through the birth canal. In Adam's birth an epidural had blocked all feeling. We were all surprised, but delighted, to see a baby so quickly. I had not called Annie. The woman had found a path of her own, going from her transition to birthing, without a definable second stage.
After a relaxing bath and a good suckle at the breast the baby girl's placenta was born. The woman by this time was physically and emotionally drained, her energy spent. Rest was well earned, and was accompanied by a sense of satisfaction and fulfilment. I left them with thanks in my heart for the healing that had begun.