the midwife`s journal <
16. my own weakness
The woman gave birth to her first child, a little boy, last Sunday evening. The small house in Richmond, the bedroom, the bathroom, the little kitchen, the laundry and toilet out the back - her place, and the right place for birth.
The woman said very little to me as she laboured. There was one exception. The time when she looked up at me with inquiring eyes and said quietly "We won't need to go to hospital then?" That moment of empowerment. Realisation, when the woman knew her baby was coming. What a moment!
On the surface this may sound like a very straight-forward birth. A healthy young woman, well supported by her mate. Labour became established by 9am, and I was present from about half past three. The baby was born a couple of hours later, and the afterbirth came without any fuss. All totally Normal, with a capital N.
The complicating factor in this birth was me - my own weakness.
The main purpose of this journal is that I may reflect on my experiences as midwife- with woman. Not only do I benefit and learn, but others, not least the woman and those close to her, can use it to explore their own feelings and memories. Yet I am finding it difficult to write about the pain, the distress of mind and body, that I experienced seven days ago. The pain is now past. I wonder if it is better that I put it all behind me and forget about it?
When a woman asks me to provide midwifery care I give her a written statement explaining how I practice. I tell her that: Independently practising midwives offer personal continuity of care, and limit the number of clients booked so that we can provide a personal service. Studies have shown that women who receive care from the same midwife or small group of midwives throughout pregnancy and birth have improved outcomes and greater satisfaction than those who receive standard hospital care. As your midwife I am committed to being with you for birthing your baby, and if some unforseen circumstance prevents me I will do all in my power to find a colleague who will stand in for me, at no extra cost to you.
I have felt it necessary to make this statement. The partnership of trust between midwife and woman is strong, but we mortals are limited.
Back to the woman in labour. When she first called I did not tell her my problems. She was coping well.
I was immediately searching for an answer. "What can I do?" I could hardly walk, let alone participate actively in the birth process. I phoned my colleague Annie. "I'm in strife" I said, and explained through tears of frustration.
Annie was ready to take over. But I was not ready to let go. I told her that I would stay in touch with the woman, and if I could not attend I would tell her.
I prayed for relief, for wisdom, for peace in my heart. I visualised something in my back that was out of place, causing the pain. Surely it could go back into its right place. I took paracetamol, filled the bath tub and got in. Every movement was painful. Walking took a conscious effort to swing and place my legs one by one. This was a totally new experience to me. I had no idea why it had happened. I hoped for the healing and soothing properties of water to be effective for me.
There was no sudden change. Just a gradual easing of the pain and increase in my mobility. When I spoke to the woman again after lunch she had progressed well, and would soon need me. I explained my situation, that I was coming to be with her, and that Annie may need to take a more active role than the second midwife usually does.
My husband drove me there, and carried my bags. When he came to take me home later that evening he was able to greet the new parents, their little one sleeping in his mother's arms. That was a rare delight for Noel, who supports me any way he can.
The woman laboured well. Her fit young body seemed to relish the challenge. She seemed to intuitively know the movements and positions that would enhance her birthing process. She went from kneeling next to the bed to sitting in the bath, progressing into spontaneous efforts to bear down. Then she got out of the bath and again went into a kneeling position.
There was one brief time when the momentum slowed and the woman seemed to resist the intense sensation of heaviness and opening in her lower pelvis. A few contractions when her mind and body were at odds.
Then she changed. With her left knee continuing in the kneeling position the woman raised her right knee and put her foot on the floor. This tilting of the pelvis was accompanied by new and more purposeful sounds, and within a couple of contractions she brought her baby's head on view. She told me later that she reached a point where she accepted that she had to get on with the job. Mind and body worked in harmony.
The woman seemed so strong, so confident. That moment earlier when she mentioned hospital, and the brief period of resisting the urge to push, were the only times when she seemed to have any doubt of her ability to birth. We had not talked a lot about hospital. There was a suitable unit close to her home, and we had agreed to go there if the need arose. Yet this woman has been through nursing training, and had had the conditioning of her mind that occurs in medically-based models of care. She must have harboured a small doubt in the back of her mind. Then the sensations of progress in labour, physical empowerment, reassured her that she was able to birth her baby in the place where she felt safe.
And I was 'with woman' despite my weakness. My prayer had been answered, not only in the miracle of another birth, but also in that Annie and I, and Noel, had been able to work together to protect our partnership with this woman.