the midwife`s journal <
28. understanding birth
I felt no regret as I watched you being bundled onto the trolley that took you to the operating theatre. That was where you needed to be. Obstructed labour puts the lives of both mother and baby in jeopardy, no matter how well you both were yesterday, and no matter how low risk you may have been classified. The skill of a midwife includes recognition of complications, if and when they arise, and procuring appropriate medical assistance.
When you asked me to attend you for birth in your beautiful mountain home I could not have assessed you as anything but low risk. You are fit and strong; your first child had been born without any complication from a professional point of view; and you eagerly prepared for this babys arrival. I say "without complication from a professional point of view" because you have told me that you experienced physical and emotional trauma in that birth. One of the lessons I am learning is that I need to understand birth and its related aspects from the womans and the babys points of view. The external quantifiable factors that find their way into the womans and the babys care records hours and minutes, volumes and lengths have little to do with the experiences, perceptions and memories of those who are most involved in the event.
Yesterday we experienced the disempowering effect of your lack of progress. Your pain and your inability to continue were not weakness. They were the result of your bodys efforts that went unrewarded - your wombs repeated strong attempts to release your child; working then becoming weary; time and again. The pain you felt was a message that we had to hear and understand.
Pain is an important aspect of labour for most if not all of us. In the early days of the childbirth education movement, around the time when I was having my children, we were told that we could dissociate our minds from pain. We could train ourselves, concentrate on something else, breathe in a special rhythm like a score of music, and develop a conditioned reflex like Pavlovs dogs. Just as the dogs expected food every time the bell was rung, so we learned to enter a special level of consciousness every time the trigger for a contraction was present. There were even those who talked about "childbirth without pain".
I used these methods myself, and I believe the system helped me birth my four big healthy babies. But I have also seen many women disappointed, hyper-ventilating and totally out of control, attempting to use the same system, and concluding that they have failed yet again. I do not try to teach that system today.
Instead of dissociation, I encourage women to embrace their pain. Instead of focusing outside ones own body, I encourage listening to the body, and going where the journey leads.
Many midwives and doctors who have only experienced the hospital-medical models of maternity care cannot understand how homebirth can be feasible. Pain is the obstacle. A midwife asked me yesterday if I take nitrous oxide to the home. Nitrous oxide which is used so commonly in Australian maternity care, and is usually followed by a narcotic injection and then epidural anaesthesia the systematic chemical disabling of the birthing woman and child.
That question gave me an opportunity to talk to the hospital midwife about the pain of birth. I want to know how the woman is experiencing her pain. I dont want her mind to be sent to some other world with happy gas, or disconnected by mind altering dangerous drugs. Pain is a potent indicator that all is well, or that all is not well. I was able to say quite confidently to this midwife that if a woman planning homebirth reaches a stage where she is unable to cope with her pain I must listen to her, and when non-medical forms of pain relief are inadequate there is a possibility that medical assistance in hospital is necessary. I dont have any doctors who will come to a woman birthing at home that would involve unnecessary delay. So if medical intervention is needed we go to hospital.
As I write this journal I am achieving several goals. I want to record memories, details, and a few special facts about my midwifery practice. I love to read each of the stories and remember. I also want to let go of any emotion, the positive and the negative, as I move on. Both the exhilarating, joyful experiences, and the fears, doubts and disappointments have to be cleared, but not forgotten. I dont want to forget. The next woman whose time is approaching needs me to hold a place for her in my mind and heart.
I also write this journal so that I can teach others. Women who want to know about childbirth; students who want to know about midwifery; and occasionally others like some elderly people who have told me that my stories have touched their hearts. I can be midwife to only a few. I want the lessons I learn as I experience and reflect on this most basic of lifes lessons to be available to others who are open to the same vistas of knowledge and understanding.
Today I saw you peacefully nursing your beautiful son. As he lay beside you, working strongly and contentedly with his mouth filled with your breast, you again reassured me of the rightness of all that you have experienced. I am looking forward to reading what you record from this event. I know that I have understood only a little of it.
You know that I do all I can to avoid unnecessary medical intervention into birth. You know that I believe that birth is not an illness. As I discussed your situation with the doctor, after she had advised you to have a caesarean, she said to me "It just goes to say that you can only say a birth is normal in retrospect."
The events that we journeyed through yesterday are a clear illustration of those great truths that birth is wellness, not illness; that any woman can develop complications; and that early detection and appropriate and timely management of complications saves lives.
It was heartening to me for you to tell me that you feel satisfied that you were able to make choices that were right for you, that you have a sense of control, and that you feel less traumatised today than you did after your first birth.