the midwife`s journal <
35. learning from birth
In exploring birth from my perspective as a midwife I have focused frequently on that mysterious, miraculous, climactic event - the birth itself. Birth - the moment of release, the long awaited meeting, the realisation of dreams, and the hope of the next generation.
Today I need to think about sharing my knowledge, teaching another.
The woman gave birth to her fourth child, a beautiful boy, last Wednesday morning. Leanne, a student midwife, was there to observe, to learn, and to help where needed. Leanne prepared well, visiting the woman several times, coming to prenatal visits, and organising her life so that she could be there when she was called.
It is hard for me to describe the role of the second midwife in a homebirth. Because this model of care relies so strongly on the one-to-one partnership between a woman and a midwife, I can't really share that role. And because I am committed to care that is centred on the woman giving birth, there is no place for even slight conflict between the way different midwives work. This was one of the difficult lessons for me to learn when I first attended a few births as second midwife. It's not that one is right and the other wrong - they are just different. If we seek to understand what the woman is experiencing then we will protect her from these personal differences if at all possible.
The role of the second midwife at a homebirth is a quiet one, somewhere in the background. I asked Leanne to work with me and through me, and to interrupt what was happening only if she believed that the mother or her baby would be harmed by her failure to do so. The woman must engage in the process of birthing, and sense the empowerment of her own body's processes, rather than the outside promptings of her midwife.
The woman's friend arrived and bundled the three youngsters into her car. Once they had left the woman was able to focus on her birthing. Labour was strong, and the woman reclined on the couch, reducing the intensity a little. After a while she wanted to be in the tub. The buoyancy and freedom of movement when emersed in a large volume of warm water is a wonderful relief to many labouring women. Resting back in the water brought a smile and relief to the woman's face. A long break before the next contraction had her wondering if she had moved to the tub too soon. Then her husband said "I expect you are closer than you think". A contraction surged, and the reassuring and empowering sense of the baby's head descending deep into the pelvic cavity removed any doubt.
It was only a few moments later when I said to Leanne "Let's get our gloves on". The baby's head was born, and my hands were with the woman's as she completed that stage of the birth.
The umbilical cord was not long enough for the woman to bring her little one up to her chest, so she supported him, quietly floating him in the water in front of her. In the soft light that came into the room that sunny morning we watched this newly born infant adjust to life outside his mother's womb.
He breathed quietly, without crying. His skin took on a healthy pink glow. But he did not seem to realise that he had left the womb as he floated fully submerged except for his face. We stood by and watched. The parents stroked him and talked to him.
There was no placental separation or bleeding, and the placental circulation continued for 20 or 30 minutes, in this out of the body, womb-like place of transition.
Eventually the woman wanted to get out of the water, and she cuddled her child and sat out on a nearby couch. With warm towels to dry both of them, the quiet protected atmosphere continued, and the baby began to seek his mother's breast. Now exposed to the air the cord had constricted and ceased pulsation.
With baby nursing quietly the woman expelled her placenta, and we clamped and cut the cord.
It was then that I was able to turn my attention to Leanne. What did she think?
The actual birth was quick, over in a brief moment. Our hands merely received the child. Students are required to record their 'deliveries' - the births at which they are positioned next to the woman, and go through whatever rituals of washing, draping and managing are popular in the maternity units at that time. Some are taught to flex the baby's head, and to 'guard' the woman's perineum, in an attempt to achieve better outcomes for the woman and child. There is enough evidence to question the value of these practices.
It was the time immediately after the birth that made this one an exceptional experience, both for Leanne and for me. In hospitals, and in many home birth situations, there are things that need to be done. What power could make everything come to a halt for a half hour or so, while everyone just looked at a newborn baby? I have attended other waterbirths in the past few years, but this one was special. The quietness of the baby, as though he was not yet fully born, made me feel that I was actually having a glimpse of that secret world inside the womb. The intuitive responsiveness of the mother to her baby gave us the opportunity to see what few have ever seen.
I don't know if Leanne realised the impact of this experience on me. Perhaps she thought that's the way it usually is in homebirth.
The parents will also have their unique sets of memories, different yet parallel to mine.
The gift of new life, new birth, is perhaps the most basic gift in human existence. There must be many powerful lessons for us all to learn when we submit to the creative strength of woman with child. And although I set out to teach, I am being taught.