The phone woke me in the middle of the night. I answered it groggily, but unsurprised. Babies like to be born in the middle of the night. A voice greeted me, it sounded far away and it sounded tired.
“You don’t know me or my wife, but my wife has been in labor for three days here and the baby hasn’t come out and we think we need some help.”
Immediately I was wide awake. These weren’t our clients. I didn’t know them and they were attempting an unassisted homebirth. I was glad they called yet felt immense trepidation. What was I walking into? They refused help from the hospital, they said they wouldn’t go in. Ethically I knew I had to go. Legally, it put me in a bind. My midwife partner came with me. I brought one student and headed into the dark and icy night.
It was about a 45 minute drive from my house. My car was loaded with the homebirth supplies. Finally we found their home – way out of the way. Down a few dirt roads, empty Mesa expanding for miles. The mountains seemed far away. Sagebrush. A few big and friendly dogs greeted us. They barked a deep baritone.
We walked into a very peaceful scene. A serene faced woman sat in a tub surrounded by two friends. Both male. Candles were glowing and her eyes were closed. Her dark brown, spiky hair was wet with perspiration. I introduced myself and calmly gathered details. I asked her to get out of the tub so I could check her cervix, listen to the baby, palpate the baby’s position and do all of her vitals. I had no information whatsoever. No history. No labwork.
She said, as I was feeling her belly….”Is there only one?” It was at that moment that I realized the enormity of the situation. This could be multiples, breech, a demise, an unknown VBAC….anything. Everything. I was thorough. We gathered all the info we could get. One baby, head down. Heart tones normal. Dilation 7. Clinical exhaustion. Absolute exhaustion. Ketones through the roof, dehydrated beyond belief. She had been ruptured for 48 hours. How could her body work? How could she find the energy to dilate and push out her baby? She couldn’t.
We offered her an IV for fluid replacement and energy. She declined. Her husband said, “We don’t need any intervention.” I wondered why they called me. Soon after she whispered to me, away from her husband, “I’d like an IV.” We started one and 20 minutes later her baby was born. In the tub and into her own hands. We stayed as safely in the background as possible. It was clear she wanted to do this alone. And she did. Her placenta was born without much ado. It took a while, a bit longer than was comfortable. But it came. Relief, joy. Happiness.
She crawled into bed, her husband holding the other children and we did the newborn exam on the bottom of the bed. It was then that she began to bleed. Lots and lots of blood. Clots, thick ones. I expelled more clots, started an IV (She had removed the other one.), massaged her uterus, gave her pitocin and then methergine. But she kept bleeding. I told her I was going to call 911. She consented and her husband said, “No! We know that bleeding after birth is normal.” I explained gently that this was not normal bleeding. In fact this was the worst hemorrhage I had ever witnessed. It was obvious why it was happening. Atonic and exhausted uterus. Her body didn’t have the strength to contract the uterus after such a prolonged labor.
He angrily declined the call. I called anyhow. “I can live with you hating me forever for calling 911, but I cannot live with her death.”
We transferred and she cried. She said, “This wasn’t the story I was planning to write. I wanted to write a piece on unassisted birth for Mothering magazine.”
I held her uterus between my hands and smiled at her. “But this is the story you should write. “