Unassisted

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. “

Please note and remember: All identifying characteristics and details have been changed to protect the persons involved. Always. 

Unsupported

I recently received a letter from a client expressing to me in the most gentle of terms that she didn’t feel supported during her longish labor. 

Oh my gosh. It was such a hard letter to get. This is one of those phenomenally adorable moms with bangs that I want to emulate. Her baby boy is the cutest and reminds me of my own long ago scrumptious toddlers. I love her and enjoy seeing her around town.

I was shocked. But then I felt it. Immediately. Yes. There was a bit of hesitation when she saw me. It wasn’t a two way love affair. Now I recognize it. She felt abandoned during her labor. This makes me feel absolutely sick to my stomach.  I remember the night. My apprentice was in there with her and I consciously didn’t go in there. I try hard to get my ego out of the way. (This can be hard.) I want to be the one, I want to be in there suggesting and supporting. Smiling and soothing. I do. I want to be that person. That is the person they will remember forever.

Yet we allow and encourage our apprentices to be in there. She may have been too new. 

But also – I don’t believe in “managing” a labor. I believe in allowing couples to be alone. To get as primal as they need to. I want them to move in those ways you move and sound only when unobserved. To groan and strain and not be covered if they don’t want to be. Our bodies work best when unwatched. We need privacy. We really do. 

Then there is less temptation to interfere, to manage. To change. I know a woman can do it. She doesn’t need me.

But YIKES – this woman misinterpreted all of this. And I just feel so sad about it. I explained and apologized. And she totally got it. But it doesn’t change the fact that she felt alone for her labor. Unsupported. And that just breaks my heart. 

This is what we do.

 

Treska and I drove into a birth one late night this weekend. We were meeting Joan. We had already had a birth in the morning that day and were looking forward to another one. My SUV was quiet, the moon was the largest I had ever seen it. Rising above the mountains. I took photos from our driveway – but  they didn’t quite turn out….so I will spare you.

Treska put on the music and we drove in through our sleepy town. Dark with sparkly lights in the plaza.  The galleries were lit up to showcase our town full of art. Full of artists. Life artists too!

She looked at me, her eyes still sleepy, her scarf making her look warm and cozy. She said, “Mom, Can you believe this is what we do? We get up in the middle of the night and we drive to a birth? A birth? We’re so lucky. We really are. Can you believe we are driving in to a birth together?”

We are. So lucky.

 

Apples and Dopplers

The phone rang at 3:30 am. I had been lying awake wondering if my phone was even working as I was hoping and waiting for a phone call from a favorite client that needed to be in active labor soon!  She was heading out-of-state to a doctor and a hospital that would do VBACs. (Vaginal Birth After Cesarean). We do VBACs at the Birth Center and at home, but this client had a risk factor that was out of our scope of practice.

She lives far out-of-town. Fall is arriving and the nights are getting cooler – crispier. My window was open and I could hear the coyotes. There were so many. They would yip alone and in groups. I was trying to fall asleep and to let be what would be. No more hoping and no more wishing. (And no more worrying.)

She wanted to let me know that labor hadn’t started and she was heading out-of-town.
“Would you mind listening to the baby before we go? We can stop by your house?”

So I got up, brushed my teeth and decided not to meet them in my jammies (my new pink and orange yoga pants that Treska had given me for my birthday) and got dressed. It was a sweet time in my house. Quiet, dim lights. Apples.

I waited. I filled in all of her information on our EHR (Electronic Health Records) and listened for the car. I watched for the car headlights coming down my long driveway. Our dogs barked and barked as they arrived, the girls awoke, yet stayed sleepily in their beds.

She sat on my red couch, her partner on the arm and we listened to the baby’s heart galloping along. I secretly wished labor would overcome her and she would begin pushing – here at my house, squatting on my shiny saltillo floor. Instead we said good-bye and they pulled out of my driveway for their long drive.

I went back to sleep.

To turn or not to turn

View on my way to clinic this morning.....

 

A couple of years ago we had a young first time mama come in. She was driving 2 hours for her appointments at the birth center. She had a sugary, sweet voice, almost like a little girl. And she was darling.  At 28 weeks her baby was breech. At 30 weeks her baby was breech. At 32 weeks her baby was still breech, and I gave her some easy tips on how to turn her baby. Pelvic tilts, moxibustion, and the such.

At 34 weeks her baby was still breech and I felt nervous. I emphasized the need to try these low-key, natural interventions to try to turn the baby. (We are unable to catch breech babies, and no hospital within 2 hours will “do” a breech birth.)  She hadn’t tried any yet. At 36 weeks she came in and her baby was still breech. I asked her how it was going with the tilts and wondered which was working best for her. She said that she hadn’t done anything yet, she believed her baby would turn on its own. I reassured her that her baby might, indeed, turn. But it might not. I encouraged her strongly to try these maneuvers to see if her baby would turn.  She nodded quietly.

Her next visit was not with me, and she was very, very upset with me for not trusting that her baby would be born the way it should be. Her baby wanted to be breech, she said. Why didn’t I accept that? I found that interesting and had to admit that I had not seen it that way at all.

So. The very next month.  We had a client who came in at 30 weeks. Her baby was breech. I didn’t mention anything about turning the baby yet. At 32 weeks her baby was still breech. I mentioned that there were some tricks to turn the baby, but she should trust her baby. It knew how it needed to be born. At 34 weeks her baby was still breech. I told her about pelvic tilts, moxibustion, the Webster technique……  At 36 weeks we talked some more about turning the baby, but emphasized my trust in her body to do the right thing.

At 37 weeks she had an appointment with someone else and was just devastated that I hadn’t made it clear to her how important it was to turn the baby. Why had I been so laissez-faire?  Now her baby was definitely breech and she hadn’t  known how important it was to be doing all the tricks to turn the baby. Her baby was not in a position where a safe vaginal birth would have been possible. She was absolutely crushed that she had to have a c-section. I was too.

Sigh.

So now I know. I will do what I believe in. My clients won’t always love all of my recommendations. They may need an ultrasound that they didn’t want. They may have an extra blood test to rule something out. But I have to practice in the best way I can. And that feels good.

And so it is in life. We will do our best. And sometimes it will be just right, and enough for everyone. And sometimes it won’t be.

As long as I know that, I am clear inside myself that this is the right way. For me. Then there is peace. That is what I am working on.

 

 

Car Birth!

It has felt like an eventful few days. Births, bats, dogs, theater…..

A long birth and a now a short birth. This day started off with a jaunt into the birth center – an early-morning ride.  As we waited, I filled my mason jar with peach tea. We chatted. Outside the birth center, a car pulled up, the gravel crunching, a red towel hanging in the window where the glass should have been. We went out to meet the mama – and as she opened the door, her adorable little face looked a bit shocked, wide-eyed. She said, “You missed it – it already happened!” When I looked at her questioningly, we realized at once that she was holding her baby! The baby had already been born! It had come so quickly, he had pulled over, didn’t even put the car in park and helped her pull her baby up and out of her sweat pants. Then he had driven 60 mph to get to the birth center. Her toddler was with her – quiet and full of smiles!

We helped her inside, she waddled with the placenta still inside, the cord between her legs, the baby in a towel. We helped her get undressed and as the story was told over and over again, the baby checked out – we waited for her placenta.  It was a beautiful birth – the new papa quiet, thoughtful and smiley.

Such a sweet and fun start to the day!

Sunrise Birth

I don’t think I am even capable of stitching right now. I got a lot done last night though! (So inspired by my stitchy, embroidery blogs I have been reading) Drove home after a sunrise birth… rather, drove home in the sunrise after a 5 am birth. Still reeling from the beauty and intensity.

Kaya and a friend are off making a fort -and having a picnic. The dogs are with them.  I should try to sleep, but it feels senseless, ’cause I will have to wake up again sometime. I’d rather not sleep if I have to wake up. No more coffee for me, just lemon ginger tea and salad and looking forward to dinner at Dee’s house tonight!

Cheers to healthy baby boys and girls that are “sunnyside up!”  Clink!

I trust Midwives.

As I was driving into a birth recently, I thought , “Well, we’re due for an uncomplicated one.”  The second I had that thought, I realized, it doesn’t work that way. Being a midwife is interesting. We are the harborers of trust. We believe in birth, we believe in women. We believe that intervention is risky. We believe that if we protect the private sphere around women, and do less, everything will be fine – will be safe. Well, it’s just not always true. Sometimes I feel like I have a doctor mind inside a midwife body. What I mean – I don’t always think everything is going to be fine. It’s not always fine. It can be downright messy, terrifying and even touch and go.

Midwives aren’t often allowed to say that. (I could be judged harshly for just writing that.) Just as doctors live in a world of dogma, so do we. Doctors are taught to expect the worst, rule it all out and act accordingly. Midwives are taught to expect the best – but be prepared. We are prepared. We are so well-trained. We have to be so capable, because we are often far away from a hospital. We have to be able to take care of whatever comes up. And “come-up” it does. And take care of it we do.

Even when we know what to do, it’s hard. We have wonderful skills, quick skills and trusted skills. I can move my hands quickly and trust my partners and students to do the same. We can start IVs, reposition women, remove placentas, clots. We can administer puffs and compressions to a newborn, compress uteri to stop bleeding, we can call our back-up docs, we can transport, we administer herbs, homeopathics and antihemorrhagics. We know what to do. And it still takes its toll on us. Our bodies are run through with adrenaline sometimes. We carry a lot of responsibility. We hold a lot.

I wonder if I am allowed to write this. It often feels like a secret among midwives – it’s hard. It can be really, really hard sometimes. It is often not about joy and bliss. It can be medical and intervention can be very, very welcomed. I love our back-up OB/GYNs. I truly love them. We are so lucky to be able to transfer to loving, quick-moving, skilled doctors when necessary.  I feel sad for those midwives who cannot – I know it is a luxury here. I sometimes take it for granted.

And so it is. Sometimes I don’t trust birth. (Can  you believe I said that aloud?) I trust my skills. I trust my hands, I trust my partners, I trust my knowledge. If birth were completely safe, we wouldn’t have maternal mortality rates of  11 in a 1000  in some countries where skilled attendants are not available. (That is approx 1 in 100 or 1%!)

I trust Midwives.

(As I searched the web for more thoughts on this topic, I found a post I really liked. It is written by Maryn Leister. Here it is: “Do You “Trust Birth?”   

Thank you Maryn! Well Said.

 

Here they come!

Scrumptiousness all day yesterday…. the babies have begun to arrive! Pink Room, Green Room, Pink Room – bedroom – Bed!

Heading to sleep now – but just wanted to share this yummy little one…..

More on their way!

On a precipice….

We find ourselves on the precipice of many births. We have so many women in “the window.”  We all wake up in the morning surprised to find ourselves still nestled in bed. I expect, every night, to be roused by the beeper. My beeper who instills a sense of urgency in my body whenever it goes off. My friend and enemy. The beeper. Even without births we are so immersed in the upcoming excitement of so many births and the postpartum of others. We have new, enthusiastic and extremely eager students. One full-on apprentice and two new month-long interns. I enjoy these women. (I know this does not rule out challenges later on….it’s the nature of apprenticeships.) I do love working and teaching these aspiring midwives. Really, they are already midwives here to learn the tools, the skills and the right questions to ask. They are helpful and hungry to learn. It makes teaching enjoyable. I love it – I really do.

So here we are – waiting. We’ve had one birth and wait for more. Births love to come in clumps, clustered together. So in the meantime I have bonded to my new home. I’ve walked hikes near here and discovered new (to me) canyons. (Above…..) I’ve unpacked and rested. I’ve read and written. I’ve spent lots of time on this couch in front of this window. I’ve drunk gallons of hot tea.

I will leave you with an image .  In the hospital is my tired, sleepy student. Sleeping mama and father-to-be in the room. A kind faced older woman knocks tentatively and comes in pushing a huge harp! She begins to play music, her hands deft on the colored strings. The mama deeply relaxing, the baby’s heartbeat softly and  in the background. The silver lining, this time, of the hospital transfer…….