Sunday, March 02, 2008

Knowing

Denise [not her real name] is a practical, down to earth young woman who lives with her two happy little boys and their father. When she booked me for homebirth she was sure that her baby would be born without too much bother, consistent with her previous birthing experiences. Denise asked me to visit her at home for a couple of prenatal checks - she doesn't own a car, and public transport between her place and mine is not easy. She had made a 'shared care' booking at the Women's, which means that most of her prenatal checkups were with the local doctor. I felt confident in Denise's knowledge of herself, her baby, and her trust in her own body, and I was happy to take her booking.

A couple of days before the due date Denise phoned me around midnight to tell me her waters had broken, but she was not in labour. She wanted to know if that was alright - it had not happened that way previously. In a brief conversation I reviewed a few important points - a small amount of clear liquor, and baby is kicking. The head had been presenting well last time I palpated her, so I reassured her and encouraged her to get some sleep before labour became strong.

The next phone call was after four in the morning, and Denise's husband asked me to come. I put on some easy clothes, brushed my teeth, and got my gear into the car without delay. It took 40 minutes or so as I drove towards the city, and across the flat docklands. I was conscious of the early light of dawn, and the movements of a city that is waking up, and I committed my work, and this family to God. I always ask for strength and wisdom as I go to a labouring woman.

The husband greeted me at the door, and told me she was still in bed - hadn't wanted to get up, in case the baby slipped out. I greeted Denise, who looked relaxed and well, and settled in. There was no rush, but I set up the basic equipment as is my routine.

I don't want to record here a blow-by-blow description of progress in labour. Denise was surprised that her contractions were irregular in their strength, and frequency. Her expectation of quick progress was not met. Yet she was well, and her baby was well, so I had no reason for concern. At one time she asked me if it was taking too long. No, I replied. Each baby has to find its own way through the birth canal.

Over the next few hours the labour became more powerful, and Denise moved into the isolation of her bedroom. Her cries indicated the intensity of the pain she was experiencing, yet her quiet confidence between contractions reassured us that she was well. She worried about her boys, who were watching a DVD - a rare treat for them. The younger one, who is about four, came to the door and checked his mother as her vocalisations became stronger. Each time she reassured him, and he seemed quite satisfied.

A change came eventually, and at the peak of a strong contraction there was a pop, as the bag of forewaters broke. The next contraction brought a strong urge to push. Denise was working intensely with her body as she progressed the baby through her birth canal, and into view. The brother checked once again from the doorway, saw the baby's head crowning, and went back to the television. It was just before 11 am when a beautiful, healthy baby girl was taken into her mother's arms. The two little boys came in, met their new sister, and left in a very matter of fact way. Their mother had had a baby. That's what mothers do!

Many times in the past I have experienced the 'knowing' that women have about their own birthing processes. I hear the woman's expectation through a critical ear, as I know that there are times when knowing is not what we think. Although Denise's knowing, or belief, that this baby was likely to be born very quickly, did not eventuate, that doesn't matter. Time takes on a different quality in uncomplicated, undisturbed birth, than in the world of measurements and calculations. As the labouring mother's mind progresses from neocortical activity to intuitive, hormone-mediated activity, the midwife protects the space around the woman so that she and her baby are free to take the journey. This is one of the secrets of midwifery.

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