Thursday, May 01, 2008

A Normal Birth
I attended a birth early thismorning, and as I had no apprentice midwife with me, I am going to try to set down an account of the amazing yet totally ordinary sequence of events from a midwife's point of view. Some of the readers of this blog are midwives and midwifery students who are wanting to learn the specific skills of a midwife working with women in community settings, with the intention of promotion health and wellness, and working in harmony with the natural processes. I hope there is something in this account for you.

0200 - phone call from "Matt", "Jenny"'s partner - labour has started. Jenny came to the phone, "Yeah, they're about 10 minutes but they're str --- just a moment --- (quiet focused breathing) --- strong."
"I'm on my way. See you soon," I said.
I drove through the quiet streets, and covered the 35 or so Kilometers quickly.
I had seen Jenny a couple of days ago. She was unsure of her dates, and an ultrasound at 25 weeks had set the due date at 2 weeks ago. That day came and went, and Jenny and I felt confident that there was no cause for concern. The baby would come.
0300 - I arrived at the home, in a beautiful bushland setting on the outer metropolitan fringe. Jenny was working quietly in her dark bedroom, and the birth pool in the corner was being filled. Jenny's mother had a wood fire going and made me a cup of tea. In one corner of the main room I opened up my gear, connected the oxygen cylinder flow meter, and took out the paperwork. The basics needed for any birth are quickly put out - the pack of instruments (sterile scissors and metal cord clamps) in a big green plastic kidney dish; a pair of sterile gloves for an internal exam if needed; procedure gloves for catching the baby, and handling blood; a plastic cord clamp; the oxytocics, syringe and needle.
Then I sat quietly with Jenny, observing her and getting a feel for her labour. During this time I use both my thinking brain and my intuitive brain. Just as mothers use their intuitive brain in undisturbed birthing, a midwife learns to partner that woman in a very real sense, going through the stages, emotionally and in a deeply connected way, with her.
Very little conversation happens - I ask "is baby telling you anything --- are you getting any kicks?"
"Oh yes, with the contractions."
The mother probably doesn't realise how significant those kicks, which she alone knows about, are. Her simple statement is reassuring to me. Healthy babies cope well with labour, and a baby that gives mother a kick during contractions is doing well.
"Are you happy for me to listen to your baby after the next contraction?" I ask. The heart sounds tell me what I already know.
Jenny got in the bath and said "Aaah, that's good". Her labour progressed quickly. By 0345 she was vocalising and saying "No, I can't do it" during the contraction, then saying to me "That's transition" after the contraction. The transformation of a woman at this time of peak adrenaline together with peak oxytocin and endorphins is marvellous. Then, as she was kneeling in the water "She's here!", followed by "help me." My hand was near her hand as the little head, then shoulders emerged into the warm water, and I lifted the baby gently to the surface.
It was 0400. Noone had seen the 'birth' - that's one of the special features of waterbirth. I shone my little torch briefly and confirmed that baby's colour was good. We waited for the best part of a minute while the newborn adjustments took place wonderfully, followed by a little cry and other movements. There was no hurry. This child was unstressed, peaceful, and well.

Jenny settled back into the water and rested, looking alternately at her beautiful daughter, and to her lover. I don't remember if anything was said. I was happy to just be there, in the background, keeping the space.
We had a comfortable arm chair set up next to the tub, draped with an old shower curtain, towels, and an absorbant pad. My notes tell me that Jenny got out of the birth pool at 0415. We supported her and dried her off as we assisted her to get out, while she held her baby to her breast. After a couple of strong contractions Jenny felt the placenta coming, and she moved forward in the chair. I received the placenta, with minimal blood, in the green plastic kidney dish. Together we checked the placenta, and Jenny and Matt felt the surfaces as I explained it. Jenny had decided not to cut the cord, so we wrapped the placenta in an absorbent 'bluey', and placed it near the baby.

In the next couple of hours Jenny fed her baby; I got the paperwork done; the two big brothers met their baby sister; we all had tea and toast with vegemite, honey, or peanut butter; photos were taken; more logs were put on the fire; and as Jenny snuggled up in her bed with her sleeping baby she asked me to close the door. I left the home confident that everyone was strong and well.

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