The details of this birth are not mine to tell.
As I listened to the story unfold, I commented "You know, there are two sets of birthing knowledge." There's the general set that is understood by doctors and midwives who have had the most basic education in maternity care. Then there's the specific midwifery knowledge. The knowledge that midwives who practise in primary care, in partnership with each woman, learn from the women and from other midwives.
Midwifery knoweldge includes
- strategies for reducing anxiety in labour. The midwife enters the woman's space and speaks only when the mother is able to listen, minimising interruption, quietly and confidently.
- strategies for being present without taking over. The midwife settles quietly to wait in a place that's out of the way after satisfying herself that the labouring mother and baby are well, rather than positioning herself in a dominant or intrusive way near the woman. This midwife may have knitting or crochet in her hand - repetitive work the does not demand a lot of concentration, but keeps the midwife observant and present.
- strategies for moving the baby in the womb. Some midwives rely on physical manipulation of the pelvic bones. Others have espoused the Rebozo technique taught by Mexican midwives. My preference is to encourage exaggerated pelvic movement using the birth ball. Each of these techniques, and probably others I haven't thought of at the moment, enable centering of the woman's body and the baby's head, the presenting part, to adjust its position in relation to the mother's cervix. This brings progress.
- strategies for getting labour started. The old fashioned castor oil and orange juice has been used to kick start many labours, but it comes at a cost of an irritated bowel for many women. I would not recommend this method as a first line of action. Some midwives encourage women to have acupuncture, or a spicy meal, a long walk, or repeated love-making, or all of the above. My usual strategy is to encourage the woman to stimulate regular contractions for a period of time by touching the areola around her nipples. This brings a uterine contraction in response to the natural oxytocin release from the nipple stimulation. The woman is encourage to walk while having a contraction, then to sit on an exercise ball and do pelvic circles and tilts, then stimulate another contraction, walk, ... In some instances the woman has progressed quickly into strong labour after stimulating only one contraction artificially. It's as though her body was ready at the starting line, and the first contraction was the tipping point that got her going.
- strategies for enabling a woman to accept the work of labour. The woman who asks a midwife to attend her, especially in home birth, knows that noone can give birth for her. The woman knows that the midwife doesn't have dangerous drugs or procedures that will take away the sensations of birthing. The woman's own hormonal mix of oxytocin, the love hormone, with endorphins, the natural opiates are used to advantage in the home where the woman feels safe and uninterrupted, unwatched.
- strategies for monitoring the progress of labour without performing frequent internal vaginal examinations. An internal examination is a significant interruption to the hormonal flow of spontaneous physiological birthing, and is performed only when the information it gives is important.