Thursday, January 17, 2013

the after-glow

Picture the scene:

We are in the room where the baby was born, just over 24 hours earlier.
The mother is sitting quietly, with a sleeping baby in her arms.
The father is near her, and other children come and go - as they do.
The midwife and the midwifery student have returned for a postnatal visit, and as there is no pressing clinical activity to attend to, we are simply 'being' rather than 'doing'.

Gone is the inflated birth pool, the tarp that covered the carpet, and the protective drape and old beach towels that covered the chair where the mother waited for her placenta to birth.

Gone are the candles and other soft lights that provided a warm and intimate glow as we welcomed this little one into her family.

Gone are the simple midwifery tools: the absorbent 'blueys', the box of blue gloves, the doppler, the oxygen bottle, and other resuscitation gear, the syringe and needle and oxytocic to be used if required ...

The daylight of this summer morning enters the room through the large window. 

Another light, which I call 'the after-glow', rests on the faces of all who are present.

There was no camera to document the after-glow, and indeed, if someone had tried to capture that moment, I doubt the memory would have nestled so strongly in my heart, or urged me to write it down.   In many ways, it was an unremarkable moment.

Yet, the discussion that followed was full of awe and wonder.  The miracle of birth, by which a child is safely brought from the womb to the arms of the mother, never ceases to offer insight to anyone who has eyes to see and ears to hear.  The natural physiological process, spontaneous yet so very vulnerable to any interruption or interference, is somehow unnoticed by our society and particularly mainstream maternity services.

If I have learnt anything in these past 20 or so years of private midwifery practice, working closely with a few women, most of whom intend to give birth without medical intervention, it's that there is so much more to learn.

As we reviewed the experiences and events of this labour and birth, we were reminded that this mother would have been treated as 'at risk' if she had been in hospital.  A previous caesarean requires, in most maternity hospitals, continuous electronic fetal monitoring throughout active labour.  Parity greater than 5, as well as the caesarean scar, require an intravenous cannula to be in situ.  Active management of the third stage is the standard process in local hospitals for all women. 

Yet this birth proceeded spontaneously at home, without incident or complication.  The mother guided her baby's head over her perineum, without any instruction to 'pant' or 'give a push now'.  The baby came up out of the water, took air into her lungs, and made that great transition from placental oxygen to the bountiful air without any difficulty.  The cord was not clamped.  We supported the mother as she stepped out of the birth pool, holding her treasure to her chest, dried them off, and sat them quietly in the prepared chair.  As contractions returned, the mother stood, then squatted over a plastic bowl, all the time holding her naked baby against her naked body, and the placenta was expelled spontaneously.  Blood loss was minimal.  Baby took the breast eagerly - as they do.  After an hour or so the father took his daughter, and the mother achieved her next milestone, that of emptying her bladder.

Anyone reading this might ask, what's so special about that? 

It's the simplicity of uncomplicated, unassisted birth that I want to record here.  Simple, yet amazingly complex in the orchestration of hormones and the mechanics of the process.  Spontaneous, yet vulnerable to interruption or disruption.

Midwives must work to protect, promote and support birth in the natural framework that has been provided by our Creator, unless there is a valid reason to avoid the spontaneous normal process.


Anonymous said...

Beautifully worded Joy. My second labour and birth was almost the mirror image of this experience. I will treasure it forever.

Anonymous said...

Thank you for sharing this post Joy, it is exciting to read such a wonderful labour and birth experience.

Anonymous said...

hank you for writing your experience of my birth Joy, and for capturing that moment of the ´afterglow´. Seven months on, I´m sitting in bed, with my precious bundle sleeping peacefully beside me as I read your refelection on her birth. She is the pride and joy of the entire family - we are all still glowing! Xx Liana