Wednesday, July 28, 2010

Notes from my practice

A baby has been born, at home. After a couple of days of pre-labour, frustratingly coupled with winter colds being suffered by the whole family, the labour began. I was called at about 3 am, and headed out into the country, driving through towns, and past vineyards and farms.

The midwifery student arrived just after me, and we went into the home together.

The student has kindly shared her reflections with me:

"When we arrived the woman was upright, pacing with her ipod on and using lots of heat packs. The room was lit by candles and the fire was burning.
"Suprisingly we did not do an assessment on arrival but instead proceded to unpack things. I helped to test and check the emergency equipment and positioned everything in unobtrusive but accessible places in case they were needed (they weren't). After about 20mins of setting up we were ready to do an assessment. It the very first of many stark contrasts to hospital midwifery in that this only included a temperature and fetal heart rate. The midwife explained that as the woman's BP had been stable all along there was no evidence to support it being unstable in labour, in addition we already knew the baby was cephalic and well engaged (from our previous appointments) so a palpation was unnessessary. A VE [vaginal exam] was also unnessessary as it wouldn't change the course of action/treatment at that time. No timings either, as there is no syntocinon to put up. All in all our assessment was about observing behaviours."

It has been an interesting exercise for me to see this birth through the eyes of someone who is new to the profession. Someone who recorded, after the birth, 
"It was the first time I have seen:
  • An upright first stage
  • Labouring in water
  • Birthing in water
  • No meds to hurry labour
  • No analgesia in labour
  • A physiological 3rd stage
  • A woman taking cues from her body, not from hospital staff
  • Family and friends with active labour involvement
  • A woman eating and drinking freely in labour
  • Waters breaking without someone breaking them
  • Kids in labour
  • Video camera in labour
  • A baby being swadled in sheets etc that the family had been using prior so it had their scent on it
  • True woman-centre care"

My enduring memories from this birth centre on the normality of everything that happened, contrasting with the potential threat of illness. The illness that this mother, father, and family faced at the time was that they all had colds - common garden variety upper respiratory viral infections. Coughing, congestion, chills, sleeplessness ... they had it all.

By the time labour was established the mother was weary.
As the time for birth drew closer, and the mother became frustrated by her physical weakness, I asked her to rest quietly in the womb of warm water. Some would call it transition. The light from candels was dimmed. The support crew withdrew to the kitchen, and had cups of tea and pieces of toast.

The miracle of birth unfolded and a beautiful pink baby boy, with a shock of black hair, was lifted out of the water by his mother and taken into her arms.

The miracle of birth continued as the child transitioned from placental circulation to strong, normal breathing, and began his lifelong search for good food.

The miracle of birth continued as the mother stood and released her baby's placenta, with only minimal blood loss.

Mother and baby are well and happy.

Another mother is waiting for her baby to be born.

She is a mother who has experienced the cascade of interventions in her previous pregnancy, with induction of labour, epidural, caesarean birth, separation from her baby, the baby being given formula feeds, and weeks of distress, pain, bonding and breastfeeding difficulties.

She is a mother who is longing to give birth to her baby, and who is learning to face her fears and work with a simple decision making process as each day passes.


凱許倫 said...

Learn wisdom by the follies of others.............................................................

Joy Johnston said...

This comment has come as an email:

I discovered your blog tonight and have truly enjoyed reading it! I've just qualified as a midwife in the UK and whilst waiting for my pin have been contemplating how to remain truly woman-centered in my first job in a big teachng hospital albeit one with good normal birth policies and 7.5% homebirth rate.

Your blog was food for my soul as I begin my journey into midwifery. Having to prove that normal physiology is just that normal is somewhat tiresome and the culture of evidence-based practice becomes a meaningless rhetoric after a whole. I found the student midwife's reflection on a homebirth heartwrenching, that should be the normal experience of most women and not just a few. I've been very privledged to witness many beautiful physiological births despite the culture of my training unit, by both seeking it out and trying to be be both an advocate and supporter of women in my care.

Your passion for midwifery, women and babies is strongly evident and I hope my passion for midwifery remains as strong in the decades to come. You are an inspiration and I look forward to continuing to read your blog.