Tuesday, August 31, 2004

Assisting the Midwife

I was invited to assist at the last minute because the other assistant was dis-invited. I'd expected to attend this client's last birth, but didn't go for whatever reason, and was surprised to be invited this time, but glad.

Mom wanted the baby on her husband's birthday... so badly that she had acupuncture, was stripped more than once, and prayed hard to deliver on his birthday. On that day, she was in early labor... 3-4 cm dilated and contracting regularly. Once midnight passed, however, contractions stopped and she breathed a huge sigh of relief that the pressure was off.

5 days later, she began labor in earnest.

Third baby, last labor was 4 hours long. I was called to come at about 11pm and flew the 30 miles in 20 minutes (I swear I didn't go over 90 mph!). Once there, mom was chatting, moaning with contractions (that were very short!), and wandering around the neighborhood. I slept on the couch as best as I could.

Hours later, mom wanted her water broken. She said that last time they broke her water and the baby came. She wanted the same trick this time. The midwife came and asked me what I thought. (I was downstairs. The client was very specific in asking me to allow her midwife to speak and Be the midwife; I honored that implicitely.) I asked the midwife if she might delay the ROM in the hopes that the baby would come first, so she bought the bag another 90 minutes or so before the mom demanded the membranes be ruptured.

Interesting aside: Does doing what the mom wants include interventions I don't feel are necessary?

The midwife broke the water... nice and clear, but the baby's heart rate went down fast and we moved her to her side and it recovered. She got up and went into the pool... very discouraged that this birth was so much longer than her last one... even longer than the first.

There are tales of third babies and boys doing what they want to do... patterns be damned. This was a third baby AND a boy (she knew already), so we just shrugged and told her she was doing great and encouraged her to hang in there.

Earlier, she told us that she had been so very tired with the girls' births... this one, she was awake! During the time after the ROM, she told us, over and over how tired she was. I reminded her how she said that about her last births and now she was there... at that place of close-to-delivery; it seemed to help.

Her hips were hurting. With nearly every contraction, she moaned about her hips and how if that single pain would just go away, it would all be fine. After the birth, I told her that every woman had that one thing that, if it went away, the birth would have been just fine. For some, it is hips; others, their back... still others, their belly... others, the nausea and vomiting. Every woman seems to have at least one major complaint about their labor that, if it would just go away, the labor would be tolerable. I smiled knowing my own complaints.

I spoke as little as possible, but whispered a lot to the midwife because she kept doing vaginal exams. The mom had a cervical lip and the midwife tried to push it out of the way. I cringed. Once the mom had her membranes ruptured and moved off the bed, she got into the pool on hands and knees and wanted to PUSH. The midwife wanted to check "just in case" and I whispered to her that she didn't need to... if the mom wanted to, let her... if it hurt, she would stop. She didn't quite take her hand out of her vagina, but she pulled out some and when the mom had a contraction, she pushed fiercely! The midwife asked her (hesitantly) if it hurt and she howled NO! and then the head was on the perineum.

Once the head was born, the mom was resting, but the midwife got nervous and began pulling on the head, well, it is traction (lifting and lowering the head... most people describe it as pulling, but there is more to the motion than that) anyway... I told her it was fine... she could wait for a contraction, but she wouldn't. She instructed the mom to PUSH as if there was a problem (there wasn't). The baby was meowing... his lips were pursing and opening... so lovely! She had just begun a contraction as she was pushing to the midwife's exhortations and out came his body to his waist. The midwife asked mom to lean back and pushed the baby through her legs and mom grabbed the baby the rest of the way out of her own body. Beautiful!

I waited a few moments (but know that this midwife was trained to listen fast for heart rate and respirations) and then gently listened as he took his first great breath. He was quiet... and perfect.

Immediately, the mom asks if she is peeing or something and we look down and the pool is filling with blood... like ink gooshing into clear water... the midwife wanted her out of the water. We lifted her and got her onto the makeshift space on the floor lying against the most gigantic bean bag chair I have ever seen and blood continued to flow. The placenta was right there, so the midwife delivered it (Duncan) and my hand went right onto her boggy uterus.

With every massage, blood squirted out... over and over, trying to get the uterus to do its job. We gave her oxygen first because she felt funky and was getting glassy-eyed... then a homeopathic I can't remember right this second... and then, finally, a shot of pitocin that we had drawn up because she'd needed 2 last time. The pit quelled the bleeding after a few moments. I gently touched her fundus to make sure things were cool and only once did I have to rub up another contraction for her because then this cute boy latched on and didn't let go!

We cleaned up and the midwife thanked me lots for sharing my patience and belief that we don't have to make sure the cervix is out of the way to birth the baby. It was funny. I felt SO relaxed... even during the bleeding... even when he hadn't taken a breath... that I figured out that it was the midwives around me in many instances that had made me nervous and act in ways I didn't believe I should... not necessarily my own fear. I loved that realization!

This was a quiet, gentle, loving birth. There were ways I wouldn't have acted, but really, it wasn't my client and the client chose the other midwife. I was there to serve the mother AND the midwife.

I feel good that I did both.

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