Friday, May 19, 2006

Home Birth

Dad called at 8pm and asked if I wanted to talk to mom, she’d been contracting for a couple of hours. I talked to her and she said she thought things were starting. I called the other midwife and my apprentice and went to bed.

This mom has worked hard for this baby.

She had had three girls at home, beautiful births. Then her husband had an affair when she got pregnant again and she terminated the pregnancy. They got back together and she got pregnant again and miscarried. She felt the termination was being punished (still does). She got pregnant again and at 39 weeks, her water broke over a velamentous insertion and the baby died from a hemorrhage before she could get to the hospital. This was a boy.

Of course, it was torturous for the family, the girls being old enough to know and remember everything. The feelings of punishment were amplified a thousand-fold and we worked on that throughout the pregnancy.

She was so in denial of this pregnancy, so out-of-touch with the baby, she hadn’t felt the baby move at 20 weeks. She came to me and lying on the exam table, I watched her belly roll with a child inside and she blankly said she couldn’t feel it at all. I took her hands and placed them on her child and she began crying as she realized there was, indeed, a baby in there.

The pregnancy was emotional. Mom, an L&D/Postpartum Nurse, struggled with the shit that happens in hospitals versus what she wanted in another homebirth. Over and over she cried to me about the amount of cesareans her hospital did, the way the women were treated like meat, the episiotomies every vaginal birth had, how scared she was that she couldn’t do it anymore because she saw all that suffering. We talked about pain in bed, the pain of no one loving them, the pain of not being respected… and talked about how she wouldn’t have that in her birth, that she was ensuring that wouldn’t happen.

The girls, all pre-teen were very involved in the pregnancy, guessing what the gender was, picking out clothes, talking and reading to the baby… it was so lovely. I did a photo shoot of the family once and they were so filled with joy, it was obvious where the glue for the marriage lay.

At 3am, dad called again and said it was time to come. Since we had a two hour trip, I knew there was no time to waste. Her last live birth was 4 hours long. I suspected this would be longer because of some emotional dystocia, but still didn’t dawdle. I called the other midwife and my apprentice, got dressed, put make-up on fast, and headed out the door.

I stopped at 7-11 for a Diet Dr. Pepper and a bag of Fritos scoops and drove to pick up my apprentice who happened to live along the way. I got her at 4am.

By 5:30, the sun was rising and we brought our equipment in, checked on mom, listened to the baby, and began setting up.During prenatals, I’d let mom know I would sit and hold the doppler on her belly the entire labor if she wanted me to… if she just needed to hear it, to say so and I would be there for her. She didn’t ask or need us to listen any different than we would normally do.

The other midwife and her apprentice arrived and we sat quietly on the couch. When we got there, things slowed some, so we made ourselves scarce so it could pick up again. Mom was gorgeous in a red silky chemise, laboring beautifully. She asked that we not be offended if she cussed, that she always cusses in labor. I told her we’d never, ever heard a cuss word ever, so that would be a new thing for us. She got the humor after a second and laughed. I told her we would sing cuss words with her if she wanted us to! She liked that.

When things were cooking, she needed her husband right by her side, or rather, in front of her, so she could pull on his arms. She moved from the bed to the toilet to standing to kneeling to hands and knees and back again, swishing her hips during contractions and having a mantra of “shit” and “fuck” that matched the rhythm of the surge.

She wouldn’t let us leave the room and wanted all her girls there, too. They each had been given a job and were doing their jobs beautifully.

The oldest had the camera and was photographing the story. The middle daughter kept thinking she would faint, so her job was to stare in her mama’s eyes so she didn’t have to look elsewhere. The youngest was the washcloth girl and she was to press cool cloths to mom’s face and neck when she needed them.

During one particular contraction, mom was on her hands and knees, face in the pillow and she began crying. I got close to her face and ear and whispered, “what’s going on?” and she just started sobbing. I asked if she knew what she was feeling and she nodded. I said, “Name it… say it out loud” and she wept out, “I’m so sad!” and I touched her hand and told her I could hear that, that she was doing so beautifully with that pain and that her son was right there with her during this labor. Within moments, she stopped crying and labored on. The entire exchange couldn’t have taken two minutes, but it was so powerful, so tender, several of us in the room cried right along with her. I grabbed one of the dry washcloths for my own tears and sent her so much love and light as she had to have been walking through such a deep and dark place for a few moments.

During the pregnancy, she spoke about not bonding with the baby. She was so worried the baby would be “messed up” because she didn’t even know the kid inside. I told her to keep telling the baby s/he would have to “speak” with her eyes, but that you loved him/her for who s/he was and that the child wouldn’t know any different, so please not to struggle doing something she didn’t feel she could do. I asked her when she felt she might let her breath go to believe this baby would get to stay and live with her and she said she wasn’t sure, but maybe when the baby cried… when she could hear his/her voice. I wondered, too, when the connection would find completion.

Mom had always delivered on a birthing chair, but we had one of those low shower stool things set up with a pillow and a Chux on it. She was okay as she began pushing on it, but she didn’t feel she was getting anywhere and seemed frustrated. We’d talked about internal exams and she wasn’t sure if she wanted any or not… hadn’t until I asked if she might want to know where she is, that maybe she wasn’t complete and that’s why the frustrating pushing. I did an exam and it was hard to find the cervix because she was 100% effaced, but she was about 9cm dilated. I could have easily lifted the cervix over the baby’s head, but she hollered at me to stop, that it hurt too much, so I got out of her vagina, never to enter again.

Mom hadn't eaten since dinner, so we tried to get her to eat something, but she didn't want anything, so she had some apple juice. Right away, she got heartburn and we tried to think of how to get rid of that. No Tums in the house, none of us had papaya tablets, and just as the apprentice remembered a remedy on the baking soda box, I thought of peppermint candy and they found some for her to suck on.

When a contraction hit, she was wiggling and I said, "Do you want to spit it out?" and she spit out about 4 chunks of the candy. After the contraction, she looked for it, but we'd already thrown them away. Her heartburn was gone, though, so that was good.

Sitting for awhile, we asked if changing positions might help… perhaps a trip to the toilet. She went and peed and then climbed onto the bed and pushed with the ever-increasing contractions.

She “fucked” a lot and said at one point she thought she was going to die (I actually don’t remember hearing that, but the others hearing it becomes important later), why was it taking so long?

We began seeing the amniotic sac coming through the vaginal entroitus. Opaque and clear fluid – we could see the baby’s hair floating in it! The sac oozed out and then, shortly after, the head began filling the sac and the baby’s head was soon born. S/he didn’t rotate and the other midwife’s apprentice, who was catching, said she thought there was some turtling (I was right there and saw the baby not rotating, but not much turtling), so I helped mom lift her left leg into a lunge and the baby began to let his/her shoulders be born.

Before the lunge, the baby’s head began suffusing and the lips were meowing, so I encouraged the apprentice to remove the sac before the baby breathed in there. She began to pull it off at the eyebrow, but I merely grunted and she remembered to pull from the chin up. (If you pull from the top down, the unlikely possibility of inhaling the membranes as the nose and mouth are freed can occur. I know of one midwife that had this happen, so I have, forevermore, pulled the sac from chin to forehead.)

The baby was born into the apprentice’s hands and we helped mom, in one swift motion, to sit back (she’d been on hands and knees) and embrace her child. She was ecstatic!

The baby was so beautiful and talked to us nicely without hollering. S/He opened his/her eyes and looked around at his/her family and everyone was so happy. Dad was whooping it up, the youngest daughter was crying… later she said from fear and then joy (“mom was yelling so much!”), the other girls were so happy… we were relieved and so honored to be at such a glorious birth. Mom looked up and said, “We’ve bonded.” I thought I would fall over with emotion.

When mom was pregnant, she’d submitted to an ultrasound for students learning how to do obstetric ultrasounds. She told them a number of times to NOT tell her the gender under any circumstances. She told every student personally, told the instructor… yet, when they were doing the ultrasound, they said, “it’s a boy!” about four times. She has to work with these doctors, so she didn’t say anything like, “You assholes!” which she wanted to say. She didn’t tell her family members what the gender was, but told me (which I really, really forgot – on purpose) as I helped her settle from crying hysterically after that ultrasound experience.

She had another ultrasound later, just for kicks, and the ultrasound tech, an experienced woman, said, “Woah! Is your husband black?” (Not kidding.) “That’s some boy you got there!”

The day before she birthed, she had another one and that ultrasound tech told her she couldn’t imagine what the others were seeing, that the baby was most definitely a girl.

So, she went into the birth as she wanted, not knowing the gender of the baby she carried inside.

When she lifted the blanket and the baby’s thigh, she laughed and shouted, “She’s a GIRL!” and the girls who’d wanted a girl were ecstatic… the youngest was a moment disappointed, but quickly was very happy. She did continue calling her a “he,” but I am sure it will take a day or two to get out of that habit.

The apprentice was sitting and watching the bleeding and thought she was bleeding a little too much, so reached up and began massaging the mom’s belly. Alarmed, I sat for a second and she’d stopped. I didn’t see too much blood, but when she reached up again and rubbed, I asked what she was doing and she said “rubbing up a contraction,” I went to her overseeing midwife and said, “I’m REALLY uncomfortable with her rubbing up a uterus that still has a placenta,” and she said, “So am I.” I went to the bed and kindly asked the apprentice to change places with me. She got up without hesitation.

I felt to see if the placenta was detached, but it wasn’t, so I asked mom to give me a push with the next contraction and I did a little controlled cord traction to get the placenta out as quickly as possible. This is not something I would typically do, but I am soooooo glad I know how to do it if I need to. The reasoning was that if the apprentice had dislodged a part of the placenta in her massaging, she really could seriously hemorrhage – an abruption – I wanted to make sure the placenta got out of there whole and soon to avoid any issues that could have possibly arisen.

As it was, she had trailing membranes, but they seemed to come out completely. (Later we saw that a piece of amnion had become dislodged and separated, but pieced together nicely when we completed the puzzle.)

When we explained it to the apprentice, she was mortified that she had done that. She said she knew not to do that! And we told her that nothing seriously happened, thank goodness, and we bet she’d never do it again in her life as a midwife. She said she would not!

I continue explaining it to my apprentice. I suppose the concept is a tad challenging, though, since I have had to explain it in different ways. It was a great lesson for me, too, to STOP someone from doing something I know is wrong instead of saying something first to someone else.

My reasoning (not excuse): This other midwife and I research a lot. She and I have learned great things from each other… putting oxygen on the mom to help release the placenta (my trick)… injecting saline into an umbilical artery to do the same (her trick)… and I had a fleeting, “Maybe she has learned something new I didn’t know,” even though that was an absurd thought. No more absurd thoughts. Act first in the mom’s safety behalf… ask after. (Always so many lessons!)

The midwife and her apprentice cleaned up, we did the newborn exam… the baby weighed almost 9 pounds!

Dad cooked some food for everyone. We ate and then said our goodbyes about 3 hours postpartum.

The baby was a little dusky at one point, but positioning helped her to pink back up again.

During the one day visit, the duskiness had ended (a pediatric cardiologist once told me that sometimes the valves take a little longer than a moment to seal completely… that if they hadn’t in 24 hours, then it is good to have the baby seen) and everyone was so happy. Nursing was going well, the baby was pooping and peeing great, mom was incredibly happy and telling us how thrilled she was with the birth – how each of us had a role to fulfill… including my observing-picture-taking apprentice who helped her youngest daughter when mom said she was going to die.

I am sure I heard it figuratively… the kids heard it literally. Especially after their brother died, it must have been a scary word to hear.

The girls all wrote the birth story from their perspective and are re-writing it for me, saying I can share it with y’all. I am allowed to use names and pictures, too. Mom agreed, too, that I could share the children’s words and faces. We read two of the stories yesterday and wept… I can’t wait to share with y’all!

I am so thankful this birth went well. My apprentice’s first two births with me… a 26 hour transfer to the hospital and then a few hour gorgeous homebirth filled with emotion and love for daughters.

Such a beautiful joyous life I really do have.

1 comment:

The MSILF said...

Where are the pictures and stories? :)