Monday, November 1, 2010

Just for the Birth

One of my most enjoyable periods working as a midwife occurred in an Asian country where birth is highly interventionalist and natural birth and midwives are seen as an "evil foreign influence". Working with a handful of adventurous obstetricians I would meet women at home, assess the health of mother and baby and transfer with them to hospital for the birth. I would stay as a support person or doula during the labour and provide postnatal support in the weeks following. Most of my clients were expatriates, terrified of delivering in a system where women have few rights to reject treatment deemed appropriate by their obstetrician.

Mrs B was an Australian woman who was determined to have a low intervention birth with her second baby. When she rang one morning with what she described as 'mild contractions', I suggested a visit.

It was a short taxi ride to Mrs B's apartment where I found her relaxing in the bath with only her son's rubber duck for company. She was vocalising in such a way that it was clear to me her birthing was going to be rapid. Suggesting it was time to leave for the hospital I was startled to find she didn't agree. "Not till I'm in proper labour" she said and headed back to the bath. And then came her next contraction!

It was a proper full on transitional contraction that went on and on and Mrs B let the world know it! Needing no more convincing, we headed towards the front door passing Mr B who had his head in the fridge. "Let's go now" I urged. Mr B took his head out to say "I can't find the beer. We can't go without the beer". What Mrs B had to say about beer is, well, shall we say, not repeatable but it did get the desired response. Mr B sadly picked up the "beerless" esky full of snacks and headed for the door. Mrs B took two steps out and let out a bellow that shook the walls and had a dozen curious heads peering around corners and over balconies. Reaching the car, I was stunned to find the back seat full of boxes and when these were removed, a child's car seat, which refused to come loose. A baby should either be born at home or at hospital. A car park is not a desirable option. About to suggest we return to the apartment, the seat snapped loose allowing Mrs B and I to jump into the back seat.

By now Mrs B was in full transition and although the hospital was only 10 minutes away I wasn't sure we were going to make it. I phoned the obstetrician to suggested he meet us there. Dr C casually asked "Oh, do you think she is in labour?" Mrs B let out another blood curdling yell. "I see" he said "On my way." Looking up, I was perplexed to see how slowly the world was passing by and realized the car was barely moving.

It was at this point that I heard "The Sound". It is a certain catch in the throat that indicates a woman is, or soon will be ready to push. That is when things really began to get interesting. As calmly as possible I said to Mr B to "Go Fast!! " and to Mrs B " Try not to push!!"

With the next contraction many things happened simultaneously. Firstly, Mrs B bellowed at the top of her lungs and pushed like crazy, secondly, Mr B finally hit the accelerator in an attempt to overtake the slow moving bus and thirdly, everyone in the bus looked down to see what the noise was all about. At this point there was nothing for me to do but get Mrs B into the head down, bum up position and try to persuade the baby to stay put. Keeping Mrs B fully clothed and working entirely by feel was the only option as by now a whole busload of mesmerized onlookers were looking down with their mouths gaping.

The hospital entrance only a few feet away we stopped. Furious "beeping" by Mr B failed to dislodge the driver blocking the entrance. Arriving at last I threw open the car door and was surprised to be greeted by two men pushing a wheelchair. "How did you know?" I asked. "Are you kidding? We heard you coming a block away." Mrs B refused to sit as by now she had a bulge to contend with and desperately hoping for a break in the contractions, which was granted, we set off on foot.

We only just made it. Mrs B jumped on the bed on all fours to the astonished disbelief of the local delivery nurses. Attaching the fetal monitor or doing an internal examination was impossible in this position and they had no idea how to proceed with the required protocol. Not a second too soon Dr C appeared. Giving him just enough time to put on his gloves, Mrs B rolled onto her side and delivered her beautiful little girl.

These first moments are very special and I retreated to the corner to allow the couple privacy to explore their newborn. I reflected on what I saw as an unfortunate, frantic rush which didn't allow the couple to relax and settle in before the birth. But, as I should have known by now, never assume anything about what a birthing couple want.

Mrs B looked up over her breastfeeding baby and spotting me said "That was absolutely, absolutely amazing! I could not have hoped for a better birth. We had spent so much time worrying in pregnancy that I would arrive too early and have to submit to the required monitoring. We hoped and dreamed we would arrive just like this, just for the birth!!"

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