A Promise is a Promise

Mrs A was 42 years old and in labour with her first child.  She and her husband had tried every fertility treatment available to fall pregnant and all had failed.  To their disbelief, they had found themselves pregnant nearly a full year after finishing their last unsuccessful attempt at IVF.  Mrs A realized this was likely to be her only birthing experience and before I was even able to introduce myself, she began begging me to " Please please, please, help me have a beautiful birth!!" I noticed she had carefully arranged her birthing room with pictures, gentle music, soft cushions from home and curious oddments such as a colourful collection of polished stones.

Between contractions she outlined her desires for this birth.  It was a curious mix of all the birthing stories she had read over the many years of trying to fall pregnant. As she was a private patient I assured her I could help her with most things on her list but when the actual delivery was imminent her private obstetrician would be called.  I was relieved to note her doctor was a favorite of the staff with his combination of excellent obstetric ability and a warm and gentle nature.

It wasn't long before Mrs A's gushing enthusiasm was muted by the hard work of labour.  She stopped talking and began humming.  She paced slowly between contractions only stopping when I checked her or the baby. We dimmed the lights and threw mats and beanbags on the floor which she would periodically rearrange. Once she realized she was not going to have to fight to get what she so badly desired, she relaxed, turning herself inward and slipping into her own world. This is, of course, the perfect lubricant and labour progressed very rapidly. Leaning forward onto her husband as he massaged her back during a particularly long pause between contractions, she suddenly sat up and announced she had to push.

Like magic, her obstetrician arrived, knocking quietly on the door.  I surprised him with the good news and asked if he would like me to turn up the lights and ask Mrs A to get on the bed so he could examine her.  He smiled and declined saying " Let's just wait and see what happens".  He sat himself unobtrusively in a corner of the room and smiled encouragement.

Mrs A stopped her pacing and began to sway, arms around her husband's neck.  With each contraction she would bend her knees, look into her husbands eyes and push.  The scene was curiously intimate.  Mrs A had long since forgotten her long list and was responding innately to her own personal needs.

It soon became apparent that the birth was very close and although loathe to break this magical moment, I was aware that Mrs A would need to move to the bed to deliver.  Dr M was no longer young and asking him to get down onto the floor to deliver the baby was not feasible. I began to set up the delivery trolley and was surprised when Dr M shook his head.  Seeing my confusion he came over.  "Set everything we need on the mat over there".  I couldn't help but blurt out " But you can't "  He smiled again and said " A promise, is a promise. " 

It took a great deal of care to get Dr M down to floor level and comfortable.  He suffered with arthritis in his knees and sitting with them bent was painful. He grabbed one of the beanbags, plumped it up and leaned back.  Mrs A was now on her knees, arms still around her husbands neck while he sat on a birthing ball. Dr M waited patiently, rocking forward with each contraction as Mrs A pushed. The baby arrived calmly,without a sound.  I asked Mrs A to reach down as Dr M was unable to pass him forward.  There was then that familiar moment of suspended time, when the baby opened his eyes, parents and baby made eye contact for the first time. He breathed quietly, curling his fingers around his father's finger. I placed a soft blanket over mother and baby. 

And there we sat, obstetrician, midwife and new family in the semi darkness for a full thirty minutes waiting until Mrs A delivered her placenta. Mrs A suddenly seemed to become aware of her surroundings. She handed her baby to her husband and turned.  " My dream baby, my dream birth, I can't tell you, I know how difficult that was for you doctor, there are no words ..........." and with that, she leaned forward and put her arms around us both. I heard Dr M, clearly moved, mutter, " A promise..... is a promise".

 

The Devil You Know

One of the disadvantages of being a midwife in a busy delivery suite in Australia is that you seldom meet women before they are in labour. As shifts change we often take on women who are heavily into labour and must take on the difficult task of determining a woman's desires and needs while she is in no mood for idle chit chat.

Mrs K was just such a woman.  She was heavily into labour with her fourth child when I arrived taking over from the previous midwife.  With three previous births under her belt I was sure Mrs K would have a clear idea of what she wanted from this birth and indeed she did.  With each contraction she would stop walking, grab her husband's shoulders and rock from side to side. Startled to find she would periodically burst into fits of giggling she explained she was just happy as she was finally getting that "natural birth" she had always wanted. Progressing rapidly, she was soon showing  signs that her private obstetrician would have to be called. I had to be careful as her doctor was known for his somewhat aggressive use of intervention and I didn't want to worry that I had called him too early.

At that moment, to my alarm the doctor himself arrived with an anesthetist in toe.  He demanded Mrs K get into bed and upon examining her declared she was 9cm.  He told the anesthetist to insert an epidural.  I protested that Mrs K had not requested one and desired to have a natural birth and perhaps we should ask her first.  Dr T responded by telling the anesthetist to go ahead and quietened Mrs K's protests telling her she would "put her baby in danger" if she refused. Within a few minutes, as the anesthetist inserted the epidural catheter, Mrs K screamed she wanted to push. 

Dr T began shouting at Mrs K that she did not want to push. Mrs K shouted back she couldn't stop herself.  The anesthetist, trying to withdraw from the situation was told by Dr T to put in the drug into the epidural catheter NOW!!.  In the middle of this madness was the midwife, trying to get someone to realize that  the baby was arriving with or without the epidural! Within minutes, after a large episiotomy, Mrs K was delivered of her baby, stitched up and her obstetrician gone. 

I found it hard to know how to comfort Mrs K as she held her baby and sobbed.  She was unable to move as by now her epidural was fully in effect and feeding her new baby seemed an impossible task.  I handed her new daughter to her husband, made her a cup of tea and ignoring all my usual tasks sat and talked her through what had just happened.  Mrs K tearfully described how it felt to have "my beautiful birth torn from me". 

" This is my last birth." she explained.  "I so needed it to be happy, to be the birth that I could remember as wonderful.   My previous births were all horrible like this.   Each time I thought I wanted to be the one to make the decisions and each time Dr T would arrive and make his decisions ignoring my requests.  From the first one I decided that was it!  Next time I will go to another doctor and each time I decided  IT WAS BETTER TO STAY WITH THE DEVIL YOU KNOW!!!.............."