In the middle of this licensure purgatory, life goes on. Births are still happening. I have no choice but to continue waking up at night, put on my big girl panties (or a depends undergarment sometimes) and go hold space for those babies to enter the world. Oh and I occasionally get paid for this too.
Tonight I head to a birth where one of my good friends is the licensed midwife. I arrive to find that I am not really needed as an assistant there are two students also in attendance. It is common for midwives to have students attend births they need the hands-on experience and we need to keep replenishing the pool considering the burnout is high in this field. Likewise, most of us believe that we want future generations to benefit from having midwives so we need to make more constantly. Students frequently have varying schedules as they are by definition students so we get used to working around tests, school, and other issues. Tonight was no different. It was actually nice to not have to concentrate as hard. We had four brains tonight, which means an easy night right? hahahahahahahahahahaha
My roommate had been patiently waiting for me to come home that day. I was going to pick up dinner, but for some reason, after watching this mother labor intensely in the bathtub, I hesitated. I don’t like calling this feeling intuition, but you could. To me it was just a hesitation, but an important one. About ten minutes before the birth, I decided that I was not going to leave until the baby was born even though I had been waiting nearly two hours thinking the baby would have arrived and I would be on my way.
First babies do all the hard work of “paving the road” so-to-speak. The mother’s pelvic ligaments and tissues get stretched and the body does an excellent job of remembering what birth looks like replicating it well provided huge changes haven’t been made. If the mom took up cross-fit during the pregnancy anything is game as far as muscle relaxation goes during second stage. That said, subsequent births are usually much faster and easier especially once the baby enters the vaginal canal. This baby had been down in the canal a while. Sometimes this is normal, sometimes not. Usually it can be caused from a crooked head, or a hand by the baby’s face, or the baby may be bigger than the previous ones.
This mom had an epidural with her first baby, but otherwise no red flags. her first baby was around 7 lbs. Seems normal for her and her partner’s small frames and ethnicity. As we move from the bathtub to the bed to assess progress of baby’s descent, the mom assumes a hands and knees position for the impending delivery. The midwife was on queen-size bed behind the mom and one student was beside her. The other student was behind them charting and keeping time. Its a good time to note that this charting student had mentioned earlier in the day that she has yet to see a true emergency. Sigh. She has been a student for over a year and every birth apparently has been routine and normal. Not that all emergencies can be predicted, because otherwise they wouldn’t be called emergencies.
Being at home, we can provide a vastly different environment than hospitals. Lights are usually off or dim, the air temperature is warmer, it smells like home or essential oils or whatever your support team puts in the oven. You are wearing what you want and relaxed. No one is touching you or yelling. Except during an emergency when we throw on the lights, and begin using what I call our midwife voices. We may ask the support team to help or leave room. You may not have your baby in the position you thought you would.
As I rounded the end of the bed focusing on the ever-so inching of the baby’s head out of the mother, I noticed it looked darker than normal. Hmmmm. Was this because of the parent’s ethnicity? or a perfusion issue? The sun had set providing just enough light through the windows to make out what was going on, but not enough to not cast doubt. I quickly hit my phone’s flashlight function and shined it on the baby’s head. Oh bleep.
I made eye contact with the midwife and we synced our thought processes. Sounds funny, but this happens often when you get used to working with the same midwives. We both knew what to do. We needed to move the mother if the baby couldn’t make the journey through the canal on its own. What was going on? The head had been born but it was losing color, meaning it was not being perfused by the cord anymore. While heart tones had been good right before crowning, this color was anything but. The midwife frantically searched behind the head for sometimes blocking the decent of the body. She couldn’t find a reason. Was it a shoulder or an arm? The student and I quickly got the mother into a runner’s start position. If it is a true shoulder hung up on the pubic bone (what most doctor’s are terrified of) this one move usually helps dislodge the shoulder as it is able to rotate around the pubic bone. The midwife was still encouraging the mother to push through the next contraction. The charting student had turned on the lights. Nothing budged. We continued to flip and move the mother over and on to her back to have better access to her pubic bone and the baby. With this change in position, the baby descended enough for the midwife to grab a hold of a tight cord. She said it twice. The student on the bed reached for the instruments to clamp and cut the cord on the perineum, something we don’t normally do unless in an emergency. Luckily, this little one began budging before the instruments were employed. With one strong surge from the mother and some traction from the midwife this baby was born. After further untangling this little guy, we just needed to stimulate him to breathe–normal for a stalled arrival. He was in his mother’s arms in minutes.
Why didn’t we call 911? Well, if after moving the mother we had not had any movement of the baby, we would have. But we are trained to handle these emergencies. We are trained to do as much as we can until we can’t anymore. We don’t give up until we get a baby out or transport, whichever comes first. We use our intuition, brains, and a combination of years of gene selection, evolution, physiology, physics, herbs, oils, and biology. It is only vary rarely that we use actual medicine. This is why midwifery is nothing like modern day obstetrics and I am glad it isn’t.
My Journey as a Licensed Midwife in Louisiana 