Over the years I’ve helped hundreds of women give birth. I feel so honored and privileged to assist these strong and courageous women. Often we develop such a good rapport that we go on to become friends. “R” (her first initial), is one of these clients. As a midwife, I adore her. She is honest and straightforward - a delight to work with. This is the story of our second birth together, her third baby. We had had a beautiful home birth together with her second. I realized during her previous birth how incredibly tuned in she is. R is one of those women who knows just how to work with her body, and she has a unique ability to correctly and accurately interpret her body’s cues. She knows her body, she knows her herself, and I really felt I could trust her intuition.
During the pregnancy we met for prenatal visits- a family affair with a great supportive husband and her two sweet daughters. At about 30 weeks, we saw the baby was still in the breech position and kept an eye on things-waiting for her to turn head down. Over the next two months we worked with acupuncture and moxabustion, Spinning Babies exercises, homeopathy, and visualization. A few times she thought baby was trying to turn but each time she checked she was disappointed to discover that the baby had not. At 38 weeks, we decided to go in together for an External Cephalic Version, or version for short. The doctor would use his hands to turn the baby. He told me in a prior discussion that he has a success rate of 80%. I know him to be a skilled, caring, and honest doctor and trust his judgement. I went along for support and also to learn more about this procedure.
When R, her husband, and I checked in for the version, we were surprised to hear that she would need to have a spinal anesthesia placed. This was her first time in a hospital for anything pregnancy related and she felt strongly opposed to this idea. After some discussion with the Dr., he decided to try to turn the baby without anesthesia. He warned her that it could hurt a lot, her attitude was basically, “no problem, I’m not afraid of the pain, just don’t give me a spinal.”
Thankfully, he was successful in his efforts and after two tries turning her one direction, he managed to skillfully and gently turn her the other way, murmuring encouraging words to her baby as he worked. R didn’t feel any discomfort during the version, and that surprised the doctor.
During the process of evaluating the baby prior to the version, there arose some concern about the size of the baby. It was clear she wasn’t a large baby, but R doesn’t grow big babies. The other two were between 6-7 pounds and born on their due date. This baby looked smaller, and they were concerned about the possibility of IUGR, a restriction of the baby’s growth in the uterus. They sent her home with a recommendation to induce labor, which she politely declined.
Despite R’s worries that the baby may not stay in her head-down position, she chalked it up to truly unreasonable fears and actually admitted to feeling a powerful sense of well-being from her baby that she hadn’t felt until now-as if the baby was finally happy inside. Because of this feeling of contentedness from her baby, it was hard for R to reconcile the concerning opinions of the doctors with her own. She felt conflicted and her husband felt concerned. We discussed options like monitoring, induction, and changing the planned place of birth from home to hospital. We spent hours over the next two weeks evaluating and reevaluating, and two more trips for monitoring and weight checks.
Two days before R’s due date, she and her husband went for another check with her OB, he said the baby looked fine but was upset that she hadn’t yet gone in for an induction as baby was still small. A little over 5 pounds according to the ultrasound measurement. Doctor did an internal exam and said she was not dilated. They decided to go see what the hospital had to say. Again. They checked her and this time said she was 2 cms. After some more monitoring they decided to start a low dose of pitocin for something called a Contraction Stress Test. There was some concern as to whether or not the baby would happily tolerate labor contractions. By stimulating contractions they could see what the baby’s response would be, and tell if it was a good idea to continue with the labor.
It was already 9pm and I came to the hospital to be with her. They started the pitocin and the baby began to move a lot, sending her heart rate into wildly variable mountains and valleys. The monitor looked like she was jumping on a trampoline. Up in the 180s, down into the 110s. R had been feeling a lot of pressure and some contractions earlier in the day, but as she was lying down for the monitor those feelings left her and all she could feel was the baby jumping and playing. The pitocin was increased slightly but they never saw a good contraction pattern, just a wild heart tracing. R got to stand up and began to experience a vision of her body inside. She shared with me the colors, textures, and form she was “seeing” inside.
Getting more tired as the evening went on, we began to wonder what the “plan” was. The labor and delivery department was busy and the midwives were all dealing with the more pressing matters of a full floor of birthing women. At last I went in search of a midwife and she came back, exclaimed she was surprised R was still on pitocin, and called the doctor for permission to disconnect her and send her to rest. R and I exchanged glances as we were reminded of Israel’s cultural imperative to push for what you need and not wait around for someone else to take the initiative. Doctor arrived, saw that baby’s heart rate patterns had normalized, all was well, and the test was deemed successful. With that, she was sent to bed and I went home. It was 2:00am.
The next day we stayed in contact by phone. It was early afternoon and no doctors had yet been in to visit her, assess her, or discuss management decisions. I encouraged her to seek out a doc and when she finally did, she found herself not only face to face with the doctor, but also with a crew of new interns. The doctor was dismissive and condescending about R’s desire to continue to labor naturally and laughed at her expense when she expressed this. He told her that since it was her first birth he wanted to put her on pitocin right away. Alarmed by the fact that this doctor was totally unaware of even which number birth this was for her, she called me for advice. This warranted a note from me to the head of the labor and delivery while R went for yet another ultrasound to confirm the weight estimate. Soon she was visited by a different, slightly sheepish doctor who was aware of her wishes, attentive to her needs, and more than willing to admit her to the lovely natural birthing room as she had progressed on her own to 4 cms dilation and was contracting nicely.
I was called to be with her at about 12:00am, and arrived about 20 minutes later. The energy in the room was peaceful. R was lying on her side in a big bed. The first thing I noticed was the way she was clutching her hip, like it hurt. After quickly washing my hands, I took the oil and begin to massage her back and hips. The next contraction I heard her give a little pushing sound at the peak. The next contraction I saw her bear down spontaneously. I remember how quickly she birthed her last baby and so I pushed the call button to call her midwife.
Her midwife walked in and asked who called her. Not wanting to disturb the very peaceful energy of the room, I gently and softly said, “R is feeling pressure and pushing a little”. I saw the MW go for a glove walk over to R. I tried to say with my eyes, “No, don’t check her”. She didn’t seem to understand. I said, “She doesn’t want you to check, just please observe R for a contraction and you’ll see what’s happening”. I told her that using hands is not the only way to see what is going on and I may not have said it right in Hebrew because she snapped that she had been to midwifery school and I assured her I wasn’t trying to teach her a midwifery course. Just that I had been with R at home last time and knew her and how she births…that’s all.
Then she got out a monitor and tried to get R to move to accommodate the monitor. R told her “No, she didn’t want that either.” The MW wanted to know why we had called her if R didn’t want anything from her. I spoke up, saying I had called her to make sure she would be there quickly as R was going to give birth. She stated that she needed to go call the doctor and tell him that R was refusing all the checks…and away she went. She was literally there for the 3.5 minutes between contractions. As the door closed, R shifted to her hands and knees and gave a big push, I saw the head begin to crown, water bag still intact. With one hand I pushed the call button and then went to support her perineum. R was serene and focused. The head crowned over an intact perineum and I checked for a cord around the neck. Then the MW appeared. I was still speaking gently and said, “She’s giving birth.” (Like that wasn’t obvious) The MW snapped something like “What are you doing! This isn’t a home birth! We don’t do it like this here!” I’m saying gently, “Please! Take over” In one fluid movement we changed positions as the midwife caught the rest of the baby and I helped R shift over to sitting as she brought her baby up onto her tummy. Baby girl was crying nicely and turning a lovely shade of pink, visible even in the low light of the birthing suite. I noticed she still had her little legs up in the characteristic breech birth positon despite being head down for the two weeks prior.
R and her husband were overjoyed. MW was relaxed and positive and everyone was calm. Placenta took a while, which is normal for R. I saw almost no bleeding at all. Placenta looked great and baby weighed in at a whopping 6 pounds! Almost a whole pound heavier than the ultrasound had estimated earlier that day. It was the day before her due date, and her baby came with just a little nudging. She celebrated with a hot tea and a slice of gourmet pizza, nursed her sweet daughter and just reveled in the awesomeness of life.
As she was getting herself and her baby settled for a rest after leaving the birthing room, she was reflecting on the whole experience. She looked at me thoughtfully, smiled and said, “I really feel how much I grew from this birth.”
-I really believe that each of our births grows us as better parents and people- though we don't always realize it at the time-
No one planning a homebirth wants to end up in the hospital. When doctors are concerned about the well-being of a baby it can be so hard to know whom to trust. We often feel caught between our own intuition about things being fine and the concerns that are voiced by trained and experienced health professionals. We want to do right by our babies and it’s never easy.
When spontaneous labor begins, we don’t choose it, it just happens. It’s true that there is a certain level of inner readiness that facilitates the start of labor, but for all intents and purposes it is not a choice. When a decision is made to induce labor, a choice is made where it feels like a choice shouldn’t exist. It’s in G-d’s hands. The thing to keep in mind is that it’s all in G-d’s hands, even an induction.
In R’s case, she succeeded in walking a middle path. Keeping her focus and yet being flexible. Maintaining her connection to herself, her body and her baby, and at the same time taking new information into account. She gracefully rose to the challenge, grew from the experience, and found a true balance. BH!
Tags: midwifery care, prenatal care, pregnancy, midwife, pregnant, womens health