Beth was expecting her fifth baby and was excited to be pregnant. She lived in a community close to me, so when she decided on a homebirth, I was her natural choice of midwife. During our first meeting, she explained why she was taking the homebirth route for the first time with this baby. Apart from her first birth, her subsequent births had been rapid, and she almost hadn’t made it to the hospital in time. They had been straightforward, easy births and she felt more confident staying at home, having someone come to her, rather than risk the drive and having the baby born in the car.
It made perfect sense to me, and I agreed to be her midwife.
Beth’s was healthy and her pregnancy sailed along smoothly. The baby remained in the breech position through to late pregnancy. We tried some exercises and other tips, but baby stayed bottom down. There was plenty of space for baby to turn, he just needed some encouragement. So, at 37 weeks off mama went to hospital to do a breech version which resulted in a head down baby who was ready for birth!
Beth was by then totally ready to give birth. She had been having contractions on and off for days and felt on the verge of delivering. Additionally, her previous babies had all been born in week 37 or 38, so she was sure she would give birth any day. However, the days turned to weeks and as she entered week 39, Beth was keen for some midwifery magic.
Sweeping the membranes is normally most effective when done after week 40. However, in Beth’s case, I considered a sweep at 39 weeks acceptable, because she was having so many contractions and because her body had birthed naturally at this stage in her previous pregnancies.
The sweep set off another bunch of stronger contractions, but not the birthing type, and Beth was still pregnant the next day.
Another stretch and sweep a week later brought the same results. Lots of contractions and a sleepless night, but no baby. I gave Beth lots of encouragement to be patient, that each baby has its own schedule and will be born eventually!
At last, at 41 weeks, Beth called me saying that the real contractions had actually begun and I should head over. I enquired if she was sure and she knew these were the real deal this time. I gathered up my equipment and drove to her home.
Shortly after I arrived, Beth’s friend, Iris, who was acting as her doula, showed up to help with the back massage. Beth’s husband was an anxious type and preferred to stay in the background and not be physically involved in the birth.
Beth and I both went into this birth expecting it to be fast and furious like her previous births had been. It was furious but it was not fast! After passing about an hour of strong contractions in the shower on the birth ball, Beth entered the birth pool. Normally the act of entering the pool speeds the labor up and, in my experience, most repeat birthers deliver within two hours of entering the pool.
Beth was feeling a lot of pressure and was in significant discomfort and appeared to be in transition (the stage right before pushing). In her case, I would have expected it to last no more than 15 minutes, however, we didn’t see any sign of baby appearing. This went on for some time. All the while Iris and I were taking turns strongly massaging Beth’s back to help to alleviate the discomfort.
I am not quick to check a cervix or to declare that things are slow, but we all felt that there was something holding up this baby. I suggested a cervical check and Beth agreed. Sure enough, the baby was higher in the pelvis than normal for this stage and the cervix was open to 8 cm (out of the 10 needed for birth). We felt it would be helpful to try exercises to help the baby’s head descend into the pelvis and aid progress. So, Beth exited the pool and tried some position changes and exercises. An hour later still no baby. Beth was concerned. Her mind was taking her to the place that there was something wrong because it was taking so long.
Another cervical check then found a swollen cervical lip, further preventing the baby from descending into the pelvis.
A swollen cervix is a tricky problem and happens when the cervix becomes trapped between the pelvic bone and the baby’s skull bone. The more the baby is pressed down by contractions onto the trapped cervix, the more it swells and the harder it is for it to retract and allow the baby through.
Luckily, there are solutions to this problem, but they take extra work on the mama’s and her attendant’s parts. We started a round of different exercises and positions to help dislodge the baby and allow the swelling to go down and I gave Beth arnica to help reduce the swelling. After another hour of intensive work and more time in the pool, we decided to break the waters and to attempt to manually reduce the cervix. All decisions were made after discussing pros and cons with Beth and she was a full partner in everything we did to help her baby come out.
The waters were broken clear, and baby showed no signs of distress. To reduce the cervical lip, I needed to push it up, past the baby’s head, while Beth simultaneously bore down to push the baby lower past the swollen lip (which was a bit less swollen thanks to the arnica). Iris, who had been a wonderful help, was sitting on the bed next to Beth and holding her hand and giving her encouragement. This step was going to be painful, and Beth knew it, but she wanted to go ahead and get this baby born! Suddenly Iris says that she doesn’t feel so good (she saw some blood) and next thing we see is Iris fainted against the wall and slumped there in a heap! Meanwhile, I was occupied trying to move this stubborn cervix out of the way and poor Beth was bearing down hard and crying out with the effort of it! She looked at her friend in despair and I told her, “Don’t worry, she’ll be ok, give her a minute and she’ll come to”. I couldn’t have moved Iris even if I’d wanted to, as she was in a corner and I didn’t have easy access. Plus, she was leaning against the wall, so I figured, all was good. This was a critical moment in the birth, and Iris and her fainting fit would just have to wait!!!
Beth and I worked really hard trying to get the baby out when Iris started to come around and began moaning!! Beth and I just looked at each other and didn’t know what to think! I used one hand to wipe Iris’s brow and said wake up, we need you here!! She moaned, “I’m going to throw up”! She was sitting right at Beth’s head and any vomit was going to land on Beth’s face! I didn’t know whether to laugh or cry!! So, I hurriedly grabbed a saucepan we had been using to add hot water to the pool and thank goodness it was handy!! Iris threw up inches from Beth, but thankfully it all landed in the pot!! Poor Beth was horrified that this was going on right above her face while she was in the throes of intense pushing! You can’t make this stuff up!
At length, we got the baby past that last bit of cervix and baby started to descend through the pelvis and we knew the birth was at last approaching. Iris thankfully returned to functioning after an essential bite of chocolate. But I told her to not look at anything down below that might send her on another fainting spell! After some more pushing, Beth cried out that this baby isn’t going to come and that she can’t do it! Iris and I gave her lots of encouragement. We had faith that she could birth this baby.
Then I listened in to the baby’s heart rate (as I had been doing throughout) and I heard a slow heartbeat. I waited a bit to see what would develop. Beth carried on pushing, getting the baby down. Another listen-in. Slow heartbeat again. We did another contraction. Slow again. Baby was mid-pelvis by then but I had no idea how much longer it would take.
I was concerned. Beth looked at me with alarm; she knew the baby’s heartbeat didn’t sound right.
I asked Iris to call an ambulance just in case I needed extra help with the baby after birth. I carried on focusing on Beth and sent Iris off to speak to Madah on the phone.
While we were making substantial progress, Beth’s anxious husband heard that I had ordered an ambulance and entered into a state of near shock. I could not help him; I had a mother and a baby’s life in my hands. Iris went to help instead, and I focused on the birth. We started to see the baby’s head as it had come through the pelvic curve and when I listened in, the baby’s heart rate had thankfully recovered. It is normal in some births that as the baby starts to descend, there is head compression which can cause a transient drop in the heart rate. Knowing that the ambulance was on its way already, I called out to Iris that all was fine and she should cancel it. It’s preferable not to disturb the sacred birthing space with an influx of anxious medics if there is no need. However, Madah refused the cancellation.
The baby was delivered a few minutes later in perfect condition and cried immediately. We were all instantly relieved and exhilarated, none more so than Beth of course who had worked so unexpectedly hard to give birth!
Meanwhile poor Dad was left to answer the door to scores of paramedics who started pouring into the house (as they do…). We told them that the baby was born, and all was well and instead they got the job of caring for Dad who was trembling like a leaf and was on the verge of collapse himself! They sat him down and brought him something to drink. (At least we gave the medics something to do!).
Thankfully all went smoothly after that… Dad recovered and got to meet his new child, Iris ate some more chocolate and swore off ever attempting to help at a birth ever again and Beth sat in bed glorious, all the pain and travails of the previous 5 hours forgotten as she gazed into her new baby’s eyes.
And as for the midwife…? What can I say? When everyone around you is collapsing (literally and figuratively), my job is to stand strong, keep it together and get the job done. I am responsible for the mother and baby’s safety and it is a huge responsibility that I do not take lightly. After all is said and done, when mama and baby are safe, then it’s my opportunity to take stock of what happened and to recover from the weight of the situation.
I am attuned into the stress these types of birth put on my system, the adrenaline and the huge responsibility I am pro-active in easing it… Anyone want to sponsor a midwife massage?? (Joke!! I have one booked coming up sooooon!!!) I do lots of yoga and (some) meditation. It is sometimes a heavy burden, but I am willing to take the challenges with the rewards.
On reflection afterwards and in peer review, I felt that I managed the challenges in Beth’s labor well. However, I could have explained to the Dad that I was calling the ambulance just to be on the safe side and that he shouldn’t be overly concerned. At the time I was laser focused on Beth and it didn’t occur to me the impact my words would have on her already anxious husband. A lesson for the future.
Thanks for reading! It was a long one! Truthfully, it was totally bananas, but was also the kind of adventure you expect to experience as a homebirth midwife. In retrospect it was a great birth, ideal that it was at home, otherwise Beth would have probably ended up with all sorts of medical interventions.
I would be delighted to hear your comments 😊
Sarah ❤️