In the past 8 weeks, I have attended 7 multiparous (not first-time mom) births. Normally, repeat births go fairly smoothly and this is what we midwives call a ‘butter birth’ where the baby basically glides out and I just need to catch. However, out of the last 7 births, I would consider that 6 were more ‘difficult’ whereby I was required to really step in to help the woman deliver her baby.
Rina was having her second baby. Her first labor had become a transfer from homebirth after her waters broke and she got ‘stuck’ at 2 cm for many hours. Rina’s labor had needed augmentation to get the labor to progress. She’d had an epidural and wasn’t happy with the care she received in the hospital. When she became pregnant a year later, she decided that she wanted to try again to deliver at home.
We’d had an excellent relationship the first time around, so I agreed to sign Rina up for homebirth care again. We had 5 long prenatal meetings and Rina was well prepared for her birth.
It happened to be that the night she went into labor, the roads into Jerusalem were blocked for some important event. So, it took me a long time to get to her and I was super concerned that she might deliver while I was still on my way.
Well, we didn’t come even close to that!! Rina’s labor was very challenging. Intensive, frequent contractions and painstakingly slow progress. Thankfully we had a great doula, so the hard work of supporting Rina through all these hours was shared by the doula, me and Rina’s husband who was very hands on. During the night, Rina moved from the pool to the ball, to climbing stairs, to sleeping, to yoga, to showering, to Spinning Babies exercises, to vasovagal releases, to the stairs again, to resting, to lift and tuck exercises, to laboring on the toilet. This night of laboring was 9 hours, and she’d progressed 4 cm during that time. By the morning, the cervix was still not fully opened and Rina was exhausted and despairing.
Plus, Rina and her husband were getting anxious about why it was taking so long. I reassured them that all was well, that labor was just looong, but not considered dysfunctional, baby was doing great and that we could continue as long as she had strength. She was running out of energy and was looking for help. I offered to help stretch her cervix open the last little bit, instead of laboring for another who knew how many hours. She was very motivated to stay at home despite the challenges, so we worked to get this labor to end in a timely manner.
Rina was pleased to use this intervention and I slowly stretched open the cervix little by little with each contraction. I worked on her cervix on and off for nearly an hour. It was quite stubborn but we got there in the end!! Once the cervix was finally open all the way, Rina’s waters naturally released and she pushed out her baby boy without too much hard work in only 10 minutes!
Rina did great! She was thoroughly spent, but enjoyed snuggling her newborn on her chest where he took in his new surroundings.
What did I learn from this birth and the previous run of challenging births? That birth is not up to me. If a woman has a long or an easy birth is mostly out of my hands. I think that the best way to handle labor, is to give it the time and space to take its due course (so long as everyone is doing ok). However, I can offer help if things seem to be getting too exhausting for the mother. However, finding the right intervention and offering it at the optimal time during labor is part of the art of midwifery.
Included here is the note of thanks I received from Rina. It is so encouraging for me to receive these notes, as it brings into focus how much I can help mothers and makes all the hard work worthwhile!
(This story was written a little while ago, and since then I’ve had a nice share of butter births, thankfully!)