Born into our family

Our family, late 1980

Today I would like to share with readers one of my own birth stories, written in 1981, a few months after the birth of my fourth child.  

This account reminds me of who I was then, and who we were as a family.   Although I had graduated as a midwife in 1973, the only serious experience I had had in midwifery was as a mother.  I had maintained my registration by paying the renewal fee each year.  I had done a little teaching as a childbirth educator for the Diamond Valley Childbirth Education Association.   Considering this long period of not practising as a midwife, and my lack of experience after graduation, I feel very blessed to have now, 30+years later, had a satisfying career in midwifery. 

I had forgotten about this account.  It was tucked away in a folder in the filing cabinet, and I discovered it just a couple of days ago.


Born into our family
We arrived at the [Women's Hospital] Birth Centre at about 11 o'clock on that sunny spring Friday morning.  We came complete with books, toys, and food; and proceeded to make ourselves comfortable.

My labour had commenced at 3:30 am, with mild contractions every 10 minutes, and a show.  Although this was my fourth child I felt sure that the labour would progress in much the same way as the others - very slowly.  I went back to sleep until breakfast time.

By lunch time the contractions were still coming every 10 minutes, and only increasing in intensity very gradually.  We were in high spirits, as we knew that our long time of waiting was almost over.  We decided to go out for lunch, this being a pleasant way of passing the time.  We walked along Lygon Street, and chose a little Health Food shop, where we purchased a variety of concoctions packed with super-nutritious foods.  We all felt satisfied and well fed as we followed the meal with frozen yoghurt.

I continued to make progress slowly.  The midwife and her student made occasional assessments of my condition, used abdominal palpation to check the position and progress of the baby's head, and listened to the foetal heart sounds.  Time slipped by easily for me, as I relaxed and enjoyed the feeling of being "at home" away from home.

The afternoon passed slowly for the children [aged 6,5, and 3, and Patti, our American exchange student and special friend], as they found their books and games rather dull after a while.  Their grandparents came to the rescue and took them to a nearby park to play, then gave them tea at the hospital cafeteria.  Noel and I had ordered a salad for tea, and although I ate some I knew I had other work to do very soon.  With each contraction I had to relax my body and concentrate on slow, deep breaths.  By 6:30pm I had had a shower and gladly went to bed.  The position which I found most comfortable was 'on all fours'. with a bean bag on the bed to support me between contractions.   The baby's head was posterior, so the combined effect of taking the weight off my sacrum, and good firm sacral massage which Noel administered with great proficiency, kept the sensations within my range of 'bearability'.  I spoke very little at this time - Noel was working in beautiful harmony with me, and was able to sense my needs from a single word or gesture.  Between contractions I rested completely. I closed my eyes to rest, but was not sleepy.  As each contraction came I concentrated on relaxing with the routine of the rhythmical breathing.  I kept to the slow breathing as long as I could, as I found this the most relaxing, and only built up to the quicker breaths when I needed to .  The children came quietly into the room at times, but did nothing to disturb us.  They showed no anxiety, and a reassuring smile or nod from us sent them happily back to their own amusements.

This intense labour had gone on for about an hour when I began to feel the changes which I knew to be transition.  Sometimes I wasn't sure if I had a contraction or not.  I got the shakes for a while, and I could not find a comfortable position.  This must have lasted for a few contractions - to me it meant progress, and I was glad.

I don't think the midwife really believed Noel when he said I was almost ready.  I had been there all day, and my progress had been so slow - why the sudden change?  Upon abdominal palpation she confirmed that the head really was 'all in'.  While the delivery trolley was being prepared I was sprinting the last lap of the race.  Although I was detached from the surroundings, I was listening closely to my body.  When I felt the urge to push I did my utmost to relax the muscles of my pelvis.  I was comfortably supported by the bean bag in a sitting position, and Noel continued to assist me and control all that went on around me.  There was no heavy breathing or strenuous pushing; just the rhythmical, light, upper chest breathing, with pauses to assist the baby's progress whenever the urge was present.  It was during one of these pauses that I felt the forewaters burst.  That felt good!  I felt the stretching of my old [perineal] scar.  The words 'olive oil' passed my lips, and Noel quickly obtained it from the midwife and was rubbing it on my perineum to help it stretch.  Another of my little pushes, and he was supporting our baby's head.

The rest of the delivery proceeded normally.  The cord was around the baby's neck, so it was clamped and cut.[:-(] The baby was delivered straight onto my abdomen, and we joyfully caressed the beautiful moist little body as he made his first little squawks and gurgles.  The children wanted to know: "Is it a boy or a girl?"  But we didn't know yet - our hearts were too full of thanks and wonder, and we let the minutes stretch out. 

We went home the next day.  Our baby's alert mind, and strong, growing body, have not ceased to enthrall us.  I gladly give as I am able to nourish and care for this little gift from God.

Thinking globally; acting locally

I am struggling with my emotions as I clear the shelves of this room which has been my professional office since I began private practice in 1993.

I am looking at thick, heavy reports, conference papers, sequential journals and newsletters, printouts, folders with copies of significant documents - all with a thin film of dust - and most destined for the recycle bin.  Midwifery, lactation, College of Midwives, Nurses Board of Victoria, and lots more.  I can't possibly transplant the contents of this room to my new home.  Retirement means down-sizing. 

I tell myself it's silly to grieve about throwing out material that has no relevance.  I remind myself that I haven't opened or looked at most of these documents in years - and I'm not likely to, in the next decade.  But I am grieving.  

Think globally, act locally (click to enlarge)

Today I would like to record a little more of what I have learnt and experienced in the past 20 years.


Thinking globally, acting locally
The global terrain of midwifery knowledge in the 1990s nurtured my hungry mind.  I was fortunate to be able to integrate theory and evidence, and apply it from first principles to childbirth and breastfeeding in my own community.

The information age took us from paper to digital communication.  I learnt 'mail merge' to produce addresses printed out on sticky-labels.  Documents and letters were photo-copied and physically mailed out; faxes and overhead transparencies were the mainstay for teaching and disseminating information within professional circles.  These were quickly replaced with email, websites, data projectors, and much much more.

This is my thumbnail sketch of significant midwifery moments from my perspective.  (Readers can use search engines to check details and fill many of the gaps that my imperfect memory will undoubtedly produce!)

World Health Organisation had, in 1985, published the Fortelesa Declaration on appropriate use of technology in birth, followed in the 1990s by Safe Motherhood publications, such as Care in Normal Birth, a practical guide (1996).  Parallel was the WHO-Unicef Innocenti Declaration leading to the Baby Friendly Hospital Initiative, placing emphasis on the protection, promotion and support of breastfeeding as a priority for all babies.

Coming as I did at the time from my own childbearing and breastfeeding years, I was ready to integrate the science (global) with the practice (local).  My husband, Noel, had researched the protective effect of colostrum on the newborn calf and been awarded Masters and PhD degrees for his research in the 1970s.  The literature review included current scientific knowledge on human colostrum and breastfeeding, and the emerging devastating impact of the loss of reliance on breastfeeding, particularly in poorer communities.  My understanding of the finely tuned natural phenomena in childbearing and nurture heightened my commitment to working in harmony with natural processes. 

In those days, many mothers received repeated doses of the synthetic narcotic Pethidine (also known as meperidine or Demarol) in labour, and their babies were born unable to achieve the most basic of physical challenges - effective breastfeeding - and often ingested little or no colostrum.  Babies were separated from their mothers, given dummies (pacifiers) to keep them quiet, nursery care, sterile water, and 'white water' (code for formula - administered with bottle and teat, of course) to give the mother a good night's sleep (with the aid of a sleeping pill).  Nipples were often severely damaged.  Breast engorgement followed: painful, hard and unproductive breasts that quickly progressed to mastitis.


Embedded in the maternity reform agenda of the late 1990s was the development of women's rights in childbirth.  Midwifery, as a profession, could not insist that mothers accept an ideal of umnedicated, natural labour, and the constant commitment of exclusive breastfeeding for six months, with continuing breastfeeding to the age of two years and beyond - unless women, MOTHERS, agreed that this was indeed the best pathway for them and their babies.

The notion of women's rights in childbirth has simmered away without, in my mind, reaching any major breakthroughs.  A competent adult does have the right to refuse any medical treatment.  This ought to be a real winner for women in maternity care, because the fact is that for most women, pregnancy, birth, and the baby's establishment of breastfeeding are able to happen without any outside intervention or assistance.  On the contrary, the principle of non-intervention in such normal physiological processes is actually established as the optimal. 

'Unassisted' childbirth is usually good. From a midwife's point of view it's the gold standard for unmedicated, spontaneous birth. When a midwife completes the statistics form for a birth we check 'unassisted' if the mother pushed the baby out herself.
 
The professional midwife who is in attendance does not necessarily assist. I think it's Michel Odent who said (I don't have the reference) that "One cannot actively help a woman to give birth. The goal is to avoid disturbing her unnecessarily."

Yet too many women today, and 10 years ago, and 20 years ago, will tell you they experienced bullying and coercion in maternity care; that they were told "You must have an induction of labour  ..."  "You must have a caesarean ...."  "Your baby must have this artificial formula milk ..."  It is, and always has been, rare if not unheard of in mainstream maternity services for women to be presented with information and support to make the decision they believe is best for them.  Maternity professionals have learnt, often without consciously recognising it, how to leave a woman no alternative.  "Your baby will die if we don't ..."

Having considered women's rights in childbirth from many perspectives, research, and practice, the only way I can see to reduce the incidence of birth trauma is through expert midwifery practice, together with effective support of women in decision making.  A woman who is working within a reciprocal partnership with a known midwife; a woman who understands the unique and awesome natural processes in the whole birthing-bonding continuum; this woman and her midwife will do all she can to stick with 'Plan A'.  Plans B and even Plan C are available, because medicine and surgery have advanced to the point where there are very few unpredictable situations in which the woman's life, or her baby's life, are truly at risk.

In the past decade I have witnessed the growth of intentionally unattended childbirth, also known as freebirth.  We don't know how many babies are born this way, because some are recorded as 'BBA' (born before arrival).  Some 'freebirths' happen under the watchful eye of unqualified people, including doulas, who probably do not have the knowledge or skill to intervene when even the most common complications arise.   I think this is a tragic development, because I see the role of the midwife as being so basic.

I say this with deep respect for those who have experienced unwanted interference in their birthing processes.  I am horrified that women are giving up the fight too early, and not exercising their right to decline treatment. Others are being swept into an idealism about unassisted, undisturbed birth that they will probably regret later.
 
Women and babies will die in free birthing.  This is unacceptable. Our bodies are wonderfully made, and science as well as experience have taught us about oxytocin and bonding. If that were the end of the story there would be no need for the professional midwife or anyone else. We could just hide in our undisturbed cave and birth our babies in blissful ignorance.
 
Women's rights in birth must come down to principles of safety and access to appropriate interventions in a timely manner.   

The principle that I follow is that there must be a valid reason to interfere with the natural process (WHO Care in Normal Birth 1996) We cannot know ahead of time if a complication (ie valid reason) may arise, even in the least risky situation. If a woman is giving birth unattended she has no idea if she is progressing normally, or not. She needs to minimise neocortical activity as the labour progresses, which means she must stop analysing and assessing what's happening. 

That's the midwife's job.