Thursday, July 14, 2011

Normal Birth?...part 1....

What is normal birth? I often ask this question. Often times a normal birth may include many things that are not "normal" but that happen. Here is an example...

She was a sweet first time Mama, her man was supportive and loving, her Mother was present and wonderful. She labored beautifully, was in the pool and started to push all on her own, instinctively and with strength. Soon the babe was crowning, and crowning, and crowning and senses prickled up a bit...and crowning, then with one push the head emerged and quickly retreated back into the perineum. With speed, we moved her out of the pool to her hands and knees on the floor, babes head was still tightly squished up against the perineum...with some help and effort, one minute after first emerging, he was out! He was not fully with us, his cord was pulsing strongly but he was purple and not breathing. We stroked him and spoke to him, his Dad loved on him, eventually we had to use the ambu bag and give him some breaths. Immediately, he turned pink and began to cry...of course, the BEST sound in the world. We moved the new family to the bed, baby boy skin to skin on Mama with Dad curled up next to them and a radiant Grandma at the bedside. One of my favorite times of a birth...the afterglow. The nurse and I were busy trying to strike that balance between invisible and present. I was ever so gently holding the umbilical cord, feeling the pulse of life, when something felt off...there was a "loosening" feeling and a gush of bright red blood. However, for some reason I knew it was not the normal cord lengthening and placental separation gush. I immediately felt up the cord, into her vagina and felt a partial cord evulsion!! I grasped the cord and crimped it off, while asking the nurse to hand me a clamp. I clamped the cord and took a deep breath for myself. A few minutes later, her placenta emerged all intact, thick and healthy. Again the new family was the picture of beauty, baby was crawling on Mama finding his prize of the breast. Then a little while later, Mama started to bleed and pass clots and bleed and pass clots....with some vigorous massage, herbs and finally medications, the bleeding eased up. Finally, all were well and healthy, basking in that afterglow.

This birth was "normal", so what does normal mean? As a midwife, I must always guard the birth process; help to create and hold a space that is calm, centered and uninhibited. The vast majority of the time I am not needed...but in those times when I am, I REALLY am.

This birth made me think of two things: 1) unassisted birth and 2) birth trauma. I will follow up with my initial thoughts and my follow up with this lovely family, but what are your thoughts? How do you feel about unassisted birth? How does birth trauma happen and what can we do to lessen it?


  1. I had both my babies at home. With my first i had NHS midwives (i'm in the UK). They told me i was not in "real" labour until my daughter's head was born to the ears. They glanced at one another, shaking their heads, when i was noisy. When my daughter finally came, after over an hour of me roaring-gasping-panting-panicking so i would not push (as they kept reminding me, i wasn't in labour yet), my daughter's apgars were 9 (on my belly), 7 (when the cord was clamped for no good reason), 10 (after suctioning, oxygen and being put BACK where she belonged on my belly, though while she was there one midwife began to pull on my cord, making my uterus bob inside me, until i was so frightened i told her to stop and give me the syntometrine instead). I really think that without their "help" my birth would have been as safe (if not safer) and nicer for me and the baby.

    My second i had an independent midwife. I had a long latent phase. Contractions came on and petered out over and over all afternoon and evening and into the night. I talked to my midwife, i went to bed and slept. In the morning the sun came up and i knew i needed my midwife. She came. She listened, first to me, then to the baby. She observed me quietly. She appeared to do very little. She did NOT try to speed anything up. She did NOT try to interfere with my strange contraction pattern. She only watched and waited. Suddenly, from inside, my baby hit the eject button and i pushed relentlessly, even when the contraction was gone the urge was fierce, for six minutes. Her cord had a true knot. Her apgars were 10 (born directly into my own hands as my midwife called out with joy that i was doing it all myself), 10 (nestled against my breasts, still screaming), 10 (grumbling angrily still!). She stopped crying the very second we cut her knotted cord from her, a few moments after the placenta came of it's own accord.

    I am eternally grateful that my midwife was there, not only because of what she did but because of what she did NOT do. She did not interfere. Suspecting a cord problem or potential dystocia from my odd labour she showed only quiet confidence in me. She was calm and sure and introduced no fear, no doubt. She waited to see what was happening before doing anything. She did only the needful and left the rest to my baby and i. I do actually know someone who lost a baby to a knotted cord in hospital, augmented by an eager registrar, and cut out, still and blue, by the obstetrician desperate to undo the damage rushing things along had caused.

    "Trauma" is too strong a word for what happened during my first birth - it led me to a wiser choice next time, but it doesn't give me nightmares. It would have been traumatic for me though, to face another birth of that nature. I wanted someone to see ME, as a person, not a uterus to rescue a baby from.

    I personally would only choose unassisted birth as a last resort, but i do believe for some women the choice is starker than mine. I have access to a fantastic IM, and the ability to pay her. Faced, as many women in the world are, with only the medical model, i might well just stay at home, and risk the possibility of complication to avoid the certainty of interference.

  2. When reviewing my own birth stories, The ones that cauased me to feel traumatized were the ones where I felt like a "number" or a piece of meat. I was forced to submit to unnecessary procedures because it was "policy" and badgered to accept pain medications to the point of tears when I specifically detailed in a birthplan (which, by the way, was summarily ignored) that I wished to have a natural birth. I felt violated and raped.
    Conversely, as a birth worker at homebirths, I have seen a woman with a significant perineal tear not feel traumatized in the least during the hour it took to suture. She had her husband beside her in her own bed, her baby on her chest and an awareness of each step in the repair.
    Therefore, in my view, it seems that "birth trauma" is more reflective of what happens to a birthing mom's psyche than what happens to her body.
    I am enjoying your blog! Thank you for sharing your experiences.

  3. I am thankful for both my births. The first time, I had a straightforward hospital birth with a decently compliant OB. For my second, I was able to locate and hire a trained, gentle, respectful midwife to attend me at home. I had no trauma and because of both being wonderful experiences, I personally would never consider unassisted birth.

    But I have also had many friends find quite the opposite to be true of their hospital or home births, so I try to empathize with the desperation a woman might feel to escape such experiences by birthing unassisted. I would still hope to help someone find a midwife to assist them but I try not to judge anyone's birth choices.

  4. @Bec, thanks for sharing your stories. Unfortunately, your first experience appears to be all too common. I am glad that you were able to find a different situation for your second birth. Midwives should be able and willing to let the process happen when appropriate.

    @Janean, your observations are right along with my feelings on this topic...

    @Lindsey, I love your line about the "compliant OB"

  5. I love this blog series by Pam England...and this week's post had your blog in mind, Aubre: