Saturday, December 31, 2011

The "Rule" of Order

Birth workers will be familiar with this concept, I have heard it worded various ways but it boils down to this; first babies are hard and work their Mamas, second babies are fast and surprise their Mamas and third babies...well they are a wild card! Now, of course, these are not hard and fast "rules". There are first babes that come quick and second babes that take their time, or any combination of the above.

I was recently with a first time Mama, who was indeed working very hard for her little one. She had great support; her husband, her mother, her father and a friend. She labored strongly and had prepared well for the work. Her baby was OP (occiput posterior), so the work was hard and she had a lot of pain in her back. I had her do many things that, at the time, she did not want to do, and that were uncomfortable. We had her on all fours, with a rebozo wrapped around her belly and shook her. We had her rock on all fours and gave her "butt bumps". We had her walk the stairs in deep asymmetrical lunges. It was hard work, and while I knew that she did not like to do it, she did it all gracefully. Eventually, it worked, she told me later that she felt the moment her baby turned at the top of the stairs. Next, we got to the work of pushing, which she did beautifully. Twelve hours after the start of the journey, a sweet 8#13oz. baby boy was so joyously welcomed into the arms of his Mama and Dad.

A week later, I was seeing the new family for a postpartum check-up. They were doing amazingly, baby boy had already made up his lost weight (that all new babies lose) and was past his birth weight. Mama was healing well, and both she and Dad were adjusting to this new reality. After discussing all the technical details like how her bleeding was, how her perinuem was healing, how breastfeeding was working and checking her fundus, we talked about how the labor and birth had been for her. Did she have any questions, issues or concerns to address? She said that it had been hard but she felt supported. Then she said something that I will always cherish. She had been thinking about the experience and realized that while she would always love me, she would also always be mad at me.

Mad because of the things that I had had to have her do...walk the stairs, shake her belly, bump her bottom...all these things were not pleasant or easy for her to do. However, she also realized that they were necessary and was thankful that I had been there to help guide the process. She had felt the support and kindness through the sometimes firm instructions. As a midwife, it is sometimes required of you to be "mean", to ask for difficult things and actions. We have to be able to ask these things, to be tough yet loving, to balance the needs of the physical and emotional with strong compassion. Sometimes, we cannot be a friend. This Mama had told me this with a smile on her face and a twinkle in her eye...she knew this truth as well. She also said that she could not imagine having had a better midwife....and while I know that she would have felt the same for any of my other sister-midwives had it been they who attended her, it did make my heart flutter.


  1. I've done this as doula, pushed clients into things they didn't want to do so that they could have the birth they wanted. I've had to learn how to do it, how to get in women's faces and speak the truth in love to them. It's an honor to be invited to that space.

  2. my first was my longest labour, but not necessarily hard... i think my second was the wild card being fast, but i had an abruption and pitocin augmentation... my third was fast, but the most intense of all the labours...

    by the way, what are butt bumps? (always looking to expand the doula tool box)

  3. Yes, it is definitely hard work, and yes, we have to sometimes encourage women do things that they don't like or that makes them uncomfortable to try to achieve what they desire in their labor and birth. I love how you addressed the emotional aspects of her birth with her at her one week check up! That's so awesome!

  4. @Jennifer, yes it is a skill that has to be learned, but is also our responsibility. Thanks for the insight.

    @OLWTB, lol, butt bumps. I was wondering if anyone would ask about those. It is a technique that I learned about at a conference and comes from Germany, where it is called "Apple Shaking" (but in German of course), it can be great to help turn posterior babes. The woman gets on all fours and rocks back and forth, you sit right behind her butt and when she comes back towards you, you "bump her". Place the palms of your hands on her butt bones (ischial tuberosities) and bump them, it will not be popular since when done correctly it is uncomfortable. You can also google "shaking the apples" to get other, better descriptions.

    @AYC, I always like to address emotional aspects at PP visits. At our practice, we like to schedule PP visits with the midwife who attended the birth so we can do just that. Sometimes at the 2 day visit, it is still too early. And by the 6 week visit, if there were any problems, it can be almost too late. The 1 week visit usually works well for this and if there are issues we can address them.