how long is too long?

We had all been working very hard for a very long time....

Susan was having her first baby. She had a long first stage, but not really much longer than a lot of Mama's who are having their first. She had a good support system, had been able to keep up with food and fluids, and was hanging in there. The she was ready to push. And she pushed and she pushed and she pushed. Susan fought for every little centimeter of descent. But, there was descent...just at a slow, slow pace. Two times during her second stage, we stopped pushing to discuss if we should transfer to the hospital. Susan really wanted to stay, her vital signs were good, her baby sounded great and her husband was comfortable with Susan's desire. I have never seen a Mama push so hard for so long....

I have often had the feeling of treading a fine line. The line between hard work and pushing a woman to give and do just a little bit more when she can. Many women in labor, at a certain point, feel that they cannot continue the work. However, most of the time, this feeling means that they are just about done and will soon have their babes to cuddle. I am continually in awe of the power reserve that women are able to plug into at these moments. The fine line comes into play when a woman may be truly reaching her physical and emotional limit and can venture into the land of suffering. Hard work vs suffering....the distinction can many times be difficult to distinguish.

Susan's birth was one of these difficult times. She was actively involved in her care and the decision to continue with the work, but it was so very hard. Eventually, Susan gave birth to her baby and both were healthy. Susan felt empowered and was happy to have been able to birth her baby the way she did. However, when I saw Susan during her postpartum care, and I saw the multiple petechial bruises on her face and shoulders....a result of her extreme pushing effort over a sustained time, I definitely questioned my decisions. Had I pushed her too far? Had she truly suffered? It was Susan who then reassured me that she was still secure in her birth and confident in her own power as a mother who fought for her baby.

This balancing act is one that midwives must continually maintain. It is one that I am continually monitoring and debating when I am with a woman. Most of the time the line is pretty clear...it is those times when the line is blurry that we must be ever vigilant.

thinking back

Today has been a day full of snow and reflection. Snow often brings me to points of reflection. My thoughts have been wondering to memories of my own births and pregnancies...so very different from each other...for many reasons. I have had three pregnancies and two births. My first pregnancy was almost 13 years ago, boy that is scary to say...I have a 13 year old!! How does that happen?

When I was pregnant with my son, I knew nothing of what I was heading into. The pregnancy was a surprise but welcomed. However, I seemed to know two things, strongly and instinctually. I knew that I had to have a midwife and that I had to breastfeed my baby. In hindsight this is amazing to me...where did this knowledge come from? I had never consciously heard of midwives and I had never been around mothers who breastfed. Somehow, I just knew of these things in my bones...maybe some crazy genetic memory. I was blessed to find a great group of CNM's. I had a difficult pregnancy that involved a serious car accident, bed rest and PUPP's(a difficult skin rash). The labor and birth continued with the pattern and were also difficult. My son was direct OP (posterior or sunny side up) and acynclitic. It took four hours and every ounce of determination and strength in my body to work him out. Afterwards, we had a tough time with breastfeeding, including a tongue-tied baby and a full blown case of mastitis. Looking back now, it is almost comical, at the time it was almost tragic.

My next pregnancy was tragic. (I have written about it before in the post titled 'Just a Flutter'.) It was a desired and planned pregnancy...that was not meant to be. Near the end of my first trimester, the pregnancy presented itself to be ectopic. The baby was lost and I was very nearly lost as well. It was devastating and is something that I still work through.

My last pregnancy was also planned and desired. It also had its share of tough issues, including pretty serious morning sickness, that had me loosing weight. The birth however, was glorious. My daughter was born at home, in a pool in our bedroom. I was surrounded by friends and family and had a great midwife. It was empowering and humbling.

Although my two births were so very different, they did share some aspects. They were both drug free and I had supportive people around me. Additionally, I had a similar experience during both. In the depths of labor, that point where you feel that you cannot possibly do or give more, I had the sensation of being in a great line of women. I could see them flowing through time, all behind me, and feel them supporting me and offering strength. This experience during my first birth was also the moment that I knew, deep inside my being, that I would become a midwife myself. So, here I am, on a snowy winter day contemplating these memories. I sit here as a midwife...the journey has been a long and twisty one...but so worth the effort. I also know that it is a journey that will never end, it will always grow and expand, like the never ending line of women flowing through time....