A Matter of Faith

Not surprisingly, midwifery continues to teach lessons to my very soul.

The month of December brought with it two very non-textbook mamas. One was a mama having her first baby. Going off her LMP alone put her due date at the end of November. However, she had 32-45 day cycles. The standard due date calculators are based on a 28 day cycle. Use Mittendorf's rule, and you add another 10 day's, not to mention extra days for late ovulation. By this time, I get very frustrated with the calculations and rules. Using other key factors like the positive pregnancy test date and implantation bleeding, her due date moved into early December. This woman asked us when she was supposedly 42 weeks, "What would women do 100 years ago? I mean, I didn't have an ultrasound to "date" anything. You would've just waited to have your baby, right?"
Yup.
Of course, true postdates/post maturity brings with it it's own risks, and we discussed them all. We presented the options to this woman, from do nothing and continue to see her more often, to biophysical profile and hospital induction. She chose to wait and respect the process.
So we waited, and waited. Labor started on it's own and she proceeded to have a very textbook labor at that point. Maybe 12 hours active with only 30 minutes pushing. A gorgeous baby girl was born with low amniotic fluid and peely skin (common in late babes), but was otherwise fine. Little girly born on the 22nd. Nursing like a champ, parents glowing like the sunrise.

Our other December mama was the one who had an abrupted placenta last summer with me. You can read about that here and here. So here's a grand multip with now two previous cesareans. She saw nurse midwives at the beginning of her care and was once again treated like an uneducated baby-machine. She and I talked a lot at the beginning of her pregnancy. We talked about the risks of uterine rupture after two previous cesareans (one just 16 months ago). We talked about her tendency to have 9-10# babies. By the time she was 4 months pregnant, she asked if we'd be her midwives again. After much discussion, we said yes. A close friend of mine told me she was surprised I took this woman on again, making me question myself.
What it came down to was this woman telling us that she'd love us to be her midwives, but honestly, there was no way she'd step foot into the hospital after all the shit they've done to her over the years (and they have done a LOT, very unnecessarily), unless she truly needed to be there. And that she was going to have a homebirth whether or not there were midwives there to catch her baby.

I truly believe in each woman's right to have her baby where she wants, even if there are higher risks involved. Having said that, it'd have to be the right woman that I felt comfortable working with and so on. Each midwife has her own comfort zone, she should know it well and I believe I do--while respecting it's own ebb and flow! This particular woman was doing pregnancy number 4 with us, and frankly, I just love her to bits, so we took the plunge.

At any rate, labor began 10 days past her due date (which is her due date, as far as I'm concerned. She has always started labor 10 days past). Our apprentice and I drove out there quickly, as this client has been known to have quick labors.We were joined by midwifery partner not long after. The mama was definitely cooking in active labor when we arrived, but the house was like Grand Central Station. Many kids running around with their new Christmas toys, the grandmother yakking on a phone, a worried partner stepping out to smoke. They were waiting for living room furniture to arrive and also a pizza! It was comical. We tried explaining to everyone the need for the laboring mama to have her space, some quiet, to be the bear in her cave... it fell on deaf ears.
"I've got a couch and two chairs coming!"
"Cottage Inn should be here in 30 minutes!"
Oh my.

Rather predictably, her contractions spaced out as the furniture and pizza came rolling in. We gently kicked everyone out after that. Only the oldest child, the partner and the mama were home. Contractions had spaced way out by then and she was ~4cm dilated, so we left, telling her to call when things picked up again.

As I was driving alone later, I got a call from our apprentice who told me she was having crying jags. (This definitely isn't typical of this tough-cookie lady.)She said she was feeling very stressed and over-emotional. We both talked about the high stress involved with this particular birth. The medical professionals had told our client that her uterus would rupture and she would bleed to death in 5 minutes in her living room attempting her home birth. I told our apprentice she didn't have to come back for the birth. I respected the pressure and concern she was experiencing. I was feeling the same, but had been praying fiercely about this birth for weeks, and was amazingly filled with peace about it all. (I must add that I also called a very good friend of my mine who can pray like no one's business. Every time I'm feeling overwhelmed or in need of reinforcement, I call her and she says this great prayer over the phone. It definitely helps.)

I went home and showered, picked up my kids from my sisters and was back in my town in the Taco Bell drive thru (yes, don't ask me what I feed us when I'm starving and short on time) when I got the call to GO! QUICK! Things were happening. So I snaked out of the drive thru in reverse, with my kids moaning and groaning and me apologizing profusely for being a good midwife and a crappy mom.
I dropped the kids off back at home, gave my mom some money and the Mr. Pizza menu and told her to order whatever they all wanted. Then I was off.

I was the first one to arrive back at the laboring mama's house. Soon my midwife partner and then our apprentice showed up. She smiled at me and said she was fine.
And then we did what we always do: prepare the room, encourage the mama to drink and nibble at food, encourage her to move around and try different positions and listen to the baby's heart tones. Baby was doing fine. We knew by this mama's history and the size of the baby beneath our hands in her belly that this was another big babe. Probably around 10 pounds. Again, not very concerning since she's slid other same-size babies out with no problems. When it came time to push, it took a little longer than usual. All in all, about 30 minutes or so. When the head came out, we were all thinking, Holy shit! That is a big head.
I was supporting one of the mama's legs, while my midwife partner supported her perineum, but I had to lean over and pull aside her labia to see for myself if there was a shoulder right there. Thank God, there were both shoulders just inside. With the next contraction, out came the baby and we plopped this gorgeous, heavy baby boy with oodles of blackly silky curls onto his mams chest.
Our apprentice said, He looks like a 3 month old!
And oh my, did he ever! We didn't wait long to weigh him. This little bugger weighed in at 11 pounds, 8 ounces! A healthy, lovely child born to a mama with a very strong uterus, a very healthy placenta, normal to minimal bleeding and no vaginal tear.
Hallelujah!

The next night I was at the brewery with my apprentice, her husband and my husband. Her husband confessed that she had quit midwifery 8 times that day. My husband asked what teachings I had to share about it all. I shook my empty head. Honestly, sometimes it's just a matter of faith. One mama was anywhere between 41-43 1/2 weeks over due and the other could have ruptured and died in her living room (said the doctors). Both women were fully informed of what protocols would be in place in the medical system and what risks were involved with stepping outside those protocols. Both women made educated free choices about what they wanted for themselves and their babies. That is their right. As a woman, I want the same for my body and anything I grow in it.

Life is all about risks. My goal is to get through this life by doing no harm and always living with sincere, good intentions. I realize that I'm only human, that I'm far from perfect and that I could be easily broken.

An old client of mine had a signature line on her email that read:
Thank God I didn't burst into flames today.

That always made me laugh when I'd read an email from her. It pretty much sums it all up. Honestly, anything could happen any second of the day. In December, there were two very fine days when anything could have happened. Ultimately, we had one very over due baby who came out when she was damn good and ready and a huge boy who was born the way nature intended, despite all the medical hoopla saying otherwise.

Thank God, indeed.

Happy New Year!