A LEARNING CURVE

Yesterday was a day of revelation for me... in the shape of a woman birthing at home, when originally, she intended to have a hospital birth with all the pain relief available, as she had done with her other two children.
It increased my belief in trusting in a woman’s own instincts during the birthing process and also a kick up the backside for me and my mistimed complacency.
S has had 2 children before.
The first was in a busy city hospital in the South 8 years ago... she was induced for post maturity
She was left alone for the majority of her labour, sustained a nasty tear, retained placenta and a major post partum haemorrhage.
Seven years and 3 miscarriages later, she met and married her current husband and became pregnant with her second child.
She employed me as her Midwife because she felt so traumatised by the previous birth, not even wanting to acknowledge that the baby was there until about 28 weeks. She was induced again for post maturity and had a positive experience this time, with an epidural and a wonderful NHS Midwife, and Myself supporting in a non clinical role.
6 months later, she called me to say she was pregnant again.... not planned.. but coming to terms with the prospect of having 3 children and a teenage step daughter to care for.
Her Downs Risk test came back at 1:115, which both parents understood and accepted, but declined any further investigations. I found out later that this had marred all of her expectations of having a healthy baby for the remainder of her pregnancy, and was the first thing she asked about when her baby was born.
S had always gone overdue, her waters had never gone on their own and she always took ages to establish her induced labours. We even joked that this baby would be born on bonfire night, and that she needed to avoid Halloween.
At 36+6, S reported a small gush of fluid, which was checked out at hospital and nothing found.
2 days later, she paged me to say her waters had broken outside the hairdressers but with no contractions. I went over to confirm her membranes rupturing, to save both herself and the hospital time, and to organise augmentation (this trust augments after 24 hours).
We sat and drank tea for a while and S reported that she had some mild period type pains which weren’t bothering her, so I listened in again, checked her temperature and said I would go home and get sorted before her labour started, and to call me when they establish.... this was at 17.00
At 17.15, her husband called me (i have hands free in the car) and shouted ‘MARION.. YOU’D BETTER COME STRAIGHT BACK!’... I could hear S in the background moaning loudly. My green light (the best £50 i’ve spent in a long time) went on the roof and I made my way back through the appalling roadworks outside their village, with workmen moving bollards for me to hasten my journey.
When I arrived, S was on all fours rocking her pelvis and moaning softly and rhythmically. When her contractions came, she would raise the volume of this primitive moan, almost singing violently in monotone... not an angry noise, more of a focussed announcement that she was in productive pain.
At 17.40 I managed to assess and she was 5 centimetres dilated with the head at the spines.... this progress was too quick for any transfer to hospital.
This is where my complacency comes in.
I ‘assumed’ that she would have her baby later rather than earlier, and she was ‘only just 37 weeks’. Fortunately I always carry my ‘serious’ kit in the car from 36 weeks, but was lacking stuff like Entonox and inco sheets, although I did have my perennial oxygen cylinder with me. I was also concerned about S’s history, so called in the paramedics... there was no point calling anybody else... they wouldn’t have got through the evening traffic in time.
17.55 the paramedics arrived... the storm was gathering....
I could see by the way that S was behaving and other external signs that she was coming up to second stage.
The paramedics were brilliant.... they bought up entonox, pads and a delivery pack, attending to anything that I asked of them, whilst silently observing and standing in modest places in the room (man at head end, woman at business end).
18.05 Everything changes..... S is now roaring in monotone and the baby’s head is visible with a huge contraction, but disappears back. S changes her position, almost as if she needs to manoeuvre the baby down by arching her back and raising herself on her knees.
18.10 baby restitutes, and as if being twisted by an internal rebozo..... arrives slowly and gently into my hands with a huge gush of liquor...
She is here....
S automatically twists round, takes her t shirt off and holds out for her baby.... skin to skin within seconds.
No amount of Syntometrine, controlled cord traction, peeing and suckling baby was going to get that placenta out, so we ended up in hospital anyway, but.....
This woman, who happily bought into the medicalisation of her labour and birth, who ‘didn’t do pain’, who couldn’t understand why women would want to birth at home... is very happy and proud of her achievements today.
There are many books and courses, study days and workshops out there that want to ‘teach’ women to achieve a normal birth...... but at the end of the day, when a woman has to step up to the mark... she gets on and trusts in her own birthing instinct anyway..... and I always watch in wonder

My learning curve has extended once again....