Babies caught in February: 4. Shiphrah Birthing Home was really slow in February (notorious to be our slowest month). We had a grand total of 7 births in February, and migraines plus 2 Sunday births (my day off) meant I missed 3 of them. Up to this point in March, we have already had 2 births and we had another birth take place during the time it took me to write this update today! It’s looking like all those ladies “due” in February are coming now, giving me a busy last-three-weeks for my apprenticeship here. And I’m here for it!
It’s been quite a while since I put some birth stories up here, so I decided I couldn’t help but share these two. But first, a side-note/soapbox:
Within the birth world, you’ll hear midwives (and the women who choose to have their care with midwives) contrast themselves with obstetricians. The philosophy of care, the methods/options/emphasis of care, the context of care… the differences are vast and varied, going all the way down to the ways we talk and the words we choose. The OB’s I worked with while working as a RN in the States would talk about how many (thousand+) babies they’ve delivered during their career, a term used to reassure women and their families of their experience and expertise. I, and any midwife I know (both in person and online through midwifery school) would never say I have “delivered” a baby, regardless of my level of experience. And I’d like to present the following two birth stories as evidence. A midwife is a birth attendant at best. Certainly we have experience and the education and skills to handle most complications that may arise, but we are neither the expert nor the center focus (which, I would argue, the term “deliver” connotes). Each birth is different, and we don’t call the shots. The mom, the baby and that nebulous third variable we call “birth” calls the shots. We don’t deliver babies, we “catch” them. Maybe you’ll see through these birth stories how that difference in vocabulary really isn’t a matter of semantics.
Mom first arrived at 4am Saturday morning, Feb 22nd, after contracting for the past 3 hours at home. This was her 4th baby, but her first to be born here at Shiphrah (baby #1 was a hospital birth, while #2 & #3 were birthed at home). A quick exam confirmed what we saw with our eyes: mild to moderate contractions, a bit of bloody show, 5cm dilated, 70% effaced, head at -2 station = early labor. We encouraged mom to rest and kept an easy eye on her as her labor continued to slow and dwindle.
At 9am she said she’d like to go home to shower; we encouraged her to take her time at home. “Shower, rest, eat, relax. You and baby are fine, and you’re still really early in your labor. Come back when your contractions become stronger”. At 4pm we ended up calling her cell phone, just to check in. “My contractions have all but stopped”, she reported, which isn’t unusual. A mom having her third/fourth+ baby could be dilated to 5cm for days (even weeks) leading up to her actual birth, contracting intermittently before really going into labor. Pondering possible reasons for the mini-labor during the night, my apprenticing midwife and I thought perhaps this mom was dehydrated or tired the night before and had some stronger cramping that resolved as she got some rest during the day. You can’t plan the way a birth will go. “Maybe she’ll come back tonight” we thought and went about our day (which meant going to see “Little Women” which FINALLY showed in theaters that week here in the Philippines).
Later that night I get a call that a fourth-time-mother was in labor; shift change meant this new midwife didn’t recognize our mom, but I did, so I ran back over to Shiphrah at 8pm. Mom was 8-9 cm now, baby -2/-1 station (if you’re not familiar with the term “station” as it’s used in labor/birth, click here), bag of water still intact. Now we’re getting somewhere!!
As her labor progressed further, we saw lots of bloody show (a good sign we’re nearing “go time”), but baby never came down any further than -2/-1. Mom started to show signs of perineal swelling, which wouldn’t concern me if she were pushing a baby almost-born, but when baby is still too-high to really start pushing, we have to start thinking “what is causing this swelling??”. When a baby is being pushed through a swollen perineum, mom is at greater risk for tearing, bleeding and other complications. So Ate D- and I encouraged mom to try different laboring positions in an effort to encourage baby to descend. We always like a baby to be nice and low (deep in the mom’s pelvis) before a mom starts to push, or else she’ll just get tired! Why force the baby to come down with pushing when your body will move him down for you, more often than not, if you just wait?? A midwife always hopes to find few positions to help baby come down further before we really start to push.
We were even more surprised to discover this swelling, greater on the left side, would completely disappear when mom was lying on her side, but return when she was flat on her back (yet another example of how lying on your back is rarely an easier way to give birth!). Four hours passed, swelling still position-dependant, baby still too-high-to-push. Mom was almost fully dilated (just a tiny cervical lip that would disappear if baby would finally descend!!), but Ate D- and I started talking with mom about possible transport. Something, we couldn’t figure out what, seemed to be keeping baby high up in mom’s pelvis. It could be a cord around his neck (though you often see fluctuations in baby’s heart beat that hint at a nuchal cord, which we didn’t find here), or it could be that he was sitting a bit crooked in the pelvis. We suspected the second reason, and that’s why we suggested the possibility of transport. At this point, neither mom nor baby were in distress, but you don’t want to wait until it’s an emergency before you move. We’d tried almost every position to get baby to come down, and he didn’t seem to want to/be able to budge, and now we were wondering if this birth needed some outside assistance.
Then, like magic, her water broke! Bingo!! When you can’t see what’s going on inside, you take what you can see/hear/smell/observe as clues; none of us broke her water, so there’s a really good chance that the baby did by moving down/into an easier birth position, which is exactly what we were wanting to happen. Mom now felt an urge to push, so we encouraged her to try on her side (to reduce swelling). Left side-lying = decent amount of baby movement visible from the outside. Right side-lying = nothing. Flat-on-her back, = no movement at all. In between each re-position, mom would say “I’d like to sit up and push” or “I want to stand/squat”. Ate D- and I encouraged her to try to push baby lower while lying on her side (while we could see signs that baby was moving down as she pushed, we couldn’t see any of baby’s head, so it seemed like he was still pretty high). We talked about waiting till he was really low before getting upright, as upright pushing positions can increase swelling if baby is still really high, and we didn’t want her swelling to increase any further. Finally, after she asked for the third time “can I sit up”, we helped her to her feet.
And that’s when everything changed. Mom felt the next contraction coming on and, with her back to the bed, squatted deep down on the floor. Feet flat, knees wide, tailbone inches from the ground. In the next contraction baby went from invisible, to “I can see his head now”, to crowning, to head fully out. The baby’s body followed as the contraction died off, spreading blood, stool and baby poop all over the floor and my feet.
Ate D- and I laughed at ourselves as we watched this baby nurse within 10 minutes of birth. He was an excellent pink color, and despite the powerful, one-contraction-delivery, mom only had the tiniest tear (far too small to need stitches).
Midwives have to use their judgement and experience throughout a birth, encouraging moms that their birth process is normal and giving options if she isn’t sure what she can do. But sometimes, if a mom asks to sit up, we should just let her sit up.
0630, March 3. Three-weeks-to-the-day left in the Philippines and I get a text message “We have labor. 4 to 5cm, G2P1”. Hooray! Homework can wait, I’ve got the second birth in March to catch!
Mom was looking uncomfortable but not birth-imminent, so I run back over to the apartment to pull together a quick breakfast and return to Shiphrah to eat while I birth-watch. Mom steps out into the courtyard to labor in the early morning sun, and Ate L- and I make sure everything is ready in the birth room, when two women walk through the doors, one looking very pregnant. My first thought was “I don’t think I’ve ever seen someone show up this early for prenatal seminars before”. It was only 0749 (prenatals usually start at 9/9:30am), and this petite woman in a beautiful brown dress was smiling at me, hands resting at her sides, not looking in labor one bit. She sees Ate L- and I blinking at her and answers our silent question: “I’m in labor”.
Ok! Her friend gathers the things they’ve brought as we show them into the other unoccupied birth room. I do a quick cervical exam, and end up asking Ate L- to confirm what I was feeling. My RN days made me a pro at internal exams; I haven’t had to have someone double check me in ages…. But I just couldn’t believe that this woman was fully dilated, with baby’s head below her pubic bone at +1 station! I was right (fingers don’t lie, no matter how mystified your brain might be!), and mom smiled, meekly saying “oh, I’m close now? Yeah, that makes sense. It was pretty hard not to push on the tricycle ride here”. #understatement. Two silent pushes later, her water breaks and we can see a tiny bit of a baby’s head peaking out. 2 minutes from SROM (“spontaneous rupture of membranes” means we didn’t break her water), baby girl is born!
We asked this mom when her labor started at home, and she said “Oh, around 7 this morning.” Our mom had a 50-minute first-stage-of-labor (from start of contractions to fully dilated), and a whole 7 minutes in the second stage (from fully dilated to baby-born)!!! Mama was sitting up in bed, nursing her baby, within an hour of arrival at Shiphrah.
After we got everything from the whirlwind birth settled, I went in to check on the birth I’d originally started with this morning. She had made some progress, stronger contractions and a bit more bloody show. I double checked that everything was ready and stepped out into the main room to catch my breath. Morning prenatal check-ups were about to start, so I knew it would be busy today.
Just then, Ate L- and I see a petite woman and her husband walk through the doors. She looks at us with her hands pressed against her back and a serious look in her eyes that quickly turned to astonished confusion as Ate L- asks incredulously: “Oh, you’re in labor too????” (She was not in labor, just a 39-week pregnant mom with a sore back. But Ate L- said she woke up that morning with a firm feeling we’d have 4 births today, and we’d reached the halfway point by 11am, so I can’t fault her the natural question).