An Unplanned Home Birth

This is my favourite birth story from the past.

***

If I never really connect with another client, it'll be okay. I've done what I needed to do. I'm a little awed by having had the chance to be someone's catalyst for change. Just a catalyst - the change was in process. But for the rest of my life I'll hear her voice shouting, "Rean! Women's bodies are strong. *My* body is strong!!" I'm so glad I was able to participate in this.

Today she gave me a gift with a tag that read:

With permission comes choice.
And making choices based on what I want
and not what somebody else is telling me,
feels so empowering.

Thank you for giving me permission.

***

A woman hired me for postpartum breastfeeding support with her second child, due in a couple of months. She asked if she could come to me for some counselling to process her first birth experience, which sucked from her point of view. She's a woman of strong moods and opinions, but a lovely person with an engaging personality. She had a doula at her first birth - a friend who was new at it and who froze. It was a bad experience. We’d been talking for several weeks and her due date was upon us. At the last minute, she finally asked if I would attend her birth. I think she realized that her desire to labour entirely alone came in part from feeling there was no one she could trust to really be there for her. She came to trust me.

Among her issues were real problems with breastfeeding last time. Combined with a birth that was speeded up chemically until she could no longer endure the contractions and opted for the epidural she had so wanted to avoid, she had a lot of "my body doesn't work" stuff going on. She experienced postpartum depression that went unspoken of and untreated. At the root of the broken body stuff was growing up as the fat kid in a family of thin, pretty people. At 11 she was on the swim team, playing soccer, and on her first diet. She is now tall, graceful, with luxuriant hair and gorgeous skin. She is also very obese. She has no idea she is beautiful.

She knew she wanted to labour at home as long as possible as a way of avoiding hospital interventions. However, she knew she'd only really feel safe planning a hospital birth as she works with special needs kids, some of whom have special needs as result of birth injuries. She felt she needed the reassurance of the hospital, but was very conflicted about that need.

So, she went past her due date. Her care provider started talking induction. She resisted for a certain amount of time, but agreed to do it at the end of the week following her date. She was prepared to just throw away her natural birth desires in the face of this intervention, with an air of really giving up. Happily, she went into labour herself the day before she was scheduled to be induced. It went off and on all day, and we stayed in touch by phone. I ended every conversation by telling her I was ready to come whenever she wanted me there. She finally called in the evening to say it was getting hard and she needed help. I found her in what I judged to be early labour, contracting hard and fast, q2-3min, but only lasting 30 seconds. No bloody show at all, waters intact. Having a hard time, but talking between contractions.) She had started at 4:30am, so I figured there were many hours to go. Things started to change after I'd been there an hour and a half or so, and I thought we were seeing a move into active labour.

(Vomiting, then into the shower, then back and tearful. Her waters releasing while sitting on the birth ball, clear, still no show. Contractions finally seem to be lengthening a bit. I thought we were seeing the 4cm mini-transition women sometimes experience.)

That would mean we still had a few hours to go. A bit later she says she thinks it's time to go in to the hospital. I've been there for two hours. Her husband gets her clothes, I start getting her up and ready. Then, she makes a funny noise during one contraction, and I look at her when it's done and ask if she was pushing just then. She says something along the lines of, "well *yeah*." I'm trying to figure out what to do, whether to dash to the car, when the next contraction comes, she puts one hand on the wall and says, "Call 911 - the baby's coming!"

The next ten minutes are a mad dash of activity. I help her get to the living room couch while her husband calls 911. I can see he's being questioned about me by the operator, trying to explain the difference between a midwife and a doula, so I grab the phone and send him for towels and green garbage bags and a bowl. I get royally yelled at by the 911 operator for having allowed this situation to develop. I keep explaining that I'm a doula not a midwife, that I have no clinical skills and have *not* assessed this woman's dilation. I know the baby's coming because the mother says so, and I've seen pushing before! I finally tell her, very firmly, that regardless of whether the birth is immanent there is no way in hell we're transporting this woman and would they just send the damn ambulance!

Meanwhile, my client is just *roaring*. I've rarely heard a woman make such a powerful noise pushing. I am having no luck encouraging her to pant to slow the birth. At first she would not open her legs and let me see what was going on. (I should add that when she first lay down on the couch and I tried to take her underpants off, she was sufficiently with-it to suggest I just cut them off with scissors!) When she finally opens, I can see a toonie's worth of baby scalp. I look at dad standing by mom's head and ask him if his hands are clean. He looks very confused, so I tell him to go wash his hands. With the next push the baby is born to the eyebrows, while dad stands in the doorway with water dripping from his hands. So I holler at him to come back and prepare to catch his baby. As the head is born, I notice flashing lights through the living room curtains. We try to check for a cord around the neck, but by the time I can figure out what I'm doing, the body is born, sliding into her father's waiting hands. She takes her first breath as a knock comes on the door. I leave the parents and go answer the door to the fire fighters and paramedics. I then run back to the couch and instinctively pick up the baby and place her on her mother's chest and cover them both. This keeps the baby warm against the draft of the open front door, and presents a view to the emergency crew of mother and child as a unit.

The paramedics are fantastic! They never separate mother and child, examining the baby and clamping her cord right where she lies. They administer blow-by oxygen to the baby, not because it was really necessary, I think, but because they felt like they ought to be doing *something*. They sit and chat while everyone calms down. There's lots of laughter. Meanwhile, I catch the placenta in the bowl dad brought. Apparently the paramedics have forgotten about the placenta part. They wait for mom to breastfeed for the first time, and then wait while mom goes to have a shower! Mother and child are finally transported to the hospital, at mom’s request, to be checked out one hour after the birth. The baby rides in her mother’s arms. Baby is 9lb14oz - big! I wish I knew some way of having someone come and check on them at home so that the hospital visit would not have been necessary, but I don't.

The parents are both very excited about what happened. Dad is very proud of catching. I worry that the next day they'll start thinking of what could have gone wrong, and may question why I didn't tell them to go to the hospital earlier. My fears are unfounded, however. They remain absolutely delighted. The mother is convinced that everything wonderful about her child is due to having been born at home. She has become an advocate not only of home birth, but of unassisted birth, after I told her about the interventions that would have happened had midwives been there. It's a little over the top, perhaps, but this has become a tremendous source of strength to her, and testimony to the transformative power of birth. The "my body is strong!" statement is her in the shower 45 minutes after giving birth, after roaring life into the world. Cool.

I'm thinkin' I should carry a few basic "surprise" supplies in future - a couple of pairs of gloves would have come in handy, and some cord clamps and scissors might be a good precaution, although perhaps not without some training in when they’re really necessary. I’m also going to be a little more vigilant with second timers in the future – I’m accustomed to the pace of first babies. The parents are writing a letter of complaint to the 911 folks. :-)
Oh – further interesting fact: this woman had uterine surgery a number of years ago to remove a cyst, so was considered a vbac for her two births. Just so you know. :-)

And as for me, I think I've found a friend.

PS - 24 days later, breastfeeding is going well, and after a moody week or two during which we talked daily and I visited two or three times a week she's coping and stable and her family and friends are telling her how relieved they are at how much better she's doing after this birth compared to last time. She is learning to trust her herself in a variety of ways, and she is processing relationship and past loss issues in ways that do not feel scary to her. She rocks.

***

So now it’s a couple of years later. We’re still friends. In the end she ran into milk supply issues at around eight months, but there seem to be some physiologic reasons for that – I’ve seen some research on the connection between PCOS, obesity, and the late onset of low milk supply. She also sought counselling for postpartum depression in the second half of the year. So, a good birth hasn’t been a miracle cure, but she’s naming problems and facing them head on, which is great, so we’ll take it.