My First Birth
So that’s a strange title. My actual first birth was in May of 2010 when I was a brand new doula. I served a sweet German family who said, “It’s okay, we’re new at this too,” when I pointed out that they were hiring someone with zero experience. The main thing I recall from that birth was wondering how much watching of the birth of the head was acceptable as a doula. I’d never seen a birth and was mesmerized but didn’t want to be weird.
Fast forward a decade and a couple hundred births later and I am in a strange world. It’s certainly not my first birth anymore and I know where to put my eyes. I know how not to be (too) weird. But now it’s me as the guide for the mother; the one helping her call the shots. I fully believe she’s in charge of her birth but it’s still me deciding if I like the heart tones I’m hearing, if labor is progressing normally or not, if that puddle of blood necessitates a shot of pitocin and what to do if the pitocin doesn’t work. When I think of this responsibility, it’s easy to panic and go back to feeling like the May 2010 me who knows just a tad-bit-more-than-nothing about what I’m doing.
Yet somehow I put one foot in front of the other while trying to get used to the title of “midwife.” In April, my license had just been issued when I assisted Patty Gross in her lovely birth center in Decatur with two back to back births. She was filling up for August so when another inquiry came in for that month, she asked if I would take her.
I wasn’t sure the family would appreciate the suggestion to use a brand new midwife but they didn’t seem to care about that at all. We hit it off right away and I was thrilled to work with such a sweet family. Because she jumped through every nutritional hoop I gave her, we were able to tackle her anemia. The next challenge was being ready for what could be a fast birth. With her previous baby, she arrived at the hospital happy and talkative-and 8cm dilated!
Rachel-who has given permission for me to write about her-lives about 45 minutes from Kueo Birth Center, where Patty had offered for her to deliver. There was a period of about 24 hours in which Rachel was contracting somewhat weakly but consistently, though the contractions weren’t especially close together. I do not check moms hardly ever but I felt a strong prompting to offer to check Rachel. I texted her and she nearly fainted with surprise that I’d suggest it. Then she said, “Yes, please.” So we arranged it for a few hours from then. I told my oldest daughter that if I called her, she’d have to bring my midwife bags ASAP. Well she was 7-8cm but didn’t plan to stay home (which is actually a missionary training site and not “home” per se). They were just putting dinner on the table and Nate, Rachel’s husband, was very surprised with her news that we were heading to the birth center right then.
As they gathered up their things and called the sitter, I went on ahead to change clothes and grab my supplies. I called Ashlyn, my oldest, who had just decided to become a doctor after attending some births with me. On a whim I asked her if she wanted to join me to be a second pair of hands in case we had a roadside birth. She agreed, thankfully.
We all arrived at the birth center-no roadside birth. Jasmin, a Kueo Birth Center midwife, joined us upon arrival. Everyone got settled and labor advanced nicely. It wasn’t too long before Rachel started pushing. She was in a very interesting position-hands and knees with her head hanging down over the edge of the bed almost like an inversion. Somehow she instinctively knew where she needed to be. She also knew she was tired so she pushed with force about every third contraction and saved her energy during the other two. Looking back, this was probably exactly what her baby needed.
Finally the head was born. It immediately turned deep purple-a sign of distress.
When I saw the head color, I knew that all the midwives I’ve ever asked were right when they told me, “Don’t worry, you’ll know,” when I asked about how I’d know the head color that indicates a bad sign. I grasped at a straw first though. “Jasmin, how do you like that color?”
Please say it’s fine, please say its fine.
Jasmin replied firmly, “Let’s have a baby” which is code for it’s not fine.
I spy a bit of umbilical cord and attempt to gently move it over baby’s head. It wasn’t tight against his neck but was too tight to pull all the way over his head. Thanks to TV, everyone is afraid of a cord but it’s truly not the dramatic issue portrayed on movies and feared by parents.
So here we go. According to Spinning Babies protocol, if the woman is already in hands and knees, you place her in running start, which is one foot brought forward and planted on the ground (…er bed) like a runner about to start a race. Jasmin noted there was no movement and said, “You have to go inside and rotate baby.”
My stomach sunk. I had known it was coming. For weeks I had envisioned Rachel birthing on the bed on her hands and knees. I’d been prompted to study for this and felt the gap in my hands-on experience scream at me prior. So in I go. My job is to turn the baby to the oblique and sweep the arm across his chest and out so as to reduce the circumference of the part of the body to be born, allowing baby to slip out. I went up the back and across the top of baby, found the arm but it would not budge. Spinning Babies did not cover this! I also felt a “pop.” Breaking a bone is not unusual and can actually be one of the tricks to resolving a shoulder dystocia but I didn’t know I’d do it in the first few seconds inside mom! When I announced I had no movement with the arm, Jasmin said, “We have to turn you over, Rachel.”
We turn her over and put her in McRobert’s position-her knees to her ears. We ask Ashlyn to come help-she’d been nearby charting. Dad has one leg and Ashlyn and Jasmin the other. Ashlyn isn’t sure how to help so she starts quoting Philippians 4:13 to Rachel, “I can do all things through Christ who strengthens me.” We’d told Rachel to pull her knees back and push with all her might but she was confused in the moment and was pushing with her legs and therefore nearly lifting Jasmin off the ground.
Jasmin goes in for an arm this time and also finds no movement. We try supra-pubic pressure-pushing down baby’s shoulder from the outside (above the pubic bone) to no avail.
A feeling of great dread and despair washes over me. I am out of ideas. I am so thankful I am not alone at this birth. Jasmin works on the shoulder from the outside then goes for the cord again and this time as she tries to pull it over the head we see more of it. Baby is truly entangled by it. I said, “We have to clamp and cut that cord.”
Midwives do NOT prematurely clamp cords when babies are out much less when they’re still IN their mother! I jump off the bed to get the supplies that are on the table right at the end of the bed. I unwrap them as I bound back up to Rachel on the bed. I speak the process out loud, “Okay clamp one is on, now clamp two. Cut!” This is for the person charting-which would be Ashlyn but she’s holding a leg.
Four minutes and thirty seconds after the head was born, the body slips out easily. There never was a shoulder dystocia. It was a “cord dystocia” all along. That cord was wrapped around the baby’s head and through the arms, all around the body. The cord kept us from moving the arm.
I knew this baby would need resuscitation help but there was no one to ask for the ambu-bag. Ashlyn was back to charting and didn’t know what I’d need, I was grabbing the resus equipment from two feet away from the bed but in my adrenaline charged tunnel vision, I didn’t see it right away. Jasmin gave baby Teddy rescue breaths with her own mouth to get him started. I started using the bag on him but couldn’t hold the mask with just one hand and also achieve a seal so I asked Ashlyn to come squeeze the bag, freeing up my second hand to make the seal. I had to tell her the count and amount of pressure but she did great.
Together we were able to give him breath while Jasmin checked his heart rate-it was always wonderful, so his body received oxygen the whole time. Jasmin was also watching for the placenta and monitoring Rachel’s bleeding-yes let’s stop and say it loudly that Jasmin was amazing! After a minute or two into “bagging” Teddy, Jasmin asked if it was okay that she called 911. I don’t know if it was the parents she was asking because it’s their baby or me because I was the primary midwife, but we all said, “Yes!” So we called for help knowing they aren’t trained in resuscitation of neonates but at least they could get us to the hospital fast. (If you’re part of an EMS team, please consider training with your community based midwives!).
As this is all happening, I’m having these thoughts:
This is a traumatizing birth unfolding right before my eyes and I can’t keep this from being traumatizing for the parents.
I’m traumatizing my daughter by having her here helping me.
This family is deeply regretting hiring a community based midwife instead of what they know-a hospital based midwife.
I’m going to lose a baby at my very first birth.
After 11 minutes of letting the ambu-bag do the work for him and one minute after EMS arrived to help, Teddy decided to carry the load of breathing for himself and let out the best sounding cry I’ve ever heard! We all cheered and decided we could breathe again too. “Praise the Lord!” came from many of our mouths. Stunned babies are expected after such a dramatic entry. They go on to do beautifully, which Teddy did.
After checking his oxygen saturation (perfect) and for broken bones (thankfully we found none-it was likely the movement of the coccyx I felt) and tucking Teddy in next to his mother and father we walk out of the room. We forcefully breathe out-maybe for the first time in 15 minutes. I’ve been reading Harry Potter and have been waiting on a chance to say, “bloody hell” (which is probably about the outer range of inappropriate words for me) but I missed my chance and a uttered a much more mundane explicative with that huge exhale. (Sorry Nate, now you can tease me about being convicted about something!)
My thoughts during the crisis were not true. Here is the truth:
It was hard and there is processing still to be done, but the parents did not let that scary 15 minutes of their birth dictate that the whole birth be labeled as traumatic.
When we walked out I immediately asked Ashlyn if she was okay and she slowly said, “That was very, very hard…but I LOVED it.” She would start her first college classes the very next week, so it was a great confirmation for her.
Rachel and Nate loved being involved in the emergency care of their baby instead of their him being worked on in a corner where they couldn’t see or be a part of it (which had happened to them before). They assured me that regret never crossed their minds.
Jasmin said that she could tell by his response to her breaths that he was going to be fine. He’s now six weeks old and thriving!
Ashlyn and Teddy
My friends who work in hospitals probably want to know why we didn’t clamp and cut the cord first. Great question! We feel strongly that babies need their cord blood for oxygen as they transition to breathing as well as for their general health. A distressed baby especially needs their oxygen supply intact. If this baby had been held back by shoulders we could have rest assured we had a little time to work because he was getting oxygen through the cord, so cutting it would possibly harm him since it would bring down his oxygen levels. It was not a tight cord, it just wouldn’t come over his head. We couldn’t know it was so wrapped around his body and arms. Also, midwives have some techniques to deal with cords we’ve noticed our hospital based colleagues aren’t well versed in.
Something else that our hospital colleagues don’t often get to see is a woman intuitively doing what she needs for baby, often unknowingly. I feel that Rachel’s position and the fact that she pushed in earnest only every few contractions was exactly what her body and baby needed in this situation. It’s fascinating to see mothers do this and the fact that we get to support this phenomenon regularly is one of my favorite parts of my job.
This first birth set some things firmly in my heart and philosophy. I love birth assistants and plan to use well trained non-midwives to help in birth, but I also plan to have a licensed midwife assist at every birth. While my birth assistant friends are brilliant and amazing, it is not fair to them to hope they can help me to that degree. I needed Jasmin’s hand in there to try for the arm, I needed her midwife brain to help work the steps together. I am praying for additional midwives in my area and west of here, as the lack of midwives out here is a hard predicament for us.
I am attending a training in Kansas next month to hone my emergency skills even more. I can practice on models and get some additional muscle memory. I am bringing colleagues with me so we can discuss and practice together once we are back home. I am working through this and other traumas I’ve carried as a doula and student midwife. I feel my mind has been tricked into thinking it’s likely something will go wrong in birth instead of it knowing the truth that birth only sometimes goes off track like this, so it’s time to address that before it gets too unruly.
How do you wrap up the story of a great first birth that had a very hard 15 minutes? I’m not sure but I can thank you for reading this far. If you’re a friend who has helped me process in the last few weeks, know that I appreciate you. If you’re a midwife I’ll work with in the future, I’m excited to have you in my life-we need each other.
Rachel and Nate, I adore you and your family. Thank you for choosing me and trusting me.