A Small Story with A Big Meaning
Monday, 15 December 2008 10:43
My meeting with Claire and David was preceded by a week of hidden anticipation. I say hidden because I pride myself on being able to provide whatever midwifery care is required in as calm a manner I can muster, and my friends at the surgery were teasing me about swimwear and snorkels and cellulite (mine). Why? Because Claire and David desired a water birth at home. I was excited. The inspiration for a water birth came from Claire. She explained : “knowing about water birthing I had decided that I wanted my baby to be born underwater a long time before I was pregnant. I come from France and my mother is a Rebirther, therefore I am used to alternative methods of healing. Water birthing is linked with my research of a better world, better humanity and better relationships between the beings. The birth trauma is a big blockage at the beginning of a life and to progress in any field we have to solve this problem or blockage before going further, and we should use anything that allows us to eliminate or at least reduce it. I have done a lot of reading about dry birthing and especially water birthing as a kind of re-experience, and have now gathered a real information file about the birth”. I am really impressed by Claire’s search for her goal; obviously she had knowledge of water birth but her efforts to attain it are an achievement. It started before she left France in July 1989. She had letters of response from : 1. Marie Stopes House, London 2. The Maternity Alliance, London 3. N.C.T. 4. Ben Bartle, Prosperity Consultant – Ref. to Jane Arnold, London. British Rebirthing Society, London. 5. International Active Birth Centre, London, who provided a very comprehensive list which included : a. Society to Support Home Confinement, Lygate Lane, Walsingham, Bishop Auckland DL13 3HA. b. N.C.T. London. Alexandra House, Oldham Terrace London W3 6NH. c. A.R.M. 62 Greetby Hill, Ormskirk, Lancs. L39 2DT. d. Ass. Ind. Midwifes, 65 Mount Nod Road, London SW16. e. Health Rights, 344 South Lambeth Road, London SW8 1UQ. f. R.C.M. 15 Mansfield Street, London W1. g. M.I.D.I.R.S. Westminster Hospital, Dean Ryle Street, London SW1. baby born underwater h. International Home Birth Movement 22 Anson Road, London N7 0RD. Claire was 27/40 when I met her at the booking clinic in Biddulph, Stoke-on-Trent. She had, of course, already met Dr. Smith who was slightly nonplussed but did not discourage her. He referred her to me, a N.H.S. Community Midwife, who believes in the absolute and undeniable right of the woman to choose the method and place of birth, if normality prevails. Midwifes are required by law to give this service. My aquatic training began. Claire gave me copies of numerous reports of babies born in tubs and I also read : Ideal Birth – Sondra Ray Models of Love – Joyce and Barry Vissell Life before life – Helen Wombach Water Babies – Erich Sidenbladh – about the work of Igor Tjarkorvsky who has been delivering babies in water for 27 years. This was the one. I wanted Claire to have, without reservation, the birth for her child the equal of which could only be matched, but not bettered, anywhere in the world, and I wanted her to have it in the way that is available to any other woman in this country , and I wanted to be proud of it. Meanwhile, I informed Miss Beech, my A.D.M.S., who came with me when I visited Claire and David at home. She gave warm and whole hearted support; came up with a checklist from a hospital waterbirth, which I found useful; took Karen my support midwife, Carole another midwife who had a mother vaguely interested at the time, and myself to Birmingham to see the tub used by them, and to speak to the midwife who performed the delivery, who happened to be too busy anyway. I was furnished with a bleep so that I could have my holiday knowing that Claire could contact me anywhere. A video show was arranged of Roger Lickey and his tub in Cornwall, but this fell short of a full water birth to me as, by this time, Claire, David and I are aiming for the ultimate, and propose to leave the baby submerged until the cord pulsation slows down, thereby giving the baby the total benefit of a recovery time in an element more familiar and favourable to him, and only introducing him to air itself slowly and gradually. The baby has Claire’s pregnancy continued in a favourable manner and regular attendance at the local swimming baths (3-4 times a week) helped to maintain her general health and well being. The due date of the baby was 23rd December 1989, and the wished for date was 25th December 1989 – I did wonder about the publicity. An important date before that was the arrival of Claire’s mother, Mireille, from France. She had been a professional teacher of problematic children and she was a Rebirther, something completely new to me. I was really very pre-occupied with the preparation for the water birth and my other work that I was unable to learn about Rebirthing, but Mireille promised to come to our branch of A.R.M. in the New Year and introduce it to us. David and/or Claire would come along to interpret. Mireille’s English is good but she feels a little slow. Mireille will be with us for the birth and will be helping Claire to cope with her labour. Claire and David’s birth plan is really very simple : 1. No drugs. 2. No intervention. 3. Unobtrusive midwifery. 4. Total water birth. 5. Bury placenta in garden. We had a full blown rehearsal on 12th December 1989. Miss Beech, Karen, myself, Claire, David, Mireille and the electrician to check for safety of the tub. Everything was satisfactory. I was presented with the bleep and David tested it and recorded the number. We all took tea and tasted Claire’s home baked bread, which set Miss Beech off thinking of her continental holidays. I had a wonderful holiday the week leading up to and including Christmas Day, my very favourite time of the year, and this year it held a special promise. I visited Claire once during the week to do antenatal checks, arranging to see her again in one week. The baby was in a posterior position and his head was not engaged, and there was no weight gain since 37/40. 28th December 1989 Claire had a readjustment to make because the baby did not arrive on Christmas Day, there was a natural dejection present. She was now term + 6 days. She also felt that the baby was sulking with her. We decided that the baby preferred to choose his own birthday and we would trust him, but Claire still had some tension, probably because a suggestion had been made that if she arrived at term + 10 she must deliver in hospital. In view of this we discussed making an arrangement for Claire to see a sympathetic obstetrician. I also felt the need for reassurance and support for the following reasons : 1. No weight gain since 37/40 weeks. 2. Non-engagement of the baby’s head. 3. Long holiday period ahead of three days with minimum staff. Plan for 29th December 1989 Ultra sound scan 10.30 a.m. This showed a smaller than average baby. Liquor lessening otherwise N.A.D. Appointment with Mr. Grant at Leek Memorial Hospital. Monitor for 30 minutes before seeing Mr. Grant. This was satisfactory. Mr. Grant gave calm reassurance whilst agreeing with the diagnosis of baby’s head being 3/5 above the pelvic brim. He suggested another monitoring in a day or two and said he would see Claire again on Tuesday week at the North Staffs. Maternity Hospital. We had another eleven days. Claire and David were happy and relaxed. 19.00 hours, the same day Claire is experiencing some abdominal discomfort and has entered the tub. I arrived to find Mireille giving Claire a facial massage to help her to feel better. The usual observations showed that all was well. An underwater vaginal examination disclosed a ripening of the cervix and the head entering the pelvis. I stayed a while and we talked with gentle anticipation of the experience ahead. We all decided to go to bed and seek some sleep. I slept well, confident that I would not be needed during the night and feeling that we were all well prepared. 06.30 hours, 30th December 1989 David rang to say that Claire’s discomfort had continued all night and that she had entered the tub again. I waited until 08.00 to ring Karen, who was also on duty, so that she could prepare her day with us in mind. My re-examination of Claire showed some effacement of the cervix and 1+ cm. dilatation. The station of the head remained the same, all other observations were normal. Claire was coping very well with the contractions which were short and sharp, about every four to five minutes. I made some preparations and commenced the partogram. I then left arranging to come back at 13.00. The word was about in Biddulph and I received a few phone calls. I reported, as arranged to Mrs. Thomas, and agreed to keep her informed through the day. I also told the G.P. on duty but he did not feel the need to visit as Claire only wanted the minimum of distraction. Karen rang me about midday, I was feeling that the labour would be a long one, we planned that Karen should rest in the afternoon ready to relieve me later on. 13.00 hours Claire and David are in the tub very absorbed in the labour, moving and adjusting in a very emphatic way, the plan to take photographs forgotten. A lot of low back massage is needed and David knows just how to do it. The vaginal examination showed a fractional increase of dilatation, the head was a little lower, the contractions were causing Claire to be very distressed. Indeed she cried out loudly, she said that it helped her to call out. David looked shaken by her obvious travail. Her mother was offering tremendous but unobtrusive support. She gave me a mischievous smile when she showed me her swimwear under her thermal and woollies (she has been feeling the cold). She will enter the tub only if Claire invites her to. I thought about my theatre suit. I was, at this time, experiencing a feeling of helplessness. I wanted to help Claire. I closed my eyes and pictured a scene. It was like a Leonardo da Vinci drawing of an open uterus, the baby was in a posterior position, the head was not engaged, the cervix was 2 cm. dilated. I mentally rotated the baby, gently flexed the head into the pelvis and insisted that the cervix gave way. It was so clear and strong. I asked Claire to maintain an upright position to aid the descent of the baby. She responded well. At about 15.00 I left, again arranging to come back at 17.00. I needed to be somewhere that I could examine my negative thoughts and feeling and set the scene ahead in plenty of time in case we needed any medical help. At 16.00 I became very restless but felt that they would be alarmed if I returned before I said I would. However, at 16.15 I decided to go. On arrival I found that it was really quiet now and serene and David said “We have experienced some changes. Claire is pushing down now with her contractions”!! 16.30 hours Claire had adopted a kneeling squat position and was not happy to move, so I examined her in that position. What an astonishing and wonderful surprise, lo and behold an egg-sized portion of the baby’s head was apparent. I phoned Karen, my voice sounded rather trembly. I had not time to put on my theatre suit, I couldn’t see the baby so I had to feel. I just kept my hand gently cupped over the advancing head and lightly felt the condition of the labia and perineum, Claire asked me to stop so I did. David had adopted the same position as Claire behind her and so was in the perfect place to look into the face of his son as it was smoothly and gently delivered. The baby looked patient and calm, a little cloud of pinky mucous floated out of his mouth, restitution took place as I checked for the cord, and I eased the shoulders out with one hand and floated him under his mother’s body, and she took him into her hands at 16.44. David was overcome with emotion and leaned weeping his gratitude onto Claire’s back and as the baby boy came into his mother’s vision he opened his eyes and looked up through the water into her face. He looked so calm, wise and reassuring, I felt that he knew all that he would ever need to know of any importance. He gave me the confidence to leave him under the water. I held his cord and he held my fingers. David came round to the front of Claire and they were together. Claire made little murmurings, apart from which it was quiet. From time to time I said “His cord is pulsating strongly” Congratulations abounded, hugging and weeping with joy and relief – including me – there was nothing to do but experience this fully. I was so sorry that Karen had not been with us, she had given me such support that I missed her. Zenon’s cord did not stop beating until about 17.05. I asked Claire to rise out of the water and the placenta delivered at 17.10 into a receiver quite readily. The blood loss was minimal and then Claire sat back in the water again and we separated the cord. In Claire’s own time she retired to the bedroom and offered her son the breast. She sustained a tiny posterior vaginal wall tear and a little labial laceration which were not sutured, and presented no problem in the days to follow. Zenon weighed 3.000 kg. or 6-10. He continued to suckle at will and Claire recovered normally. I visited one evening and David and Zenon were in the bath together, and he has a bath each day with one or other parent. The tub has been returned to Bristol now and Abel B’Han said that out of 100 tubs borrowed 50 of the babies were born under water. He did not say how many spent their first minutes there. I have to say that this experience has been the climax to my midwifery life and fulfilled a lot of my beliefs. It has been a privilege.