Writings From a Midwife

This is my 28th year as a midwife…and every day I reflect on the learnings which have come with time…and experiences in hospitals and at home and with my treasured clients in private practice x

I thought I should start documenting some of these learnings, perhaps for future midwives or young and/or energetic passionate midwives to read and hopefully gain wisdom from…so I have decided to write some birth stories from my perspective as a midwife (with the clients permission of course). Over time I plan to publish these writings in this blog…so happy reading!

I learn soooooo much through my clients and their experiences, many of these are from clients who come to me after previous traumatic births…in the aim and hope that their next birth may be a better, and way more positive experience x

One of my clients came to me after having two babies, her births were horrid to say the least!. First pregnancy (GDM on Insulin), otherwise uneventful pregnancy. Got to fully dilated, baby’s head never came down, failed forceps with an episiotomy, then a caesarean (an absolute horror story if you ask me)!!!!

Second birth she had a hypoglycaemic episode at term (GDM on insulin) an induction, stretch and sweep, tonic contractions to follow, then an ARM with a prolonged fetal bradycardia and another caesarean…another awful experience. She started to no longer trust her body.

 Third baby she came to me…to see if it was possible to ‘try’ for another vba2c. A few ideas were suggested…lots of support with her diet in trying to keep her bsl’s under control, no insulin and instead metformin if diet support alone wasn’t allowing for stable blood sugars. She had had so many hypoglycaemic episodes on the insulin, it was to be avoided unless needed as a last resort.

I also suggested no intervention in labour WHAT SO EVER! This means no VE’s, no IOL, no ARM augmentation NOTHING but pure physiological labour…and if any of the above were ‘truly’ needed then it might be best to have a planned caesarean…and my client agreed.

So on the big day, when regular contractions were reported, I went over to my clients home, and kept her there until her contractions were powerful, and she had small beads of sweat under her eyes! I had a feel of her tummy only, and baby’s head was well engaged, in fact almost all in the pelvis, which was a significant change from the day earlier, which is a sign of excellent progress. All the while I kept a close eye on her baby’s heart beat with my trusty little doppler, her pulse, and her bsl’s x

It was time to go into hospital as planned…her husband was so nervous that another family member drove her and I followed in my car. She was under strict instruction not to enter the hospital front doors until I had parked my car and I was there with her. This was because she was planning a vba2c and she may have met someone at the hospital who insisted on taking her straight for a caesarean because she wasn’t ‘allowed’ to ‘try’ for a vbac.

We got to the birth suite doors, and no one would answer the bell…I pulled out my doppler and heard a perfect FHR just above the pubic bone, and the FHR was best heard very central just above the pubic bone. The woman was making grunting sounds and I knew baby wasn’t far away! I whispered in her ear that her baby seemed very well and that the delay at the front door was a blessing, no one hassling her for examinations, or drips, or wanting to fiddle in some way. This delay was giving her time to bring her baby down without other peoples thoughts and advice influencing her.

Eventually the door was answered and we were ushered into a room…a Dr tried to put a drip into her hand, obviously incredibly junior as she didn’t recognise the guttural sounds that my client was making, birthing energy, the power coming from her mouth and body…it was unfortunate that she had to be subjected to this while in such advanced stages of labour, but for me I didn’t ask her to stop as it was buying my client more purely physiological time…then a massive GUSH! Fluid everywhere…time to wrestle with her underwear and what I saw was her wee boy’s head crowning with long black hair on his head. Again I whispered in her ear…this one is coming out the way nature intended❤️ 

My beautiful client taught me that my intuition to not intervene in any way with her third birth was the way to ‘care for’ my clients, especially vbac clients…and I’d like to talk about each of the main reasons why I felt this way, and how this has helped me care for future clients…

VE’s. The stimulation of the cervix through VE’s causes a surge in hormones such as prostaglandin, and in her case with her second birth, caused a precipitate labour and a fetal bradycardia, and another emergency caesarean. I could write a lot more about the limitations of VE’s and especially routine vaginal examinations, but I will leave this for another story…

Education about diet, and then Metformin rather than Insulin if needed at all: 

Since my early days as a midwife, I feel the management of women with gestational diabetes has changed significantly. We used to spend a lot of time educating women about diet, what worked for them food wise, what spiked a bsl rise…instead now its like there is a bsl rise…straight on insulin. It could be a resources issue, but still women are becoming the victims of this. Once a woman is on insulin a lot changes in her care…one example of this is induction of labour (IOL) is recommended around 38-40 weeks gestation…and the implications of IOL on a first time Mother is that it increases her chance of having a caesarean to 50%. Because my client had experienced hypoglycaemic episodes in her previous pregnancies, then I thought if needed Metformin might work better for her and it did, with much more stable bsl’s…

When at home with her third labour, I placed my hands on her pregnant belly, both hands spread across, and I felt the power, the beads of sweat under her eyes and on her brow told me for sure that this was as powerful as it gets…her voice, the sounds she made told me where she was at…there was no need for VE’s, no need for anything in fact as she had her own power, in her own time, on her own clock…

And the result of this was a spectacular physiological birth…spectacular is an understatement!

x Juliana

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