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Homebirth To Surgery

The latest birth story published on this blog is a ceasarian section. Originally the parents wrote it as individual accounts, but I have merged their stories so you can compare it from both perspectives. I did think of including my story too but that leaves it open to a tirade of unsolicited and unwanted comment.

Instead I will talk about transfer to hospital.

There are situations when without doubt you need to transfer to a hospital. Although these occasions are rare, they are quite self-apparent and require little discussion. The client knows and trusts you and will appreciate immediate action is required.

What about the other times? The time when it feels that every possibility has been exhausted and further options are running out. This is open to interpretation. I have no hesitation in spending days with a woman who has a meandering labour so long as she is rested and has plenty of food and fluid. Given time the baby will be safely born.

I don’t have any expectations so long as the mother and baby are well. As a midwife I do have a drummed in sense of where progress should be, so I do not use vaginal examination as an indicator of women’s “progress” as this interferes with the less intervention philosophy. We know that active management of labour doesn’t lower the ceasarian rate, as shown by O’driscoll, so putting fingers into a woman to assess her progress is pointless. However VE does have a place in determining the baby’s relation to the pelvis and the labour.

In some cases labour doesn’t fluctuate but is continuous and relentless, these women usually birth quickly and easily. So at what point is it right to suggest that something isn’t progressing as experience tells us it should? I spend lots of time thinking about this. As a homebirth midwife my expectation is that 95% of the time everything is fine. In the absence of a mother or baby issue it is difficult to conclude that every possible avenue has been followed and perhaps changing the place of birth and asking another opinion is the right thing to do. This is a very hard but important part of practice to reflect on, especially since the right wing obstetric opinion is that homebirth midwives are either unskilled or don’t care about anything but birthing dangerously at home. This couldn’t be further from the truth.

The couple who have kindly told their story are a young, enthusiastic and health conscious pair who’s expectation was that birth would be exciting and beautiful at home in the security of their family.

When it was becoming clear to me after the first day of relentless labour that we seemed unable to change the position of the baby and nothing we had tried had helped her to be ready to push the baby out, it was with a huge sense of failure that I asked them how they were feeling and also revealed to them how I was feeling. We didn’t act immediately but once again tried the strategies known to work. Numerous hours down the track where it was now obvious to them that we didn’t seem to be able to change anything the couple decided to alter their place of birth, but not their plan to birth normally.

Here is where I find it very difficult to sit. I have a 6% transfer rate, which to a free-birther is high but to midwives working in other environments is very low. I don’t rely on opinion to drive my practice but I constantly use it to reflect and learn.

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midwife assumes role of photographer during surgery

At the hospital the midwives, Registrar and Ob were fantastic. It is very positive when hospital staff are respectful of all views and try to facilitate working with women.

We remained at the hospital for 14 hours after admission before the clients consented to a section and every available source of help was offered to us. The woman remained at the same dilatation for 22 hours before her section (and as most of that time was at the hospital it can’t be put down to a hippy homebirth midwife encouraging a woman to stay at home). In this case the hospital staff were incredibly supportive and we even managed to have the first recorded lotus placenta with the Ob saying, “that was easier than I thought Lisa, we could do that again”. Not too soon I hope!

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Lotus placenta following surgery

I don’t think many midwives/obstetricians who deal with intervention and caesarian sections every day understand how devastating an experience it can be, even when it is unquestionably necessary. A woman may take many months to come to terms with it and a sense of failure is something we share.

I love this family very much and have spent countess hours wondering if I did the right thing. How many obstetricians do this unless they are charged with professional misconduct? Also, because I have on going contact with the families I birth with I try to help them to make sense of what happened, when sometimes I need to make sense of it myself.

Jonah and Katie’s story was given to me with love along with the pictures. They were received the same way.

One response to “Homebirth To Surgery”

  1. Amy Gow

    Lisa,
    I really appreciate reading this today. I’ve cried with families as they’ve made the decision to consent to a cesarian section after long, hard labours. I have a profound respect for the mystery of birth that only deepens the more I am exposed to it, and I think it’s important that we question each and every time we need to “fix” it. That said, it makes it hard for me keep in balance sometimes and to accept that sometimes bad things happen.
    Thanks for helping me to keep it all in perspective, just knowing there’s someone else out there that’s feeling the same way makes it all a lot better.
    Amy