Why don’t we have more births like Marina’s in U.S. hospitals?
My focus is helping women have the most optimal birth experiences possible, whether they are carrying a healthy or high- risk pregnancy, and whether the birth is happening in a huge medical center, a birth center or in their home. Newborns clearly can have gentle and loving arrivals in all of these settings. But when I first began to attend home births I was surprised how women behaved differently in labor in the privacy and comfort of their own home than I had seen in my many years of hospital births. They moved more freely and sensuously from room to room and I saw behavior I had never seen before. We need to adapt the hospital environment so women are more relaxed and also feel this freedom to move instinctually in that setting.
Marina and her husband Mark came to me wanting holistic, prenatal, birth and newborn care. Marina is a tall, vivacious redhead who was 32-years-young when we first met. She has a Master’s degree in Social Work and is actively involved in promoting health and well-being for children through a variety of agencies. Mark is an archeologist, who when not in the field, works from home. His boyishly handsome looks and happy demeanor are heartwarming. He continues to be one of the most loving men I have ever met. Marina’s interest in professional midwifery care was sparked by her older sister’s two births with Nurse-Midwives; the first in a hospital and her second a home birth.
Marina received full prenatal care, including an ultrasound, during her many office visits and one birth preparation visit in her home a month before her due date. My birth assistant Ramona accompanied me to the home visit. Ramona has attended many births in hospitals as a respiratory therapist, childbirth educator, and doula. Doulas provide physical, emotional and informational support to a mother and family before, during, and shortly after birth, but they are not clinicians.
It was Wednesday, June 25th, four days after her due date, when I arrived at their cozy home, tucked in a corner of oak forest, for her labor. Marina had been having mild “waves” (contractions) for two days but they had now been every five minutes for several hours. Sunshine, a lovely doula and birth assistant-in-training, whom the couple had met before, was with me and I would call Ramona when labor was more advanced. Mark and Marina’s sister were attentively tending to Marina’s needs.
“My back aches,” Marina stated and I was soon to realize why. She was 4 cm dilated (10cm is when most women begin to push), and her cervix, the opening of her womb, was almost completely thinned out or effaced. The baby’s head was down, the back of its head was on her left side, which is ideal, but the infant’s head was not well tucked yet; its chin wasn’t close to its chest, which is more commonly found. Also, the baby’s head was tilted (one ear tipped towards its shoulder). I would monitor this but expected it to resolve on its own. This explained her achy back, and I was glad the back of the baby’s head (occiput) wasn’t turned toward her spine, which may require my needing to turn the little one’s head if it didn’t do it on its own.
Marina’s vital signs and her baby’s heart rate were normal. We monitored the baby’s heart rate regularly using our handheld ultrasonic Doppler. Marina was focusing on keeping her breathing deep and we encouraged her to let go of each wave when it ended and to rest between them. The laboring woman eased into the deluxe labor tub that had been set up in their living room. Her muscles relaxed and her breathing deepened once she was immersed in the warm water.
At 2:40 am Marina moved to her rocking chair. She was drinking fluids well but we could tell from urine dips that she wasn’t getting enough calories. “Drink more Recharge (natural Gatorade),” we told her as she got into her patio hot tub. “The baby’s pressing down,” she announced as Ramona massaged her feet and some acupressure points. The waves were washing in steadily every 3 to 4 minutes at 5 am when Marina got back in the living room’s tub. Her achy back felt best when she was on her hands and knees, and Ramona provided expert comfort by massaging the area.
As the sky lightened her cervix opened to 8 cm. The baby’s head was well tucked now, though still tilted. She seemed extremely uncomfortable suddenly, so I advised breaking her bag of waters. “It can actually bring you relief” so Marina agreed, and clear liquid flowed. Tensing more with the late labor waves called transition, we administered a few drops of “Rescue Remedy,” a flower essence formula effective for calming and relaxation.
The sun had been up about an hour when Marina announced with the classic grunt, “I want to push.” An encouraging red splash on her inner thighs (bloody show) also signaled labor was switching gears. She was moving from the phase of surrendering to the waves to actively helping them bring her baby out into the world by pushing. I encouraged the remaining thin “lip” of cervix behind the baby’s head, and the child descended towards the exit even more. She moved to the birth chair, and we exclaimed, “Marina, we can see your baby’s head!” Her eyes widened as she reached to touch her awaited one for the first time. “I feel hair,” the young mother said softly with awe.
Our tall redhead stood. As the summer sun’s rays warmed the home, I sat on the floor behind her, applying a warm moist washcloth to her opening. Her mother arrived, camera in hand, ready to photograph the wondrous event and Mark sat on the couch, facing his standing wife. Marina leaned forward laying her forearms on his thighs, as he encouraged her. “You’re doing great Honey, you are doing great, the baby will be here soon.”
As first ones do, the baby’s head advanced three movements down and retreated two. The warm compress invited relaxation into the stretching sensations and the soon expected “ring of fire.” “Don’t back away from that intensity, push gently into it,” we advised. Birth instruments were next to me in their green cloth sterile towel. Our equipment, including medications, oxygen tanks, IVs and more was within reach if needed.
Sunshine spooned blackberry honey into the pushing woman’s mouth. Now I understood why the head had been cockeyed; the child’s hand was on its head! Though this is not common, it isn’t concerning either. I applied gentle pressure against the baby’s head to slow the birth while holding the elbow close to the soon to be born’s body, and the wet newborn squiggled into my hands.
I gently dried the baby with a warm, soft receiving blanket as I checked the skin color and muscle tone. The child looked about while the pulsing cord continued to provide oxygen. We would not cut off that supply of oxygen for at least several minutes.
“Marina, take your baby” as I passed the fresh gift between her legs. The relieved mother, who had been awake the entire night, took hold of her precious treasure and stood tall. She tucked the now breathing, naked bundle into the crook of her left arm gazing at her newborn as astonishment stilled her breath. That indescribable miraculous moment, when the intense sweaty primality transmutes instantly into boundless wonder was upon us. “It’s a girl,” Marina whispered. This new mother had walked through months of dreams, fears, anxieties and, more recently, fatigue, but now the exuberance of victory flooded her. I was joyously stunned as I watched what this triumphant woman did next. Closing her right fist, she pumped it into the air three times, exclaiming to the summer morning, “That was great, that was great, that was GREAT!”
Vanita Lott, Certified Nurse-Midwife, Transformational Holistic Pregnancy Coach
Founder of Awakening Birth Now.com, Awakeningbirthnow@gmail.com