A day in the life of a midwife

The telephone rings, it’s 2am, my colleague is calling to tell me it’s the time. After 3 days of increasing contractions, they have reached the strength we need to bring this baby into the awaiting world. I rub my eyes and wake myself up and feel a moving sense of excitement about the coming birth. This has not been an easy journey for this new mother, choosing natural birth in an ever growing culture of birth medicalisation in India and going against her families wishes has been very difficult, to say the least. But this mothers strength and trust in her body and her inner wisdom to birth has never wavered. Her determination to have a natural birth has meant months of preparation, both physically and mentally. She’s attended exercise classes, walked every day, changed her diet and focused on achieving the optimum health and fitness ready for this day, and the power that her body will need to get through this labour to hold her baby in her arms. My husband wishes me luck and I head off to the birth centre on my scooter with the warm Indian breezy night leading the way. As I approach the birth centre, I can see the lights of the centre on as chechy prepares the room for the arrival of the mother and her husband and I feel warm inside. The mother arrives at the centre, puffing and panting, looking like a birthing goddess, us midwives look at each other and smile a big knowing smile- we can tell that baby is not far away. Upstairs to the birth room, birth pool running, hot water bag on back, husband massaging and offering sweet words of encouragement. The mother is swaying and groaning as each contraction helps her body to open and move baby down, steadily closer and closer. In to the pool, the mother sighs with relief as the warm water soothes and calms her working muscles. It’s not long until we see signs that baby is making their way to the outside world. Strong deep groans and pushes brings baby closer and closer until, eventually, we can see the top of baby’s head. The mother reaches down and touches her baby’s head and with this can feel how close she is to meeting her baby but also finishing this marathon labour that she’s put all her heart, soul and strength into. Baby moves forward little by little, until her head is born, followed soon by her body, we reach down into the water and pass baby to her mother. The baby immediately opens her eyes and feels the warmth of her mothers skin on hers, her heart and breathing start to regulate and the bond between mother and baby increases even more than has already started while in utero. Us midwives smile, sigh with happiness and shed a tear or two. The oxytocin and love in the room is palpable. Birth never gets tired, every birth is so special and such an honour to be involved in, including those with the challenges that inevitably every woman will face in one way or another. Every mothers journey is so individual and their fight is so different. Being a midwife, supporting and building relationships with women and their families has changed my life and the way I feel about the world in so many ways. I can’t think of anything I would rather do.

 

How I (met your) became your mother(Part one)

In my late teenage years, many influential factors (none of them scientific) give birth to a notion in my head.

“When I have kids, I will have a normal birth”

Little did I realise that, that small concept from my immature brain was going to be the stepping stone towards a beautiful and gigantic transformation of my life.Carrying this thought with me, I completed school and went on to pursue my Bachelors degree in Nursing and Midwifery, wherein, I confirmed that a normal birth is

-exactly what I wanted,

-absolutely possible

-definitely how a birth should happen

Like most Indian girls, after college, I got married off. I started my career working in a corporate hospital and I realised that there is a huge difference between theory and practical. Theoretically, we study a lot of things but practically we follow in the footsteps of our seniors. It didn’t matter if it was right or wrong. It was just easy to follow and continue what they did, rather than trying to change, ask a million questions and in response, receiving blank or angry stares that fuse our brain.

Then came the big news, “I am pregnant!”. Excited, me and my husband decided on the best hospital near my hometown. At my first visit, I ensured that the doctor knew that I wanted only a normal birth. Each visit, I would emphasize on normal birth.

At 36 weeks, the doctor tells me that my baby has IntraUterine Growth Retardation (IUGR) and that I have to get admitted the next day. Neither was I told, nor did it cross my mind to ask her why I was getting admitted. I just followed instructions like an obedient lamb.

The very next day, I got admitted (I had just crossed 36 weeks).

Blood Tests(Ticked)

USG(Ticked)

ECG(Ticked)

Body part preparation(Ticked)

Consent forms(Ticked)

Wait a minute, consent forms Reading through it, is when i figured out that I was going to be induced.

That night, in the hospital bed, I couldn’t sleep. I tossed and turned. If I did fade into a sleep, I would jerk awake almost immediately. Was it excitement? Was it anticipation of the pain? Was it the fear of the unknown? I do not know

Exactly at 6 in the morning, with 2 pigtails on either sides and in a hospital gown, I was taken into the labor room. A nurse came, opened my legs, inserted a few tablets and left. No food or water was allowed.

4 hours later, nothing happened. My folks were outside the labor room waiting eagerly to know what was happening. At 10, another male careprovider came, opened my legs, inserted medicines and left. He too didn’t care to explain anything. Everything was happening so quickly for me to even comprehend what was happening. When I came into my senses, I was like, “What just happened”? Honestly, at that point, I cared less as my priorities were different. But thinking back in retrospection, it was a huge invasion of privacy. Touching my body without my permission is abuse. “How could he?” “How dare he?”

At 2pm, my care provider came. She checked me. I am guessing there was no progress and so they decided to break my bag of waters. Painful as it was, it was just the spark to add fire to my agony. IV fluids with pitocin were started. There began, my confinement, my pain, contractions and what not! I was crying and screaming in pain. At some point, (I had lost the sense of time, by then) I started requesting for a C-Section for the pain was intolerable.

Through the pain, I could hear arrangements being made for my operation theatre. My gynecologist was talking to the anesthetist to see if (s)he was available. The nurses were also busy with preparing everything for me to be transferred.

Next, one last check before leaving. Lo and Behold!, the baby had started crowning. I was immediately shifted to the labor cot.

As soon as I was moved to the labor table, I felt sleepy. My contractions had slowed down which guessed was because the IV fluid with pitocin had stopped running.

What to do when the baby is sitting right there and I do not have any contractions? Some intervention is required and thus, my baby was born at 6:02 pm with the help of vacuum.I just had a glance of her and immediately fell in love with her. She was soon whisked away for all the “inside” procedures. The care providers continued doing their “thing” down there while my eyes were searching for my new found love. She was nowhere to be seen.

I  was shifted to the recovery room. My heart just yearned to see my daughter. But, alas! She was in the NICU citing high respiratory rate, observation, etc. Obviously!

Finally, when I got shifted to my room. Every time the NICU staff would call me, I would just run to hold my baby in my arms and feed her. It was difficult for me to sit and feed her but no pain in the world was going to stop me from breastfeeding her.At times, the staff wouldn’t call me and simply feed her formula which I had requested them against, but they simply wouldn’t care to listen.

4 days later, both of us were discharged. We went home happily. For me, at that point of time, the only things that went wrong were the introduction of formula and pain of the episiotomy.

But do you really want to know, what all really went wrong? The realisation only hit me when I was pregnant the second time!!!

Wait for it all in the next journal!!

Community Midwife-  BV team

Bincy shibu

 

 




Continue reading “How I (met your) became your mother(Part one)”

Why birth centres based on the midwifery model of care can make a huge difference?

Why birth centres based on the midwifery model of care can make a huge difference? It is very important to understand the caregiver’s expertise and credentials and philosophy of birth prior to choosing any place of birth.

Midwives are guardians and experts in natural births. It is equally important to understand that natural births are ones where there are no interventions involved in the birthing process. International midwives are trained in emergency situations where they can handle neonatal /adult resuscitation if required. Birth centers unlike common perception in India are equipped with equipment that are required to deal with emergency situations.

And yes they do make a difference because they respect and honour the mothers preferences like no other medical professional as far as birth and care for her newborn is covered and time and again it is proven that the satsfication in childbirth experience is the highest with midwives.They bring with them compassionate and holistic care and they are also trained immaculately to recognise when there are deviations from the normalcy of birth. They bring in undivided attention, appointments are generally an hour long, they tune in completely to you,your baby, your family, your requests and see to it that all your queries are answered as honestly as possible. There are certain facts that most people in our country do not question as to how confident and knowledgeable they are their bodies and babies.

It is true we do primarily live in a blame culture where we would like to hand over complete responsibility to our caregiver and let them decide whats best. It very important for any individual to learn, research facts/information on what they feel is right for them and their babies.

Birth centres are a new concept as far as our country is concerned and anything that is new is fraught with controversy, rigidity and mistrust. Again what most people would come ask me is how safe is it?

Birth is safe as life. Does it mean that just because a woman is pregnant she would not work/cross road/get up from the bed? Trusting birth is a crucial element and to truly comprehend that natural birth does not require technology is a prerequisite that women must develop in their minds, bodies and souls.

Midwives do not expose women and babies unnecessarily to potentially harmful interventions. Research shows that midwives are the safest care providers for the majority of women with normal pregnancies and birth. Here are some expert on research on midwifery care.

It is safe to say that a woman should give birth in a place where she feel its safe, and at the most peripheral level at which appropriate care is feasible and safe. For a low-risk pregnant woman this can be at home, at a small maternity clinic or birth centre, in town or perhaps at the maternity unit of a larger hospital. However, it must be a place where all the attention and care are focused on her needs a safety, as close to home and her own culture as possible.

Maternal and Newborn Health/Safe Motherhood Unit of the World Health Organization, Care in Normal Birth: A practical guide. World Health Organization, 1996.

Recognizing the evidence that births to healthy mothers, who are not considered at medical risk after comprehensive screening by trained professionals, can occur safely in various settings, including out-of-hospital birth centers and homes …Therefore, APHA Supports efforts to increase access to out-of-hospital maternity care services…American Public Health Association, Increasing Access to Out-of-Hospital Maternity Care Services through State-Regulated and Nationally-Certified Direct-Entry Midwives (Policy Statement). American Journal of
Public Health, Vol 92, No. 3, March 2002. In terms of quality, satisfaction, and costs, the midwifery model for pregnancy and maternity care has been found to be beneficial to women and families, resulting in good outcomes and cost savings. … With its focus on pregnancy as a normal life event and health promotion for women of all ages, the midwifery model of care is an appropriate alternative or complement to the medical approach to childbirth. American Public Health Association, Supporting Access to Midwifery Services in the United States (Position Paper), American Journal of Public Health, Vol. 91, No. 3, March 2001. Midwives are the most appropriate primary health care provider to be assigned to the care of normal birth. Maternal and Newborn Health/Safe Motherhood Unit of the World Health Organization, Care in Normal Birth: A practical guide. World Health Organization, 1996. Midwives attend the vast majority of births in those industrialized countries with the best perinatal outcomes…Coalition for Improving Maternity Services, The Mother-Friendly Childbirth Initiative, 1996

What  is a doula?

In the times before modern medicine decreed that all women should give birth in hospitals, women delivered their babies in the company of other women, drawing on their knowledge and experience. The doula – from the Greek word meaning “servant” – is a remnant of this era. Doulas function as birth support professionals, attending to the couple’s emotional needs throughout the delivery, while doctors and midwives take care of the clinical aspects of the birth process.

What exactly does a doula do?

Doulas are professionals who are familiar with the birth process and are experienced in helping guide women through the process of delivery. They can tailor their services to meet your specific needs, but most offer services that range from pre-birth planning to post-delivery counseling. A woman delivering her first child could benefit from a doula’s help in understanding the many different birthing options and in creating a delivery plan. A doula can also help coach the motherto-be on how to tackle the physical and emotional aspects of the birthing process.

During the delivery, a doula will be by your side, offering encouragements and massages, while guiding your breathing patterns and providing relaxation exercises. The doula can also provide support to your partner, who may be feeling any number of complicated emotions during the birthing process. In addition, once you’re discharged from the hospital, a doula can come to your home to help you learn how to interact with your newborn baby. For first time mothers, this support can be critical in forming a more cohesive family group and preventing post-partum depression.

How do you find a doula?

If you’ve decided to use the services of a doula during your birth, the next step is to find one! Perhaps the easiest way to find one is through the recommendation of friends and family members. Ask around – you might be surprised to find out how many women take advantage of the doula’s wealth of knowledge during delivery. Plus, by asking around for contacts, you’ll be able to get personal recommendations for specific doulas and the services they provide. If you aren’t able to find a doula through this process, you can also ask your doctor or other staff members at your hospital – many of these professionals work closely with doulas and may be able to give you a few names.

Once you’ve identified a few possible doulas, take the time to interview each of them before making a decision. The birth process is very personal, so you want to be sure you’re working with someone you feel comfortable with. When you interview each doula, consider whether or not you’ll feel confident with this woman on hand while your feet are up in the stirrups. If the answer is no, move on until you find a candidate that you really click with.

Husbands Inside the labor room-required or not.

The first thing that is most important here is to consider whether the husband is truly comfortable and whether he is prenatally educated enough to be within the labor room. I have witnessed over and over again husbands who were unsteady and unsure of their roles during their first class at B!rthvillage go full steam on ahead inside the labor room. At the same time there are husbands who have chosen to be steady support outside the labor room which is fine too.

There have been husbands who have chosen to go into the labor room directly without attending childbirth classes, again here at times there have been cases where they could not handle the situation or when communication channels have been weak within the laboring couple resulting in incompatible decisions being made with respect to inductions/ cesareans

There is also general thought process that goes around is that why make men suffer along with the laboring woman I would like to add that BEING IN LABOR AND BRINGING A BABY INTO THIS WORLD IS A PRIVILEGE AND SHOULD BE VIEWED AS ONE OF THE MOST EMPOWERING EXPERIENCES THAT ONE MIGHT GO THROUGH.

Here is my plan of action for the father to be

Love, tenderness and care for the mother- to- be is very essential right through her pregnancy and beyond. Discuss beforehand as to what you feel your role should be and her comfort levels with it. Never go on a hunger strike. Eat and drink well, this is very important in keeping your strength up. Labor and the intensity that comes with it is usually pretty strong, be prepared to handle it and hold her through as there is always light at the end of the tunnel.

Think about where you would like to position yourself in the labor room. Discuss about what coping measures would suit you and her best.

Attend childbirth preparation classes together and try to figure out on what birth and parenting options you would prefer be it natural, medicated, induced or cesarean.

We all come from different households/cultures hence a new mom should not feel upset if her husband would feel better being outside, in such a situation, consider hiring a labor support professional during this period (as they are slowly making their presence felt inside labor rooms within India and Cochin included).

Women and Their choices over their births

It has never ceased to amaze me in my classes as to how fastidious our women are in terms of choosing the latest in fashion, cosmetics , jewellery, hairstyles and conversely on how easily they give up their rights over bodies and babies. There is also a seemingly new trend of women who fear natural childbirth and the world it opens up too. The various reasons that people state for choosing their caregiver/place of birth.

The hospital is close to my house
The gynec is my relative/ aunt
Its our family hospital
It is strongly recommended by our friends
It is neat and clean and has five star status
The gynec is open and friendly
My parents recommended this hospital

Though I do not discount the above points I think it is equally if not more  important to think of the following :

  • The birth practices that are being practiced at the caregivers site (whether it is in tune with your philosophy of birth).
  • Your choices in childbirth are being honored.
  • Informed consent and refusal of your wishes.
  • Clear evidence based explanations on risks, benefits, costs of any procedures being carried out.
  • Freedom of movement during labor.
  • Complete support in initiating breastfeeding once the baby is born.
  • Exploring all options in childbirth.

We as Indians often never discuss or communicate with our doctor what we require to know and more often I have observed that we bring lame excuses to the table such as nobody has time to answer these questions, does all this really matter?

It ultimately boils down to taking responsibility for your health, your baby’s health how prenatally educated you are on various options available and making the right choices in the right places.

It is also important to remember that women and babies always remember the way they have been treated during their birthing process and on how active they were during that period which can pave the way for increase sense of confidence, empowerment for the rest of their lives(babies included).