Wednesday, July 31, 2013

The Value of Waiting

One of the most valuable things I have learned in the past 7 years of attending births, is to wait and do nothing. Yes, the emergency skills are incredibly important. Yes, knowing when to step in and intervene is incredibly important.

But in my opinion and experience, it is even more important to learn that when everything is going beautifully, you do nothing. Even if labor is on the longer end of normal. If baby and mama are doing well, do nothing. Check heart tones as often as mama has agreed to, provide emotional or physical support if mama needs it. But otherwise, do nothing. If you need to bring a crossword puzzle or a knitting project or a book to keep your hands busy, do it. But don't interfere with the beautiful dance of hormones just because you feel like you're doing nothing. You should feel like you're doing nothing, because nothing is exactly what's needed in the vast majority of normal births.

When I have couples thank me after a birth, I tell them that I really didn't do anything. Because most of the time, I don't. And I'm quite happy with that fact. There have been a few recent births in which I have needed to step in and be more hands-on, and it is hard for me to do. I am constantly weighing whether or not anything could have been done differently to have avoided things leading up to needing intervention. At a recent birth, I should have asked the large number of family members present, to go upstairs earlier than I did. Their presence was clearly inhibiting her labor. I saw it, my apprentice saw it. Yet, I didn't want to overstep my bounds because I know that this mama had wanted her family there. In the end, it was necessary, and should have happened sooner. And I will be writing soon about what the consequences can be with having too many people in the birthing space.

Doing nothing is what, again - in my opinion, all Midwives should strive for in the vast majority of their births. If they learn to do nothing, women are learning at the same time that their body works beautifully as it was made to work in birth. This is what is essential in women taking back their birthing rights in our culture. They must first learn that the birth process works most efficiently when left alone. They don't need vaginal exams, being told when/how to push, they don't need someone else catching their baby (unless mama and her partner don't wish to), and they certainly don't need someone assaulting their baby with a towel and a bulb syringe and a stethoscope as soon as the baby is out of the womb.

I say that it is one of the most important things to learn, because it is one of the hardest. During a longer labor, it is hard to not want to check dilation to see what progress mom is making. But there are other ways that can measure the progress of baby's descent without being invasive. There is the ever-so-interesting "purple butt crack line" (purple line on natal cleft), but the most telling is where you are finding fetal heart tones. You'll notice that it'll start somewhere near where the usual spot is, from prenatal appointments. Then as labor progresses, you'll find it lower in the belly. After mom has been laboring well and is vocalizing low through contractions, you'll find it in the center of the belly, above the pubic bone. This clearly shows the descent progress of the baby, without ever stopping mom's hormonal dance to put your hand up her vagina. And at this point (once heart tones are found right over pubic bone), if mom needs a boost of energy and resolve? She can check herself, and will, more often than not, find baby's head not far inside of the vaginal opening. I have watched a mom go from utterly exhausted and feeling defeated, to a sense of renewal and excitement when she feels her baby's head for herself.

Walk through the checklist - Does baby's heartrate sound normal and reactive? Is mom's blood pressure normal (I usually only check upon arrival, unless I have a client whose blood pressure has been elevated at the end of pregnancy)? Are you noticing descent progress via heart tone location? Is mom making progress as far as contractions being consistent and becoming more intense? Does mom have the option of total privacy?

If all are normal - do nothing. :)

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