When Midwifery Works

by Mrs. BWF on January 4, 2012

This is a guest post by a friend of mine who is a midwife. She is also an amazing woman, wife and mother. She supports all women’s choices in birth, but at the same time always practices safe and competent midwifery, as you will see here. For those that want to know how midwifery works, how home birth is safe and what happens when it’s time to change plans, this post is perfect for just that. ~Mrs. BWF

pregnant

When Midwifery Works

I recently attended the long anticipated birth of a dear friend of mine. This birth was a planned HBAC. Her first birth was a c section at 35 weeks due to problems with one of the babies. Those babes are now robust, fun 7 year old girlies.  I was with her during that pregnancy from the day..yes the day those babies were conceived on a camping trip.

I was delighted to be asked to be midwife this time around. We’ve been through some ups and downs in our friendship over the last three years but when it came down to it, she knew she could trust me as her midwife and I knew any differences we had in the past had nothing to do with her desire for a healthy pregnancy and vaginal birth.

Of course when you live some place where homebirth and midwives are not the norm, you get looks and comments but this mama was having none of it and put everyone who offered a differing opinion in their place with a firm “It’s MY choice so shut up”. Love.

Labor commenced at 40 weeks 2 days. I was excited and went to check on her when her water broke in the early morning. She labored beautifully all day as I went to check on another midwife and her client and came back again.

She labored all through the day and into the late evening with no cervical change at all. As I examined her I could feel what I thought was a forehead and not an occiput (back of the head) and I had estimated a 9 ½-10lb baby. We tried everything I know of to get little big guy to turn but he did not.

Around 11:30pm I offered my opinion that the hospital was where we needed to be. No one was in distress, but obviously with the position of this baby I felt that intervention of a variety I could not offer was necessary. We left for the hospital around 12:30am.

We were well received and that is the reason we chose this particular hospital because they treat homebirth transports with respect because they know we do not want to have to be there. It wasn’t part of the plan.

After 2 doctors and a sono confirmed the same presentation my palpation led be to believe was true was confirmed mom opted for a repeat c section and a beautiful 10#6oz baby boy was delivered face up, brow presenting just as I had expected.

Some may see this as a failure. Of her, of me,  of midwifery. I do not. I see this birth as a success of midwifery because midwifery is not about catching babies at home. It’s about Midwives caring enough to choose the safest passage and recognize when help is needed and make hard calls that will maybe crush long anticipated birth experiences.

I spent a lot of time doubting myself and my skills, of wondering if maybe I wasn’t cut out to be a midwife of grieving this loss for my friend. Until I realized I was exactly right, and that this birth was a success because I protected my friend, protected her scar, recognized a situation that was beyond my abilities and made the call to go for help before anyone was even remotely close to being in trouble. Despite my knowing how the situation was going to be received and all the “I told you so’s “ that are likely to come from it, I put mother and baby first and chose what was best for her.

Midwifery works when midwives make hard calls. Midwifery works when despite all the doubt in your head you know what is right and you put your big girl panties on and deal with it. Midwifery works when you knowingly walk into a place that may receive you with hostility because they do not agree with your path or choices or midwifery but its what’s best for your client. And a lot of the time midwifery works when you lovingly and sweetly guide a new baby from his mother’s body into his daddy’s hands. Midwifery just works.

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{ 42 comments… read them below or add one }

Stephanie January 4, 2012 at 6:22 pm

Thank you for sharing! <3 That's so wonderful!! And I love that you were able to tell with your hands what they needed expensive medical equipment to tell.

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Kathleen Neely December 27, 2012 at 8:44 pm

funny eh ??? they doctors need all of that equiptment… and the Midwife does not LOL

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Sharalyn January 4, 2012 at 7:19 pm

Stands up, applauding. Yes! Exactly so!

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Crystal - Prenatal Coach January 4, 2012 at 8:13 pm

Beautiful! Thanks for sharing your story :-)

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sarah January 5, 2012 at 12:22 am

That is what I am talking about. Yes it DOES.

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Calmicbirthservices January 5, 2012 at 12:51 am

Thank you for writing such an awesome blog.. Each word rang true ..

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Abbey R January 5, 2012 at 12:58 am

Wonderful!!!

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Jenny January 5, 2012 at 5:04 am

Wait, why couldn’t baby be born vaginally just because of this position? Am I missing something?

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midwife January 9, 2012 at 2:40 pm

This baby wasn’t coming vaginally because in approx 15 hours of good strong labor, the moms cervix remained at 2cm & in a complete posterior position. She was a VBAC & I wasn’t willing to risk her scar at home.
On transport in the hospital she was offered labor w pit, epidural & close monitoring due to her VBAC status or a repeat c section. SHE chose the c section , it was her right & her choice but in my professional opinion, this babys position along with his size of 10#6 21″ there just wasn’t room for him to get repositioned well. We tried but I could not manually reposition his head they her cervix bc it was only 2cm & posterior.

Not every mother can or will choose the difficult birth of a brow presenting baby. I also notice this us much more difficult in a woman who has never given birth vaginally before.

But in thus case, w vbac with ROM , 15 hours of labor with no cervical change = transport.

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Trista January 5, 2012 at 1:18 pm

“lovingly and sweetly guide a new baby from his mother’s body into his daddy’s hands” …Love it! :)

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Kellan January 5, 2012 at 6:01 pm

This post makes me want to get preggo again already, just so I can experience her brand of midwifery, lol. No, really, though, LOVE the story, especially the end, since it was completely unexpected and rings with truth. Yes, OBs, hospitals, and expensive equipment are all there IF we need them – but are unnecessary in most births. With this one, I’m glad the midwife/friend realized she was in over her head and got help before any signs of big trouble occurred. Once my daughter’s older and I have a support system, I may well look into becoming a midwife myself – or at least a doula. I’ve become a birth-story junky…

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Joyful Baby January 5, 2012 at 10:56 pm

Love stories like this. I agree with Kellan, makes me want another baby! I’ve had a wonderful midwife experience and would love another one!

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Graceuco January 6, 2012 at 4:22 am

Thanks for sharing. I recently had my first. Had a doula, supportive doctor and was ready for a natural hospital birth. But after 48 hours post water breaking, I was still 1.5cm dilated and baby was -2. I found out after my c-section she was posterior. I often wonder if I had been at a home birth if things would have been different. So your post brings me some comfort and reassurance.

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CTia January 6, 2012 at 12:31 pm

Wonderful post! I love hearing the other side of when it’s the right thing to make that hard call, even when mom wanted natural oh so much. I hope I will be that kind of midwife…able to see the bigger picture. Midwifery works…and will thrive, if we have more midwives like you!

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rosanne gephart January 8, 2012 at 7:59 pm

Lovely!

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Bonnie B Matheson January 9, 2012 at 3:45 pm

But from your answer about why the C-section was necessary it seems that some women might have opted for the more difficult vaginal birth and succeeded in birthing the baby naturally.

I can’t help feeling your “fear” for her coming through. And I believe that fear becomes a self fullfilling prophecy. I wonder what would have happened if she had had no negative vibes around and just labored until the baby was born….Could she have had a vaginal birth? From what I have learned over 50 years of childbirth information the answer is yes, she could.
From: http://www.birth.com.au/A-posterior-labour/About-posterior-position?view=full

Posterior labours have an increased chance (but are not guaranteed) of:

Having a longer prelabour, before getting into the stronger labour.
Producing more pain in the woman’s back, rather than in her front.
Taking a little longer, as the baby rotates around to the front.
The baby’s head being ‘deflexed’ (or looking forward), rather than ‘flexed’ (and looking down with their chin on their chest), meaning that the baby’s head may not fully engage, until the labour is established.
Taking longer to push the baby, out as their head rotates, and flexes.
Causing the mother to tear if the baby’s head is born in a posterior position.
Progressing just as efficiently as anterior labours, especially if the woman has good contractions, assumes forward leaning, active birth positions and has a positive attitude, with the baby turning to become anterior, before being born.

You speak of making the choice for the mother. I believe the mother’s wishes should take precedence as long as she knows and accepts the consequences.

This is NOT a criticism of your management of the labor. But it is meant to show those reading this article that there is another view to be considered.

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liz December 28, 2012 at 10:07 am

Ditto. I would have consulted a senior/ more experienced midwife.

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Pam January 9, 2012 at 4:14 pm

@ Bonnie, I don’t know what you were reading but nowhere here does she say that she made any decision for the mother. She offered her opinion that the hospital was the place they needed to be and the mother opted for a c-section even after being offered a closely monitored vaginal birth. The mother’s wishes did take precedence and it was the mother who decided her baby would be born by c-section in a hospital. Try actually reading instead of skimming and then posting your criticism.

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Bonnie B Matheson January 9, 2012 at 6:31 pm

Pam, this is the sentence I was referring to in my post above.

“Despite my knowing how the situation was going to be received and all the “I told you so’s “ that are likely to come from it, I put mother and baby first and chose what was best for her.”

She said SHE CHOSE WHAT WAS BEST FOR HER.

yes, the mother did opt for the C-section. When fear is present the mother is very likely to respond to it. Unless she is EXTREMELY sure of herself and her facts she will defer to authority.

I have had so many years of experience and heard so many stories. Forgive me if I sometimes forget how much that huge body of knowledge and experience colors my thinking.

When I was having babies I knew very little even though I thought I did know. For instance I knew almost nothing about home birth. It makes me sad as I would have been a perfect candidate for home birth and yet I never had one.

I did not mean any disrespect to the midwife or the mother. I was just making comments based on what I have observed. One thing I have seen again and again is how one person’s fear can infect another.

Not all midwives Trust Birth.

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Mrs. BWF January 9, 2012 at 7:16 pm

Bonnie, while I appreciate what you are saying and would normally agree with you, I know this midwife personally and her fears do not effect her supporting women. She supports all women’s choices from having an unassisted birth to a planned cesarean. There are very few midwives I would ever let attend my birth and she is one of them.

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Ashley January 10, 2012 at 10:36 am

Bonnie, both of my children were born at home with the help of midwives, but I don’t want a midwife who “Trusts Birth.” I want a midwife who respects birth. Based on the little I know of the story, it sounds like that’s exactly what this midwife did. It doesn’t help the homebirth cause to imply that if you’re unafraid everything will be ok.

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Kathleen Neely December 27, 2012 at 8:51 pm

things can and do occasionally go very wrong, respecting birth means realizing that things can go wrong and making the decision to avoid those problems. I think that the mom totally did the right thing by having a repeat C section. A big huge Baby in the posterior position, oh yeah that is why I had my first C section, and also I was only 17 years old and had Rape trauma. I was so scared that I went overdue for 4 weeks, yes respecting birth means being prepared for everything and anything that can go wrong. And being prepared to change your PLANS. because mother nature is not always kind… its just a fact of life.

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Melodie January 10, 2012 at 10:01 am

thanks for sharing.
I think you made the right choice, and I would like to think more midwives should follow in your footsteps. You protected a laboring mother and her baby with your knowledge. And that, to me, is exactly what you’re supposed to do as a midwife. :)
You should be proud.

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Kelsey G. January 22, 2012 at 8:10 pm

This is beautiful. No shame whatsoever in using the hospital as what it is MEANT to be—a last resort choice. Well done Midwife and Mama :)

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Nicole February 21, 2012 at 10:00 pm

Hey Mrs. bWF-
I am just curious. It sort of surprises me to hear you say that there are very few midwives that you would let attend your birth. Why is that? Like I said, it just surprises me to hear you say that.

On another note, I think that fear came through, too. But I think that is OK. This just read as sort of a catharsis to me and I think that is just fine. Personally, I think that erring on the side of caution is ok especially when the lines of communication are wide open. I personally would have probably chosen to labor longer but that is just who I am. I don’t fault or judge another woman for making a different choice.

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liz p February 21, 2012 at 10:18 pm

APPLAUSE for this midwife!! wonderful story, happy ending, responsible provider!! YAY!!

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Amy Hogen February 21, 2012 at 11:41 pm

We lost our first baby boy during delivery…full term, otherwise healthy. We were a planned home birth with a midwife turned hospital transfer story. Our little boy passed away due to what we feel was a hospital error; the external monitoring reading me instead of him, the OB being observed being indignant and throwing things for being called in a 2am, the lack of collaboration with our midwife.

Our midwife gave us extraordinary care…and she knew when to change delivery locations because what was happening at home wasn’t working. She transferred a healthy, stable baby. Most people think that because we lost our baby during delivery of what started out as a planned home birth is a reason to not deliver at home and to me…

~ It is the perfect example of midwifery done well ~ a sign of healthy decision making and proactive care ~

Thank you for writing about this topic

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Mrs. BWF February 21, 2012 at 11:45 pm

Amy, I am so sorry for your loss. (((hugs)))

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Ncumisa February 21, 2012 at 11:51 pm

I loved this post. Congratulations to the mama & the midwife on a successful birth. Homebirth is frowned upon by all my friends (except one). I’ve been investigating having a homebirth, but my husband is very against it, so we have decided on a hospital birth attended by a midwife & doula. There’s a great hospital near our home where they are pro that option.

Bonnie’s comments concern me (I agree with Ashley). I would rather be attended by the midwife whose story this is than by Bonnie any day. I believe this midwife made a good decision based on the knowledge she had on hand. I would rather this than a midwife whose primary aim is to deliver at home at (seemingly) the expense of the mama & baby’s health.

Thanks for this blog. Love reading it.

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tara February 22, 2012 at 12:17 am

What a great story!! It’s great to hear from responsible, smart midwives like this, I wish she lived in NY so I could hire her for my next baby!! And Amy, ((((hugs, hugs, hugs))))) I am so sorry for your loss.

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Amy's midwife February 22, 2012 at 1:24 am

Mrs. BWF,
Thank you for sharing this story. I do not see “fear” in any sentence of your story. What I see is a midwife who was able to recognize a situation that needed to change and made the responsible decision to share her concerns with her client and allowed her client to make the final call and feel supported and loved through the process.

Bonnie, When a midwife transports or transfers care to access appropriate technology, it is not a difficult decision, it is actually an easy decision because as midwives, we are guardians of lives at the most vulnerable time of life for that woman and her baby! In a good midwifery relationship, the mother trust’s her midwife to make that call and the midwife trusts that mother to understand why that call must be made.

In a good midwifery relationship, there is mutual respect for that intuitive knowledge that we as women all have. Yes, it is sad when a birth plan is scrapped but what is worse to me is that we (as the alternative birth culture) have decided that transporting equates failure! We will go so far as to chastise a midwife or mother who opts for transport and throw the “fear” card at them.

Consider this mother…On one side she is taking it on the chin from the alternative birth community for transporting and on the other she is taking it from the hospital community for attempting a home birth. Where is the love? Is this how we treat childbearing women!!! As an aging midwife I can tell you that there is still nothing more precious then watching a mother hold, nurse and love her new baby…no matter where it is born or under what circumstances. There is also nothing more heartbreaking then to see a mother with empty arms because someone’s ego got in the way (whether it is a midwife or a physician). Who are we to judge that mother or that midwife when we are not in their shoes?

Excellent call Mrs. BWF. Not every midwife could recognize that big ole brow and protect that uterus and scar so this baby could be born healthy and mom be well enough to hold him! Having seen two hospital ruptures in the past few years that both lead to life saving cesarean-hysterectomy (one received 28 units of blood product), she is fortunate to have you as her midwife! Mrs. BFW, your mother can have more babies! Isn’t that awesome! You are a great midwife!

People, we need to realize that there is a time and a place for appropriate use of technology and it is not AFTER someone has ruptured…

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Erica W July 1, 2012 at 1:08 am

What an awesome birth story!! I gave birth at home to a posterior baby (#3) who never turned… it was insane, to say the least! I find the link Bonnie posted very interesting because it describes my labor very well… baby had zero room to turn in spite of every effort we made to help give her room to do so… turned out she was HUGE (I am 5’6″ 128lbs pre-pregnancy)… 10# 4oz, which explained a lot.. she was nearly 2# bigger than #1 & 1 lb bigger than #2… we realized in hindsight that she was born @ 42+3 because my labor took forever to keep active due to her position… her head was not putting the pressure needed on my cervix to help me dilate & stay dilated.

Anyway, there are definitely babies born posterior w/a whole lot of work & incredible pain (no orgasmic birth there!) far beyond birthing a baby in an anterior position, but it sounds like this mama had the birth SHE needed.

All 3 of my labors were posterior for a while, but for the 1st 2 both babies were able to rotate… #3 could not… now we’re expecting blessing 4 & I am sure praying that this baby rotates early on, & that this labor goes much smoother. In spite of baby being born posterior though, I only pushed for 30 minutes, which seemed like an eternity at the time, of course. All at once, on top of trying to push, my belly, thighs, back, AND my hips were ALL contracting w/each & every contraction… I really did not know how I could keep enduring it, but by God’s grace I did.

If anybody tells me about a posterior labor, I cringe because I know 1st hand the incredible challenges presented by them… I honestly don’t know that I could have hung on as long as I did if I had known ahead of time what the intensity of my labor would be like & the duration of it. I kept thinking I was going to have a baby in just a few minutes and THAT kept me going. At any time I could have called it & asked for a transfer, but baby nor I were in any distress (aside my having every past of my body contracting from below my bust), so I kept going. We were also in the middle of a huge snowstorm/ice storm & I knew a transport would be horrid w/the possibility of getting stranded… that did NOT appeal to me at all ;0). I also didn’t know how I could possibly sit in a vehicle, buckled in, & not lose it… if I thought about those things, I obviously thought about a transport, but not because I necessarily wanted one or there was need due to distress… I just didn’t know how on earth I was going to keep going on. I did also fear how we would be received at the local ER for a transport, but knew I’d do anything for the sake of my baby, even if it wasn’t part of the birth plan.

My husband, midwife, family, & nurse encouraged me to keep going (again, knowing neither baby nor I were in distress), & finally a chubby baby emerged sunny side up :0). I’d say that my hubby whispering in my ear how strong I was, how incredible I was doing, & to push my baby out was overall what got me through the last moments when I just didn’t think it would ever end. I was honestly never so tired in all of my life.. not having kept any food down… having hyperemesis.. & enduring something I never knew possible… but what an amazing experience… one that was incredible, but I hope NOT to repeat this time ;0).

Thank you for sharing your story!!

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Heather September 1, 2012 at 12:31 pm

I absolutely believe in midwifery!!! I prefer to have midwives over ob doctors anyday!!! They understand a woman’s body and desires more than a regular doctor!!! Great story and wonderful ending!!!

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Jill O'Reilly September 1, 2012 at 1:05 pm

I too have years and years of birth experience (not fifty yet… not that old) but I did not sense any fear coming through on the part of the midwife. I have attended several facial/brow presentations and they are not easy births on anybody. This was a VBAC mama with an unproven (hate that word) pelvis, large baby, malpresenting. In the midwifery world we say “three strikes you’re out.” Those are three things this mama was going to have to overcome and since none of us were there, it’s impossible to criticize the midwife’s call. Like I said… I did not sense fear coming through at all. A great deal of responsibility… yes.

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Flmidwife September 1, 2012 at 1:30 pm

We like to call this an assisted homebirth. Most women who labor at home with their midwife and then transfer say they feel like they had two birth experiences and don’t regret where they started. The nursing staff would always refer to us as failed homebirth transfers, and we requested a vocab change. There is no failure in needing a little help, so our local hospital now helps us by referring to us as assisted homebirths:-) great story, thank you for sharing. Transferring is a hard decision.

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Jamie September 1, 2012 at 1:49 pm

I love this post. I’ll attempting my first VBAC in a little over 3 months at a birth center with a midwife. Of course I’m very hopeful that my VBAC will be a success and without complications but I feel so good about my decision with my midwife because I know above and beyond she is putting my health and my baby’s first. As much as she believes in the body’s ability to birth naturally she has told me she will not hesitate to transfer me if she believes I need interventions that she cannot do. Some have told me she doesn’t sound confident in her abilities but I don’t believe that at all, I believe she’s very confident. And I’m glad that I have a midwife who is going to give me her best shot at the birth experience I’ve always wanted and believe I can have but is also never forgetting the most important factor of mine and my baby’s safety.

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A home birth midwife September 2, 2012 at 9:42 am

I would like to point out that posterior and brow presentation are two different things. Brow presentation means baby is coming with head tipped back which can put a lot of stress on baby’s neck. NOT the same thing. And one of the thankfully uncommon transports I have made resulting in a c/s was for an 11lb mentum posterior face presentation.

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eileen September 2, 2012 at 3:49 pm

My very own first born was a brow presentation, this was back in 1982. I had horrendous back pain with a (short) 7 hour active phase. (I had 2 days of off and on contractions prior to this).
At 7cm, my midwife told me the baby was brow presentation and that brows can’t fit thru the pelvis. She gave me two options: she can try to fix it or I needed to transport for a C-section. Of course I said FIX IT. After she converted her head from brow to ‘military’, my daughter clunked down into the pelvis. Water broke, heavy meconium, pandimonium with PUSH PUSH PUSH PUSH PUSH..and she was born screaming. Well, I was screaming, too so why not her? lol

Judging by the way I tore (up/down/sidways) and the back pain, I believe my daughter was also posterior. She also had the cord wrapped tightly around her neck 2x’s. Apparently, I also hemorrhaged.
So, I believe there is usually a good reason baby is presenting brow. Either they have a hand up under their chin and can’t flex or there is a tight cord.
I trust birth (as long as it remains trustworthy, eh?)

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Virginia September 3, 2012 at 5:52 pm

Congratulations on your ability to be professional and do the correct thing. It takes courage to make choices. No choice should be criticized because even if it does not work out (and who is to say what work out is) all choices become learning opportunities. It is not mine or anyone job to tell someone what to do. I just encourage and support women to find out what feels right for them, make a decision, and stand by it. It is when we do not make decisions (and that is a decision in itself) is when we become victim.

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Anna December 27, 2012 at 8:54 pm

This is beautiful. I applaud this midwife. I am the daughter of a midwife and on the journey to midwifery myself. Any midwife who says they are NEVER afraid is either dangerous or lying. This is an art and a science and there are hidden aspects that surprise and frighten us at times. Fear, concern, worry, is all a part of trust. I believe you cannot live a BRAVE life or practice trustful birth until you lean into the fear that comes with the responsibility and the groundlessness inherent in supporting a woman in labor. The fear is not inherently problematic. Not listening to one’s gut is nearly ALWAYS problematic.

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Issy January 27, 2013 at 7:12 am

It’s very interesting to see all these women commenting that they had very large prosterior baby’s! Is it more common for larger baby’s to be in this position?
My daughter was posterior I gave birth to her in a hospital 96hours of labour I was only 16 years old, they ended up giving me petocin and after 3 and a half days of labour I couldn’t Handel the continuous mind blowing contractions from the petocin, I ended up epidural, pushed for and hour age birth to a 6pound 7oz girl they had to resuscitate her it took her 10 min to start breathing!
I’m 9 weeks with baby 2 and and already booked in to a birthing center I want to do this one all natural

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Abbie March 25, 2013 at 9:28 pm

Thank you for sharing. My seventh baby was brow presentation. In fact, by the time I was wheeled in to the operating room, he was full brow presentation. He was my first c-section. I’ve often wondered or doubted whether we made the right decision and most people look at me oddly when I try to tell them he was coming out eyes first. I know that was the right decision after multiple attempts to move him and then he was born with a swollen lip and forehead. I have not read any brow presentation birth stories (I guess they are so rare), so seeing this reaffirmed our decision to get our little guy here safely via a surgical procedure.

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