I can’t remember exactly when it happened, I know I had been working in a ‘case loading’ model for about 2 years when it did. By ‘case loading’ I mean that another midwife and I were offering care to a group of about 80 women, they would see one of us at the start of their pregnancy, then all the way through, including the birthing phase.
The project ‘rocked’, home birth rate was beyond 18%, women spoke of very high levels of satisfaction, the service seemed to work (depending on how you measured it). Working this way was very enjoyable, as a midwife I have never since experienced the same sense of autonomy and stretching of professional competency that the project demanded.
What happened at the time made me feel angry and dismayed but later as I reflected upon it I began to see how it exposed the prejudices and narrow mindedness that can creep up on a group of professionals with out them noticing, like a frog being boiled alive as water gradually reaches scolding hot from being cold.
A woman in our caseload had experienced an horrendous emergency cesarean section previously and was requesting a home birth this time. She was being supported by our team, all of the necessary supervision support was given to her and us and the pregnancy passed with out event.
Late one evening I was called to her home, she had been having what she thought were ‘early labour’ tightenings since midday and these had become ‘more intense’, “please come”, she said, “and see how I am doing”! She and her partner lived very close to me and although on a day off I checked in with my colleague and went to see her and the family.
When I arrived, the lights were down,gentle music was playing and she was standing against a pine chest of draws,rocking gently back and forth, the sway and rhythm of it a little mesmerising, but reassuring.
Her partner started to tell me how the afternoon had gone and when her eyes opened she said she wanted to know how far she was ‘progressing’. We talked about her contractions, how long they were lasting, the frequency between them, wether she was experiencing any pressure in her ‘back passage’?
I watched as another tightening ran its rhythmic course and noticed her breathing change, her body take control as she yield to postures best suited to comfort herself, as the birthing process gripped her, as she, grasped his hand I saw the blanched skin of his knuckles and her nail marks left behind.
Having spoken about all these ‘signs of labour’ she wanted to know how far ‘dilated’ her cervix was and having palpated her abdomen and determined the position of the baby I gently examined her, she had asked if she could stand while I did so and with one of her legs on a small stool we proceeded.
“How far am I”? She pleaded, “2 centimetres”, I replied. Seeing the disappointment in her face I quickly explained that her cervix was ‘paper’ thin, the baby’s head was very low down and that the cervix was tightly applied to it. “All of these findings suggest that things are progressing well”, I said.
We talked for a while as we drank our tea about how things were going, she seem encouraged and was keen to for me to go home, I explained that first thing the next day I had something’s planned (day off remember) and that I might not be around.
Her partner asked me to explain what I was ‘feeling’ for when I did a vaginal examination. I talked about the cervix being ‘thick and hard’ and ’round the back of the body’, about it ‘softening and thinning ‘and moving to the front of her body and beginning to open, about the baby’s head applying pressure to the cervix as it descends, the feeling of the bulging membranes, like pushing a ballon through a polya neck shirt. He seemed to be thinking deeply, thanked me and I went home.