The Strength of Midwifery

Many in the world today depend on good vibes, energy, or spiritual enlightenment as their
higher power. They tap into their higher powers through a variety of practices. My higher
power of energy, wisdom, spiritual knowledge and life carries the name Living God, Creator of
the universe and my Savior. I connect with God through prayer. I find my strength in Him. He is
my rock, fortress and strength. I can not do midwifery in my own strength, knowledge base or
skills. It is not enough. Whoa! you say, “why not, were you not well trained?” I was well trained
and prepared to go out as a midwife but I am not able to give life. He knows and sees
everything, I can not foresee every possible situation or outcome but he does. Resting in the
knowledge he does and life comes from God and Him alone gives me great assurance He will
guide me in every birth. I may not understand the reasons behind events that transpire yet
trusting he does.

Through the years, I have seen evidences of His hand and power over every births I have
attended. A few are memorable:
I was a student and had been with this family for several days. The team would support this
client through intense contractions throughout the day. Around midnight her contractions
would stop returning at 7 am, we were exhausted. The morning prior to the evening birth, I was
taking a nap where I had a dream. In the dream, I saw the baby was going to need help
immediately after birth. The cord was going to be tight around the neck and it was going to take
effort to get him out. When I awakened from the dream, I felt uneasy so I told my preceptor, “I
had a bad dream about the birth but baby will be fine.” “What is your plan on managing this
birth?” She asked. I responded, “I was gong to think about it and get back with her with my
plan”.

In the next few hours a plan formed in my head. I assigned each person a job to do when birth
was imminent. The only person knowing of the dream was the preceptor. I did not want fear to
interfere with the process of birth. Once baby’s head emerge I could see the cord was tight and
small. I somersaulted the baby out, resolved the cord and stimulated him. HE quickly responded
to the stimulation squeakily letting us know his dislike of the treatment. The cord had collapsed
the trachea making breathing nosey. I corrected the problem and he was fine. Looking back on
the birth, I realized someone bigger than me loved me and gave me foreknowledge preparing
me for the birth without fear.

Another birth that stands out was the last birth I attended before graduating from midwifery
school. The client was G5P4 and 42 weeks pregnant. She had had prodromal labor for weeks
leading up to the birth. Thanksgiving night descended upon us with freezing fog. In the early
hours of the next morning the call came in announcing her contractions were 5 minutes apart
and 45 sec long. She live over an hour away on curvy mountains roads. I met with my preceptor
and rode with her. The fog swallowed the brilliance of our lights making the way slow. Soon
after our arrival the contractions waned.

Throughout the day we attempted to augment labor without success. Around 7 pm we
checked her, I was greatly disappointed when I found she was only 5 cm, 100% and 0 station.
The head was well applied to the cervix. However, her contractions had completely fizzled out.
We sent her to bed and we went home.

Arriving home around 930 pm, I spent a few minutes with my family before heading to bed. I
was asleep by the time my head hit the pillow. 1.5-2 minutes later my phone screamed into my
sleeping brain WAKE UP Now. I answered to a voice frantically announcing “One moment my
wife was sleeping. The next moment she awakened on her hands and knees beside the bed in
active labor. Please come, quick!” I sleepily replied, “On my way.” The tears were flowing
without restraint when my husband came to check on me after hearing my phone ring. I looked
at him and said, “I can’t do this. I can’t even focus my eyes and I am too tired to drive”. He
assured me he would drive me to meet up with the midwife in town. I notified my preceptor of
the sudden changes and I would see her in town soon.

After meeting up with the midwife and just before losing cell service the dad called to let us
know the client’s water had broken. Her previous babies had come within 15 minutes of SROM.
Our belief was baby would arrive long before we did. Once again the freezing fog was impeding
our progress.

On arriving, I found the client laboring in her bathtub while her husband was filling the birth
tub. I could tell birth was eminent. She asked if she could move to the birth tub. I affirmed she
could. As she walks down the hall to her bedroom, I kept looking to see if anything was falling
out. I thought to myself why are you doing that? She settled in to the tub. Within a couple of
minutes she asked if she could push. I said, “If you feel like you need to.” Her next contraction,
she bore down. I watched, then gulp, before whispering out cord prolapse. The adrenaline
rushed over me alerting every system to prepare to act. My thoughts are flying in clear
succession. How did did the cord get in front of the head? Get the head off the cord. Will we
get to the hospital in time? Will I really be able to keep my hand inside until a cesarean can be
done? We are over an hour from the hospital. Gag, I am going to puke. Pull yourself together
Eudine. Where can I go puke. Somewhere during the thought volcano, I inserted my fingers to
assess the situation to form an appropriate plan. What I felt caused me to withdraw my hand in
haste. Where a head had been 5 hours before were now 10 little toes wiggling and grasping my
finger, with a controlled voice, I announce breech.

My first thought was head down bum up to protect the cord. I bark the order to have mom flip
from semi-reclining to optimal cord prolapse position. Second thought that won’t work, the tub
is still filling. It won’t do any good to save baby and drown the client in the process. I tell myself
“slow down, breathe, think!” I had my client move back to reclining on her back. My preceptor
was instantaneously by my side checking for a pulse in the cord as I attended to other things.
No pulse. We know time is of the essence. She commanded in a firm quiet voice, “ out of the
tub and on the bed now.” “Dad get behind her and support her in a squat.” “ Mom push like
you have never pushed before.” Boom baby quickly descends to her nipple line, stops and
bounces. Baby is bum to bum, tum to tum according to text book this position states baby is
undeliverable and death is inevitable. Neither my preceptor nor I were willing to accept this
paradigm. My preceptor was in the most ideal position for assessing the hold up of the baby.
She quickly found the darling’s hands were clasp behind her head entrapping the head over
mom’s pubic bone. After removing her hand, she said quietly, “Go get the hands”. I went in and
careful slid the hands into the cleft of the neck then into the axillary before they slid down the
lateral side of the back. As the arms became fully extended, I pushed them anteriorly as they
externally rotated to a neutral position. Withdrawing my hands to resume their previous position of supporting the hips and low back my preceptor assumed praying hands to dis-
impact the baby’s head. Once baby’s head was unlocked from the pubic bone, she rotated the
head 45*, the chin dropped, flexing the neck and baby slid out floppy. From cord prolapse to
delivery was the longest 5 minutes and 40 seconds I have ever experienced.

Client slipped down to the bed gathering her baby girl up to her breast. Baby was stunned and
non responsive. Dad gave 3 mouth to mouth breaths while we were getting our bag and mask
to resuscitate baby. She pursed her lips refusing to opening her mouth as to say, no go with the
mask“. So we had dad give a few more breaths which she received as willingly as a lover’s kiss.
Baby let out her first strong cry at 6 minutes old. Neither mom or baby sustained any injuries.
As I reflect on this birth I know that God choreographed this birth, the timing and maneuvers
my preceptor and I did because of how smoothly it unfolded. My heart was racing yet my
thought process was clear as a supernatural peace enshrouded the room. The family did not
know the seriousness of the situation until days later.

A third birth

The ringing phone brought me to consciousness in the wee hours of the morning. The pain
etched voice horsely said, “the contractions are coming hard and fast. Hold on.” Breathing
sounds then “these are really painful”. My response, “I will see you soon”. While driving a short
time later, I was praying about being calm, entering the birth space without baggage, asking for
wisdom. This was followed by thoughts of “baby will need to be resuscitate, it will be ok. Be
prepared to observe vitals and behaviors for deviations from normal and react accordingly.”
Upon arrival mother is in transition, labor is intense. The contractions are so intense and close
together, she needed support with each one and assessing baby’s position is not possible. Every
time I left her side to set up equipment, I am summoned back. 20 minutes after arriving she is
entering 2nd stage. My student and I are continually holding, support, and calming her. The
head crowns, we move her out of the tub to be able to monitor better. Maneuvering in the
bathroom was challenging. After several position changes the head delivers but descent and
rotation are not happening. We have her walk to another room so we have room to help her
move into positions that will promote a quicker delivery. A second student arrives in time to
help get the baby out. We needed all hands on deck as she arrived floppy, pale, no breaths and
incredible heart rate. Stimulation, breaths, talking to baby brought little change for several
minutes. Occasionally she would open one eye and squeak at us before laying back letting us
continue our efforts. Finally she let out a big cry letting us know she thought we were rude for
insisting she breathe. Throughout the process, I repeatedly prayed God give her breath. I was
calm, trusting him to fulfill the promise she would be ok.

As guardians of birth we are present but are unable control all the how, when, and why it
happens the way it does, even when we try so hard. We may try an induction or augmentation
but we don’t control the response of the client’s body. Some babies take time to arrive both
with gestation and length of labor. We may understand the mechanisms presenting and be able
to facilitate changes through different positions, rest, hydration and nourishment, or location of
delivery but in the end the mama baby dyad have to resolve it. Wisdom is the strength in
knowing our limitations and acting accordingly. Wisdom is greater than knowledge and
understand is greater than application. The presence of wisdom and understanding brings peace and clarity in times of chaos allowing knowledge and the application of skills to be
performed with confidence.