Midwifery continues in Tuatapere

It has been awhile since I wrote--as much of November was enjoyed with my family before they all went back to the US. I did attend an interesting and harder primip birth that ended successfully with a nice, big baby boy after a longish labor at the Centre.  What I appreciated at that birth was seeing how much the parents obviously were "in-love" and relied on each other.  I wonder what would have happened if she had been at a hospital instead of at the Centre? Would she opted for drugs? Instead, she moved around, in and out of the tub, standing, sitting, squatting and rocked her baby into a better position so he could be born.

Another patient had a quick and easy birth at 36+3 weeks, with poor dates.  She only showed up for antenatal care at 23 weeks, had one ultrasound at 26 weeks which made the accuracy of her due-date plus/minus about 2 weeks.  She was having her third baby, her youngest two children are 11.5 months apart.  In fact, she has two children who celebrated their First Christmas this year.  She had a nice, fast birth--bless her heart...

Due to our Tuatapere renovations, she had to use our temporary birth room at the Centre, interestingly enough she mentioned, during  her brief labor that she liked the room much better because it was cosy!  Her partner barely made it to the birth, arriving  less than 15 minutes before the baby, but a friend the patient's and the 3 year old big sister were there.It was such joyful intensity to be a part of this birth. 

May I say she was another Southlander (a person who lives in the South part of the South Island of New Zealand) who just got down to business of birth, because that is what you do here.  I am not kidding when I say this: no one, even the ones who plan to birth at the hospital, want an epidural. Trust me, I just taught a series of birth classes, where all pain management options were discussed.  Also, the option to birth a the hospital, centre or home are REQUIRED to be told to all pregnant women...imagine a health care system that views this as right for all birthing women?

We had a lovely, precipitous homebirth on the 23rd of December.  This was a patient who had recently come back to me. I had sent her to see the "Specialist, " as is required for a history of 1 term, then 4 preterm births at 34, 35 weeks, all labors < 4 hours long. She has one child with Down Syndrome and her last baby died at 4 months of "cot death" or SIDs.

Anyway, a nice, well-meaning locum physician (who also happened to be from America), wanted her to move away from her family, into the big city for a few weeks before her due-date and get induced to avoid an "accidental, uncontrolled" delivery (physician's words).  It did not sit well with my patient so she stopped coming to all visits. I called her trying to reassure that I was not a midwife stalker but that I needed to talk, I left a short note on her door and then eventually I thought I would just write her a letter and tell her I was available in any way. I also mentioned that I respected her decision to NOT follow the doctor's recommendation.  The doctor can only make a recommendation, not an absolute.

And lo and behold, she sent me a text, asking if I would still be her midwife. After no care from 30 weeks to 36 weeks, I did one get a home prenatal visit with her before she had her baby. At that visit, she asked if she could have a homebirth, something we had talked about previously.  Based on her history I could only say that it was an option if she got to term, which is 37 weeks gestation. She had already had one birth in her mother's driveway trying to get to the hospital with her last baby--so I knew she would probably have another fast birth--but how reassuring to have me come to her--with all my supplies instead of her trying to drive somewhere?

On December 23rd, when R was 37 weeks + 4 days, I got a phone call after I had gone to bed: "This is N, my Mum is in labor."
Me: "Hi N, who is your mum--honey?"
N: "R!"
Me: "I am on my way!!!"

I told my student get ready, (one is living with me) and I was out the door in five minutes. Years of previous training as a Formula 500 race car driver/midwife kicked into gear--literally. Time attending homebirths in Minnesota weather enhanced the driving skills, as the New Zealand night was pitch dark, and it was pouring sheets of rain, with uniquely sea-fueled winds to blow the car around on the twisty-turning roads.

My student has never been to a homebirth--so she got to see the white-knuckled fingers on the steering wheel, the focused concentration, speaking succinctly about what to get out of the car when we arrive instructions...it was a 30 minute drive to R's house. The patient's mother was standing outside having a smoke when we pulled up.  Pt's mother  said: "the afterbirth just came out." So I knew the baby had already been born.

I entered the house and her bedroom--I already knew how tiny it was, but I did not realize how dark it would be lit by one 40 watt bulb on the ceiling. I could barely see, and movement was quite limited. My patient was sitting on the floor, behind the door, with a beautiful wee babe in her arms wrapped in towels.  My emergency childbirth instructions must have helped as he was warm, dry and skin-to-skin with his mum.  Placenta had NOT been born so we actually had some use! We helped with that task, tidied up, and eventually weighed and examined our little baby friend.  As his photo testifies he is very beautiful.

His father did the catch and as he shared the birth story--turns out our baby friend was born in the caul (amniotic sac) which is a fine thing for a baby who lives by the sea. (One of the many attributes of this kind of entry into the world that a baby born in the caul will never drown). The father did such a good job receiving his son, but someone in the household must have panicked and called "111." Fortunately, we arrived before the ambulance, and saved the mum and baby an unnceccesary trip to the big hospital for nothing. Although, my patient probably would have told the ambulance fellas to leave on her own.  She is one strong lady.

New Zealand midwife charting requires that we document how many minutes of skin-to-skin baby receives. It must be a minimum of 30 minutes--but one hour +  is recommended. (!!!!!!!!) 



New Zealand has made the evidence-based importance of skin-to-skin a priority, we are mandated to see that it happens for every healthy mum and baby--even if a c/section.  A prayer that in my lifetime-- may it become routine in American hospitals.

BTW, my two wonderful, and excellent American midwife students Amber (on the right) and Pam have arrived.  Amber has been to one birth so far; she is a University of Cincinnati midwife student and will be in NZ for 3 months.  Pam is a student with Frontier, and will be here for 5 weeks.
We have many pregnant women waiting in the wings--due at any moment. 

I am ready for them to be born!  A couple are going to the big hospital due to 1) VBAC 2) Known congenital anomaly.  The rest are planning a birth centre birth, and one more homebirth planned.