The fear based midwife

My experience of natural birth by Sarah Randall

My name is Sarah, I’m 32 years old and work as a midwife in a private hospital. I have also recently survived the birth of my first child! I would like to share with you my birth experience, and how it opened my eyes to how I, and other hospital midwives viewed childbirth.

This experience has taught me a lot. A lot about me personally and a lot about childbirth. Which is ironic since I am a midwife, I should know everything about childbirth right? Turns out not.

So, my husband and I had decided that the year 2017 was the year. The year to try for a child. We were lucky. I fell pregnant with the first try in January. I was blissfully unaware how full of fear I was regarding every step of pregnancy and the birth process. Working in obstetrics, I had a front row seat to everything that could go wrong in every aspect of pregnancy and birth. With the pee barely dry on the stick I only gave the fact that I was of good health a fleeting thought and looked forward with trepidation towards everything that could potentially go wrong.

One thing I knew was that ObGyn’s make me nervous. I could see how the cascade of interventions had a tendency of complicating matters, making things potentially dangerous, and had a strong gut feel that a midwife led birth was the way for me. My husband needed a little more persuasion as he was (like most people) under the illusion that a Doctor was safer and knew more. We planned a visit to both an Obstetrician and a midwife. He liked both, but after meeting the Midwife, Cheryl Rowe, decided that he saw an older version of me in this woman and could see me following a similar path. He also came round to our view that an intervention free birth was indeed a safer birth. When people asked why I was having a midwife led birth I responded with “I’m a midwife, it makes sense that my child should be delivered by a midwife”. They would nod politely, exchange concerned glances and continue to sip their tea.

My pregnancy journey began smoothly. Until 14 weeks. Despite my 12-week scan being normal, we decided to have the downs screening done. At 14 weeks we received a message from the Ob that was covering us that I needed to see him urgently. He told me that my BHCG level was elevated and twice above the medium of the norm. This meant that my numbers for the downs screening were out the ‘Safe Zone’ and there was a possibility of IUGR or Pre-Eclampsia due to potential placenta insufficiency. He decided that a prophylactic does of Ecotrin and a visit to the Foetal Specialist were in order. Thus began the self-fulfilling prophecy.

At 18 weeks the specialist saw us, reassured us that all was in order, the placenta was fine, and we found out we were expecting a girl! I carried on with the Ecotrin until 26 weeks. My midwife had her suspicions as to whether all of this was necessary.

At 26 weeks I started feeling Braxton Hicks contractions. At 28 weeks they started to get excessive, and my midwife diagnosed Irritable Uterus. She also believed that the stress of work was not helping this condition. So started 5 weeks of intermittent sick leave. One Saturday whilst 33 weeks along I started having painful contractions while at work. It was a busy day in the ward and by the end of it I was finding it difficult to get from point A to B. The following Monday I was booked off by the OB with Pre-Term labour. I was put on Adalat and strict bedrest. Again, my midwife thought this intervention was unnecessary. I was put on early maternity leave. As the weeks proceeded the Braxton Hicks subsided and became less uncomfortable. I then made it to 36 completed weeks whereby I returned to my Cheryl’s care.

All through this time I had continued to be fearful of what could go wrong and tried my best to foresee and plan for every complication I could think of. I also at this point realised that my environment at work had made me feel unsafe in my pregnancy, and with my choice to be attended by a midwife. I was at this point very seriously considering moving over to my OB. However, I kept returning to my gut feeling that the end of the day, despite all the noise, I felt the safest option for my child was to be birthed by my midwife.  All the while I waited for this preterm baby that did not come. During this time of waiting I bonded deeply with the doula who would be at my birth. Her name is Suzanne Martin. Suzanne was amazing at listening to my fears and giving me the reassurance I needed. At 37 weeks I provided my birth team with my Birth Plan. Of course, built into it were interventions geared towards any and every crisis my overactive imagination could procure. Cheryl humoured me.

At 38 weeks I got the flu which resulted in me having to slow down and return to a 3 week period of bed rest. At this point I was rather frustrated with my daughter. Where was she? For a preterm baby she was running awfully late. Of course these feelings of depression and insecurity, which had at this point only just been kept at bay, returned with a vengeance. My maternity leave was ticking by and I feared I was losing time with my baby! I was told that my child was very unlikely to come while I was unwell, as the body is more intelligent than we give it credit for. Of course, my body was waiting for a safe time to birth my baby. So, came the 40 week mark and no baby. This day was probably one of my lowest points. I had convinced myself that my baby was coming the night before because I had mild Braxton Hicks and the slightest of back pain. I was sorely disappointed to learn that she was only dropping.

On the way to the appointment the next day, still feeling fluey and extremally sorry for myself, I confided in my husband that I felt I may never meet my baby, that something would happen to either her or me before we got a chance to meet. This appointment with Cheryl was the hardest one on my journey. She told me some things I did not want to hear, but really needed to. She told me that I had been anticipating complications from day one, and that it stemmed from a culture of fear in the delivery room. I did not want to hear her. I did not want to admit that she was right. Of course, at this point my normally quiet husband piped up with the gem I had supplied him in the car, only confirming what Cheryl already knew about me.

Throughout my pregnancy Cheryl had always pushed the notion that my body and my baby knew what to do, and this was Baby’s pregnancy, not mine. She also advocates strongly for the baby choosing its birthday. So in response to my moaning about this baby never coming, and nagging for an induction, it was at this point that she said to me ‘Sarah, as much as I love you, to be quite blunt I’m not thinking about you, I’m thinking about her! (pointing to my belly)’ This was the first time I had ever seen a Practitioner be so blunt in the advocacy for the baby. Every pregnant woman gets to the point that they are sick of being pregnant, and for whatever reason want the baby out – I have seen some Practitioners entertain this. It was another ‘Ahha’ moment for me, where I realised my midwife was not going to give into my tantrums, and she really was going to wait for when Missie Mouse was ready. I had an internal and was told that of course my cervix was not ready. I went home to lick my wounds. I got over my flu and continued my weekly appointments.  I knew at this point that Cheryl would only induce me once I was 42 weeks with a favourable cervix, however there was a 6 day discrepancy in dates meaning we could legally push the 42 week mark later and give Missie Mouse a bit more time. The day before my 42 week milestone, we went for our appointment. Cheryl did her internal and a stretch and sweep. She also gave me two homeopathic remedies to assist labour. For the second time she gave me the option to leave and pursue a chemical induction with a Ob. She then also said something that will stick with me. ‘Sarah, if you want to be a future me and do what I do, you need to experience physiologic birth. Only once you have pushed a baby out will you truly understand what your patients are going through, and not fear when the birth is imminent’. This was another of those moments that hit a nerve with me. I needed to do this. I had also (begrudgingly) allowed my child and body the benefit of the doubt, at that point I was already of the view that I had come that far in the race, it would be a shame (and perhaps have distressing consequences) if I tripped at the finishing line. After I left the appointment I started with Braxton hicks that became more regular to the point that I could not deny, labour had finally started.

Labour continued into the next day, by that afternoon contractions were 3 minutes apart and the midwife asked me to come in for a check. I was at that point 9cm dilated. We went straight to the hospital where my membranes were ruptured. I was greeted by my two amazing Doulas Christine Pearce, and Suzanne Martin. Of course, I had a textbook birth, I laboured in water, birthed on land and only sustained a minor tear due to a compound presentation. I was allowed to push only when I felt ready.  My daughter was placed directly on my chest with Apgars of 9, 10, was given ample time to receive all the red blood cells she could receive, then put on her father’s chest for more skin to skin. Not once was she put in an incubator. I birthed the placenta without any chemical intervention, and the only needles used were to repair the tear. I arrived at the hospital at 16h30, gave birth at 18h00 and was home at 20h00.

Ironically enough after the ‘Big Scare’ at 14 weeks I did have an IUGR baby – I had a small placenta with an extra lobe and false knot. My daughter at 42 weeks was only 2870g! But then, 10 hours after her birth, my husband recorded a video of her holding her head up independently for a minute and a half! Small is not weak. That inquisitiveness has never left her! I suspect that if I had gone for a chemical induction my child would probably have ended up in NICU because she was not ready.

Of course post-partum was a dream. My bleeding was controlled, my stiches healed well, my daughter breastfed beautifully, and we bonded well into our new family unit. My postpartum fears of haemorrhage and depression did not come to fruition. None of my fears did, I had a beautiful, uncomplicated birth.

I was only aware how fear riddled I was once it was pointed out to me, and I could view the whole pregnancy in retrospect. But it is not just me. I received fearful messages from all those medically minded who worked in a hospital. At the end of the day it came to this, medical professionals including midwives view natural physiologic birth as risky. Why? What could be more low risk than an uncomplicated birth? We know the side effects of every medication and intervention we perform in a birth with interventions, where are the side effects in an intervention free physiologic birth? When one of my colleagues heard I had had the baby she told me how worried she had been when she heard at 40+ weeks I had still not delivered. Why had she worried? Why had I? Tragically when I later told these same people about my amazing uncomplicated physiologic midwife led birth, I sensed that they did not brand this type of birth as safe, but rather me as lucky. It took this experience for me to realise that we in the private childbirth community see physiologic birth as unsafe. My next question is this, Are we surprised the way childbirth in the private sector is going? Are we surprised that almost all births are run by Obs, that the majority of them result in caesars, and that the few vaginal births are heavily medicated?

While some may argue this culture of fear did not cause the situation we have now, it doesn’t help. Yes, we know that one of the root causes is litigation and how the field in perceived and labelled as ‘” high risk’”. The important thing is how do we the midwives find a solution?

  • The first step is to identify the fears we are harbouring and unconsciously transferring onto our patients and community.
  • The second is to lead by example. To have natural midwife led births, or at very least NVDs.
  • Are we advancing our careers to become Private Midwives?
  • Are we breastfeeding our children, or giving up at 4 months when we have to return to work because it’s too hard and too much work?
  • When those in our community ask our opinion on which Practitioner to pursue their antenatal journey with, who are we recommending?
  • Are we supporting the midwives who work amongst us or making their lives more difficult?
  • When we see what could be an uncomplicated birth, are we providing the Dr with our professional opinion and advocating for the patient, or keeping quiet because Dr knows best?
  • In short, what are we doing to eradicate this culture of fear?

Soon my maternity leave will end and I will return to work.

Previously on my long list of fears was leaving my child at home and returning to work.

I’m not afraid anymore, I’ve got work to do.

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