Photo by Caroline Brown

Midwifery Today, Issue 149, Spring 2024
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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 cannot do midwifery in my own strength, knowledge base, or skills. It is not enough.

You may ask, “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 cannot foresee every possible situation or outcome, but He does. Resting in the knowledge that 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 evidence of His hand and power over every birth I have attended. A few are memorable:

I was a student and had been with this family for several days. The team supported this client through intense contractions throughout the day. Around midnight her contractions stopped, 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 that 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 to manage this birth?” she asked. I responded, “I was going 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 who knew of the dream was the preceptor. I did not want fear to interfere with the process of birth. Once baby’s head emerged, I could see that 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 he disliked the treatment. The cord had collapsed the trachea, which made his breathing noisy. I corrected the problem and he was fine. Looking back on the birth, I realized that 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 that her contractions were 5 minutes apart and 45 seconds long. She lived 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 went home.

Arriving home around 9:30 pm, I spent a few minutes with my family before heading to bed. I was asleep by the time my head hit the pillow. One-and-a-half to two 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.”

My 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 told her 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. We believed that baby would arrive long before we did. Once again, the freezing fog impeded our progress.

On arriving, I found the client laboring in her bathtub while her husband was filling the birth tub. I could tell that birth was eminent. She asked if she could move to the birth tub. I told her she could. As she walked down the hall to her bedroom, I kept looking to see if anything was falling out. I thought, “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.” During her next contraction, she bore down. I watched, then gulped, before whispering “cord prolapse.” The adrenaline rushed over me, alerting every system to prepare to act. My thoughts were flying in clear succession. How 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 so I could 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 ten little toes wiggling and grasping my finger. With a controlled voice, I announced “breech.”

My first thought was head down, bum up to protect the cord. I barked the order to have mom flip from semi-reclining to optimal cord prolapse position. My second thought was that it 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 told 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 knew time was 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.” The baby quickly descended to her nipple line, stopped, and bounced.

The baby was bum to bum, tum to tum. According to textbook, in this position 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 holdup of the baby. She quickly found the darling’s hands clasped 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 carefully 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. After I withdrew my hands to resume their previous position of supporting the hips and low back, my preceptor assumed praying hands to disimpact the baby’s head. Once baby’s head was unlocked from the pubic bone, she rotated the head 45 degrees and 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.

The client slipped down to the bed and gathered her baby girl up to her breast. Baby was stunned and non-responsive. Dad gave three mouth-to-mouth breaths while we were getting our bag and mask to resuscitate baby. She pursed her lips, refusing to open 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.

Because of how smoothly it unfolded, I know that God choreographed this birth because my preceptor and I worked as though we were one person with four hands. 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 was just as awe-inspiring.

The ringing phone brought me to consciousness in the wee hours of the morning. The pain-etched, hoarse voice said, “The contractions are coming hard and fast. Hold on.” I heard the sounds of breathing, then, “These are really painful.” I responded, “I will see you soon.”

While driving a short time later, I was praying to be calm, to enter the birth space without baggage, and to ask for wisdom. This was followed by thoughts of “baby will need to be resuscitated; it will be okay. Be prepared to observe vitals and behaviors for deviations from normal and react accordingly.”

Upon my arrival, the mother was in transition, with intense labor. The contractions were so intense and close together that she needed support with each one. Assessing baby’s position was not possible. Every time I left her side to set up equipment, I was summoned back.

Twenty minutes after I arrived, she was entering second stage. My student and I were continually holding, supporting, and calming her. The head crowned and we moved her out of the tub to be able to monitor better. Maneuvering in the bathroom was challenging. After several position changes the head delivered, but descent and rotation were not happening.

We had her walk to another room so we would have room to help her move into positions that would promote a quicker delivery. A second student arrived in time to help get the baby out. We needed all hands on deck, as she arrived floppy, pale, no breaths, and an incredibly normal heart rate. Stimulation, breaths, and talking to baby brought little change for several minutes. Occasionally she would open one eye and squeak at us before lying back and letting us continue our efforts. Finally she let out a big cry, which told us she thought we were rude for insisting she breathe. Throughout the process, I repeatedly prayed for God to give her breath. I was calm, trusting Him to fulfill the promise that she would be okay.

As guardians of birth, we are present but unable to 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, nourishment, or location of delivery, but in the end the mamababy dyad have to resolve it. Wisdom is the strength to know our limitations and act accordingly. Wisdom is greater than knowledge and understanding is greater than application. The presence of wisdom and understanding brings peace and clarity in times of chaos, which allow knowledge and the application of skills to be performed with confidence.