HBAC - Home Birth After Cesarean
It was a hot Sunday morning in June when Erica called to say her waters seemed to be leaking. I arrived at her place as her husband Cam was setting up the pool for a possible water birth. Meanwhile two wonderful and excited grandparents were entertaining two-year-old Jeremy the back yard, trying to find a cool place in the shade.
The midwife arrived to assess Erica’s progress. She immediately outlined the interventions that Erica could expect if her labour did not pick up quickly since her membranes had ruptured. She said that because doctors are fairly “conservative” in this city, she would have only about six hours before they would have to go to the hospital for an induction, as there is an increased risk of infection once the membranes rupture. There were some herbs and homeopathic remedies that she could take to stimulate labour, or she could perform what is known as a “stretch & sweep,” a procedure in which the midwife manually stimulates the cervix, stretching it and separating it from the bag of waters. I suggested there was another approach: allow little Jeremy, who hasn't quite weaned yet, to nurse. Jeremy happily obliged!
[I thought that the midwife was a little premature in outlining these worrisome interventions while there was still plenty of time and mentioned that the treatment was what I’d call “aggressive” rather than “conservative.”]
The midwife had to leave for a few minutes, and almost immediately Erica’s contractions intensified. [Likely because of the nursing!] She felt most comfortable being upright and even slightly arched back, preferring to lean against a wall or the kitchen countertop during contractions. She tried to labor for a while in the pool but it turned out to be useless. She felt better upright and could not get comfortable in the pool. I admired the way she would to listen to her body, doing whatever worked best for her.
The midwife returned and set up her equipment in the bedroom. The birth supplies covered a dresser and part of the floor. [Though I suppose it is reassuring to know there is emergency equipment such as oxygen and pitocin available, I find this practice somewhat intimidating. The doctor who attended my births brought only his black doctor bag, leaving it off in a corner somewhere until needed. I found this to be much more reassuring, indicating to me that he was confident he wouldn’t need anything except his hands.]
Erica moved into the bedroom where the birth equipment was ready, and tried different positions with each successive contraction. She began to get discouraged and to feel like she wasn’t handling it very well. I assured her that she WAS coping, because that IS what it feels like, it DOES get more intense and more difficult to cope with, and that she really was doing beautifully!
Erica began to grunt occasionally with the contractions, and to clutch her husband so I knew she was getting close to pushing. She would kiss him after each contraction ended.
We left them alone to labour in privacy for a while. There is nothing that can soften a cervix like a few good smooches. Good birthing is like good sex: you have to let your partner know what you like, what feels good, and what is unpleasant and what works for you. You have to lose your civilized self, lose your inhibitions, and let your primitive centers take over. It’s not pretty, but it’s profound!
Labour progresses. Erica is weepy and tired of being in labour. I wish I could take some contractions for her and give her a break. I understand why doctors give drugs and become heroes when they take away the pain. But they take away so much more than her pain. They take away her power, her pride, her womanly performance.
This labour is Erica’s alone. I can’t take it away from her. I can only support her as she travels along the difficult path, just as I have traveled before. It is her rite of passage. It’s her own pain she must work with, her own fears she must face, her own body she must learn from and with which she must work. Just as that heroic doctor that takes away pain became what he was through many grueling months of studies, weeks of sleepless nightshifts, and years of residency to get his diploma, so too will Erica earn her reward.
I marvel at the work of a labouring woman. Her expression is one of deep concentration, and weariness from this difficult, relentless work. Fatigue, more than pain. But not fear. In fact, we mention how nice it would be in this humid weather to labour in the air-conditioned hospital and Erica laughs. She’s happy to remain here in her unbearably humid and simple home than go to the cool technological comfort of one of Ontario's best hospitals only two blocks away.
Sheila Stubbs, 2002
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