HBAC - Home Birth After Cesarean

A Doula's Perspective

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.

Inspite of Erica's leaking, the midwife says she feels bulging forewaters and wonders if Erica would like her to rupture the membranes. But Erica is afraid of the labour becoming more painful more than she can handle. I shared my experience with her: the first contraction following ruptured membranes was the worst then the body adjusted and contractions settled into a new pattern. Erica decides to do it and that appeared to be exactly what happened. She cried out and rolled to her side as the contraction hit, and writhed in pain on the bed, but when that contraction was over, she got back up upright again, and handled the contraction as before, leaning on Cam, moaning softly.

I see such beauty in the act of childbirth. Full and round and soft, the woman is a complete contrast to her husband's angular firmness and strength. And yet at this time, the man becomes soft and tender in his manner while the woman become mighty in her task. Like the great queen bee, ruler of the nest, her many workers attend to her, as her job is ultimately to most important in the hive. We all attend to Erica, who is at this moment the supreme ruler, as she should be. I catch Cam looking at me as I admire Erica, and I am embarrassed. He wife is in a state of undress, and we are almost strangers here with her.

The midwife puts her fingers in the birth canal while Erica pushes [I don't know why]. Erica makes powerful sounds as she works the baby down through her pelvis. "Come on, baby", she pleads, "Come on!"

The midwife gets Erica to sit on the birthing stool, leaning back against Cam as he sits on the side of the bed. Slowly, the head descends and becomes visible, Erica's perineum bulging. The midwives whisper amongst themselves: the head appears huge, and they consider it might deliver more easily if Erica were to get on her hands and knees. Erica get into position [the position she seemed to prefer throughout her labour anyway] and with the next contraction, she opens her mouth and screams. Not the tight-throated "Eeeee!" scream of fear, but the open "Ahhh!" scream of birth. The baby's head is already out. I jockey around to take a picture, but the baby is quickly born with a gush of fluid that shoots across the bed and onto the floor. Still on her hands and knees, Erica squeals with delight and bends down to the baby who was placed beneath her. She smothers him with kisses, getting blood on her lips and her chin. He cries, and her instinct is to nurse him.

The midwives have many procedures and paperwork that must be done, but they can wait while the new family has some moments together. There is no rush like there is in the hospital.

Mom, dad and baby are lost in a blissful new world. King and Queen on the most honorable of thrones, they sit back on the birth bed and relish the moment - silky wet new skin against Erica's sweat-moistened chest, they are both enveloped in Cam's protective arm. The midwife crowns the new prince with a small knit cap.[She is worried about the baby loosing heat, but when the temperature outside is reaching 35oC(95oF), I don't really see the concern. Maybe I'm wrong.]

Baby Casey is 7lbs 3ozs, not the 10lbs the midwives expected by the look of the descending head. I still believe if Erica had gone to the hospital, she would have met with too much intervention, since her first birth was a cesarean section, though the midwives think I am too cynical. Either way, it is just so much nicer in your own home. What sweet memories they will hold in this place.

I have much to do. I want to spare the new parents some tasks so they can devote their time to the baby. I get to work cleaning the puddle of fluid off the floor, changing the sheets, doing laundry and tidying the kitchen. The hot, humid air is filled with earthy smells of birth: blood and amniotic fluid, and the rose-like scent of newborn skin. The unmistakable mew-sound of a newborn's cry mingles in the high-pitched delight in Erica's voice as she welcomes her new son. I feel privileged to do this work in this humble castle, as the royal family tends to the need of the new prince.

Sheila Stubbs, 2002