It was a sunny, summer Monday morning. The heat was already hazing over central London as I approached the hospital. The midwives had phoned me in transit to the birth center. It was going to be a busy day; the center was almost full. […]
The phone rang; one of our planned homebirth women, who had thought she was in labour during the night, now knew that she was. Helen, a 44-year-old first time mother, had booked a home waterbirth with one of the group practices. At 2 am Helen had called out the night on-call midwife, who had stayed with Helen for a few hours, reassured her and left her to rest. Unfortunately, Helen’s designated midwife was on study leave for the day, and the remaining members of the group were occupied with other women in the birth center. Helen was assured that a midwife would call on her soon. Since Helen had given a good history on the phone, we knew there was no hurry. She reported mild contractions about every five minutes. Her waters had not broken, her baby was active, and she felt well. We decided that as soon as our waterbirth was complete, the senior student midwife and I would go to attend Helen.
An hour later, after a lovely baby girl had been born in the pool, Rachel (the student) and I left the birth center to travel two miles west to see Helen. Rachel was excited, as she had met Helen before. Helen opened the door of her apartment wearing a lovely smile. She greeted us warmly and said she was glad we had arrived, as her contractions were getting stronger. Her partner, Tom, was already there, and Helen’s mother and Tom’s mother were on their way. This was going to be a family occasion. Helen’s dear friend, David, was also a birth supporter, and as he was a first class chef, he was doing the cooking for the day! Helen had kept a video diary of her pregnancy and had arranged for another close friend to film and photograph the labour and birth. […]
Rachel thought Helen had gone out of labour; after all, she had reported contractions from 1:00 am. It was now 6:00 pm, and Helen had had only one vaginal examination. How could we know if things were progressing? How could anybody sleep so much in labour?
“Observe her,” I said. “See how every few minutes her abdomen moves slightly under the water?” Helen was perfectly relaxed and totally in control. She decided at 6:30 pm that it was time to eat, have a walk and be examined. She relaxed in the garden, ate some light pasta, and then I found that her cervix was 8 cm dilated with the head flexed at the spines. Things were moving on. Helen spent an hour out of the water and then needed to go back, as the contractions were too much. […]
Helen had defied traditional knowledge:
Traditional care would consider Helen, having her first baby at 44 years of age, high-risk. Traditionally, under these circumstances, homebirth would be considered very risky and waterbirth as a pain reliever inadequate.
Helen had a slow labour. Contractions were never more than five minutes apart, and her cervix did not dilate at even 0.5 cm an hour. Such a slow labour may mean a large baby, shoulder dystocia, postpartum haemorrhage, perineal damage. In fact, William was an average 3.2 kg (7.04 lb).
Helen had no complications, but she did have a 24-hour labour that was neither exhausting nor debilitating.
If we analyse this, I think we have a key to the value of individualised care and real advocacy for child-bearing women. The facts are, Helen was a physically fit and healthy woman, regardless of her age. Her pregnancy had progressed without any complications. She had planned a homebirth with her group practice midwives, who supported her decision. Decision-making was shared throughout and was based on the confidence of the midwives who knew Helen.
Thanks to Helen, Tom and William for allowing me to tell their story.