Midwifery Today: Hands off birth by Barbara Herrera

Hands-Off Birth

by Barbara Herrera

From The Birthkit, Number 44, Winter 2004

This birth story is different from any I have ever written. As I share it, I watch my words go into midwives’ ears and minds and watch as they try to grasp what I am saying. During most of my life as a doula/midwife, I would have thought of myself, “What a fruitcake!” But the moral of this story is this: I serve the mother and her family—in whatever way she needs me to.

My client, Donna, was pregnant for the eighth time. She had had three hospital births (each with a different doctor), four homebirths (all with same midwife), an episiotomy or tear with every birth, one shoulder dystocia that resulted in a broken clavicle (homebirth), and three stuck shoulders (homebirths).

Midwife management and unwelcome comments during the last four homebirths had inspired Donna to find another midwife: me. Donna and I had “known” each other for more than 15 years through La Leche League. She had quietly watched me share about my midwifery style on an Internet list before choosing to talk with me.

You see, she wanted an unassisted childbirth (UC or freebirth). A couple of births previously, her husband would have agreed. But after some issues with the last delivery, he had insisted on a midwife. Donna’s compromise was to find a midwife who would keep her hands off and her thoughts to herself.

As we got to know each other, I learned what she wanted. She wanted me to be there in case the baby needed help getting started or she began hemorrhaging. That was pretty much it. While I have a fantastic hands-on midwifery education from Casa de Nacimiento and a plethora of clients from years of birth center and homebirth practice, I have been feeling myself less inclined to do something and more inclined to keep my hands out of the vagina—to trust that what I see and hear is The Truth that no cervical dilation can translate. It has been quite an evolution.

At 39 weeks and four days, Donna’s daughter called and said, “Come now—it’s soon!” I flew out the door (without makeup—unheard-of for me), calling the other midwife (a licensed midwife whom Donna had gotten to know as well), and arrived at 5:20 pm; the other midwife at 5:30 pm. The baby was born at 5:59 pm!

I was surprised to see Mom (naked) and Dad (clothed) in the blow-up pool. After four waterbirths, she had debated having another, thinking she would want a land birth this time. The first pool, nearly filled, had popped and the older girls had had to run out for another pool. The kids who were able helped me carry in my equipment (I have two giant soft-side cases and two O2 tanks in Iron Duck bags).

Then I entered the home, softly, breathing deeply before entering the room where the pool was. I watched for a moment, waiting for her to blow away that last contraction, and then asked how she was doing. They said great, and I asked if the baby was moving. She nodded and said a soft, “Yes.” I asked how she was feeling.

Drinking? One of her children brought over red raspberry leaf tea for her to sip. Then, I retreated to quietly set up the equipment right outside the room. The other midwife came and helped me. We checked everything—oxygen on, birthkit at the ready, med tray with syringes prepared—and then we sat and watched silently.

Mom started grunting, and I heard her whisper that her water had broken. It was clear, so we charted that. She started pushing. I know from her history that the head is the most challenging part for her because of her previous tears and episiotomies, and the only part that truly hurts her. As she was on hands and knees, leaning on her husband, I heard her say: “I am scared. I am scared.”

Her husband whispered to her, but she looked up at me and said, “I am scared!” So, I knelt down in front of her face and gently told her that she could do this. I suggested she put her hand on her baby’s head and feel it come out slowly. No matter what happened, we could take care of it. She pushed a little more—and the head was out.

Everyone’s attention was focused on her bottom end. I was sitting directly near her face, and she was the most glorious picture of serenity and ecstasy. It gives me chills, even now. I felt so honored to have witnessed her bliss in those few moments. She waited for another contraction and asked everyone to come to the other side.

I moved backward, as she began pushing her baby out. Momentarily, she thought the baby was stuck but her husband reassured her that he felt shoulders and no cord. Then the baby plopped out of her body. I moved to the side of the pool, just watching, as I could see a tight cord around the neck—twice. As they began to lift the baby, the short cord interfered, so mom and dad both pushed the baby back down and unraveled the cord.

When they brought the baby to the surface, they both took a giant breath, sighed a loud, “Ahhhhhh!” and made little futzy noises. Mom sucked out a little mucus with her own mouth, nothing dramatic, and mom and dad just oohed and aahed over their latest addition.

The baby latched on quickly (12 minutes postpartum). As mom stood up and stepped over the side, about 15 minutes postpartum, a gush of blood mooshed into the water and I heard the other midwife whisper into my ear, “Do you want to check her fundus?” I said, “Nope,” as I watched this very alert mom talking to her family as they made guesses about the baby’s sex.

They didn’t look for about 20 minutes—it was a boy. They now had four boys and four girls, “A matched set!” mom said. I could see that the placenta was detached (separation gush, no trickling) and asked mom if she was ready to deliver it. She wanted to wait a couple of minutes, and that was fine. When she was ready, we helped her stand. I stood underneath with a chux, she pulled the cord a bit, and out plopped her placenta at 6:25 pm. We had her cough because there were trailing membranes, but those came out just fine.

She sat down and nursed her new son … and her toddler. I took pictures. Donna was not ready to cut the cord, so we put the placenta, in the chux, in a bowl next to her (she had seriously considered a Lotus Birth). After an hour or so, she went to her bed with the baby and the placenta in the bowl. She got up to pee, and there was no tear.

This was her first birth without a tear. As she showered, dad held baby. Then she hopped back into the bed, where she did the newborn exam (a cursory look to see how things were. I wanted to check the baby for spina bifida; everything else could wait). I pulled out my flannel sling, and dad weighed the baby (it was the first time they had weighed their own baby). I stood by, smiling. I went home after this but returned for a more in-depth exam of the baby the next day.

The greatest part of this birth were the “firsts”: the first time their child did not have a bulb syringe shoved up its nose (mom’s words); the first time mom and dad were the first to touch him; the first time dad got to catch his child, despite four previous homebirths, in which, at the last minute, the midwife had jumped in the way; mom’s first time not tearing; and the first time she had had no vaginal exams (during the entire pregnancy OR labor)—the first time she was the one who called the shots. This was her birth—hers and her husband’s and family’s.

It was such a privilege to witness. Neither the other midwife nor I ever touched this baby that entire first day. It was one of the mom’s major requests, because all her other children had been dressed by the nurses or midwife. She wanted this child naked. It was odd to not examine him, and I wouldn’t do that in every circumstance, but she knew what she was doing, and I honored her desires absolutely.

The only piece of “equipment” I used at this birth was my sling scale, and I was not even the one to use it—dad did. I left them my scissors and a clamp to cut the cord when they were ready. About 20 hours later, mom got to cut the cord—yet another first. Otherwise, I did nothing but observe and be there for what she hired me for: emergencies.

Someone has commented that I was doula-ing, but I was midwifing. I was watching her clinically, judging blood loss, watching the baby closely for breathing issues, etc. I just didn’t have to do anything. How cool is that? The other midwife and I were totally blown away by this birth, and it caused us to re-examine our beliefs about what a midwife needs to do at a birth and what a midwife could do at a birth.

I was more relaxed than the other midwife about moments of concern, such as the blood loss or the baby not being totally pink while still in the water, probably because my relationship with the family was more intimate. But the other midwife was loving and gentle and respectful as well, the whole time. We were merely witnessing the most fabulous experience of our careers as midwives.

While I am glad I have the clinical skills I need in an emergency (and many I don’t need in an emergency), it was the best lesson in the world to use everything but my hands at this birth. My mind, eyes and spirit were my midwifery tools that day.

Donna has told her friends and family this was The Perfect Birth. I am humbled and blessed.

Barbara Herrera is a midwife and owns Ama Mama Holistic Healthcare in San Diego, California. Mom of four grown children and spouse to Sarah, she remains awed by birth.

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