Letters to Anne
Writing a piece on birth is perhaps harder for a midwife than anyone else. With so many births to choose from, where does one begin? There are my own exhilarating birth experiences, when my daughters were born, as well as those of my sisters-in-law and my good friends. Also, of course, the many deliveries I witnessed as a student midwife, often conducted by overworked, underpaid government midwives. I have recollections of all kinds of labour and birth, from happily uncomplicated ones to vacuum extractions and spontaneous precipitate labours. Seared on my mind is a birth where the mother wept throughout her labour, knowing that she would have to give up this, her third, child for adoption. The list goes on and on. I could tell the story of my one and only delivery in the back of an Uno, or my experience of mid-air baby-catching as ambulance staff lifted the poor woman from a wheelchair onto a hospital bed. Or what about the woman who couldn’t take her panties off in time and whose baby came into the world with a pair of knickers on her head? My head spins with stories and memories and I wonder where to start.
Yet, if there is a common thread that runs through all these birth experiences, it is the wealth of understanding I have gained from both the women I have tended in labour, and from the many patient, skilful and caring midwives I have worked with. This piece is intended as a tribute to a fellow midwife and dear friend.
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Dear Ann,
For ages I’ve felt the need to tell you how much I’ve learned from you as a midwife. You are the one who taught me not to interfere. I will never forget how you held my hands that day, as you spoke in a gentle whisper: “not yet”. I was bursting at the seams, ready to deliver the baby. A few minutes later I reached out to put on my delivery gloves and, without saying anything, you simply took my hands and held them. Nothing could compare with that birth we did together: not any of the births in movies I’d seen; not any of those I’d experienced during my midwifery training; not any of the births I’d attended over the three years I worked in the hospital; not any of those I witnessed from the margins, when other midwives and doctors were in charge.
Slowly the baby’s head appeared, and with each contraction, a little more became visible. The atmosphere in the room, so quiet and calm, made me all the more aware of my racing heart. The birthing mother was lying on her left side with her right leg supported on your lap. My hands were in your hands. You’d seen it before, so many times, and you knew what to do and what not to do. You released my hands and I fumbled like mad to get the gloves on. There was enough time – yes, the baby’s head delivered slowly by itself, as it should, and rotated, as it should. By now I was just watching. Then, with the next contraction, I finally got to do my thing!
You showed me that, so often, the less one does, the better. Such a valuable lesson to learn, and from such a wonderful teacher. For the first time I understood that fine balance between knowing when to just let it happen, and when to assist, guide, stretch, press down, encourage the urge to push. You also taught me to have faith in one’s judgement as a midwife, to believe that one is making the right decision: whether to cut an episiotomy, for example, or to call it quits and recommend the intervention of a gynae when a labour doesn’t progress.
I remember how, on weekends, you sometimes made yourself available to me. It was so reassuring to know that I could call you towards the end of a labour and that you would arrive with your characteristic calm and your belief in the process, and in me.
You’ve stopped delivering babies, you’ve done what you needed to do. It’s midnight as I write this. Sleep well, and thank you for the gift of your wise hands that day!
Love Ciska
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Hello Ann,
The other day I remembered the very first birth I witnessed, as a student nurse at old St Monica’s. It made me revisit the story of my own journey to midwifery. Three students were allowed to go up to the labour ward and stand at the foot of the bed. The mother was giving birth to her fourth child, and the baby just slipped out. I couldn’t believe my eyes. It looked so easy. The next couple of births I witnessed were similar, and so were the first few deliveries I conducted myself. This was probably helpful, since it created in my mind the idea that birth was good, and easy, and ordinary, in the best possible way. In retrospect, I think those midwives called us for the easy births in order to get it all over and done with – we needed to do fifteen births for our training and pestered them like crazy.
As a newly qualified midwife, the picture changed dramatically. Having the theoretical knowledge about all the possible scenarios, the different foetal positions and complications, is one thing, but having to recognize, diagnose and handle them is a totally different story. Once I started working as a midwife at Mowbray Maternity Hospital, I realised how little I knew and how scary delivering a baby can be. I loved it, though. It was this passion that helped me stick it out.
After learning to recognise complications in labour, and how to deal with the transfers from the clinics, I still had to learn how to ‘be’ with women in labour. I’m so grateful that our paths crossed at The Active Birth Unit. This is where I was to learn what it really means to tend to a woman in labour. Having worked in a very busy labour ward with high-risk labours, dealing with these healthy, low-risk women was quite a challenge!
I realised with a shock that I had to learn new skills, and these labouring women scared me to death, especially the Primips. Before, I ran from woman to woman, from monitor to drip stand, from ward round to sluice room, all day long. Here, especially in the beginning, when the unit had just opened, I often looked after only one labouring woman for a whole day. This was much more exhausting and stressful, but infinitely more rewarding. What I found most challenging about attending women through the full duration of their labour, was the psychological aspect. You know how, as the labour progresses, they become quiet and introspective, experiencing things much more privately and intensely. It was this intensity that scared me. But I found that, when I’d been with a woman from the beginning of her labour, I came to realise that her behaviour wasn’t frightening or alien in any way; I could see and feel her strength. I would observe how, after each contraction, she would come out of that space and reorientate herself. I became aware that, as long as a woman knows that she and her baby are safe and that the labour is progressing, she copes superbly. I slowly started losing my fear of other women’s pain. A funny thing to say, but it was exactly that which enabled me to support them better during labour. Even Primips don’t scare me so much anymore!
Love Ciska
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Dear Ann,
I’ve been meaning to ask your advice on something for a long time. I find it so difficult to find the right place for myself in the pregnancies and births of close friends and family. At first I want to run away and let others handle everything, but I also so badly want to be there and involved – to guide, and care, and help. Frustrating really. I don’t know if it’s a matter of wanting to respect their privacy, or if it has to do with the blurring of boundaries between love and professional care. Oh, but I know what you’ll say, and yes, you are right. I must just trust my gut and things will work out as they should.
Which brings me to the point! I have just returned from the hospital where Chris and Natalie’s baby, Olivia, was born 2 hours ago. I am on such a high! Being a close friend, I had tried hard not to become involved as a midwife, only to be supportive as a friend. But this morning they sent a message from the hospital saying: “Can you please come?” It was such an exhilarating experience. Natalie wanted to try without an epidural and succeeded. Her first contractions were at 6am, and the baby was born at 10h19am. Can you believe it, the gynae missed it and I delivered her with no gloves! A first for me in these times when we are all so scared of one another’s blood. It was unbelievable how soft she felt, and how lovely and right it all was. Natalie gave a distinctive grunt very shortly after the gynae left, having said that her cervix was 6cm dilated. I called the hospital midwife to come and check, since I had no business doing an assessment on her. She called the gynae immediately, but with the next contraction, Natalie started bearing down. Olivia’s head slowly crowned and then, in a jiffy, she was out. We laughed afterwards, because the hospital midwife told Natalie not to push and I simply said, “ Do what your body is telling you to do!” It was very special!
Hey, isn’t it great, women are doing it for themselves!
Love Ciska
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Hello Anne,
Now for the latest on the midwife front. I had a telephone-conducted homebirth at 5am today! The woman in labour called at 4h45 and the baby was born at 5h03. I arrived at 5h10! Another first for me – lovely, though. The dad did a sterling job while I was racing over, breaking at least three laws at any given moment, from talking on the cell, to jumping red lights, to exceeding the speed limit. But when I heard the first cry over the cell-phone, I relaxed, knowing that only a very healthy baby could cry like that. I congratulated him, but the exasperated dad told me that the baby was still half in. I had to laugh and said, “Well, pull her out then!”
At least I arrived in time to deliver the placenta, though of course that was less eventful! The brave woman’s perineum was intact. I had always dreaded this sort of scenario, but you know, it seemed that this is how that little baby was meant to be born, delivered by her dad. He himself was delivered by his father at home, also because of a very quick labour.
Funny, as I write this to you now, I believe that I am more confident as a midwife, but I don’t think I will ever be as cool and calm as you! Every time I venture out to be with a woman in labour, my tummy turns until I am able to meet her where she is at, physically and psychologically. Every experience is so different. I am forever learning from these women, whose wonderful stories surround me.
By the way, I’ve been asked to write a piece for a book of birth stories. I hope you don’t mind if I call it “Letters to Ann”.
Your loving friend,
Ciska
By Ciska
