I have pondered the predicament of this young woman, who I will call Bea, and others in similar situations many times. Bea is booked to have her baby in a hospital, under the care of a team of doctors and midwives. Bea is hoping to find someone who will palpate her abdomen and tell her how her baby is growing, and whether she will be suitable for VBAC (vaginal birth after Caesarean).
Bea experienced an emergency Caesarean birth after a long and painful labour for her first child. She felt traumatised, disappointed, confused, depressed; at times blaming herself and at times numb towards herself, her child, the child's father, and the world.
In preparing herself for this next birth, and in an effort to come to terms with her memories, Bea has had counselling. One of the outcomes of that counselling is that Bea recognises a lack of confidence in the (nameless) people who will provide care for her in labour and birth. Midwives, doctors, others: all with a role in the system that produces babies, yet Bea has no confidence in that system.
Bea is an intelligent woman who is used to researching every aspect of life, from the energy efficiency of white goods in her home, to the source of the food she buys. She wants to know about pregnancy and birth specifically as it relates to her. She reads posts from other mothers on social media.
Bea is particularly concerned about the size of her baby; whether he or she will 'fit'. Bea would like me to palpate her abdomen and (hopefully) tell her that her baby will fit through her birth canal. I can't tell if the baby will 'fit'! Many times I have attended little women who have big babies. Many of them have given birth spontaneously and quickly. I have never tried to be a prophet, predicting events in the future. The decision making processes in midwifery require the midwife to understand and work in harmony with the natural physiological processes, and only interfere if there is a valid reason to do so.
Bea told me she has at least three birth plans: a vaginal birth; a caesarean after labouring; and an elective caesarean.
You need to take ownership of your own natural processes which are essential if natural birth is to progress well. ...to make the best decision you can at any point when a choice or decision needs to be made. Here are a few examples:
- The doctor tells you at 38 weeks that he assesses the baby to be large and advises an elective caesarean (without labour) at 40 weeks. Do you think the best decision at this point is to say yes, to say no, or to make a decision closer to 40 weeks?
- It's a few days before (or after) that magical 40 weeks. You think you are coming into labour - it's midnight and you woke up with a contraction, and felt baby make a few big moves. Waters have not broken. Do you get all excited and ring your support team, and ring the hospital, and wake your husband? Or do you tell that baby to go back to sleep - you have a big day ahead if labour does begin, so you need to get some shut-eye!
- Later ... You think you are really in labour now. Memories flood back each time your womb contracts, and you remember the early part of your first labour. You remember using the labour ap on your phone to track the contractions. You know you need to get organised - little Johnny will go to his granny after breakfast, DH will stay home from work, and the birth support friends will need to make arrangements for their families and work. Contractions are coming every 10 minutes, and feel good. You need to walk and rock through them. Do you ask your team to come now, or to wait for another call? Do you call the hospital now?