These two births were similar in that they were both holdout primips from the previous month, shared the same due date, and happened back-to-back.  Other aspects of their labors and births, however, were polar opposites, and very interesting to compare to one another.  I learned a lot here, including a glimpse of how much I have yet to learn.

The first is a sweet and bubbly, youngish mama who came to our place in the evening beginning to have regular contractions.  We had her try to rest and then went to bed ourselves, with the instructions that she will call us if they get stronger and wake her up.  I got the call around 2am and we checked on her.  I had first labor shift while my preceptor tried to rest some more.  The client relied heavily on me: wanting me to provide sacral counter-pressure through every contraction, as well as breathing with her to help her keep a rhythm.  This is the kind of physical support that I usually provide to my doula clients laboring in the hospital, and is entirely different from my usual focus when I’m in the midwife role.  But despite my repeated efforts to include her partner in supporting her, he was ultimately more comfortable with me doing it.

The memorable refrain from this mama was a panicky “I don’t know what to do.”  This was the first time I’ve heard that type of reaction from a homebirth client.  In hospitals, sure.  And in those situations, the question was never really directed toward me: when they’re panicking and don’t know what to do, they get an epidural.  But out of hospital?  I didn’t know what to tell her.  I mostly focused on trying to help her stay in the present, to just be with this one contraction, and then let it go.  She was having a hard time letting go between them: she was experiencing back pain that was constant, and couldn’t tell when she was between contractions because she was waiting for a place of no pain at all.  When I later talked to my preceptors about how to respond to this plea, Terri said that what she’s really saying is that she can’t find her center, and needs help locating it.  Also, that I can’t help her find her center if I’m not solidly in my own center.  So I think I wasn’t calm-confident enough, though Terri says it will come with time.

Around 6am, mama started feeling pushy, and I went to fetch my preceptor.  Through the pushing phase, she kept trying to climb up and out of the contractions, standing up and shouting that she’s ripping in half and she can’t do it.   She would shift back and forth, one minute truly in her body, knowing what she needed to so and that she can do it; the next minute in her head, overwhelmed at the enormity of what she’s doing.  But despite her conscious uncertainty, deep down she knew she was strong, and did exactly what she needed to do to birth her baby.

Our lovely junior midwife came in at the eleventh hour and used her magic words to help this mama resolve herself to the final push.  More than any other skill, I long for this ability to know the right thing to say, to be able to listen past someone’s words and to their core fears and desires.  I have been honored to witness this in her and other healers, and hope that I can someday wield it as beautifully and seemingly effortlessly as they have.

***

That evening, we get another call, from a warm and down-to-earth couple whose water just broke, but only infrequent contractions.  Same thing: they come over, get settled, and we send them to bed.  This time I don’t get called until morning.  They’d been up for a few hours with more regular contractions, but laboring well privately and didn’t need us.  The whole day progressed like this: one of us would come in, check fetal heart tones, and otherwise feel completely unnecessary, so we’d go back out to the midwife-chatting area, or go have lunch or read a book.  This couple was so great, laboring together, she seemed to be able to rely on him 100%, and he was attentive while remaining calm and letting her labor as she needed to.

She labored throughout the day and into the evening.  By later that afternoon, she was complete and pushing, but the head stayed high and the contractions spaced further and further apart, despite the use of black and blue cohosh, walking, and acupuncture courtesy of her sweetheart.

Around 9pm, when the contractions had all but stopped entirely, we had a chat about her choices.  Option 1: she could take the break she was being given, allowing her to rest, even sleep, with the thought that labor would start again when it was ready.  Option 2: more nipple stim, more walking, more etc.  Option 3: transfer to the hospital for Pitocin.  Option 4: transfer to the hospital requesting a Cesarean.  This was a long talk, with many factors considered.  Baby had been doing perfectly throughout, client was tired but healthy.  Then we midwives left the parents alone to think it over together.  When we returned, they said they wanted to go for the Cesarean.  We asked if she was sure, and she was sure.  We asked if she had any questions first, and she said no.  So we packed our bags and went.  She didn’t have a single contraction from the moment she decided until they wheeled her into surgery.

***

This second birth was a wonderful learning opportunity to find out about how positive an experience a Cesarean can be, and about my shadow feelings on the matter.  When we offered her all the options, and she went straight for the C-section, I was so upset.  I’d known I’d have a first client to have her baby surgically, but I’d presumed it would be medically indicated, or at least the last ditch option.  Yet here was a client who had been planning a vaginal birth out of hospital and instead of wanting to go through the levels of intervention one at a time, she did what seemed to me a complete 180 in choosing a Cesarean when the baby was doing wonderfully.  I was telling myself that as long as there were no risk factors, the “right” answer was to go slowly, remaining as physiological as possible and thinking carefully before progressing each level of intervention.  It stung of resignation and defeat to me.

But what I saw happen was so beautiful, so real.  When we’d checked in at the hospital, the OB checked her and said there’s no reason she can’t push this baby out vaginally: adequate pelvis, baby not too big.  Again offered to let her rest, with or without an epidural, and then if things don’t pick up, try some Pitocin in a few hours.

I wanted her to accept so badly: even the surgeon suggested she should try to deliver vaginally!  I felt so certain that this was not the best thing for her.  Yet I was about to be slapped in the face by the realization that my distress was not about honoring my client’s choice, and supporting her, but about me and my biases and desires.

She did not accept the OB’s suggestion.  She said “I feel comfortable with my decision” and they prepped her for surgery.  She did not seem like a woman who had been pressured into something she did not want to do, nor like she was afraid for the baby or herself.  She still, even at this point, seemed relaxed and confident and peaceful.  And it struck me: this IS her right choice.  The sort of thing I knew in my brain but not in my heart, but it clicked for me (at least a little—I’m not saying I’m now a Buddha capable of removing all projections of my ego onto my clients).  If she feels good about her decision, it is not my place to feel hurt on her behalf.  And she made this choice with complete information; she was not coerced and was allowed time to decide what’s best for herself and her family.  It was not the decision I think I would have made, in the same position, but it was never my decision to make.

Afterward, they both talked at length about how amazing the staff was: how respectful and calm.  It wasn’t the birth they were planning, but they were happy with it.  They thanked us for letting them have the experience of laboring privately, and for being with them in the hospital.  They said it would have been much different without us.

I was drenched in a now-familiar feeling of smallness in the face of so much wisdom I have yet to attain.  The more I stand as witness to my clients, the more I realize that midwifery is only one small part knowledge of palpation and conditions and treatments, and almost entirely about knowing how to put my own past and thoughts away and just be present to someone.

***

Upon later reflection, I was most struck by the contrast between the one client who vocalized lack of faith but embodied it anyway, and the other who projected an inner comfort with the process yet ultimately chose not to complete it.

The juxtaposition of these births defied my presumptions: of the two, how can the calm, peaceful labor with a perfectly in tune partner have concluded in a Cesarean, when the previous mama, so outwardly unsure, easily birthed her baby vaginally?

Because labors do not adhere to logic?  Because all women are different, and all labors unique?  Because each was suited to the client, perfect for the situation?  Or is it more mysterious and unknowable, the desire to figure it out evidence of hubris on my part?