Getting through a transport
If this is a truthful blog about Dinah's Days and Nights, gotta talk about transports. Transports are shit. Transports are really hard. Transports have to happen.
Last week, a first time mother, (and yes, it is usually a first time mother or a VBAC) labored the way first time mothers labor..... A couple of nights of irritating contractions keeping her from resting well, phone conversations and suggestions about ways to get through it and then a meeting at midnight at the birth center. On the phone things sounded good..... she was not exhausted, contractions were consistent, low down in her belly and she sounded like she was coping well. She arrived with her husband, excited and rolling withthe labor..... looking good. I examined her. Cervix completely effaced, 0 station and 3 cms dilated. A nice little bulgey bag of water and baby in a perfect left occiput anterior position....... couldn't be better. 3 cms at midnight, mmmmm. I really wanted her to rest because clearly there would be a lot of work ahead. She lived 40 minutes away. I didn't really want her to drive there and back again in labor, but I've made the mistake too many times before of keeping a 3cm laboring mom at the birth center. Frequent result: exhaustion despite best efforts. C and her hub were happy to head home with a bottle of skullcap and some rest ideas. I went home to rest myself (in theory). Of course with a mom in early labor and menopause plaguing with its nighttime habits, I didn't sleep.
At 4 o'clock, the expected call came. I could hear C in the background loudly moaning and I hopped into the car. She sounded hot and heavy. I ran into the birth center thinking "I knew this was going well" and filled the tub. She was going to arrive almost in transition and would need the water right away....... But you know the end of this story so you know that is not what happened. In she came huffing and hollering........... "Aaaaaah I can't I can't this huuuuuurts" More mmmmmmm. Not good. Birthing a baby requires the "Bring it on" attitude not the "I can't it hurts" attitude.
I checked her: Completely effaced, 0 station and....... still 3 cms with NO bulgey bag of water...... So if you've been to a few births you know what had happened.... yes, water broke on the way home and baby turned posterior....... Oh lordie. This kind of deal requires huge stamina: Mother stamina, spouse stamina, midwife stamina.,.... and it requires motivation: mother motivation, spouse motivation, midwife motivation. So we worked VERY HARD. We worked on motivation. We worked on stamina and we worked on rolling that baby to the front. All of us worked very hard. Knee chest push that baby up and encourage her to turn. Lunge with the left leg. Lunge with the right leg. Dance with the hips rolling. Walk up and down the stairs. Pulsatilla. Aconite. Gelsemium. All these had their parts to play. From 6am to noon C progressed from 4cms to 5 cms and this was not looking good.
When it was time to go, C cried, her huband cried and off we went. At the hospital, wires, tubes and more tears. I stayed at her side in the hospital till at 4pm she got an epidural and it was time to rest. Home discouraged, disappointed, exhausted. That's transports.
After a transport it is easy to self blame, to feel that you are the only midwife who gets transports; that another midwife could have done differently, better; to feel guilty.I know that it is right to think through what happens after every birth whatever the outcome, but especially the transports: How did that happen? What can I learn from this? But at the end of the day, a midwife can't go on if she blames herself. In fact there is something egotistical about self-blame, like the midwife is the center of everything that happens. I must remember that I have a part in the birth story but I am not the cause of most things that happen at a birth.
Being a midwife involves learning to live with transports.
By the way, by 3am, C was still at 8 cms and ended up with a C-section. She, her husband, and her baby, are doing OK.