Friday, December 7, 2012

MM&M: Call The Midwife

Call The Midwife

I have a small, private midwifery practice in UpState NY. My practice, Local Care Midwifery, PLLC, specializes in planned home birth. Like the popular BBC production currently showing on PBS, my clients call the midwife.
Several times during prenatal care, we discuss the criteria for making this call. At the prenatal homevisit, about a month before the estimated due date, I review labor signs and criteria for calling the midwife.
  • "Call the midwife if your water breaks. I may not doing anything besides tell you to go back to sleep but call right away."
  • "Call the midwife if there is blood running down your legs. This is not normal and I would need a call"
  • "Call the midwife if all your are doing is dealing with contractions. Five minutes apart, ten minutes apart, I don't really care. However, if they are intense, if they are taking all of your attention, I need a call"
  • "Call the midwife if you are just not sure, if you are concerned, or if you just need information or reassurance"
  • And this is what I always say to the partner, "Most importantly, if YOU think that it is time to call and your wife says 'No, not yet', YOU WIN. Call the midwife!"
That last instruction, may be the most important. The reason I say this is because when things are working well, the woman in labor may not realize that she is really deep into the process. Labor, the work of giving birth to another human being, is really hard work that is done best by deeply relaxing. With deep relaxation and intense physical work, endorphins are produced. Endorphins are powerful brain chemicals. They can produce a hypnotic effect lovingly known as LaborLand. LaborLand is a strange place with soft, blurry edges and no sense of time; it is a place where the rational mind does not function. Labor is working really well when the laboring woman's body is gracefully surging from one contraction into the next and her rational brain in not engaged. Labor is working perfectly when the mom-to-be is so far into LaborLand that she has no idea how close she is to giving birth. Sometimes, a laboring woman has no idea that she is really in labor. Someone else, dad-to-be for example, takes one look at her and thinks "This is labor" or "Wow! This is different. I want a professional to keep me company.Time to all the midwife!

The other day, a dad was awakened by his wife with what she said just was 'just cramps'. Shortly after he got up, she moved to into what appeared to him to be intense contractions. He wanted to call the midwife. Eyes closed, breathing deeply, she adamantly said, no. Mom was deep in LaborLand. With the next contraction, she was pulling on her husband's shirt (there may have been some arm punching involved) and crying "No! Don't call. Not yet! It is too early." Good husband that he was (and not loving those arm punches) he listened to his wife. Having remembered my instructions, he also figured he was right. So he tracked contractions. Two contractions actually. Two intense contractions that were only three minutes apart. Time to call the midwife!(Remember this was just twenty minutes after his wife had woken him, saying she was merely 'cramping'.)

He called. I arrived. She had a baby. All was well. We were all glad that in spite of his laboring wife's demand that he not, that this dad took matters into his own hands and called. This was definitely the right time to Call The Midwife!

May all babies be born into loving hands...

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