Our former and current students are some of the greatest minds, and sometimes the assignments they submit are too good not to share. Here is one assignment turned in by Greta Slabach. The assignment is covering Models of Care in birth experiences by finding examples of underlying philosophy and how the management fits within one model or another.
Birth Experience One:
The first birth I attended was a medically induced birth with a client. She was induced 6 weeks early because of possible preeclampsia and high blood pressure. After about 18 hours of steadily increasing Pitocin, her waters were broken because the contractions were still not very strong. About 4 hours later, she was dilated at a 4. At this point, she was on 14 milligrams of Pit (more than most of the nurses had put someone on. With her last baby, also induced for high blood pressure, she had 12 milligrams.) and the contractions were almost unbearable. She started talking about an epidural, even though she hadn’t wanted one. Four hours later, she was about 6 centimeters dilated. A conversation was had with her husband about an epidural again but it would be a bit before she could get one. About 15 minutes later, her body started to push, out of her control. The nurse with us at the time told her to stop pushing because she would destroy her pelvic floor and my client became hysterical because she could not control her body. Baby arrived, healthy, happy, hiccupping and then screaming, only a few minutes after the doctor hurried in. She had dilated completely from a 6 in 15 minutes. They cut the cord and rushed baby off for a 10 day NICU stay.
Working under a medical model, there was definitely a philosophy of pathology. Diagnosed with high blood pressure and considered “high risk”, there was never any conversation about how to avoid preeclampsia with diet, lifestyle, etc. Even though one of the main causes of preeclampsia is low protein (something we both discovered afterwards). My client has never been able to have a homebirth because of her high blood pressure, which only occurs when she is going to her appointments to get it taken. Home readings tested fine.
When my client, on her third baby, started to instinctively push, the nurse did not trust her to know what this stage felt like and did not believe her when she said she couldn’t stop. My client felt like she couldn’t trust her own body.
Even when her baby was born breathing perfectly and doing well, instead of leaving the baby skin to skin with her, attached to the placenta for the maximum time to get all the blood and oxygen the baby could (especially needed since the baby was preemie), the doctor cut the cord immediately and sent the baby off to the NICU. There was no discussion if the parents of the baby wanted this or a waiting period to see if baby would do well if left alone.
After the birth, my client was supposed to stay at the hospital until her blood pressure calmed down. But, after a few days, when a nurse finally realized that her blood pressure would only get high when they came to check it, she was finally discharged.
Birth Experience Two:
My third birth, my first homebirth, was for a woman on her fifth pregnancy. She called the midwife and myself when she was pretty far along in labor. The midwife hung out in a corner of the room and listened to the baby heartbeat occasionally. There was a moment of concern when the baby seemed really distressed, but the midwife noticed that it was only a certain position that caused this and we all left mom alone again.
The baby was “sunny side up” with his head twisted to the side and so was being very stubborn about coming out. The mom was getting tired with the labor and the midwife helped her into a few positions for letting the baby slip back and readjust. These were difficult for the mom and she asked about going to the hospital. She was, however, fully dilated and effaced so the midwife told her that at the hospital they would just put her under observation. The mom went to the bathroom to talk things through with her husband and 10 minutes later, the baby was born while mom was squatting on the toilet, supporting herself on her husband. Baby was healthy and normal.
This birth, midwifery model for sure, was very gentle. Even though we had a heartbeat scare to the point where the midwife was almost ready to call 911, she still tried a few different things and left mom alone again as soon as there was no danger.
Mom moved around as she wanted, tried different positions and was generally given space (which is what she had asked for). Even when the mom was getting tired of the harder labor, pushing stage with the baby turned funny, the midwife encouraged her with the knowledge that nothing was wrong and was willing to transfer her if needed but also reminded her that it would still be a while before a c-section.
The midwife did not make the mom move from her position on the toilet when she was pushing and helped deliver that baby in a pretty cramped little bathroom. There were some loops of cord around the baby’s neck but the midwife assured the mom that it was normal and okay. She left baby with mom for as long as mom wanted and dad cut the cord when they were ready. The placenta was saved for encapsulation and the couple’s other children and the two grandmothers joined us soon after.
It felt like the mom was allowed to go with what her body needed and was not rushed into anything she did not want to do. The midwife explained everything as she was doing it.
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