Home Birth Emergency- Mother and Birth Attendant Teamwork
I had a client that asked that we share on her birth experience together. She wanted to share her story, then have me share my perspective. The goal was to share on what home birth in an emergency looks like, while revealing that it often can be addressed in-home. Covering the teamwork between mother and attendant; how to ultimately pull through together as a team. Her idea was brilliant in my opinion!
First, you will read her story from her perspective, then mine as the attendant.
*Please note that the birth attendant is a legally documented Midwife, not a Doula.
The Mother’s Perspective:
Where to begin?! I felt for weeks the anticipation of my birth looming closer. I remember reaching out to my birth lady being like what happens if you are not here or I go early? I felt deep within I was going early. I was nervous. I was the classic text book high risk scenario. High BMI, large prior babies, past GD with second child. But I wasn’t about to let the medical field put me into their box. I was tired, severely tired of being told to take out my piercings, being judged on my tattoos like I was a degenerate. I felt I was rapped with my second daughter. The pain I felt when a doctor at Einstein East Norton PA hospital shoved her hand up me to “check my daughter” was worse then the worst contractions I experienced with her birth. She said if I didn’t let her check she wouldn’t let me VBAC and would send me straight to the OR for a cesarean. I was tired of the medical rape. I was tired of their ultimatums and being treated like a number. I was tired of being told if I didn’t shove needles in my kids straight after birth I was going to murder my child/ren. I was tired of their BULLSHIT. My experience at Grandview hospital in Sellersville PA with my first was worse in a lot of other ways. The trauma and broken trust of the medical field absolutely runs deep when it comes to to birth, pediatricians, doctors and about half the nursing staff I’ve encountered is on my shit list. Excuse my curses, my passion on the topic takes me back to my most vulnerable moments.
Fast forward to pregnancy number 3. I was already like “Oh my God, I’m having another kid, I’m traumatized from the first 2, and Covid just started making news.” I was confused scared and panicked to find a provider outside of the medical field. Fast forward 18 weeks I started gushing blood. I was showing all the signs of a miscarriage. I went to the hospital that night but left because they wouldn’t let my partner in with me. ( Thanks bullshit Covid regulations that have helped no one. )The next morning I gushed more blood.. darker blood. Decided to go to a different hospital. They detected a heart beat! He was still there! Thank the lord . My attendant, Des and her partner Taylor were the ones to figure out it was caused by an infection due to a clogged milk duct. The prior week Des had encouraged me to get the infection under control or it would cause serious problems. I had gotten the infection to go away but the impact on the baby was already in effect. They figured out what the hospital couldn’t by reading my blood work results.
Back to my birth: I had a lunch with my sister’s mom and closest friends. I was already feeling some painful contractions but they weren’t amounting to much; I was on the dot 38 weeks. I was having a ton of Braxton Hicks before this. This was the start of my three day labor! Every day around 8 or 9 pm it felt like I was going into labor. Until eventual one morning they didn’t go away. I was in my tub from 3AM to just before Des got here around 10/ 10:30 AM. Shortly after Des came, my bestie Kelly showed up. I don’t even remember how many hours I was in active labor from that point forward. I think 22 hrs in totally just about. From being in prodromal labor for days, I wasn’t eating right. The pain made me feel so sick I couldn’t eat; that was a huge mistake. Everyone was good at giving me water! After a while Des started feeding me honey to get some nutrients and energy into me since I couldn’t eat solid foods. I remember feeling disoriented and wanting to sleep but I couldn’t and I knew I shouldn’t. (Even though I know some moms can, I knew I had to stay vigilante the best I could.)I could see everyone’s faces starting to look worried and tired themselves. Des describes my birth in detail best; I went through a period of trying to push out what happened, so recollection of the day is scattered. I don’t have a high threshold for pain so pushing out the details helped me during recovery.
I knew it was going on too long and that the baby needed to come out. I tried with the best of my efforts to get baby out, but I was growing more and more weak. I just remember looking at Des like, “help me”. She did just that, and she explains it better than I could of. I don’t know the “ins and outs” of what she did technically, but when she went in I was able then to effectively push him out during a contraction.
My child’s father did in deed lose his shit. Since his 3 prior babies were all c-sections, he never witnessed a vaginal birth (despite my efforts to get him to watch some). He ran out of the room to collect himself. The collection of what occured that day didn’t come until days later. My baby was most certainly not using his lungs when he was born. I was not panicked, as I knew inside of me he would be okay. I don’t know how, and I’m pretty sure mostly everyone else thought he was not okay or worse. I remember the Cops responding first, than EMS. The cop that Des was instructing on how to to do mouth to mouth was a sweetheart. He came to check on my son days later, but I wasn’t home. I personally wanted to go to the hospital because I was weak and couldn’t hold myself up. I felt I needed oxygen and fluids, myself.
The hospital (of course) took their liberties, but for what the situation was it was handled the best way medically that I could of expected. It could have been worse. When I told the one nurse, “No don’t touch me.”, she didn’t. When I told the doctor to wait until I wasn’t ready to push my placenta out, he waited until I collected myself. They had Draven in the NICU for ten days; Three days cooling, four days warming him back up, and then the rest of the time to make sure he was eating to their standards. Everyone thought I was traumatized by this situation, but I wasn’t in the way one would think. The on-going labor was tiring and intense, sure, but I prepared myself to endure all of the unexpected, even a transfer.
The hardest part for me, was not bonding with my son immediately after he was born or getting him to breastfeed. Not being with him every waking hour for those 10 days was my nightmare. But let me tell you how my child was a fighter; He survived an almost 2nd trimester miscarriage, a hard labor, a NICU stay, but from point A to B he was handled with the utmost care. With Des’s knowledge and “know how”, she saved my baby. I know not every birth attendant can say that. I knew from the get-go she was my lady, and all my trust went into her. I felt she went above the call of her duty, put herself on the line mentally, and even questioned if this is the line of work she should be doing. My experience with her showed me there is no other line of work she should be doing because this woman saves babies! She saved my baby; I am forever grateful and indebted to this woman for this. Draven is currently over 14lbs and almost 3 months old. He’s meeting all of his milestones; he is breastfeeding, intact, and vaccine free. Most importantly he is safe, sound and happy. I also got the birth I wanted and prayed for.
While I wouldn’t do it again to avoid another NICU stay in a consecutive birth, I am happy with our outcome, and thankful for our experience. I’ve learned a lot, Des learned a lot, and I know our experience will help her help many women in her future and that is most invaluable and priceless to me. With this all said, I also feel I need to make this one point understood. When you hire a guide for your freebirth, you are choosing a birth where any out come falls on you! Not your birthing support. Just like when someone chooses a doctor for a medical birth. Scheduling a third c-section, I could of just as easily as bled out; that would have also been MY choice. You pick the people in your room and they are not liable for your birthing choices. Had Draven not made it, I would have taken full responsibility for that possible tragedy. I also took responsibility for his NICU stay; that was on me, my choices, and not knowing that was a potential outcome. Finding the right birth attendant is so important. Their knowledge can make or break your birth. Whomever you choose to hire to walk with you on your pregnancy and labor journey, is on you.
Though I expected there to be some hang-ups based on my medical history, I just couldn’t bare 9 months of harassment and being beaten down by medical professionals. Maybe one day the holistic world can meet the medical world in a better tailored union for the “crunchy mom”. But until then, women will continue to take the path less traveled, but most certainly bravely ventured. Free birthing, unmedicated, 11+ pound baby, with true shoulder dystocia, 22 hrs, no tearing, is not for the weak willed! And I’m proud to say I’m a VBA2C mother. Thanks for reading my story.
The Attendants Perspective:
The mother in this story is now a dear friend and very special to me, as is her sweet (big) baby boy. She has encouraged me to share on the experience, after sharing her thoughts through her birthing experience. I told her I absolutely would! I will also share on the necessity for the attendant to remain a team with the mother in an emergency. All should be intuitively led, always. My role at this birth was as a hands-off attendant, but I am a legally documented midwife in the state. What is mentioned that occurred is legal action.
This wasn’t a little quick fix situation- I’ve been there and this wasn’t it. It was like, “Ope, this isn’t good, let’s try this.”, then, “Okay, we’re good now!”. Followed by “Oh no we’re not, here we go.” Over and over. Literally, one after the other, which in hindsight is to be expected in that situation. Sometimes birth doesn’t follow the beaten path; here’s a story of one that did not.
This mother had been in labor for a good 3+ days at 38 weeks gestation, minimal sleep, and not much to nourish the body. She was a VBA2C, and was determined to have her home birth. Everything progressed beautifully, just slowly, up until transition. Baby wasn’t descending through the pelvis. Prior to this day, I had never touched her internally. I did not know her pelvis shape, but as soon as I did I could see what was happening. She had more of a platypelloid pelvis with a decently flat front pubic bone. The baby was hitting the pubic bone each contraction and was not getting passed it.
We had tried every position, in and out of water, including McRobert’s. Further decsention was not occurring, baby’s head was right there, but wouldn’t budge further. Mom was already weak; she said she couldn’t physically change positions anymore, and did not want to. I respect complete autonomy so here we were, with her on her back (the worst position for this situation). She looked me in the eyes and asked “what next”. I told her I supported whatever choice she would make, no matter what. If she wanted to transfer, I’d be there for it. She looked at me in desperation and said “Is there literally anything you can do for me?”
I thought about the internal anatomy, baby’s fetal positioning, what I had felt internally, and said “Well, we can try [this] but it won’t feel good, and it’s invasive, but it just might work.” I’m not an internal touch person – I don’t typically touch women when they give birth, not in this way. Never will I touch a woman without permission; autonomy is something I am passionate about. After explaining what I would do, she immediately asked me to and gave me permission to touch.
Based on what I knew about the anatomy, I figured if I held her pelvis open by lodging my fingers between her pubic bone and baby’s head on each side, that her baby would descend (because the pelvis does move in labor). So I did just that; something I’ve never read in a text book or been taught, it just made sense physiologically. I held her pelvis open the next contraction and the head began to successfully descend. The next contraction I kept my hands off in hopes baby would do the rest on his own, but no. So I did it again and this resulted in the birth of the head. I knew then that he was a big boy.
This was the first time I thought “Oh, we’re good now”. What I did not know, that I was later taught by an elder mentor, is that if you have to assist with the birth of the head, you’ll likely have to help the rest of the way. & she was right!
Baby’s head was getting darker and darker purple.
No progress in descending further during 2 contractions.
Baby turtling back inside mom.
Literally every sign of shoulder dystocia.
Looking back at the birth video, you can hear it in the mother’s voice; she knew something was not well, innately. She knew before I did, she just didn’t know exactly what was wrong. I knew I had to act and relayed to the mother what was occurring. I told her what I could do, but it would again likely be painful and invasive. Again, modeling the team work effort and necessity for informed consent; with autonomy and choice ALWAYS as the forefront in priority. She gave me permission, and the next contraction I tried what I had learned in text; Woods Screw maneuver. For those who are unfamiliar, this is reaching in, locating the impacted shoulder and rotating it away from the public bone, pushing it into the chest. While doing this, I could visually watch the textbook images in my head; it was gnarly. Once I had the shoulder hooked, it felt so *wrong*. There was a brief moment of hesitation because I didn’t want to break his arm, but I was immediately met with functioning adrenals that reminded me that I also didn’t want to see a dead baby. The Woods Screw maneuver ended up working; the shoulders released and baby was awaiting imminent birth. I backed up and asked Dad if he wanted to catch his baby.
While her contractions were very weak, they were bringing him earth side. After 2 more contractions, he was born at 1:09 AM with no reflex, poor color, floppy, and the one thing I will never forget is how his bottom lip folded in. He wasn’t breathing, which can be normal for shoulder dystocia babies, to take a little longer to transition to oxygenated air. I watched cautiously; Mom had him in her arms, rubbing him, talking to him, all of the magical things that usually work, to no avail.
Back story: I didn’t have my typical full birth bag at this birth because I was coming directly to her from the airport. I asked if she wanted me to go home and get all my stuff, or just head her way, she wanted to me to come right away, so I did. In hindsight, I would have had ample time to go home and get back hours before birth. I always follow mother’s instruction, though. This was the very *first* birth I attended without my resuscitation equipment.
Noticing that he was not making progress, I snapped into action. I grabbed the suction bulb and stethoscope. Mom went to suction the mouth, but she was anxious and dad was loosing his marbles (rightfully so), so I took over. As soon as I touched his body I told her present friend to go call 911. I don’t know how else to say it that “I felt it in my bones”. Never would I typically make the call that soon after birth to call EMS, but I knew. I heard a heartbeat that wasn’t decent, but it was there. Her friend came back in the room and I asked if she called and she said no, not yet. I then saw a whole new side of me come out. I looked her in the eyes and very firmly and sternly said “Call them right NOW”. She picked up on urgency and called. I kept up with resuscitation using mouth to mouth, as I didn’t have a BVM on hand.
I personally believe it is more effective using mouth to mouth anyway, as you can feel the lungs fill and hear them exhale. I found so much comfort in this; knowing the oxygen was 100% getting into his lungs and hearing it exhale, where with the BVM this does not occur the same way. *Mouth-to-mouth is also against OSHA, unsanitary, not suggested, and a professional “NO NO” (eye roll)*. I did this until the police officers showed up. I looked in the eyes of one of the officers and firmly asked him to switch out with me. He looked at me in shock, and started doing only chest compressions. I remember keeping this “firm and direct” tone the entire postpartum. I don’t know what came over me, but it helped in the situation. I told him he needed to take his mask off (COVID) and give him breaths. He looked at me with fearful/unsure eyes but immediately listened to me and followed my instructions until the EMTs showed up. He did not question me, but trusted my firm instruction. While EMS absolutely did not show up accurately equipped, they were mostly respectful to the family and myself. They took the information offered to them from what had occurred; her gestation, time of birth, that he never went without oxygen, etc. respectfully. It was a breath of fresh air to work together with the same goal, instead of them brushing us off like they knew everything. This baby was eventually stabilized in EMS care, but they had chosen to transfer to ensure all was well, which he was and is, but that’s a whole different story.
While some might read this and think “Well if the attendant or the mom did XYZ, it would have been different.” – That is not autonomy. That birth went how the mother chose, and as a team we made it work. She had her VBA2C and gave birth to an 11lb 4oz baby on her bed in her home; right into Daddy’s arms.
That birth was the most challenging I have been to, to date. I learned a lot that day. I didn’t know I’d go home to endure days of flashbacks that I couldn’t control. I didn’t know I’d need to speak about the birth as much as I did to process what happened. I had no idea any experience could make me question if this is the right career for me, but it happened. Going to a birth 5 days later, having a flash back as I open my suitcase and see the equipment used at the last birth, was something I didn’t know could be possible . I had no idea how hard that postpartum would be.
After one gives birth, I make sure all is well and good, and I see them happy in their home before I leave. This doesn’t happen with transfers. There is no closure or mental peace for myself until I see both mom and baby well in that same setting. I waited over a week for this birth to come to an “end”. My energetical and intuitive connection with her continued in that time. I’d message her at the exact times she would be awake pumping for her baby, she would claim. I could feel her hurt and it was 100% my own as well. Not in regret, but in love and concern. No regrets.
The peace and closure came when she invited me over to meet baby Draven. I was so happy and excited until I got to their bed and bedroom where she and he were snuggled up. I saw him alert, breathing, on his mommy, and his bottom lip was folded in gently as it was at birth. I went to hug Jackie, lost my composure, and apologized. I was very much so overwhelme to see them. At that time, the energetical and intuitive connection could finally be severed, and I could feel peace pertaining to this birth.
If I could go back, the one thing I would have done differently is to act sooner. I should have acted sooner in my opinion, but I did not learn this until I sought ample peer review, consulted with multiple elder midwives, and watched the videos over and over time and time again. Hands on birth is gnarly, but sometimes it is required. I feel confident that if the same situation occurred again I’d handle it with absolute grace and fluidity.
The team work between mother and attendant is paramount. In my opinion, it should always be mother led, she should be calling all of the shots. The attendant should be keeping their mouth shut and sitting on their hands unless there is a reason to speak up or touch, while being educated on “when” is also important. In those cases of touch being necessary, full informed consent should be given unless it is a life or death moment where seconds count, with no time to talk. If something is clearly not well, that should be relayed to the mother, followed by options, and nothing occurring unless she authorized the go-ahead. This is how we leave the mother empowered in her birth.
No one wants an emergency to occur, but sometimes they happen. In those situations we can make it less traumatic and leave the mom empowered by giving her ultimate say with informed consent. It would have been really scary if I randomly reached inside of her body without explaining what I was going to do. It would have been scary if I didn’t relay to the mother, “I do hear a heartbeat and he is alive”, but perform mouth to mouth on her baby with zero reassurance. All of those moments and actions are important. Of course, there are times that there isn’t time for talk or options, but those occasions should be few and far between. Leaving the mother in charge or informed in what is occurring and offering reassurance is how we decrease trauma and help her obtain her own empowerment.
If you are an unassisted birther or are planning an unassisted birth it can be helpful to know what to do if you might find yourself in a shoulder dystocia situation. The first course of action is to change positions to an upright position; standing, squatting, on all-fours, lunging, etc. Any position that opens the pelvic opening wider. If this does not help, locating the shoulder externally and applying sub-pubic pressure while in a McRobert’s position may be helpful. Sometimes internal impacted shoulder rotation is required. To learn more on shoulder dystocia situations, enroll in the HERBAL Freebirth Course: https://herbal-training.com/freebirth-course/
The teamwork between birthing woman and attendant is crucial to outcome. The person present should also never do something that they are not fully knowledgeable on, as a little information can become harmful in an emergency. We do not suggest HERBAL Doulas do things of the sort that are mentioned in this article, unless they have obtained outside training/understandings on their own.