And so, as we saw through my last post in our series, complications do occasionally arise at homebirths. Thankfully, midwives are usually able to handle them with success!
Join me now as I see the little family through their first night together.
The singular trill of a robin startled me from my revere. I lifted the shade over the kitchen window just as a cacophony of birdsong filled the air. The first tentative rays of sun had reached their fingertips across the sky, kindled the treetops to flame, and lured the Belgians and the Standard Bred mare with her frisky foal into view. Steam rose from the backs of the horses and mingled with the light and shroud of the morning mist. I stood there a moment, soaking in the sights and the sounds, allowing them to revive me before I returned my attention to my work.
I was busy at the sink, cleansing my hemostats and bander and scissors, wiping down my measuring tape, my stethoscope, my doppler, the tote.
I’d spent the night in the spare bedroom with Adam upon my chest. We’d risen about an hour before daylight to usher Emma to the bathroom and back for the first time since she’d birthed her son. She and Robert had been enjoying him in private ever since, and the hum of Pennsylvania Dutch sprinkled with laughter filled my ears as I washed and rinsed and wiped. I sighed and I smiled.
Robert entered the kitchen then. He’d donned a stained, but clean work shirt, pulled on his simple britches, and snapped his suspenders into place. His face was a wreath of smiles.
“Off to chore. You’ll be alright in here, I suppose?”
“Alrighty! I’ll return with warm milk and fresh eggs, then we’ll see what can be done about breakfast!”
A clatter of hooves rose from the roadway and followed him into the mudroom where he shoved his feet into a pair of muddy boots and his arms into the sleeves of a light jacket. He squinted through the screening of his loose-jointed front door.
“And help with breakfast has arrived, it seems.” He winked at me, mashed a fraying straw hat over his mop of dark hair, and flung the door wide.
I looked back out the window to watch as he greeted a round old man with a scraggly beard and a round older woman hidden in a black bonnet and cloak a-perch in a rusty buggy. Emma’s mother and dad. The gelding hooked to the buggy stomped his foot, shook his head, and whinnied to the horses in the pasture.
Ah! My replacement.
It had been a long day and a long night, but I’d done my job and we’d all come through together. I reveled in the simplicities of the cozy morning but, still, after more than thirty hours in attendance, I was more than ready to head home.
Toward eleven the night before Mary and I had tested Emma’s ability to visit her bathroom. Though her son was more than two hours old and we’d filled her with food and drink, she demonstrated a woeful inability even to sit up much in her bed. She did need to empty her bladder, however, so we spread a layer of towels and chux pads beneath her and, to everyone’s relief, she managed to accomplish the task without the aid of a catheter.
We decided to tidy Emma and her bed up a bit, cut Adam’s cord and conduct his newborn exam, then let Mary go on home while I settled in for the night.
By the sharp contrasts of light and shadow cast by the kerosene lamp, we drew the blanket from little Adam’s body and rolled him to his back upon his mama’s breast. Though we handled him with gentleness, our actions elicited a frown from the baby as all four of his limbs reflexively popped from the warmth, every tiny finger and toe spread to the skies.
He threatened to cry, but I leaned in and whispered into his ear, “Sh-sh-sh-sh.”
He quieted and opened his eyes, first one, and then the other, and looked full into my face. I smiled as I returned his penetrating gaze, struck with the force of his humanity, tiny as he was.
“Oh, Adam, there you are. Hello.”
I carefully opened his legs and fastened the Averbach bander to the thin, pale cord an inch and a half or so from his belly, marveling how only two hours previous it had been loop upon thick loop of sinewy turquoise wrapped with coils of magenta, pulsing and alive.
I passed the scimitar-shaped scissors to Robert and fixed a pair of hemostats a half inch further along the cord, then instructed Robert to make severance between the instruments.
“It’ll take a couple snips, Robert, these scissors aren’t as wicked as they look.”
It took exactly two, the first slice making a grisly, grinding sound, the second, the clean clink of metal against metal.
“There.” Robert straightened and smiled. “He’s free!” He began to unbutton his shirt.
I shifted the lever of the bander in order to work the tiny circlet of rubber over the raw end of the stump as I released its jaws, then I wiped away the droplets of blood that had dribbled onto the baby’s belly and lifted him to his father.
Robert gingerly took the squirming child and cuddled him against his bare chest, and Mary covered both of them with the blanket, rich with mother scent, that had kept Adam warm next to Emma since his birth. Robert lowered himself into a rocker tucked into the corner of the bedroom, and we turned our attention to Emma.
Emma had sustained a slight tear. I’d noted that soon after the birth, but it, thankfully, was one that didn’t require mending. I sent a silent prayer of gratitude heavenward for that as I replaced the chux pad cradling Emma’s hips and washed the blood from her thighs and bottom with a soft cloth and basin of warm water. I helped her into a woman-sized diaper reinforced with overnight pads, strapped her into her binder, then helped her change into a fresh nightgown. We rolled her with care, first to one side, then to the other, as we drew the soiled sheets and shower curtain liner from beneath her. As per our instructions, a clean set of linens lay ready for use beneath the plastic, and in no time we had Emma blessing us for how much better she felt. She eased onto her side, and we laid what we needed for Adam’s examination into the curve of her body so she’d be able to watch all we did from where she rested.
I turned to receive the child from Robert, warming to my task.
“May I?” I asked, reaching for the baby.
I loved performing newborn exams, and I approached them with a respect near to reverence. I recognized the experience as a baby’s first encounter with life apart from his mother, aware that the way I handled him would shape the way he viewed the world henceforth. I worked according to that knowledge, determined to make the experience a positive one.
And I could see that wee Adam was already familiar with me. But of course he was. We’d met many times already. Through layers of skin and muscle, fat and fascia, I’d run the heel of my hand along the curve of his back, I’d cupped his little bottom in my palm, and tested the relationship between his head and his mother’s pelvis with the my fingertips. I’d listened countless times to the pattern of his heart as it thrummed and rippled through the waters that cushioned him – listened for fluctuations of rhythm as he kicked, as he wiggled, as his mom laughed at something his daddy said, as I stroked him and shifted him. He’d felt the pressure of my fetalscope and the flick of my measuring tape as I stretched it the length of his spine. He’d heard my voice as I talked to his parents, talked to Mary, talked to him.
But the folds of tissue that had separated us from one another all those months had been swept aside, and there we were, soul beholding soul by all five senses.
“Hey there, sweetheart.” I crooned as I tucked his soft, rosy body into the flannel of my sling. I brought the D rings together, hooked them to the scale, and lifted the bundle from the bed.
“Oh, my! He’s almost eight pounds! Seven, fourteen! Good job, Mama!”
Gasps of surprised delight rewarded my announcement as I returned him to the bed. I left him within the comfort of the sling. He was calm yet, and I wanted him to stay so as I auscultated his heart and lungs, and took his temperature. I slipped the thermometer beneath his arm, noting the downy coating of lanugo covering his shoulders.
“Ah, see the hair? It’s called lanugo. He’ll shed it over the next few weeks. And look, it’s here on his ears too, just a little fringe of it. He’s got a nice lot of vernix on him, too – this gooey white stuff – in all his creases. Get that rubbed in over the next few days, and it’ll protect him from germs in the environment.”
I pulled my watch from my wrist and held it between the thumb and first finger of the hand that held the thermometer in place under the baby’s arm, and popped my stethoscope buds into my hears with my free hand. I placed the bell against the little chest and listened to the beating of Adam’s heart, shifting the bell in a circular pattern over the vigorous organ in order to listen to each of its sections.
“Strong, healthy heart. His pulse is steady at 100 to 110.”
The thermometer beeped. “And his temperature is 96.8 degrees.”
I moved the bell of the stethoscope to his back and listened through one breath over each quadrant of lung, then I shifted the bell to the space just below his throat to count the number of breaths he took in sixty seconds.
“46 breaths per minute – surprisingly even – such a peaceful baby. And his lungs are clear.”
From there I measured his head, his chest, and his length. I palpated the bones and tissues of his skull, his neck, his clavicles, his spine, and felt for the subtleties of his pulses. I examined his eyes, his ears, his lips and tongue, and the roof of his mouth. I rotated his hips, felt his nipples and abdomen, assessed his plumbing, and tested his reflexes. I noted his color, looked for markings, and observed the strength of his limbs and symmetry of his form.
Mary scratched my comments into the chart as I moved over him, then I printed his feet, dressed him, and tucked him into the crook of Emma’s arm.
We said our goodbyes to Mary and she took her leave. I’d intended to clean and stash my equipment then, but Emma called to me from the bedroom.
“Kim, I’m sorry, but think I need to relieve myself again.”
We repeated the towel and chux pad trick, switched out her maxi pads, and returned Emma to a state of comfort. Almost before I’d got her tucked back under the coverlet, Robert had climbed into bed and fallen sound asleep. I looked at Emma. She, too, was clearly exhausted.
“I know you’d like to keep him with you, but should I take the baby while you two sleep awhile?”
“Oh, Kim! Would you? I really am just so tired.”
So I abandoned my tasks at the kitchen sink, put out all the lights, drew back the covers on the bed in the spare room across the hallway, and snuggled into it with Adam on my chest. His fuzzy head bobbed at the hollow of my neck and his tiny pink tongue explored all its creases as I patted him to sleep. I basked in the rare chance to cuddle with a newborn babe before I drifted off myself, little knowing that seven years later I’d be patting Adam’s new brother to sleep upon my chest in that very bed.
The names of the clients in this story have been changed, and some of the details of their lives have been altered or combined or exchanged with the details of other clients’ lives in order to adequately protect Emma and Robert’s identity.
by Kim Woodard Osterholzer, Colorado Springs Homebirth Midwife
Photographs by Monet Nicole, Sarah Donahue, Natalie Babcock, and Kim
Thank you so much for the gift of your time!
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Kim Woodard Osterholzer, Colorado Springs Homebirth Midwife and Author
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