Through my last post in this series I drew you into the nighttime life of a midwife as Emma’s labor began.
Join me today and witness the miracle of two becoming three.
“Emma? May I come in?”
I’d arrived at the cozy, aging farmhouse – a quaint combination of trim and ramshackle, oozing with love and joy, hope and possibility – just a pinch after five in the morning. Robert had helped me inside, and as he did so, shared the news that his beloved appeared to be tiring.
On the one hand, I was a bit concerned to hear him say that. Emma likely was only getting started and, though the night prior had seemed plenty difficult to them, I suspected the bulk of the effort this birth would demand of her lay yet ahead. On the other hand, I was only a bit concerned. If I’d learned anything through the years I’d been catching babies, it was that women – even the littlest and frailest of women – possessed within their depths immeasurable reserves of stamina and strength. And so, while I was concerned for her welfare and meant to tend with diligence to it, I still was filled with confidence in Emma’s ability to bring the life within her earth-side.
I could hear Emma shifting about in her bathtub, blowing through a contraction as I dug my doppler and blood pressure cuff from my backpack. I wanted to check her cervix, too. I usually check a first-time mom’s cervix soon after my arrival. Nobody can fool a midwife quite so well as a first-timer. More than once I’d been called and told, “Come quick, my wife wants to push!” Only to find that wife a single centimeter dilated and the baby fully twenty-four hours from making its appearance. But I’d ask to check her after I’d gotten a bead on the baby and Emma’s vitals, as everything else hinges on how the two handle their labor.
I tiptoed through the darkness of a home bereft electricity, toward the splashings and breathings, and the flickerings of a handcrafted candle resting on a shelf inside the bathroom door. A myriad of candles twinkled throughout the house.
“Come in, Kim.”
I was enveloped in a swirl of steam as I eased though the door as if into a moist embrace, and I noted the faintest trace of birth scent – that distinct pungency of elemental womanhood every soul on earth instantly recognizes – a scent that either summons or repels, quickens or paralyzes.
Ah, good. I don’t know how far into this she is, but I think she’s into it enough for me to be here.
“Hey there, Emma.”
I knelt beside the tub. Emma reached a warm, wet hand toward me and smiled as I took it in mine.
“My hand’s chilly.” I whispered.
She nodded, pulled it to her forehead, and closed her eyes. “It feels good.”
“How are you?”
“I’m okay. A little tired, but okay.”
I glanced into the tub and shook my head. Amish folk are so incredibly frugal that, even when in labor, they fill their bathtubs scarcely deep enough to lap at their swollen, heaving bellies, much less cover and soothe them.
“Your water’s too shallow, Emma.”
“Ought I add a bit, then?”
“Well, let’s listen to the baby and get your blood pressure first. Then I’d like to check and see where you’re at, if you’re willing.”
“Oh, yes, whatever you say, Kim.”
Mary, also just arrived, entered the bathroom and whispered her hellos, and Robert followed her in. I squirted a thick bubble of blue gel on the doppler probe, and slide it along the left side of Emma’s belly. I hoped not to find the baby’s heartbeat there since, if I found it low and below her navel, she’d more likely be well-along. But there it was, next her belly button, galloping along like a runaway horse.
“Good! One-thirties. I’ll wait to take your blood pressure till after your next contraction.”
As if on cue, her uterus tightened and rose from the depths of her belly. I was pleased to observe its strength and duration. Emma laid her hand upon mine and squeezed lightly as she shifted and breathed and finally relaxed with a long, shuddering breath.
“Good, Emma! Good job! Way to relax!”
“I don’t feel too relaxed.” But she laughed as she said it, and nodded toward the blood pressure cuff.
I strapped the cuff around her narrow arm, snapped the stethoscope buds in my ears, placed the bell just inside her elbow joint, and began pumping. I let the air slowly escape and squinted in the dim light.
“Here.” Robert switched his headlamp back on and leaned over to shine a beam across the face of the dial.
“Ninety-eight over sixty. Good! Thanks, Robert.” I loosed Emma from the cuff. “So, what do you think? May I check you?”
Emma smiled. “You may.”
Robert helped Emma from the tub and Mary dried her off, and then another powerful contraction swept her slender frame. She gasped and flung her arms about her husband’s neck, and he held her tenderly as she clung to him and swayed her hips.
Mary and I slipped past them to set her bed up for the examination. Emma made her way in, leaning heavily on Robert’s arm, and he helped her climb up. I peeled the package of a sterile glove open and dropped a dollop of gel on its insides, then pulled the glove over my hand and climbed up next to Emma on the bed.
“Okay, Emma, can you bend your knees for me? Yes, just that way. Now, let them fall a bit open. Rest this one on me, and the other against Robert. Yes, like that.”
I swiped the gel up with my fingertips. “Ready now, Emma?”
“I think so.”
“Okay. Here. I’m going to touch you…”
I touched her gently, and slipped my fingers inside. Emma stiffened slightly, so I paused.
“Are you alright, Emma?”
“Yes, I’m alright. It just feels so odd!”
“Yes, doesn’t it? Why don’t you take a deep breath, and let it be just like another contraction.”
We took a deep breath together, and I slid my fingers forward till I found her cervix and probed its contours.
“Okay, good!” I eased my fingers from her. “You’re a good five, you’re eighty percent effaced, and you’re at zero station.”
Robert immediately rejoiced and praised his wife, but Emma looked as I knew she’d look, and her words provided confirmation.
“I’m only five centimeters?”
I stripped the glove from my hand and seated myself more comfortably on the bed. Another contraction rose and squeezed her, so I held my tongue. Mary bustled quietly behind us, opening trash bags, spreading chux pads, folding squares of paper towel, stacking baby blankets, and filling a squeeze bottle with olive oil.
When the contraction subsided, I helped Emma onto her left side with pillows tucked beneath her head, her right leg, and at the edge of her back.
“Five, yes, but that’s great, Emma! And eighty percent effaced is even better!” I stayed there with her awhile, stroking the length of her back, reminding her of the things we’d learned in our birth class, and describing what the next few hours might look like.
“Why don’t you two snuggle up together here and see if you can get some rest between contractions. I know you don’t think you can sleep, and maybe you can’t, but sometimes a woman’s contractions will spread apart a bit when she lies on her side, so who knows? You might doze off. Sometimes contractions feel stronger on your side, but this is your chance to get a better break between them before they get stronger and closer. And hopefully Robert will fall asleep! If he does, he’ll be fresher later when you’ll really need him.”
The two found the plan amenable, so Mary blew out the oil lamp and I crawled off the bed. I made a few notes in Emma’s chart by flashlight, and then we settled on the sofas for a little nap of our own.
Three-some hours passed before I woke to the sound of a woman working her way through a heavy contraction and sat up, wondering a moment where I was. I rubbed my eyes and my memory returned, and I hopped from my nest of afghans and throw pillows to sneak into the bedroom.
I was pleased to learn both Emma and Robert had managed to fall asleep, and that the contraction that had roused me was the first Emma had noticed in a long while. The frilly curtains adorning the east-facing window were ablaze in the midmorning sunshine. The light warmed me through as I listened to the pitter-patter of their baby’s heartbeat. I straightened and suggested Emma get a meal into her, and then head out for a walk.
Emma, bubbling with eternal cheeriness, readily agreed, and soon had a serving of yogurt and home-canned peaches in her. I watched her from the kitchen windows. If she wasn’t walking hand in hand with her man, she was hanging from him while she rode out her powerful contractions. A note in her chart from that hour reads, “While the contractions are definitely stronger and more painful, Emma and Robert are doing beautifully together and, between her contractions, we still get to see Emma’s lovely smile.”
Emma returned to the house around nine-thirty. I had her sit through five contractions on the toilet, then I checked her again and was pleased to find she’d progressed to seven centimeters dilation and full effacement, with the baby’s head a centimeter deeper within her pelvis. Emma spent the next two hours shifting between the tub, the toilet, and on her left side in the bed, then mentioned she felt just the slightest urge to push, and asked to be checked again.
“Nine centimeters!” I said as I stripped my glove into the trash. “Good job, Mama! You’re getting there, sure enough!”
Emma agreed to a cup of chicken noodle soup and another soak in a bath of fresh water, and a note in my chart reads that she reported feeling “revived, if not rested,” but another five hours passed before her cervix grudgingly agreed to make way for her child’s head.
That gave me five hours to wonder what was going on in there as I alternately popped homeopathic arnica and gelsemium beneath Emma’s tongue and spent spells attempting to massage the last little rim of cervix away with evening primrose oil. To take such a long time to move from nine centimeters to ten usually suggests some sort of challenge either with the way the baby’s positioned, with errant arms or cords gone awry, or with problems with a woman’s pelvis. But Emma’s baby appeared to be positioned well with spine forward and head flexed, and Emma’s pelvis felt roomy enough. That left us with a limb or an umbilical cord issue. As the baby’s heart sounds remained strong and responsive, I put my money on the limb.
With Emma so close to complete, we’d been checking the baby’s heart tones every fifteen to twenty minutes, and were doing all we could to keep Emma nourished and hydrated, and her bladder empty. I’d also been dosing with kali-phos and liquid chlorophyll, and I put her in every position known to midwives and laboring moms from knee-chest, to McRoberts, to the birthstool and the toilet, to exaggerated side-lies and back to the bathtub. Emma was amazing – tired, but tireless in her efforts, and Robert was her continual companion and unflagging encourager.
Toward six Emma expressed a stronger desire to push, and I suggested she sit on the stool again and let me see where she was. I draped a chux pad over my lap, pulled on a glove, and, as gently as I could, reached up within her yet again. I found only the slightest lip spread across the foremost rim of Emma’s cervix. I took a moment to re-check the position of the baby’s head by its suture lines and soft spot, and I found the tiny triangle right where I wanted it at the upper left hand side of the curve.
“Emma, you’ve only a slip of cervix remaining in here. May I try to hold it back while you push a bit?”
“I’d be so grateful to push, Kim!”
So, just before the next contraction began, I ran the first two fingertips of my right hand over the stubborn remnant of flesh standing between the baby and the world without, then placed them squarely over its apex and began to press. I planted my right foot on the floor and braced my elbow against it, deepening the press. Emma gasped and placed both her hands upon my head. A powerful contraction rose to meet us, and she squeezed my hair into two tight fists while we she bore down and I held fast – while that last little bit of cervix slipped away, and the baby’s head shifted to fill the space.
The contraction began to dissipate. We breathed together as I drew my fingers from her and she released my hair.
I sat back and smiled up at her. “Emma! Good job! You did it!”
The smile on her face was radiant.
And then she pushed for nearly four hours.
We listened to the baby’s heartbeat after every other contraction as the many minutes of those hours ticked by, and, though it was a battle to keep Emma fueled and functioning, thankfully, the baby remained stable. Again, we tried every position imaginable for pushing. Emma’s waters ruptured at seven in the evening. We were reassured to find them clear and the baby’s heartbeat still strong and steady. She made progress, but the progress was by mere degrees. The sun set, and I felt my good spirits fade with the ebbing light.
I had Emma take a break from pushing, and put on her left side in the bed, curled up in Robert strong arms. She rested between her contractions till a quarter after nine, then she rose to use the toilet.
When she finished, she came and found us making notes at the kitchen table.
“I think I’m ready to push again awhile.” She smiled, but it was a grim smile. “And I think I’d like to do it on the stool.”
So Emma settled herself upon the stool, and Mary listened to the baby while I knelt before her.
Isn’t it funny how birth so often insists we assume positions of humility?
Oh, God! Oh, God, please! Please help! Please help Emma bring this baby to earth!
Then Emma sucked in a great breath, grasped the handles of the stool in both her hands, curled her swollen body around upon itself, and roared through a mighty push. A trickle of fluid splattered over the pads between her feet, and I knew she’d moved the child. I looked at Mary and nodded. She reached again for the doppler, and the rapid tapping of the baby’s heart filled the room.
“Happy baby.” I whispered.
Emma sucked in another breath and roared through another push. More fluid. Mary clicked on the doppler again.
“Yes, happy baby. Ready to come meet mom and daddy.”
Emma roared, pushed, and squealed.
“Mary? Will you get the flashlight?”
Ah! Thank God!
Her tissues were beginning to bulge. I squirted a puddle of oil into my palm, and cupped her tender places in my hand. Emma shifted and sucked in another lungful of air.
“Easy, Emma, this time try just to breathe…”
“Oh, Kim!” I felt Emma gather her strength. “I can’t!!!”
I squirted a fresh stream of oil between my hand and her bulging skin and looked up. “You can! You can, Emma. Look at me.”
She lifted her head, but kept her eyes shut tight.
“Look at me, Emma.”
She opened her wild, dark eyes then, and we connected. “You can do it, Emma. You can be gentle. You can be easy. Breathe. Breathe with me.” And together we breathed and breathed and breathed as the baby’s head stretched and spread its mother’s womanhood wide, and slowly began to fill my hand.
The baby crowned, the contraction spent itself, and Emma whimpered, “Oh! Oh! Oh, Kim! Oh! It burns!”
“I know, Emma. I know, but you’re doing so well! You’re doing so beautifully! And you’re almost there! You’re almost through! Please, let’s keep it so gentle.”
A final contraction began to build and slowly, slowly, ever so slowly, the child – with his two fists clenched beneath his chin – spiraled forth and unwound into my hands.
I lifted him to his parents like an offering, purple and slippery and trailing a coil of his thick, turquoise cord.
And the three of them burst into tears.
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.
Candle photographs by Kim. The photos of the belly, hands, and dopplers are by Monet Moutrie of Monet Nicole. The picture of the baby is by Brezi Merryman of Captured by Brezi, and the mother of the baby, featured in the photo essay, “Welcome, Lola,” generously provided permission to use it for this post as it illustrates the last lines with perfection. Interestingly, I wrote those lines the night before this magnificent child was born ♥
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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