Today, I was dismayed to see yet another “autonomous” birth video shared and reshared, glorifying undisturbed birth of a baby that is clearly struggling to breathe. The comments, usually by mothers and parents, or birth doulas, enthusiastic about avoiding unnecessary intervention, cheer. But I (and a handful of other midwives) cringe.
It should be noted here, that I do indeed straddle this philosophical divide well, as I am both a 3 time unassisted birthing mother AND a 25 yr veteran midwife. My ideal birth is indeed undisturbed but only IF IT IS NORMAL.
We have a trend in the fringes of midwifery (undoubtedly fuelled by the over-interference of hospital providers), to do less and less, and to normalize abnormal. This is a critical situation in my opinion as new midwives, or half-initiated birth-keepers, enter the fray, insisting loudly on large social media platforms that interference is the “problem” that parents need to avoid.
This is simply not true, but I understand how this erroneous belief has wound its way into hearts and minds.
Picture for a minute, the typical vaginal hospital birth – the birther is in the bed, their dutiful partner relegated to obsolescence at their head. The provider, under a light-halo, delivers the baby, and then, as frequently happens, severs the cord and transfers the prized possession of the baby across the room to the baby warmer, where all of the focus in the room transfers, leaving the newly born mother feeling like a vessel only and depriving her of touching her seconds-old infant.
There is so much wrong with this ubiquitous scenario that needs to be changed, that I understand the relief, joy and “reshares” at seeing a quietly attended birth where the birther is lovingly supported by their partner and they or their partner receive their own baby, autonomously. No one meddles, no one directs, no one but them are centered. I love this.
BUT, and this is a BIG but; not all babies make it when undisturbed, and even more than that, the very definition of midwifery is to help when needed. It is very disturbing to watch midwives sit by, watching innocently, when to my trained eyes, things ARE NOT NORMAL.
I don’t mean this in a judgmental kind of way, this is entirely a ringing-the-bell-for-reality kind of post. I want to call in midwives always, not call out. But I don’t see how we’re going to get off this slippery slope without a bit of alarm and some raised voices. So I’ll say it as clearly as I know how at the top of my lungs:
LIMP, FLOPPY BABIES ARE NOT NORMAL. NO RESPIRATORY EFFORT AT BIRTH IS NOT NORMAL. DARK PURPLE HEADS AND PALE BODIES ARE NOT NORMAL. FLACCID WHITE CORDS AT BIRTH ARE NOT NORMAL. NOT BEING ABLE TO FIND HEART TONES IS NOT NORMAL. GASPING, GRUNTING, RETRACTIONS, AND NASAL FLARING ARE NOT NORMAL.
All of these signs are signals of apnea – lack of oxygen. We know from our understanding of Shoulder Dystocia that we have 4 minutes from compromise before the possibility of permanent brain damage. Seeing any of these signs above warrants ACTION on the part of any self-respecting, client-centering, trained midwife. We can not continue to sit on our hands when birth is no longer normal. DOING SOMETHING FOR A BABY WHO’S STRUGGLING IS RESPECTFUL AND KIND, NOT INTERVENTIVE.
If you don’t want to take action, or don’t know when to – then please, be a doula! We need doulas very much! They serve a very valuable birther-focused role. But doulas are NOT midwives, and it is unsafe and unethical to confuse their roles.
Midwives have two patients/clients/warm bodies at every single birth – the birther AND THE BABY. We must be the baby’s midwife as well as the birther’s – or else we’re really just being a doula. The only way babies can communicate when they are inside is with their heart rate – so we must get very, very good at FHT monitoring in the community-based setting – you can take our CEUed e-course here.
Once we can see baby, BELIEVE what you are seeing.
Seriously, I challenge you to bring to mind what a normal neonate looks like – even if you don’t routinely use a stethoscope at birth – you can tell just by looking! Normal newborns most importantly have tone – their arms and legs if not moving, are drawn up to their bodies. They have a good color, or their immediate poor color is rapidly improving. They have a grimace, the muscles of their face are scrunched up with moving eyes and/or mouth. And finally, they are attempting to breathe – coughing, sneezing, sputtering, crying. They can be quiet too, but then they are actively breathing in and out. This is all normal.
Anything less than normal is a baby saying “HELP ME!”
Imagine arriving at a friend’s house and they opened the door choking, turning blue and then went limp on the floor. Imagine you sat by them and said, “I believe in you. You can do this!” while you lovingly stroked their hand. If this sounds ludicrous, thats because it is! People need to breathe – without breath, people die.
Yes, the neonate has the emergency life line of the cord, but that is NOT a given and none of us know how long it will continue to deliver oxygenated blood. I have seen a cord lengthen, followed by a gush of blood and placenta within 2 minutes of birth. The bottom line I want to impart is this – please believe the babies, just like you would believe the gestures of an adult who is not breathing. Birth should indeed be undisturbed for people that don’t need disturbing.
But for everyone else, Midwives, that is literally WHY YOU ARE THERE.
If you would like to see video examples of this discernment in action, please turn into our instagram account for a 3 part series this month.
With love,
Augustine, the midwives’ midwife.
