A month ago I experienced every independent midwives biggest fear: 3 births happening at the same time!
However, I made it to all of them.
It all started Wednesday afternoon when my client went to a consultant appointment to book a date for her elective CS for breech only to find out that her baby was footling breech with the umbilical cord in the pelvis. This represents a danger if she was to go into labour and her waters broke (the cord and foot would come first) so the consultant recommended to have a CAT3 CS the next day. This means that she was advised to be admitted on Thursday and wait for the theater team to be free to do the CS. She was 39 weeks.
For context, the other two births were approaching 42 weeks and I was on call as second midwife for them (meaning they were not my clients) and luckily those births had two different lead midwives (Beth and Amy). However I was asked to cover one of these births last minute because a local midwife left for an private midwife agency from one day to another leaving us hanging, which added to the challenge. (If you’re reading this as a midwife considering this path please please please know how important your network of IMs is. Your word, your loyalty and your commitment to other IMs is so valuable. We can’t survive alone.)
Early on that week we knew things weren’t looking great and the possibility of the births happening together was increasing so we had asked midwives in nearby areas for last minute support and everyone was amazing to offer to be on call for us!! We joked that it would all unfold on the full moon on Wednesday but it didn’t.
First Birth: Elective CS on Thursday afternoon
On Thursday my client went in to the unit as planned and she was told that the CS would happen after 3pm. I have to say that for the days prior I was in communication with the Trust’s head of Midwifery and others to see if I could attend the birth in theatres and to make sure my client got the gentle CS she wanted. Going into theatres as a second birth partner it’s a battle in any hospital so I was denied that request, however the team was fantastic in Ipswich hospital at facilitating the birth of the baby from the tummy to the chest for skin to skin leading to the first breast feed taking place in theatre. My client was over the moon that she got to see their baby being born from her tummy and that the baby was not separated from her until after leaving theaters (for baby checks). You could feel the oxytocin in the recovery room (where I was allowed to attend). This way of doing CS is fantastic for babies’ microbiomes and for a great breastfeeding start.
1 done, 2 to go!
Then things went a bit wild. While waiting for the CS outside theaters the second birth started unfolding. I had come off the on call for 24h and I really thought I was going to miss it. However it all slowed down. By 9pm I had left my client in the postnatal ward and I drove home to Chelmsford. I was hoping I could go straight to the birth as it was in Ipswich but nevermind! I got home at 10pm, had dinner and I was in bed by midnight. My toddler’s routine was completely messed up so actually the first thing I did was breastfeed him to sleep.
Second birth: Homebirth and Forceps on early hours Friday
At 1:40, after I had been sleeping for 90 minutes I got a call from Beth to attend the second birth. I quickly jumped in the shower and I made my way. Beth is heavily pregnant so she asked for support sooner rather than later. On the way, at 2:30am I saw a little message pop out on my phone. It was Amy asking “Beth, how’s your client doing?”. I quickly send her an audio asking “What are you doing up at 2am Amy, don’t tell me your client is in labour TOO!!?”
Well yes, she was!!! And Amy was on her way to her! Worst nightmare! I thought, “right, we can do this”. Hopefully this second time mum will give birth soon and then I can make my way to Southend to support Amy.
When I got to the second homebirth, Beth’s client was clearly in estabilised labour and soon after I got there we got some signs that made us think that she was approaching second stage. After all when a multip says “I’m pushing” or “Baby is coming” you believe her!! She was being so amazing, powering through the contractions in the pool. However, we soon realise baby was not ready to come yet. After I had been in attendance for a few hours, unfortunately we started to hear some fetal heart decelerations that did not resolve with position changing so we called an ambulance for back up or transfer. While the ambulance was arriving I asked for consent for a vaginal examination which indicated the birth was not imminent, far from it even for a multip. So Beth transferred over for obstetric input. Mum had a forceps 1h later as there were still concerns with the baby’s heart rate but the baby was born in good condition.
One happy midwife got home at 8am and, since the third lady having a homebirth didn’t seem in estabilised labour that night, I went straight to bed.
Third birth: Homebirth and emergency CS on Saturday
I only managed to sleep 3h or so as I had to get up to see a client that afternoon that was 36 weeks and I had already changed her appointment the day before. It was a really hot week so I was happy to be driving around in the air con. My client was fine and after spending some time with my son and doing admin I went to bed at around 11pm.
Soon after I went to bed Amy texted that she was heading over to see her client and that she would call me when she needed me. I woke up at 5 am, saw her messages and she called me to attend as she had been awake two nights herself.
I got to this last homebirth at 7am with a Mocha and a chocolate twist for Amy (another second midwife’s job, to care for the first midwife!). Amy’s client looked like she was in estabilised labour, using entonox and moving around. The hardest labours are those that go on for days. They really test women’s endurance and strength and Amy’s client had plenty!!
At some point in the afternoon we thought that maybe she was approaching second stage (she had declined VEs) but she wasn’t. We were keeping a close eye on mum and baby and we noted that mum’s pulse was going up significantly beyond her baseline, so consequently baby’s was going up to. When we mentioned it to her straight away she asked to transfer which was going to be our recommendation. A couple of hours later in the evening she had a CS due the clinical picture and baby showing some signs of distress. Another baby born in good condition though.
After tidying up and emptying the pool I was home for dinner and ready to go to bed as I had another client visit the next day.
Aren't homebirths meant to be all fantastic and free from intervention?
Yes and no. I wish I could write the story of three amazing homebirths as they all of these women planned for one. Is not very good marketing is it? However, all of them got to have safe births with no unnecessary interventions and their birth plans were respected. I always like to reflect on whether we could have done things differently to preserve physiology but, without going into all the clinical details that explained what happened, I think everyone did their best.
For the first client a breech vaginal birth with deskilled attendants would have been more stressful and riskier than an elective section. We spend hours going over her options which included transferring to another hospital or having a homebirth inviting another second midwife with more breech experience. Everyone has different perceptions of risk and how much risk they’re willing to take.
For Beth’s client (second birth) safety was also important and they were happy that the emergency was dealt with swiftly, respectfully and that she still had some time in hospital to attempt vaginal birth. I don’t want to go over all the details of the birth and mum’s history out of respect to the parents and their journey, but I can say that in all my years as a midwife I have only transferred out a low risk setting (home or birth centre) for fetal heart concerns in a handful of times, all of them justified as something else was going on on the background (not due normal physiological changes in the heart rate on second stage).
Lastly, the third homebirth. Amy’s client felt respected in her choice not to be induced, not to have VEs, not to labour in the hospital and she preferred a CS as opposed to an instrumental birth. Amy advocated for her in hospital and the family was happy with the outcome.
All these pregnancies and births would have been very different on the NHS with lots of pressure and fear from professionals. They would have also been quite different if these women freebirthed but I trust that women (or their birth attendants) could have spotted the complications and sought help as I believe in women’s choice to freebirth when she is well educated and supported. However, attending these births knowing that we respected women’s plans and we did not cause the interventions but we rather spotted abnormalities and acted safely and respectfully, made me really appreciate the work we do as independent midwives. Because even us being there is an intervention on itself but at the end of the day it’s the birthing woman’s choice of how much surveillance she wants, what’s her threshold for transfer and how far she wants to push guidelines. This is why my antenatal appointments are at least 2h long and I invest at least 2 more hours at home afterwards curating curating for clients so they make true informed choices (reminiscences of my job as a lecturer and my years as a student at masters level!).
I have been out as an independent midwife for a year now and I love it. I love the challenges, the growth I’ve experienced, the relationships I’ve developed with my clients, the beautiful homebirths I have witnessed and even doing my own bookkeeping!
If you want to learn more about how I can support you as an independent midwife contact me below.
Hello! My name is Irene Vine and I am an independent midwife covering Suffolk, Essex, Cambridge and East London. I provide full antenatal, postnatal and birth care including homebirths and outside of guidelines care. I am passionate about supporting women achieve a birth experience where they feel empowered, heard and understood. If you would like to experience the best possible care with unrushed appointments and a midwife who is always at the other end of the phone, give me a call! I cover most cities and villages in East Anglia, such as Chelmsford, Colchester, Ipswich, Cambridge, Harlow, London or Southend.