Two weeks ago, mid September 2024 I attended my second homebirth as an IM. It was a last minute request to support this birth as a second because the named midwife was going on holiday so her second midwife, Katrina Calaske, and myself attended the birth. This is a slightly unusual arrangement as continuity of carer is important for IM clients but we couldn’t have had a better birth! We only needed to cover 5 days but at 9am of the first day I received a call from my midwife colleague, Katrina, that D. waters had gone after a night of backache. Just our luck that the client actually went into labour the day her main midwife went away! It goes to show how unpredictable birth can be.
We thought it might take a while but Katrina headed over as she had an incling things might progress. She got there at around 1400 and even though D. wasn’t contracting she stayed to observe. After 1h D. informed her that she needed to open her bowels again and Katrina noticed a change in behaviour so they started filling up the pool. Katrina then called me at around 1500 to attend. We knew some history about the client such as that this was her second baby and that she had declined NHS scans and blood tests. She had had an early scan at 7 weeks and some private bloods last month that reassured us that her iron levels were well within limits. The only other “risk factor” was advanced maternal age over 40 which on the NHS would have prompted tests and pressure to induce the labour. We knew D. was well informed about the choices she was making so we never questioned them. This is the type of client we independent midwives are so happy to support.
As with my previous birth I got there 25 minutes before the birth. The dad welcomed me with “I think we can see hair!” So I rushed upstairs and sat quietly in the birth room by the door (no hair visible yet). Tricky moment because I didn’t want to disturb her flow at that stage but also I was a complete stranger! I opted to stay quiet. I remembered the NHS midwife that entered the hospital room when my son was close to crowning, she tapped my shoulder and introduced herself and I shushed her because I needed all my attention in what was happening inside my body!
D. was beautifully calm and kneeling upright in the pool. It was the afternoon so it wasn’t dark in the room. Katrina was reassuring her through the contractions but she knew what to do. She wasn’t using any pain relief and wasn’t being loud during the contractions. Once again I was in charge of documentation while Katrina auscultated the fetal heart every 5 minutes. D. had her hand down below feeling baby’s head coming in and out with contractions. I knew Katrina was keeping an eye so I didn’t feel the need to peak much. After all too much eye contact and feeling observed can engage the labouring woman’s neocortex and take her out of planet birth which can affect progress. Plus, we couldn’t see much anyways as D.’s hand was on the way but we never asked her to remove it or change her position to make our jobs easier. We trusted it was going well. We knew baby was coming and D. was verbalising what she could feel. During the last two contractions we heard a little dip on baby’s heart rate but knowing that this was physiological we did not scare the mum about it, we just acknowledged it.
Around 5pm D. just tilted backwards slightly and gently breathed the baby’s head out, in control, mindful of her perineum. Within seconds a little girl emerged from the pool into her mum’s arms. She was wearing the cord like suspenders around her neck but easily got herself out. She cried straight away. In retrospect Katrina told me the baby was born direct OP or face to pubes as I did not notice it at all since I didn’t see the head being born! She suspected it when she first palpated. It was such an easy OP homebirth, you wouldn’t have known. How brilliantly women do when people looking after them belief in them and trust that they can do it.
For a while we stood there in awe but eventually D. exited the pool. The little girl had continuous skin to skin during the pool exit and during the placenta delivery (with dad) that happened in the toilet. We didn’t cut the cord until it stopped pulsating. It never ceases to amaze me the agility that women have moving around after a physiological birth, because it’s not meant to leave you unable to function!
Due to the physiological undisturbed birth, breastfeeding got off to a very good start, bleeding was minimal and the perineum intact. I helped mum achieve a good latch reminding her of the signs of good attachment and observing her feed, but left her to it so they could bond and have some quiet time while Katrina and I completed our documentation with a cup of tea. Dad was emptying the pool out. We didn’t stay long after that. I left around 7:30 so I could make it home for my son’s bedtime and Katrina left an hour later.
I came back the next day for a postnatal check, a NIPE check and some breastfeeding support. Even though I hadn’t met the mum long we connected easily and had a lovely appointment. It is true that the midwife-client relationship takes several appointments to build, however we midwives are pretty good at building a rapport with women quickly. In this case I felt like I understood D. very well, like we vibed together, that we could be friends. Katrina reported a similar feeling having met D. briefly online, as a matter of fact we recently discussed how being able to inspire trust in a client, even after just a short meeting, will help her relax and labour well. It was a delight to work alongside Katrina who is such an experienced midwife who certainly has a calm, kind and reassuring nature.
This homebirth and postnatal appointment really made me feel confident that I can make a difference to parents even if I don’t know them long. It reassured me that I can bring positivity and knowledge to help a couple achieve their dreams around their parenting journey. And it made me well happy to be an independent midwife.
All in all, the mum gave birth like a goddess and it was a privilege to witness it. She almost didn’t need us but on the NHS she would have been pushed into interventions. As independent midwives we are there to safeguard your birth, to let it unfold, to bear witness and be a watchful eye in case of an unlikely emergency. If you would like a birth like the above, respected in your choices and left to birth, hire an independent midwife!