My meeting with Claire and David was preceded by a week of hidden anticipation. I say "hidden" because I pride myself on being able to provide whatever midwifery care is required in as calm a manner as I can muster, and my friends at the surgery unit were teasing me about swimwear and snorkels and cellulite (mine). Why? Because Claire and David desired a waterbirth at home. I was excited.
The inspiration for a waterbirth came from Claire. She explained: "knowing about water birthing I had decided that I wanted my baby to be born underwater a long time before I was pregnant. I come from France and my mother is a Rebirther, therefore I am used to alternative methods of healing. Waterbirthing is linked with my research of a better world, better humanity and better relationships between beings. The birth trauma is a big blockage at the beginning of a life and to progress in any field we have to solve this problem before going further, and we should use anything that allows us to eliminate or at least reduce it. I have done a lot of reading about dry birthing and especially waterbirthing as a kind of re-experience, and have now gathered a real information file about birth."
I was really impressed by Claire's search for her goal. Obviously she had knowledge of waterbirth, but her efforts to attain it are an achievement. It started before she left France in July 1989.
I met Claire at the booking clinic in Biddulph, Stoke-on-Trent. She had already met Dr. Smith who was slightly nonplussed but did not discourage her. He referred her to me, a NHS Community Midwife, who believes in the absolute and undeniable right of the woman to choose the method and place of birth, if normality prevails. English midwifes are required by law to give this service.
My aquatic training began. I wanted Claire to have, without reservation, the birth for her child the equal of which could only be matched, but not bettered, anywhere in the world, and I wanted her to have it in the way that is available to any other woman in England and I wanted to be proud of it.
Claire's pregnancy continued in a favourable manner and regular attendance at the local swimming baths (3-4 times a week) helped to maintain her general health and well being. The due date of the baby was 23rd December 1989, and the wished-for date was December 25th. Claire and David's birth plan was really very simple:
1. No drugs
2. No intervention
3. Unobtrusive midwifery
4. Total waterbirth
5. Bury placenta in garden
We had a full blown rehearsal on December 12th to check for safety of the tub. Everything was satisfactory. We all took tea and tasted Claire's home baked bread.
I visited Claire once during the week to do antenatal checks, arranging to see her again in one week. The baby was in a posterior position and his head was not engaged, and there was no weight gain.
Claire had a readjustment to make because the baby did not arrive on Christmas Day. She was now term + 6 days. We decided that the baby preferred to choose his own birthday and we would trust him, but Claire still had some tension, probably because a suggestion had been made that if she arrived at term + 10 she must deliver in hospital. In view of this we discussed making an arrangement for Claire to see a sympathetic obstetrician. I also felt the need for reassurance and support for the following reasons:
1. No weight gain since 37/40 weeks
2. Non-engagement of the baby's head
3. Long holiday period ahead of three days with minimum staff
December 29, 7 PM:
Claire is experiencing some abdominal discomfort and has entered the tub. I arrived to find Mireille, Claire's mother giving her a facial massager. The usual observations showed that all was well. An underwater vaginal examination disclosed a ripening of the cervix and the head entering the pelvis. I stayed a while and we talked with gentle anticipation of the experience ahead. We all decided to go to bed and seek some sleep. I slept well, confident that I would not be needed during the night and feeling that we were all well prepared.
December 30, 06:30 PM:
David rang to say that Claire's discomfort had continued all night and that she had entered the tub again. My re-examination of Claire showed some effacement of the cervix and 1+ cm. dilatation. The station of the head remained the same, all other observations were normal. Claire was coping very well with the contractions which were short and sharp, about every four to five minutes. I made some preparations and commenced the partogram.
December 30, 1 PM:
Claire and David are in the tub very absorbed in the labour, moving and adjusting in a very emphatic way, the plan to take photographs forgotten. A lot of low back massage is needed and David knows just how to do it. The vaginal examination showed a fractional increase of dilatation, the head was a little lower, the contractions were causing Claire to be very distressed. Indeed she cried out loudly. She said that it helped her to call out. David looked shaken by her obvious travail. Her mother was offering tremendous but unobtrusive support. She gave me a mischievous smile when she showed me her swimwear under her thermal and woollies. She will enter the tub only if Claire invites her.
I was experiencing a feeling of helplessness. I wanted to help Claire. I closed my eyes and pictured a scene. It was like a Leonardo da Vinci drawing of an open uterus, the baby was in a posterior position, the head was not engaged, the cervix was 2 cm. dilated. I mentally rotated the baby, gently flexed the head into the pelvis and insisted that the cervix gave way. It was so clear and strong. I asked Claire to maintain an upright position to aid the descent of the baby. She responded well. At about 3 PM I left, again arranging to come back later. I needed to be somewhere that I could examine my negative thoughts and feeling and set the scene ahead in plenty of time in case we needed any medical help.
Claire had adopted a kneeling squat position and was not happy to move, so I examined her in that position. What an astonishing and wonderful surprise, lo and behold, an egg-sized portion of the baby's head was apparent. I couldn't see the baby so I had to feel. I just kept my hand gently cupped over the advancing head and lightly felt the condition of the labia and perineum. Then Claire asked me to stop, so I did.
David had adopted the same position as Claire behind her, so he was in the perfect place to look into the face of his son as it was smoothly and gently delivered. The baby looked patient and calm. A little cloud of pinky mucous floated out of his mouth, restitution took place as I checked for the cord. I eased the shoulders out with one hand and floated him under his mother's body, and she took him into her hands at 4:44 PM.
David was overcome with emotion and leaned weeping his gratitude onto Claire's back and as the baby boy came into his mother's vision he opened his eyes and looked up through the water into her face. He looked so calm, wise and reassuring. I felt that he knew all that he would ever need to know of any importance. He gave me the confidence to leave him under the water. I held his cord and he held my fingers. David came round to the front of Claire and they were together. Claire made little murmurings, apart from which it was quiet. From time to time I said "His cord is pulsating strongly, he is all right". The world stopped and time stood still. Eventually the cord beat a little more slowly and felt limper, and Zenon let go of my finger, so I asked Claire to lift him to the surface as he was now ready to take some air. She raised his face to the surface and as he took an experimental breath she sang "Happy birthday to you" all the way through.
Congratulations abounded, hugging and weeping with joy and relief - including me - there was nothing to do but experience this fully. Zenon's cord did not stop beating until about 5:05 PM. I asked Claire to rise out of the water and the placenta delivered at 5:10 PM into a receiver quite readily. The blood loss was minimal. In Claire's own time she retired to the bedroom and offered her son the breast. She sustained a tiny posterior vaginal wall tear and a little labial laceration which were not sutured, and presented no problem in the days to follow. Zenon weighed 3.000 kg. or 6-10. He continued to suckle at will and Claire recovered normally.
I visited one evening and David and Zenon were in the bath together. He has a bath each day with one or the other parent. I have to say that this experience has been the climax to my midwifery life and fulfilled a lot of my beliefs. It has been a privilege.