Moment of Birth

I think we midwives can do too much at births. There, I’ve said it, I’ve come out and admitted it. I think we often do too much at births. I don’t mean during the labor (although I think some are guilty of ‘doing’ too much then, too)….I mean at the actual birth, the moment when the baby is pushed out and is in mommy’s arms and being cradled.

I don’t always blame them (us?)…after all, this is the moment of truth. This is the time when we need to be ready to MOVE MOVE MOVE…if there is going to be one of those “what if” moments, those true “emergency” moments, here it is! It is right now! But I think that we can be too aggressive in this moment and can interfere with the magical PRECIOUSNESS that this moment is wrapped in and rob the family and baby of the most blissful moment they will likely ever experience.

What does a typical “moment of birth” look like? Baby comes out, someone catches the baby and suddenly mom is holding her baby. (this is in a homebirth – hospital births may or may not hand baby right to mom, many immediately clamp/cut the cord right there between moms legs and hand the baby off to a nurse to take baby over to the warmer). As soon as baby is out, what do we often do? Rub baby down with a towel, “stimulate” baby, put a hat on baby, suction the baby’s nose and mouth with a bulb syringe – in other words, a lot of fussing. What I think we SHOULD do is take a moment and sit back and away and LOOK. Look at the baby, look at the color and the face – is the baby responding, looking around? Then let’s give baby a chance to come around and give the parents a chance to meet the baby. Why are we doing anything in that moment?

When I am at a birth, usually the rule is “the midwife is taking care of mom, the assistant is taking care of baby”. Almost always the assistant is a student midwife (until she is in the role of “primary midwife” that she will assume before finishing her apprenticeship – then she’s the midwife with me as the assistant). Knowing that this is their responsibility, they almost always spend the first handful of births making sure that they are “on that baby!” – super attentive and watchful and, yes, interfering. I often find myself physically placing a hand on their shoulder and saying, “Baby’s fine…look at him.” to keep the student away from fussing with the baby. I try really hard to remember to set the atmosphere to a welcoming one for the baby before the baby is out – ceiling fans off, room warmed up to a nice 78-80 degrees – so that baby can be held in mom’s arms and just transition into this world with love and warm skin wrapped around him and ecstatic kisses from mommy and daddy.

• If baby is looking around the room and pink and has that “Who are you? Where am I?” look that so many babies come out with – then baby is FINE!! Why are we TOUCHING this mother or this baby??
• If baby is crying, then baby is FINE!! Why are we touching this mother and this baby?

Mom and dad get to know baby while I feel the baby's cord

• If baby is not crying and not very responsive, the first place I go is to the umbilical cord to check the baby’s heartbeat…this can be done in a way that nobody, not even parents, know that you are doing anything. If the heartbeat is fine, then listening to the baby’s lungs with a stethoscope is an appropriate next step to see if baby is actually breathing. Sometimes babies are born so gently that they really aren’t all that upset with it and they are breathing and just not CRYING – they obviously see no reason to cry, and I think that’s okay!
• If baby is not breathing but has a good heartbeat – then having parents stimulate and talk to their baby usually works just fine – but if you sit back and watch you will find that parents will almost always do this NATURALLY and without instruction.

Moment of birth: notice mom's "recovery" and baby's color

Watch instinct at work, its fascinating! Not only is baby going through a transformation, but so is the mother. Usually a mother will welcome her baby into her arms and will take a moment in shock to just relax and breathe and come back from that labor-land place she has been in for hours. Think about waking up from being asleep, there’s a transition period where you wake up, but you give yourself a moment to really “wake up” – it’s the same thing at birth. Once baby is out, moms will give themselves a moment to “come back” – and that’s usually the exact same amount of time that the baby needs us to be patient as they are transitioning into being a breathing land creature that we are. There is a reason we don’t do an APGAR score for one full minute, to give baby time to transition and realize that it’s born. In that one minute, mom will get her bearings about her and will begin to look at and explore her baby – and in that one minute, baby will go through a huge physical transformation and begin to respond to being born.

Same mom & baby minutes later - mom is "back" and baby has not been touched by anyone but mom - notice her color! Beautiful!

After about a minute, mother will begin to get to know her baby, and she will usually begin to move and love and talk to her baby – which is exactly what the baby will need if they are “slow to start”. She will become more and more firm with her baby if baby needs it, and will remain cuddling and kissing on the baby if he does not. I find this instinct magically perfect…the instinct to give the baby a minute to transition, then begin to assess her baby’s well being and responding perfectly to it. You won’t be able to see this wonderful example of our perfectness if you start to rub down baby with towels and rough up baby and such.

I had a student once that started off in the medical field outside of birth…she was becoming a paramedic. More than a few times I would put my hand on her chest and hold her back and say, “Baby’s fine…she’s crying, she’s good…” and back her physically away from the new family to give them time to just relax and sink into this miraculous moment of their baby’s birth. When this student got pregnant again and gave birth to her 4th baby, I was blessed to bear witness to it – and as she lifted her son up into her arms and he looked up at her and let out a wail, she looked at me while still kneeling in her bathtub and holding her glistening baby lovingly against her heart and winked and said, “baby’s fine”…I had to laugh and said, “Yes, he is!”

I recently was at a birth where I was a backup midwife – I hadn’t met this couple before, their regular midwife was at another birth and was just not able to make it. Already there were two of the midwife’s students, one was in the role of “primary midwife” and the other was an assistant to her. My role at this birth was to observe, evaluate the senior student’s management of the birth, and assist them with anything they wanted or needed me to assist with. For most of the birth I sat back in the corner and watched these two amazing women take care of their client in the gentlest and kindest manner – impressed with their gentleness and their trust in the birth process. I was really impressed with them and feel that the senior student is going to be a phenomenal midwife very soon! While the mother was pushing in a birth pool, she was holding herself up with her arms so I came around the back of her and hooked my arms under her armpits so that she could relax her upper body and push (and yes, I admit that a couple of times I whispered to her, “you are so strong, you are doing such a good job.”…I couldn’t help myself, she was a strong powerful mama!) As the baby emerged and was placed into her arms, I released my grip on her and allowed her to sit back into the tub with the baby in her arms and sat back. As I had been looking over the moms shoulder, I had the perfect view of this beautiful little baby blinking and looking up into his mama’s face – actually brought tears to my eyes. As I sat back I saw the assistant, towel in hand and stethoscope around her neck, heading towards the baby. Although I was there only as an assistant, I couldn’t stop myself – I put my hand up and said, “Baby’s fine.” Assistant went to put a towel on baby, again I said, “They are fine…”

I’m not sure if she was confused or annoyed that I stopped her…but both students seemed a little…I don’t know….almost confused that I’d interfered with them. Baby coughed, and started to breathe just fine – without suctioning, without a towel, without a hat – and by just looking we could see the baby’s gentle transformation. Looking back I wondered if I shouldn’t have just let the students do what they were used to doing, but there was a part in me that had to stop them, had to show them that babies usually do fine when we give them a chance to do fine even without us, had to show them to look first and act second. I hope that they understood that I wasn’t trying to interfere with them or correct them – but was rather trying to show them a “neat thing”…a “watch this” moment…see what happens when we do nothing!

New family allowed to rejoice and bond without interference

I think that we can get so caught up in teaching our students how to do everything – that we can forget to teach them how do nothing, and that can sometimes be the toughest thing to do at a birth! Nothing! I hope that these two students understood that I actually respected their actions at this birth enough to take an opportunity to show them something and that I wasn’t correcting them or being judgmental of their actions. (the senior student at this birth is going to be such an asset to our community when she gets her license – I am already a fan of hers!)

As it stands, I think my current student (who also sits around with a stethoscope around her neck as mom is pushing) knows that all I need is a thumbs up from her and a smile and for her to say, “Baby’s fine” to make me happy. I know she’s not afraid to do things that need to be done, but I also know she’s not afraid NOT to do things – and I think both skills are equally important.