OK, OK, you guessed! It's the autobiography of a young midwife, Jennifer Worth, working in the East End of London in the 1950's. In the first pages, the midwife nonchalantly describes getting a call out (at the convent where she was living while in training), rolling out the door at 2am, and...clipping her birth kit to the back of her bike! How cool is that!! I can't tell you how much this sparked my imagination, and actually reminded me of my first births with the midwives while I was a student at SMS. I was so excited to hear my cell phone ring in the quiet stillness of the night. I concientously changed my cell ringtone to something I thought would be a gentle awakening in the wee hours. This midwife (Jennifer's) description of what it was like to prepare for and attend a birth reminded me exactly of what I imagined it would be like before I knew what it was like. Reading her description of getting the call, checking her kit, and riding to the birth in the company of the other night workers. The quiet, quick, straightforward birth, everyone down to earth with their expectations for hard work and pain, but not fearful, and open to the inherent wonder of birth.
Reading from her perspective actually made me wonder why birth is so damn complicated. Is it the me? The women? The culture? Of course all of these births Jennifer is describing are at home, so that helps greatly. I have been to plenty of home births that mainly involved women standing around in the kitchen, eating, making food for the family, laughing, massaging and generally loving up the mom, entertaining other kids, and being glad that a new little one was on the way. Creating a good, relaxed, loving and normal vibe in other words. But, I've been to lots of births where people got really, really excited when the mom had a (as in one, single) contraction, lit candles, and turned on the yoga music seemingly expecting a wholly spiritual, mainly pleasant event, to take no longer than 6-12 hours (whether it's a first birth or not). I can't help but think that a return to a more realistic view of birth could be helpful: not sheer terror, agony and suffering. Not orgasmic and ethereal. Real, hard work, that takes time, patience, love and care. The spiritual element I think comes from the community of people that come together to support the mom, and her finding her inner resources to do this hard work. I just saw a nice film in fact, about the need to return to realistic images and expectations of birth. It's called Laboring Under an Illusion. But, I digress.
Jennifer describes some antiquated practices, like shaving and enemas, but she seems to giggle at herself and the rediculousness of the practices in hindsight. (Side note: sometimes I do wonder- if we still used enemas routinely in the hospital, might we use less pitocin? They do get things moving, and not just the poo. But of course, the best solution is neither enemas nor pit, but patience.) She describes testing for proteinuria by holding the top half of a vial of urine over a flame and watching for the protein to cook, thus turning white (like an egg), which is kind of ingenious. Glucosuria was tested for by adding something called Fehling's solution to the urine and comparing the color to a chart. So much more complicated than our fancy dipsticks these days! Fetal heart tones were assessed exclusively with a fetoscope (pinard horn), not with a handheld doppler and certainly not with one of the gawd awful continuous electronic fetal monitors.
Mothers were routinely kept in bed for 10-14 days after birth. This is now known to predispose women to deep vein thrombosis, a blood clot that can break off a vessel and become lodged in the lungs, or rarely, the brain. However, Jennifer also points out that in the days and places where women had 5-10 or more other children and extremely difficult living situations, 'lying in' did ensure that they got a little bit of much needed rest to recover, eat, and breastfeed. I, along with many, many other student midwives, have been taught the phrase, "A week in the bed, a week on the bed, and a week around the bed," as our advice (given with all of our full medical authority) to new moms. No electronic commuting, working from home, full schedule of childbirth and postpartum yoga classes. Certainly no going back to work that requires standing all day, lifting, etc. and provides little or no break time for pumping. Just a few weeks where the priority is to feed mom, feed baby, snuggle and get to know each other, and sleep when the baby sleeps. But by all means, get up to use the bathroom, take a walk, flex your legs and keep that blood pumping.
Jennifer talks about delivering a-gasp!-breech baby. The technique sounds exactly like what I was taught in 2006! Things don't change that much, except of course that the midwife in this book was experienced and adept at breech birth, and this is not so much the case for most practitioners today.
Another interesting aspect of the book is Jennifer's description of midwifery training, and nursing training in general-the two being then and now more closely linked in England than in the US. She mentions the Nightingale School of Nursing, and a book Nightingale wrote about birth at the time, "Introductory Notes On Lying-In Institutions, Together With A Proposal For Organising An Institution For Training Midwives And Midwifery Nurses." I must read this! I just finished reading her "Notes on Nursing: What it is, and what it is not." I learned a lot from it and look forward to reading her thoughts on birth practices and midwifery. At any rate, it's fascinating to read Jennifer's description of becoming a nurse, and the strict hierarchy and occasional cruelty of the matrons she learned from and worked under. It sounded familiar.
Most intriguing is the fact that to learn midwifery after being a nurse for some time, Jennifer was sent to a convent in an urban slum. She lived with the nuns, whose entire practice was exclusively midwifery. I am trying to picture moving into a convent. Having my own stone room, a cot, a desk, a wash basin, a bike, and that's it. And all I would do, from dawn to dusk six days a week-midwifery. Antenatal clinic once a week in the church basement, births zoomed off to by bike, and twice daily postpartum visits to moms in the first week after birth, then once a day for another 1-2 weeks. I have to admit, it actually sounds kind of great. I would miss Alex of course, but I think I could love living with other midwives, and having my own stone room for a few months. It would be pretty amazing to have the opportunity to focus so closely on developing my skills.
Well, I should go. I am at Children's tomorrow morning, and I want to get up at the crack of dawn, so I can finally put my big rack and basket on my bike! I want to put my kit on it and roll away!
The book is The Midwife, by Jennifer Worth.
No comments:
Post a Comment