Hey, Fairy, What’s Up?

In the early days of January of this year I found myself sitting on the floor in the playroom of a rural country home surrounded by three beautiful children and their mum. Their dad was busy making lunches in the kitchen and I had already been treated to some cake and tea in the front room where we’d all spent most of the morning chatting and reading to the children and where the oldest child told me the story of Mulan with astonishing attention to detail. When I asked where she had learned all of those particulars about Mulan, she told me that she had heard the story on a podcast about strong women (and, no, she hadn’t seen the Disney movie). The Christmas Tree was still up and it had ornaments on it that had been handmade by the children. The house smelled of homemade food and I recognised the ways and obvious values of this family.

Lena, my own daughter, had been brought up in a similar way. Wholesome foods, an avoidance of sugar, limited screen time, plenty of crafts and wooden toys, those were all important to Gerald and I as was the idea of fostering independence, resilience and self-reliance along with compassion, kindness and acceptance. Sitting there on the play room floor I felt right at home. I felt safe and I felt an affinity with this family, a kinship. I felt particularly connected to the mum whom I had met only twice before.

We were admiring The Castle, a structure that the middle child had built with her dad as a surprise for her mum. There had been a ceremonious reveal of The Castle by way of opening the door to the playroom. Access to this room had been strictly forbidden from the night before. The Castle was made of wooden blocks and it was a castle purely because of the imagination of the child who had built it. It had a kitchen, a sitting room and it had a roof (the latter needed to be imagined by all the players). I was assigned ‘Fairy’, not really by choice, but by being handed the little fairy doll and I was told in no uncertain terms by the curator of this play that I was to act out the character. ‘Okay’, I said, trying hard to channel my inner fairy.

The youngest child, just over two years old, had another fairy doll. He flew his fairy over to mine and started the conversation:

 ‘Hey, fairy, what’s up?’

Not having been a fairy in years, all I could come up with in reply was:

 'Hey, I’m great, how are you?’

Fairy small talk!

The channelling didn’t pick up much from there and I felt like an amateur among the professional players.

The encounter was successful regardless and the children passed me as a reasonable companion for a very special day in the future. Importantly their parents felt like I could be the one to support them on their new baby’s birthday. My role would be to support the whole family as they moved through their transition to becoming a family of six. I’d be keeping the children company, blend in and provide containment wherever it was needed the most. I was going to be the female elder in the house that day.

I’d driven for quite some time to their house in the countryside and the drive reminded me of my short stint with an NHS home birth team last January and February. Though in a different part of the country, the births I attended with that team were in similarly rural settings. 

Just like it had during the previous year, driving on those windy roads surrounded by trees, fields and occasional rows of houses made it obvious to me that twenty-odd years of living and working in Belfast had left their mark. I have become accustomed to the type of infrastructure that city life offers. Everything is at my doorstep, quite literally. The supermarket, bus stop into town, the local pub; everything is within walking distance. The roads are easy to navigate. Busy, yes, but I prefer them to the single lane country roads that you see in the rural parts of this island (there’s only one road in Belfast, the Rocky Road, that I have sworn to bypass at any cost after my Sat Nav sent me on my first and only encounter with it on a frosty dark December night just last year).

On the drive back from meeting this beautiful family the sun was shining and I imagined how my life would be different in the country side. I enjoyed the thought of it, it felt like I'd be quite happy tucked away in a remote little cottage. We’d have to get back into planning ahead a bit more. Weekly shops would have to become a feature again and our pantry would need a little stocking up but overall I felt a kind of longing for this way of life. Once I had finished dreaming about how it might have been for us as a family if we had spent the last twenty years living in the countryside, I moved on to reminiscing about all the home births I had witnessed as a registered midwife.

I remembered one birth in particular. It must have been about six or seven years ago and it was nothing like any birth I had ever been a part of before and it taught me many invaluable lessons. I like to think of it as the ‘freest’ birth I ever attended in the NHS.

By all accounts this birth was ‘high risk’ and expected by some of my colleagues to end in certain tragedy! 

‘Big' baby: Shoulder dystocia!

Mum declines any monitoring of the baby’s heartbeat: Baby will get distressed and we won’t notice.

Mum declines induction of labour at 42 weeks: How irresponsible, her baby is at ‘high risk of stillbirth'! At the very least she should agree to have her baby in hospital with continuous monitoring.

There weren’t many of my colleagues still prepared to stay on call for a home birth once she crossed the 42 week threshold and so I found myself on call with only the most likeminded of my colleagues. 

In the end fate sent me there with the best midwife colleague ever and none of those worst case scenarios happened.

Of course they could have happened and I fully understand that there were ‘risk factors’ present but ultimately describing any mother as ‘high risk’ for any of the worst case scenarios I listed above doesn’t really tell you anything. ‘High risk’ simply means that a complication is statistically more likely to happen than the accepted statistical baseline for ‘low risk’ for the same outcome. My philosophy has always been that anything can happen at any birth and if it does, you deal with it. I have always approached each birth with the same energy and I never take anything for granted, ever. ‘Low risk’ to me is the same as ‘high risk’ because we can never ever predict how a birth will go. I choose to be optimistic about every birth because by far the most likely outcome is that the birth just occurs. As for the possible complications, it doesn’t really matter if they are marginally more likely to occur or not. A thing either happens or it doesn’t and to the family concerned statistics won’t matter if it did. First and foremost I choose to trust our innate blueprint for birth implicitly. I trust it over interfering. Given the right conditions (and a favourable mindset and belief system in all that are present) birth works in the overwhelming majority of the time. 

And so it did for this mama. She went into labour at around 21 days ‘overdue’. She declined all routine examinations and listening in. Though she did ask for a vaginal examination once and she asked us to listen in to the baby’s heart tones once, too. Although she was 43 weeks pregnant, her baby’s amniotic fluid was clear all the way through labour and although her labour wasn’t typical and relatively ‘slow' for a third time mama, her baby emerged without complication in the pool with her oldest child present. 

There was one complication: a haemorrhage and this is where we went completely off script. None of what happened was within any kind of guideline and all we had as the attending midwives was trust in the woman and her choices given that the mum declined anything we had to offer. Instead, her doula gave her a bit of placenta to eat and then she did what looked like a kind of energy healing on the crown of the mum’s head. The doula present at this birth had worked with Angelina Martinez Miranda, an indigenous midwife who has a little birth centre in Mexico. Co-incidentally I had heard Angelina speak at a Midwifery Today conference in Germany a few years previously. She spoke of how her midwifery practice had made birth safer for women in her area and how the families she cared for had far better outcomes than those who went to the local hospital. There was even a statistically significant reduction in both maternal and infant deaths in the area overall since she started her midwifery practice. Mexico is known for its high caesarean section rate of around 50%. Women started to flock to this midwife’s clinic instead of the hospital knowing that they would be safer there and that they would be listened to (sound familiar?). The doula had learned how to support complications in non-medical ways working at that practice and so when the mama declined our injection of syntometrine (our first stop in the protocol for heavy postnatal bleeding) the doula offered to help and the mum accepted it.

It worked! 

I wasn’t particularly surprised that it did. I had long suspected that my training as a medical midwife barely scratched the surface of what is possible. My training was in the parameters of what obstetricians describe as ‘normal’. I was also trained in how to respond to the common obstetric emergencies using the same tools that our doctors would use. Everyone adheres to the same protocols and we are all trained according to the same paradigm. Even though midwives are told that they are the ‘experts in normal pregnancy and birth’, as a profession midwives are remarkably poorly equipped to deal with a situation such as bleeding without resorting to pharmaceuticals as a first point of call. Outside of ‘rubbing up a contraction’ and passing a catheter all we were taught to do was to use drugs in a certain order (and if the bleeding won’t stop doctors have a surgical protocol to follow). There was never any lesson on all of the ways in which birth related complications could be supported when there is no access to the resources that are easily available in a first world country. I think that this is a true shame because not knowing leaves us dependant on unlimited access to the drugs themselves and to fridges to store them at the right temperature. I can’t help but think of places in the world where this type of access has been suddenly disrupted. Shouldn’t we preserve this knowledge should we ever need to resort back to basics (or want to rely on our own resourcefulness in the first instance like the mama we were supporting that day). 

Having watched how this bleeding ended up being resolved, I figured that our bodies are more capable of dealing with some of the issues that can occur during a birth than the medical model regulates for. That’s not to say that there is never a place for pharmaceuticals and surgical procedures, there are situations where our own resources won’t be enough and where access to pharmaceuticals and surgery will preserve life, no doubt. 

These are all reflections that have engaged my mind on and off since this birth all those years ago. There was no time for any of this on the day because, of course, it was our role as registered midwives at this birth to watch her blood pressure and pulse making sure that we didn’t need an ambulance after all. Once everything settled, my thoughts were preoccupied with the issue of how the heck we would document all of this (I decided to leave out the ingestion of that sliver of placenta and the energy work on the head). 

Of course we had had all the conversations in the lead up to this birth and we also had the support of the most epic consultant obstetrician I have ever had the pleasure of working with. Everything that needed to be documented to support us as midwives in this birth that fell ‘out of guideline’ was documented by a (very) senior doctor and the mother had ‘realistic expectations’ of birth and she knew that there are never any guarantees but generally good reason for optimism given that she was a healthy young woman.

She was one of the most educated women about induction of labour I have ever met. She knew exactly why it wasn’t for her. She also knew when it might be something she’d consider.

She was educated about hospital birth, too, and she knew exactly why that wasn’t for her. For her, ‘safety’ meant not to meddle with the process and stay at home but she didn’t exclude the possibility of going to the hospital in an emergency.

She knew why she wasn’t likely to want routine vaginal examinations or routine listening in to the baby but she also kept an open mind and did end up requesting each of those once when she felt that the circumstances called for it. 

This was what was right for this mum and it will not be right for someone else. You have to be true to yourself and you have to follow your own path. 

Here’s what this birth taught me:

Know the hormonal blueprint of birth.

Understand the subtle ways of birth.

Babies are shy, placentas are shy. Keep your voice hushed and only speak to the mum if she speaks first.

There’s no place for small talk in a birth space, observe quietly.

Birth works best when it is undisturbed. 

Take the woman’s lead, trust her.

True emergencies are rare, particularly if you are committed to keeping your hands off! Know the ways in which birth can turn into an emergency. Anticipate what you’d do but don’t expect the emergency to happen.

Expect birth to work if you leave it be.

Do the work of getting perspective, do it repeatedly! You must not judge risk by the worst possible outcome.

This served me well as a registrant and I still teach this to my R.O.A.D. To Birth community. I am glad, though, that I am no longer practicing as a midwife. It has opened me up to being able to be around as a birth partner for some of my clients if it feels aligned and so I have recently taken the drive back to that beautiful home in the country side. I spent hours with those incredible children as they anticipated the arrival of their new baby. We played, crafted, had some snacks, chatted, read a book and did some imaginative play (I have gotten better at it already, this time I was ‘Dad’!). Then it was time to watch the baby emerge.

Since this last encounter with this family I have experienced an expansion that is still in the process of integrating into my being. 

I got to witness such an intimate part of this family’s journey and I am so grateful for having been invited into their home.

Here are some of the insights I gleaned since the day this new human emerged into the world:

Women are incredibly resilient and powerful. They have everything they need to give birth within themselves. Finding your power is part of the quest in pregnancy, labour, birth and parenting in general.

Men are usually overlooked in today’s maternity systems. When men can fully step into their role they become a source of strength and protection for their partners. Their connection and intimate knowing of their woman can induce momentous energy shifts when needed. Men are incredible (of course this could be any birth partner who knows you intimately, your sister, your mother, your lover as long as you feel free to be yourself around them).

Children make for fabulous birth partners and witnessing a sibling’s emergence (if they want to) helps them integrate the new baby into the family organically.

There must be absolute trust between all the people in the birth space so that everyone can be themselves. That is the only way everyone can step fully into their power.

The unexpected can happen. Engage with the possibility of an unforeseen emergency and be certain that you are happy that the birth environment you are choosing is right for you in all circumstances. The less responsibility you outsource, the more responsibility you take. The flip side of this is that you get to keep your autonomy along with the responsibility. 

We are all conditioned into the medical model of birth (and life in general). How deep this conditioning runs can only reveal itself when we find ourselves without access to it (by choice or circumstance). Our fears show us what our beliefs truly are.

Expecting for birth to unfold without major complications is a realistic expectation.

When you are committed not to meddle unless there is an obvious problem you will find that the accepted definition of ’normal’ is way narrower than we know. That doesn’t mean that medical input is never appropriate.

And here’s a totally far out one to conclude this week’s blog:

The Universe truly does hum 🕉 and if you listen really closely at the next birth you are privileged to witness you might hear it! Alternatively get into a forest, stand by the sea or stare at the moon next time there’s a clear night sky. 

Would you like to get on the R.O.A.D. To Birth with me? Shoot me an email to [email protected]