From MIDWIFERY MATTERS, Issue No. 90, Autumn 2001
Andrya Prescott
Independent midwife
I HAD A TELEPHONE CALL from Sarah who was enquiring about my midwifery services. She was 18 weeks pregnant with her first pregnancy and desperate to gain some control over her care. She was quite emotional on the telephone and when I suggested we meet for a consultation she said that she would actually like to go ahead and book with me. We made a date and off I went.
When I got there her husband Paul was there and she sat with him holding his hand and looking very nervous. I asked her about the kind of care she had been receiving and how she felt about this pregnancy. She was excited to be pregnant, it was a very much wanted baby, but she didn't know how she was going to be able to birth her baby. She said she was scared.
We started to go through the notes so that I could have a really clear picture of where I could help Sarah. Also I wanted to find my own limitations; I was already aware that there were issues that hadn't been brought up yet and I might not be the right person to deal with them.
The booking notes I use are extremely detailed and cover both the physical and emotional aspects of women's histories; this gives clients the opportunity to discuss things at any point. Clients can talk about emotional aspects at the time of booking, leave this until a later date or keep their feelings to themselves, but they get the message that we care, that emotional history can be relevant and that it is their choice whether to disclose issues or not.
When I asked about Sarah's menstrual cycle she said that she had been irregular until she went to a homeopath. I asked her more about the homeopath and she told me about some of the help he had given her in dealing with something that happened to her when she was younger. She bared her soul at this point. When she was a teenager her cousin had violently sexually assaulted her. Sarah was trembling as she retold parts of the abuse, she had physical scars left by his fingernails and the emotional scars were more than evident. I listened to as much as she wanted to tell me and gave her the space to grieve. Her husband comforted her.
When she finished I said that I felt that this pregnancy was likely to be very eventful emotionally but I felt positive about the way she was approaching it. For her to tell me this in the first hour of meeting me indicated that she was more than ready to deal with all of this.
Sarah's physical history was very typical of a woman with a history of abuse. There were plenty of illnesses such as constipation, asthma, hypothyroidism as well as depression (which came before the memory and awareness of what had happened). The homeopathic remedies had helped her enormously and she saw the homeopath regularly.
She visibly relaxed during the course of the booking appointment and expressed her relief to have had the opportunity to receive the kind of care I offer.
I felt really pleased she had booked with me too; she was so honest and open.
Antenatally I gave her various books and resources to try out. With each book I emphasised that she may feel uncomfortable with the style or content so she could choose not to read it if it wasn't right for her. This was essential for her to take control of her own body and mind. She had a tendency to 'do what she was told' which I was keen to not perpetuate. She eventually found one of my books, Creating a Joyful Birth Experience, the one for her. It has a workbook style approach and uses drawing and left right brain activity to help deal with hidden issues. Sarah used the book from 28 weeks until a fortnights after the birth and really found it gave her a focus and a place to deal with the emotions which had previously overwhelmed her.
With each antenatal I spent well over an hour with her, we would talk about the different aspects of birthing and especially about the baby crowning, which terrified her. I showed her pictures of births especially of crowning and talked through how to cope and focus when it happened. We discussed trying perineal massage that she started to do with Paul's help. She found it very hard to begin with but felt it would help her to get back in touch with her body, reclaiming ownership. The look of delight on her face when she told me she finally felt totally comfortable with it and felt confident and excited about pushing her baby out was second only to when she did do just that!
We spent a lot of time thinking about how being a mother will make her feel as her child grows up. Sarah did not want to perpetuate the abuse cycle so I affirmed over and over that by facing her demons to the extent and with such strength and amazing capability she would be moving beyond that without a doubt.
Sarah moved steadily and firmly away from the victim role as the time for motherhood drew nearer. She stopped apologising as frequently as she had been doing and the words she used became stronger and more positive.
Sarah chose to use a visualisation tape to help her cope with the prospect of labour and also to get in tune with her body. She found it invaluable when starting with the perineal massage also.
Sarah's labour started at 41 weeks and four days. Paul and Sarah were really excited and nervous! Emotionally she felt in turmoil but was very calm on the outside. She had a good size baby on board but then she was over nine pounds when she was born and at 5'7" I was not too concerned. Sarah was progressing beautifully, about 5-6 cms when I arrived (according to the purple line) so she got into the pool. The contractions grew in intensity to the point when she bellowed, "Eve should never have picked that fricken apple!" Sarah's homeopath arrived and was on hand should she need help. Paul was massaging her shoulders and being fantastic support.
The purple line extended to the sacral dimple and the labour slowed into a very long 'rest and be thankful' stage. We talked about the next phase and Sarah didn't feel overwhelmingly scared, just a bit nervous. The baby had a very healthy heart rate so she got out of the pool and we all had a bit of sleep. The contractions began again with a real urge to push, she was really focused inside herself and, aided by the visualisation, she helped her baby move down.
The baby's head birthed. not small. followed by a hand and then another hand and finally his body! She couldn't believe it! As he lay next to her she sobbed with joy (Paul and I didn't have dry eyes either!). She helped him as he rooted around for her breast. He latched on and nursed like a dream. Her placenta took some time in birthing but came away eventually. Baby weighed in at 11 pounds!! Don't forget the arms by his head. She did have a tear that needed suturing which was done with consent and with clear explanations of the process so that she could retain a sense of control.
Postnatally Sarah was ecstatic, if very emotional. She also had a flashback to the abuse on the second day. This came as a shock to her but when she told me about it she was really calm, she had sweaty palms but was not obviously distressed. She actually felt it had been cathartic, almost an ending to that part of the healing.
For me this has been an amazing shared journey with Sarah, Paul and the baby. I found myself mirroring the advice I gave to Sarah for myself, setting up good support structures, Sarah believing in her body and ability, me believing in my ability and also we had to trust each other.
We are still friends and she is really enjoying her family and the changes that have come about as a direct result of the experience from the abuse through the pregnancy and now into motherhood.
I always enjoy the beautiful births of women with no problems, but there is something deeply moving about being a part of such a healing. It is a great privilege.
[names have been changed]
Andrya Prescott (formerly Andrya Grubb) is an independent midwife who works
in Hampshire, Surrey, South West London and West Sussex.
www.independentmidwife.com
This article was originally published in Midwifery Matters ISSUE 90 Autumn 2001, p24
LW updated December 30, 2005