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Sister Morningstar wrote a beautiful account of a birth which she supported over the telephone in the Spring 2015 issue of Midwifery Today. It reminded me of several births which I have supported over the phone. But this month, I had a new experience of giving midwifery birth support via Skype.
Usually I do not travel if a woman is due, but this spring, I very much wanted to celebrate my mother's 90th birthday with her in New York. Her life has been a celebration of optimism and she has been my major support my whole life and the reason I am a midwife today.
My client, who was pregnant with her fourth, said, Go! Your mother is more important. I gave her my phone number in New York and told her to keep in touch. It was her idea to Skype me in New York. Her previous pregnancy, only 1 year and 4 months before, had been accompanied by contractions on and off starting at 36 weeks, yet she did not deliver until after 41 weeks. I would be back by the time she was 41 weeks, so there was a chance when I left that I would again be there to attend her birth. Last time, after a month of contractions on and off, she had 4 days of stronger, but irregular contractions and then 3 hours of strong contractions before she delivered. But with this pregnancy, perhaps partly due to the close proximity to the previous pregnancy, she had a harder time. At 30 weeks she began to suffer from sciatica, shooting pains in the right leg, starting at 30 weeks of pregnancy. This subsided after a week or so. Then at 34 weeks, she began having strong contractions every 5 minutes for hours after she spent time standing or walking. Several times, the contractions went on for several hours into the night. When she lay down she felt the contractions were as strong as real labor. We spoke often. She was able to stop labor by drinking wine 3 times. Once she was 37 weeks, she agreed there was no reason to try to prevent her from giving birth. I monitored the fetal heart beat several times. The fetus was head down and fetal heart and movement was reassuring. The fetal head was engaged at 35 weeks when I checked her, and was probably another reason she felt the contractions so painfully because the head was putting strong pressure on her cervix. During my visits to her, indeed she had strong, painful contractions every 5 minutes as could be felt by touching her stomach and seen by her behavior. Some days she would have less contractions, but whenever she was active walking, the painful contractions every 5 minutes would happen.
On Monday at 39+2 weeks, she had 3 hours of stronger contractions than usual, but they stopped. On Tuesday night, she had diarrhea. At 4 am a tablespoon of blood came out after several hours of contractions but in the morning at 6 am the contractions stopped and she went to sleep. On Wednesday night she had her usual painful contractions during the night but went to sleep for a couple of hours. At 4 am on Thursday morning, her time, she woke up when her water broke and 10 minutes later, she called me on Skype. I was online, checking email in New York. I asked her if the water was clear and she said yes, all clear except for one small green glob of gook, the rest was clear. She felt plenty of fetal movement. We stayed connected. She had contractions that were hurting. At this time, they were the same bothersome, painful contractions that she had had since 34 weeks which she could talk through by focusing. I continued to reassure her, and apologize that I wasn't there. I asked her to get the baby clothes ready so she could keep the baby warm after birth, which she did. I asked her to turn on a small radiator in her bedroom, which her husband did. Then I spoke to the husband about the importance of delivering the placenta and how to do it with the cord still connected. I asked her if she was hungry. I asked her if she was thirsty. She said she very much wanted me to be there. I tried to reassure her well. I think we both felt quite connected. She smiled at me and I sent her a kiss by kissing near the camera. She trusts both her body and she also trusts me very much, as we have developed a trust from her last pregnancy as well as the many calls from 34 to 39 weeks during this pregnancy. But many women, no matter how reassured they are, are anxious before birth. The midwife tries to reassure them, which helps some. At 4:38 she began to have contractions that she could not talk thru anymore and I could see her swaying and also pushing her back up against the wall at the peak. 4:42, 4:46, 4:48. It is very easy to time contractions while you are watching them on Skype. You see both the contraction and the time in the right hand corner. And I just jotted them down on the pad next to the laptop. I could make notes while she labored which I always hesitate to do when I am actually in the room with her. We chatted between contractions, about how well she was doing and that the baby was coming very soon. Her husband asked for a time estimate. I said about 6 am. She was thinking about getting in the bath. I told her to do whatever she wants. She enjoyed having my company meanwhile, so we talked thru some more contractions. When she began having rectal pressure she decided it was time to get into the bath. While she got into the bath, our connection was off for a while until the husband found a position for the laptop in which the laptop was not vulnerable to water or to falling. From then on, I did not speak. I listened. I breathed. She breathed. I had given her all the information at my visits, and in the past hour and a half, which she needed and which her husband needed. I was there in case they had a question. She went into her own world, essentially alone with her husband, with me somewhere connected thru the internet.
She delivered herself into water and delivered the placenta herself. After that, they signed off and had their own time together with the baby. Her husband emailed me some hours later to tell me all was OK, the cord was not cut until 2 hours after birth. She was now resting in bed after a lovely 2 hours bonding with the baby. She did not transfer to hospital. She did not have a tear. The baby had an Apgar score of 10, 10 as far as I could see and the woman lost a very small amount of blood and felt great postpartum.
The woman and her husband were very happy. The woman has no risk factors. However she is an afraid and nervous type and nervous about birth as well. Her husband was the calm one of the two. She would have preferred if I had been there, but she was happy with the birth and the connection over Skype. But said that next time, she wants me there in person again, like her previous birth.
I am offering this story not as a suggestion to midwives to do Skype births, but merely to verify once again, how each pregnancy is a world onto itself and each woman has different needs and her idea to use Skype worked well for her this time, as an alternative to going to the hospital since she is even more afraid of hospitals.
My 90 year old mother thought it was the greatest thing, when she heard that a woman and her husband would have their baby by themselves, with a little help from me long distance. Spending time with my mother gives me perspective on birth. I no longer see the baby as a baby. I see the new baby as the beginning of a long life that extends 90 years, full of stories and adventures that will hopefully extend long after I have passed. I sometimes try to imagine what new technology will be available when this child reaches maturity.