The first birth I ever witnessed I was ushered into a room, made to stand in a row with two other students. A woman screamed, her husband looked terrified, packages were ripped open, forceps clanked together then a doctor, sweat on his brow, literally pulled the baby out.
Tears all round when the baby cried, relief and joy from the woman, but the forceps part was horrifying. I didn’t know what to think.
I did know back in 1988 that I was instantly at home the minute i stepped in the door of the small maternity hospital in Glasgow, welcomed by friendly no -nonsense midwives.
The hospital was nurturing and women-centred, wonderful in many ways though care was standard for the time with many unnecessary routines, customs and “this is how we do it” processes, questions were not encouraged.
Degree education and the midwifery research shaping our practise today was yet to come.
Usually women birthed with only a midwife in attendance, no doctors unless a complication occurred, then forceps were commonly used and the caesarean rate was around 10%, tiny by todays standards.
Pregnancies two weeks past the due date considered normal. ‘Overdue’ babies with dry, peeling skin a common sight. I honestly can’t remember much about induction of labour.
Women stayed in hospital for 3-5 days post birth followed by community midwife visits at home for up to 10 days (or more) depending on need.
Leaving the cocoon of home to go anywhere in the first few weeks after having a baby was unheard of. Family, friends or health professionals went to them.
(Now in 2022, women are expected to take their aching, sleep-deprived, still bleeding, lactating bodies out to see GP, Child Health clinic, or Lactation consultant. It’s all wrong.)
This lengthy ongoing midwifery care in the home meant vulnerable babies were closely followed, problems prevented, symptoms of illness in mum or babe picked up early including the women’s emotional state and awareness of social supports (or lack.)
Extra help could be organised in a timely way.
Now it’s all rush, rush, rush. Rushing to end pregnancies. Rushing labour. Rushing women home 24hrs after a vaginal birth, 48hrs after a caesarean. (Some women want this, many don’t)
Breaks my heart when I read quotes like this
“I re-entered the world of the maternity ward and the pressure began to leave the hospital , to make room (no 7-10 days of lying in these days) and to breast feed on demand. There was no recognition of the enormity of the experience that had just occurred , instead of being offered rest and help we women are sent home to be perfect mothers on no sleep”
Polly Clark
It’s unfortunately true.
Back to 1988. Learning palpation of the pregnant abdomen and fetus inside, accuracy important with no portable ultrasounds available.
Did fundal height = pregnancy weeks? Subjectively measured, no tape measures, no plotting on a graph. Baby head down or breech? Spine against maternal spine or facing front? Chin tucked in or not? Head engaged in the pelvis or not?
Next, learning to use pinnards, placed on the woman’s abdomen, ear on the other end, listening intently. Relief for backs and necks when hand held dopplers became available.
Admission CTG’s were not routine, done only if a problem identified. During labour we listened intermittently with the pesky pinards.
Women endured lengthy waits in Antenatal clinics for routine checks, sitting in rows on uncomfortable chairs, appointments often quick and impersonal.
Labour and birth was the domain of the midwife, no doctors involved unless abnormalities presented, then it was important to refer, a legal obligation clearly understood by all.
Recall relationships between obstetricians and midwives as collaborative and friendly. (Rose – tinted glasses maybe?)
All women birthed on the bed, 🤷♀️ either on their backs or semi-recumbent, legs on midwives hips, coached in direct pushing “big breath in, hold it and push, push, push,” points given to us student midwives for enthusiasm.
Entonox was the drug of choice for pain relief, IM morphine ( primps only) or pethidine. Sedated newborns needing naloxone, injected into tiny thighs common. Don’t remember many epidurals?
With birth imminent the womans thighs and abdomen (she was lying down … of course) were covered with green drapes, in a vein attempt at sterility but as we all know birth isn’t sterile, it’s primal and messy, drapes didn’t contain the gallons of liquor, the blood, the poop and usually didn’t stay in place.
Again, women acting instinctively won’t choose to recline in bed for birthing or cover themselves in drapes to meet their baby!
With babies head visible at the vulva, almost crowning we were taught to press fingers firmly down on the emerging head to ‘ help flexion and slow expulsion,’ other hand supporting the woman’s perineum to prevent excessive tearing. These maneuvers now of course shown to make no difference, even to cause harm!
Next, episiotomy.
Explaining episiotomy to someone non- the – wiser I suggest they look at their hand with fingers splayed, look at the soft area of skin at the bottom of the thumb, imagine taking a pair of scissors and cutting through. I reckon it’s a good example. Of course much worse, this cut done at THE most tender part of the female anatomy (😖😩) in Scotland routine for almost all first time mums at that time, thought to prevent problematic tears (it doesn’t)
Apologies to those women whose perineum I cut, HATED doing it every single time.
When baby was born the cord was clamped and cut with HUGE urgency, babe whisked across the room to be wiped, labelled and swaddled before being presented, ‘given’ back to the woman.
Next waiting (patiently) hand poised at the umbilicus, ready to GENTLY palpate for signs of placental separation, “no fundus fiddling!” ( insert Scottish accent) the shrunken uterus felt as a firm ball, cord seen to lengthen at the vulva with a small gush of blood.
The awful, routine, continual fundal massage common in many USA hospitals I didn’t witness until coming to Oz and seeing it done by impatient private obstetricians. So unnecessary and painful.
Allowing the placenta to deliver naturally without drugs or interference in late 1980’s Scotland was unheard of.
Syntometrine was given IM into the woman’s thigh with the anterior shoulder ( consent??) causing a quick, sustained contraction of the uterus and often vomiting.
With separation confirmed controlled cord traction was done, left hand on lower abdomen, stopping the uterus from being pulled out too. We’d collect all in a kidney dish and check for completeness.
Vulva and vagina then CAREFULLY and GENTLY checked with a swab wrapped round a finger.
The midwife attended stitches if needed, doctor called if the tear was complicated and of course some lucky women needed no stitching at all.
Along with weighing, tagging and injecting of the babes we bathed them within the hour when of course they should have been skin-to-skin or breastfeeding or being looked at adoringly by their parents.
All this routine handing over of power and agency from the women and expectation from us that they would comply SEEMED like a mutually agreeable thing, consent to routines and processes given by implication.
This was birth in late 80’s Scotland. Women didn’t outwardly complain but (we know now) often went home feeling bad about the experience, some traumatised.
It’s sobering, there’s much to reflect on for everyone working in the system, we can’t shy away from these women stories
Now in 2022, induction of labour rates are a massive 48%, caesarean rates 38% and correspondingly reported rates of birth trauma are on the rise.
The first birth I witnessed where we DIDN’T interfere I remember thinking “aaah, it can be like this!”
Middle of the night, woman (second baby) in tune with her body, in her oxytocin/endorphin fuelled world, eyes shut pacing round and round.
I followed the lead of the midwife supervising (calm, quiet) hovered, said nothing, wasn’t needed, the woman climbed onto the bed at the end, powerfully and efficiently birthing her baby.
Still remember it vividly to this day, a stark contrast to the norm.
On transfer from labour ward babies were taken for “observation” in the postnatal ward nursery staffed by midwife or nursery nurse, women were taken to their beds. This routine, casual separation of the two, genuinely thought to be best practise. Beggars belief.
Conversely, in our current public Australian maternity hospitals 2022 , babies never leave their mums side, not for a minute. The rational absolutely sound but staffing doesn’t reflect the support these women often need. In my opinion the complete erasure of the postnatal ward nursery in THIS climate is a mistake.
Some women in our current system will benefit greatly knowing their baby is in safe hands for 1-2 hours while they sleep making a huge difference in their ability to parent in those first few crucial days. A common sight back in the 1988 Scottish nursery were bleary eyed women wandering in overnight looking for their babies.
Scottish babies were swaddled fiercely, Babushka doll like, only a tiny bit of face showing and regularly placed to sleep on sides and stomach, another normal thing to do at the time.
Research eventually demonstrated that sleeping on backs with heads uncovered was safest, rates of Sudden Infant Death Syndrome (SIDS) plummeted when this was embraced.
During the day rows and rows of the swaddled Babushka’s were lined up in their fish-bowl cots for daily checks, including rectal temp with a mercury thermometer (!!) a top and tail wash and cord “care,” the stump cleaned with alcohol wipes and a mystery powder applied.
Humans are designed beautifully to manage cord separation, none of this interference was needed.
Small bottles of water, glucose water and formula sat in rows on the nursery bench top brazenly advertising formula companies. Day three after birthing, women attended a formula demo in the nursery , “bounty bags” full of company merchandise were handed out with gay abandon, gigantic tins of various formulas set out in a big colourful pyramid, formula companies knew how to push their product.
An abiding memory i have is of babies being given their first water feed to “test” their stomach then expected to drink vast quantities of formula! The stink of projectile vomit was common.
No judgement at all for women who actively chose to formula feed but i feel for those who had wanted to breast feed whose journey was made difficult by this blatant advertising and our lack of knowledge.
We unknowingly gave the wrong advice and support. Timed short feeds on both breasts, increasing each day, baby in the nursery at night, topped up with formula when they should have been back out with mum, full breasts bound between feeds with a multitude of bandages and safety pins!!
And the culture didn’t help. The Sun newspaper until 2015 published daily page three photos of women proudly showing off their naked breasts for the male gaze but the sight of a women breast feeding her baby , showing the slightest bit of naked boob in public caused/causes outrage. God forbid she show a nipple!!
Babies needing extra care in ANY way went to the special care nursery, a low bar for admission in those days. Much easier on the midwife, not so good for women to be so routinely separated for issues easily manageable on the ward. Again, acceptable practice at the time.
My first job was in the labour ward of a large hospital. No such thing as a grad year, no clinical facilitators, no wellbeing officer, no staff counselling, it was sink or swim. Luckily I swam, loved what i was doing, proud (and scared!) to be supporting women all on my own to give birth.
I asked questions of the more approachable experienced midwives.
Why do we direct woman to start pushing even when they have zero sensation or urge to?
That perineum looked nice and stretchy, was the episiotomy really necessary?
Or i’d tell them I felt terrible asking women (i did!) to turn over onto their backs for the birth when they clearly preferred kneeling or on all fours.
I would also be told “your woman is too noisy, show her how to keep her lips together, keep her energy for pushing.” 😩
New and junior I kept my head down and followed hospital policy but used my own instincts behind the closed birth room door, trying to help the women follow theirs where I could, knowing there could be a better way.
A small number of women chose to birth at home, supported by community midwives. No one judged them, this was a normal choice. When occasionally things did go wrong the obstetric “flying squad” went out.
Obstetrician and midwife would jump into the back of a reversing ambulance at the open fire doors and speed off into the night (always the night!) with huge bags of kit ready to tackle whatever obstetric emergency was presenting.
Eight months in my (now husband) and I moved to a new city. I found a job in a large tertiary hospital, spent the next four years rotating round, special care/intensive care nursery, postnatal ward, antenatal ward and finally back to birth-suite.
His dream from the moment we met was to emigrate to Australia, i laughed when he told me “i’m NOT moving to the other side of the world!” I declined and declined and declined, cried every time I thought of it, we’d need to split up, “i’m not leaving Scotland.”
But after a few years I did change my mind, we left dead of winter freezing Scotland in January 1995 arriving in sub-tropical peak summer QLD. My adventures in the Aussie Maternity system began.
Lindsey Crossan. Registered Nurse/ Midwife