That Roaring Freight Train

When you walk into the room of a birthing woman, you step in and gather awareness. You smell the smell of labor and birth, you observe the environment and movements of the people in the room. There are those she has invited to support and love her, and there is her professional birth team. There is a gathering.

Nobody can project the speed of the birth. They can hope and wish and intuit, but often we forget the most important passenger has the journey all mapped out and really the birth is in "their" hands. How easily we forget the biggest journey of all is occurring for that little baby who will squeeze through tight passages only to open that mother's awareness beyond any scope she's ever imagined opening. But, what happens when that birth is fast, or what we call a "precipitous" birth? I've heard it explained as "intense" or like a "roaring freight train."

Disclaimer: I am a 35 year old woman and Midwife who has yet to birth her own babies, so this writing is based on experience and listening to birth stories. I have not yet experienced the freight train, but I will begin with my own birth story from my Mom and also from my Daddy's perspective. It was Jan 4th, 1976 and my mom had the flu alongside my sister. She went to bed that night still sick and hoping the flu would kick soon. She suspected she might be in early labor or getting ready since my date of arrival was said to be Dec 17th. Now my mom, she doesn't really believe in a due date...Therefore, it was her belief that I was meant to arrive when I was ready. So sick or not, she was going to bed.

Sometime in the early morning on Jan 5th, my mother realized she was in labor and that it would be best if she and my daddy made the trek towards the Twin Cities and the hospital. We lived in a small town about one hour south of the Cities. We got in our green Fiat, and she brought a garbage can just in case. 12 miles north of was a town called Northfield. Aside: When I turned 6, we moved 2 blocks away from the very small hospital I was born in. I would run down the street to watch the Life Flight helicopters every time one roared over our house. Another obsession-helicopters and wondering about the person flying to a bigger hospital in the Cities. The house has yet to be vacated by the Egbert-Preddy clan almost 30 years later. Mind you, the time is around 5 am once they were ready to leave the house. In the Green Fiat, the sped north on 35. They got close to exit 69, the exit to Northfield, and my mom tells my dad to turn off an get to the closest hospital because "this baby is coming." Dad's story is that he drove her up to the front doors of the hospital he was so nervous, and that he barely missed the birth. Momma says it wasn't that dramatic and that he made it in plenty of time. They got there around 6 am and I was born at 6:24am, after a push or two. I came out screaming and immediately "voided" (aka pee'd) on Dr. Risgard who was my doctor until he retired. I was the first baby in 1976 to be born at Northfield Hospital.

The other birth that stands out in my mind today was a pretty vulnerable birth. I was a student in the end of my training. Three days prior, we had a very difficult birth which had left me wide open. Somewhere in those 3 days, I pulled on my "big girl" pants and knew that Midwifery was the work I wanted to do for a long long time. That I had met my calling. Some would have turned away at this point, I just faced it and kept leaning in. This sweet momma whom I had developed a solid relationship with quickly was due to birth any day. Her vulnerability, three months prior she had lost her husband to a tragic accident. I had the "heads-up" call somewhere in late evening and was instructed to go to the Birth Center, because this mom was in early labor. She was on her way and it would take 45 minutes. I made my way to the birth center and thought, "I'll set up the birth suite, do the initial intake and then I'd call the rest of the birth team in for support." Hah!

I remember sitting at the reception desk when the mom, her sister, and grandma walked in the door. This momma wasin-labor, and I mean rock and roll active labor. She asked to be checked. When I checked her, I said, "There's a bulging bag of water here, you're 4 cm, however when I pull my hand out let's just be prepared." Driving that train, her water broke immediately, her eyes popped open and she said, "Oh my god, here comes the baby." And I looked around, seeing that it was just me since I couldn't call the rest of the birth team and looked at her sister and said, "Grab that Oxygen tank and that tray please. Do you mind being a birth assistant?" She was excited and said, "of course!" Grandma was right in there with us.

Freight train. She dilated from 4 to complete in a minute and Momma jumped in the tub. She was squatting, and baby was a-comin' and FAST. One push, eyes open wide (a reflex called the fetal ejection response) and I can feel the top of the baby's head in my hand and perineum slowly allowing baby to come through. There was a moment of panic from the mom. Her husband and support not with her, grief all around, and yet here we are immersed in birth. Inside me, I could only focus on being present with this mom. Loving this mom. No focus on the past, just focus here. I told her to look me in the eyes and together we were going to make little "puffs" and ease this baby out. And so we did. "Pfft, pfft, pfft, pfft, pfft, pfft," and slowly this baby slid out and restituted and she followed her body and sat back on her tailbone. She reached down as her baby was born and pulled her into her arms, looked at me and said, "We did it." They did it, and this was 12 minutes from the time she stepped foot into the birth center. Literally.

Writing this, I feel my heart flutter and swell. She had a minute to rest, and I had a minute to call my team. I called my supervising Midwife, who was on I-5 heading South towards the birth center since she hadn't heard from me. I said, "We have a baby. I'm sorry I didn't have time to call." She first asked how I was, and I bursted into tears saying, "Shaken, but great." Then mom, and I said, "Amazing." She said, "Well done. You're a Midwife." Sweet and easy placenta birth. Momma, babe and Aunty snuggled on the bed in tears. The daddy of this new baby was around in spirit. It was clear. 12 hours later, the new family quietly snuck away from the birth center.

Some bodies are meant to birth slow. Some bodies are meant to birth fast. I believe babies come as they are ready during labor as so much of their journey is learning how to fit through this small space into a much more vast and expansive atmosphere. I also have been contemplating the fact that we as providers love to research current evidence on the events of birth and pregnancy. Yesterday, a Physician out of Canada began a piece and in the title questioned if our over-indulgence in evidenced-based care in Obstetricsa is doing more harm than good. Even though I read daily new releases on evidence-based maternity care, I wonder the same thing...are we doing more harm than good?

When it come to precipitous birth, be prepared for overwhelming sensations and doing your best to accommodate the adjustments. That is the best one can do. Work with your partner. Work with your team. Let us providers get out of the way and allow you to connect with your baby and your body on a deep, intuitive level. When that freight train passes, embrace the bond of new life.