I live in Bali, Indonesia. I would like to share a story and
get feedback from midwives or mothers who have had similar
experiences. I am not a midwife. I once apprenticed in
direct entry midwifery in Australia but had to discontinue
my training. I lived in India and now live in Indonesia.
Somehow or another I often end up being at births at home or
otherwise, usually to support the mother. Sometimes I am the
only one attending and even though I am not a midwife, end
up acting as one.
In this case my friend who was about to give birth to her
fourth child at home asked me to be present at the birth. I
had been at the birth of her third child. She had decided
not to go to hospital and to give birth at home, and asked
me to be with her. Since she was going to do it anyway I
decided to attend. The birth went well and she had a healthy
baby girl.
This time we were prepared as usual. I borrowed a fetascope
from a Balinese midwife and bought clamps and scissors for
the cord. I had been checking the baby's heartbeat for two
or three months so I would know its normal baseline sound
and be able to check it in labour. Although I am not a
midwife and in reality I was only there as a labour support
person, I decided to monitor the pregnancy and labour as if
I were the midwife, simply because there wasn't one!
The baby's heart rate was always around 117 to 120 and the
day my friend went into labour the heartbeat was steady and
reassuring. Her labour progressed in a funny sort of a way,
with the contractions not regular or increasing in length
and frequency but continuing nevertheless. I checked the
heartbeat regularly but did no internals since I figured it
was safer that way and the contractions could do their work
without my checking on progress.
After about eight hours of these contractions the mom had
some blood issue from her vagina (not a lot, but not
reassuring). It was fresh blood but dark in color, like it
didn't have a lot of oxygen in it. My feeling was that it
was from the placenta or the cord. The mother is a heavy
smoker and I wasn't in the mood to take any risks
whatsoever. I suggested she transport even though the baby's
heartbeat seemed fine when I checked it. The mother said she
couldn't move, that the baby felt really low down and she
wasn't going anywhere. I checked the heart rate again and it
was 125. I asked her man to call an ambulance because I
figured that if an ambulance turned up, she could hardly
refuse to get into it! But in Indonesia such luxuries like
ambulances and fire engines only turn up in the movies or,
for ordinary people, when it's too late. Her contractions
continued and they seemed to be intensifying, although
inconsistent. I checked the heartbeat constantly while the
dad tried to get hold of a doctor. We had no more blood but
the heart began to speed up at the beginning of a
contraction, slow right down at the end of a contraction,
and take forever to recover. The heartbeat was descending
rapidly too, and although my mind for some reason refused to
accept the reality of the sound, somehow my instinct knew
that something had gone wrong with the cord. I thought it
may be pinching between the head and the pelvic bones.
Within 10 minutes of first seeing the blood, the heartbeat
slowed to 88 and then disappeared altogether. I was saying
to the mother, "I have no heartbeat and there is no doctor
(her man still hadn't returned from his search). We need to
get this baby born right away." The mother kept saying,
"It's OK, it's just descended so far that you can't hear it
anymore behind my pelvic bones." But I wasn't so sanguine.
Within another five minutes she was pushing and begged me to
break the waters, which I refused to do because of the
bleeding and my worries about the cord. However, after one
more round of pushing (about five minutes) I had a
presenting, bulging waterbag that I nicked and the baby's
head was out, dark blue. I checked for the cord immediately
and it was twice and very very tight around the neck. I
clamped and cut it immediately--I must say even I am amazed
how fast I did it, since I'd never done it before. The baby
slid out and she was cold and white and gone from this
earth. I only tried to resuscitate her for a very short time
because I knew she was gone and it was too hard for the mum
to keep on going.
This experience was really hard for all of us. I don't know
what I could have done better or to prevent this from
happening. I would like to hear from anyone who has had a
similar experience. The mother is very depressed now, and
many Balinese are telling her it was black magic. This is
making it worse and harder for her to accept. I don't know
if I ever want to go to another birth.
-Janma
Reprinted from Midwifery Today E-News (Vol 2 Issue 31 August 2, 2000)
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