Peggy Vincent is the author of two books chronicling her experiences as a midwife: Baby Catcher: Chronicles of a Modern Midwife (Scribner, 2003) and Midwife: A Calling (Memoirs of an Urban Midwife ) (Volume 1) (CreateSpace, 2015).
Q. You’ve had a lot of experience in a wide variety during your years working with childbearing women. What are some of the biggest differences you’ve seen in how birth is approached as a labor and delivery nurse versus as a midwife (both in hospital and out-of-hospital)?
A. As a delivery room nurse (before I was a midwife), the obstetrician was ‘in charge,’ although there were many who trusted me and several other nurses to sort-of run things on our own, as long as everything was normal. But there were other doctors who seemed never to see birth as normal, always looking for an excuse to step in, intervene, and interrupt the natural process.
Once, in the early days of the Alternative Birth Center, a doctor hesitated at the doorway (it was his first ABS patient) and asked me, “What am I supposed to do?” and I answered, “Ideally, nothing.” He frowned, said, “I didn’t go through med school and residency to ‘do nothing,’” and he went into the room and found a frivolous reason to move her over to L&D.
Some OBs viewed childbirth as a disaster waiting to happen.
As a nurse, you’re obligated to follow the doctor’s orders. Although you can argue, reason, and question them, ultimately, they write the orders. As a midwife, I viewed all births as normal (within a wide range) until proven otherwise. I wrote the orders myself for my clients who chose a hospital birth. I had to conform to certain Standards of Practice, however, or risk losing my privileges, so my hospital births entailed more intervention (often stuff that I deemed unnecessary) than my home births. I explained this difference in my management style in hospital vs. at home to my hospital clients, so they went into it with eyes open.
It was the clock, mostly; there was a big board in a public corridor with every patient’s dilation…and I knew the doctors were scrutinizing my ‘management’ of women’s labors. If I had a woman who was complete for longer than 2+ hours, I knew there might be questions raised. Of course, the easiest way to manage this was not to examine the woman until she felt like pushing!
And charting! Charting, charting, charting! Everything in the hospital had to be documented about every 15 minutes. Charts and fetal monitors and overseeing IV drips took so much time away from eye-to-eye patient care.
At a home birth, I didn’t write orders at all, of course, because my assistant and I were the only “outsiders” there…and we did what was necessary. Charting at a home birth might be no more than 5-6 lines; like I might write: “FHT q 15 min ranging from 140-150 for last 3 hours.” Ditto with blood pressure. Though I’d take it maybe only once or twice during a normal labor; more often after the birth, but not much.
At home, women feel, duh, “more at home!” Every person present is there at the woman’s invitation; no strangers. Labor proceeds at its own pace. Nobody is watching the clock…so much that sometimes no one checked the time of the birth, and later, while filling out the birth record, I might have to ask, “Did anyone check the time?” Unless you’re deeply into astrology, it’s not really important. So the parents could choose or we’d pick an average.
The only time one truly might need to check the clock at birth is when a baby’s born a little stressed, and it’s helpful to later note how much time elapsed before the Apgar Score was up to a cheerful and reassuring range.
Q. Approximately how many births have you attended during your life? How many of those babies did you “catch” (meaning, you were the primary care provider)?
A. I quit counting when I began working for Kaiser, where the numbers piled on so fast that they became almost meaningless. There was one morning when I caught nine babies in 90 minutes; that’s not midwifery care, that’s assembly line. I caught a baby, then caught a second one, then delivered the first one’s placenta, then caught a third baby, then put a few stitches in the first one’s perineum, then delivered the second one’s placenta, then caught a fourth baby, then grabbed the third one’s placenta…and so it went.
Lifetime total of babies I’ve caught…around 2,500-3,000.
As a nurse, I did at least 100-200.
Home births before I got hospital privileges: 1000 +/-
During the years, I did both home and hospital births: another 1000 +/-
Kaiser for 5 years, working three 12-hour shifts/week: who knows? 500-1000?
Q. You were instrumental in getting an Alternative Birth Center opened in Alta Bates Hospital. What were some of the major differences in protocol between the birth center and the regular labor and delivery ward of the hospital?
A. Yes, the original ABC was my baby. I lobbied for it, attended scores of meetings, wrote the original protocols, bullied the concept through committee, and was the coordinator for the first 2 years of its existence.
Originally, there was to be no analgesia (pain medication), no IVs, and no fetal monitors). After about 6-9 months, the protocols were modified to allow one half dose of a narcotic during labor, if requested.
Women had to have a normal pregnancy, of course. Also, no breeches or twins.
There were no restrictions on number or ages of people present at the birth; one woman (a doctor) invited everyone on her short block in Berkeley to come, and about twenty-five of them did, including maybe six kids.
Q. Several times during the book, you discuss obstetric skills that were once common in the birth world but are slowly being lost as doctors turn to surgery and other interventions instead, such as how, for a difficult posterior delivery, skilled use of forceps can mean the difference between a vaginal and a Cesarean birth. Can you think of any other examples of techniques or skills that are disappearing?
A. All forceps deliveries are becoming a thing of the past. Sometimes a vacuum extractor is used, but often the first choice is surgery.
Vaginal delivery of a breech baby has all but disappeared, and this is the one that worries me the most. I’ve seen scores of vaginal breech births, and while I was moonlighting at Mt. Zion’s Birth Center (to get experience before attempting to get one started at Alta Bates), I came on duty at 3 pm, relieving a nurse who perhaps had minimal experience. The mom was having her third baby, and the resident was present as the mother was said to be 8-9 cm dilated and would surely be birthing soon. The other nurse left, and about 15 minutes later, the baby’s butt appeared at the introitus. The birth center was a good 10 minutes away from the delivery room, and the resident kind of freaked out, gabbling that he’d never even SEEN a breech birth before, let alone delivered one. I said, “Well, I’ve seen a lot of them,” and he just stepped aside and asked me to do it. It was a cinch, a catch really, as it was her third baby. But, today, she would probably be convinced by her doctor to have a Cesarean.
The reason this worries me is that there will occasionally be a woman who presents at the hospital about to give birth to a breech, no time for a Cesarean, and no one present who knows how to safely attend that birth…and a poorly handled breech birth is not pretty…which only adds to the belief that they are inherently unsafe. A self-fulfilling prophecy.
Q. Nowadays, the vast majority of American babies who are still breech at term are delivered via c-section, due to perceived notions that surgery is safer than vaginal birth in these cases. Not surprisingly, it’s absolutely fascinating to read your descriptions of natural breech births, since it’s so uncommon in our society. How many breech births have you been present at during your years as a nurse?
A. I’d have to guess; maybe fifty?
I’ve delivered five breech babies myself.
The first was a smallish 5-pounder of a woman having her fifth or sixth, and the doctor didn’t make it, and there were no other OBs in the hospital (about 1972)
The second was that one at Mt. Zion. That would have been 1987-88-ish.
The third was a few months before I went to midwifery school (1979), and a supportive doctor talked me through doing a breech birth, saying, “You might run into this situation unexpectedly sometime as a midwife, and you should have done at least one beforehand.” I didn’t tell him I’d already done two others!
Just a few weeks later, I caught the fourth one when a woman came in crowning with a frank breech; her doctor arrived as the head was being born.
The fifth was the second baby of an unexpected set of twins in the hospital – one of my own patients. When we realized there was a second baby, and that it was breech, I called my backup doctor immediately, but the baby was born by the time he arrived.
Q. I was heartbroken to read about your first pregnancy, which was tubal/abdominal and ended in loss of pregnancy and could have resulted in your own death as well.
A. Yeah, it was very, very serious and took a long time to recover from, due to the torrential blood loss.
Q. Have you ever encountered tubal pregnancies in any of your own clients during your years practicing as a midwife? Is there anything a woman can do to lessen her risk of having that problem?
A. Interesting; I can’t remember any. It may be that women who would otherwise have come to me a few weeks later began to have symptoms, went to the doctor, were diagnosed, and the situation was handled, usually these days with oral medication, not surgery.
My case was highly unusual, in that it ruptured the first time, re-implanted on the omentum and became an abdominal pregnancy before rupturing a second time.
Q. I absolutely loved the story about Nancy, the woman who delivered naturally, despite her “deformed, misaligned pelvis” and her doctor’s absolute certainty that surgery was the only option. Can you describe the significance of her story in your own journey toward becoming a midwife?
A. Interesting: turned out she lived only a block from me, and she, her husband, and their daughter used to dress with a family theme for Halloween, and they always came by our house. I remember one year they came as New Orleans jazz musicians/cabaret singers. Awesome costumes.
She’s an internationally known collage and fabric artist. Lovely woman. She only had the one child.
Her birth reaffirmed what I’d been reading in some of Ina May Gaskin’s books: that when a woman is standing, her pelvic opening is larger – the hormones of pregnancy relax the otherwise rigid ‘joints’ of the pelvis so they become more mobile, and the weight of the woman’s upper body pressing on the pelvis pushes the bones a smidge more apart, allowing more room for the baby to negotiate the curves of the mom’s body.
It also helped me realize how important it is to allow women to do whatever they please during labor. Left on their own, with supportive assistance, most women will hit upon what becomes their favorite position or technique: jitterbugging, dancing for hours to Grateful Dead recordings, door-knobbing, swearing, hanging from someone’s shoulders or belt loops, walking obsessively…ANYTHING other than voluntarily lying flat in bed. But there have been a couple of exceptions, mostly profoundly quiet and stoic Asian women who just lie still, grit their teeth, and that’s it. Not a sound. Interestingly, the Asian pelvis is more likely to have platypelloid characteristics, very wide and open, conducive to quick and relatively easy expulsion of the baby once full dilation is reached.
Q. One of the other most awe-inspiring stories in the book was that of Adina, the model who developed Guillain-Barré Syndrome six months into her pregnancy and became almost completely paralyzed. Her baby was born naturally, vaginally, and her body birthed it with absolutely no pushing on her part because she was physically incapable of it. How did being present for this birth affect your views on the process of birth and the way pushing is often “directed” in the hospital by medical staff.
A. Profoundly. I think it was the same for Joe Weick, the obstetrician (who was also my backup doctor for several years of my practice. I began to just wait until a woman actually felt like pushing, rather than urging them to Push-Push-Push-Push as soon as full dilation was reached, as had always been the norm.
Q. Have you ever arrived too late at a client’s house to assist in the actual birth?
A. Sure! It’s inevitable that a midwife will miss an occasional birth, just as the doctors occasionally miss them. The difference is that in the hospital, a nurse with at least SOME degree of experience will catch the baby. But at home, it’s going to be the dad or partner or friend or even the mother herself!
Because of that possibility, I always had a quick talk with each woman and her primary birthing partner about a few basics:
- Call 911 (or not! – as they tend to panic and make a big deal of it)
- Let the baby come out; don’t try to push it back!
- Let it be born against gentle resistance of a palm to help reduce tears
- The rest of the baby will probably come whooshing out, but…
- If the shoulders stick, try getting them out one at a time, top one first
- Don’t worry about the cord. In reality, it doesn’t need to be cut at all.
- Don’t worry about the placenta. 911 or midwife will probably arrive first.
Q. In one story, you describe how a client successfully induced labor by using castor oil, albeit way more castor oil than you would recommend. How commonly used are natural induction techniques like this?
A. Among midwives, pretty common when a mom is going past two weeks overdue and everyone (including backup doctor and her own mother) is getting antsy.
Q. What are some of the more interesting songs or types of music that you’ve seen women want to listen to while in labor?
A. Pachelbel’s Canon was SUPER popular…but sometimes if the labor was pokey, I’d advise something more upbeat, something with energy and verve and a bouncy beat.
One woman I think was a violinist in an orchestra, and she had several of her musical friends come. They all were masters of different instruments. She didn’t want them to bring their instruments; she just wanted them to hum their various parts of Ode to Joy for maybe the last 45 minutes of her birth. It was transcendent.
Grateful Dead was pretty popular; I don’t know why.
Not much jazz.
New Age stuff like Enya
Background nature sounds: waterfalls, birds, rivers, oceans. Again, these were sometimes too peaceful when really we needed some solid rock and roll stuff to raise the energy level! Stuff from the Seventies, maybe: Jefferson Airplane, Crosby and Stills, etc. Even Elton John.
Q. You write that it’s pretty common for women to retreat to small, enclosed areas where they feel safe when birth is imminent. Where are some of the more interesting places where you’ve had a client actually give birth?
A. Wedged between the toilet and a wall just 18 inches away.
The floor of a tiny shower in student housing apartment of UC Berkeley.
The 2 feet of space between the back of a couch and a dining room chair.
A closet, with the woman’s upper body invisible because of coats and dresses.
Q. You mention that the two foods that you encounter most often while attending a birth at a client’s house are lasagna and brownies. What are some of the strangest foods you’ve ever been offered at a birth?
A. No strange ones except during the Eat the Placenta Era. I sampled a smoothie, a stew, and a soup. Not to my liking.
I ate Indian food that was way too fiery for my taste, although I like things extremely spicy and hot…but that was too much for me.
One Chinese mother-in-law cooked a fantastic soup loaded with so much ginger that my assistant and another person present couldn’t eat it, but I loved it.
And a woman who had been put on a severely restricted diet by a ‘traditional healer’ had the woman at her birth…and she made a soup that, as far as I could tell, had almost nothing in it: water, 3-4 leeks, a sliver of ginger…that’s all. No salt. No taste, really. Just…yech.