There is mud on my windshield. It has been there for days. I haven’t had time to get my oil changed and my washer fluid refilled, so I dare not use my windshield wipers to remove it...
It rained mud down on my car the other night when I was called to repair a torn perineum for a mother who had an unassisted homebirth. I didn’t get home until 1:30am and went straight to bed.
The next day I woke early and made my rounds, doing house calls for postpartum mothers and newborns and working my way to my office in town for prenatal checkups. I got home after midnight again and still hadn’t had time to go through a carwash or refill the washer fluid, so the mud remained.
The next morning I left home at 7:00am and drove an hour to do a home visit for a postpartum mother. As I was leaving to go to a second home visit, I got a call from a client who was about a week before her due date. I had helped her with her two previous births and have never witnessed two births more alike than those. So when she said she was at work but having regular contractions that were hard to talk through I asked her to go home and prepare for the birth. I would send my apprentice to be with her. I planned to head to her house after I finished the second home visit. Half way through the visit, the mother texted me a list of contraction times about five minutes apart. I quickly left and drove quickly to her house, about 40 minutes away.
This birth, the third for this mama, took a little longer than her first two. She soaked in the birth tub while we quietly chatted about work, family, and relatives. Because she had torn with each of the first two births, I encouraged her to push in a different position this time. That plan to ease baby out slowly went out the window when the urge to push came! She pushed the baby out very quickly and suffered another perineal tear. Her baby was a gorgeous 7 lb 0 oz girl.
After an hour or so of skin-to-skin nursing in the birth pool, daddy took baby while we helped mama out of the tub and my apprentice guided her to the bathroom. My apprentice alerted me that there was a trickle bleed that wasn’t stopping. I got my flashlight and took a look as she sat on the toilet. Blood was trickling, but not from the tear. I guarded her uterus as I attempted to express any clots. There were none. Strange, I thought. I got my flashlight to look at the blood again and saw something large, smooth and pink protruding from her vagina. Her cerivx. A prolapse!
I quickly called my apprentice to bring the sleeping bag to the bathroom and make a pallet for mama to lay on. “I can see your cervix sticking out and I am going to put it back where it belongs,” I told the mama. She looked scared. “It will go right back where it should be and the bleeding will stop,” I confidently predicted while praying it would be true. I guided the mother onto the fluffy mat my apprentice had prepared and asked my apprentice to get me a sterile glove. Mama was now laying on the mat on the floor, cervix visible at the introitus. I didn’t feel like waiting for the sterile glove, so I felt, externally, through her abdomen for the firm mass of her uterus and found it easily. I held it firmly and pulled/pressed it up toward her ribcage, pulling the cervix along with it, up inside her vagina and back where it should be. Just then, my apprentice returned with the gloves. I quickly traded my soiled gloves for sterile and did a quick internal exam to confirm that the cervix was indeed in the proper position. Then I checked and re-checked her uterus for firmness and position. It stayed normal. Bleeding normal. I assured the mother that everything I was seeing was normal and all good signs.
After many minutes had passed and all signs were good, we had her slowly and gently sit up, then kneel, then climb onto a waiting office chair with wheels. We wheeled her to her bed and put her in it, with hips propped a couple inches so gravity would help keep her uterus where it should be, and reunited her with baby for more nursing.
Hours later, with everyone fed and watered, mother assessed and re-assessed, newborn exam complete, repair of second degree laceration complete, mom and baby tucked safely into bed, I got back into my car and drove home, peeking between the blobs of mud on the windshield.
Another busy day, another successful homebirth. I arrived home after midnight again, sterilized instruments, started a load of laundry, showered and fell into bed.
...This work can be messy, but it is what I am called to do. Someday I'll have time to get my car washed, but for now it remains muddy.
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