I am a midwife. I walk with my clients and families through their pregnancy journey. Most of my families will have the birth that they have planned for, but some will not.
Their names are always with me; the names of women that I have had to transfer to the hospital while in labor. I have wiped their brows, caressed their cheeks, massaged their backs, shoulders, arms and feet. I have done countless flights of stair walking with them, lunge walked the hallways with them, supported them through multiple difficult position changes to encourage babies to rotate. I have fed them and made sure they were drinking. I have shared this most intimate of experiences and forged a bond with them. I have had to look them in the eye and tell them that, in my opinion, the best place for them in that moment was the hospital. To tell them that all their plans and dreams for this birth will need to be drastically altered. I have shared tears with them over this decision, both in the moment and later in postpartum checkups.
This is what we do as midwives; we walk beside our families, holding space, guarding their health and sometimes making difficult and unpopular decisions. It is an extremely heavy responsibility that often feels lighter than it is. However, in these moments, every ounce is felt to the core. Ultimately, this is why you hire a skilled birth attendant, to recognize when these decisions must be made. To make the tough call and speak the truth. Like many midwives, I keep a Birth Log/Journal of all the births I attend and babies I catch. I also keep a separate journal for these Families, their stories and their outcomes. In this way, I can remind myself of their faces and their strength. I carry them with me always.
Transfers happen. Every family that chooses to birth in their community be it at home or in a birth center, must be realistic about this fact. Every provider who practices in their community must be open and honest about this with their families. I am the Clinical Director at a freestanding birth center, Mountain Midwifery Center in Colorado. As a practice, we are very public about our rate of transfers in labor, it is 12%. I am very proud of this number and will happily shout it from the rooftops. Why? Because it is 100% appropriate. In any given population of healthy low risk pregnant people who start spontaneous labor, anywhere from 10-15% of them will develop a complication or reason to transfer before the birth. Therefore, a transfer rate of 12% is exactly where it should be. When a family is interviewing providers to attend their birth in a community setting, they should absolutely ask what that providers’ transfer rate is. If the rate is well below 10% I would be curious about their safety protocols. If their rate is well above 15%, I would be curious about their strategies for assisting the birth process and their comfort level with normal variations.
When a pregnancy is conceived in a healthy person, it will most likely remain healthy and result in a normal labor and birth and a healthy baby. Plans will be made and expectations will be created. Families have dreams of a particular image for their birthing experience. I often counsel my families about this truth of health, but that they also do not have complete control of this process. Families can do everything correctly; the pregnant person can eat well, drink plenty of water and get regular exercise, the family can educate themselves on the process, they can choose the best provider and birth location for themselves. And, all of this does not guarantee the final outcome. Everyone on the birth team should be open and honest about this possibility. Does the need for an appropriate, well-timed transfer mean that anyone failed? No. Is there such a thing as a ‘failed home birth’ or a ‘failed birth center birth’? No. Birth is not a competition, no one births better or worse than someone else. Birth is a powerful, transformational process that creates parents, families and siblings. Regardless of how your baby arrives; via vaginal birth or cesarean birth, in your home, at a birth center, in a hospital, whether you choose a midwife or an obstetrician, none of this matters. What matters is how you are treated through the journey and how you are treated no matter the final outcome. In reality, much like a wedding day is only the beginning of your marriage your birth is only the beginning of your journey as a parent. We plan, hope and dream about a flawless wedding or a perfect birth but what matters is the journey that follows.
In the end, we can only jump on and try to enjoy the ride. We can plan and prepare for life’s obstacles but we must be flexible in dealing with the speed bumps and potholes that we encounter. Transfers happen and so does life; it is in the mess that the living happens.
Aubre Tompkins is a Certified Nurse Midwife and the Clinical Director of Mountain Midwifery Center in Englewood, CO. She is a passionate supporter and defender of Physiologic Birth, ensuring choice for families and providing care to families in all the shapes and sizes that they come. She is also committed to growing the profession of midwifery both locally and abroad; this passion is fulfilled as both a preceptor to student midwives and as a Board member of Midwife International. On a personal note, Aubre has a fantastic husband and three precocious children that keep her busy at home.
You can also learn more about her birth center atwww.mountainmidwifery.com.