‘Hi, Adele. It’s Johann.’
Adele has been expecting the call. She checks her watch. It is 5 am.
Johann tells her that he and his wife, Kristie, have been awake since 2 am, when the first mild contractions set in. She was able to doze between them at first, but Johann has been flat out. Kristie wants a water birth, which is a tall order at the best of times on the Barrier. At Orama, where they are staying, their water heating is via a chip heater. Producing the necessary quantities of hot water to fill a birth pool is a challenge. They have a tiny hot-water cylinder, which Johann has drained, and even with the contents of the neighbour’s cylinder he has still had to fill every available pot and pan and set them heating on the stovetop.
Kristie first presented to Adele at 27 weeks. She and Johann were missionaries in Africa, but had come home to New Zealand for the birth of their third child because they had been offered free accommodation and support at Orama in return for Johann working in the community. Adele had read Kristie’s birth plan and its extensive list of requests with a sinking heart. She felt she was bound to disappoint Kristie, not least because she already had a week’s holiday booked and paid for, her departure date just two weeks before Kristie was due.
But things had fallen into place. Kristie had been donated a birth pool from a business over on the mainland, and as the time drew near she and Johann had inflated it and leaned it up against the wall in a bedroom. Adele had called a relief midwife over from the mainland to cover for her while she was away, and Orama had donated accommodation for her. As it turned out, when Adele arrived back from her holiday she found Kristie still pregnant and the relief midwife relaxed and happy after a holiday of her own. Now, when Johann makes the call, Kristie is four days overdue.
After feeling initial misgivings at the very detailed birth plan, Adele had adapted; by now, she knew that planning for the birth was the way in which many mothers seek to control the process. That sense of control can be essential to preparing the mother for a smooth delivery.
As she walks out of her door, Adele instinctively checks the weather. It is a crisp September morning, but it looks settled, which is reassuring. If there is an emergency, the helicopter will be able to fly.
As she makes the ten-minute drive up and over the hill to Orama, she visualises the birth and—because this is what she does—the things that could potentially go wrong. But when she arrives just before dawn and is welcomed into their home, all is serene. The room is warm with the toasty smell of a gas heater, and there is music. It is the music that Adele notices in her customary, hyper-aware birthing state: it is worship music—modern songs of praise, gentle and uplifting.
‘I stopped worrying about being overdue,’ Kristie is telling Adele, as the music swells in the background. ‘I spent a lot of time by myself up on the hill looking over the sea. I just felt I needed space, you know? And I kept saying to myself that it was God’s timing. I just sort of took the phone off the hook.’
Adele nods.
‘I need the music going,’ Kristie says. ‘I get pretty vocal, and I don’t want to scare the boys.’
Her two small sons are asleep in another part of the little house. Kristie is handling the contractions well, breathing calmly and shifting position now and again. There is not much for Adele to do but have a cup of tea and wait, listening to the music.
At about 7 am, Kristie climbs into the pool, stretches out and relaxes against the soft sides, a blissful look on her face. Johann climbs in as well, and presses on her back during the contractions. One by one, the boys stumble, blinking, into the room. Once they have woken enough to absorb the news, Adele gathers them up with their little pre-packed backpacks and takes them to a neighbour.
When she comes back, Kristie asks her to check what stage she is at, and Adele finds her six to seven centimetres dilated. The contractions are strong and regular by now, and, between them, Kristie sings and prays aloud.
‘I’m ready to push,’ she gasps to Adele. Adele is surprised, but encourages her, and with the very first push the baby crowns. Adele knows Kristie wants to feel as much in control as she can, so she suggests Kristie touches the soft, downy head of her son. She cries out in delight, the sound as much a hymn of joy as anything on the stereo. With the next push, the baby is born into the warm, enfolding water. The vernix with which he is coated makes it hard for Kristie to get a hold of him, but Adele and Johann help lift him on to her chest. He cries, and they cover him with a warm towel. Mum gives him his first kiss—and the second, and the third—as Johann strokes her hair and gazes at his baby son.
Adele stands and watches. She is moved by this very spiritual birth to a couple with love and commitment to each other, to humanity, and to their Lord.
Later, Kristie and Johann had a fourth baby. This time, it was born in Benin in West Africa, and the only attendants besides Johann were the vultures watching from the doorway of their mud hut. The nurse who was supposed to assist had broken an ankle and couldn’t attend. Nor could a New Zealand midwife who had raised funds to be there: she was still on the plane when the baby was born. Kristie managed the birth herself, and subsequently wrote about her African and Aotean birth experiences in a book called Mud Hut Mom: My gentle birthing journey.
Every now and again, Adele thinks about what ‘home birth’ really means—especially about what makes a home. She has attended births in all manner of places—a bus, sheds, in tiny houses, in houses still under construction, and in houses so remote from road access that they might as well have been boats at sea.
Now she is about to do the real thing.
She drives the same route she drove when she attended the vehicle over the bank. It is wet and wild again, which means there is no prospect of getting helicopter assistance, should all go badly, but she is just relieved to be answering this call as the baby is well overdue. She gets out and opens the huge gate in the predator-proof fence across the base of Kōtuku Peninsula. She drives through and climbs back out to close the gate again. The wind dashes sleety rain on the windscreen as she carefully negotiates the steep track: it has been vastly improved since that motor vehicle accident, for which Adele is very grateful. It is late afternoon by the time she is walking down the path to the narrow wooden jetty. She can hear water churning in the culvert beside the track. She is in full wet-weather gear: raincoat, over-trousers and gumboots, but she’s shivering as she walks out on to the jetty.
It is a small sloop that Adele knows well from a previous birth. For Jacinda, the mother-to-be, and her husband, it is home. They had presented to Adele early in their second pregnancy and had told her about their dissatisfaction with the birth of their first child on the mainland. Jacinda had said she felt that she was subjected to unnecessary tests and procedures. She was not listened to, Jacinda explained: even the midwife seemed indifferent to what she felt was needed. Jacinda and her husband wanted a different experience, so they had sounded out Adele to see if she would be willing to attend the birth of their second child at home on the sloop. Adele had agreed. Now they were expecting baby number three.
Jacinda had a scan which indicated a definite due date. Armed with that information, Adele booked a holiday and set her departure date for three weeks after Jacinda’s due date. That, she thought, would ensure the baby was safely delivered two, perhaps even three weeks before she went away.
Murphy’s Law seems to apply especially to childbirth. The due date came and went. Another week passed, then another. Adele had begun to worry. The hospital was keen for Jacinda to be sent over, because induction is recommended if the pregnancy extends beyond ten days after the due date. The risk of complications, whether due to the size of the baby or the state of the placenta, soars. But Jacinda was perfectly confident that all was well with the baby and would be well with her, so Adele agreed that the plan to have the baby on the sloop could go ahead. And as it has turned out, the weather made it all academic. First, fog made it impossible for planes to fly. Then a storm front was predict
ed to cross the North Island. By the time the fog lifted, the front had arrived and Aotea was cut off in this maelstrom of wind and wintry rain.
Adele climbs over the lifelines and into the cockpit, the boat fretting at its mooring lines and the halyard slapping at the mast. The usual view out into the bay has been erased by the rain. Adele is relieved that things are finally in train. She is confident that Jacinda will handle the birth—we screen women carefully before agreeing to home births, and there are few risk factors in Jacinda’s history—but the cramped confines of the boat promise to take Adele outside of her comfort zone.
She peels off her wet-weather gear under the cover of the spray dodger, and then ducks through the companionway into the cabin, where it is as though she has entered a different world.
Her own home was cold, but here all is warmth—there is a little wood stove throwing out heat—soft music and subdued light, and lavender scents the air. Jacinda’s husband helps to set out Adele’s equipment, and as she examines Jacinda she finds everything within easy reach. The contractions are weak and still quite erratic, so the birth is not imminent. Adele is able to go back home for a meal and some sleep before being woken by the phone.
‘It’s time to come back,’ he says.
Jacinda’s husband has made a beautiful wooden birthing stool from a diagram on the internet. Adele is not sure if this will work for Jacinda, but when the time comes she is prepared to give it a go, and it proves to be perfect for the birth. The baby comes through the birth canal quickly and cries loudly immediately after emerging. No problems at all—it is such a relief.
Adele gives the baby to Jacinda so that she can enjoy some skin-to-skin time. She has not checked to see if it is a boy or a girl, as the birth plan stipulated that Jacinda did not want to be influenced by the baby’s gender as she enjoyed these first few precious minutes spent bonding.
Twenty minutes pass.
‘Sorry, Jacinda,’ says Adele, who feels she has been very patient. ‘I just have to know. Do we have a boy or a girl?’
‘It’s a girl!’
It is a profound relief for Adele to have welcomed this little soul into the world, and the occasion seems to have special significance because, in the preceding days, there has been a death in community. Adele is set to attend the tangi in just a few hours. It is that circle of life again, the way things pass and are renewed.
‘It’s OK,’ Leonie tells Jen, who has just apologised for failing to make conversational sense. Her waters broke a few minutes previously and without the cushioning forewaters present, the baby’s head is now firmly in contact with her cervix. Where previously she had been chatting between contractions and taking deep, controlled breaths through them, they are now powerful and regular. No wonder she can’t hold up her end of the conversation anymore.
Jen and her family are closely attuned to the rhythms of life on Aotea. Leonie has come to admire their down-to-earth practicality since she first met them.
Jen has been telling Leonie that, when the labour started, she decided she had best get a few things done before it got too far advanced, because she knew from her previous experiences that she would not have time for domestic chores after the delivery. So, contracting every eight minutes and with wide girth and all, she filled her bucket and waddled off down the path to water the row of brassicas she had planted just a few days previously. It has been a dry summer; she has painstakingly watered her prolific garden every day as her pregnancy advances. By now, she knows the whole routine of childbearing well enough to be able to judge what is in her power and what is not.
‘It’s OK,’ Leonie reassures her again. ‘We all understand you’re a bit busy to talk.’
Soon a powerful urge to push overtakes Jen, and she scrambles to her mattress and on to her hands and knees. This is her third birth, and she knows from past experience that this is the best position for her. Another contraction overtakes her, and she groans.
‘Why are you making that noise, Jen?’ her three-year-old pipes up from the other side of the room. He has been standing in his cot, taking everything in.
‘Because it makes me feel better,’ Jen replies.
With the next contraction, she bears down hard and it is plain the baby is on its way. The older child, summoned by his dad, comes into the room. Everyone watches as, with a few hefty pushes, Jen births her new son, a brother for the children who are both watching, awestruck.
When the time is right, her six-year-old solemnly helps his dad cut the umbilical cord, separating the new arrival from his whenua. A few minutes later, the placenta itself is delivered, and Jen lies cradling her newborn son in her arms.
‘Thanks for having the baby, Jen,’ the three-year-old pipes up again. The excitement is over. He yawns cavernously, snuggles down again into his cot blankets and falls fast asleep. Everyone smiles. It is a special family moment that none of them will ever forget.
Certainly her eldest son does not forget it. Leonie learns later that the next day at school, he regaled his teacher and his classmates with a ‘morning talk’, using an impressive array of technical terms with insight and understanding.
You might call these typical Great Barrier birth stories, but in the end there is no such thing. And, of course, not everything runs so smoothly.
Adele answers the phone. She has been expecting to hear from Phaedra—expecting her voice tight with excitement and a little trepidation at what is about to start. But, from the moment Phaedra starts talking, something in her voice tells Adele that all is not well.
‘There’s blood,’ Phaedra says. ‘Lots of it.’
Phaedra had everything ready. She had the birth pool blown up and leaning against the wall of her bedroom. And she had been feeling restless. She got up at three in the morning and made a cup of tea. After sitting in the dark and sipping it for a while, she had told herself that nothing was happening, so she went back to bed and tried to go to sleep again. But she remained fidgety, and when she rolled over to try to get comfortable she was seized by a massive uterine contraction. There had been absolutely no warning signs—no niggles, no backache, no show (the passing of a ‘plug’ of bloody mucus that often precedes the onset of labour). Nothing. She felt a rush of liquid. Once the contraction had resolved, she stood to go to the toilet and felt the liquid curling down her legs. Deciding that her waters must have broken, she made her way to the toilet, holding firmly on to her girth. The liquid was flooding out, and when she had dabbed at it with toilet paper she saw at once that it was blood. Frank blood—bright red—had drenched the paper. Even as she stared at the wad of bloody paper in her hand, there was another gush spattering into the toilet.
Shit, Phaedra thought. I should not be bleeding.
Adele listens carefully to all of this. She tells Phaedra calmly that she will call Leonie straight away, as she is only eight minutes’ drive away.
‘Leonie will be there shortly, and I’m on my way, too.’
In the brief conversation that we then have, we are both aware that copious blood at this point in the pregnancy probably means an antepartum haemorrhage—a bleed before the baby is delivered, probably due to placental abruption, the early partial or complete detachment of the placenta. This is a full-scale obstetric emergency. Because the placenta supplies the baby with oxygen while it is in the womb, the prognosis for the baby is poor if it has detached too soon. And with the baby unborn in a bleeding uterus, the mother’s survival may be doubtful without emergency surgical intervention. Both of us know we do not have that kind of measure at our disposal.
Leonie wakes Ivan, as she may have need of his obstetric experience too. The adrenaline is ramping through her body. She is throwing on clothes as they discuss the situation.
‘She had an ultrasound early, didn’t she?’ Ivan asks. ‘Where was the placenta attached?’
‘It was reassuringly high—well away from the cervix,’ Leonie says. They both know that the high position in which the placenta was attached to the uterus is a good
thing, because it rules out another serious cause of bleeding at this stage in pregnancy. Soon, Leonie and Ivan are running to their four-wheel-drive and are on their way.
They arrive to find Phaedra stripped of clothing and naked. A blood-soaked towel is jammed between her legs.
‘There was another contraction,’ she says. ‘It was huge, and there was more blood.’
She is pale, alone, but holding it together. She was in the process of packing clothes for a probable trip to hospital when the latest contraction set in. Leonie is amazed. The practicality and good sense of the islanders has never ceased to astonish her.
‘I felt the baby move,’ Phaedra says. ‘The baby’s all right.’
Leonie and Ivan exchange glances. Leonie quickly ducks into the bathroom and sees more bloody towels, a pile of them on the floor, and blood splattered inside the toilet bowl. The blood loss is already maximal. There is a gasp from the bedroom as Phaedra undergoes another contraction. Leonie hurries back in. The contractions are coming thick and fast. Time is running out. They need to assess baby and mother and alert the emergency services.
Ivan checks Phaedra’s vital signs while Leonie searches for the foetal heartbeat. So certain has she become that they may lose the baby that when she hears the beat—strong and clear—she is almost shocked.
‘Phaedra,’ Ivan is saying. ‘Your recordings are OK. But can we put in an intravenous line to replace the blood you have lost?’
Leonie gently palpates Phaedra’s pregnant abdomen. She can hardly make out the baby’s head, which means that it is fully engaged in the pelvis. Sure enough, the vaginal examination finds her cervix fully dilated.
Ivan is already rummaging in his emergency kit when Leonie asks for his aid.
‘Ivan,’ Leonie says. ‘The baby is on its way. Can you set up our resus equipment?’
Island Nurses Page 9