by Paula Heelan
A year later, in 2001, the family moved to Ocean Grove. ‘We’re very close to the beach and I love the community here,’ Pia says. In 2002 Pia and Chris had their fourth child, Erik. ‘The birthing experience was a big change for me,’ Pia says. ‘I didn’t know how the healthcare system worked and when I went to the doctor he said I had to go to the hospital for antenatal check-ups. I turned up to the hospital but found it very intimidating. Unlike Germany where independent midwives are more the norm, I couldn’t find one near me and nor could we have afforded one. It was just too difficult so I had to have Erik in a hospital – my first hospital birth.’ Everything went well and Pia was back at home two hours later. She checked herself out.
After the hospital experience Pia wanted to do midwifery more than ever. In 2003 she gained a Certificate in Aged Care at the local TAFE, followed by Division 2 Nursing in 2004. This gave her the ability to work in aged care while undergoing further studies. She worked in a local aged care facility for the next four years and loved working with the elderly, which showed because she became a favourite among the residents. ‘I started at Deakin University in Geelong in 2005 and came out with my nursing degree in 2007. When the kids were still little, my studies spanned five years full time with one year working in aged care, one year in TAFE nursing and three years gaining my Bachelor of Nursing.’ Pia then went straight on to do her midwifery training. ‘It was a really good experience and all the study over the years helped with my English.’
One of the births Pia experienced while she was training stands out in her memory. She was assisting a woman who was having her second baby. ‘Her partner was with her and as a second support person she brought along her dad,’ Pia says. ‘This was unusual. Usually women bring along their mothers or sisters. I didn’t quite know what to do with it,’ Pia recalls with a laugh. ‘But the labour went smoothly – and her father was incredible. He made her laugh the whole time – they clearly had a very special relationship. Usually the support person is there to calm the mother down, but he was the opposite. He was loud and he distracted her. I had never seen anything like it – and haven’t since. The woman almost laughed her baby out.’
When Pia finished her training she wanted to take her family to Germany for a long visit. ‘I wanted the kids to spend time with their relatives and I also wanted to reconnect with the midwives who had looked after me in Nuremberg and I was keen to compare the two maternity systems.’
They stayed in Nuremberg for six months and Pia was able to do some midwifery in-home work while they were there. ‘Part of me wanted to stay in Germany, but the kids and Chris missed Australia and I guess I did, too. We were a bit torn at that stage about what to do.’ When the family returned to Australia Pia got a position at the Geelong Hospital – finally and jubilantly she was able to work as a midwife.
The 10th of October 2010 is a special day for Pia and Chris. It’s the day their fifth child, Lars, was born. ‘I call Lars my bonus child,’ Pia jokes. ‘There’s a big age gap between him and his older siblings, but he was our surprise bundle of joy and brought us all closer together. He was born at home in the birth pool in our bedroom in the early hours of the morning. He was my first water birth and we had my lovely midwifery colleagues and friends Lynne and Hayley with us. I finally found out how homebirths work in Australia.’ Pia didn’t know at the time that the date, the 10th of the 10th, would later become even more significant in her life.
In 2013 she joined a midwifery group practice in a hospital. ‘A lot of hospitals have this now,’ she says. ‘A midwife has a case flow with generally four women in a month under her care for antenatal and postnatal visits and remains on call for birthing. I began attending homebirths and then in 2014 decided to leave and move into a private midwifery practice.’
Today she works independently through The Birth House in Geelong, which opened in 2013. ‘There are four midwives using The Birth House space,’ Pia says. ‘For every birth, a primary midwife and a second midwife attend. Babies can be born at home or at The Birth House – it’s the woman’s choice. A woman can choose what she wants to do and how to do it,’ Pia says. ‘There is no pressure. As long as they are healthy women, birthing is something very natural and doesn’t require medical intervention for the majority of births.’
Antenatal and postnatal visits are a big part of Pia’s job. ‘The dynamics are very different to hospital births,’ she says. ‘Homebirths are well prepared and the partners provide vital support. It’s important to make sure there’s a strong support system in place to go through labour and birth. If a hospital transfer is needed we go with them and continue our support – but this rarely happens.’
Recently a nineteen-year-old woman from Tonga was in Pia’s care. Her English was limited so her sister-in-law came along to all her appointments to translate. ‘I wasn’t sure during the antenatal period how the birth would unfold because of the language barrier,’ Pia says. ‘With Australian women you can usually judge how the labour is going by the noises they make and by their breathing. But this young woman was very quiet and I found her difficult to assess. But everything went well and she had a beautiful water birth. In my experience the mothers take the baby straightaway to hold them. But instead, this woman’s twin sister took the baby. Her sister-in-law told me the custom was not to give the baby straight to the mother. She needed time to rest. I learned a lot that day and was reminded about the importance of being aware and respecting cultural differences. I would have given the baby straight to her.’
Pia is often asked what would happen if two women went into labour on the same day. ‘It rarely happens, but if it does there’s always a midwifery colleague on hand to assist. It had never happened to me until the 10th of the 10th 2014,’ she says.
September and October are busy months in midwifery – the spring babies are born nine months after Christmas, and midwives keep this in mind. ‘I had booked a full-time load for September and October and because I knew it would be a busy time, I asked Chris to take the 10th of October off work in case I got called in. I wanted to make sure one of us would be at home for Lars’s birthday.’
On 9 October a call came in from Liza, one of the women under Pia’s care. ‘Thirteen days overdue, she was desperate to birth her baby,’ Pia says. ‘She was booked to come in to the Geelong Birth House for the birth of her third child. She lived about an hour away. Her previous two babies were born in a hospital and this was her first experience with a private midwife.’ With excitement, Liza told Pia her waters had broken – it was about 4 pm. ‘In most cases labour starts within 24 hours after the waters have broken and more often within the first six hours. Liza dropped her two boys with relatives and came into The Birth House with her husband, Jason. More than six hours since her waters had broken, the contractions were still mild.’
Meanwhile on the same day, another of Pia’s women, Penne, began irregular contractions. This was Penne’s second pregnancy. She’d had her first son, Mandala, two years earlier at a homebirth with midwives in Melbourne. She told Pia she had been born at home and initially not wanting to copy her mother, made an appointment at a hospital when she fell pregnant the first time. But not comfortable with the clinical, anonymous feel of the hospital environment, she didn’t go back.
Penne’s contractions settled by the evening and she rested comfortably at home overnight. She was 37 weeks pregnant – the same stage her first baby was born. Penne and Liza were five weeks apart with their due dates. ‘I didn’t think for a minute they would start their labours on the same day,’ Pia says.
On the morning of the 10th Pia went to The Birth House to check on Liza and Jason. At 7.23 am Liza’s contractions were mild and regular, but not yet established. ‘It was difficult for Liza because at two weeks overdue and disappointed the labour hadn’t progressed quickly after her waters had broken, she was feeling fretful. But she and the baby were both doing well. I left knowing the labour would progress when she and her baby were ready.’ Pia drove back to
Ocean Grove to cuddle her own birthday boy who had turned four. ‘We opened the presents together and finished decorating his special birthday cake.’
At 11 am Penne called Pia to let her know her labour was progressing. She packed her bag and left for Penne’s house. ‘I was looking forward to this birth,’ Pia says. ‘Penne’s striking, cosy house featured high, exposed rafters and soft light flooded the living space – you’d think it had been built for birthing.’ When Pia arrived, Penne’s mother, her partner Makot and her little boy Mandala were with her, and a birth photographer was on hand to discreetly capture the occasion. The atmosphere was calm, warm and quiet. Penne’s labour progress was gentle. She moved around, hopping in and out of the pool and changing positions to stay comfortable.
Around 3 pm her contractions grew stronger and closer and she stayed in the birth pool to focus on her labour work. She fell into her own zone. ‘Her mother and partner took turns to give Penne drinks and support,’ says Pia. ‘And I got some knitting done. As French obstetrician and childbirth specialist Michel Odent said, “Midwives that keep themselves occupied during labour allow women to feel less observed to access the primitive part of their brain and birth their babies naturally with less interventions. Midwives that knit are simply doing their job, and doing well.”’
Having Pia sitting nearby knitting was very calming for Penne. ‘Pia and I had spent a lot of time together because I had contacted her when I was about nine weeks pregnant. My pregnancy was fairly non-eventful, so we had plenty of time to natter about all kinds of things and our friendship grew along the way. When she was with me at the birth she gave me a steady confidence that I could do it on my own and I trusted her completely. She didn’t intervene or fuss over me except to check the baby’s heart rate and remind me every now and then to drink water. That’s just how I wanted it. She also didn’t tell me that she had another mum in labour at the same time! She gave me her full attention.’
Eventually, from the intensity of Penne’s contractions and her breathing sounds, Pia knew the labour was progressing well. ‘At 4 pm I contacted my midwife colleague Judy to let her know we might need her to come over soon for the final stage of labour. Judy had been to see Liza at The Birth House, but her labour still hadn’t established. Judy then arrived just as Penne started gently pushing her baby out into the birth pool. Her partner sat on the side of the pool holding her hand. At 5.20 pm we could see the baby’s head starting to birth and by 5.24 Penne’s daughter, Sabali, came into the world. Penne exultantly lifted her up and out of the water. Like most births midwives attend, there was very little for me to do apart from watch the miracle of a mother independently birthing her baby.’
Penne and Sabali stayed in the pool connecting for a little while. ‘Penne birthed her placenta 30 minutes later and she just needed a little rub of her uterus to wane a small bleed,’ Pia says. ‘Everyone helped tuck Penne and Sabali into their prepared nest by the pool, where the whole family could snuggle up.’
Around 7.30 pm Pia received a call from Liza. Her contractions were finally progressing and growing stronger. ‘At this stage I was still at Penne’s house – ten minutes from The Birth House. Penne was doing exceptionally well breastfeeding her daughter. Her mother, who was one of the best support persons I had ever seen during labour, was also a nurse and she was happy to keep an eye on Penne. Usually we stay up to four hours after a birth, it depends on the circumstances of each birth. This day I felt I needed to leave a little earlier for Liza, and as I knew Penne was in good hands, I headed off to see how my other expectant mum was going.’
Pia jumped into her car and dashed off to The Birth House. It was just past 8 pm. Liza’s contractions were stronger but still irregular with long breaks. ‘The baby’s heart rate was perfect and Liza was doing really well with some short rest periods,’ Pia says. ‘She was keen to get into the birth pool – the labour had been going on for 24 hours. Often the advice is not to go into the birth pool before labour is established because the water immersion can slow the labour. I think it doesn’t really matter – if the labour slows down the woman can leave the pool and after some little relief return to it. In some cases water immersion can increase contractions and accelerate labour.’
After 40 minutes in the pool, to Liza’s relief, her contractions increased in duration and strength. Her labour progressed fast and she became a little overwhelmed and wanted to get out of the pool again. ‘The baby’s heart rate was perfect, but when Liza came out of the pool the contractions slowed again. Jason and I tried to convince Liza that it was a good thing for labour to progress. We gently suggested she might be holding onto it for some reason and she just had to make the conscious decision to let go. She had undergone some personal family matters and physical issues at her last birth. This time it was completely different and we just had to remind her and keep encouraging her to let go. Then at 9.50 pm Liza felt the baby’s head descending and lots of pressure. Then with Jason in the pool with her, at 10.10 pm on the 10th day of the 10th month, Liza’s little girl, Athelia was born. Mother and baby were both well and Liza was overjoyed to have finally had the water birth she’d always wanted.’
It was a busy 24 hours with two of Pia’s women giving birth on the same day. ‘I was so happy I was able to attend both births because as the midwife, I had built close relationships with both women and their families. The next day when I told Penne and Liza about each other, it turned out they had met before.’ A few weeks later Penne and Liza caught up again through The Birth House to celebrate the birth of their daughters together.
Her son Lars’s fourth birthday wasn’t the first family celebration Pia had missed. Over the years in the course of midwifery work, she’s missed New Year’s Eve and Christmas celebrations, birthdays and dinners because of call-outs. ‘But Chris knows how much I love to be a midwife and how long I dreamed to become one,’ Pia says with a smile. ‘He doesn’t complain when I pack my bag and rush out the door. He is a wonderful support. The lifestyle can be taxing on relationships and it requires a lot of patience and understanding. For me it’s all worth it – even the long days and nights. I take every day as it comes and just enjoy being a homebirth midwife in Australia.’
Recently, Taryn Morgan made the decision to leave Queensland and move to Victoria. She was pregnant with her first child when her aunt recommended The Birth House in Geelong. ‘There weren’t a lot of options for homebirthing in Townsville and I loved the sound of The Birth House,’ Taryn says. ‘When I was thirteen weeks pregnant I called in for a Meet the Midwives get-together. I met Pia and we clicked right away. There was a lovely warmth about her and over the months I came to trust her completely and value her assistance. We chatted about all the birthing options and she visited me at home every few weeks for my antenatal checks. As I progressed it was found I had a complication that could have put my baby at risk of infection, so it was decided a hospital birth would be the best option. At the hospital some of the nurses were keen to take over, but Pia stayed with me. She held my hand, encouraged me and was with me when my baby was born. Then she visited me twice a day and continued my postnatal care. I had some trouble breastfeeding and Pia guided me through that, too.’
Pia says Taryn was a strong and courageous young woman. ‘As she was a single mum I felt she needed some extra support during her pregnancy and post-birth. It was important for her to have continuity of care.’
During the time Pia starts care for an expectant mother – from about three months, through to six weeks post-birth – she builds strong relationships with the woman and her family. ‘I learn about different lifestyles, work arrangements, love, fears, dreams, vulnerabilities, respect and relationships. The women I look after allow me into their lives and that requires enormous trust.
‘It’s a unique, intimate experience to be at the birth of a baby with a family you know. It’s not just a job – it’s a very special lifestyle.’
CHAPTER
13
Genevieve Brideson
Tasked with a pilot to retrieve a woman in labour with twins at 34 weeks, Royal Flying Doctor Service (RFDS) flight nurse Genevieve Brideson left her base and flew to a regional centre. Genevieve had been told the woman’s observations were stable and her membranes had ruptured. The babies’ foetal heart rates were fine and the woman was contracting regularly every fifteen to twenty minutes. Both of the babies were thought to be head down, one with its back upright on the right side and the other with its back to the mother’s back on the left side.
The expectant mother’s Bishop’s score (components of dilation, effacement, consistency, position and foetal station) was seven, so it was predicted she wouldn’t birth for a number of hours. ‘When we arrived the ambulance was waiting at the airstrip for us,’ Genevieve says. ‘Usually a midwife would come as well, but the hospital was busy and didn’t have a midwife to spare. At first glance I thought the mother seemed a lot further on in her labour than I had been told, so rather than unload her from the ambulance, I grabbed some equipment and climbed in to check her observations and progress.’
On closer examination and to Genevieve’s shock, she felt a little foot. The first of the twins was a footling breech. ‘Having never birthed a breech baby before, my first thought was, I need more people, back-up and equipment. I asked the ambulance crew to take the woman and I straight back to the hospital under lights and sirens.’
The pilot alerted the RFDS communications and logistics team to inform the hospital that Genevieve and the woman were on their way back. The ambulance officer had also called the hospital, but somewhere along the way the communication broke down. ‘On arrival, the staff got a surprise to see us,’ Genevieve says. ‘The only doctor in town with obstetric experience was out of town consulting and needed to drive in. Everyone was frantic, but things were organised rapidly. Luckily, two of the hospital’s senior midwives with experience in birthing breech babies were on duty. They were called into the room to assist and I handed the woman’s care over to them.’ Genevieve was asked to check the neonatal resuscitation trolleys and to be available to help a second GP when he arrived due to the staff shortage. ‘I contacted the pilot to let him know what was happening. He was happy to wait for me because he couldn’t leave without a flight nurse.