I am on duty when I microwave my soup at lunchtime at our practice. There are double consulting hours and the assistant is present, so I find it cosy to eat together when the shift allows. Just as I take my first bite, my phone rings. 'Contractions have started and are coming every four minutes,' says a male voice. I ask my standard questions and confirm that I am stopping by to check on his wife's progress. Thirty-nine weeks pregnant, first child, Italian origin and open to pain relief, it says in her chart. I finish my soup, say goodbye to my colleagues and drive to the specified address. 

Once arrived, the woman stands sighing over the countertop. Red blushes colour her cheeks. Her head makes a friendly nod when she sees me. 'Buon giorno,' I say back smiling. After my examination, I note 5-6 cm of dilation and powerful contractions. The couple is keen to give birth in hospital so I call the delivery rooms and ten minutes later we are on our way in the car.  

Labour is progressing smoothly and between contractions the husband talks endlessly about Italy, how they met and how in love he was with her. He looks endearingly at his wife who bravely sighs away her contractions. I go through different positions with her and indicate that the baby can find its way into her pelvis better if she changes positions. 

Later, when I help her relax a bit more in the shower, I look at her feet. 'What size shoes do you have?" I ask between contractions. She quickly looks at her red-painted nails and wiggles her toes back and forth. 'Usually size thirty-five, sometimes with trainers even thirty-four'. 

'If they are smaller than size thirty-six shoe size, they cannot give birth to a child in the normal way,' a midwife once told me, when I was a student myself. 'Size thirty-six will do but smaller really won't!' she said. It has stuck in my mind all these years.  

She was right. In all the years since, being a midwife myself, I have had several women with small feet and never would have succeeded if they were size thirty-five. Since we In the Netherlands are trained scientifically as midwives, I looked to see if there was scientific evidence for this. There isn't, which makes me combative to give this woman the chance to prove otherwise. 

Evolution
In development as humans years ago, we became smarter and smarter with the advent of agricultural industry, among other things. This also changed the development of the human brain. We became more creative, smarter and so our brains grew and so did the skull. Of course, the female pelvis also had to adapt to this to continue giving birth normally and thus reproduce. So with this theory in mind, you could actually say that women with small feet also went through an adjustment regarding the pelvis. The fact that the feet did not get bigger is then completely unrelated to this. 

Pain relief…
The woman has pain relief in her birth plan but does not ask for it. Soon she gets pushy in the shower. I quickly help her dry off and she wants to lean on her hands and knees on the bed. She presses vigorously. Unfortunately, after a few contractions, I notice that the time between them is getting longer and the duration of the contractions is shorter. 'They are not as strong and I can't push well with them!" she moans between contractions. I confess to noticing the same thing and suggest an infusion of medication to strengthen the contractions. 

Thirty minutes later, she is on a heart monitor for her baby and oxytocin medicinally flows into her bloodstream through an IV. The contractions become powerful again and follow each other faster. After a few contractions, we still don't see anything externally. 'Can I take a moment with you to assess how deep the head is?' I ask and she nods. It turns out the head is already very deep in the pelvis and I get excited. This woman is going against the theory of small feet! This woman is just going to bring her child into the world through natural means. I give a push in my coaching to her and soon the nurse and her husband are cheering along. 

After more than 90 minutes, she gives birth to a healthy son who is given a beautiful Italian name. I am proud of her, of her perseverance, the confidence she has in body and the fact that she could put trust in my hands. I commend her for the work she has done. 

Later in the week, I come for a maternity visit. Her mother is in the kitchen kneading and rolling out dough with her sleeves rolled up. The kitchen has been completely taken over by her and it smells deliciously of olive oil and basil. I get a bowl of deep-fried dough balls pressed under my nose with icing sugar. 

I tell her the theory about the small shoe size. 'Oh that's why you asked about it during my delivery!' she says laughing as she remembers my question. I nod, 'Women with gnome feet don't have to have it because of their height, but powerful we are!' she says with a wink. 'I saw that because you proved it!'