Today I am on duty, together with our 2nd year student. She is doing a 10-week internship in our practice. Her family roots are in Iran and she also studied obstetrics there. The Dutch healthcare system is different for a midwife here, but that doesn't stop her from doing her training here again. She cheerfully stands next to me during every visit and clearly enjoys our Dutch obstetric care and everything our profession entails.
When we get a call from a pregnant woman in labour, we discuss in advance in the car afterward what her learning goals are. She would like to give the pressing and sighing instructions clearly and handle the baby when it is born. Once we arrive at the specified address, the pregnant woman in question is sighing in the kitchen to handle her contractions. They are having their third child and the man is deftly gathering all the stuff in his car as they want to give birth in the hospital. He is clearly not upset. 'I am also doing this for the third time,' he says with a nod to my student. I introduce her to the couple as their 'upcoming midwife of their children' and they nod smiling. 'Everyone has to learn,' the man says kindly.
We leave for the hospital and on arrival, the pregnant woman soon lowers herself into the bath. We had asked the nurse to fill the bath beforehand. She relaxes her face as she feels the warm water around her belly and back. Her contractions follow each other in quick succession and soon we are approaching the final stretch of labour, the pushing phase, also known as exorcism.
The woman is eager to get out of the bath and, after we have dried her off, climbs onto the bed but cannot find a good position to prepare for the final stretch. I suggest sitting on hands and knees. 'This way you make room for your baby to turn in the pelvis and you yourself often have more control over your posture and pushing along.'
I push a pair of gloves into my student's hands, while grabbing the birthing woman's hand to support her. She feels pressure and squeezes along with the contraction. I want to put on gloves too but don't get the chance because she won't let go of my hand. I decide to stay beside her and the student stands ready to catch the baby.
In the woman's ear, I whisper encouraging words in between to keep her breathing calmly and give her courage. The baby's head is born, quietly sighed by the mother, and the student gets big eyes and looks at me. "I see the face!" she says softly but startled. I look with her, while my hand is still attached to the birthing hand. I see the baby's face between the mother's legs. 'Yes, that's right,' I say quietly and nod that she should continue developing the baby's body. My student clearly locks up and I see her staring at the baby. I see her looking doubtfully at mother and me. She still has clean gloves and in a flash I swap her hand with mine. Smoothly, I develop the baby with my bare hands as I instruct the woman in pressing and sighing. A healthy baby boy is born, which I push between her legs into the mother's hands. Gratefully, she looks at us while I stand washing my hands.
'So what happened in your head?' I ask the student later in the nursing coffee room. 'I locked up when I saw the face,' she says begrudgingly. 'Yes I saw that' , I say laughing. 'If you turn the mother from back to hands and knees, the baby turns with her,' I explain. She nods. 'If the barer lies on her back you see the back of her head when the baby is born and so you see the face you put her on her hands and knees,' I continue. I do it again with my hands in the air and use the apple I wanted to consume as a high of the baby, so she gets a picture of it. She thinks for a moment and then nods understandingly. 'I've never seen this in Iran, there women don't get down on their hands and knees,' she says. 'We do more things in the Netherlands that they don't do in Iran, but it's probably the same the other way round,' I say with a smile.
Moments later, we conclude the care of the delivery with the happy couple and the maternity nurse takes over from us. 'How nice than I could continue to hold your hand,' the mother says to me as she deftly puts the baby to the breast. I give the student a wink. 'Sure we do! It's nice when we can work together, isn't it?", I say as I give her a high five. 'Do it again!" I say to the couple, laughing. The husband almost chokes on his coffee and had to cough, while his wife still shouts very loudly 'NO, this really was the last one!' as we head out the door. 'I heard that last time too,' I say to the student as we walk out of the hospital.