Curiosity and the Caul

medium_677786684Carrie was having a fairly fast and furious labour, and had spent most of it journeying between the sink and the toilet in her upstairs bathroom. The toilet was her ‘best’ place, and she spent so much time on it that we weren’t completely sure whether her waters had broken. So it was no great surprise to me when she plonked herself down on the loo for the eleventh time that hour and began to push. I murmured something to Carrie about lifting her bottom for a moment so I could put a towel under the seat and provide her baby with a soft landing. Yet, as soon as the words were out of my mouth, Carrie – who clearly did not want to have her baby on the toilet! – was off to the bedroom. Although I arrived in the bedroom only two seconds after her, she had already launched herself onto the bed, in what has become known as the ‘stranded beetle’ position, and had resumed pushing.

Now, that was a surprise!   Carrie had been keen to have an upright, active labour; she had practised all sorts of positions during pregnancy and knew that I would work around any posture she chose. So why this one, I wondered? In the fleeting moments where my mind was able to wander briefly from the task at hand, I caught myself trying to remember when I had last attended a woman in this position and couldn’t remember another time when this had happened at a home birth.

Curious, I thought. Not a problem, or anything to worry about, because this baby clearly isn’t letting a bit of gravity get in the way of her rapid progress through Carrie’s pelvis. Certainly not anything I want to get into a conversation with Carrie about at this point, because she needs to keep focusing inwards right now. Just curious.

What was also curious, but equally unproblematic, was the fact that Carrie’s baby, whose birth was now imminent, had had a perfectly regular heartbeat with nice reactivity throughout the second stage of her labour. I don’t know about you, but when babies come through the pelvis as fast as this one, I tend to expect to hear a few decelerations resulting from head compression. In fact, if I hadn’t been able to see the baby’s head by this point, I might have wondered if maybe the birth was not as imminent as I thought.

As baby Odessa’s head emerged, it became clear that the waters hadn’t broken; this baby was coming in her caul. Not only that, but, once all of Odessa’s head was born, I could see loads of cord in the sac. When I broke the amniotic sac and helped Odessa out, I discovered that, while no loops of cord were actually around her neck, there was a good foot or so of cord lying next to her neck. Because Carrie was lying on her back during the birth, the cord was uppermost when Odessa was born and, suddenly, I felt a sense of ‘rightness’ about the position Carrie had chosen for pushing and the fact that Odessa was born in her caul. Had Carrie been on all fours, or sitting on the toilet, or leaning forward on the sink while she pushed, there might have been far more pressure on this cord, which could have caused cord compression and possible distress for Odessa. The same thing might have happened if the membranes had ruptured earlier, as this would also have put more pressure on the cord.

For me, one of the most important things that emerges from this story is reinforcement of the idea that it really isn’t a good plan to intervene unless there are truly good reasons to do so. In this situation, had I done an ARM [to break Carrie’s waters], or even suggested a change of position, this may well have impacted on Odessa.

medium_2414457426It is also a reminder that there is a whole dimension of birth that we don’t fully understand, and that isn’t taken into account in the current climate of evidence-based practice; the possibility that women and babies have an innate sense of what needs to happen, and, because of this, will sometimes do things that challenge our rational ideas about how things should be, yet which turn out to be exactly the thing that helped everything go well.

I remember Ros Weston writing about a woman whose labour progressed really slowly – it turned out that there was a true knot in the cord.   I have shared Carrie’s birth story with other midwives, and almost every one of those midwives has had a tale of their own about a similar situation: that is, where some aspect of labour seemed to be outside of the norm but, ultimately, this turned out to be the one thing that helped everything become normal. Is this just coincidence? Do we enjoy this kind of story because we still want to see magic and mystery in a journey which modern society tried so hard to rationalise? Or is it that, no matter how much we try to pin things down and turn them into numbers and facts, there really are elements of birth that are beyond rational comprehension and simply require our trust and respect?

 

This post is the full text of an article originally published in The Practicing Midwife and republished here with permission.

Wickham S (2006).  Curiosity and the caul.  Practising Midwife 9(6):32.

photo credits: Luz Adriana Villa A. via photopin cc

1 comment for “Curiosity and the Caul

  1. November 24, 2014 at 10:33 am

    That’s really interesting Sara- I was at a birth recently where I transferred in for what turned out to be a cord presentation (I’ll write it up in my blog in the next week or so)- Although it felt totally mad to think about ‘what if we hadn’t transferred’ I did, when reflecting quietly to myself think that baby may well have been born quickly and in the caul to protect himself. If I hadn’t have examined her I wouldn’t have known…

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