Suturing, which is also known as stitching and perineal repair, is something I feel all home birth midwives should know how to do, but as students we were not given the experience I felt we should have gotten, to do it. As with many things, it depended on who your mentor was as to how much experience you got. Realizing this, I worked hard in my last year, too get as much experience as I could, which was not much, but at least I did get to do it more than once. In all honesty, I really enjoyed it and wished I could do more, to be really good at it but my time was limited.I knew I would soon be working with women at home and sooner or later I would need to suture. This thought worried and excited as I did not know when this time would come in my professional practice.
I received a text from my colleague at 9:30 in the evening. Our lady had had a show(lost her mucus plug) and was contracting incoordinately throughout out that day. I had just put the dinner on the table (Spanish dinner time) and soon after finishing I went to bed. I knew I needed some sleep as I could be called out at anytime during the night or early hours. At 4:30am my phone went and sure enough she was making good progress. My colleague had been there since 2pm and felt I needed to get there sooner rather than later as she was feeling the desire to push with her contractions. Now this lady lived about 40 mins away from me and I was traveling by taxi, so I rang for my taxie before I was dressed. I usually have a set driver who takes me to births when I need it, but her taxi was off the road that night. I use her because she is a woman and she is very keen to take me to births. I had thought out how I would get to births with out a car in the wee hours and felt deeply uncomfortable with just ringing any random taxie on a night. At times I have to go to places unknown to me outside of the city, and engaging a random male taxie driver just felt very wrong to me. I tried to find a driver who was known to one of my friends but with no luck. Then by complete chance I met Luz. Her name says it all (it means light) and she is so lovely and interested in what I do. It is also an amazing coincidence that in Spain, to assist to give birth is called ‘dar de luz’ (to bring to the light).
But this night I was on the road to a house 40 mins outside of the city with a random male driver. He was nice and got me there in one piece, so it was fine, but he was recommended to me by Luz. He did drive painfully slow though and we seem to hit every red light. The ride to the house was an exorcise in letting go. Every time I felt like screaming at him, FUCK THE LIGHTS, SHE IS PUSHING! and CANT YOU GO ANY FASTER, THERE IS NO ONE ELSE ON THE ROAD! I had to remind my self, that part of birth is surrendering to the things we can not control and that this ride was simply one of those things. Fortunately enough for me, this was our ladies first baby and although she felt pushy when my colleague rang me, by the time I arrived, at 6am, the baby had changed position and she continued to labour for another 2hours.
I arrived at the house and as usual tried to catch the vibe of the energy in the space and adjust my energy to suit. The house was big and a bit cold. Our lady was very mobile and her husband, a doctor, was very welcoming. The space was dark and protective coverings were all over the expensive rugs and furniture. I got the history from my colleague and asked the question I have asked my colleagues at every birth we have attended together, do you have a resuscitation area set up for baby? Until that moment, I never understood, that they both choose not to do this, as the answer is always, “Oh, I have my equipment in my bag, by the door”. This time I asked, why do they never set up an area. I was told that it might frighten the parents. I said, I felt it was better to have it there and ready, if anything happened. My colleagues response took me aback. She said, if I was nervous about these things happening then I needed to have a talk with her about it and that it would effect the labour in a negative way to show my fear. I was shocked and a bit hurt. I was not afraid and yes I was nervous, because no one wants to have to resuscitate a baby, but sometimes it has to be done and I wanted to be prepared, so I could work as safely as possible. I told her this and she said if I wanted to set up my equipment that I should cover it so as not to worry the parents. I did this and left it by the door.
But I digress, anyway, the baby was born well and with mom on a birthing stool, my first delivery with one! She did amazingly well and tore only slightly. One point to mention is that when birthing on a stool, once baby is out, it seems advisable to get the mother off the stool straight away and into a reclining position, as the force of gravity can cause her to bleed briskly immediately after birth. One hour later she delivered her placenta on the stool as well, and bled briskly, so was quickly moved off the chair and into a reclining position.
Later, on examining her, which I was encouraged to do by my colleague who is the most experienced of our group of midwives and takes on the role of mentor for me. This was my second birth with her and this time she really encouraged me take on a leading role. I found that our lady needed just a few sutures to aid the healing of the lower part of her perineum. I was terrified to do this, but knew I had to have a first time, it did not help that this was the wife of a doctor who was there in the room while I did the job. I have to say in all honesty, it was far from the most beautiful job of suturing ever seen, and I am still worried that I pulled them a bit too tight, on the urging of my colleague, but I did it! From infiltration for anaesthesia to choosing to leave my strings medium long, I was in control of the care I was giving and I am proud of this. Of course now, I am reviewing everything I have learned about suturing and hope to have a chance again to do some more, as I did enjoy it. Of course I know that it would be better for our ladies if they did not need any suturing, but if they do, I want to be really good at it.
We use a frying pan, or wok, or pallea pan, to get the moms bum in the air so we can suture easily, its strange, but they are all the perfect height and every one has one.