When Birth Changes Course

If you've spent any time around me, you probably know that music is a fairly significant part of my life. So it feels particularly appropriate that one of my favorite photographs from this year was taken in a hospital, after a home birth plan had changed, while I was wearing a Charles Wesley Godwin shirt with one word across the front:

STRONG.

Honestly, the first thing I thought when I saw the photo was, well, I look like a badass!

The second thing I thought was that the shirt could not have been more appropriate.

This has been Mountain Time Midwifery's busiest year yet. It has also brought more changes in plans than we would have chosen.

That combination has been harder for me than I expected.

When you spend months preparing with a family for a home birth, you become invested in that vision too. I want people to have the births they hope for. I want the birth pool, the quiet bedroom, the familiar surroundings, the moment when everyone realizes the baby is finally here.

But birth does not owe any of us a particular ending.

And part of being a good midwife is knowing how to hold both things at once: respecting the plan while remaining willing to change it.

Giving birth time

One thing I have thought about a lot this year is that not every person we care for would necessarily have been offered the same amount of time or flexibility in a conventional medical setting. Community birth allows us to individualize care in ways that can be difficult inside a system built around standardized protocols, staffing patterns, institutional policies, and timeframes.

That does not mean waiting indefinitely or pretending risk doesn't exist.

It means looking at the person in front of us.

How are they doing?

How is the baby doing?

What has changed?

What hasn't?

Is there a reason to intervene right now, or is there room to keep watching?

Sometimes the answer is, “We can give this more time.”

And sometimes the answer eventually becomes, “It's time to go.”

Both can be good midwifery.

I think that distinction matters, especially when looking back at births that ultimately ended in the hospital. A transfer does not necessarily mean that attempting a home birth was a mistake or that everything before the transfer was somehow wasted. Sometimes the opportunity to labor without unnecessary intervention, to move freely, to eat and drink, to rest, to be surrounded by familiar people, and to have decisions made around the individual rather than a clock is valuable even when the final place of birth changes.

And then we go with you

When we decide that hospital care is needed, our clinical role changes.

Our relationship with you does not.

We follow.

We help communicate what has already happened. We answer questions. We help you understand new options. We remind people of your preferences when those preferences can still be honored.

We support your partner.

We sit beside you.

We advocate when advocacy is needed and become quiet when what you need most is simply someone familiar in the room.

And sometimes, apparently, we stand in the corner wearing a Charles Wesley Godwin shirt looking unusually tough.

Both things can be true

A client whose homebirth changed course shared these words afterward:

“I still grieve the home birth I didn't get. And I deeply love the birth I did. Both things can be true.”

I keep coming back to that.

There is sometimes pressure after a transfer to immediately declare everything okay because everyone is physically safe. Of course safety matters.

But it is possible to be profoundly grateful and still disappointed.

You can know that going to the hospital was the right decision and still wish it had never become necessary.

You can love the way your baby came into the world and mourn the birth you had pictured.

You can feel proud and sad at exactly the same time.

Those feelings are not contradictions.

Coming on strong

There's a line in Charles Wesley Godwin's song “Strong” about kicking until the end.

That feels like birth work to me.

Not because every birth should become a battle. It shouldn't.

But because there is something powerful about continuing to show up when the story changes.

The birthing person keeps showing up. Their partner keeps showing up. The midwives keep showing up.

Sometimes strength is laboring at home for hours. Sometimes strength is getting into the car when you desperately wanted to stay. Sometimes strength is accepting help you hadn't planned to need. Sometimes strength is advocating for another hour. And sometimes strength is recognizing that the safest choice is no longer the choice you wanted.

This year has reminded me that we cannot measure good midwifery solely by where the baby is ultimately born.

I can measure whether we listened. Whether we gave reasonable options. Whether we were patient when patience was safe. Whether we changed course when it wasn't.

Whether our clients felt cared for instead of abandoned when the plan changed.

And whether we kept showing up.

At home, in the car, in triage, beside the hospital bed.

Maybe even wearing a Charles Wesley Godwin t-shirt.

It takes blood and sweat to find a new way

You're coming on strong, I know your night's been long

But I can see you coming around the bend and kicking until the end

Like Prefontaine from an outside lane

Proving them wrong, coming on strong