Sunday, April 1, 2012

The all-nighter

1983 - I worked night shifts at the Women's
Although I haven't seen this one listed in midwifery skills or competencies, it's a reality for any midwife who accepts bookings from individual women. In order to be 'with woman', I need to be with her on her time-table, and that often means missing a night's sleep. As a labour progresses and the woman accepts the diminished activity of her front-brain, environmental distractions are also minimised.

Picture the scene: dim light, a warm glow from the wood burnt low in the fireplace, and a woman labouring on her knees in an inflatable plastic birth pool. She moans softly and moves her bottom in big slow circles as contractions ebb and flow, then rests her head on her arms, eyes closed, re-entering her resting state without comment or any record being made. Someone is near her - sitting quietly and also dropping off to sleep from time to time. Other members of the birthing team are similarly occupying couches or chairs, through minutes or hours of the night. Then the labour changes, and everyone is aroused, refreshed, and I am ready to complete my part of the work at hand.

Another scene is a hospital birthing room. Again, lighting is reduced and all is quiet. The labouring woman, and her husband, are sleeping. She has laboured with slow progress, and when she lies down, the interval between her contractions increases greatly. She needs to replenish her energy reserves before the next bout of active labour. I am resting on a chair, eyes closed, dropping into sleep as is evidenced by an occasional snore! I am also very weary. I know that the fetal head is high because the labour is so positional - strong when mother is upright, and slow when the weight of the womb is taken away from the cervix and the birth canal.

Today I am reflecting on the way a woman and midwife navigate the night-time terrain, because I have come from an all-nighter last night.  The ability to rest and re-charge as the night progresses is essential for both mother and midwife.

When I worked night shifts in midwifery it would have been unthinkable to admit to falling asleep on the job.  If a woman in my care was having a sleep I would have plenty of other jobs to attend to, or perhaps it would be time for meal break.  Of course tiredness was an issue, especially on the first night, and especially in the 'wee hours', somewhere between 2 and 4 am, when everything and everyone went quiet.  But these days, working in partnership with individual women, it's the norm, and I believe it's the right thing to do.  My body and mind accompany the woman through the phases and stages of labour. 

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