Witnessing Birth. Witnessing Death.

I have seen births; and I have seen deaths.

Over the years, I have had the privilege of witnessing the process of both.

Many of these events came as part of my medical training, many years ago, when I was a lot younger.  

As part of my training in my 5th year  (of a 6 year undergraduate medical degree, which is how it used to be done back in the day) I lived in at a major maternity hospital for 10 weeks, on call to observe and assist at 20 births, 3 of which were C Sections; 3 out of 20, that’s roughly the ratio that it used to be; this was 1977. How times have changed.

I knew nothing. It’s hard to describe the absolute void of my knowledge regarding life events. I knew some theory of course. It’s not as if I had stuffed cotton in my ears and worn a blindfold for the previous 5 years. I had been in clinical school for nearly 2 years by then. I had seen and talked to sick people. I had actually been very peripherally involved in resuscitation of patients who had undergone cardiac arrest, mainly keeping out of the way of the crash team and standing goggle-eyed watching the drama, at the edge of the crowd. Unlike on TV, not everyone made it.

I had seen babies, and I had seen two or three dead people, but I had never been involved in either the process of entering the world or leaving it.

So that year of witnessing and assisting in birth was a real eye-opener for me. It was fascinating and it moved me in ways that I had never felt before. Although it was a hospital, it was a public hospital, which meant that midwives ran the show, not OBs. The few births that I assisted in of private patients of an OB were, even then, quite different; much more intervention. All the babies I saw being born survived, although it was shocking to me at the time how many looked dead immediately after delivery; blue, motionless and limp, until that first breath magically ‘pinked them up’, and the first wail announced that the baby had joined the living. I saw ‘easy’ births, fast births, slow ones, uncomplicated births and tricky, difficult births. I saw perineal cuts and tears, while standing with my legs crossed, unconsciously shielding my own pubis with my hands. I saw forceps deliveries, and I still can’t get over the force applied to get the baby out. I saw epidurals, and was terrified out of ever having one myself (I never did.)

I assisted at those C-sections, once getting sprayed with amniotic fluid and nearly passing out in the operating room. It was a marvel how fast the OB worked to deliver the baby (or babies), while making sure that any blood vessels were sealed and minimal blood loss obscured the field. It really is an amazing skill.

But I never got to see a birth outside of the hospital environment, including the times I birthed my own children. Until one of my daughters announced that she was going to have a home birth with a midwife and a doula- I don’t think I had even heard of doulas – 8 years ago. I confess it took quite a bit of convincing to get me on board with that, and I won’t go into details, but after 3 uneventful home births, I must say that I have become a convert. As long as there is good backup if things go south.

The difference between home birth and hospital or even birthing centre birth is pretty profound. There is no panicky transfer; the surroundings are familiar, not sterile and foreign. There are no troops of strangers coming and going, no shift changes. The lights can be turned down. Other children can come and go as appropriate. Things are allowed to unfold in their own time and their own rhythm.

I remember the first home birth; how my daughter was almost meditative in the inflatable birth pool in the dining room area of her apartment. We- the midwife, the doula and I -had been banished to a side room because she was getting annoyed with our being there and breaking her focus. She was breathing and moaning softly, and then there was a change in her tone or her volume, and we all looked at each other in the little dim bedroom, and thought – This is it. We all went back to her, I in the background- and it wasn’t long before the baby was born. I remember the feeling that I was witnessing something sacred. I was drawn to my feet by this feeling, that I had to stand to witness, just like in a court or before royalty- almost pulled upright by some outside force. It was the most moving experience that I have ever known, all the more for surprising me as it did, and outside of the fact that this was my granddaughter being born of my daughter.

Thank G-d all went well, and there was no complication during or after, and I was just blown away by the power, yet the peacefulness of it all.

I have seen other grandchildren born, and it is always ineffably moving, no matter where; but the tranquility and peace of a successful home birth is inimitable. OK, it’s just been one daughter; I have seen other similar videos, of course edited, but I suspect that they have this commonality. Because when you commit to a home birth, you are committing to trust the midwife, to not have any drugs for pain relief, and not to intervene in the process but to surrender to it. It’s not for everyone and it doesn’t always work. But when it does, it is magical.

When I was by the bedside of my dying father, nearly 20 years ago, I had not been exposed to home birth, but I did feel the awe of witnessing the passage of the soul from this world. He passed away in my home, after three weeks in his final illness, comfortable and surrounded by loving family. The lights were dim, there was a nurse in quiet attendance, and he had been able to communicate by hand pressure until only a few hours before. It was sad and we were sad, but it was a good death. He was 85.

It wasn’t until the recent passing of my father-in-law that I was able to see the parallels.

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He was in hospital, and he had been in decline for some years, especially the last 2 months. He had come to terms with his mortality, but he just wanted to live longer because he had so much more to do, for his family; he didn’t want to let go. He told me the day after his admission for what was to be his final illness that he had felt that he was going to die and he was at peace with that. But he got through the crisis, and now he was optimistic that he might be able to go home once more. So he underwent several procedures and was in ICU; but after a few days it became clear that he was not in fact going to make it, so his level of care was downgraded to CCU. And then the tyrannical ‘machines that go beep’ were disconnected, because they were intrusive and there was no longer any reason to monitor every vital function.

And we waited.

It wasn’t easy. We took it in turns by his bedside as he slept; he was rouseable and could speak a little, and then he could communicate by hand pressure, and then, in the last day, he couldn’t, and he slept on. The hospital gave us another room so people could rest and eat and talk, and my mother-in-law was at his side almost the whole time, especially the last 3 days.

My brother-in-law was beside himself at one stage; he just couldn’t take the waiting; he couldn’t take the unevenness of the process, the Cheyne-Stokes breathing that stopped and started, and the anxiety- is it over? Has he gone? No, he’s breathing. Now? OMG, now? No, not yet. Etc.

And it was then that it struck me that this was almost exactly like awaiting a birth. He had never experienced that, I told him, because his children were all born by C-section; he only knew of dates and schedules and numbers and ounces of formula, and nothing of natural birth.  But the ‘Is it now? Yes? No? Not yet.’ anxious internal dialogue was the same.

The waiting was the same.

The feeling of awe, of witnessing something sacred, was the same.

The transition between worlds was the same.

Of course, a birth, the entering of a new life, is joyful; and death, the exit of a living being, is sad.

But the holiness is the same. It’s a continuum, an arc.

I have at times thought about the ‘arc of life’ but never had I felt it so strongly.

We enter from one world to this world; we leave this world for another.

We are souls in transit.


Image from Flickr.