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Week by Week

Amish Births



This post is mostly about Amish culture, very little about actual births.     

     I have been looking forward for months to the birth of my first Amish
primip -- she is a beautiful girl -- a model, an actress -- at least--in any
other life.  "My" Amish community is very liberal, although Old-Order, so
modern conveniences are used, but not necessarily owned, or allowed in the
house.  Women at home wear little black see-through scarves on the back of
their heads, with their hair always pinned up. I've noticed that the young
married girls wear their scarves way back on their heads, so as to show off
as much hair as possible.  In public they wear the more discreet black
bonnets.  I went down many times this week to check on Rebecca.  During one
of my visits, she was outside gardening with her long never-cut brown hair
blowing in the breeze.  She had on a sweat shirt, over her house dress, and I
thought she must be an "English" teenager from town.  I didn't even recognize
her until she spoke to me. She glowed with anticipation of the birth of her
first child, the ultimate fulfillment in this girl's life.  
     Rebecca had a straighforward pregnancy, no problems whatsoever, until a
week or so ago, when her blood pressure climbed to 140/90.  She had pitting
edema in her feet, but felt and looked wonderful, was on 1800 mg of Calcium,
was excercising regularly. She had started out at 110/70, but had been
120-130/80 on most of her visits.  She was due on May 5, and her baby was low
in a good postion, and her cervix was almost 3 cm.  I swept her membranes,
gave her castor oil, and
breast pump in order to get her labor going.  I thought that an induction at
this point was better than a hospital birth for high boold pressure later on.
 It took
about 3 days to get things going, and she was cheerful and happy, and so
excited to be having her baby.  Her sweet husband was with her every moment,
taking off time from his construction job to be with her.  His dad runs a
construction crew that build some of the finest, most expensive houses in
the big city.  They drive over an hour everyday to get to work.
     She finally kicked in Friday afternoon, and things were slow.  I visited
other Amish friends, including the mother of baby Benjamin with cleft palate,
who has now had a successful repair.  She was cooking Hamburger Helper for
her husband and her 3 year old daughter, her 2 year old daughter with serious
vision problems, and baby Benjamin. We talked about the surgery, and the
birth
last summer, and the need for folic acid in her diet.  Next I visited the
family next door to see Big Mary who is now about 10 months old and was 11
1/2 pounds when she was born in 2 hours one hot August afternoon. Her mom is
still nursing her, and just got back her period, but Mary was guzzling down
a sugary grape drink in a plastic bottle-shaped container from the grocery
store. Next I went to see my baby born the first of April who had almost died
from RSV, home on an apnea monitor, and then went to see the mother of a baby
last summer, whose older 10 year old son had shot the 8 year old son
accidentally, while playing with the gun.  The boy is doing well, will need
lots of surgery, but is expected to live now.  It seems that the Amish are
always losing children, either from accidents, or from birth anomalies. The
Amish love their children so much, and welcome each one in a way that seems
to me that many of the "English" do not. 
     Sarah my midwife partner, and Dorothy, my new part-time assistant, and I
all stayed all night at Rebecca's where there was way too much sleeping, on
everyone's part. This quiet media-deficient house with no radio or tv did
have a clock that
chimed "Old Susanna" at 9 pm and 9 am.  She had dilated to 7 pretty quickly,
but had very mild contractions all night.   Finally, around 7;30 am, her
labor kicked in.  She pushed in several positions, for two hours. Baby David
had his hand up, and a tight cord, so, even with her enormous pelvis, she had
to push for all her
might.  She never uttered a sound, smiling in between contractions.  David
was 8-10 APGARs with a hard to resolve nuchal hand.  He was 8 lb 9 oz.  She
also had decided not to have her mother at the birth, preferring to be only
with her husband.  She had told me earlier that she did not go to her parents
for advice about having her baby at home, because she knew what they thought,
and preferred not to take their advice.  Pretty gutsy for a sweet gentle
Amish girl.  His parents, on the other hand, had thanked me for making my
services available in their family, and the grandmother told me she hoped
that I would have the opportunity to deliver many of her grandbabies.  She
was proud of Rebecca and Jacob for deciding on home birth the first time
around. 
     I had been told many times by many Amish clients, that everyone was
watching this birth.  One of my Amish friends, Dorcas,  told me
confidentially that she really hoped that things went well, because it would
be very good for me, if things went well, and not so good, if things went
bad.  No pressure there! 
     Rebecca's blood pressure stayed normal, by the way.  My blood pressure,
however, climbed when the same Dorcas, also kicked into labor on Saturday.
Sarah ran interference, driving back and forth between houses.  I sent my
cell phone with her, so she could beep me with dilation.  She came back to
Rebecca's, promising that she'd be back to check on her at 11:30 AM.  Larry
would call us if things got serious faster, but his horse was lame, and he'd
have to walk all the way to the phone, 1/2 mi. or so.  When 11:30 came,
Rebecca had been pushing half an hour already, and it was hard to gauge how
soon the baby would come.  Sarah stayed with me, and we hoped that
they'd beep us soon enough, if they needed us.  As David was being handed up,
I looked at Sarah and said "Go!"  She took off, intending to beep me
with dilation.  After Rebecca's placenta, some bleeding, and a small repair
to
a second degree tear, and fainting on the way to the bathroom,  I hadn't
heard anything --maybe my pager wasn't working -- and I was getting nervous
about Dorcas.  I borrowed Grandpa Enos's cell phone, to call Sarah
on mine.  "Relax, she is only 4 cm, but really kicking in."  Grandpa Enos
with his long untrimmed beard, and Amish straw hat, came and knocked on my
car window, where I had the phone plugged in.  "Can you hurry?' he said.  I
just got a page, and I need to use my phone."  Sure.
    Dorothy and I cleaned up--Dorothy missed her son hitting one out of the
park on opening day--and we left them in the safe hands of her mom and
mom-in-law.  
     I arrived at Dorcas's to find her in transition, doubled over during
contractions, with Larry holding her up.  Dorcas's last birth was for her
second child, and was a posterior labor that went on all night.  Larry held
her up, shaking her hard for hours, while she leaned forward.  Finally they
suceeded in turning the baby so he could be born.  Of all of my Amish
clients, Dorcas is one of my all-time favorites.  I love her, and I know
she loves me, but I didn't know whether she would have another baby at home.
 She was in SO much pain during that labor.  She also had a terrible time
with the baby on the perineum.  She and her mother insisted that she lay flat
down, and nothing would dissuade them.  Abraham was on her perineum for a
very
long time and she was in agony.  She had a large episitomy the first time,
and I was sure she would think that if she went to the hospital, they would
get that baby out faster.  I was wrong, though, and she called me pretty
early for an Amish client, at about 23 weeks.  She told me that she had
thought about going to the hospital, for "dope", but didn't think it good for
the baby, and knew it would just slow things down.  We had wonderful
prenatals, with Dorcas laughing and gossiping about all the neighbors, and
trying to find out who was pregnant.  The Amish never discuss who is
pregnant, until after the birth.  I have a pretty good reputation for not
giving anything away, but Dorcas would try to trick me.  
     Dorcas weighs only a 100 pounds, non-pregnant, although she has a
nice ample pelvis.  She and her mother chanted during this birth, and the
last, "Granny is smaller than me, and she did this 14 times!"  
     Throughout her pregnancy, I had really been careful with the position of
this baby.  The head continued to ride over the pubic bone, but felt anterior
to me.  I felt hands and arms up by the head everytime I felt. I had her do
lots of pelvic rocks and this baby stayed anterior. She was only in hard
labor for about 4 hours, although she is "type B" Amish, which is the kind
that "passes out" during labor, and becomes "unconscious" afterward.  The
first few ladies that I served like this, really freaked me out, because I
thought something was terribly wrong.  I finally learned that this is just
how some Amish women react to childbirth.  Dorcas stayed stronger this
time, with mother Laura cajoling her to stay strong, and to "take deep
breaths!"
     After we resolved the anterior lip, I convinced her to stay on the birth
stool this time, and she only pushed for half an hour or so.  Her water was
full of green meconium, that turned more and more brown, as more came out.
 Heart tones never faltered.  Baby William was also born with his hand up,
and
the cord lassoed around his neck and down his back.  We bulbed, but he
screamed, so we put the resque-vac away, and handed him up.  9-10 APGARs, 8
lb 14 oz. After Dorcas's last birth, she had been truely traumatized by
how painful it had been.  She said over and over and over to me, maybe a
hundred times, "It hurt, it hurt, it hurt."  When she got back to herself,
she asked me to help them sing "How Great Thou Art," which we did -- Amish
grandma Laura, Dorcas, and me.  It was beautiful.  
     This time, although her labor was painful, she sang throughout, a kind
of atonal, hymn.  I have only attended Amish funerals, and so have never
heard singing at a church service. I have read that they sing long drawn-out
hymns in German, remembering the melody and handing it down from generation
to generation.  I suspect that her "notes" were similar to the ones she sings
in church.  I was so pleased for her that she could sing her way through her
labor this time.  After her third boy was out, and she was lying on the bed,
covered from head to foot with layers and layers and layers of blankets, she
said "Oh, Jennifer, I need to hug you!"  I bent down over her and hugged her,
and felt that a really good friend had just had her baby.  Most of the Amish
are friendly, but shy, and many are stand-offish.  They keep to
themselves,and we "English" are usually not allowed in very far.  I was very
honored by that hug.  We cleaned up, again, and were really glad to go home
to sleep in our own beds.  
     I had to make up to my daughter for missing the first time I was
supposed to babysit for my granddaughter.  She's heard it all before.






Jennifer Williams, CPM, Bloomington, In



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