Four births, four different days — what my role actually looked like at Shifrah and Puah

One of the questions I get asked most about my time at Shifrah and Puah is what I actually did. Not in theory, not as a philosophy, in practice, in the room, when something was happening.

The honest answer is that it depended entirely on the birth. My role shifted from one woman to the next, sometimes from one hour to the next within the same labour. What I want to share in this post is four births that show that range, together they give an accurate picture of what showing up for women in this context actually looked like.

The resuscitation

She was a first-time mother. Her labour lasted 45 hours. By the end she was exhausted in a way that had moved beyond ordinary tiredness, her contractions had slowed, her energy was depleted and it became clear she did not have enough left to push the baby out without support. Pitocin was started through an IV to strengthen the contractions. The midwife made the call to apply fundal pressure, pressing firmly on the top of the uterus to help the baby move down and the baby was born.

He was not breathing.

The midwife began resuscitation immediately. My role in that moment was simple, I moved to wherever I was needed and did whatever was asked of me. I kept the space clear, I handed what was needed, I stayed present and calm because the room needed that. Resuscitation in a resource-limited environment requires complete focus from the practitioner doing it. My job was to make sure nothing interrupted that focus.

After one minute, the baby began to breathe.

We placed him in skin to skin contact with his mother immediately. From that point I stayed with both of them, monitoring mother and baby, watching for any signs of change, keeping the environment as calm as possible while the midwife managed the immediate clinical picture. The mother had lost a significant amount of blood. She had not eaten or drunk throughout the labour. When she stood later she collapsed. The baby developed a fever that evening and was transferred separately. They were reunited the following day.

What I carry from that birth is not the resuscitation itself, though that stays with me. It is the question of what adequate preparation looks like, for the body, for the labour, for the partner who needs to understand what the woman needs through those hours. These are conversations that happen before the birth, not during it. That is where the work is.

The fifth child

She arrived mid-morning at eight centimeters dilated, contractions that had begun the night before. Everything pointed to a baby arriving by midday. By three in the afternoon she was at nine centimeters. By five she had not progressed further.

What I noticed across those hours was the pattern of interruptions. Every time someone came into the room, every question asked, every check performed, her labour slowed. When the room was quiet and she was left to move through it in her own rhythm, something in her body settled and worked. When she was interrupted, it stopped.

I said to the midwife, when no one is in the room with her, she is doing exactly what she needs to do. Can we give her some space.

The midwife agreed and stepped back.

One hour later her waters broke. Ten minutes after that, her baby girl was born.

My role in that final stretch was to stay present without directing, close enough that she knew she was not alone, quiet enough that the room could hold the quality it needed. When the waters broke I moved into position alongside the midwife to help receive the baby and support the mother through the final contractions. She had a small tear that did not require stitches, though in Uganda all tears are typically sutured regardless of clinical necessity, for cultural reasons.

That birth taught me something I already knew but needed to be reminded of. Sometimes the most powerful intervention is the absence of intervention. Sometimes the room itself is the medicine.

When she needed someone to hold her

She arrived in the morning, labour already well established, strong contractions coming fast. She had taken herbal preparations before coming to the centre, something common here, women arriving having already intervened in their own labours in ways they do not always disclose. Her contractions were more intense than spontaneous labour typically produces and she had refused to eat, for a reason that only became clear later. She was afraid of having a bowel movement during pushing and had decided that not eating was the solution.

I stayed with her through the labour, providing counter pressure, positioning support, encouragement and consistent presence. When she reached the pushing stage she had very little strength left. The midwife applied fundal pressure once to assist the baby's descent. The baby was born alive.

She had two tears and lost a significant amount of blood. She was sutured and I stayed with her through the immediate postpartum period. When she attempted to stand, I felt her begin to go before she did, I moved quickly and caught her before she reached the floor, holding her until the midwife could get to us.

She was discharged the following day. That evening she collapsed again at home and was taken to a medical clinic where she received glucose. The next morning she returned to the maternity centre and her haemoglobin came back at six.

She was transferred to the main hospital for a blood transfusion.

My role in that birth was continuous presence and physical support, and one moment of being in exactly the right place. The catch mattered. What mattered more was everything that preceded it, the hours of staying with her, knowing her body, being close enough and attentive enough to feel the shift before it became a fall.

The space between a mother and her mother in law

The fourth birth I want to share was different in almost every way from the three above. The labour was fast, the birth was smooth, and the mother and baby came through it well. What this birth asked of me was not clinical support but something more interpersonal.

Her second baby arrived quickly. She was at eight centimeters when she came in and two hours later the birth was complete, waters released just before the baby, no tears, minimal bleeding. A textbook second birth.

What was less straightforward was the mother in law.

She was present throughout and her presence was clearly felt. During the pushing stage she moved increasingly close to her daughter in law, offering direction and physical proximity in a way that was creating pressure in the room rather than support. The labouring woman needed space. She needed to follow her body's signals without someone else's urgency overlaid on top of them.

I positioned myself physically between them. Not confrontationally, I simply occupied the space in a way that meant the mother in law could not get closer without making it obvious. When she attempted to move forward I made eye contact and quietly asked her to step back, to give her daughter in law the space she needed to do what her body already knew how to do.

She stepped back. The room shifted. The mother pushed when she felt the urge and the baby came.

That moment, the physical creation of a boundary in a culturally complex situation, in a language I do not speak, in someone else's country, is one of the things I often think about. It was not dramatic. It was one step and a quiet sentence. But it was necessary and it worked, and knowing when and how to do it is part of what this work asks.

What connects these four

Four births, four different days, four completely different situations. A resuscitation, a labour that needed silence, a collapse that needed a pair of hands in the right place at the right moment, and a boundary that needed to be held without words.

What I brought to each of them was the same thing, presence, attention and the willingness to respond to what was actually happening rather than what I had expected. That is the work. Not the techniques, not the qualifications, not the certifications. The capacity to read a room, stay steady inside it and do whatever the woman in front of you needs next.

That is what I practised for a month at Shifrah and Puah. That is what I am bringing home.

— Sabah, The Line Between · Beaufort, VIC

---

Sabah is a certified doula and acupressure therapist based in Beaufort, Victoria. Her practice, The Line Between, is rooted in the philosophy of matrescence, the profound transformation of becoming a mother that deserves to be held with knowledge, presence and deep respect. She came to this work through her own pre-conception journey and a deep conviction that matrescence is a universal feminine passage that every woman deserves to move through with community, language and care. She is also the founder of The Mother's Village, a monthly gathering circle for women on every part of the motherhood journey. She writes from the threshold as a practitioner, a thinker and a woman navigating this passage herself.

---

If this resonates with you and you feel called to support the work at Shifrah and Puah, you can learn more and donate directly at shifrahandpuahmaternitycenter.org