When She Met Her Baby

I walk into the hospital room with my preceptor to back-up a birth. I have not met this client before, but she had told the primary midwife that she was okay with having a senior student attend her baby. I creak open the door. The room is quiet, the woman between contractions. Her partner is sipping water, everything is very calm. The primary midwife sees us. She turns to the client and encourages her to follow her body and keep pushing on her own for a bit. Then she steps aside to give me and my midwife preceptor report. When she finishes updating us on the progress of the birth, she goes back to coaching the woman in her pushing. Acting as the back-up midwife, I find the infant resuscitation area and begin to set-up all the equipment.Best to be prepared for anything, because you never really know how a baby will come out until … well, after it’s out. I turn on the suction, oxygen, warmer, confirm the mask size, and do a series of other checks. I end by flicking open the intubation blade to ensure the light works and pass a hope to myself that no one has to use it today.

I throw the infant stethoscope and a baby blanket around my neck and walk toward the bed. I take over documenting the fetal heart rates and settle into my role as a back-up midwife. My job is monitoring baby before and after birth, and supporting the primary midwife in whatever she needs. The woman is still pushing on the bed in the centre of the room and the pushes are not effective. The midwives and I discuss different positions we can try with an epidural in order to encourage fetal descent, and the mom compliantly flips from hands and knees, to side-lying, and then to waterski.

Hours pass, more things are tried, descent is still poor. OB is consulted to assist with the vaginal, instrumental delivery. The baby is born. It needs help to breathe. It is brought to the warmer – the same warmer that I set-up earlier. Pediatrics is there to assess baby. The baby is breathing on its own but poorly – the decision is made to take it across the hallway to the more advanced resuscitation area. Dad follows baby, Mom is in shock.

Respiratory therapy is in charge of the resuscitation. I am running between rooms, providing Mom updates on what is going with baby and providing Dad updates on what is going on with Mom. After a while, the baby is stable enough to breathe on its own, but the pediatrician recommends the baby be monitored in the special care nursery for 12-24 hours. The Dad agrees, and the nurse offers a quick stop to see Mom before heading to special care.

She hasn’t, after all, met her first child yet.

I hustle over to Mom’s room to give her the update. She looks obliterated with exhaustion. We hear Dad walking in and calling Mom’s name. He gently pulls the curtain aside and reveals a little, blanket-enveloped, human burrito. As soon as they make eye contact, Mom and Dad both start crying and reaching for each other. Mom is hysterical with joy. She longingly stretches out her hands toward her baby, frantically waving them back and forth to encourage her partner to walk faster toward her. It’s hard not to take a direct hit to the heart from all the grief and love in her voice as she cries out for her newborn; as if those 20 minutes of separation were the longest, most grueling 20 minutes of her life.

Maybe, they were.

I’m completely stunned and overrun with emotion. I started crying the moment she reached her hands out for her baby. Mom and Dad grip each other and their baby with such an intense relief that I can physically feel it. Their united sobs are accented with exploding moments of pride: “Isn’t our baby perfect?” I want so badly to make this moment last as long as possible for them.

Eventually baby goes to nursery and Dad goes with. I wrap up my duties as a back-up midwife, which are minimal considering we transferred to OB care and baby is now in the nursery.  I convince Mom to eat a little something. I grab her an orange Jell-O from the kitchen. I tell her that I am leaving, and thank her for allowing me to support her in such an important moment. She looks up at me, a stranger she met merely 5 hours prior, with tears in her eyes. “Thank you for being here and for your help. I am so happy you were here.” Then she hugs me. I mean, she really hugs me. The kind of hug you reserve for the people you want to receive a deep loving intent from your soul. I almost start crying but instead put together my feelings:

“I’ll never forget you, or your family. You inspired me today, and I’m so grateful.” 

She nods.

As I exit the door I yell, “I’ll hear about it if you don’t eat that Jell-O! Get to it!”

She smiles as I duck behind the curtain and out the door. Back to the real world. Although, I don’t think it gets much more real that what I was just doing for the last 5 hours.

Level 4: Bite sized chunks of learning

As I said in my last post, the expectations in senior year are a giant leap up, but I’m grappling with it. They need to be a step up because you are now the most responsible person in charge of the lives of two beings, but boy, it makes things hard to learn in a systematic way.

What do I do when things are abnormal?

The main difference I’ve found between this year and my previous midwifery placements is that we are expected to manage abnormal. I’ve been so conditioned to what is normal that when abnormal hits I am a deer in the headlights.

Baby shoulders stuck but the head is out? I’ve only ever done that on a doll. 

Fetal heart rate tanking? What’s your plan?

Mom bleeding out after delivery? Vocalize next steps. Command the room.

This is the time to learn to ACT in bad situations, and it’s challenging. The only way to learn is to do, with guidance.

How am I going to do this?

My new preceptor has me working on one small, new thing at every birth. Last time it was documenting. The time before that it was being on top of labour support and fetal heart rates, and making position suggestions to rotate the baby and encourage descent.

Next time it will be anticipating the next steps before my preceptor does. That’s the hardest part, especially when things are abnormal. She wants me to vocalize and instruct everyone, including her. That feels weird.

My preceptor told me I have a great handle on managing normal. When things aren’t going normally, though, I’m no where near running any sort of anything. If feels like I never will be, even though I know I have a year to get it.

Here are some things that have helped me start to build my capacity, but have also made me feel fucking dumb:

  • Post-epidural, a mom’s blood pressure tanks to 60/40 (normal is 120/60). I throw up the IV bag and get the IV equipment ready, thinking she will likely need a second one. Then I stand there like a log trying to get my brain to think of what to do next.
  • Baby being delivered by forceps. Many nurses and physicians enter the room, but my preceptor advocates for me to keep documenting. So I do, I document the abnormal fetal heart rate patterns. When in doubt, always document.
  • A mom is bleeding more than I’ve ever seen, and I look up pleadingly at my preceptor, demonstrating that I know that its too much bleeding. I suggest another shot of oxytocin – then my preceptor nods and takes over while I rub her uterus as hard as I can to expel any clots. Poor mama.
  • A baby’s heart rate is dipping while I listen with a Doppler. I notice and vocalize that the fetal heart rate is abnormal. I document. Then I need my preceptor to initiate the next steps because though my mind has read about what to do 1000x in this situation, my body has never actually done it before and the slow thudding of a decreasing, prolonged fetal heart rate is agonizing.

It’ll get better, right?

Everyone in my class agrees, this is hard. Even the most optimistic and skilled of us are working through our own issues. As we adjust to midwifery life again, and build stronger, trusting relationships with our preceptors, we will naturally gain confidence and skills. This is a job that takes time to learn and just plain old experience. It also means doing things wrong 1000 times. No new person in health care ever managed a post partum hemorrhage after reading about it once, so I just need to see how one is run and get in there as best I can every time.

For now, I move forward one day at a time, learning what I can, and napping when I’m overwhelmed.

Level 4: I wanna be like you, midwife

When I arrive at a birth, I try my best to think of the major things I need to do before I get there. Immediate needs:

  1. Fetal heart rate, contraction timing
  2. Maternal vitals
  3. Set up equipment and document
  4. Offer vaginal exam (VE)

Generally, as I’m washing my hands after arrival all I’m thinking about is how am I going to do this vaginal exam, steps to finding a cervix, and what different centimetres feel like. Oh ya, and where is the piece of paper that I need to write it down on?

Meanwhile the midwife has already washed her hands, is doing a blood pressure, counting contractions, setting up equipment, explaining the plan to the client, assessing the heart rate … wait, how did she end up sitting on the couch with her hands poised, handing me a piece of paper, waiting patiently for me … who only had one job?

She even has enough time to tell the client to position herself in the position I need to do the VE … damnit, I barely have one glove on … and I forgot to open the gel before I put gloves on so my preceptor has to do that for me … I was getting there I swear!

Is that going to be me someday? I wanna be like her, someday (in 9 months, to be exact). Right now that seems unlikely …

Slowly, slowly, catchy monkey …