How does one transition into transition, per se? How does a student midwife make the transition from observer and learner to realizing the full weight of the task in front of her, make decisions, and realize the power and vulnerability of her position?
I had my transition moment a few weeks ago after a particularly rough day that started in the clinic and ended in a long night with two laboring women who I knew well from their prenatal care visits.
I wore flats that Wednesday. As I packed up my bag that morning I thought to myself, “Better bring my danskos, who knows where this day will take me?” I popped hot pink polka-dotted socks in the soles of my shoes and headed out the door for what I was sure would be yet another routine day of return OB visits, listening to happy, healthy babies, doing birth control consults, and telling (very happy) women that because our guidelines have changed I did not have to give them a pap smear that day.
I showed up, smiling, coffee in hand, and was greeted by one of my favorite patients. She had been having prodromal labor for weeks and just wanted it over. She was exhausted, but managed to give me a smile as I hooked her up to the fetal non-stress test. She was contracting, her cervix changing, so we sent her over to L&D. My preceptor told me we’d be heading over to be with her through the birth after clinic, and I was instantly glad I had the foresight to bring my impenetrable dansko clogs.
I opened my charting system to take a look at the day ahead. One patient, A, had scheduled herself for a problem visit. 27 weeks pregnant and having increased discharge. Probably some sort of easily treatable infection, or just the routine increased discharge of pregnancy, I thought. I looked forward to seeing her again. About my age, full of hilarious questions about her own anatomy, and a boyfriend that stood by her side protectively at every visit made her a joy to have in clinic.
She came in, worried, having cramping for the past two days and enough fluid to soak through pants. I was instantly on heightened alert and decided to do a sterile speculum exam. I popped open my speculum and felt my heart sink. I could see her bag of water protruding through a dilating cervix. I went to get my preceptor, who double checked, and in lightening speed we had given her drugs to both slow down the contractions and help mature her baby’s tiny tiny lungs.
As I explained to her what was happening she burst into tears, and I found myself chocking back tears filled with so much empathy of the fear she felt. An athletic young woman, I looked at her and thought that it could easily be me on the other side of this scenario. I quickly gave report to the EMTs coming to transport us all to the hospital, trying not to let my voice shake, give them confidence in me, give A confidence in me, as my midwife and consulting doc would be staying at clinic.
I wished desperately to be able to have the power to stop her labor, dry her tears, comfort her and her family in this moment of fear and uncertainty. Her contractions continued, no matter how many drugs we pumped into her body. Her bravery was immeasurable, tolerating body-wracking chills, nausea and vomiting due to the drugs that we were giving to try and mature her baby’s lungs and brain. We had the NICU team come talk to her about what challenges a baby born at 27 weeks may face, and as silent tears slid down her young cheeks, she bravely nodded and told us she understood.
I felt powerless, useless, my small gestures to try and comfort could never be enough as this family’s life course was drastically changed by the impending birth of an early preemie. One of the hardest things to learn is that I could not let my emotions overpower me, because I had to walk two doors down and give my whole self, my best midwifing to my other patient in labor.
I stepped outside for a moment. Breathed in the dewey scent of a damp twilight, took a few moments, and returned to my other patient. Her labor progressed quickly, uneventfully, her friends and mother there for support and guidance.
She reached pushing effortlessly, but as she pushed, my preceptor and I watched deep, deep heart rate decelerations develop. Her epidural was too strong, she couldn’t feel enough to push, and the baby wasn’t coming. The decels continued, and I glanced at my teacher. She looked back at me, remaining calm, but asked quietly, “Will you call out and see if our consulting doc is still in the house?” Also trying to calm my quickly accelerating heart, I used the intercom to ask, in the most even tones I could, if our doc was still on the floor. He was, and came into the room, took a look at the monitor, the deepening decelerations on the screen, and quietly recommended an episiotomy, and the vacuum afterwards if the baby still wasn’t coming.
We nodded, cut, and soon a pink, screaming little girl was in her mother’s arms. Everyone healthy and happy in that little room, and concern over a decelerating heart rate conducted so calmly and quietly that no one seemed to be alarmed.
I held myself together until we stepped out of the room, but then my emotions washed over me in the most intense, real way they have through midwifery school. Soon I would be the midwife standing at the end of the bed, watching the decels, calling my back-up doc, instructing the nurses to start the oxygen, make the call to cut an epis ,and no one would be standing behind me. My ability to assess a situation, act quickly, calmly, and comprehensively will mean the difference between good outcomes and bad outcomes.
I have always known midwifery is a difficult, sometimes heavy calling to bear. Although it is usually filled with joy, beauty, and love, tonight I felt the weight of the other sides of midwifery: the fear, the sadness, the powerlessness to prevent. A’s labor continued through the night after I went home, and ended up delivering the next day. To my knowledge, her little baby is getting stronger in the NICU every day.
After having experienced this night I have had many simple, joyous births that fill my heart with all the happiness that I envision midwifery to be. But these nights, the dark ones, the scary ones, they push you and call upon you to confront your own fear, weaknesses and strengths, and remind me of the true meaning of midwife: with women. With families. No matter how hard.