It is 6:15 am, and your phone rings. You reach for it, knowing that it has to be urgent because it is your, “GET OUT OF BED — someone is having a baby!” ringer. It is a blocked caller, a fellow midwifery colleague likely.
“Hello?”
“Hey, it’s me, can you come to relieve me? I have been awake for twenty-four hours and I am fading”.
“Of course, no problem, I’m on my way.”
You jump out of bed, peel the toddler off of your chest who has been waking up teething. You brush your teeth, hit “start” on the coffee machine, put on your birth clothes, and head for the door. Wait…. Breakfast! You grab a banana, your coffee and head out the door. You arrive at the birth, smiling, but secretly tired because many babies have decided to come this week. It is okay though and you know this client. You know that she is finally labouring, and you know that she is afraid of her allegedly big baby, afraid because she knows that her vagina is going to tear into the abysmal state that her friends have warned her about in their birth stories.
“Hey, you! You are doing it! You are having your baby!” You are met with a sigh of relief when the client looks over. She’s glad you are here, another friendly face, and knows that you have her back. You immediately sense the relief, you watch her shoulders drop, and a half smile forms. Her partner smiles though, he’s glad you are here too, with some energy and ready to make sure she is okay.
“I don’t know if I can do this? I don’t think I can do this”, she says abruptly.
“You can, and you are,” You say. You put your hand on her head, bend over, and say:
“Listen, I know that you are scared, I know that this is all new for you, and you came into this with a thousand different ideas of how this was going to go, or what your body can do, but you need to say ‘I…can….do this.’ I know we aren’t sure how this is going to end today, but we are going to help protect your space, to make you feel safe. If we do our job properly, you will be happy with whichever way your baby comes into this world”.
She starts to cry, “Are you sure? How do you know? How can you be sure?”
“Because I have seen hundreds of women do this before you. Go inside, and tell your baby that you are ready and that you are going to help them make this journey, I know it sounds silly, but it helps”. You don’t have time to explain how you know this to be true.
She takes a deep breath, melts into the bed, closes her eyes and she focuses. “Okay baby, I have you, I am ready, come however you need to.” Then, the surrender. Off she goes, to another world, another place, another time. She isn’t sure where she is going, she isn’t sure how to get there, but she goes anyway.
You watch her and think back to when you were a midwifery student. You wonder how you ever came to know this? At what point did you learn how to touch labouring women? At what point did you come to learn what to say? When did you start to fully understand that women move, roll, sway, squat, grunt, cry, moan and need to feel so….. safe?
At what point did you come to learn exactly where to find the baby’s heartbeat with the doppler machine? At what point did you come to know when things weren’t going well? How did you learn this supposed ‘sixth sense’ of what clients need, when they don’t even open their mouth, or say a word?
“Oh, it hurts! I can’t… I can’t... It hurts!”
“Okay, breathe, just breathe. Slow your breathing if you can, I know it is hard, but go inside and pay attention to what is happening”.
“Do you feel something new? Look for where you feel everything, is it pressure?”, you say. “Is it in your back? Your front? Down low? Look for that pressure, let it build, let your baby come.”
Her eyes are still closed, she’s somewhere else. Somewhere in another place and time. You can hear her breathing, and she moves into the position. It is the position you know she needs to be in when the baby’s head comes down into the pelvis, coming around the curve of her pelvis, and about to tell her exactly what to do.
“I don’t know what to do! I need this to be over” she pleads. “I feel pressure, I feel the pressure”
“Great, let’s use gravity, let’s move onto your hands and knees and see if that helps”, you offer. She slowly moves to an upright position, because we know gravity speeds this up, and often helps.
“Is the pressure there all of the time? Or just between each contraction?”
“It is all the time, I think I need to push”
“Beautiful, when the next one comes, take a breath, and push down, see how it feels, you will know if it doesn’t feel right”.
She pushes with the next contraction and you can hear in her grunting that the baby is coming down. You don’t need to check, you don’t need to cause her to doubt her body, after all, she was almost fully dilated before, she is likely fully dilated now. You sit back and you do the calculation in your mind. Your brain is working rapidly. You are taking in all of the clinical knowledge, calculating how fast you think her labour is progressing. You're assessing whether she is ready to push and whether she is fully dilated. You are thinking about the position of her baby. Is the baby lined up nicely? Or stuck in a position that is going to make things harder? Is she in the right position? Or does she need to squat or move onto her hands and knees? Does she need a break? Has pushing been unsuccessful? Does she need to lay on her side? This usually works, you remember. Does she tell you that she “really” doesn’t have any more energy left, and she simply can’t go on?
You say, “let’s go sit on the toilet, the toilet is magic in labour. Your pelvis will relax, and the baby will come around the bend- you’ll see”.
You check in with her partner, communicating every step of the way. “The baby sounds great, very happy. She is progressing nicely and is almost ready to have the baby. Do you want to catch the baby with me?”
“Catch the baby? Wait, What? Catch the baby? No, I don’t think I can do that.”
“Are you sure? It’s really easy? She does all of the hard work, you just get to help her meet the amazing person that comes from all of this”.
“Really? Okay, you will make sure I do it right?”
“Of course, if there are any complications, we will move you out of the way, and carry on” I assure them.
She is quiet now, almost sleeping between contractions. Her partner says “Is she okay? She was frantic a minute ago, now she is out of it?”
“Yes, she’s okay, she is likely ten centimeters. We will find out shortly, let her rest, it is her body’s way of taking a minute. Clients rest often when the cervix is gone, to prepare for pushing, let's just not interrupt her”, you explain.
She starts to push, she isn’t sure if she is doing it right at first. She looks around the room for some confirmation that things are going to be okay. You look at her and, using your midwife voice, you say “Okay, your baby is coming really soon, when I tell you, I am going to ask you to breathe, and not push. I know it is hard, but let’s try and do this together, I got you”.
She pushes and pushes, and the baby’s head slowly starts to deliver. She opens her eyes wide, “is the baby out?” She is on her hands and knees, face emerging from the pillow, her dark, safe place.
Her partner is holding her hand, “you can do this, you are so close, keep going, listen to the midwife”.
“The baby is almost out, with the next contraction”, you say. The lights are dim, she moves her knees as far apart as she can. The baby’s head is slowly starting to come through the vagina.
“Okay great, your baby is right there! A couple more pushes, and you will be done, so soon. Now, with the next contraction, give a push, and then breathe.”
She holds onto her partner and the head of the bed for dear life. She closes her eyes, and reaches one last time, somewhere out into the world, into a place that we can’t even see, a place where she goes to collect her baby and bring them home.
“Okay, are you ready?” you say to her half anxious, half excited, partner. The partner comes around, sees their beautiful baby coming through.
“Okay, go ahead and give a push”, I urge. I use my midwife voice, my confident and everything is going to be alright-voice. She is on her knees, on the brink.
Then, that moment happens. That moment when the partner feels their baby fall into their hands for the first time. They freeze and she lets out the biggest sigh of relief. She slowly comes back into her body, looks around, as if she has been away, and isn’t sure for how long. She hears the sweet cry of a new life, one that she will never forget.
“Wow, what a beautiful birth”, you say. “Okay, you can pass the baby through, underneath, between her legs. I will help you. Are you ready mom? To meet your baby, when you are ready, reach down”.
You smile, because here is the best part, the partner is still standing there, holding their baby, and in awe. The umbilical cord still attached. They are staring through tear-filled, misty eyes. They are frozen in time, trying to find a way to say what they feel. “You did it, you did it! We have a baby!”
You help the partner move the baby up onto the mother’s chest. You reach for the camera, to try your very best to capture this moment in time. The client has collapsed into the bed, shaken and relieved. They lay there together, the three of them, sobbing, grateful, relieved, making one of the sweetest memories they will ever have.
For a minute, as a midwife, you feel full, the fullest you can be. You feel grateful to be a part of such an amazing moment. You take a minute and feel joy for all of these micro-moments in time that help make you the midwife that you are.
She looks up at you and smiles. “I did it! It’s over,”
“You did it… it’s over, just like I knew you could”.
This is just one example of all the ways that clients give birth.
Being a midwife means holding space for everyone, regardless of how complicated their life story is. Being a midwife means that you are good at creating a place where people can come, and be at their most vulnerable. A place where you can reflect on what your hands were telling you, whether you were right in your thinking. A place where you can hold their hand while they are on the operating room table, a place where they are grieving and need you to help them with their pain. Being a midwife is one of the heaviest and most joyful jobs in the world.
Sometimes people roll their eyes when they hear about women wanting to have so much control in their births. Healthcare providers sometimes have trouble looking past the need for control… at what is underneath.
Why is it so difficult for people to understand that some want a shot at birth where they can just be left alone? Instead of asking why so many women can be so difficult, and criticizing them for not knowing that birth doesn’t go as planned - and to just accept it. Maybe we need to start thinking about why we have such a culture of fear in childbirth? Why do women have to fight so hard to have autonomy and to be allowed to birth on their hands and knees?
Not all midwifery births are like this one, but many are, and although we aren’t perfect, we know that when you come to us, you are looking for a safe place. Maybe we need to stop asking our clients why they are in such need of control in their childbirths, and start asking why they are coming in so afraid?
Being a midwife is so much more than any of us could have ever hoped for.
Happy International Day of the Midwife to all of the amazing midwives out there who are working tirelessly to negotiate being the best midwife, partner, and mother you can be. All while constantly learning, growing, and helping people find their way.
Congratulations to the Midwives of Ontario, for fighting for pay equity and the right to be compensated for what our work is worth. Just because we are primarily a large group of women, working for women, performing traditionally ‘women’s work’, it doesn’t mean we do not deserve to be paid fairly. Caring for pregnant people is one of the most wonderful and honourable things we can do as a society and culture. Women and pregnant clients are helping to raise the next generation and without them, we are all lost.
Happy International Day of the Midwife from one Midwifery Family to the next!