Saturday, January 21, 2012

So, you want to be a midwife?....

This profession is definitely an adventure, and is never dull. It requires strength, both physically and mentally. At the birth center where I work, we take 24 hour call shifts 1-2 times a week. These are our "labor" shifts and I generally look forward to them. The following is an example of a recent call shift that I had. A day in the life of a birth center midwife....

I woke up at 6:00am, got my three children up and ready for school. I also get report from the midwife who had been on call before me, and one of our Mama's, Sue, had started labor last night and her water broke at 11:30pm. The fluid was clear, baby was moving great, and her GBS (group beta strep) test had been negative, so she was laboring at home with her husband and family. At 7:30, I get a call from a sweet first time Mama, Carrie, whose water just broke. She is not yet having any contractions, the fluid is clear and her baby is moving well. Since her GBS test had been positive, we plan to meet at the birth center, so I can give her some IV antibiotics. She arrives in high spirits and is excited that her baby will be coming soon. I start her IV and the antibiotics, take her vital signs and listen to her baby. Both she and babe are doing great. Since her water is broken and she is not in labor, I do not do a cervical exam. She decides to wait on starting any herbs to start labor as she feels confident that things will progress well. We make plans to meet again in four hours for her next dose of antibiotics.

I decide to stay at the birth center. One of the less glamorous sides of being a midwife is the paperwork. There always seems to be some sort of charting to is a never ending process. I get a call from Sue's husband, he just wants to check in. She labored through the night, then had a nice nap through the morning and is now starting to labor again. We talk about making sure that she gets enough fluids and eats well. They will check in again later. A little while later, Carrie returns for her next dose of antibiotics. She and baby are still doing great and she is now starting to have some cramps. Again, she declines any herbs for labor stimulation and heads back home to go to her prenatal yoga class.

I go over to the clinic to see if anyone needs anything....and, of course there is always something. The day before, one of our ladies had presented to her prenatal appointment, at 39 weeks, and had very high blood pressure. She felt great and denied having any symptoms of a problem, however, due to her pressures we drew blood work and ordered urine tests. Today her tests had come back abnormal and we had to diagnose her with mild preeclampsia. This condition, at her gestation in pregnancy, requires immediate induction of labor. Needless to say, this was difficult news for me to deliver and for her to receive, she and I, and her husband, spent a long time on the phone discussing the situation. I called the physician who would take care of her and gave him report, then called the labor deck at the hospital and faxed all of her records to them. By this time, Carrie had returned for her third dose of IV antibiotics. At this point, she decided that she would like to try some herbs to encourage labor along. She and her baby continued to look great, so I gave her the herbs and instructions and she returned home.

A little while after Carrie left, I get a call from Sue's husband and they sound ready to come in. Sue's labor had really intensified over the last few hours and she was eager to be evaluated. They arrive to the center, take time to settle in, and I check them out. Sue and the baby are doing good and she is 3-4cm dilated. They settle in for the work of labor. I call in our student midwife and we all get down to business. Sue's labor pattern and her problems with persistent back pain, lead us to think that her baby may be posterior, so we get to work to encourage the little one to turn around....

By now, it is time for Carrie's next dose of antibiotics and she arrives. She and her husband are excited and looking forward to meeting their little one. Carrie seems a little more reserved, is reporting "stronger cramps" and is having trouble standing still. I call in my nurse to come help so that both Mama's can have continuous support. Again, Carrie and baby are doing great. I do her first cervical exam and discover that she is 5/80/0! Since she is not really contracting yet, we all decide to try a little nipple stimulation...which works like magic and her labor takes off. Meanwhile, Sue has progressed to 5cm as well. They are both laboring well. Between myself, our student and the nurse, we support and monitor both families. Then......

I get a phone is a second time Mama, Doris, and she is ready to come in! Here we go! I call my "second call" midwife to give her a heads up to be on stand by and we all get ready. Doris arrives and is rocking out labor, she and baby are doing great and they settle in. Since she is a second time mom, I stay with her while the student and the nurse continue working with Carrie and Sue. About an hour after arriving, Doris and her husband welcome their amazing new son to the world! It was a gorgeous water birth at 0035.

Meanwhile, Carrie has really kicked in to high gear and now its her turn to rock out labor. The nurse comes to be with Doris and I go to be with Carrie and her husband. I check Carrie's cervix and she is 8/90/0...and it has only been about an hour since her first exam! About 15 minutes later, Carrie starts to grunt and push spontaneously. She is sitting on the bed and I ask her where she wants to have her baby....she climbs into the pool, along with her husband, and 11 minutes later at, 0121, welcomes her gorgeous baby girl to the world. After they are all snuggled into bed and stable, I go to check on Sue.

She is working really hard. She has spent hours walking the stairs, sitting backwards on the toilet, rocking on her hands and knees and been squatting in the sling. She has been eating and drinking well to keep her strength up. Still her little one is posterior and still her cervix is 5cm. We have tried herbs to help her relax and she is now starting to become exhausted. We; myself, Doris, her husband and the student, have a long talk. Together, we decide that it would be best to go to the hospital at this point. It is a tough decision, but it is right one at this time. I call the midwives who work at the hospital and they are happy to take care of her. We pack up and all head over to the hospital. As we are driving over, my phone rings.......another first time Mama, Samantha, is in labor and almost ready to come in!!!!! I call my nurse and tell her, she starts getting a room ready. I have just enough time to get Sue settled and comfortable, when the phone rings again and Samantha now needs to head in. I literally run back to the birth center.....

Samantha and her family arrive and with one look, it is clear that she will be having her baby sooner rather than later. The student checks her cervix and she is complete! We all take a deep breath and settle in. A short time later, while on the birth stool, Samantha welcomes her sweet baby girl to the world!

It is now 5am and I am blissfully and completely worn out! I call the midwife who is on call next and she heads in to take over....thank goodness! So, you want to be a midwife?....


  1. Oh my goodness that sounds amazing, super hard work, but amazing! I am about to graduate with my bsn and hope to get a job on an L&D floor before i head off to midwifery school. So excited!

  2. Hi aubre, I was lucky enough to see you the first time my husband and I visited the birth center. I want to be a nurse midwife but since I have a young child I'm becoming certified as a Doula right now. I loved your post, give me great insight into what the daily experience might be like as a midwife! I think it sounds exciting!

  3. YES!! I (still) want to be a midwife!!!!

  4. I am in CNM school right now and I LOVE that you are chronicling your journey, Thanks so much for sharing!

  5. thanks for this. can i ask what birthing center you work at? the dream is to either be in private practice or work at a birthing center once i'm done with cnm school. thanks!

  6. I am a CNM and I can't wait to begin working! I am working as a L&D nurse still until I find a CNM position. My MD's let me do everything except catch...which I miss:( But at least these women are gettting the support of a midwife and I can advocate for the birth that these women want!!

  7. Wow, I just was moved to tears reading this because it takes me back to the births of both my kiddos there and how wonderful all you guys are. I'd heard about this night. You rock! I look at Sierra who will amazingly be 7 months old tomorrow and Peyton who'll be 3 in April and am thankful every day for midwives because I will treasure their birth stories as some of the most positive experiences in my life.

  8. ♥ this is what I am working towards I really cant wait!!

  9. music to my ears..thanks for sharing this. I look forward to my birth center..

  10. Sounds like the best kind of exhausted. :)