A Day in the Life of a Midwife

By Adrian E. Feldhusen CPM, NHCM

It is Friday. I know from prior experience that the snowstorm brewing off the coast of New England will surely bring a baby. Babies love snowstorms! At this time, I have 2 mommies to be that are 2 weeks overdue. I would love for one of them to appease me. In all my years, my favorite births happen during snowstorms.

Sure enough, the pager goes off at 1:45 AM. But it isn’t who I thought it would be- it is a woman who is due just a few days before Christmas, 2 weeks from now. Her water just broke and she is having little cramps. I tell her to go back to bed, page me again when they become regular, and I try to fall back asleep myself. I look out the window, to notice that the snow has not yet begun to fall. At 3:30 AM, the pager goes off again. They have started, and are about 10 minutes apart and getting somewhat stronger. I tell her to sleep if she can, eat when she is hungry, and keep me posted. I mentally go over my day in my head- do I have a sitter for my children? What do I have in the freezer that I can put in the crock pot for dinner? Can I be quiet enough if I wake up now and scrub my bathrooms that I won’t wake the family? I decide that I probably can’t, and go back to sleep for a little while longer.

The pager goes off again at 6:45 AM. They are now 6-7 minutes apart. The snow is coming down heavy right now, and the roads are completely covered. The world is incredibly hushed and quiet. I decide that in a little while, I should probably go fill the big birth tub with warm water in preparation for the upcoming labor, as it takes a few hours to get it full. Feeling like I have not had much sleep at all, I roll around in bed a while before getting up and fixing myself a cup of tea. The kids start to stir, and we make breakfast together as I shower and dress in my “birthing” clothes. I call my faithful apprentice, who gets on the road quickly, as I call a sitter and fetch her from her house so my kids are happy and entertained all day. Dinner is thrown into the crock pot, laundry hung over the woodstove, and the dog is fed. I head out to the center at around 10 AM.

As I drive down the road, I go over in my head all that needs to happen today in addition to having this baby. I feel grossly overwhelmed for a moment, before sighing and resigning to the fact that I am only one person and can only do what I can do. I left instructions with the middle daughter to please bake these 4 batches of cookies for our open house the next day. My son has orders to bring in firewood and keep the woodstoves running hot. The little one has been told not to fight with her brother and sister and to behave. The sitter has been briefed on what to do if the chimney catches on fire accidentally or someone else needs my services during the day. A little relief comes over me.

I arrive at the center about 45 minutes later, after thoroughly enjoying my drive through the snow covered woods. The family says the contractions are steady at about 5 minutes apart and they are going to see the Chiropractor for an adjustment at lunch time. The tub is being filled and the room is readied for the family to arrive anytime they need. My apprentice and I go out for a wonderful lunch, knowing we will have little time to nourish ourselves before long. We go over all the little details of this woman’s history, previous horrible childbirth experience, and what we can do to serve her today as she gives birth this time. The excitement is setting in- I still to this day get excited every time a baby is on the way.

Back at the center, we decide that we have some time to spare. The two of us cut and hang 11 ceiling tiles in the newly constructed back room. We joke that our husbands would be in fits of hysteria to see us now… climbing on ladders, tools strapped to our sides. The ceiling is done to our satisfaction, so we set to work cutting and laying the carpeting down. Once completed, a final clean up and move the furniture in. We marvel at our work for a brief moment. Out to the front office, where we work on some paperwork, insurance billing, and making new brochures for the center’s open house tomorrow.

I get an email from the Department of Health and Human Services. How are the new birth center rules coming? We need to get them back to the state for final approval next week. I pull out the file and begin to work on the final details. We are updating the laws regarding birth centers and how they operate. I promise to get them out in a day or two. As I furiously type, a call comes in to the center- it is a client, wanting to know what she can give her newborn baby to stop the hiccups. There must be something wrong with it- they are happening all the time. No, I assure her, hiccups are normal and just a result of an immature diaphragm. They bother the parents more than the baby. Just let her be. It will get less as she matures. As soon as I hang up the phone, it rings again. My son wants to know if he can have a snack. “You are a teenager, I think you can decide if you can have a snack by now.” He laughs at me and tells me that he loves me. It makes my whole day. In the background I hear the 5 year old screaming- and am happy that I am not at home to break up the argument that is obviously ensuing between the two sisters. I tell my son to get her a homemade cookie and put some art supplies out for her to work on. Distance mothering- it is an art.

The call comes at 4 PM, the family is ready to come to the center. They arrive at 4:30, and remarks fly about how wonderful she looks- hardly in labor, handling it beautifully. She smiles and wishes that things would pick up and this baby would come… I hug her and tell her that it will be all right- her body knew how to conceive this baby, how to grow it, and it will know how to birth it. She sways as a contraction surges through her belly, encompassing her entire being for a minute. After it is over, she waddles her way down the hall and into the birth room to unpack her things and settle in.

The phone rings again, it is my husband. What is for dinner, he asks? He is on his way home from work and will relieve the sitter. I tell him that there is food in the crock pot, cookies on the counter, and laundry that needs to be folded and put away. He asks what kind of cookies… I smile, knowing that it will occupy his mind until he gets home and has one in his mouth. He makes me promise that I will call when the baby comes. It is very sweet that he still worries about me in such a way after all these years. I am not sure what my evening will hold for me at this point, and if I will even be home to sleep tonight. I give him instructions on what clothing to bring for me in the morning should I not make it home as it is a big day at the center and I must look my best. The governor’s office is looking for me, they need some information before they can finalize the appointment of my latest position on the Midwifery Council this week. I sigh as I try to wrap my brain around all of the little things once again that must get done today.

My apprentice and I discuss the latest babies, the ones coming up, and we formulate our plans. She tells me how she isn’t too keen on going to the birth with the chicken wearing a diaper and a dog that nips at your feet under the bed. We come up with the idea to wear boots to protect her toes, and not think about the chicken. We hope that the woman in Maine doesn’t have her baby at the same time as the woman in Vermont. Both are very overdue right now. Settled that we have no control over such things, we have a lengthy discussion of what to do when a woman has a postpartum hemorrhage and how to handle it. Teaching the next generation is a very valuable part of midwifery, I believe.

I go down the hall to check the mother in labor. She is laboring well in the big birth tub right now. Her contractions are picking up now and she is completely focused on what her body is doing. The Doppler hears the baby’s heart beat loud and clear, thumping along steadily. I settle into some more paperwork as she relaxes in her husband’s arms for a while in the tub. I check the legislative calendar for news on our bill that we have worked so hard on. It has been a few weeks since my final testimony was heard in the House of Representatives Commerce Committee, and as of last news, it was a unanimous vote out of the committee and will be on the consent calendar. This means it will be signed into law in the spring after the Senate approves the amendments. The law will mandate insurance reimbursement for anyone in the State of New Hampshire who wants to have an out of hospital birth- specifically a birth center. In the fall we will introduce the legislation to expand it to include home births as well. It has been a tremendous victory for all of us, but mostly for the 3 midwives who put an incredible amount of time and energy into the project, testifying, and lobbying repeatedly and tirelessly. I never thought of myself as a politician, but being passionate about something will change your own personal boundaries in ways you never thought possible.

Satisfied that this has passed into the next session, I begin work on billing for the last birth to the insurance company. Thankfully it is Medicaid, who pays us very quickly and easily. Some of the other insurance companies take months, if at all, and not without a fight. I register the birth with the Department of Vital Records. While I am on paperwork again, I fill out the latest additions to our database, update our web site information, and add a few photos to our slide show to be shown tomorrow at the open house. I remember that I need to call my senator on Monday morning to lobby a bit for us at the upcoming JLCAR meeting- the Joint Legislative Committee on Administrative Rules. Just a fancy name for a group of legislators who will decide how I practice for the next 10 years of my life, most who don‘t know a thing about a New Hampshire Certified Midwife. Now I am being called from down the hall.

She is having to work hard to stay on top of her contractions now. She needs lots of energy, positive affirmation, and hands to hold to make it through. One by one, we praise her each time she gets through the powerful surges that are working her baby down. She suddenly leaps out of the tub, and kneels on the bed clutching her husband’s shirt. Powerful moans and this incredible birth song fill the air. Slowly we begin to see the head, full of dark black hair, emerge. She says she feels like she is tearing in two- we assure her that her tissues are completely intact and she is doing just fine. A few more pushes, and out comes the head. The baby opens its eyes and tries to cry, even before it is completely born. I wiggle my fingers in under the head and find a cord around the neck, so I loosen it a bit and allow it to slip past the shoulders as they emerge. Out he comes, in all his glory, covered in dark hair and crying loudly. It is now 8:23 PM. We hand him up to his mother, who is still kneeling and grasps her baby to her chest, crying. Another life born into the world, gently.

Settling into the bed, we tuck the new family under the covers and busy ourselves cleaning up. In just 16 hours, guests will be arriving for the open house. Laundry by the load is being done. The tub is drained and scrubbed. A meal is made for the family. We perform a newborn exam and proclaim the baby perfect, of course. Her bottom check for tears and estatic that there aren’t any, she takes a shower and roams around the center with her new baby in arms. The charting done, paperwork completed, and our work finished, I go home and leave my apprentice to release the family when they would like to go. It is now 11:30 PM.

I arrive at home, hit the pillow hard, and hope that the pager doesn’t go off again tonight. I have this feeling that the open house will go really well tomorrow but that another baby will be born in the midst of the excitement. Sure enough, halfway through the open house, the call comes- “I am in labor” is heard once again. We are going to southern Maine this time. Off we go at 2:45 AM. Oh yes, and did I mention that the Vermont baby came the following day? 3 babies in 4 days. What a life.