I often find myself reflecting on previous births I’ve attended. As a new midwife, I reflected on the mechanics of birth. How could I have prevented her laceration? Could I have positioned her better or intervened more or less? In school you are taught to review the ways to resolve a shoulder dystocia on your drive to a birth and the management of a postpartum hemorrhage on your drive home. That way, the management of those two most common obstetric emergencies are routine. Even after ten years of practicing midwifery, I still find myself reviewing those emergencies to and from the births I attend. But more and more these days, my mind will wonder, my reflections are no longer related to the mechanics and management, but on small things...a look the mother gave me before her last push; the tender support of a partner; the scared, nervous hands of a soon to be grandmother rubbing her daughters back with vigor. Bearing witness to these moments are the true joy of midwifery. However, the first birth I witnessed, I was unaware of the mechanics, unaware of the cardinal movements or perineum support and head control, unaware of the management of a shoulder dystocia or postpartum hemorrhage. I was a true unbiased birth witness.
It was the fall of 2000, I was a naive freshman at Skidmore College where I was studying biochemistry with the plan to head to medical school. Emergency medicine had always intrigued me. I became an EMT prior to arriving at college and loved the endorphin rush of an emergency call and the relief you saw on patients faces when you said, “I’m here to help.” My career plan was simple, Skidmore College for a well-rounded liberal arts degree with a strong background in the sciences, then medical school, and then emergency medicine residency. I had it all figured out. However, as life goes, these plans were about to be changed. On parents weekend at Skidmore, I got to chatting over dinner with a friend’s mother who was the nurse manager in our local emergency department back in Connecticut. She found out I was an EMT, interviewed and hired me on the spot, all over our pasta primavera dinner. “Perfect” I think, this experience will fit so nicely into my life plan. So it's there I find myself 8 months later, working an evening shift and about to witness an event that would change the trajectory of my life and career plans.
I am working as a patient care technician, basically a nurses aid with some additional job responsibilities specific to the Emergency Department. I loved the work, I loved talking to patients and their families. I loved watching the nurses and doctors care for patients and complete their tasks. I loved being “in it.” This particular day it was early evening and I’m cleaning the middle bed in “room 4”, getting it ready for the next patient. “Room 4” was reserved for the TRUE emergencies. It was a larger room, so it allowed for quick turnover to have extra space. The triage nurse quickly wheeled in an 18 year old girl and sternly said, “get her changed now.” I was shocked; the girl looked well enough, certainly not sick enough to take up “room 4.” But I did as I was told. The girl was clearly scared. She stripped herself naked. As she stood in front of me I saw her naked body. She still looked well, was slightly obese, but no signs of obvious illness or emergency, so I remained confused. I helped her into a standard hospital gown and she laid down on the bed. The room then started to fill with staff and I was pushed to the end of the bed. Within 5 minutes, she was crowning and delivered a beautiful, healthy baby with a strong cry. It was surreal. This woman was silent, not screaming out in pain like the movies told me she should. The newborn continued to cry as the NICU team assessed the baby, all the while, the mother, this 18 year old scared and quiet woman stayed silent, scared, detached. The OB was now in the room, congratulated the woman as she would any other newly postpartum mother and asked if she wanted to hold the baby. A small, timid head shake “no,” was her only response. That was it, no one else addressed the mother. The baby went into an incubator, the new mother stayed alone on the stretcher and both were wheeled upstairs to maternity. The room was quickly cleaned and ready for the next “emergency.”
I followed the team with my eyes, slowly walked in their direction so I could watch the team and two patients wheel out of the ED. The baby in an incubator and the mother on the stretcher. She was alone, not just physically, separated from her newborn child, but clearly alone emotionally. She appeared so disconnected, so disempowered. The whole event occurred in about 15 minutes, but the look of the mother as she was wheeled away, her blank stare toward the ceiling has stayed with me forever. That internal emotion of witnessing birth and a disempowered mother, will stay with me forever. It is that moment that has shaped my career.
A good family friend also worked in that ED as a paramedic. He called by parents that night to inform them that I “was hooked.” He said, “Suzanne is going to go into obstetrics. I’ve seen that look before and she is hooked.” He was talking about birth and about new healthy babies. He thought I was hooked on that. He was right! I WAS hooked, but what he didn’t know, is that although the birth was amazing to witness, I was hooked on the mother’s emotions, her hidden emotions. Her stoic expression as she effortlessly pushed her first born into the world, her fear that was palpable, her vulnerability, and her disengagement which was the only coping mechanism she had left. It was on that day that the future med school plans changed to midwifery.
Anyone who has ever talked to me about birth will know this. I am amazed by the continuous power of pregnancy and childbirth. I will typically talk about the power of birth to empower a previously disempowered woman. It is a motivator for positive change in a woman’s life, to quit smoking, eat healthier, leave an abusive relationship. A positive birth experience can heal wounds, often ones that are unrelated to childbirth itself. I once had a patient, who shortly after an unmedicated birth, yelled, “I AM A FREAKIN’ ROCKSTAR!!!” with her arms outstretched. She was a rockstar and I believe that her birth, that feeling, that empowerment crossed over to many aspects of her life. But unfortunately, birth also has the power to do the opposite. It has the power to make a woman feel unfit to be a mother, to feel that her body failed her and to question what will I fail next? The power of birth is that it is too powerful.
Afterward I learned that the young, scared woman had told her mother the night before that she was pregnant, she had received no prenatal care and no support. For ten months of her pregnancy, she hid it from the world. I can only imagine, she hid it ashamed, scared and disempowered. I find myself wondering where she is now, what came of her and who raised the baby. That newborn should have graduated high school last summer. Thinking about her birth still catches me off guard, and her face will still enter my mind practically every birth I attend. When I think of her birth, I can only see her eyes staring up at the ceiling. Other details are blurry, I can’t even recall the gender of the baby, but I can see her face and what her face meant. I never want one of my patients to feel the way she felt. The power of birth is not that it is creating life, but that is a real time demonstration of how powerful a mother is. It should be every birth workers goal to help the mother see that power too.
For more information on traumatic birth and healing from traumatic birth, visit www.pattch.org, The Prevention and Treatment of Traumatic Childbirth whose mission is to expand awareness and advance knowledge about traumatic birth and its adverse impact on all childbearing people and babies.
