If you have worked with birthing women, the following conversation will be familiar. If you have had a baby – or been with someone having a baby – in a hospital, this is the conversation that the midwife and the obstetrician were having outside the room sometime after you arrived:
Obstetrician – Has Trixie Whosibob arrived?
Midwife – Yep, she’s in room 23.
Is she in good labour?
Yes. She’s an uncomplicated primip (first time mother), well in pregnancy, no risk factors.
How many centimetres is she? (meaning: how open is her cervix? not how tall is she)
I haven’t done a VE (vaginal examination) as Trixie doesn’t want one.
When are you going to do one?
Not as long as the woman doesn’t want one. (grinding teeth just a little)
So, we don’t know if she’s in labour. (huffiness is kicking in about now)
She is in labour. (oh dear, I see where this conversation is going)
So you have done a VE? (elevator music?)
No. My clinical judgement (as a goddamn health professional, with eyes) is that she is in labour. She’s contracting 3/60, the head is…….(trailing off as am talking to a fast retreating back)
Just page me when you’ve done a VE. (as her baby will be unable to come out unless someone touches her cervix, you mad hippy midwife, don’t you know this is a hospital?)
(kill me now)
* * *
I used to wonder how an eight hour shift with a labouring woman could be so draining. I’d leave the hospital absolutely washed out, just capable of steering the car home, not interested in any post-work action more taxing than lolling on the couch and mainlining tea. How could it be so very tiring, when much of my time was spent sitting quietly in the semi-dark and writing stuff down? For a while I thought it was the pressure of responsibility – eight hours of a voice in my head chanting ‘two lives in your hands, two lives in your hands, two lives in your hands’. And that is kind of tiring, but the acuteness of it fades after the first few months in. Then I thought it could be the politics, the non-stop jostling for recognition, understanding, autonomy, respect. And that too can be tiring, but it’s also oddly invigorating, the constant justification of my professional judgement. Hard to get in a rut if you have to talk about it all the time. It could be the hospital itself, the hideous fluorescent lighting, the constant hum of air-conditioning, the alarms, the phones, the visitors, the doing everything in triplicate, the glacial pace of change. But even all of these things slide into the background over time.
Now I think I’ve got it figured out. It’s one of the best parts of midwifery, but also one of the least understood and respected by our medical colleagues (and, disappointingly, by some midwives). It’s this… if you’re open to it, midwifery is a job that engages every one of your senses and something more, something utterly intangible.
Yes, if a woman lets you, you can stick your fingers in her vagina and feel how open her cervix is. But that is just one piece of information and it’s not as illuminating as so many people believe. You can put your hand on her belly and feel how often her contractions are coming and how long they are. And you can feel her belly all over, feel what position her baby is in and how far down the baby’s head is. You can do all of this and still not know very much. Where it gets interesting is beyond touch, beyond the measurable.
Sit in the room with this woman. Not up in her face, but off in the corner. Be quiet. Pretend to occupy yourself with notes though, so you’re not just sitting staring at her like a zoo exhibit. Now watch. Listen. Smell. What is the look in her eye? What does she sound like when she’s getting through a contraction? What is the smell on her breath? How chatty is she? How restless? How out of it?
Beyond this again, what do you feel? Can you sense momentum? Do you just know that this labour is steaming ahead, relentless. Are you with a woman who is so quiet, so still, but somehow you know you cannot leave this room, that her baby will be here in minutes? Or is it an absence of momentum? Are you watching a woman who is making a good show of being in labour, because that’s how she thinks she should act? Or is she stuck in a labour that is going nowhere, that is every bit as intense, but is somehow stalled? Is this feeling of absent momentum her? Or is it you? Are you impatient, wanting her to birth on your shift, at your pace? Are you hesitant, willing her to hold back, fearful that her reportedly ‘big baby’ will get stuck in your hands. How are you, even subconsciously, pushing your needs into this space?
Now get out of the room and summarise this for the obstetrician on shift.
Is Trixie in labour?
Yes. I can feel it in my body.
No obstetrician is going to give two hoots for what I can feel. They want a quantifiable measurement. They want a number they can pass onto their colleagues without fear of ridicule or criticism. They want a timeline, a schedule, a plan. This isn’t really their fault. We work in a big system that thrives on order and predictability – not feelings.
This is why my job is draining. I’m sitting quietly in the semi-dark, writing stuff down, with every nerve-ending on high alert. I’m as open as I can be to absorbing this woman’s labour, to sensing it, integrating it into my body. It might sound mad, but it is based in something real: hormones are catching. I’m sure every one of you has experienced sensing someone else’s mood. Have you walked into a room and been stopped short by tension or anger? Have you ‘caught’ someone’s ‘infectious’, buzzing happiness? Wisdom has it that what we say accounts for far less of how we are perceived than how we say it (ie body language matters more than words), but even that isn’t the whole story. So, I’m feeling all of this, absorbing all of this. Then I walk out of the room, push it all down, look the obstetrician square in the eye, put on my best serious health professional voice, summon the magical phrase ‘My clinical judgement is…..’ and hope like hell that it’s enough.