B & Me: A graduate midwife's story

The Interview

“If you are successful, you’ll be looking after complex, high risk women. But you’ll be well supported in doing it.” B said, kind and serious at the same time. 

“I understand. I feel like, by the time I finish my course requirements, I’ll be ready. I’ll be ok.” I tried my best to look as if I meant it.

"Undergraduate, post graduate, dual degree, it doesn't matter where you've come from. By the end of the graduate year, nobody can tell the difference," B said with confidence. 

I burst into tears once I got back to the car. I had no idea if I’d ever be ready.

*    *    *

There was a note in the diary.

The diary usually just contained a list of scheduled caesarean sections for the day. By then I’d attended seven full shifts of scheduled caesareans. I was nearly finished the two weeks of elective sections we were all required to endure as part of the Midwifery Graduate Program. I was more than 6 months into my graduate year and feeling less and less useless and out of my depth each day. I greedily lapped up each experience as it came.

Next to each name on the list in the diary there were numbers and letters, mainly acronyms, which hopefully provided information about the indication for caesarean and potential complications. Next to the third name on the list the letters, “NNM / PLS” had been written. This meant there was a neonatal management plan in place. The letters, PLS, stood for Perinatal Loss Service and indicated that planning had occurred around what would happen in the event that the baby did not survive. There was an accompanying note.

A particular Consultant Neonatologist was named in the note and was to be called to discuss the plans and to ensure he would be completely available to attend. When I spoke to him he told me that the baby had a heart defect, but it was impossible to know the extent of the defect. If it wasn’t so extensive and the baby could be successfully intubated and oxygenated, it might be able to be stabilised and it could have an operation to fix the heart.

If the intubation didn’t work to stabilise the baby it meant that the defect was extensive. If the intubation didn’t work they wouldn’t make further attempts to resuscitate because, the Neonatologist advised, it would be unlikely to help. If the intubation didn’t work, they would stop. They, the parents, didn’t want cardiac massage. They didn’t want their baby given adrenaline. They wanted to let the baby go peacefully, if that’s what was to be.

I wasn’t going to be the only midwife in the theatre. My colleague, another young midwife, with a stunning smile and matching attitude would be there, too. There would be neonatal nurses, Obstetricians, Registrars, Junior doctors, students. I felt safe, supported. Just like B said I'd be. A baby might die, but there was a plan and I knew my role and what I was supposed to do. I knew what to say. I knew what paperwork needed to be filled out. I was ready.

*    *    *

Week 4

I swore under my breath and did a quick about-face. I was speed walking the wrong way down the corridor. Up and down the halls of the postnatal ward, I always seemed to be walking the wrong way. I spun around abruptly and B was there. Just checking up.

B was the Graduate Midwifery Program coordinator. She looked after us all, mother hen-like, trying to make sure we swam, rather than drowned, in our graduate year. “Are you going ok?” she asked. She had probably heard the swear words and could smell my stress-sweat.

I was carrying a piece of paper, tattered from being folded and refolded since 0700 hours. It was an A4 schedule of medications and observations, scrawled hand writing across a printed table, multiple crosses, ticks and scribbles. I had taken it out my pocket to try and figure out what I should be doing next. And which direction I should have been walking. I refolded it and put it back in my shirt pocket with the three pairs of scissors I’d managed to acquire that morning.

“All good!” I lied, "Just busy." I plastered on my fake smile, the one I used for patients in the hallways. At the same time I ran a list of outstanding tasks through my mind, tried not to let any of them drift too far away and float off into that part of my brain that stored things and only let them bubble back out when I was lying in bed trying to get to sleep.

“Make an appointment with me if you want to chat, ok?” she said, with a smile and genuine caring.

*    *    *

I can’t remember if he cried when he was born.

I think he did. A quiet cry. A squeak.

He was plump and pink, just like the other two I’d seen born already that day, the two that belonged to the other mum's on the list. I wrote down the time of birth. The Obstetrician passed the baby to the Neonatologist, who placed the baby boy on a resuscitation cot. The Doctor's and neonatal nurses started to work.

He had a full head of black hair. He was, what we’d call, a “good size”. Big, but not too big. Somewhere between 3 and 4 kilograms. He had chubby bits in all the right places. They intubated him and helped him to breathe. They watched for the machine to say that his oxygen uptake was improving. The baby’s Dad watched over the doctors and flitted backwards and forwards to his wife, who lay, cut open, on the operating table. She lay there with her insides exposed, while the Paediatric medical staff ascertained whether her child would live or die.

My colleague and I did midwives’ tasks, as it was not our role to ascertain such things. On the outside, calm and steady, we took blood from the umbilical cord. We inspected the placenta. We called the ward clerk to register the baby as a patient. We filled out the forms that say a baby has been born. On the inside, our chests tightened as we kept an eye on the cot and tried to gauge the probability of a poor outcome without anyone saying a word.

*    *    *

Week 23

“I dream about it. Being a midwife. Most nights.”

“That’s a bit of a worry,” B said, sipping from her cup and raising her eyebrows.

“Is it?” I asked.

“You need to have things that matter to you outside of midwifery. When it comes down to it, it’s just a job.”

I nodded.

*    *    *

His oxygen uptake wasn’t improving with successful intubation. The pink had started to drain away from the baby's cheeks. The baby’s Dad, with bilateral tear trails running down each of his, said that maybe they should stop. Just stop and just see what happens. And when they knew he was sure that's what he wanted and that he knew what it meant, they extubated the baby.

The baby’s Mum did not want to see her little boy. She couldn’t bear to hold him. She couldn’t bring herself to look at him. She lay on the operating table, being stitched back closed, while they stopped assisting her baby to breathe, her grief too large to let her look over or reach out to him.

The neonatal nurses looked awkward and out of sorts when there was no more work for them to do. Where were they meant to stand or to look?

The student midwife began to cry and was asked to leave when the Obstetrician noticed her tears. She could cry outside, but inside the operating theatre there was only space for the parents' grief. My colleague followed her out to pick up the pieces when the student fell apart in the hall.

*    *    *

Week 31

“I think nine out of ten midwives are wonderful. Friendly, happy to help. It’s the one in ten that get you. But, even the supportive ones treat you like you’re a bit of an idiot.”

“They don’t treat you like you’re an idiot. They treat you like an entry level practitioner. Because that’s what you are.” B stifled a laugh and smiled as she said it.

*    *    *

With the final stitches in place closing the Mother’s wound, it was time to leave the operating theatre. Yes, she was sure she didn’t want the baby to come with her. Yes, she was sure that she needed her husband with her in recovery. She was wheeled away and her husband followed.

The neonatal nurses and the Obstetrician left. They had played their role. I had reassured them that I knew what to do next. The Neonatologist and I stood, while the theatre staff cleaned and prepared the theatre for the next operation, watching the baby boy's breathing slow, knowing it wouldn’t be long.

A bassinet arrived so that I could transport the baby boy from theatre and so we could clean and prepare the resuscitation cot for the next theatre case. It was when I went to transfer him across to the bassinet, that I realised it wasn't the place for him to be. He should be held and I should hold him. So, I shushed and rocked him and patted his bottom, like I’d done with all the other babies I'd cared for in my first year of practice.

I admired his perfect cherub lips, his slightly upturned nose and his dainty eyelashes. I stroked his black hair. I saw his beauty and perfection.

Rather than be sad, I radiated as much love as I could muster from all of my cells. And I hoped so, so much that he could feel it. I knew that with his mushy, brand new baby brain, he would never know hurt, or fear, or sorrow. He would only know this day, this moment, where he would be held, warm and cherished. I let my heart swell inside me and my adoration spill out into the cold theatre and wash over the bundle of blankets as I held him. Of course, nobody saw a thing, but I could I feel it.

I have no idea if it made a difference. In the scheme of things. In all the sadness and suffering in the world of midwifery and all the lives that come and go. The logical part of me knew that I was probably comforting myself more than I was comforting him. The cynic inside me suggested perhaps it did not matter at all where he spent the last minutes in his short life. The cynic also scoffed and said I was being silly and that in a few years time, when I was a good midwife, an experienced midwife, moments like these would pass by without a second thought. But the biggest part of me felt immensely proud that I was the person who had the chance to love him when the grief that had consumed his parents would not allow them to be present in that moment.

A few minutes later, using his stethoscope, the Neonatologist pronounced the baby dead in my arms.

*    *    *

Week 48

“My door is always open, okay? Even when you’re not a grad anymore.”

“Really?” I asked, genuinely surprised.

“Of course," B said, "But you won't need it."

Frankie Finch, a 34 year old midwife from Perth, completed a Bachelor of Midwifery with Charles Darwin University while living in the Kimberley. She began practicing in 2017 and now lives in Perth with her husband and dog. Other than being a keen and passionate midwife, she has a Bachelor of Arts in Indigenous Australian Cultural studies and worked for a number of years in the field of Native Title. She has recently made a questionable decision to undertake further study, commencing a Master of Health Administration, Policy and Leadership in 2020. She is currently working as a permanent labour ward midwife in a tertiary hospital and while it is often stressful and challenging, her colleagues and the women make it completely worthwhile.