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Guest: Frankie Finch
Tags: Story competition winner, Midwives
SoundCloud: Episode 21: B & Me: A graduate midwife's story with Frankie Finch
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.
Mark Aitken: Welcome to the Nurse & Midwife Support podcast, your health matters. I’m Mark Aitken, your podcast host. I’m the Stakeholder Engagement Manager with Nurse & Midwife Support, and I’m a registered nurse. Nurse & Midwife Support is the national support service for nurses, midwives and students. The service is anonymous, confidential and free. You can call us anytime you need support: 1800 667 877. Or contact us via the website: nmsupport.org.au.
I’m delighted to announce the winner of the Nurse & Midwife Support International Year of the Nurse and the Midwife Story Competition is Frankie Finch, with her wonderful story, B and Me: A Graduate Midwife’s Story. Frankie is going to share her story and after that we’re going to have a conversation about that, after that story. So, hello, and welcome Frankie!
Frankie Finch: Hello, thank you very much for having me. Thank you very much for liking my story. Just a little bit about myself, I am a midwife in (nearly) my fourth year of practice. I work in a labor ward at a tertiary maternity hospital in Western Australia. I just started some postgraduate study, I started doing a masters in Health Administration, Policy and Leadership this year in order to better understand and hopefully make some changes to the systems that we work in. Writing is just a little bit of a side project of mine, but, obviously, you don’t get to that very often with life and all of the other things that we’re doing. It’s nice to do a little bit of writing and to have that seen and appreciated.
Before I start reading my story, I just wanted to say a couple of things. Firstly, that my story involves looking at perinatal loss from the perspective of a midwife. While I feel like this is an important story, I also wanted to acknowledge that this is a small piece of the story of perinatal loss. The much bigger story comes from the parents and families who have lost a child in the perinatal period. I want to acknowledge the women and the parents and their families that have been effected by perinatal loss and say that it’s an honour to be present for a small but significant part of their experiences.
The other thing I just wanted to mention quickly was that the story itself jumps between conversations that I had with my graduate program coordinator, throughout my graduate year. It jumps between those conversations and one particularly significant day I had at work, during that period. This is easier to show on the page, because I signified the different conversations with different fonts. It will be a little bit trickier when I’m reading it out loud, I’ve got my cup of tea here. I figured that I would have a sip from my cup of tea as a big pause, to show you that I’m jumping between these time periods. I’ll get started. As I’ve already said, the story is called:
B and Me: A Graduate Midwife’s Story.
“If you’re 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 cesarean sections for the day. By then, I’d attended seven full shifts of scheduled cesareans. I was nearly finished the two weeks of elective sections we’re all required to endure as a part of the graduate midwifery program. I was more than six 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 cesarean and potential complications. Next to the third name on the list, the letters NNM/PLS had been written. This meant that 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. The accompanying note, a particular consultant neonatologist was named in the note and was to be called to discuss the plans and to ensure that 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 incubated and oxygenated, it might be able to be stabilized. It could have an operation to fix the heart. If the incubation didn’t work, to stabilize the baby, it meant that the defect was extensive. If the incubation didn’t work, they wouldn’t make further attempts to resuscitate because the neonatologist advised that it would be unlikely to help. If the incubation 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 to 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 Bea 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 do say, I knew what paperwork needed to be filled out. I was ready.
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 seem to be walking the wrong way. I sprung 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 and 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 handwriting across a printed table, multiple crosses, ticks and scribbles. I had taken it out of 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 three pairs of scissors that I’d managed to acquire that morning.
“All good,” I lied. “Just busy.” I plastered on my fake smile, the one I use 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 flow off into that part of my brain that stores things and only lets 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. Okay?” She said with a smile, genuine and 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 mums 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 pump. The doctors 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 three and four kilos. He had chubby bits in all of the right places. They incubated him and helped him breathe. They watched for the machine to say that his oxygen uptake was improving.
The baby’s dad watched over the doctors and flittered backwards and forwards to his wife, who lay cut open on the operating table. She lay there with her insides exposed, while the pediatric 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.
* * *
“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.”
* * *
His oxygen uptake wasn’t improving after successful incubation. 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 see what happens. When they knew he was sure that that was what he wanted. That he knew what it meant, they extubated the baby. The babies mum did not want to see the 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 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 parent’s grief. My colleague followed her out to pick up the pieces, when the student fell apart in the hall.
* * *
“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 you’re an entry level practitioner, because that’s what you are.” Bee stifled a laugh and smiled as she said it.
* * *
With the final stitches in place, closing the mother’s womb, it was time to leave the operating theatre. Yes, she was sure that 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 boys breathing slow, knowing that it wouldn’t be long. A basinet arrived, so that I could transport the baby boy from the theatre, so we could clean and prepare the resuscitation pod for the next theatre case. It was when I went to transfer him across to the basinet, that I realised it wasn’t the place for him to be. He should be held, and I should hold him. I shushed and rocked him. 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. 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 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 that perhaps it did not matter at all where he spent the last minutes of his short life. The cynic also scoffed and said that I was being silly. That in a few years’ time when I would be 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.
* * *
"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.”
Thank you very much.
* * *
MA: Thank you very much Frankie. A wonderful story and I really appreciate you sharing it. It’s heartfelt. It’s honest. It’s poignant and it’s uplifting. It made me cry, laugh and glad to read it and reread it. Even though there is sadness in death, you honour and celebrate life, the baby, the parents and your colleagues. Such a wonderful gift. What I’m really interested in, also, did B read the story?
FF: Actually, she read it two days ago. I sent it to her when I found out that I was going to be reading it, but she was on leave, so I think she only got it yesterday or the day before.
MA: What was her response?
FF: She said that she enjoyed it. She congratulated me on the story, but also on my development as a midwife. Obviously, I’ve come a long way in the last three years. Since I was in a graduate program. I’ve become a lot more confident in expressing myself and being a midwife.
MA: Well, well done you. I love the journal and diary format, what was the reason for choosing that format?
FF: Well, I felt like I had two stories. I felt like I wanted to express how supportive and wonderful that graduate program was. How it facilitated growth and independence, but I also wanted to show that hugely significant day in the life of a midwife. Those sorts of days can happen every day, for different midwives. They two fitted together, in the end, which was really nice.
MA: You show vulnerability and rawness, honesty and incredible emotional depth. Was that difficult to share? What did motivate you to share it?
FF: That’s a tough one. I find writing cathartic. I feel like understanding feelings and events happens for me when I write them down. I get an understanding of the things that have happened, and the way that I felt about things, when they’re written down that I don’t get in ordinary life. Just having them pass by. In sharing it, I saw the add, I was procrastinating studying. I thought, oh yeh, I’ll finish that off then chuck it in and see what happens.
MA: Well, we’re incredibly pleased you did Frankie. Is there anything you’d like to say to a midwife considering writing their story?
FF: The more writing that we do, the better it is. It’s tricky, because you have issues with confidentiality, legal stuff. I guess, a lot of the times when you have these not-so-wonderful outcomes they’re the subject of legal proceedings and it can be tricky. But writing for yourself is just as good as writing for everybody else. If you have to write it down and keep it in a safe place, that’s ok too. There may be an appropriate time to share it. Writing, debriefing and sharing with your colleagues is so important for getting through this sort of thing.
MA: In the beginning of your story, you state, “If you are successful, you will be looking after complex, high risk women. But you’ll be well supported in doing it.” That’s a really important point that you make, the importance of it being reiterated, that you’ll be well supported in the often complex and challenging work we do as midwives and nurses. How important do you think it is? That nurses and midwives get support? What would you say to a midwife who needs support?
FF: Support is everything. Being a midwife, in particular, it’s a part of who we are. When we do this job, we want to do it well because it’s a reflection of who we want to be as people. What kind of care we want to provide, this is the sort of experience where without the correct support it could have broken a human. Using the supports that are there, for hospitals, providing those supports. To have another midwife with me there, in that experience. To have my graduate coordinator support me to be ready to go and do that, before being thrown in the deep end, it meant that (while it was sad) it was an experience for growth and empowerment. That’s how you spin those types of experiences to become positive ones, by having the appropriate support. If you’re a midwife out there who feels like it’s not there, there are obviously places that you can reach out to. Find your champion at work, is the best thing to do. The people that you can go to just to debrief, who are always going to listen. I feel like that has been pretty important in my success, in this high risk stressful environment that I work in.
MA: Thanks Frankie. Just to remind everybody, you can also call Nurse & Midwife Support, the national support service for midwives, nurses and students: 1800 667 877. Or via the website, at nmsupport.org.au. The service is anonymous, confidential and free. We’re available 24/7, so please don’t hesitate to call. Frankie, congratulations, once again. Thank you so much for sharing your story, and writing it. We really hope you continue to write, because we think you’ve got several more stories to tell and we’d love to hear from you in the future. To thanks again, Frankie.
FF: Thank you very much. Just a quick shout out to my colleagues at the Mothership, particularly in the labor ward. They are all amazing.
MA: Thanks very much.
FF: Thank you!