Michelle's exciting new journey

This past week was an exhilarating one, as I got to see my first birth. I usually go with Susan or Ciska (they switch off being on call and seeing clients) to their appointments on Tuesdays. Since we returned from Jo’burg, Susan and Ciska have been adamant on getting me to a birth, so this week Susan was priming all the women who are due soon with little comments like, “yes, either me or Ciska will be there, and maybe Michelle too.” As I left last Tuesday, Susan told me to keep my phone on and with me at all times. There were seven women due in the last two weeks of the month, so I was officially on call.

There was a possibility that I would be called to a birth in the near future, as Susan performed two “stretch and sweep” procedures on women who were over-due that day. “Stretch and sweep” refers to a process in which the midwife will prime the cervix by literally stretching it with her fingers and sweeping her fingers around it in hopes that this will release hormones that will begin a feedback loop of contractions. The hormone is released, it goes to the brain, the brain sends signals to start contractions, these contractions open up the cervix more, and more labor hormone is released. It is a beautiful, and amazingly simple system.

I left the practice antsy and excited. Would the call come late tonight? In the early hours of the morning? Not until the next day? I turned my phone’s volume up as high as it would go. There would be no way I would miss the call. I woke up the next morning, and there was nothing yet. I went to my internship and patiently waited. Should I SMS Ciska? I decided not to, and to try and get my mind on other things, like compiling a budget for Gender DynamiX’s exchange program next month.

I returned home that afternoon, and a bunch of us made plans to go to the Taste of Cape Town, an annual event in which restaurants from all over the city bring food for locals and tourists alike to try. I was excited to go, but no sooner had we made our plans, my phone rang, obnoxiously loud. It was time. I picked up, and tried to hide much of the excitement in my voice. I needed to sound like a mature, capable apprentice. I got the information, and hurried out of the house, caught a mini-bus taxi, and was in downtown Claremont in no time.

Ciska had told me to tell the head sister (nurse) on the labor and delivery ward that I was an apprentice midwife joining her for the delivery. It was the first time I had referred to myself, out loud, as an apprentice midwife. It fit, I think. I got into the room, and Ciska caught me up on the situation. The woman in labor had been induced at 11:30 that morning, and labor had been slow and contractions spotty. At about 3:30, Ciska broke her water, and that’s when she called me. Labor had progressed quickly, and by about 6 p.m., delivery seemed imminent. My primary jobs were to run and fetch things that were needed, help get the delivery kit set up, and take note of things once the baby was born, like birth time, weight, height, and head circumference.

While laboring, the woman was walking around, leaning on her husband, sitting on a bosu ball, rolling her hips, humming, moving, humming. She was completely in her own space, and honestly, I don’t even think she realized I was there until after the birth. It was amazing to see Ciska’s many roles in that space. She was completely calm, guiding, leading, following. Giving instructions and taking them from the soon-to-be mother. She later told me that the only time she becomes assertive and gives directions that absolutely must be followed is when she needs something quickly, like to examine mother or baby. There was one instance in which I really feel that I could pin-point a key difference in midwife and obstetric care. As the second stage of labor neared, pushing, Ciska needed to make sure that she was fully dilated, which she would do through an internal examination. Ciska asked if she could examine her, and at first she said no. Ciska asked again, and told her that she really needed to check, and that she would not examine her without her consent, but that it had to be done. Ciska needed the woman to partner with her and work with her. In any other OB-lead birth, there would have been no question. It would be, “I am going to examine you now.” It got me thinking, had my GYN ever asked me expressly if she could examine me? No. It was always, “I need you to put your feet here, lay here, do this.” It was never a question, and never a feeling of active partnership.

I stood watching as Ciska moved with the woman into a squat, with the woman leaning against the bed, her husband sitting on the bed behind her, and Ciska in front. The baby slipped out in an instant, it seemed. I was overcome with a short burst of emotion, but then remembered my duties of remembering birth time. 6:40 p.m. I was instructed to let Ciska know when five minutes had passed, and then they would prepare to cut the cord and deliver the placenta. Dad cut the cord, and Ciska called me over to tell me about delivering a placenta. Following its delivery she showed me how to examine it and make sure that there were no pieces missing, as it could have dire complications for the mother.

We situated Mom and Baby in a warm bath, dealt with relatives, other nurses, paperwork and suddenly it was already 9:00. It was a whirlwind, and I was flying high. On the car ride home, Ciska asked me about my feelings, and I tried to tell her about this unbelievable feeling. I could do that every day, I said. She smiled and told me that no matter how hard a birth is, or how tired you are, it’s that high that keeps midwives going. We live on it.

Since that birth, I have come to terms with the fact that I am resigning myself to a lot more school, seeing as how an undergraduate degree in anthropology and women’s studies will not help me much. Instead of starting all over again, I will probably look at an accelerated BSN/RN program following my graduation next May. Unfortunately this means taking chemistry and statistics over the summer, anatomy and physiology and genetics in the fall, and a few other core nursing requirements. I am a little nervous, but at the same time excited to embark on this new journey.