A midwife's lesson in a lifeless birth

Apr 8, 2010, 12.00am IST
ELIZABETH LETTS.


The case was straightforward. The mother was close to term with her first baby.

One day she noticed that the baby wasn't kicking as much as usual. She waited to call, thinking maybe she was worrying about nothing.
The next day, the baby still wasn't moving, so she came in for a routine evaluation. There was no heartbeat. The baby had died in utero...
I was fresh from an intensive three-year programme that took liberal arts graduates and turned them into advanced-practice nurses. I was so inexperienced I still had a mentor with me at all times.


Mine was Barb, a former home-birth midwife who had delivered thousands of babies, wore earrings of jade the midwife's good-luck stone and had long tapered fingers that looked like they had been designed to usher new life into the world. Once, as she coaxed a baby with a plunging heart rate safely down the birth canal, she told me she "was not afraid of birth".
I was not afraid of birth either, but I was afraid of death. Thus far in my career, it had stayed neatly out of sight.

But today this stillborn needed to be delivered, and the safest course was to induce labour... Barb, who was delayed in clinic, called me to review the case with me. She wanted me to go to "be with the mom".


I entered the room and greeted the patient, whom I'd never met. The intravenous drip... was already under way; the anesthesiologist had started the epidural. Medically, there was nothing more to be done. My job, as I saw it, was to cheer her up.


She was alone, her brown hair tied back into a messy ponytail, her gown bunched around her big protruding belly. But for the absence of the reassuring tick-tock-tick of the fetal heart monitor, this could be anyone's happy day. I remember feeling relieved that she didn't look unhappy. No tears, no rage, just the slightly dazed look of someone who accidentally wound up in the wrong place...


Not sure what else to do, filled the silent birth room with the sound of my own voice. I told her all about my training in midwifery, my hometown, my likes and dislikes. I learned that she was a graduate student in crop management, that she grew up in Ohio, that we both liked a movie that had come out the week before.


The time dragged, the monitor spewed forth paper, and I kept chattering. I remember that i was proud of myself for coping with this difficult situation with diplomacy and tact.


I had been there for several hours when Barb arrived in a burst of energy. She wore faded jeans and flip-flops. Her jade earrings swung at the side of her neck. She threw her arms around the patient, hugged her a long minute, and then said, "I'm so sorry."


My patient collapsed into uncontrollable tears. Barb sat on the edge of the bed, her hand on the patient's arm, and they spoke in halting, slow, tearful words about the awful momentousness of what was happening. I sat in my chair in silent shock.


Death had been in the room but had been nicely hidden under the sheets, under our cheerful demeanour, under the silences of things left unsaid.


The baby arrived at last, and as Barb lifted the perfectly formed lifeless body, the cord unfurled to reveal a true knot. A rare, unpreventable accident.
Barb and I left the room so the mother could say her goodbyes. By then, the father had arrived, and they were in the room together. I never saw them again.


My farewell had occurred earlier.


I said goodbye to the green nurse-midwife, the one who believed that providing support meant sitting in a corner pretending that death could be covered up with small talk.


I now know that birth and death are right around the corner from each other, and that as a midwife I may be charged with bringing either one into the world.