As I travel around the country speaking and signing copies of The Blue Cotton Gown: A Midwife's Memoir, I spend more time talking about midwifery than I do about the book. This makes me smile; I didn’t set out to be an ambassador for the profession, but I couldn't be more pleased.
I am surprised that most people don’t know that, worldwide, roughly 70% of babies are born into the hands of midwives; they don’t know that in the US the numbers are growing, almost 10%, up from 3% ten years ago. I’m surprised when they don’t know that midwives are legal in all 50 states and that most practice in the hospital in collaboration with physicians. I'm surprised that they don't realize that there are two kinds of midwives: the nurse-midwife is an advanced practice provider, usually with a Masters degree, who can do deliveries in the hospital, a birthing center or at home, prescribe medication, and is also trained to do gynecology. The direct entry midwife trains by apprenticeship and delivers, usually at home. I was both kinds.
My first birth was by accident. This was back in the seventies. Three weeks before her due date, our friend, Laura, and her husband, Lou, asked my husband, Tom, and me to come over for dinner. I was the only woman who had seen a baby born in our group, so I was the expert. They lived in a commune, in a large converted barn in relative luxury, four couples and three kids under seven.
After dark, when a spring snowstorm came up, we decided to sleep over rather than get the jeep stuck in the mud.
Tom, Mica (our five year old) and I are shown to an empty bedroom and we settle down for the night. At around three, I hear rustling, low voices and footsteps back and forth to the john. Maybe one of the commune's toddlers is sick… Tom sleeps through it all. At 4 A.M., Star, one of the women of the house, comes to our door. "Can you come, Patsy? Please! Something is happening."
The small woman pads down the hall on her calloused bare feet and leads me up narrow wooden steps. We stop at the door to a bedroom illuminated by dozens of candles. Pachelbel's Canon plays low on the stereo. On a mattress on the floor, Laura crawls, naked, moaning and swinging her head.
Lou kneels beside her, in shorts and a tie-dyed shirt, massaging her back. His long ponytail droops over his shoulder. "It's coming, Patsy! I don't know what to do…We planned a home birth and I was supposed to catch but I can't. I just can't…" His face is as white as the bedsheets. "You have to do it," he said to me.
I go very still... Pregnant woman... almost full term... moaning... blood... muddy roads... hospital two hours away. That's what I'm thinking. Then there's a pop and a gush of clear fluid out of Laura's vagina. "Go get Tom, Star, he's hard to wake up. You'll have to shake him and get the birth kit. You have something prepared don't you, Lou, some supplies?" The man looks wildly around.
"Top drawer... bureau." Laura snaps between moans. "My back hurts so bad. Damn! I have to push, but when I do it only hurts worse." She lets out a wail and starts shaking. So much for childbirth breathing. "Get a grip, Laura," I tell her. "Yelling is not gonna help, and it scares the baby." I don't know where I came up with that line, but it works. I've used it a hundred times with women in labor since then. She shuts up.
Then Tom steps into the room with Star, takes the situation in at a glance. "Where's the birth stuff?"
"Inside the chest. I need some gloves. She's gotta push."
Something is bulging between Laura's legs as she wags her butt back and forth and I haven't even washed my hands. Tom pulls a paper sack out of the drawer and finds a box of exam gloves. They aren't sterile, but nothing else is either, and they'll have to do.
"It's almost over Laura. I'm going to touch you. Don't move around." I part her labia and find a head covered with dark wet hair about the size of a large apple just sitting there.
Laura moans again and curses. She growls like something coming out of the earth and the head moves a quarter inch into my hands.
"What's in the bag besides gloves, Tom? Shoe strings, scissors?"
Tom isn't a paramedic, or a doc. He hasn't even thought of it yet. That comes years later after he took the Roane County EMT class and served on the squad. He's a bearded hippie bee- keeper, with the shoulders and arms of a carpenter and the soul of a string bass player.
"Scissors in a plastic baggy with shoelaces. Some gauze and a blue infant suction thing. There are some worry beads, a baby blanket and a laminated picture of Krishna." He drops the beads in the drawer and hands Lou the picture of Krishna. The medical supplies he lays out on a pink flannel baby blanket, and then puts on gloves himself.
"I don't suppose you could roll over?" I ask Laura between contractions. She's still rocking back and forth on her knees. "Lay on your back?"
"Oh, shit," she says, and she's right. As the baby slides down the birth canal, some BM moves through the rectum and out of the way. Tom takes some gauze and wipes it up. Everything is coming down fast but the baby's head doesn't flex. I know from the drawings in the emergency childbirth manual that you should keep the head flexed but this baby's upside down with its chin tucked under the pubic bone and I haven't a clue what to do so I just hold on and put my hands around the head like a crown.
"Breathe it out now," I say with authority. "Breathe it out slowly." Laura breathes. "Now pant!" A baby's face is emerging between Laura's legs, scrunched and blue, looking up at the ceiling.
Tom reaches over and suctions the mouth like he's done this before. "It's trying to suck on the bulb," he laughs. "Good sign." Then the whole wet mass swivels and shoots out on the bed. I scoop it up. The infant's still dangling from the umbilical cord.
"A baby!" the father yells then slumps into the fetal position. The newborn screams.
Laura laughs. "That wasn't so bad!" Women always say that when it's over. I look between the infant's wet legs.
"It's a girl."
"I told you!" says Lou, raising his head.
After we tie off the cord and dry the infant, I hand the baby to her mother. Lou pulls himself together and the three of them squirm to the head of the bed where it's still dry. I throw a blanket across them and the candlelight shines on their faces.
Behind Star, in the doorway, stands the rest of the commune. Three men and women in various states of dress or undress, two sleepy toddlers and one baby who sucks on a breast. Mica sleeps through it all.
No one says anything, not a word, not even the kids. Pachebel still plays on the stereo, music of holiness... Tom and I just kneel on the bed in the wet amniotic fluid.
That was my first birth, a calling, and being a midwife is such a hard job, with so much responsibility, you don't want to go there unless you are called. A few years later, with many such homebirths behind me, I went back to school and became a nurse-midwife.
October 5- 12 is National Midwifery Week and I celebrate, not just midwives, but the women and men who choose midwives. I celebrate diversity too. Some people prefer a physician. My husband, Tom, now an OB/Gyn, is my favorite back-up doc but he won't stay through labor to rub your back or fool around with bio-identical hormones. He sends those patients to me.
I honor us all.
This story is adapted from The Blue Cotton Gown: A Midwife’s Memoir.