Thirty-Six Births

by Bonnie Voigt

On my last night as a student midwife, I donned my dread along with my scrubs. My car no longer smelled like weed. I had long since kicked the habit. When I arrived, tealights glittered in the birth suite. Melora was in the bathroom laboring on the toilet, an effective position to encourage dilation. Her husband stood next to her, his long, dark hair pulled back in a bun. She leaned forward, moaning. I could hear fluid dripping and asked her if she was peeing or had her water broken.

She grunted, and I heard a loud pop echo off the toilet bowl. I wrote ‘ROM – rupture of membranes’ in the chart, my hands gloved, two steriles in their package in my back pocket, ready to go. Amy watched from outside of the bathroom.

I was primary, so I was calling the shots.

Becoming agnostic was easy because I already had been under the guise of devout Catholicism. As a child, I prayed and attended church. I looked forward to having conversation with my grandmother, when I walked through the gates of heaven greeted by all of my deceased pets and family.

Communion and prayer became meditation, yoga, Instagram psychologists, and an engrained weed habit. My husband John and I hotboxed his parents’ back room, our bathroom, our cars, and synesthesia made music warm and penetrating, and my favorite songs felt like soft carpets, smelled blue, and were so immersive I didn’t think about death nearly at all.

I no longer had to worry about pleasing Jesus, yet I grieved the loss of immortality. I entered pseudo-grief over the extraordinary and miraculous Jesus I’d once believed in. A woman named Adriene on YouTube guided me into yoga poses. I breathed deeply on a timer but after it went off, I tightened my muscles right back up again.

I still needed to serve, I’d decided. To be purposeful, indispensable to a cause. At night, as I lay next to John, the darkness would remind me of the all-encompassing void after life. My breath would hitch. I focused on the click of the ceiling fan. Consciousness that felt much like a self, like me, would snuff out.

The concept of birthing outside a hospital was new to me, but this work called. My high school yearbook quote was “'I won't have time to talk to you. I'll be too busy being better than you.” I was 19 and needed to be something amazing, damn it. Midwifery in Texas is apprenticeship based, and I searched for a preceptor until I found Amy, an experienced midwife with a laundry list of credentials, and we clicked, I felt. Everything I said seemed to make her laugh, and she was impressed that I’d completed two semesters at UT, before dropping out. I mistook her desperation for help for genuine interest.

Amy asked if I wanted to start out on call half-time, but I wanted to jump in. So, I became Amy’s any time of day or night.

I had probably two weeks of training when I got the first call. I was not high and home with John when my phone blared its nuclear war siren. Sometimes, if I hear that ringtone from someone else’s phone, my entire body goes rigid before I realize, no one needs me now.

As I dressed in my new pink scrubs, John sat up in bed and looked at me. It was before dawn. Amy told me I couldn’t wear perfume because pregnant women have strong noses, but I was scared that she could smell the weeks-old weed on my scrubs, so I sprayed a spritz or two anyway. I drove the hour and a half to the birth center, my AC turned up full blast but still not cold enough to get me to stop sweating. I am an irreplaceable cog in the machine, I thought.

The birth center was on the first floor of a Lysol-smelling building. When I was younger, my mother told me that when we enter the church and when we leave, we are to dip our fingers in the holy water and make the sign of the cross. I loved how cold the water was as I’d reach up into the marble pedestal to dip my fingers in. I wondered, if I drank this water, would God’s favor fall upon me?

I extended my hands as the sanitizer station at the entrance dispensed liquid. I brought it to my nose as I rubbed my hands together.

Amy taught midwifery classes for extra money, and I’d paid her to teach me Anatomy and Basic Prenatal Care and Neonatal Resuscitation, though I’d only been through orientation at this birth. This is the way midwifery works. Apprentices work for free. I wanted the importance, I wanted to sacrifice myself to service. All I needed to do was attend 50 births, two years of school, sit for certification, and I’d be a Licensed Midwife in the state of Texas.

Soft music was playing when I walked into the birth room for the first time. I had never met this couple before, the mother a tall woman with her braids tied back in a bun, the father a generic looking man. I can’t remember him; I was focused on her.

She was nodding, swinging her head low. I had never seen a laboring woman before, and it was beautiful and strange. She called out like a cow and I looked away. It was as though her mind had left her body.

Her vocalizations echoed through the room, a clinical version of a bedroom, furnished with nightstands, lamps, an electrical fireplace, a big corner tub filling with water, but there was also the sink with the sterile equipment, the bottle of olive oil, plenty of rags, and the emergency table with oxygen. I didn’t know yet what most of this stuff was, so I kept glancing down at my watch. I wanted to be doing something. I should’ve committed the emergency supplies to memory. So far, I’d presented my eagerness as competence.

I felt like I was intruding on someone taking a shit. Birth is deeply personal. I was an intruder.

Amy asked Olivia if she wanted her cervix checked, and she nodded, groaning as another contraction wracked her body. I wasn’t sure yet if dilation was checked on demand, but feigning competence I nodded warmly. We waited for the contraction to subside, and when it did, I stood next to the father, watching as Amy inserted her fingers to the woman’s cervix.

“You’re at 10 centimeters, my dear.” My heart dropped. I knew this was the goal, fully dilated and ready to push. I didn’t know yet I’d feel unready every time a woman reached completion. This first time, I was terrified that people in the room would die. I’m not sure if I was brave. I wasn’t thinking about the mother. Just about myself.

“We’re gonna have a baby,” the father said, kissing his wife on the forehead. She reached up and hugged his neck, and they swayed for a moment. The smell in the room was heavy, mucousy, reminiscent of semen.

My heart was pounding, my armpits sweating. But this was my purpose. I awaited the miracle as Olivia’s vagina yawned open while her baby’s head, as big as a grapefruit, bulged out. The baby had dark curly hair, white and wet with vernix. I stood frozen to the spot, and the only thing I could think to do was pray. I silently recited the Hail Mary and the Apostles’ Creed until the words smeared together.

After the first dozen births, I’d felt determined and knowledgeable. Amy made me feel appreciated for the strides I took, both in the classroom and birth room. But I couldn’t ignore how I came to loathe Amy’s phone calls, the adrenaline boost I now recognize as an anxiety attack when it would ring.

I thought my fear would go away as I acquired more knowledge, wrote protocols, became NRP certified and could confidently resuscitate a newborn. Yet the fear lurked, becoming resentment. After almost two years, each call solidified my bitterness. I missed dates with my husband and Christmas Eve. I was called in at a theater with my nephew, the alarm going off in the middle of the movie because I couldn’t have my ringer off, ever.

I was sleep-deprived and lonely. I had FOMO because other people my age were about to graduate college and I was elbows deep in births, wiping poop from anuses.

And yet, it was beautiful. I still hold my breath when I remember the feeling I got while touching a baby’s head halfway to our world, still halfway in the watery womb. Each birth I attended was a new dose of miracle. It was my hands that held the baby first. Knowing that there are children in this world, talking and running and crying, and my hands were the first to welcome them gently to worldly sensation outside of the womb, has brought me close to heaven. I think of these moments now and know I was necessary and instrumental in ways I might never be again. When I look back, I know I wasn’t just Amy’s apprentice, but a pillar for those mothers to lean on during one of the most vulnerable times of their lives.

After Olivia reached completion, she grunted and pushed, and her baby’s eyes bulged, eyelids purple from the pressure of the birth canal. Amy yelled to me, “Get the olive oil.”

I ran across the room and grabbed the yellow bed pan with the oil. I put it on the bed next to the mother, and Amy squirted the oil onto Olivia’s perineum to help with the stretching. She cried out, and her husband crawled onto the bed, behind her so he could support her as she pushed. The baby’s head was born.

“Time of head 19:33,” I said. We paused. The room was silent as we awaited the next contraction. Olivia’s head tilted back, mouth agape, as she rested against her husband. My heart stuttered in my chest. She had another contraction, pushed, and no progress. Almost 30 seconds passed in the span of what felt like years.

“Get the baby’s heart rate. Now.” I went into panic mode. Amy was too calm, as if to keep from screaming. I think she, too, had deep-seated panic that rose up each time the babies were born, but we were needed here.

I fumbled with the Doppler and pressed it on Olivia’s mons pubis. The volume on the Doppler was turned all the way up, and in the stillness a loud WOM, WOM... WOM sounded, slow and all wrong. An emergency unfolding in front of me.

“Olivia, I need you to push.”

“I’m not having a contraction,” she groaned.

“Olivia, PUSH. Now.”

She did. The baby’s head was dusky blue, then purple, lips bulging, cheeks suctioned to the birth canal.

Another grunt. The dad had started weeping.

With a wet, popping sound, the baby was born. But she didn’t cry. She was limp, arms and legs and head bobbing.

“Bonnie, PPV. And a towel. Now.”

What the fuck was a PPV? I ran to the towel warmer and grabbed one, bringing it back to Amy, who began to rub the baby vigorously. Both Olivia and her husband were crying now.

“Get me the PPV, NOW!”

I stared at the blue baby. I should have been NRP certified before this. In a better system I would have had at least 6 months of classes before I was the sole person responsible for the PPV. But I was naïve, I thought the baby would always be born and cry and it would be beautiful, a miracle.

Under the receiving blanket was what appeared to be a breathing device with a mask and a big blue bulb. I thought, this must be it, and threw it at Amy, who placed the mask over the baby’s nose and mouth. She squeezed the bulb once, twice. The baby began to pink up. I unfroze and began to rub the baby’s feet with a towel. Amy gave the baby another breath with the PPV, and the baby’s cry pierced the silence.

Amy handed the baby to Olivia, who had tears streaming down her face.

“It’s a girl,” Olivia cried, and I cried so hard I had to wipe the snot from my nose with my wrist and then scrub it off in the sink. The baby’s mewling filled my chest with relief I’d never experienced but had been chasing all my life.

At home I would sit in the living room while John went to our usual smoke spot. The sound of the lighter flicking made me miss the habit. But I was in the primary stage of my training – I needed my mind sharp. As I watched him exhale, I wished my responsibility would dissipate.

Melora went into labor nearly a year and a half after Olivia did. I had attended thrity-five births in the interim. Hers was my thirty-sixth birth.

“I think she’s close,” I said to Amy. “She’s grunting like her body’s starting to push.”

Amy nodded. “You’re doing an excellent job. You’re the most competent student I’ve had in years.” When she said things like this, it was hard to imagine ever telling her I wanted to leave.

Things began to progress. Amy was on Doppler duty, and I barked orders. Melora let out a yowl, singing a gravelly chorus to the worship music in the background. She was on the floor now, on her hands and knees, vocalizing.

I began pulling on my sterile gloves. Melora squatted and groaned. Her husband whispered prayers into her ears, and she clung to him with her eyes closed. Moments later, half of the baby’s head was visible. The only noises in the room were Melora’s low grunts and the quiet Christian rock.

Amy squatted next to me. “What do you do?” She asked.

“Feel for the cord,” I said, and inserted my fingers just below the baby’s neck. To my horror, I felt the cord wrapped around twice. I attempted to loop the cord over the baby’s head, but the mother screamed. The cord was too tight, too short, and I could end up ripping the placenta off the uterine wall. I glanced at Amy, wide-eyed. The baby slipped out a little farther, I saw, and the cord was wrapped around the baby’s shoulders like overall straps. The normal coils were stretched taut, and the baby was dusky purple. Time slowed in that horrible way. Amy told me to get the clamps.

I ripped open the white and blue sterile packet of instruments. Amy and I clamped the cord in two spots, and I cut between them, sawing the blood vessels and Wharton’s jelly until the two halves came apart. My heartbeat punctuated every moment.

The rest of the baby’s body slid out onto the floor, limp as a dishrag.

“Oh, Jesus,” the father said, holding onto his wife. I grabbed the PPV and a towel, and Amy rubbed the baby up and down. She used the PPV to give the baby breaths while I put the bell of my stethoscope to her heart. I could hear was the baby’s slow but constant beating heart.

“Heart rate is over 100,” I said.

Though her heart rate was up, her color was awful.

“Breathe into her, Jesus,” the dad cried. Melora and her husband joined hands, blood pooling underneath Melora’s buttocks, as they recited the Our Father loudly.

Amy grabbed the limp baby and put her mouth on the baby’s nose and sucked. She spit mucus onto the Chux pads beneath us and then sealed her own mouth around the baby’s before sucking again, then spitting.

“Hallowed be Thy name, Thy kingdom come, Thy will be done.”

I thought the baby was going to die. Amy put her back down and began working with the PPV again. I pressed the bell of my stethoscope to the baby’s chest.

“On earth as it is in heaven.”

Their chanting grew faster.

I took over with the PPV, and Amy took my stethoscope.

“But deliver us from evil.”

The baby began to flex her body, finally letting out a screeching cry, fluid guzzling in her throat. I used the bulb to suction it. Their final Amen was a weeping noise. I can still see their faces sometimes as I lay in bed, begging for sleep.

“Thank you, Jesus,” the parents cried.

I quit over the phone. I called Amy, and I told her I was applying to a nearby state university.

“To pursue a CNM degree? You can run the south location then,” she said. Her voice was sure sounding, like the last time I told her I was quitting, when she said I’d be back.

“I’m going to major in English,” I said. Fictional births and deaths. I didn’t want to save anyone’s life.

“Okay.” After almost two years, and that’s all she was going to say? I felt guilty and relieved. Quitting midwifery felt like quitting Catholicism. She’d relied on me, and now she had to find another apprentice.

I changed my ringtone and put my phone on silent.

What is holy now:

Opening mail and finding a birthday card. Opening a new soap and discovering the smell reminds me of my elementary school librarian whom I loved. My son’s birth, but only in hindsight.

The decision to have a baby was straightforward enough. Baby, now, my hormones said. But my birth was complicated by my prior knowledge. I knew too well the endless possibilities of things that can and do go wrong.

When I was 7 centimeters dilated, I thought of Olivia, of Melora. Their babies, blue. The bruising and screaming, the pelvis-shattering pain. He won’t fit, I thought. I will need to be sliced open for him to be born. When my water broke, stained with meconium, I remembered the baby who’d aspirated meconium and had to stay in the NICU.

I was with a midwife until I went to the hospital at nearly 8 centimeters dilated, and in the hospital I shook uncontrollably. Numb from the waist down, out of breath, I felt blinded by overhead lights, and numerous strangers entered the room. It hardly registered in my mind that in minutes, a baby would be here. My baby, who I would love with a terrifying intensity. I didn’t believe I could, but the second he was born, I felt my heart expand like the universe, obliterating every worry or desire that came before him. The world was the hot, wet, screaming baby on my chest, separated from my body for the first time. For a few ecstatic moments, a concoction of hormones and the intensity of this new love came together to show me that heaven is a slippery seven pound baby, cry gurgling while he searched the world for me.

Maybe the midwife at my birth answered a calling. In the time since the two years I was a midwife in training, I have met a few would-be midwives who eliminated themselves from the running, acknowledging that this is a life reserved for a special few who can stomach the schedule, the complications, but most of all the weight that is never lifted.

It’s cold this morning, and I am dressing my son, pulling his fat little arms into his onesie. For me, there is still no Jesus but this, I think, this is close. He squeals when he sees a cat, smiles at me with two stubby teeth. In his eyes there is only joy that is easy to provoke and sustain.

He doesn’t know yet that he will die one day, and that perhaps on the other side of that is a great big incomprehensible nothing.

But that is precisely from which he came. So it can’t be all bad.

---