A day in the life of a midwife

Oct 6, 2014, 14:56 PM by India Ogazi

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When my manager first suggested I write an “A day in the life of” story about a midwife, I thought “OK.” Then I thought, wait a minute, am I going to witness a live birth with a moaning mother who’s refused medication? I imagined her lying in a kiddie pool with a midwife rubbing her back, wind chimes blowing through the wind and yoga music playing in the background.

My manager quickly assured me that is not the case with UTMB’s midwives. So I cautiously agreed and on a Tuesday morning, I entered the labor and delivery floor of John Sealy Hospital to meet midwife Susan Nilsen.

I walked in with a little trepidation, not knowing what to expect. And if any of you have read my previous “A day in the life of” articles, you know that’s how I begin many of these experiences, fearfully. Hmmm, maybe I have a fear problem. Maybe I should do an “A day in the life of a psychologist” to get some free advice on overcoming fear. But, I digress — enough about me.

Nilsen1Nilsen, who also is director of inpatient services for UTMB’s Regional Maternal and Child Health Program, has already delivered one baby by the time I meet up with her. It’s 9:15 a.m., but 22-year midwife-veteran Nilsen’s work day began at 6:45 a.m., with a team meeting. OB-GYN’s, nurses, faculty and medical students review each laboring mother’s history from the time she arrived in the unit and her current status.

The meeting is adjourned by 7 a.m. and Nilsen spends the next two hours teaching medical students and checking on her assigned patients. By 8:45 a.m. she delivers her first baby. It’s a girl, and a healthy one, at 8 pounds and 3 ounces. Her mother names her Rosalie.

Nilsen’s eyes light up as she describes the experience. “Whether you’re religious or not, it’s a miracle,” she said. “It [delivery] never gets old. It never stops taking your breath away.”

This is why Nilsen has been a midwife for more than 20 years and has no plans of retiring anytime soon. When I sit down with Nilsen she’s in her downtime. All of her patients are stabilized and she’s monitoring their labor activity via fetal monitors attached to the mother and baby. The monitors send heart and oxygen rate and contraction readings to Nilsen’s computer, which allows her to keep track of every patient simultaneously. Nilsen currently has two laboring patients under her care, but at any given moment a new laboring mother could arrive. In the meantime, she sets the record straight about midwifery.

“There’s a misconception that midwives only deliver babies at home,” said Nilsen. “But 95 percent of all certified nurse midwives deliver in a hospital.”  Another myth Nilsen quickly dispels is that midwives don’t provide patients with pain relief. “They can so get an epidural,” she said.

 Nilsen explains that midwives are experienced registered nurses with a graduate degree and a midwifery certification. According to the American College of Nurse Midwives, midwives are independent practitioners who provide a full range of primary health care services for women from adolescence to beyond menopause including primary care, gynecologic care, prenatal care, childbirth and postpartum care.

UTMB’s midwives deliver babies in the hospital and provide clinical care for RMCHP patients. “Midwife means ‘with woman,’” explains Nilsen. “The main difference between an obstetrician and gynecologic doctor and a midwife is our delivery — it’s more quiet and intimate.

“We dim the lights; there’s no counting or yelling,” she said. Nilsen quickly explains that midwives need and respect OB-GYNs; however, they take a different approach — one that is more focused on the mother. They also don’t perform caesarian sections, but will call for an OB-GYN if one is needed.

At 10:15 a.m. Nilsen begins to check on her patients. Her first patient hasn’t progressed in her labor, but she’s progressed in pain. She’s moaning and moving her feet up and down, as if she trying to run from the pain. The patient had refused an epidural earlier, but now requests one. Nilsen obliges and requests an anesthesiologist to administer the medication.

Nilsen’s second patient’s labor hasn’t progressed either, but she’s in less pain. What a difference an epidural makes. Patient number two has received an epidural and, even though she’s in labor, she’s sitting up-right and can comfortably carry on a conversation with Nilsen. Nilsen examines her and moves on to check with the patient she delivered earlier, who is in good condition.

She returns to her waiting area, where she will continue to check each patient’s Nilsen2progress through the computer monitoring system. Unless there is a change in the patients’ status, Nilsen will repeat the patient visits in approximately two to three hours.

By 11:30 a.m. two more laboring mothers are admitted. From 11:30 a.m. to 5 p.m. she continues her routine of patient monitoring and labor management.

She explains that labor and delivery can have its dull moments, punctuated by moments of sheer joy and excitement. But it’s an experience she wouldn’t trade for any other profession. “I’ve delivered my own grandbaby here at UTMB,” said Nilsen.

By 5:47 p.m. she delivers a baby girl to a first-time mom and another girl to another first-time mom, an hour later. Now that’s a punctuation mark, an exclamation to be specific.

Nilsen3Nilsen handles it all in a calm, nurturing manner, never losing her command of the atmosphere. She’s not the free-spirited, anti-medicine practitioner I imagined, but a professional and warm health care provider whom I tell I would be proud to have delivered my own baby.

Nilsen came to UTMB from Fort Hood, seven years ago and was promoted to a supervisory role after Hurricane Ike. “When I took the position I told them I plan on retiring here, because I love the collaborative teamwork environment and the academic setting.”

Glad to hear you’re not going anywhere, Nilsen. Keep ushering in the miracle of new life. And that’s a day in the life of a midwife.