I groan to the piercing sound of my alarm as it wakes me up from my peaceful sleep.

Midwifery intuition is something every midwife will eventually gain.

I cried five times today

I remain cocooned in my duvet for a while, trying to squeeze in every last second of rest possible before getting ready for my shift. As the sick feeling in my stomach begins to return, I realise that I should be thankful that I managed to get any sleep at all. I am in a constant state of anxiety and nerves before every shift. The second alarm goes off. I turn it off and sit bolt upright in bed. I check my phone to see who I am on shift with, and most importantly, how well staffed the shift is. I am on my last shift as ‘supernumerary’, but by looking at the off duty I already know there is no doubt I will be included in the numbers tonight.

I start to put my make-up on to make myself appear alive. My housemates have always teased me about it, but I stand by the fact that a woman would much rather see a midwife who appears awake than one who looks like she’s not had sleep for several days. None of my housemates are at home today, so I quietly reheat my food and prepare the first of many cups of coffee for the night.

I keep half an eye on the time, counting down the minutes until I must leave. Eventually my alarm sounds again, reminding me that now is the time to leave. As I gather my belongings and prepare for the drive to work, I take a deep breath and blink back my tears.

Sitting in the staff room with my flask of coffee in front of me, I watch each midwife slowly filter in through the door. Each one of them greets everyone in the room. I smile back each time, still undecided whether it is acceptable to say ‘good morning’ when it’s 7pm. It just feels so unnatural to say good evening when you’ve just woken up. I turn to my phone again to see a message from my mum. I reply and end the message with “I’m at work, pray for me”. I’ve been qualified for seven months, but only rotated to the delivery suite two weeks ago.

My first seven months have been enjoyable. They have also been stressful at times of course, but overall I have really enjoyed the confidence and independence I feel when on shift. I love that after all my hard work during three years of training, I have finally made it. I have achieved my goal, the one I have been dreaming of ever since I was in school. I love talking and building a relationship with women, and I love talking to my colleagues and feeling part of a team. I love that I feel like I am making a difference to people’s lives. I feel like I have developed immensely, both as a midwife and as a person.

But I always knew the delivery suite was going to be hard, and I recently had a run of shifts which made me feel incompetent and knocked my confidence completely. I suddenly feel no better than I did as a student, and I have become much more anxious about what my colleagues think of me.

Suddenly, the day shift coordinator pops into the staff room to begin handover. I snatch a glance at the message from my mum; “you will be fine, try not to worry”.

After receiving my allocation, I grab a piece of paper and make my way to the room. Gently knocking on the door, I say softly; “just night staff”, and walk into the room past the curtain. It still feels weird to me to say I’m working a night shift. Occupational health has only just let me do them again. Most people think I am crazy for wanting to do night shifts, but I don’t mind. I felt guilty when other midwives were allocated weeks of night shifts and I didn’t do a single one, so I guess my guilt was overwhelming.

On night shifts, women and their partners generally want to sleep so, and as this particular woman had had an epidural, I encourage her to take the opportunity to rest before the pushing stage to come. Consequently, for the first few hours, my work consists of categorising the CTG (monitoring), and occasionally checking her pressure areas and doing some observations. I don’t mind it really, this work is what I’m more comfortable with so overall I am able to act independently. There are still times when I am unsure of my classification, and have to muster up the courage to ask for help. And I am still nervous every time I ask someone to buddy my CTG, as I am scared they will disagree with me.

Shortly before midnight I am relieved for my break. On my return everything has changed immensely. I feel like I am walking into chaos; the woman is groaning in pain as her epidural eases off. I receive handover again from the other midwife, who informs me the woman is now fully dilated. After an hour of ‘passive’, where the woman continues to moan in pain, it is time to start actively pushing.

Gradually the CTG (monitoring the baby’s heart rate) starts to deteriorate, and an hour into active pushing it becomes suspicious. I always hate the active pushing stage when I’m on my own. It’s hard to be both a cheerleader for the woman and maintain your clinical skills. I still feel so new to everything and even basic activities seem to take me so much longer.

A doctor and midwife come in to review the case, and a decision is soon made to use forceps. Immediately my heart sinks, never in all my time training have I had to go to theatre for a forceps delivery. The other midwife pops in and out of the room with checklists, consent forms, and hospital gowns. The doctor discusses the consent form, and the anaesthetist comes in to review the epidural block. All this time I’m standing like a lost child in a shop while people go to work around me. I try to go through the theatre checklist, but that is quickly interrupted by the midwife saying they are ready. I look at the woman, who is still in her own clothes and hasn’t even had her pre-theatre medication, and wonder how other midwives manage to prepare people so quickly. I throw the gown over her and rush to theatre.

Once inside you are met by bright lights and the sharp smell of recently cleaned equipment. The floor is sparkly clean, and it almost feels like an ice rink. I am immediately instructed to focus on fetal monitoring, so I quickly attach the transducer to her bump. The number of people around me has doubled now and I can’t help but feel overwhelmed, but I try to put on a brave face so as to comfort the woman in my care, who I can tell is becoming overwhelmed too.

The theatre team fumble at the bed around me. I go to help but immediately get told off by the other midwife behind me; “focus on fetal monitoring” she tells me, and after looking into her eyes I feel extremely nervous. For the first time I panic, thinking that this baby may be born in a poor condition because of me.

Like clockwork the theatre team put the woman’s legs into lithotomy, and shortly after, the obstetric doctors arrive. They reassess, determine the baby’s position, and prepare for a forcep delivery. “I need you to palpate contractions” the registrar tells me and I nod back, trying to seem confident but secretly crying inside. In all my midwifery skills, I find palpating contractions one of the hardest things to do, and now I’m having to do it surrounded by an audience.

Time, which had been flying faster than ever before, suddenly slows. I feel the whole room watching and waiting for me to announce a contraction is incoming. Seconds seem to drag on into minutes, and the ticking of the fetal heartbeat is the only sound echoing through the room.

“I think one’s coming” I mumble, but the doctor just looks urgently at me and I realise I have to be more confident with my decisions. So I just repeat myself, louder, with more confidence and hope I’m right. Pull one is complete, but the head is not quite delivered yet. The other midwife declares “fetal bradycardia”, and I look over to the CTG machine in the corner.

I hadn’t realised, but the numbers had slowly started ticking downwards. 90bpm… 80bpm… 70bpm… The doctor looks at me again, almost willing me to declare a contraction. I palpate her uterus again and announce another incoming contraction. I look to the woman now, who is surrounded by her partner, the anaesthetist, and the theatre staff, all urging her to push. Eventually, the head is delivered and after another contraction, the baby is born.

I always find the cry of a newborn baby the most relieving. It’s when you know that everything is alright. All that work you have done has been successful. The baby is in the mother’s loving arms, and for the first time there is a sense of peace.

The other midwife comes up to me to discuss the birth. She tells me that I need to go through my notes and documentation because I missed certain things. I immediately think of all the times I was overwhelmed and forgot to write something down. I apologise and she softly reminds me that it’s all okay. Nonetheless, I still feel my eyes slowly filling up with water. She looks at me, more meaningfully than before, and asks if I’m ok. For the first time in my career, I’m honest with her. I shake my head and somehow utter the words that I need to speak to someone, but I can’t do it at this moment. She understands and tells me to go and take a break.

I soon find myself in the bathroom sobbing on the floor as my mind races with all my past wrongdoings. I want to speak to my mum, but it’s 4am and she won’t be awake. I snatch at my breath in between hyperventilating, and look at myself in the mirror. I dab at the red rings around my eyes and take a few deep breaths. It has only been five minutes, but I know I have a job to do and I can’t leave now.

So I walk down the corridor, avoiding eye contact with anyone who passes me so they can’t see that I’ve been crying. I stand outside the door for a second, listening to the voice of the woman inside. I smile to myself, practicing the brave face I need to put on in the room. I enter and congratulate the couple again, coo at the baby in her arms, and joyfully support the mother to feed her baby. Anything to hide my meltdown and the heavy feeling of failure inside.

I go outside to grab a thermometer and the coordinator catches me; “you’ll be able to relieve yourself, won’t you?” My mind fills with the long list of tasks ahead of me which will need to be fulfilled. I nod in agreement knowing that this is the only acceptable response.

At 5:30 am I get my second break, which I realise I should count as a blessing since there have been many shifts where I’ve only got one. The midwife from theatre walks in and sits down next to me. Most times I can stay strong, but there is something about this night where as soon as I open my mouth to speak, I burst into tears. All I can think is how I can’t do this job anymore.

I can’t deal with the pressure of caring for two precious lives. I can’t deal with the feeling of being incompetent and the feeling of uncertainty. The fear of losing my PIN, of a complaint, and of my colleagues judging me. I feel like I should be better; I should know more and feel more confident. I realise that the pressure and stress I feel in this job has slowly been outweighing the positive experiences I have as a midwife. Gradually, and without realising, I have slowly grown to dislike my job. As a student I felt bubbly, excited and proud to be a prospective midwife. I studied hard to achieve my dream, but now my dream is becoming a nightmare, one which wakes me up in the middle of the night. I am unhappy, but I don’t know what else to do, midwifery has been my life for so long.

And then there was the final blow; “I don’t want to be a midwife anymore”. And in that moment, I truly believed it. I could have given my last handover and walked out of that hospital never to return. Perhaps in another life that would be the reality. But midwifery had also taught me to be brave, dedicated, and to persevere.

So when my thirty minutes was up, which I largely spent crying, hyperventilating and hugging the midwife, I left the staff room with a brave smile on my face. Another midwife, who had been on her break at the same time, came up to me and hugged me. “You’re a good midwife”. And as I heard those words, I forcibly blinked back more tears. I looked at her, only a couple years older than me but considerably more experienced, and I realised that she too had cried like I had early in her career.

I cried five times that day, and I know I will cry many more times in the future. But I studied for four years in school and trained for three years to get this job. It wasn’t easy, and at times the thought of being a qualified midwife was my main motivation in life. I had come so far, and I didn’t want to give up so easily. So I carried on, and two months later I’m still a midwife. Still struggling at times but becoming slightly more confident each shift.

Midwifery intuition

Midwifery intuition is something every midwife eventually gains. It’s when you have a feeling deep down that something isn’t right, for example, a feeling that you’re headed for a caesarian section, or the feeling that you have to do a certain procedure; whether that be cannulation, a vaginal examination or escalating to a doctor. It was something I thought would come with time, not something I would be forced to learn very quickly.

I was caring for a lady with her first baby, a spontaneous labour admitted to the delivery suite at 5cm. Four hours later I was due to examine her, but I could tell from her behaviour that she was transitioning. She was 9cm, but she was involuntarily pushing with her contractions, so I knew she’d most likely be fully dilated sometime within the next 30 minutes. Just as I was trying to do my documentation, I saw a gush out of the corner of my eye. It’s rare that a lady’s waters break with a gush. It’s a common misconception that the movies have portrayed. It’s often a small trickle, and subsequently the midwife has to squint her eyes to work out whether it’s liquor or just urine (a surprisingly common occurrence).

A lady’s waters breaking usually doesn’t catch my attention too much, but it was the colour of the liquor which I was more intrigued by – thick meconium. “Great”, I thought to myself. This is a classic sign the baby is in distress, and therefore will need observations for twelve hours following delivery. The CTG (baby heart rate monitoring) was completely normal, or rather, it was as soon as I realised I had completely lost fetal contact after the waters broke. I stopped my writing halfway through and dashed over to try to find the fetal heart rate.

“Your baby’s just wiggled away from me”. I tried to sound cheery so as no to panic the mother and her partner, but after multiple position changes and adjusting the transducer to all kinds of angles, it became evident my little loss of contact had now totalled two minutes. I buzzed for another midwife, as you usually would, for some assistance in finding the fetal heart rate. A support worker opened the door and after explaining the situation, I asked for a second midwife to attend. My heart sank when I heard the news that there was no free midwife available to help me.

Nevertheless, the support worker wandered over to offer to scribe for me. I tried to tell her what I wanted to write, but my head was filled with so many different thoughts that I couldn’t put into words what I wanted to say. Whereas I would usually look to a more experienced midwife to support my decision making, I realised that I was on my own and needed to have the confidence to make the right decisions.

I explained to the women and her partner that I couldn’t monitor their baby effectively, and therefore I would recommend a ‘clip’ to put on their baby’s head to monitor the heart rate directly. I was also obliged to say there was a tiny risk of infection near the ‘clip’ site. Fear sprang into the couple’s eyes. I tried to explain that the risk is extremely low and that I had never seen a baby gain an infection from the procedure, but the word “infection” seemed to be the only thing they could focus on.

Each second continued to tick by with no fetal heart rate, so I decided it was time to put on my stern midwifery voice; “I cannot ensure your baby’s well being if I do not apply this clip”. Some may say it’s a bit manipulative, but when you’re panicked and in the moment, and the outcome of this baby is on your PIN (personal identification number), you’ll do anything to protect it and ensure your baby is born well.

This managed to convince them enough and within a few seconds the clip was on and working. She was now fully dilated as I had predicted, and I encouraged her to push with her contractions. There was good advancement, but with this being her first baby there was no knowing how long it would take for the baby to be born.

The fetal heart rate was 75bpm according to my monitor, nearly half what it was earlier. I asked the support worker to try to find a midwife, although I was practically begging by this point. To my relief, another midwife came to assist me. She didn’t stay long before she realised what was happening and dashed to get a doctor. Meanwhile, I was taking the role of chief cheerleader, urging the woman to push with her contractions. The doctor appeared and started setting up for forceps while I continued to encourage the woman to push.

The baby started crowning, and it was at this point I must have forgotten who I was, because in the chaos I found myself pushing the doctor to the side as I dashed to support the woman’s perineum. One push later and the head was delivered smoothly, followed by the baby, which thankfully, cried beautifully at delivery. The neonatal doctor attended shortly afterwards but left quickly once they could see the baby had been delivered.

Half an hour later it was time to handover so I could go home. Suturing had only just finished, and the night shift midwife walked in. “It looks awful in here”, she whispered to me. I looked around at the blood on the floor, sheets thrown everywhere and liquor all over my scrubs. I smiled awkwardly and apologised, saying that I hadn’t had the time to clean up. I handed over and stayed past my shift to help her tidy up. I went home feeling exhausted, but also thankful that everything worked out ok.