Diary of a Midwife: One Day in the Life
An Austin Expecting Series: Diary of a Midwife
Midwives offer care through pregnancy, childbirth and postpartum, including the option to birth at home or in a birth center. For many of us though, the practice of midwifery remains somewhat of a mystery. In this first installment of our latest Austin Expecting series ‘Diary of a Midwife,’ we get up close and personal with Austin-area Licensed Midwife, Heather Hilton.
3:35am – Crying from the corner of the room. I literally closed my eyes long enough to blink and she’s awake. Deep breath. Summon all the mommy patience. I scoop her up and bring her to bed. She just wants to cuddle and feel her mama’s touch. I melt into mama guilt. Of course she does. My fluffy little duckling. I hold her in my lap, and she falls back to sleep, curled up like a kitten.
4:02am – Startled awake to an alarm. What time is it? Wait…why did my husband set an alarm so early? Why isn’t he turning it off? Wait…that’s my phone! Where’s my phone? Can’t….reach…..it…….toddler…..on….top….of…me…”um..hello?” I’m trying to use my very best of course I’m awake at 4am waiting for your call voice. The nervous father on the other end is describing in epic detail that his wife’s water just broke. “That’s great!” I manage to remember in my sleepy fog all the right questions to ask: Is the fluid clear? Is the baby moving? Was it a trickle or a gush? Turns out the fluid is pinkish, which suggests her cervix is probably changing (yay!). It was a tiny trickle, which suggests her baby is nice and low, and baby hasn’t moved since the water broke, but they’ll watch for movement now. I stress, in my gentlest terms, the importance of REST at this time. The absolute worst thing they can do is stay up waiting for labor. They’ll be exhausted by the time labor actually starts. We agree to touch base again in the morning (as in, when the sun is actually up) unless something changes before then. I hang up feeling grateful that my clinic day doesn’t start for five more hours. Sleep….
5:35am – DING! I’m dreaming I’m working in a diner and food is ready to be served. DING! I have an adorable pink apron and I’m dishing out comfort food, like meatloaf and Salisbury steak. DING! This one somehow shocks my eyes open and I’m not in a diner…I’m in my bed with my sleepy toddler and snoring husband. What a crazy dream. DING! Oh my God…those are texts! Crap…how many texts have I missed? I fumble around for the phone I left in my bed after the last call and try to remember my password. My heart is racing. Someone needs me and I’m sleeping through it! A completely different mama than the previously mentioned “my water just broke” mama is furiously texting me…
Text 1: I started having contractions around midnight, and they’re starting to get stronger, around 8 minutes apart.
Text2: They’re lasting 75 seconds and I can really feel them in my back, too.
Text 3: When is it time to come to the birth center?
Text 4: I just threw up my dinner. I’m really struggling. Cramps are getting closer..
Immediately, I press the phone icon and call this sweet mama who has been waiting to have her baby. She’s 41 weeks and we’ve all been praying that the full moon, or the recent thunderstorm, or SOMETHING, would help tip her over into labor. Now it seems it’s happening, and I’ve slept through her texts! A shaky, sweet voice answers the phone and explains that “this is it” and she knows from her last birth that her baby won’t be long in making her way earthside. We agree to meet at the birth center immediately. Deep breath. My next call is to my student, Jessica, who answers with a groggy “hiya” and happily agrees to meet at the center. Then I dial my friend and midwifery partner, Salli. (She never sleeps through texts and always promptly answers, especially when I’m calling.) We strive to both be present at each birth, and since it seems this baby may be coming fast, Salli decides to head in also.
5:42am – I’m quietly rummaging through my drawers for my birth clothes. When most of what you wear is black, it’s a little hard to find your special black birth pants and black birth shirt…in the dark. A little assistance from my cell flashlight and my outfit is together. I’m throwing clothes on as I stumble into the bathroom to brush my hair. My phone sits on the counter next to me while I hurriedly brush my teeth, pull my hair into a messy bun and slap on some deodorant (you’re welcome). I never really kiss my husband goodbye anymore, because it wakes him up. But we’ve been married for 20 years, so if he doesn’t know I love him by now, a kiss isn’t gonna save us. On my way out the door I miraculously remember my phone charger and toss it in my trusty backpack, along with the almond milk I will need to for the large amounts of coffee I plan to consume later. And I’m out the door!
5:56am – I breathe a sigh of relief as I pull into the parking lot of the birth center and realize I’m only the second person here. Jessica has beaten me by a few seconds. How does she do that? Running inside, I switch on the Keurig then make my way down the hall to the birth room. Ok…lights turned down, check. Candles going, check. Birth tub filling, check. Oil diffuser running with clary sage and lavender oils, check. Bed turned down and pillows fluffed, check. Oxygen tank on with masks attached, check. We’re ready.
6:13am – The gang’s all here…Jessica, Salli, and myself. We’re chatting about nothing in particular and I’m enjoying the warmth of my coffee mug in my hand when I see headlights veer around the corner into our parking lot. We all perk up to attention and I move towards the front door to help our laboring mama inside. I can hear her howling as soon as I open the door. She’s working hard. She’s bent over at her car door, barely able to catch her breath with the intensity. Ever so softly, I lay my hand on her shoulder “you’re doing a great job. You’re here. Let’s get inside and get you more comfortable.” As her contraction ends, she nods her head, grabs my arm, and begins shuffling towards the door, which is being held open by Jessica. As we pass the laundry room, I can hear the beeping of the dryer as Salli gets towels warming. She knows we’ll need them soon. We’re halfway to the birth room when mom falls to her knees with another contraction. Her gentle moaning turns to a guttural groan, and then we hear it. Her breath catches in her throat and we can hear her grunt. It’s unmistakable, and uncontrollable. “Do you feel like your body is pushing?” Her forehead has broken out in a sweat and she can barely speak between the giant waves of pulsating power her uterus is serving up. “Um…I think so….there’s so much pressure….I have to poop!” Magic words!! We’re having a baby!
6:16am – It’s all hands on deck as we help mama slide out of her yoga pants and into the warm water of the birth tub. Jessica is taking mom’s temp, blood pressure, and pulse as I listen to her sweet baby with the handheld Doppler. Salli sits in the corner, quietly charting the numbers we call out. Vitals and fetal heart rate are normal. Now we wait.
6:22am – Mama got a few minutes of delicious rest before the next wave of pushing. She’s laying back against the side of the tub, and bracing her feet against the other side. We’ve placed towels around and under her to keep her as comfortable as any human can be while another human is traveling through their body. And here it comes. Her eyes open wide as the intensity builds again. It catches her breath and she allows the power to move through her. Using a flashlight, I peek into the tub and see that her perineum is flattening out. It’s happening!! At the peak of her push, the vagina is slightly opening and a tiny little tuft of black hair can be seen. “We can see your baby! You’re doing it!” She barely believes us. It feels too fast to be real. But there’s no time for conversation. The contraction is over and she collapses back into complete rest. Again listening to her baby, who is bumping along with a perfect heart rate. We all sit quietly and smile at each other. This is what we live for.
6:27am — Eyes wide open, pupils dilated, and the guttural pushing. Now the vagina is opening and five centimeteres of baby head can be seen. “That’s right…exactly like that.” We quietly coo encouragement, not sure if she can actually hear us. She’s so focused, so strong, unstoppable.
6:34am — The body is so wise. Rest given when rest is needed. Another surge is coming and mom is prepared to work. She looks so determined, ready to be done. As her baby’s head stretches the vaginal opening to it’s maximum diameter, she cries, “It’s burning!!” We remind her that burning means stretching, and stretching is healthy. And then just like that her baby’s face crosses the perineum and the head is out. Time stands still. “Ok, sweet mama, open your eyes and look at your baby. One more big push and that baby will be in your arms.” Her power is completely uncontrollable and here comes a shoulder, then another, and then whoosh! Entire baby out into the water. “Pick up your baby, Mama. She’s here.”
Time of birth: 6:35am. She pulls her wet, sticky baby onto her chest and she and her husband are crying, or maybe laughing, or perhaps both. They’re elated. Blissed out. Baby’s eyes are open and she’s just staring at her parents for a about ten seconds, which feels like an entire lifetime. Then her body tenses and she lets out a giant lusty cry. And we exhale. We watch her body turn beautifully pink, starting at her chest and abdomen and traveling down her arms and legs, and to her face and her plump red lips.
Over the next two hours, mom and baby experience a mixture of medical care and sisterhood. Medically, the placenta is delivered, vitals are recorded, bleeding is monitored. But as a sisterhood, she’s doted on. Food, drinks, ice packs (for you-know-where), fresh blankets, a multitude of pillows, whatever helps her feel supported. At some point, Jessica leaves to pick up breakfast for anyone who’s hungry (everyone), and I start boiling herbs for the postpartum herbal bath. Immediate postpartum is complete. The family will stay for a few more hours until they feel ready to go home, and we’ll monitor their vitals. But for the most part, all is well and the birth train has come to a full stop.
8:45am – I pick up my phone to check my texts and realize what time it is. Crap!! I left my toddler sleeping at home and my other five kids have school and/or work today! I have a text from my husband that the oldest son (19-year-old) has stayed home to be with her. He’s a saint. Sigh of relief. Now I have 15 minutes to eat breakfast, throw on some more deodorant, make another (third? fourth?) cup of coffee and be bright-eyed for my first prenatal appointment of the day.
8:52am – Phone rings and I immediately remember the mom whose water broke earlier in the night (or was it morning?). It seems she’s in early labor. She’s watching funny movies with her husband and starting to have mild contractions. It’s her first baby and she understands that it may be a while before labor is really active. Secretly I’m praying we can get through the clinic day, but of course I’ll be there whenever it happens….because that’s what we do. She promises to call as soon as labor picks up.
9, 10, 11am – Pretty standard prenatal visits. Belly rubs and baby hugs. Questions about seasonal allergies, Braxton hicks contractions, incorporating siblings into the birth experience – all the typical midwifey stuff. Somehow while I’m with my clients I forget about lack of sleep. My cup feels pretty full.
12pm – Lunch hour! My 15-year-old goes to a charter school in Austin, so my lunch hour is spent driving to Austin to pick him up from school and take him home. He gets out at 11:45a, so I’m always late and he’s always patient about it. I drive him home and get back to the birth center in time for afternoon clinic.
1, 2pm – More prenatal visits. The afternoon moms had questions about gestational diabetes, and when is the best time to get an anatomy scan (18-22 weeks), and is it ok to have sex while pregnant (yes). My clinic day ends at 3p and I kind of can’t believe that I’ve survived the day. Whew. So tired.
3:06pm – Walk in the door at home to a happy little toddler running towards me. Her face is dirty, her hair is tangled, her clothes don’t match, but she’s smiling ear to ear. My oldest son, a natural caregiver himself, gives me a tight hug and asks if I need anything else before he hands her off to me. I know he’s dying to go do whatever 19-year-olds do, so I thank him and tell him how much I love him and send him on his way.
3:45pm – My twin girls walk in the door from school. They’re in third grade and always have a lot to talk about when they return home. I try to stay conscious while I listen to who likes who and what they ate for lunch and what girl wore what outfit, and on and on and on. I keep thinking at some point they’ll get bored with me and let me drift off to sleep, but so far they’re happy to just keep buzzing around me like little bees, electrified with the excitement of another day in third grade.
4:17pm – My toddler has toddled up the stairs to watch “shows” with her big brother. My girls have pranced off to play in the neighborhood. My 15-year-old is brooding in his room….because that’s what 15-year-olds do. And here I am, finally with a peaceful moment. Before I even know it, I’ve nestled into the sofa and my eyes are too heavy to keep open. Sleep…
4:23pm – My phone is buzzing next to me. Someone is texting. She wants to know if it’s ok to color her hair while she’s pregnant. I quickly swipe an answer into the text box and press send. Sleep…
4:37pm – Buzzing again. Aforementioned 15-year-old wants to know if his friends can come spend the night this weekend. Yes, and thank you for disturbing my only chance at a nap. Sleep…
5:02pm – Again with the buzzing. Why do I even try? This time it’s my darling husband, calling to say he’s leaving work. Cool. Love you. Don’t talk to me. Sleep…
5:40pm – “Mom, what’s for dinner?” My girls have returned home, and brought an appetite with them. I groan and pull myself to sitting. Nap time is definitely over. No sleep…
5:44pm – I forgot to lay any meat out to defrost so we’ll just have to make do. I start boiling water for pasta and throw a few handfuls of frozen meatballs into the boiling water. Pasta and meatballs…a dish no one really loves but everyone’s willing to tolerate. Sounds like a win tonight.
5:58pm – Pouring jarred pasta sauce into my pasta/meatball creation and my phone is ringing. I reach for the nearest dish towel to wipe marinara sauce off my fingers as I follow the sound of my phone. When I get there, I see it’s the “my water broke early this morning” mom. As I answer with my sweetest of course I’ve had plenty of sleep and I’m anxiously awaiting your call voice, her husband confidently reports that her contractions are now coming every 6-8 minutes and building in strength. He clears his throat before he gathers the gumption to spill out every detail of her bloody vaginal mucus, which she presented to him on a square of toilet paper, and offers to send me a picture. (Sure! Why not?) I encourage him that this is great progress (!) and offer suggestions of hot baths or showers and positions on the birth ball (read: yoga ball, pilates ball, exercise ball, giant inflatable thing to sit on/lean on/drape oneself over) as they wait for contractions to increase in frequency. I give the almost always given advice of eat, drink, sleep, and we agree to talk again soon when things change.
6:12pm – While I’m serving dinner, the mama who birthed early this morning is texting me photos of her baby’s puke. “Is this normal?” It’s greenish mucus with brown strands of blood. “Yep. Totally normal. Baby swallowed some amniotic fluid and blood on the way out.”
6:56pm – Signing all the necessary permission slips and reading logs for the kids. I’m trying to have a grown up conversation with my husband about his day, but with six kids needing our attention, it’s kind of a losing battle.
7:30pm – I decide I better do my best to nap while I can. I know that mama is working hard, and I imagine she’ll want to come to the birth center before midnight. Kids are occupied, toddler is doing her toddler thing, husband is occupied watching tv…it’s my big break. I head to the bedroom and curl up under my quilts…with my clothes on. Thirty seconds later I’m out.
7:52pm – I wake up with no sense of where I am or what time it is. My heart is racing. “Honey, your phone is ringing.” My husband gently jostles me into consciousness and it all comes flooding back. Oh yes, I’m a midwife. And my phone is ringing. Because the brave mama who has been patiently waiting all day has finally shifted into full blown active labor. Her husband is breathless and ready to leave for the birth center, and I can hear his wife’s deep, primal moaning in the background. Yes, sir. It’s definitely time. I can be at the birth center in ten minutes.
It takes about five minutes for me to be ready to walk out my door, and in those five minutes, there is a mixed flood of emotions. I’m excited that my client that I love and adore is finally getting closer to meeting her baby. I’m disappointed that I didn’t get more time to talk to my husband and share the same general space. I’m guilty for leaving my children, again, especially the little one who never quite understands. I’m exhausted, because I know my best chance for sleep tonight lays in 30-minute power naps between listening to baby’s heartbeat.
My husband walks me to my car, which is our usual routine if I leave for a birth when he’s home. He puts his arms around me and holds me close. I inhale him. I need this moment to carry me through until I see him tomorrow. Neither of us say the things we want to….him about how much it sucks to be married to a midwife or how he feels like a single dad when I’m running off to births at all hours; me about how I hope he understands how much I love him and the kids even when I’m not home. I love being a mother and a wife and a midwife. I don’t love doing them all at the same time. He bends down to kiss my head and says “have fun!” And I know I will.
Heather Hilton has been attending births since 2001 and became a Licensed Midwife in 2007. In 2011, she opened Central Texas Birth Center in Georgetown, Texas, where she also works as a staff midwife. In addition, Heather has served as an instructor for the Association of Texas Midwives Midwifery Training Program since 2014. Heather has six children, three dogs, and a very patient husband. For more information, visit:
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