Not two weeks after Mom’s memorial service, there was a rush on the maternity ward. Birth always comes this way, coupled in a twisted dance with death. You don’t learn that in medical school.
I was a health unit secretary, thirty-two years old, and since my coffee at eight that night, I had admitted five women. I kept misplacing things—files, messages, my keys. The phone’s perpetual buzz and nurses’ requests, usually so stimulating, now grated on my nerves. I couldn’t wait to get home to Leif for our Friday night ritual. He would warm Chinese takeout in a two hundred-degree oven. We’d crawl into bed, eat egg rolls, and have sex while ignoring a movie. I trusted Leif not to mention Mom.
You have to understand: Back then I navigated the world in a tiny bubble of competence. Now I see that Leif was a safe bet and what I’d thought was an adventurous job—Spanish and Hmong spoken in the hallways, doctors passing me orders, new babies wailing from the nursery—was dead-end and secretarial. In school I’d earned a business degree and an accounting certificate because, unlike the looser liberal arts subjects, success had measurable outcomes. I could organize a ledger or file drawer; I could manage orders and schedules. As it turns out, being capable gets results but isn’t exactly an inspiring life goal.
I’ll grant myself one thing, though: I had heeded a barely discernable nudge when I sought out hospital work. I wanted to care for people. I did it the best way I knew how—by pushing paperwork.
That night I was still clumsy with grief. Nearly every room on the ward had a laboring woman, and we were grossly understaffed. Maryann, the midwife on duty, steamed down the hall, muttering darkly and shooting nasty looks into the full rooms. She rested her huge brown elbows on the counter and pointed at the calendar. “Give me that.”
I spun my chair and lifted the pharmaceutical wall calendar from its hook.
Maryann was the first nurse midwife to work at St. Luke’s Presbyterian. Whenever she leaned her fierce face into mine, I suspected she saw through my city-savvy façade to my small- town self, the kid who put herself through college by ringing up broccoli and baking soda at the red owl—or, that night, the girl who just wanted her mama back. There was little Maryann didn’t notice.
She removed her reading glasses from her hair, perched them on her nose, and found the date. “Knew it!” she mumbled and harrumphed back to the nurses’ station.
A small black circle marked the day. At our last staff meeting, Maryann had argued for increasing the number of doctors on call during full moons, but two of the younger OBs had made a stink, saying she was superstitious and that was no way to determine a schedule. I was surprised. We’d always made adjustments for the full moon when I worked down in ER. I suspected the docs were wet behind the ears. Maryann had muttered, “Lazy schmucks.”
The elevator opened and another patient entered, this time off the street—no insurance, no prenatal care. I took her information and rang for a nurse.
An hour later, as I moved my magnet from the “in” to the “out” box and slipped into my jacket, Maryann and the single doc on call were frantically crisscrossing the hallway. “You!” Maryann shouted, mid-stride. “I need another pair of hands.”
I froze. In seven years of hospital work, I’d never set foot in a room with a laboring patient.
I re-hung my jacket and locked the cupboard. Raised voices from 146B reached the front desk.
WITNESSING MY FIRST BIRTH
Embarrassing to admit it now, but I’d always blocked out the screams and groans behind the ward’s closed doors and imagined instead TV births, the woman laboring on her back, demurely covered with a paper sheet, the husband sweating and holding her hand—maybe not violins in the background but at least a routine of pain and arrival. Instead I saw an older Hmong woman and two teenagers chatting cross-legged on the bed, another woman wringing out a washcloth in the open bathroom, and, on the far side of the bed where there was barely enough floor space, Maryann crouched beside a naked woman. The mother was on hands and knees on the linoleum. Her brows were contorted, her eyes strained, but otherwise she seemed under as much duress as with a bowel movement. Maryann’s left hand was spread across the woman’s tiny back. Her right hand hovered between the woman’s spread legs. Yellow liquid pooled on the floor.
My muscles went slack.
“Get me some chux pads and close that door,” Maryann ordered.
The nurses must not have resupplied the room. Adrenaline surged, and my limbs swung into action. From the hall supply closet I pulled a stack of pads and raced back.
“Here,” I said, even though Maryann’s hands were full with a wet black-haired head. The mother gasped.
“One downside and one up. Gloves!”
Avoiding the sight of the woman’s naked body, I found a box of latex gloves and took an inordinate amount of time fumbling them on. The cotton chux pads were lined on one side with blue plastic. I opened two and sidestepped between the bed and birth huddle to get to the puddle of urine.
“You’re doing great,” Maryann cooed to the mother. “Okay, push now.” The sister translated, unnecessarily.
Shaking, I reached around the woman’s legs and Maryann’s big arms to lay down a pad. I didn’t know how to get it under her knees, so I placed it and the second on top of her calves just as she grunted, jerked her body back, and the baby somersaulted out in a burst of blood.
One human being emerged from another! There he was, glistening, brown, a breathing creature cupped in Maryann’s palms. He thrashed his arms and, finding no uterine walls to push against, snapped open his eyes. They were black pools rimmed with long, sticky lashes.
He looked at me first.
Maryann ordered me to hand her the bulb syringe, and I groped my way into awareness. The baby began to wail. His grief at the harsh air could have come from me, it felt so close. Finally a nurse arrived, chiding, “Hannah! Why are you here?” Maryann snapped, “Doing your job,” and I was shooed out.
On the winter street, tears freezing on my face, I reached into my jacket pocket for my bus pass and finally noticed the latex gloves on my hands, blood splattered, like an extra layer of skin. I peeled them into a trash can. The baby, that stunningly aware, miniscule body, had erased everything: my mortification at the woman’s nakedness, my aversion to blood and urine, the awkwardness of squatting so close. My fear of Maryann. The strangeness of being the only white woman in the room. The unbearable reality of being motherless.
Suddenly, I knew that baby had emerged from the same place my mother had gone. I didn’t believe in heaven but how else could I explain that profound sense of continuity? He filled a hollow place in me, forcefully, irrevocably.
CATCHING THE BIRTH BUG
Later, Maryann said I had caught the birth bug. Her story’s not so different from mine, only she was stuck in a traffic jam outside of Chicago. As she tells it, the combination of a Cubs game and a tractor-trailer accident had the freeway stalled for fifteen miles. The July heat was relentless. Most cars had their air conditioners blasting. Maryann’s station wagon was a clunker; her kids hung out the windows panting like dogs. Her husband had turned off the ignition. The next lane over, “within spitting distance,” another car with open windows held a couple in obvious distress.
“The lady moaned like a ghoul,” Maryann told me, “and her husband kept saying, ‘No! Don’t!’ ” When Maryann realized what was happening, she jumped out and offered her help despite having no medical training. Knowing Maryann, I imagine she just took over, setting the woman up in the back of their station wagon and sending her kids running down the line of cars looking for a doctor. “When that sweetpea popped her little head out,” Maryann said, “I got high. Been a birth junkie ever since.”
Maryann called it an addiction. For me it was more like I’d been living in murky darkness, the basement of my life, and then a match was struck. Birth flared my world with light. My father would probably call the synchronicity God’s grace—a death followed by a birth, releasing me from all I’d known. Grace may be the right word, although there’s no way I’ll concede the grace to God. It was falling in love—irrevocable, fearsome, and blazing.
In the weeks that followed, my attention on the ward began to shift. I pretended otherwise, but sending orders to the pharmacy had lost its charm. I wanted more than forms, names, and dates. I studied Maryann bustling about the ward in a silk blouse and white nursing sneakers, always purposeful and sharp. After seeing how calmly she’d squatted in urine to catch that baby, I felt awe toward her, even envy. When Maryann was on duty, I hand-delivered forms to the nurses’ station so I could peek into rooms. She spent far more time with her patients than the doctors did. She joked with the dads and shared smiles with the moms while pacing the hallways; she almost never wheeled anyone into surgery. For the first time I really looked at the mothers—everyday women, often my age, sometimes teenagers, sometimes older, Hmong, white, Latina, black, brave or fearful, burnished with sweat, riveting participants in this activity I’d never fully considered but for which my body was made. They were captivating. I revered them.
Maryann was too sharp not to notice my awe. She leaned into the reception counter, pushing her nose close to mine. I conspicuously shuffled some paper. “You’re spying. Have you got the bug?”
Her full, meticulously made-up face showed no judgment. A patch of flush tingled my hair roots. I shrugged.
“Listen. If you want more, I’ll show you more. Just ask.” She swung away then added, “On your own time.”
MY YEAR OF SHADOWING
A week later, amid my stutterings and profuse disclaimers, which Maryann slashed with her big, jabbing finger, I asked. This, I discovered, was Maryann’s gift: She ferreted out cracks in peoples’ hard shells, inserted her confidence, and did her best to pry them open. The doctors use Pitocin or prostaglandin gel; Maryann used her wily, fearless heart.
Thus began my year of shadowing, at first once a week during Maryann’s night shift, later in my every spare moment despite Leif’s protests, using even my two-week vacation to observe Maryann’s day-time clinic appointments. Maryann treated me like a puppy, telling me to sit, to hand her the blood pressure cuff, or wait in the hall. Banished, I’d lean against the wall and imagine the prenatal exam, Maryann attending the emergent drama inside the woman’s womb, their touch and talk more intimate than anything I’d experienced in my Swedish Lutheran upbringing.
When she’d let me, I bought Maryann cafeteria spaghetti and meatballs. I couldn’t articulate the jumbled ache in my chest and instead asked her for technical information. How long was it appropriate for women to labor naturally? How did Maryann know when to tell a mother to push? Why did she remove the baby monitor after the first hour when the doctors never did? Maryann would transfer her glasses to the bridge of her nose, pause, sigh, and answer.
Finally one Tuesday night, I was washing up at the nurse’s station when Maryann grasped either side of the doorframe, blocking my exit. I’d just watched my fifteenth birth. The clock read midnight. I had to be back behind the desk by eight. Leif had left a message with the answering service saying we had to talk. I pulled out a paper towel and wiped my hands thoroughly.
“How long are you planning on being a passenger?” Maryann’s questions always felt like accusations. “ Sorry?” “When are you going to get behind the wheel? Admit it. You want to catch a baby.” “I don’t think—” “Try making a decision using some part of your body other than your brain.” I stuttered something about being thirty-three and not able to afford six more years of school. “Can’t I just watch? For fun?” She crossed her arms. I looked at my feet, cramped in their low-heeled secretarial pumps, and felt my body flush with heat. “Forget nursing school and go the direct entry route. You can manage it in two years.” I looked up.
“Lay midwifery. Homebirth. The real deal.” “I don’t know,” I said. My hospital career had unfurled with terrific ease. I’d climbed up to the plush maternity ward in seven years. “I’m not really cut out for it.”
“Bullcrap. Change your shape.”
CHANGING MY SHAPE
That night, unable to sleep, I pictured my cookie-cutter self shaped in the safe mold my parents had helped me perfect. But my mother’s death had dented me. That first birth had stretched me, and all my other borders were shifting to compensate. Leif, breathing warmly beside me, wanted marriage and kids and a little bungalow in South Minneapolis. Until now I’d agreed— isn’t that what every woman wanted? In the morning he would challenge my new priorities. I didn’t know what I’d say.
Change your shape. I lay perfectly still, as though the slightest movement might expose my thoughts. Mom had been the good pastor’s wife and I supposedly the good pastor’s daughter. While growing up I made decisions as though always peering around her, trying to do what she’d consider proper, a wad of her dress balled in my fist and a tangle of desires in my stomach. I looked to my magnificent father, trying in devious and undetectable ways to catch his attention. But then I stopped. I left. I exploded out of that stifling parsonage into a place of responsibility and independence.
Or had I? What if my impending marriage to Leif was yet another grasp for my parents’ affection? What if my every decision, even my fast-paced hospital job, was motivated by insatiable longing? The idea of having a baby seemed perfunctory and safe, but catching one—welcoming life, touching skin so new it smelled like the spring thaw! It was the most joyous act I could imagine. I wanted to get on my knees like Maryann, right at the axis of activity. I didn’t want to die holding an unstapled newsletter in some back room.
Lay midwifery was an outrageous idea—impractical, not even legal in Minnesota.
I could think of nothing else. A year after my mother collapsed, a month after Maryann’s confrontation, I yielded and called the Birth House.
Excerpted from Hannah Delivered, a new novel of midwifery by Elizabeth Jarrett Andrew, just published April 15, 2014. She is the author of the spiritual memoir, Swinging on the Garden Gate; the collection of personal essays, On the Threshold, which was a finalist for the Minnesota Book Award; and the guide Writing the Sacred Journey: The Art and Practice of Spiritual Memoir. Andrew is the two-time recipient of the Minnesota State Arts Board grant.