Good afternoon passengers. Thank you for flying with threeyearsoflife today. Please pay attention to this quick safety briefing, and we’ll be in the air before you know it. The lifevests are located under your seats, and there are emergency exits at the front, sides, and rear of the cabin. In the very unlikely event of an emergency, the floor lights will direct you towards emergency escape hatches. If necessary, oxygen masks will drop from the ceiling above your seat. Attach these masks like so, and breathe normally through your nose. Put your own oxygen mask on before assisting anybody else. I repeat, PUT ON YOUR OWN OXYGEN MASK BEFORE ASSISTING ANYBODY ELSE.

Or else, like me, you might pass out. And that doesn’t help anyone at all.

As part of our program, we’re asked to follow a number of women through their pregnancies, build a relationship with them and their family, and support them in their labour. JJ was my first “Continuity of Care” or “Follow-Through.” I met her at her first antenatal visit around Easter, and the midwife recommended that she take a student because she was a little bit vulnerable.

Over the past few months, JJ and I have become quite close. We chatted on the phone about her symptoms, her plans for the birth, her other son (two and a quarter years old), and about her situation. It was difficult to draw clear lines and build standard boundaries about where my role as a midwife stopped, and my role as a friend began. JJ’s the same age as me, and has had a difficult time that she was really open about from the beginning. I got to know her son, who would yell my name and run towards me with open arms at the beginning of every appointment, and they would drive me back to the train station after her appointments, joking about men.

Last week, JJ started to feel early labour coming on; she had pressure on her cervix, she was visiting the bathroom every few minutes, and felt the beginnings of cramps and tightenings. On Thursday, 28 June at about 8:00am, she called to let me know that she would be going into the hospital for some testing, and that she thought she was in true labour now. There was a problem though; rather than going to the hospital where we had met, JJ decided to go to the much newer hospital nearby. This meant that if I went to her birth, it would not be in the role of a student midwife, and would instead be going as her friend. This meant that all the hours I had put in with her, on the train for three hours every time she had an appointment, keeping my phone near me and trying to answer every time she called just in case, would be wasted. As far as my degree went, it didn’t count towards my qualification at all.

JJ is so nice though. We had developed a real connection, rather than the clinical type that the university expected of us. I want to be the kind of midwife who stands by her word. So I borrowed a friends car, drove for an hour and a half (ON THE LEFT!!), and got to the hospital at around 1:00pm. She had just been given a painkiller and was sitting on a yoga ball leaning forwards onto the bed. I was pleased that JJ wasn’t lying down on her back. She had eaten lunch, had loads of water to drink, and was wearing her own clothes. Everything was going great! She did a great job, breathing through her contractions and talking to me in between. I held the CTG (cardiotocograph – it tracks baby’s heart rate and contractions with an electrical signal) onto her abdomen and rubbed her back through contractions for a couple hours. They discussed options with us for moving forwards, and talked about moving her over to the ward to spend the night as it didn’t seem like anything was progressing. She was about 1cm dilated at this point. We call it “the Latent Phase,” and this early labour can start as early as 37 weeks. It was getting progressively more intense but was still manageable at this point.

Her mum arrived at around 4pm. JJ was just starting to enter established labour, and was beginning to show more signs of discomfort. The midwife asked her to move onto the bed for an examination, and as soon as the exam started, the pain followed. They let JJ know that she wasn’t far along, and that they could break her waters, but the poor woman was in so much pain that she wasn’t able to respond very clearly. We had discussed options before, so she knew what to expect. JJ eventually agreed to an ARM (Artificial Rupture of Membranes – the midwife uses a thin rod with a small hook to break the waters. The fetus puts pressure on the cervix, and together those two things cause more hormones to be released, speeding up labour). They also attached an FSE (Fetal Scalp Electrode – a small wire that is attached to the baby’s head to get a better idea of their heart rate and determine whether they are in stress). The fetus had an irregular heartbeat, and the waters had some meconium (baby poo) in them, so the midwives were a little bit concerned. During these procedures, her contractions elevated, getting worse with the irritation to her cervix.

From then on, her labour progressed rapidly. JJ was contracting strongly, and was using gas for pain relief. We encouraged her to breathe through the pain, and to move around in order to relieve some of the pressure. Due to the way the baby was lying (he was posterior, which means he had his back against hers and wouldn’t properly fit through her pelvis), she had enormous pressure on her bowels and felt the urge to push. We encouraged her to breathe the pain out and to try to relax her body as much as possible, and JJ kept saying that she felt like she couldn’t help but push.

This part got intense. I was on her left, her mum was on her right. JJ was gripping each of us with one hand, red-faced and intense. It became animalistic – she couldn’t speak, and could barely whisper between contractions. JJ cried, squeezed our hands, writhed around on the bed staring at something we couldn’t see above us. She asked for her other child. She screamed “FUUUUUUUUCK” and then yelled at me when I laughed. She asked for water, but vomited it up almost immediately. The gas made her loopy, and docile but the contractions made her unrelentingly desperate. She wanted to hyperventilate, and we tried to slow her down, speaking in steady voices and trying to calm her. She ripped all her clothes off, in a sweltering moment, and then shivered the next, clutching at the blanket. At one point, she grabbed a handful of my shirt, pulled me down next to her, looked me straight in the eyes, and said, “I can’t fucking do this.”

What does one say? How do you pull her out of that carnal and instinctual state and tell her that she doesn’t really have a choice? We kept saying, “Yes you can,” “You’re already doing it,” “You’re halfway there,” “I believe in you,” but she didn’t seem to hear us, and it didn’t seem to matter. I didn’t know what to say, what to do. I just kept holding her hand, and stroking her sweat-drenched forehead.

Exhausted, JJ asked for an epidural. About an hour later, at 8:00pm, the anesthesiologist came in and tried to talk her through the procedure. He was very matter-of-fact, and I think she needed someone who wasn’t going to indulge her pain in that moment. His job was to make the pain go away, but he needed JJ’s consent before he could even consider doing that, and for her consent he needed her to focus. She finally answered his questions and agreed to the epidural, and we tried to get her up and seated on the side of the bed so he could put the long needle into her back. She was leaning on me, with an arm wrapped tight around my neck when he put it in. The midwife put a mask on me, because she was holding my face right over the sterile field and I wasn’t able to move. He had put the first needle in, and was just administering the test bag of fluid, when I began to feel dizzy. I turned and beckoned her mum to replace me, and ran out of the room to grab a glass of water – I hadn’t had anything to eat or drink since 2pm, and was feeling really nauseous all of a sudden. I reached the nurses station, asked where the fountain was, and felt my legs turn to sand under me and saw my vision go black and sparkly in slow motion.

I came to with a care team around me – two doctors, three midwives, and a receptionist all around me in scrubs. I think my first words were “I’m such an idiot.” I had taken medication without food, which always makes me nauseous, had been standing in an awkward position, and was just damn hot! They got very excited (there aren’t usually non-pregnancy related emergencies in Birth Suite), and recommended that I go to the emergency department, which I politely declined to do. I hadn’t hit my head – though I am growing a nice bruise on my thigh – my blood pressure, temperature, oxygen saturation, and blood sugar were fine (they tested), and I felt totally fine after a cup of apple juice. They found me a vegan meal from somewhere, and let me back into the room – thankfully, JJ had no idea, and kept focusing on her labour.

Immediately after helping me to my feet, the same doctor came into the room to give my woman another examination! After almost 8 hours, JJ was dilated about 6cm. They talked about how the epidural worked (its a very strong cocktail of pain medication inserted directly into her spine. She had slight control over her legs and feet but for the most part couldn’t feel much below her bellybutton.) and left her alone to get some rest. She slept for about three and a half hours with her mother and I chatting softly in the corner.

When JJ woke up, at around midnight, she was starting to feel strong pains. She asked me to rub her back, and she kept dozing through the contractions that we could see printed out on the CTG. They checked her again and she was still only at about 6cm. They started to discuss the option of a cesarean section, as the baby was showing signs of distress and they were concerned about her pain levels. They completed the necessary paperwork and consent info when JJ was in a moment of lucidity. The top gynecologist in the city happened to be on call that night, and he came in to take a look at her. He did another examination at 1am, and determined that not only was she fully dilated, but that it was too late for a cesearean. The healthy baby boy was born at 1:20AM on 29 June via vacuum extraction, after two brilliant pushes from JJ. She asked me to cut the cord. He was breastfeeding within minutes, she didn’t tear (she had needed 32 stitches with her first, so we were VERY concerned about that), the placenta birthed without issues, and I left her with her mum to bond with her new baby.

I drove for an hour in the dark (the borrowed headlights were not great!), and got home at about 3am. I took a long, hot shower, and passed out. It took me the weekend to recover from this birth. I feel as though I’ve run a marathon. I can’t even imagine what JJ’s feeling right now. I have been so struck by the vulnerable strength of this woman, and I’m so honoured to have been present for it. JJ is incredible, and while I don’t know how much I really helped, I’m so thankful for the chance to be there with her.