Is This Normal?

This morning I thought I’d share about the first time I discovered something seriously wrong with a baby.

I was serving one of my favorite clients – Yes, I know, there are those who say all of my clients are my favorite clients – and I guess they are!  But I can’t help that.  After all, I’m the grown woman who’s favorite color is the rainbow!

Anyhow, where was I?  Oh, yes, one of my favorite clients.  Rose.  Rose and Ned.

I do love all my clients, but I had a special thing going with Rose.  I believe I’ll actually tell about her through the next few postings.  Rose was my first real client.  When I came to serve her, I’d been certified two years, but I still worked  exclusively with my preceptor, meaning every woman I’d attended to that point had been a client of hers.

But Rose hired me, and her first birth proved a sort of first birth for us both.  The experience rewarded Rose with her first child, while birthing in me the sense that I really was a midwife.  Her willingness to trust me in spite of my emergent status as a midwife, coupled with the wonder of her birth itself, served to translate Rose into a very special place within my heart.

Rose is Armanda’s sister.  By the time Rose and I met, I’d already served Armanda, two of her other sisters, a brother, and her mother.  Before I moved to Colorado, I was able to serve Rose and Ned through the births of five sons – Davin, Absalom, Haven, Somerton, and Sanborn.  They had their first little girl this past springtime with Hannah.

This is the story of Rose and Ned’s second son, Absalom.

Absalom was born eight days after my husband, Brent, died, at eleven days overdue.  We were a little surprised to have him go so far over, as his older brother had come right on his due date – but his due date came and his due date went, and three days later, Brent died.  Three days after that, Rose appeared at Brent’s viewing with a van load of other folk from her community.  I’ll never forget finding Rose before me in that line that snaked nearly out the door, huge and uncomfortable and embarrassed to be in such a big and diverse group, but steadfast in her hope to comfort me.

We hugged one another close.  I remember feeling the curve of her great, round belly pressing into mine, and I could feel little pricks from the stick pins Amishwomen use to close their dress fronts, too.  With tears filling my eyes, I whispered in her ear, “Rose, what are you doing here?”  And she shrugged one of her shoulders in this endearing way of hers, and smiled her trademark shy smile in answer.

Five days later I attended Absalom’s birth.

Absalom appeared as we’d hoped he’d appear at his birth – a big, strong, healthy baby boy – and, as he’d remained apparently healthy through his first couple weeks, his mother and dad and I were relaxed and happy at the two week visit.  I love two week visits.  The birth is “passed,” as Amish ladies say, as is the first week of adjustment pocked by a dearth of sleep, crampy afterpains, painfully swollen breasts, and fluctuations in weights.  The newborn screen – that vicious gouging of sweet newborn heels – the only part of midwifery I just truly hate – is over with.  Usually moms and babies are fairly recovered and well-adjusted by the second week visit, leaving it mostly a lovely little get-together.  I arrived at dusk – around five o’clock, being, as it was, early February – and was swept through the door by a cloud of freshly falling goose-feather snowflakes.  Ned, finished with choring, came in close behind me, stomping the snow from his boots and blowing the chill from his calloused hands as he burst through the back door.  “Have I missed the show?” he asked.  I told him he was just in time for the best part.  Rose smiled her pleasure as Ned said, “Well, good!” scooping a squirming Davin up from the floor and tossing him into the air.  The two settled into his recliner by the fire to enjoy the goings on as I stripped Absalom of his clothing to weigh him.  Absalom let us know he didn’t approve of the stripping one bit with a string of yells and a thorough soaking of my baby weighing sling.  He was so mad!  And he grew still madder as I dressed him again, though I crooned to him and told him I was sorry I’d offended him.  but he wanted none of me, nor my apology, so I just bundled him off to his mama, and took a seat to wait for him to quiet down a bit before attempting to listen to his heart.

We visited there in the darkening room, talking about who-knows-now-what pleasant things, till Ned rose to light the lamp and I crossed the room to kneel before mother and babe.  Absalom was sucking contentedly at his mother’s breast, and I carefully pressed my stethoscope in against his chest for a listen.

And as I listened to the beating of his heart, my own heart skipped a beat.

I can’t say how long I knelt there before the cozy two-some, slowly shifting my stethoscope in a circle over his chest.  I kept my face neutral as I listened.  “What is that?”  I asked myself. “What’s that swishing noise?”  My mind reached and stretched to identify what I was hearing and to try to think what to do.  I felt ill.  I just kept kneeling and listening and thinking and feeling sick, while Ned pulled the curtains closed, while the woodstove warmed my chilly toes, while the lantern light danced and flickered in the corner of my eye.

I looked up into Rose’s happy face, and a wave of her contentment washed over me.  I smiled at her, easing the bell of my stethoscope free from Absalom and popping the headset from my ears with a click as I stood up.  “Okay,” I said, making my decision even as I spoke, “I’ll be back around to see you two in four weeks.”  I pulled on my jacket and swung my bag up to my shoulder.  “Call if you need anything.”

I thought I’d abstain from worrying them now.  I’d just go on home and scour my books for a probable diagnosis, then call and tell them what I’d discovered.  But, even as I drove along the icy road with my headlights crafting twin streams of swirling snow to illumine my way, I remembered afresh the cardinal question of midwifery:

“Is this normal?”

All we really need do as midwives is determine if what we see is normal or not.  If what we see is normal, then awesome!  Carry on!  But, though midwives come to know a lot throughout their careers, the bottom line is, we’re midwives, not doctors – if what we see before us isn’t normal, well then, it just isn’t, and it’s time to seek help.  We don’t need to know exactly what it is we’re seeing.

As I passed the nearest home at three-quarters of a slick and snowy mile from Rose and Ned’s – the nearest home with a telephone, I glanced at the temperature gauge on my rearview mirror.  Nine degrees.  Nine degrees, and it was only five-thirty.

If I followed through on my plan to go home, conduct my research, then phone Rose and Ned with instructions, I’d have to leave a message at that house to reach them.  By the time I did that, it would be toward eight o’clock, and far chillier than nine degrees.  Somebody from that house would have to pedal a bicycle through the drifts and over the ice to tell Ned I’d called.  Ned would then have to bundle up and make the bike ride to and fro in order for me to tell Ned by phone exactly what I already knew:  Something was wrong with their new baby, and they ought to take him to see a doctor.  No amount of research would change that, but it would delay the baby’s access to treatment, not to mention seriously inconvenience and even endanger his father and the boy sent to call Ned to the telephone.

I swung the car around.

As I trudged back up their walkway, feeling sicker than ever, I understood what else had inspired me to put off telling Rose and Ned what I’d discovered.  One of the hardest jobs in the world is the job of telling a mother and dad there’s a problem with their brand-new baby.

I tapped lightly at the door and stepped back into the circle of fire and lantern light to apologize for the poor decision I’d made, to share the heavy news, to make recommendations, to answer questions, to mingle my tears with theirs.

They were gracious – as all my clients have been through my years.  Rose and Ned elected to wait out the night, and visit the doctor the following day.  A serious malformation was discovered in the otherwise perfect boy – pulmonary stenosis – an obstructive narrowing of the pulmonary artery.  His tiny, strictured artery was stretched open a few days later with a balloon attached to the end of a catheter, threaded from his groin heart-ward.  Happily, the procedure was a success that never needed repeating, and today Absalom is a healthy, active boy of nine years.

I learned so much through that experience.  I was reminded of lessons I’d learned in my apprenticeship, and warned to heed them.  Midwifery is a wonderful calling – on the days it’s wonderful.  But on the days it isn’t wonderful, it just really isn’t.  I was reminded of that – reminded to keep my eyes open, and my strength and courage girded about me, ever vigilant and ready for the not-so-wonderful times.  I was reminded of my place as a midwife, as simply a monitor of normal.  I was reminded to be ready to make an apology whenever and wherever an apology’s needed.

And I was reminded to be humble – to be humble and to stay humble.

As ever, the names of mom, dad, and babies are changed.

Photo taken by Kim Woodard Osterholzer

Thank you so much for the gift of your time!

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Kim Woodard Osterholzer, Colorado Springs Homebirth Midwife and Author

Books by Kim:

Homebirth: Safe & Sacred

Homebirth: Commonly Asked Questions

A Midwife in Amish Country: Celebrating God’s Gift of Life

Nourish + Thrive: Happy, Healthy Childbearing

One Little Life at a Time: Recommendations + Record Keeping for Aspiring Homebirth Midwives