My desire (long ago now) to contribute to the (re)production of midwifery knowledges by ‘interrupting’ it through research was conceived in the year when I was a midwifery student. As an ex-nurse, I undertook one of the final post-graduate courses for a diploma in midwifery, half way through completing my university degree majoring in Feminist Studies and Education. Here is a small vignette from my time as a midwife in training.
Pain, sublimation, and a naïve search for ‘(t)ruth’
When I was a midwifery student in 1995, I watched an anaesthetist insert an epidural catheter into a woman’s spinal column after the duty registrar made a diagnosis of ‘patient distressed’ and a treatment plan for ‘epidural analgesia’. I had thought the woman was labouring without many problems; it was her first baby, her husband was providing physical and emotional support, and she was also using the gas to provide some relief. I knew there were no obstetric complications and she was an otherwise well woman. Things had seemed fine till now. The midwife was keeping the registrar informed of progress. When the registrar popped her head in the door ‘just to see how things were going’ and subsequently make her diagnosis, the woman was standing leaning over the end of the bed, moving her hips around in circular
motions and moaning rhythmically and loudly, while her husband stood by holding the gas tubing to pass to her when she requested it with one hand, and rubbing the small of her back with the other.
I was doing little things to help me cope with the feeling that I was being intrusive, like passing on cold flannels and sips of water to the husband every so often to give to the woman, whilst silently hoping I would see a normal birth that shift; perhaps even catch the baby. The registrar asked the woman how she was finding the gas, and she replied that it was ok, but made her feel slightly nauseous. After a few brief and quiet words with the midwife that I was not a party to, the registrar left, and the midwife said “Well, I think we’ll pop in an epidural just to make things a bit easier for you if you like…I’ll just get the anaesthetist down to do it, ok?” The woman seemed ambivalent, but felt that the staff would know best and agreed.
Feeling disturbed but not really sure why, I carried on performing my small and helpful tasks, including smiling, as the anaesthetist arrived with a trolley. Helping the husband help her up on the bed, holding her knees up, so she could ‘curl up tight
in a small ball on the edge of the bed with your spine curled towards me’, while the midwife helped the anaesthetist by opening packets of gloves and other sterile equipment onto a trolley
by his side. Holding her nightie up to be taped to her shoulders while the anaesthetist painted betadine solution on her back, to create a sterile field where the needle would be inserted
between certain lumbar vertebrae into the epidural space, in front of the spinal cord. Smiling at the husband, trying to convey a sense of reassurance, of the everyday. Hoping he couldn’t see the disappointment in my eyes. Struggling with my feelings of confusion. Not wanting to meet the midwife’s eyes (what might I see/convey/not see?) Silently furious with the registrar – had she given birth? How old was she anyway, and why do they always seem so young and inexperienced? Wasn’t she familiar with normal birth? How could a female doctor make these
decisions? Why does this seem to happen all the time? What had been going wrong? Then the needle catheter was in, secured and taped over, op-site smoothed down firmly, drip stands organised, the woman settled back on the bed, nightie smoothed down nicely,
immobile except for her arms and head, blood pressure cuff blowing up on her arm, all set now, husband beginning to look relieved, ice cubes brought in to measure the level of loss of
feeling on her skin, good that’s a job I can do now, the block mustn’t go as high as the lungs or we’re in trouble, midwife just pops in the urinary catheter and drainage bag, that’s just there
because now she can’t feel when she needs to pee as well as to push… CTG machine on and galloping away, baby’s heart beat sounds fine (‘won’t be long now, have we got a name for him or her?’) Everything’s ok at last, big sigh of relief, husband in chair beside bed, no need to massage her now, she’s nice and quiet, midwife’s doing the paper work and checking the equipment.
Then I notice the anaesthetist putting an orange sticky label on the fluid bag, and I ask him quietly out of the couple’s earshot what he is adding. He says “It’s just a small amount of a
narcotic we pop into the bag as well, Ruth”. I say “Oh. I thought it was just a regional anaesthetic, why do they have that as well?” He said, “Well, we just find things work better in
combination like this, different anaesthetists use different combinations of drugs, it’s just asmall dose”. I say, again, “Oh”, and pick up the phial to read the label – Fentanyl, otherwise known as Sublimaze, the label tells me. “Sublimaze?” I say to the anaesthetist – “Sublimaze?” I repeat again, unsure myself what I want from him now. “Do they know they are getting it?” I ask, finally, and he says, “Well not specifically, Ruth, they know we use a regional anaesthetic and an analgesic and that they work very well together” – but it is clear his patience may run out soon so I stop my questioning of him. I feel flat, a bit nauseous and dazed, and am simultaneously kicking myself for having these feelings. After all, the woman seems happy, and her husband is certainly relieved. But as I go home soon after that, well before the woman birthed, I can’t get rid of the thoughts that the name ‘Sublimaze’ sounds like a combination of
the words ‘sublimate’ and ‘haze’ or ‘daze’. I look up the word in the dictionary when I get home and find that it says:
sublimate (sub-lim-ayt) v. to divert the energy of (an emotion or impulse arising from a primitive instinct) into a culturally higher activity. Sublimation. n.
For some reason I feel quite stunned, and wonder for days afterwards if I really will practice as a midwife when I graduate; I almost think I don’t want to, I only want to do homebirths anyway, but how will I manage round-the-clock midwifery practice and juggle childcare as a single parent…I feel so exhausted all the time, just by being a student. I’m exhausted by having to ask questions constantly, and a desperate and lonely feeling that I can never find the right answers, no one seems to care about, or know, or tell, the ‘truth’….
Still looking for (t)ruth years later, after becoming a (non-practising) midwife, then a doctor, then returning to psych nursing. It’s gonna be ok.