Consultations, home visits, births. Midwives do it all. What does their workday look like? And what happens while they are on call? Midwife Angelique Coppens reports.
6h00
My natural alarm clock goes off, my daughter is hungry. I let her latch on and we lie in bed lazily. In my head I go over the agenda of the day: today I have consultations. I am not on call for deliveries and can start the day a bit slower.
8h15
I drop my daughter off at the day care and drive on to the practice.
8h30
When I arrive at the practice, I start up my computer, make coffee, brew tea and pour some water for the families who will pass by today. Another fifteen minutes to check the first e-mails and go through the patient files.
9h00
The first consultation of the day. Stijn and Ann come by for the check-up at 16 weeks of pregnancy. We plan half an hour for this type of consultation. We check the heartbeat of the baby and check the mommy to be. In the meantime I ask the partner if he would like to feel how high the uterus has already grown. Back at the table we go over the physical changes. Ann has few complaints so far, the nausea is getting better and the tiredness is also clearing up. We will see each other again in eight weeks, at 24 weeks of pregnancy. In four weeks Stijn and Ann visit the gynaecologist for the structural 20-week echo.
9h30
An intake interview. In front of me is Sarah, pregnant with her third child and already an old acquaintance to us. Her previous two pregnancies were also followed up by us. That is why going through all the questions goes by quickly and we have an hour to talk. This pregnancy is very desired, but a bit unplanned and there is a lot on Sarah’s plate. I am listening. I can see a bit of the weight has been lifted off her shoulders after she has been able to tell everything. I check her blood pressure and weight, run a first blood test and promise to call her the day after tomorrow with the results.
10h30
A 38-week check-up. Eva is almost full term and is visibly tired. Even our stairs up to the consultation room make her completely out of breath. She relaxes a bit with a glass of water while I listen to her baby. I feel with my hands towards the position of this baby and conclude that he or she is completely on schedule. The baby has descended nicely. I put my hands on her belly and reassure her that the baby will come when it is ready. Maybe a little later than Eva hopes, but she still has plenty of time. She has to work another week but she is dreading it. Together we go over the options and make some decisions.
11h00
Tine is last on my schedule this morning for a 90-minute consultation. We really need this time because there is a lot to discuss. She is 28 weeks pregnant and besides the routine check-up, we are also learning some Spinning Babies techniques today and we are reflecting on her birth plan. We go through each step and explain what choices she has. Does she want to give birth underwater? What conditions are attached to this? What are the advantages? How does she want to experience her labour, who does she want to be around her? At home Tine can then think about the topics discussed. In about six weeks, around 34 weeks of pregnancy, we will come back to it and finalise her birth plan. But first I will start with the medical check-up. Tine’s blood pressure turns out to be a bit higher than we would like. As her blood pressure has been higher for some time, I call her gynaecologist. We confer and decide to take an extra blood sample. Depending on these results we plan the further follow-up.
12h30
The morning schedule is over. I still have a lot of administration ahead of me, but it will have to wait. My colleagues arrive for lunch and team meetings. I mention some of the families I would like to get my colleagues’ perspective on. Together we also discuss what the next month will be like. Our holiday planning for the summer is also on the agenda, considering it is also a public holiday for schools. After all, there must always be permanence.
13h45
My colleagues and I are leaving for home visits. My colleague Eva will stay for a few more hours. Birth kits have yet to be made and the midwives’ supplies such as gloves, syringes, needles, … have to be stocked up. At 3 p.m. she has her next meeting with GPs & midwives in the Ghent region.
14h00
I am very excited for my first home visit of the afternoon. I am very much looking forward to this. Jonas was born three days ago and I had the honour to accompany Freya and Tom in the hospital, together with the midwife on duty. It was a beautiful delivery on the birthing stool. I am curious how they are doing now. We install ourselves in the living room and first go over the delivery. How did they experience it? How do they look back on it? Freya doesn’t remember much of the push phase and it’s very nice that I can help her refresh her memory. Tom really loved the birthing stool. Sitting behind his wife and feeling all that power in her body. I can see that he is still impressed. Jonas wakes up and I go over to check on mummy. I check her blood loss, sutures, uterus and blood pressure, amongst other things. Then I check her baby’s weight, colour, belly button and such before we look at breastfeeding together. I’m outside again at 3.30pm, I’ll see them tomorrow.
15h40
The second house visit of the afternoon. Sofie gave birth to her second child four weeks ago and she still suffers a bit of pain when she latches her baby on. We are trying the rugby position and this already feels much better. I let her and her baby practise on their own and adjust where necessary, with respect for the mother. With her first child Sofie had a very unpleasant experience when her daughter and her breast were both roughly grabbed to show the breastfeeding. So I pay extra attention to this. Sofie notices this and says that she greatly appreciates it.
16h30
Normally my last house visit starts now, but I took a step back because I will be on call soon. I pick up my daughter and enjoy a few more hours of quality time.
19h00
I am on call. I will available for all questions, urgent home visits and births until 19:00 tomorrow evening.
21h00
Ann calls me. She has had a very busy working day and feels worried. She has felt her baby move less and her belly hurts. We discuss the possibilities.
21h45
Tara calls. She is 22 weeks pregnant and is suddenly experiencing some blood loss. I send her to the delivery room. I also call them, so the midwives are aware that Tara is on her way. I pass on all the necessary information and they promise that they will keep me informed.
22h00
I crawl into bed. My daughter has just eaten and so I may be able to sleep for a while before a delivery announces itself.
23h15
The next phone call. Hannelore’s water broke. She thinks. She’s not sure. After a few questions I decide to go and check for myself. Out of bed, clothes on and off to Hannelore I go. Nedka, Hannelore’s partner, opens the door and she is sure that Hannelore’s water broke. And maybe already contractions? Hannelore is in the kitchen with only a t-shirt and underwear on. Underneath her is a wet towel. I have to laugh when I see it. I install her on the bed and after my check-ups I’m sure of it. Broken membranes! The baby is doing well, clear amniotic fluid. I don’t see those contractions Nedka was talking about yet. She is far too nervous for that. I give Hannelore a foot massage and some instructions. I will come back anyway, but if they need me sooner, they will call me. I am there for them.
1h30
I am back home and crawl into my warm bed.
2h50
Nedka calls. Now it’s for real! Hannelore is on the ball and has contractions.
3h15
I enter Nedka and Hannelore’s home. Nedka is right: Hannelore is in labour. She wants to stay at home as long as possible, but she wants to give birth in hospital. In agreement I decide to examine her for a moment. Four centimetres dilatation. What a great examination. Hannelore is doing fine. I stand by her and put some pressure on her lower back. Every 15 minutes I check the heartbeat with my doptone. I also read her birth plan.
5h00
Hannelore decides to take a bath upstairs. I stay downstairs and give her some rest. Nedka gives me a strong coffee and I send a message to my colleagues. I also send a message to the planned home visit at 9 a.m. that I will arrive later. She immediately sends me “good luck!!”. I suspect she is feeding her baby.
6h30
Hannelore is out of bath and has strong contractions, every three minutes. She wants to know where she stands and I am allowed to examine her again. Six centimetres. Very good! Hannelore says she would like to go to the hospital. Nedka packs all the things together. Hannelore goes to the toilet and I call the delivery room. Stien has the night shift and will pass everything on to the colleagues. She asks for the medical details and which room Hannelore wants. Do they have to start filling the bath? Together we discuss that this would be a good idea. It could be quick.
7h00
We are on our way. Nedka with Hannelore in the car in front of me, I am just behind them. That way I can keep a close eye on them and support them if necessary. I get a phone call from my colleague Ruth. She will forward the phone calls to her phone so that I can concentrate on the delivery and she can answer all the questions. I am very grateful to her!
7h20
We arrive at the emergency room. The nurse already knows me and wishes us good luck! There is no need for a wheelchair. Hannelore wants to walk. I decide to take one anyway in case she doesn’t like it on the way.
7h30
Hannelore took care of three contractions on the way to the delivery area, but now we have arrived. The midwife of the morning shift welcomes us warmly. The room is already heated. The light is dimmed and the bath is already half full. Nedka looks around admiringly, Hannelore does not. She is too busy taking care of her contractions. She’s having a hard time, she says. And she feels so much pressure. Is this going to take a long time? I examine her again and this show us that it’s going smoothly. She is seven centimetres dilated and the baby is low. Hannelore gets new courage. The baby’s heartbeat is being listened to, but she can walk around in the meantime. Nedka pushes on her lower back and I guide her through her contractions. The midwife on duty and I go over the situation and we prepare everything for the delivery.
9h30
Hannelore is just in the delivery bath and has an urge to push. There are three of us sitting around her bath, gently encouraging her. She listens to her body and pushes when she feels like it and very gently the baby descends.
9h45
Hannelore is too hot. She wants to get out of the bath. What would be the best position for her now? I let her choose what she wants to do. Any position, as long as it feels good for Hannelore.
Out of the bath and on the bed on her hands and knees. Much better! She pushes and the baby’s head appears. Nedka looks at me insecure: ‘Can she give birth like that? We reassure her. This is a good position.
10h30
Noah is born. He lies skin-to-skin on Hannelore. She still can’t believe it. We are all glowing. Noah is already looking for the breast. The midwife on duty and I install her better in bed and soon Noah drinks fluently.
12h00
I say goodbye to Nedka and Hannelore. I will see them again soon. They would like to stay one night at the maternity ward and will probably go home tomorrow. Then my colleagues and I will continue to follow them. I pass by the nursing post where I meet the midwife that assisted us. I thank her for the pleasant cooperation and we will go over a number of things.
13h00
Time for breakfast! I stop at the bakery for two croissants and a large take-away coffee and check my e-mails. Sarah’s blood results are in. I call her and promise to send her another prescription for an iron supplement, because her levels are a bit on the low side.
In the meantime, my colleague Ruth has forwarded the phone calls back to me. She briefs me about last night: nobody in labour, but she had about ten phone calls with small questions. There were no urgent home visits. Furthermore, the delivery room has called concerning Tara. She is admitted for a few days because of the blood loss.
14h00
I am at Manon’s home, the mother who wished me good luck this morning. She is on my schedule to discuss her daughter’s cramps. Manon was indeed feeding her daughter when I sent her a message. She is surprised that I have not slept since then. But that is for later. First, I will check little Fien.
15h30
I am on my way home. There I take a shower and install myself behind the computer to finish my administration. I fill in all the patient files and answer e-mails.
16h50
A phone call from Maya. She gave birth two months ago but now she feels miserable. She has a painful left breast and thinks she has a fever. I decide to stop by.
17h10
Maya opens the door and my suspicion is correct. Maya has mastitis, a breast infection. Together we latch her son on and I massage the breast so that the milk can loosen up. We agree on a policy and she will follow her temperature closely. Luckily she doesn’t have a fever yet, but it is important to keep an eye on it. She will keep me informed and depending on the situation I will visit her again tomorrow.
18h30
At home. My shift is almost over. I call my colleague who will take over at 7 p.m. to brief her and then forward my phone calls on to her. My working day is over.