“What do you do?” It’s the question you might get asked when you meet someone for the first time. We all have our go-to answer: I’m a lawyer, I work for a start-up, I teach preschool — but we actually want to know the details: When do you get in? How do you spend your day? Tell us, really: What do you do?
Meet Autumn Nelson. She's a certified nurse midwife from Philadelphia, Pennsylvania, who has been practicing midwifery for seven years. For the last five years, she attends births at a birth center, Lifecycle WomanCare, and also at various hospitals in the greater Philadelphia area.
We tapped Nelson to give us the details about the profession she works in by looking at one day in her life.
In short, what does a midwife do?
I should specify because there are different types of midwives. I'm a certified nurse midwife and so my specific type of midwifery is as a women's health care provider. I do health care across a woman's life, so I can do birth control, annual visits and pap smears. I write scripts for mammograms. I also do care through pregnancy: prenatal care, delivery and postpartum. Midwives specifically approach health care according to the midwifery model, which is different than the medical model. It's just a more holistic approach to health care.
What is the difference between an OB, a midwife and a doula?
Midwives are health care providers trained to support physiologic birth: birth via the body's own innate power. An OB is a surgeon so they have special skills on how to birth babies that are not coming out physiologically. Doulas offer emotional and physical support through labor but do not provide medical care.
Why did you decide to become a midwife?
I always knew that I wanted to work in health care. I actually had a cousin who became a women's health nurse practitioner and that really opened the door for me to medical providers who weren't doctors.
It was the midwifery model of care, the idea of caring for people, having a big focus on educating and empowering people to make their own decisions in health care that appealed to me. That's what really sold me because they think people should have that autonomy and should be empowered to make decisions about their own bodies and be educated to know what's going on.
A day in the life of a midwife
8:00 a.m. My on-call shift starts. I generally do 24-hour shifts so I'll stay until 8:00 a.m. the next morning. On days when I am not on-call, I see clients scheduled from 8:00 a.m. to 4:00 p.m. We see about two clients per hour with a 45-minute lunch break. This is specific to midwifery care. 30 minutes is more than most doctors but that gives us more time to connect with our clients. In the 30 minutes, I do everything during the visit. I do all of the lab work, drawing blood and taking vitals. This helps me talk to people for a little longer and connect with them on a different level that is a bit more personal and holistic.
8:45 a.m. I checked on my three postpartum clients at the hospital. These were women who had given birth at the hospital and were getting ready to head home. I spend about 20 to 30 minutes with each of them. I make sure they are healing appropriately and recovering from their births. I also talk to them about nursing and feeding, and make sure that things are going well. One was a new mom so she had more questions. Sometimes, if the birth plan doesn't go accordingly, we need to have more time to unpack that as well.
10:30 a.m. I return to the birth center, where most of my on-call shift takes place.
10:45 a.m. I do some office work, answering emails and other clerical tasks as well. One mom is calling me because she is past her due date, so we're talking about some of the options she has.
11:30 a.m. I grab a handful of crunchy chickpeas, water and a granola bar for lunch. It's going to be a busy afternoon so I want to make sure I have something in my system. On days when I am seeing scheduled patients, I eat a fuller lunch.
12:15 p.m. Two of my clients arrived at the center in labor around the same time, though they are at different stages in their labor. My nurse and I split up the admissions process to get them to their birth suites more quickly.
12:45 p.m. I check in on my first client. She was 4 to 5 centimeters and is coping well with her contractions. We turn on the tub, get it filled up, help support her in some position to get through her contractions. Meanwhile, the nurse comes in and out, meets the clients, gets their vitals and listens to baby as well.
1:15 p.m. I check in on my second client. Spend some time with her basically doing the same thing.
2:00 p.m. My first client's water broke.
2:30 p.m. After spending some time laboring, my first client has her baby.
3:00 p.m. Now is the time we're monitoring the second client, checking on vitals, making assessments on baby and making sure the bleeding is appropriate. The most common complication is postpartum hemorrhage so this is what we're always watching most closely.
3:30 p.m. My second client has her baby. Once both clients have given birth we have now have four patients: two moms and two babies. Myself and the nurse between us divide and conquer tasks.
6:15 p.m. My first client goes home with her baby. On average, our moms go home four to 12 hours after they give birth.
8:30 p.m. I receive a call from a client who's water broke at home. She isn't experiencing contractions so we decide together that she can stay home for a bit longer.
9:45 p.m. We send my second client home. Tomorrow, a nurse will make a home visit with her to make sure baby and mom are doing well. Insurance only covers one more midwife visit at around six weeks, but I make sure I am communicating and staying up to date on their progress via phone calls.
10:00 p.m. The third client calls back and says her contractions have started, so she comes into the birth center. Typically we ask them to come in when contractions happen every four minutes and last for one minute.
10:20 p.m. We check her into a room and make sure she's doing well.
12:15 a.m. She's ready to deliver. She pushes for a while and welcomes her baby at 1:00 a.m.
1:00 a.m. My nurse and I work together to make sure the newborn transitioned well and that mom's recovering well too.
5:30 a.m. Things are quieter now, so I'm able to lie down and get some rest.
7:30 a.m. I respond to some messages and questions from the first client who went home yesterday with her baby. She is explaining how the night went and has some questions about breastfeeding.
8:00 a.m. My on-call shift ends and I'm able to head home.
How does the day you've described compare to your standard day-to-day?
This is a busy on-call shift (usually we average one to two babies per shift). My office days are very different. Office days are when clients schedule appointments. I see prenatal clients but also do well person care: annual exams, pap smears, STD testing and contraception counseling. I love my office days and being able to provide gynecological care.
What have you learned most about yourself through working as a midwife?
I mean midwives, our work is really hard and it can be great and joyous and it can also be really sad. I didn't always know that I was capable of helping to move people through those really important moments in their life. I've learned that I am capable of that and also learned all the things that I need in my life to help support me to be able to do that work right.
I think it just echoes what I've learned most about my clients as well: Essentially, we can do this really hard thing and get a lot of joy from it.