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Learning in Stride: Space, Place, and Histories

There are only so many rooms.

By Stephanie Tillman, CNM, MSN

In every clinic, in every hospital, in every birth center, in every home. There are only so many rooms. A history exists in each one, layered by each moment working with women, caring for women, and being a midwife. We spend the majority of our time providing for the people in our care, and perhaps do not also consider the space, its history, and its impact on our work.

I attend birth at a community hospital. Overworked, underpaid staff and busy shifts are irrelevant when it comes to the history of the rooms. Room 5 is where the quiet woman squatted and the baby slid out just as quietly, then broke the silence with its red face and beautiful first cry. Room 12 was the worst shoulder dystocia anyone in the hospital had ever seen. Room 1 is where I was forced to cut my first episiotomy as a student, the birth ending in a vacuum delivery and fourth degree tear. Room 14 is where I spent three hours interpreting during a fetal demise. Room 7 is where I attended my first birth on my own, both the woman and I feeling strong. Room 9 had three beautiful deliveries in a row, all on one busy shift a few weeks ago.

I work at two clinics in the community. Four clinic days a week, I might top off at 120 patients total between my 4 rooms: a breakneck pace. The history created in those rooms each day, each week, each month, is overwhelming. 15 minutes ago, I held a woman shaking over feelings about an unintended and unwanted pregnancy, and now I am in the room listening to a dancing baby's heartbeat. 40 minutes ago, I couldn't find the baby's heartbeat at all, and now I am discussing partner notification of a Chlamydia diagnosis. 3 hours ago I discussed the possibilities for a beautiful birth in any setting with the right mindset and provider, and now I am apologizing for a negative birth experience and finding ways to think about how next time it can be different.

At my last international assignment, there was only one large room with five birthing tables. Everyone experienced everyone else's pain, joy, sorrow, and indifference at the same time. It was often difficult to tell if the midwives’ or the women's emotions were stronger, or, at times, if anyone had any emotion around birth at all. With 10-15 births per day, those women, those midwives, and that room holds more history than anyone could ever know.

In part I am writing this post because I wish that as a student I could have had the opportunity to manage an entire clinic day on my own: not only the complexities of the clinical care, but the emotional care of the patients, the sensation of room to room care, and care of myself. I wish a preceptor had spent time processing the day and sharing how to handle difficult days, difficult rooms, and finding ways to switch from tough experiences to happy ones at a moment’s notice.

My relationship with rooms feels different now. Each midwife finds connection with her surroundings, finds beauty in what is available, and ultimately focuses on the patient and her needs. Now that I am their midwife, and my professional and emotional life is tied to these women, I feel differently. I can feel my patients’ connectedness with me, and the end of each clinic visit leaves a wisp of our experience in the room after we part. And when I re-enter the room, I breathe it in and out as I greet the next person, who will now create her own history in the room. We will create a history for each other through the care provided in those moments. I draw from each woman to bring renewed strength to my own work, but there are days when I am out of strength. When the women I see are looking for solace in an unfamiliar space, looking for strength from me when my well feels dry, when they are unfamiliar with the history I am carrying, those are the toughest days.

I have written about how beautiful and difficult days can be, and have recognized selfishness in midwifery care when I find women who can provide strength for me. I tap into it, for my own sake as a midwife and for the sake of the women coming into the rooms after her. I try to remind myself of the presence, the numbers, of midwives caring for people, and how we are all together in what we do each day. I try to remind myself that I am not alone in this work, as I try to remind the women I serve that they are not alone. I recently found solace in Walker Karraa’s important post about difficult births and their effects on care providers. For now, it seems of utmost importance to name, to recognize, and to find ways to support all the aspects of the care we can provide.

After a particularly difficult day of moving room to room on the labor floor, I asked one of the nurses how we are able to leave one room and go to the next, and then the next. She responded simply: “We do.”

I wish in each room we could burn some sage, be with each other, process what happened and find ways to start again. Where I work, that is not possible. Many who work in this environment have built up walls of strength that sage and sharing could not break through easily. But perhaps that is exactly what we all need. At the least, we need to be there for each other.

Each morning when I turn on the lights for the rooms, my rooms, our rooms, I breathe the history in and out, and try to start again. I hope that you are able to find a similar renewal. And I hope that you will, as students or as teachers, find a way to share this with each other, so that when we as midwives are out on our own, no one has to feel alone with the history of the rooms. Because sometimes, I do, and perhaps sometimes, “we do.”

Stephanie Tillman is a recently-graduated Nurse-Midwife now practicing full-scope midwifery in the urban United States, at a Federally Qualified Health Center (FQHC) and as a member of the National Health Service Corps (NHSC). With a background in global health and experience in international clinical care, the impact of public health and the broader profession of midwifery are present in all her thoughts and works. Stephanie's blog, Feminist Midwife, discusses issues related to women, health, and care. Find out more at and follow her on Twitter at @feministmidwife.
Posted By Barbra Elenbaas | 3/1/2013 12:26:57 PM



Any opinions expressed in this blog are those of the individual participant(s) and do not necessarily reflect the views of the American College of Nurse-Midwives. ACNM is not responsible for accuracy of any of the information provided by guest bloggers and/or members via the Comments section. We welcome all feedback – including comments, ideas and suggestions. We also welcome civil, friendly debates. However, any and all content that is deemed inflammatory or rude will not be posted.


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