There are the births that we remember because they are personal, the ones that are special in some way, and the ones that challenge us. There are ones that show you the place you work in a new light.

Apart from my own 2 childbirths, each of which left me feeling frustrated that I had missed something important, the first birth I can remember came when I was a student nurse. I never even saw the birth; what I did see was the physician moving his hands in the air as he described to a student doctor how the baby would descend and be born, how his hands would cup the head and draw the infant into life. I wanted that! It was the moment I knew I would become a midwife.

I can remember some of my own student births clearly-especially the one, near graduation, when I was urged to go help a midwife with a side-lying birth, the first I had seen. What they didn't tell me was the mother only spoke Albanian, dad had about 100 words of English, and it was my birth to do. We all survived, it was a lovely birth, and I internalized that language doesn't matter, but vocal tone does. Many women, near the time of birth, hear best in their childhood language-touch and tone matter more than repeating more loudly.

Many of the best births I attended were "family" births, where family members were gathered in support and love. A few stand out for the positive energy that came into the room. One time the woman and her husband arrived, followed shortly by her parents. Then the sister drifted in as the mother was in transition. Just as she was beginning to push, her brother arrived. He stood quietly in the background, off to one side, smiling. It would be so easy to think how weird, her brother and father were there. But in that room, the family's strength and love provided the energy she needed for a physiologic birth in a very medical setting. How wonderful that the staff could be flexible enough to support what the mother needed!

Other best births were the ones where the mother discovered her own power to birth. The teen, who looked at me to say "That wasn't as bad as everyone told me," pushed out her little boy without medication. The mother with HIV had been told she "shouldn't be allowed" to have a baby someone else would have to raise, even though antiretrovirals were making the risk of perinatal transmission lower every year. She managed to maintain a regimen of care and have the vaginal birth she wanted. (Her baby does not have the infection, and the mother has raised him herself.)

The harder ones are those you remember because they challenge you or your belief. Sometimes it is the obstetric ones-a infant born with abnormalities that were unexpected, that you see for the first time as the infant is coming into your hands, a very preterm infant who will have to fight to live, or a stillborn whose life is cut short even as it starts. Sometimes it will be a social issue such as drugs or homelessness that forces us as care providers to stop and remember that every family deserves to be equitably treated, even when we disagree with their choices. Every laboring woman deserves encouragement toward birth, support through the work of labor, attention to needs and preferences. She deserves this even when it is hard for us to do so.

And then there are the births that let you see your own colleagues from a different perspective. My daughter had prenatal care in my practice and gave birth at the tertiary center where I attended births. She and her husband had worked through their plans, supporting each other as they planned for a physiologic birth. She had asked my husband and me to come to the birth, to be there and support them as they supported each other. Late in labor there was a slowdown, and she needed oxytocin. The nurses and midwife worked with her to manage transition without pain medications she did not desire, even though for the first time that day she needed an intravenous and continuous monitoring. They supported her plan. As I watched my colleagues, with whom I spent time every day, care for my daughter, I felt so blessed to be working in a place that did not find it weird that her father was holding one hand as her husband held the other while she pushed; that worked to meet her birth plan's spirit when the exact letter no longer applied; that welcomed me into the room in the role of grandmother and did not expect me to revert to midwife.

So think about the births you go to, if you work in a birth setting. As nurses, we must find ways to support every woman as she works in labor and support her power to birth her child. When plans change, as they often do, help her birth safely. Remember that she will need an opportunity to process what just happened, sometimes to grieve, sometimes just to understand.

Those of us who work with pregnancy and birth are so fortunate. It is an intimate time, and yet we are invited in, over and over. We need to make our presence count for good.

-Jan M. Kriebs, MSN, CNM, FACNM

Adjunct Professor

Midwifery Institute at Jefferson

(Philadelphia University + Thomas Jefferson University)

Philadelphia, Pennsylvania