As my fingers gently slid into the warm, wet space of Susan’s vagina, my eyes closed in concentration, riveting my attention on the sensations. An aspiring young midwife, I was doing the second vaginal exam I had ever done on a woman in labor. Yes, I could feel the bag of water and . . . and then it happened. Susan’s breath quickened and a contraction began. As the wave grew stronger, I felt the hardness of the baby’s head moving downward and the yielding tissue of Susan’s cervix expanding around it until, at the crest, I could feel only a tight thin band. Slowly the wave subsided. As it did, the cervix released its tension and the uterus and Susan’s entire being rested.
When I had examined her a few hours earlier, what I had felt deep inside was thick, soft and spongy. The tip of my finger had barely been able to find the opening of the cervix. The difference between then and now was stunning. In those vivid moments of feeling the cervix, my fingers had touched the very process of change—the truth of impermanence.
“I can’t do this much longer.” Susan’s voice was plaintive as her mind catapulted into the future. “Just stay right here with me,” I whispered. “We’ll do it together, one breath at a time.” The next contraction began and Susan’s eyes locked into mine. Breath by breath we rode the wave, anchored in the present moment.
Suddenly Susan’s body began to push. She surrendered to the process in a rhythm of work and rest, work and rest. Before long the baby’s scalp, with wet dark hair, appeared at her vagina. The obstetrician arrived and prepared for the delivery. Slowly the entire area between Susan’s legs stretched and opened, and a head and tiny features of a baby’s face emerged. My mind couldn’t comprehend what my eyes were seeing. Another contraction, a little downward pressure by the doctor’s hands, and a shoulder appeared. Then the chest, the other shoulder, arms, hands, impossibly tiny fingers, belly, back, pelvis, vagina, legs, feet, toes. As if startled, the baby flung out her arms and drew in her first breath. Dark eyes popped open. A loud cry. We were witnesses to the first breath. A new being was here. Now. Though I couldn’t have described it in this way then, the birth process had become my teacher.
I wasn’t to encounter the dharma for another eight years, but when I did, the teachings found easy resonance. When I heard of moment-by-moment change, I thought of labor, where I used my entire being—touching, seeing, hearing, smelling, my intelligence and my heart—to encourage and welcome the process. When I heard how “this fathom-long body contains all the lessons we need to know,” it rang true. When I heard about charnel grounds practice, I felt a curious kinship with the monks who sat day and night in the graveyard watching the decomposition of bodies. I had also sat day and night witnessing change in bodies, at the beginning of life’s process rather than the end.
Twelve years and hundreds of births later I was working as a midwife in a county hospital. The population we served was poor. Many were immigrants. It was my first day back at work after a silent ten-day retreat. I was caring for nineteen-year-old Maria, newly arrived from Mexico with her husband, José. She was in labor with her first baby.
I felt grateful that the labor and delivery unit was quiet and that Maria was my only patient. I hoped to bring the presence and inner stillness from the retreat into the labor room. Maria’s contractions had done their magic opening her womb, and she was bearing down, bringing the full power of her young body to the work of birthing her baby from the water-breathing to the air-breathing world. My hands told me the baby was small. I expected it would be born soon.
The baby descended through Maria’s pelvis, and the muscles and skin around her vagina expanded in that astonishing capacity of the female body. A head and face emerged into my waiting hands. Even after all these years, I was still unable to comprehend the truth of this remarkable moment. Another push and a shoulder appeared. Maria cried out in pain and relief as the rest of the body—the torso, little arms, hands, fingers, pelvis, tiny penis, legs, feet and toes easily slid out.
Guiding the baby onto Maria’s belly, my hands immediately told me to pay attention. Something was amiss. This baby felt soft, loose, almost flaccid. The first breath came, but weakly. He was pink . . . but barely. Deliberate drying with a warm blanket improved his color but brought only a feeble cry. The vibrancy of life in the body . . . where was it?
The nurse and I exchanged glances as I took the baby from Maria’s arms to the resuscitation cart. Maria and José had only a brief look at their sweet little boy, whom they immediately called Juanito. The resuscitation team arrived quickly and began the work they were trained to do. Their faces looked worried. Juanito was breathing, but not well. His color was still pale.
“We have to take him to the nursery,” they said to Maria and José, who didn’t seem to understand the gravity of the situation.
In the nursery, Juanito’s tiny features were obscured by a breathing tube in his nostrils. An IV tube snaked upwards from his little arm. Wires were stuck to his chest with round blue stickers, and the muscles between his ribs were working hard to bring air into his lungs. I looked expectantly at the attending pediatrician. The pain in his eyes belied the almost matter-of-fact tone of his voice: “Congenital anomalies incompatible with life.”
Now it was my turn to feel a contraction. It was in my chest, around my heart. “How long does he have to live?” I asked.
“Probably just a few hours, once we take out his IV and remove the O2.”
My ten days of intensive practice were not far away. I came to the breath. I noted sensations—a lump forming in the throat, a heaviness in the body. I watched the mind. It was once again confronted with something it couldn’t comprehend.
A huge NO, almost like a howl, reverberated through my being. Breathe, I told myself. I do not want this to be happening. But there it was. And what was there to do but be with what was so and continue my work—which had just become midwifing Maria and José through Juanito’s death. With as much care, attention and presence as I had tried to bring to his birth.
It has been twenty years since that night with Maria, José and Juanito, and I still remember moments. Like the moment when I nestled Juanito into Maria’s arms, and she looked at him with such a sweet, sad, quiet smile. Or the moment Father Patrick arrived to baptize Juanito and I left the room so that the four of them could be alone. Or the moment at the nurse’s station when a tear fell onto Maria’s chart as I wrote the orders for medication to stop the milk that would soon be filling her breasts. Her body didn’t know that there would be no baby to feed.
But mostly I remember the breathing. Sitting together in the quiet semidarkness of the hospital room, we listened to Juanito’s breathing, as first Maria held him, then José, then I too, deeply touched to be asked. By the time I had put Juanito into Maria’s arms, his breathing was already irregular. And shallow. A little sigh came on each out-breath. As the night wore on, the spaces between Juanito’s breaths grew longer . . . and longer. My attention would shift back and forth between feeling my breath and listening to his. Several times the thought arose that a particular breath was his last . . . and I would come again to my own. Then, suddenly, in what seemed like forever later, Juanito would take in another breath. Followed by another little out-breath sigh. And then we would wait. And wait. Finally, no more.
When I returned home, I was able to sleep only a few hours. I awoke knowing that my cushion was the place I needed to be. Opening the door to my meditation room, I paused to read the framed calligraphy on the wall: “Birth will end in death. Youth will end in old age. Meetings will end in separation. Wealth will end in loss. All things in cyclic existence are transient. Impermanent.” Images of the previous night filled my mind as I settled onto my zafu. Breathing in . . . life in this world begins on an in-breath. Breathing out . . . this life ends on an out-breath. Breathing in . . . knowing the truth of change. Breathing out . . . knowing in this moment with utmost clarity that—just like Juanito and Maria and José and Father Patrick and all the babies who have ever come into my hands and all the parents I have ever cared for and everyone I know or have ever known or ever will know—there will be a time when I too will breathe in . . . and will breathe out . . . and will not breathe in again.