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Thursday, Oct. 23, 2003 02:20 pm

Against the odds

Ray Spooner works in a field dominated by women — and he's loving every minute

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Ginny Lee

It is a late September afternoon. Eighteen-year-old Johniesha Deberry is in labor. Her child wasn't growing as expected, so birth is being induced. A fine-boned woman, with beautiful clear, black skin, Deberry wears a well-worn hospital gown. Her black hair, tinged with red, is tied in a high ponytail with a bright plastic hair elastic. She looks tiny and scared.

 

4:15 p.m. Deberry flashes a weak smile when her midwife walks in the room. Ray Spooner's blond ponytail falls to his shoulder blades. His short beard is carefully trimmed. He wears a small silver hoop in his right ear. His profile is dominated by his hawk nose, which gives him the regal look of a Mayan warrior. Spooner is not rail thin, but very fit, the result of two of his favorite hobbies, long-distance biking and rock climbing.

But it is Spooner's voice that is most surprising. When he speaks, Spooner is almost inaudible. His voice, which retains the accent of his native London, isn't precisely a whisper, but it is deep and soothing. "Hellooooo," he'll say. Or "yesss." His voice is like a caress.

In other jobs, Spooner's quiet voice has been a liability. Yet women in labor find his voice relaxing and reassuring. Even with their eyes closed they focus in on his voice. Spooner likes to tell a story of one of his first deliveries when the wife yelled at her husband, "Be quiet, I can't hear the midwife!"

Spooner is one of four certified nurse-midwives at Carle Hospital in Urbana, Ill., and the sole midwife at the Planned Parenthood of Champaign-Urbana, which is how Deberry became his patient. Spooner has been delivering babies in Champaign-Urbana for ten years, the last six as a certified nurse-midwife. All told, he's attended roughly 1,400 deliveries. His patients respect him, they trust him, they listen to him, they come to him for every kind of advice. They pray that he'll be on call when their time comes.

Deberry's eyes widen when Spooner shows her an instrument that looks like a knitting needle. He explains that it will feel a little uncomfortable when he breaks her water. He helps Deberry recline, an uncomfortable position at this stage of her pregnancy. He sits on the edge of her bed, his face is relaxed, his gaze focused.

"Any questions?"

"Yes, why did we do this again?" she asks him.

Spooner smiles and patiently explains about the baby not growing, something he's told her a couple times already. It's probably because the baby takes after his mother and is naturally small, he says.

"Your cervix is soft and ready to go," Spooner says. "I think you'll have your baby by 6:33."

"He's OK, though," she asks in a small voice.

"Yesss, he'll do fine," Spooner says before he leaves the room.

 

There are thousands of nurse-midwives across the United States: the American College of Nurse-Midwives counts 5,700 members currently in clinical practice. But of 44 nationally who are male, only one, Spooner, is in Illinois.

Male obstetrician/gynecologists aside, labor and delivery is a singularly female preserve. Peggy Vincent, midwife and author of Baby Catcher, talks of "the intuitive gift of women who care for women, of knowing when to speak, when to be silent, when to laugh, when to hug, when to be pliant, and when to stand firm. How to be mit wife."

A midwife is part soul mate, part surgeon. It is a far more intimate relationship than with a doctor. They have to keep the mother-to-be's spirits up, help her use her energy wisely, be calm and supportive, but not intrusive; they also have to catch the baby, deliver the afterbirth, stitch up torn flesh, and deal with any medical emergencies. In short, midwives have to deal with a lot of "blood, . . . and screaming," as Spooner often says.

When people picture midwives, they often picture a "Mother Earth" type: down-to-earth, no-nonsense, warm and caring, Birkenstock-wearing gentle souls. Spooner is much of this. Like all the other nurse-midwives at Carle, he is vegetarian and a non-smoker, but draws a line at pastel colors. He favors black scrubs, but also wears funky patterns like tie-dyed or musical notes.

Ask Spooner why he chose midwifery, he shrugs. It's not odd to him that he is a midwife who happens to be a man or a man who happens to be a midwife. Midwifery suits Spooner. After a youth full of dead ends and bad choices, he has found his calling. Never mind that it is in the company, almost exclusively, of women: it is the intensity and the utter unpredictability that he loves about the job.

"Labor is so far removed from day-to-day experience," he says. "My patients and their partners will take this experience to their grave. It is such a gift to be with them. This is one of the most intense moments of their lives. Giving birth is the most primal, the purest you'll ever be," Spooner adds. "Any façade of who you may be is totally stripped away. The pure form of you, for better or worse, comes through. Labor is the great equalizer."

He relishes the idea that, in labor, well-educated women with good jobs and health insurance aren't any better off than the poor, uneducated and even homeless patients who make up some of the clientele of Planned Parenthood.

The use of midwives has swung like a pendulum across socio-economic levels for as long as women have been giving birth. Before the advent of the medical profession, women had their babies at home attended by a midwife. As doctors became the vogue, only poor women still used midwives. It was a sign of social status to give birth in a hospital. More recently, as women sought to have more control over their birth experiences, affluent women again sought out midwives while poor women did not have that option. Now midwives -- at least those licensed to deliver in a hospital -- are mainstream. In many cases, the health care industry (Planned Parenthood included) has recognized that, for routine deliveries, midwives provide an economical option.

 

4:45 p.m. Deberry's face tenses with each contraction. They are coming steadily now. Although she was sure she wanted an epidural to numb the pain before labor started, Deberry is not asking for one now. Spooner sits out at the nurses' station. He pulls out the obstetric unit's scheduling book (all inductions and C-sections are listed in the book) to display the intricate mosaic of hundreds of bits of colored tape he created on the cover. It is in the shape of a baby's head crowning.

"I am very meticulous about some things," he says. He has designed dozens of T-shirts and posters for various friends and for various events. In 2001, a small group climbed Mt. Fuji to raise money for the Champaign-Urbana Planned Parenthood. He designed the poster for that project and did the climb. But don't give him a short deadline; he does nothing in a rush. That includes delivering babies.

By his own count, Spooner worked about 30 jobs by the time he turned 30: jeweler, batik artist, rescuer of lost lambs (literally), builder of sophisticated tools for physics experiments, welder of pipes in Israel, flipper of crêpes in the Alps, tender of bar in Spain, maker and seller of yoga props in the states.

As a bright but unfocused young man, Spooner apprenticed as a jeweler at London's Sir John Cass School of Art. Although he didn't complete the program, he did find work as a jeweler. This phase of his life was troubled. It wasn't unusual for him to fall asleep drunk behind a trash bin.

In 1982 he went to Israel on a lark with a friend. That trip marked the beginning of his gradual unfurling; his looking for and ultimately finding what he was meant to do. In Israel, he met Rae Weichsel, a tall, loud and gregarious woman from Urbana, Ill. They fell in love. After traveling the world together, they married in 1983 (Spooner wearing a suit from Goodwill). In 1989, when Spooner was 30, they had their first child and returned to Rae's hometown. Scanning help wanted ads in the local paper one morning, Spooner noticed lots of listings for nurses. Rae's mum was a nurse, he mused; perhaps that would be good steady employment. Before the sun set that day he had registered for the nursing program at the local community college. A product of the highly selective English education system, Spooner could hardly believe his luck. "I remember thinking, 'You'll take me?! I can come?!' "

In the beginning, Spooner was not thinking about delivering babies. In fact he was dreading his obstetrics rotation.

"I remember my first birth. I was backed up against the wall thinking, 'Do people really do this?' It was a very intimate occasion and I had never met this person; I was a stranger here.

"I put in my four- or five-hour shift and was getting ready to go, when the woman called out, 'Please don't go! Don't leave. Your voice is just helping me so much.' I stayed several more hours and afterwards she told me it helped her relax and get through the delivery. I wasn't really doing anything, not consciously. Later I got to thinking, if I can help people through this without really doing anything, maybe this is the field for me. The doctor came in, did the episiotomy, caught the baby, put it on the woman's chest, sewed her up, shook the husband's hand and walked out. I remember thinking, 'It shouldn't be like that.'

"I left the hospital that day on a high. It was a very primal experience. Something had changed, something very intangible. I was looking around the world and everything was different."

 

5:30 p.m. At the nurses' desk, Spooner stifles a yawn. He's been on duty almost 12 hours and has 12 more to go.

Jennifer McBride, the labor and delivery nurse attending Deberry, walks by. "Johneisha is getting unhappy," McBride says pointedly to Spooner, like an aggravated wife. This is a common attitude of Spooner's female colleagues, both nurses and midwives. They respect him and recognize that many of his patients worship him, but they also look upon him with good-natured exasperation and frequent eye rolling. The way they see it, Spooner is no better than the rest of them, but because he is a guy he is a minor celebrity.

Spooner gets up and goes into the room. When Deberry arrived two hours ago, all the labor and delivery rooms were full, so she's been laboring in a cramped triage room. Deberry moans and arches, her eyes clenched shut, her foot waggling, as each contraction crashes through her.

If you want someone to pay attention, whisper. Spooner leans over and looks right into Deberry's face. His voice is barely audible.

"Try to relax," he murmurs. "They're just cleaning your room, it'll be 15 minutes and we can move you."

Deberry winces again, begins to waggle her feet. No mention of the epidural.

In 1992, Spooner finished his nursing degree and Carle hired him as a labor and delivery nurse. There was some concern at first.

"I went to the staff first to see how they would feel about a male provider," says Kathy Easter, who is now also a nurse midwife, but then was the labor and delivery nursing supervisor. "Some were very vocal against it. They were concerned about whether women are going to like having him; it's a very intimate experience and he's a male. Then I asked Ray how he would handle being a male in an obviously female world. His response was 'I'm not going to make an issue of it. When I go to the bathroom I'll make sure to put the seat back down.' He was more of a novelty than anything else. I don't think he does anything different. As a labor and delivery nurse you have to prove yourself and he did."

Although his colleagues were initially concerned, the worry was misplaced. Spooner was enthusiastically embraced by female patients throughout the community. The exception is among Muslim women, who all insist on being delivered by a woman provider.

"Patients all love him once they talk to him," says Karolee Harr, the pre-natal nurse at Planned Parenthood. "Most women think it's cool, they have something special."

 

5:40 p.m. "I'm so hot" Deberry whimpers for the third time, turning her face into the pillow as another contraction arrives. Spooner leaves the room, finds a paper fan and brings it in. He begins to fan her. Still no epidural.

After two years of nursing, Spooner went back to school for his nurse-midwife certification. It was a logical next step. Certified nurse-midwives have more autonomy than labor and delivery nurses: they can deliver babies on their own (though an ob-gyn is always on call in case of emergencies), and can serve as a woman's primary care provider.

A lot of Spooner's job as a midwife involves just chatting with his patients. This wouldn't be remarkable except that Spooner has struggled with shyness all his life. "It boggles my mind that he chose a job that requires interacting with people," says his wife, Rae, shaking her head in disbelief, even after all these years.

Yet Spooner is an adept conversationalist; he doesn't just chat about the weather, but picks up on a variety of cues and reveals aspects of his own life. On one visit, he admires a patient's ring, and tells her he used to be a jeweler.

"Your hair wasn't that color last time you were in," he observes to another. She agrees, laughing.

A different patient mentions that she would like to continue yoga classes. Spooner asks her about her teacher, who, it turns out, is an acquaintance of his. "We met in India," he tells the patient. Some conversations are not so light. When a patient tells Spooner she's feeling stressed because her partner "is not a one-woman man," Spooner asks, "is there anything we can do to help? Like smack someone upside the head?"

"Beyond the physical assessment, blood pressure, weight and baby's measurements, these visits are social," says Spooner of patient check ups.

Many times, he just listens. He listens to their hopes and dreams, their tales of woe, their fears.

"He makes himself more your friend than your doctor," says Amanda Nolder, one of Spooner's patients. "That makes me trust him."

Spooner also has become adept at speaking to large groups. For example, he's the midwife who gives the water birth class at the hospital. His talks are a refreshing mix of wry, irreverent humor and straightforward, down-to-earth information and advice.

He shows slides of women in various states of dress and undress and talks about options, from bathing suit top to T-shirt, to nothing. His quip that "we strongly recommend that dads keep their clothes on" elicits a chuckle from the group.

 

6:05 p.m. Spooner goes to check on another woman in post partum, returns with a blueberry muffin and styrofoam cup of tea.

Just as he finishes the muffin, a cry erupts from Deberry's room.

He goes in again to the cramped triage room, bringing his tea with him. Now Deberry's boyfriend is fanning her and holding her hand. Four friends lean against the wall.

Spooner sits on the other side of the bed and leans in close. In a calm, deep voice he says, "that's good -- that's all baby coming down." Deberry cries out again.

"Nice big deep breath," Spooner says. "Just like the last contraction. That's it that's it."

"OW OW OW it hurts. I can't move," she squeaks.

"That's it, deep breath. When you say it hurts, where does it hurt, in the back, front, below?"

"I don't know . . . in front."

"He's moving down, try not to tense." Spooner leans toward Deberry again. "Don't let it get the better of you. That's it, in and out."

In his office and examining rooms, both at Carle and at Planned Parenthood, Spooner's cork boards are so covered with pictures of babies he has delivered that the cork is invisible. The pictures are meticulously arranged, straight and tidy. He is in many of the photos, often wearing a giant lavender "Listen to Women" button. He tells a story about the birth commemorated in each photograph. In one, the parents were listening to music during the labor and delivery. They had no names picked out and didn't know the baby's gender. The baby, a girl, arrived while Ella Fitzgerald was singing. Baby Ella is now two.

Another picture is of a very young-looking woman, just a teenager when Spooner delivered her third and most recent child. That was during National Teen Pregnancy Prevention month. Spooner enjoys the irony.

"I have delivered all three of her kids. She has no resources, she lives with her mum, but she is there for her kids; she is a good mum."

Not every photo tells a happy story. Giving birth is not a risk-free process. Some babies were stillborn. And some are struggling.

Spooner has seen everything: every kind of sexually transmitted disease and dysfunctional situation. His patients confide some very deep secrets to him.

"Sometimes I wonder what it takes to faze me," he says. "Should I be outraged? I've seen it all. You'd have to be really, really bad for me to consider you a bad parent."

Spooner's own journey from the fringe to become a respected member of the community gives him a rare perspective. He's been there and is not about to cast the first stone. Spooner's patients sense this and feel comfortable confiding in him.

"Nothing in labor works if they don't trust you," he says.

 

6:25 p.m. Deberry is rolled into the actual delivery room. She makes less noise and fewer movements. Her eyes are closed; she is focused totally inward. "No! don't want to feel this no more. J-J-J-J-J-J, ch ch ch ch ch ch ch," She licks her lips.

Another contraction, she reaches for Spooner's hand just as he is reaching for hers.

"Hang in there," he whispers. "If your body says push, go for it. Your body will tell you what to do, just listen."

 

6:33 p.m. No baby yet, despite Spooner's prediction, though he is not far off.

6:36 p.m. Things get serious. Spooner has Deberry put her knees up; he puts on a glove and checks the baby. Spooner whips off his black scrub jacket. He lowers the foot of the bed; spreads out a plastic blue sheet under Deberry. Scrubs his hands. Puts on a disposable blue gown and gloves. Deberry stops moaning. There is no sound; just pushing.

"I can't do this anymore," Deberry gasps.

Just then Spooner announces, "I can see the baby. He has a fine head of hair."

He rubs mineral oil on Deberry's perineum, to help her skin stretch and not tear.

Friends hold Deberry's knees according to Spooner's instructions; they pull back while Deberry pushes.

"Push, don't waste the contraction," he says to Deberry. "You know what to do. That's it. Push hard."

"I can't, my legs hurt."

Spooner has Deberry's friends release her legs, and she relaxes, just for a moment. The epidural is no longer an option.

 

6:50 p.m. Another contraction. "That's it, there you go, good job, that's it, push with it, hard as you can," says Spooner.

Deberry opens her eyes; friends gather around her; no one talks.

"OK, you know what to do. I can see his hair, it makes me want to grab the baby by the head and pull him out," Spooner jokes. "One, two more contractions like that and your baby will be out."

 

6:55 p.m. "Aaaah, aaaah, aieeeeee, I'm RIPPING!!" One blood-curdling scream and out gushes Deberry's baby, squished up, hands folded on its chest, still and grey like a stone garden sculpture emerging from her vagina. The nurse takes the baby, a boy she'll name Daijon, and places it on Deberry's abdomen and he starts crying, wetly and weakly, like the mewling of a kitten.

"You should be proud of yourself, you did it without anything," Spooner tells Deberry, as soon as he cuts the cord.

Deberry, holding the baby, keeps her eyes closed; she winces but does not cry out as Spooner delivers the placenta, palpitates her abdomen and stitches up a single, small, bloody tear.

Jennifer McBride, the attending nurse, takes the baby to clean and warm him up.

Walking out to the nurses' station, there is a spring in Spooner's step.

He turns to the visitor with a grin and a jaunty tilt to his head, his hands up, palms out.

"D'you get it?"

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