Susan Wente poses for a photo.During a recent snow and ice storm, I awoke from a deep sleep to hear my cell phone ring.

As a midwife, the phone is essential when you are involved in home birth and every night it’s less than eight inches from where I sleep. An extra charger is also necessary in case you are at a long Amish birth where there’s no telephone.

I pick the phone up and heard one of my Amish fathers, Ezekiel, say, “It’s Penny’s time. You should come.”

I know it’s useless to ask him how close her contractions are or if she’s broken her water yet. If I were to ask the father questions he would just somberly say, “She just says it’s time.”

I also know because where he lives doesn’t have a phone, he may have walked several miles in the middle of the night and during a snow storm to call me. His laboring wife would be alone and he needs to get back to her soon. I hang up the phone, dress quickly and quietly so I don’t wake my husband.

I have four trained birth attendants who assist me on home births. The attendant for Penny’s birth is Rose. She has been a birth assistant for 25 years and her calm, loving, no-nonsense demeanor is always welcomed. Rose is also Amish and a good friend.

Amish orders or groups are frequently very different from each other. Rose, living is a less conservative group, has a phone in the barn, hot water, bathtubs, showers and heat with propane. Rose’s husband sometimes uses a tractor and has a generator on the property.  At Penny’s farm, they burn wood for heat and water is warmed on the wood stove. They use a small galvanized or rubber bathtub which is hung in a bath house. They will have a spotless outhouse.

Ezekiel will have to use a phone from a friendly English family (“English” is the term Amish use for the rest of us). His cows will be hand milked and only horses will be used in the fields to pull the plow. Ice is still cut from the lakes in the winter and stored in ice houses. When needed the ice is then placed in an ice chest of varying size.

What all Amish have in common is a spotless house, no phone, TV or radio. Amish homes are peaceful and it’s easy to listen closely to others. The loudest sound besides soft talking is usually a clock ticking.

The Amish faith is core to everything they do, children are loved and welcomed. I have always felt the Amish “walk the walk.” They keep promises and they practice their beliefs to the best of their abilities.

But they are not so unlike us in many ways. They have the same problems in meeting expenses, depression, exhaustion, family conflicts, and those challenges in raising a teen and dealing with the elderly. The vast majority of all Amish deliver at home for many reasons which include cost, comfort and the need to be close to their home and family.

Amish do not carry commercial insurance and many families have eight or more children. They also prefer midwives and doctors who understand their culture. Despite this, I have never had an Amish family refuse a high-risk transfer to a hospital for either mother or baby.

At most Amish births, only the father is in attendance. They are attentive and respectful to their wives. Like any husband, it’s difficult to see someone they love in pain. Most of my fathers would describe it as a feeling of helplessness. All women, whether Amish or English, labor the same. It’s hard, but rewarding work.

As I walk out to my car and hope the back roads are clear enough to get through.  Snow drifts on roads in that area can get to be three to 4 feet tall and I don’t look forward to plowing through them. Its 4 degrees, blowing and the skies are overcast. My Subaru can usually get through the drifts well. A midwife’s car has to not only been very reliable, it must be all-wheel drive, the gas tank must be filled and all the correct equipment needed for a birth in it at all times. No exceptions.

When I arrive at Rose’s farm, all lights are out since it’s now 1:40 a.m. I knock on the door and stick my head in calling out, “Rose, Penny’s in labor.” I hear an “OK” and return to my car. A few minutes later Rose is running out and settles in the car with a big sigh as she ties on her black bonnet. The drive is 45 minutes and we chat about birth, families and friends. We also review Penny’s prenatal chart and discuss any concerns before we get there. The radio is never on because that would not suit the Amish way. We share stories and laugh.

Arriving at Penny’s farm, I can see the road is not clear for the last 50 feet. We load up and trudge through the snow to the farm with the birth bags, a baby scale, a file box and oxygen bag. One of the bags must be 70 pounds. I also carry three battery-operated lanterns and a headlamp so I can see in the house.

We don’t knock. Just walk in and unload the equipment as we take off our tall boots and coats.  I can hear a reassuring clock ticking and the wood stove is doing a good job in keeping the old farm house warm.

Penny is making no sound, but I hear Ezekiel softly coming out of their bedroom. He looks happy and relieved to see us, saying he thinks the baby will come soon. Rose and I know he is probably right since this is Penny’s fifth baby.

Rose and I have worked so long together we don’t need to say a word. We just look at each other and Rose gets busy setting up, which includes neatly laying out the sterile instruments, DeLee catheter, laying out the Pitocin with syringe in case there is a hemorrhage, placing the other emergency medication nearby and setting up the oxygen near Penny’s bed.

She also goes through and gets supplies out of Penny’s birth box. These supplies include blue pads, bulb syringe, sterile gloves and 4X4s, and supplies for after the birth. At the same time I grab the blood pressure cuff, stethoscope, fetal Doppler, jell and sterile gloves and head into Penny’s bedroom which is lite softly with a kerosene lamp.

Penny’s working hard but noiselessly. Her hair is hidden by a white scarf and she wears a modest white cotton gown. Going to her side, I check fetal heart tones, blood pressure and her temp and then do a vaginal exam. Her husband has returned and he’s holding her hand, telling her how well she is doing. The love and respect between them is apparent.

After I check Penny I tell her everything is normal and the baby will come soon. I ask her to change positions and she does so with Ezekiel’s help and without complaint. Fetal heart tones are checked frequently according to hospital standards for intermittent monitoring. Penny usually has her babies in her bed, so Rose brings in a cookie sheet and I place it nearby incase her baby has tight shoulders in coming out. Placing a cookie sheet under the woman works well when the bed has little resistance.

After pushing 20 minutes, Penny delivers the baby at 5:07 a.m. on her hands and knees without any problems. The baby is a boy, 9 lbs. 4 oz. with agars of 9 and 9. Penny breastfeeds immediately without problems.

In the meantime, I ask the mom and dad what their son’s name is. They shyly look at each other. Ezekiel beams as he announces the name, which is Jonas E.

Common in many Amish families, the middle initial stands for the father’s first name. That way when you have a lot of Yoder or Miller babies, many with the same biblical name, you can sort out who their father is.

Rose and I pull a galvanized tub out of the bathhouse, fill it up with buckets from the wood stove’s water tank and provide Penny with a much-deserved bath. After making sure Penny is stable and doing well. Rose and I clean up. During this time I asked Ezekiel to go out and finish chores in the barn since someone needs to be with Penny all the time the first 24 hours.

When Rose and I clean up, we work side by side, doing dishes or helping with the other children. If the mother doesn’t have many linens or nightgowns, on occasion we hand wash clothing. Once Ezekiel returns, we review the written postpartum instructions. Penny has used the bathroom and eaten, which are required before we leave.

I asked them if they want a vitamin K injection, Hepatitis B vaccine, eye drops, or for me to arrange for Jonas to be circumcised. Like all of my Amish families, they decline. I say I will be back in two days to do a maternal newborn check and the newborn screen and to call me for anything at any time.

Before we load up the car, Ezekiel gives me his mother’s address, asking me to stop by and let them know so a “maid” can be sent over that day. A maid is a single Amish girl who is paid and usually lives with the family the first four to six weeks doing household chores, wash and taking care of the children. It is one of the most civilized things that the Amish do. I think this is one of the reasons postpartum depression seems to be less prevalent.

As Rose and I drive back, we talk about the birth, and what supplies we are getting low on, who is newly pregnant in the Amish community and who is due next. We always talk about how the day will be for us. Neither of us can take a nap. She has children in the house and an aging mother to take care of. I have a full day providing nurse midwifery care at the OB/Gyn Clinic at Spectrum Health Gerber Hospital then a 24-hour call.

Neither of us complains because we know this is where we want to be at this time in our lives.