Thursday, February 4, 2010

In which I quote a midwife I know

Lots of midwives follow Navelgazing Midwife's blog, which has a lot of information on it, and is extremely well-written. She has been a midwife for many years, and a writer for longer. I knew her when I lived on the Left Coast, and she has quite a presence in San Diego.

As you all know, recently I quit (although I hate calling it quitting; I'm not a quitter) apprenticing. I feel really good about the decision. Yes, I regret that I may not become a midwife until I'm 40 -- or older! -- but I'd rather spend the next ten years with my family, preparing for when I enter another apprenticeship or school, than drive us further apart by continuing.

My guilt mostly comes in that I chose to apprentice without really thinking about the details of how and when and WHY I was choosing to do it. It was a few months before I realized, Damn, I'm spending most of my time doing prenatals, and very little time on births. Also, when I did births, I realized, Damn, midwives have a LOT of responsibility.

Can you overestimate the responsibility in being a pregnant woman's care provider? Midwives value autonomy, and they have it, but the other side of that is a huge amount of responsibility.

At this point I could also veer into midwife's responsibilities versus client's responsibilities, and walking that line, but instead I'll delve further into the apprentice thing.

Many women want to do what I did; they want to become a midwife. They want to go to midwifery school and apprentice. Leigh will have no trouble finding another apprentice, if she wants one. However, most people don't get the reality of what midwives do -- and what apprentices do -- and so I want to copy this post from Navelgazing midwife because I think she really gets it. All credit goes to her. I just want to spread this message because I think if I'd really really REALLY thought about it before I started with Leigh, I might not have started and might have saved some stress on myself and my family.

Sweet women come to me, starry-eyed and their heads tilted sideways, looking at me with respect and (sometimes) awe. It's an honor to help women on their paths towards birthwork, but it is also a responsibility. I've listened to midwives wax poetic about being a midwife, pulling the potential apprentice along, muchly because the midwife needs some free help with her work. I think this is unfair and, as happens too often, the women end up leaving the "apprenticeship" once the realities of birthwork tarnish the dream. While I might be seen as a wet blanket with these dreamy women who come asking questions, I know it does no one any good if they begin and quit, one "apprentice" after another; it's just easier to get the whole picture out in the open from the get go.

"I want to hold babies" is a common refrain from the women who sit across from me. I smile and say, "Listen, we only hold babies from here (the vagina/vulva) to here (the abdomen)." Taken aback, I'm assuming they just hadn't thought of that since their faces goes blank. I then begin listing the things a midwife does hold: sweaty hair, the barf bowl as the woman throws up in it, the laboring woman as she dangles and the mother's hand as she squeezes it white and bloodless. We hold placentas as we demonstrate their amazing beauty. We hold scrub brushes as we wash blood off our instruments. We hold needle holders as we suture vulvas. It's important to me to make sure the woman knows the unglamorous parts of the "calling"/"job", just as much as she knows about the good parts.
She needs to know - the most important thing we hold is two lives in our hands.

If, after telling her all those realities, she is still drooling and her eyes light up more with every description, then it is obvious the woman is pretty darned birth-obsessed and a good candidate for apprenticeship.

But there's more. I let Donna (my apprentice) tell these parts of the apprentice story. She speaks about missing birthdays, telling them how many she missed in the first year along. She tells them about missing her kids' school awards... how we've had births on Thanksgiving, Christmas Eve (which requires us to make a home visit on Christmas Day) and wedding anniversaries. How we are called at all stages of the pregnancy, sitting with a woman with a UTI in the hospital at 30 weeks, going to a woman having a miscarriage at 13 weeks or driving 60 miles for a look-see if the woman's membranes have ruptured (nope!). She tells the woman how she can be gone sometimes for 3 days at a time, pumping her breasts so she can keep nursing her one-year old.
We both share the reality of putting 60,000 miles on your car a year, not having an income, paying for gas and child care, food outside the house, buying birth clothes or shoes, all kinds of incedentals that are easy to forget about.
As I said, this might sound all dramatic and tragic, but really, really, women need to know the realities of being a midwife's apprentice. And none of this includes the prenatals, the office work, the making of charts, the answering of emails, calling women back with lab results and all the other nuances in the life of a woman wanting to be a student midwife.

I imagine women's spirits sagging by this point, those sitting in front of me and those reading this, but there are AMAZING parts of being a midwife, too. But if you don't want... no, CRAVE... all that I said above, then reconsideration of this career is called for.

Being at a birth is glorious, but it is a blip in the life of a client's pregnancy. We become part of the family's life, we become part of the birth story forever, even if they can't remember our names 30 years later. We are invited in to see the wondrous joy a new baby can bring, but we also become counselors as the pregnancy brings out the warts and hoptoads lurking beneath the marriage's fascade or their relationship with the in-laws. As midwives (and students), we are privy to things most regular folks never hear from their neighbors, co-workers - and even closest friends. We become connections for women and their families to find food, help them see parts of themselves they'd hidden for decades and stand by them as their world is forever changed by the new soul coming to them.

Some clients become friends, but most slowly disappear over time, coming around again when the midwife holds an anniversary picnic or when they are again pregnant. It's important to keep a boundary between friend and care provider because care providers sometimes have to make serious decisions a friend would never even think of. It doesn't mean you can't empathize with your client... heck, if I don't cry with a client at least once during the pregnancy it's because she's changed care providers! Women become their own type of midwives, creating their style as they walk through their apprenticeship. A good mentor/preceptor doesn't want a clone, but fosters her apprentice's individuality. While I am a motherly type of midwife, other clients want a more business-like provider; there is a midwife for every type of client (in some areas like here in San Diego). Midwives are responsible for being perceptive as to how close or far her clients want to be. It can be a fine line and is crossed sometimes, but realizing it and correcting it quickly brings the relationship back into balance.

It's pretty clear, without even saying it, that a midwife musthave worked through a great deal of her own issues... fear, abuse history, pregnancy, family dynamics, child-rearing and more. It's crucial not to bring one's own issues into the prenatal, laboring, birthing and postpartum periods. We talk about that with new doulas, to see each birth as an individual experience, not thinking, "Oh! My last lady had pitocin and a cesarean, so this woman will, too." But allowing the birth the unfold in its own way. Sure, there are themes and generalizations, but when WITH a woman, BE with her, see her as herself and see her birth as her own. With midwifery, this admonition is even more important because there can be a tendency to think her clients' births will be/should be just like her own midwifery birth. Midwives, too, must allow the woman to have her own walk, even if that walk includes a cesarean. We have to BE with her, not drag her along, but to stand by her side (or even a tiny step behind) as she feels her way through her birth experience.

Birthing women are extremely vulnerable. They (often) take advice literally. They(often) are easily swayed. I am not saying that they don't have a mind of their own or that they can't feel very strongly about certain things, but I have seen women bend to the will of her midwife simply because the midwife is The Expert. Midwives canNOT exploit this. Can NOT. When offering options and giving informed consent, it is imperative to keep one's feelings about the coming choice out of the equation. It doesn't mean you can't share how you feel about a test or a procedure, but not being married to the outcome is vital. I really can't stress enough how important it is to not exploit a client's vulnerability. I believe it takes a great deal of self-discipline not to. Midwives, please don't. Please.

This has gone on longer than I expected, but I felt led this morning to write this out. These are thoughts that come out in small spurts when I speak about what being a midwife is about. Of course, midwifery is different for every woman; these are MY experiences and they seem pretty universal, but others certainly have their own story to tell. I am honored... that word seems so small... so honored to be called to be a midwife. I hold the honor close to my heart and work so hard to do the blessing justice. I always have room to grow (who doesn't?!) and I welcome the ways my midwifery practice will continue to change, evolve, as I learn more and more with every client (and inbetween).

I hope this resonates with some of you. I write this for those birth addicts who know in their very soul they are destined to be midwives. I'm waiting to bring you into the fold.


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