a post I wrote regarding midwives not transferring with their clients to the hospital, not visiting them in the hospital, not calling postpartum, not contacting them - after what they believed was such an intimate experience
In my own practice, I call the mom at 12 hours pp, go to their home on days 1 and 3, see them in my office (sometimes in their home) at 2 weeks, at the office at 6 weeks, again at 3 months and then we have an "outing" to get the birth certificate and that, many times, turns into a lunch together.
I describe midwifery care like this:
Picture a spiral going inward... we (midwives/caregivers/family members) are wayyyyy out, but as the pregnancy advances, the spiral goes inward towards the mom who is at the center of the spiral. The pace picks up as prenatal visits come more frequently and then in labor, even faster, and by the time the birth is occuring (the actual birth of the baby), almost every person present is physically touching the mother - if not physically, definitely psychically. Then, the moment the baby is born, the spiral begins moving outward again... all of us on the periphery move outward slowly at first until by 2 weeks pp, most of us have left the new family to themselves again. I feel midwives "wean" from their clients as much as clients from midwives.
I know that many midwives do not want to appear as know-it-alls, hovering around telling a new family what to and not to do. I have heard moms tell me that their former midwife had something to say about everything and how annoying that was at times, that they wanted to learn some things for themselves. I believe that message was transmitted to many of us and I know that I hesitate "touching base" all the time if there is no reciprocation - am I bugging them?
I just told my apprentice today that as much as I would love to be friends with clients... as much as I thought we would be social friends after the birth... rarely does that come to fruition. Is it busy-ness? That they have new babies and mine are adults? That their lives continue while I move on to new families? Is it an aspect I hadn't anticipated having to teach about? (I have known this phenomenon in doula and LLL work, too.)
Alllllll that said... I also know, all too well, midwives who have seriously abandoned their clients. Another student midwife and I used to defy our mentor midwife's "orders" to NOT go see women who transferred/transported to the hospital when they were still in the hospital. She did not seem to understand the word "abandon" and despite my telling her that the women asked for her specifically, she refused to visit until they were home.
I always visit my moms in the hospital - asap pp (after having transported with them and remaining hours pp... I return 12-20 hours pp again) - because sometimes it is these women who need to talk out so many of the disappointments and so much of the pain. I have gone to other midwives' clients when I heard their midwife didn't want to go. One midwife had a client transfer 24 hrs pp with sepsis and the mw called me and said she didn't have "time," could I go sit with her? I dragged my hanging open jaw all the way there, baffled at how a MIDWIFE could not go tend to her own client.
I also know that some women are in shock and unable to talk about it all at the time. What might be my clarity is certainly not her perception... sometimes for months. I always always make sure clients know they can call me/email me ANYTIME, day or night, even years down the road... that if they think of a question twice they want to ask, that means it is a message to call or email.
I know that MANY midwives are not comfortable at all in hospitals. It is foreign land to them and they despise the countryside. I, however, spent a great deal of my doula learning in hospitals and birth centers and am equally "fluent" in all three possible birth locations (including home). I know that this makes a huge difference - for my clients especially.
I do not have ANY tolerance for midwives who abandon their clients either in the hospital or postpartum. It drives me batty and I just do not understand it at all. I make sure to teach any students I work with, teach, or apprentice that this is so unacceptable that I don't care if every midwife in the Universe doesn't see the woman but once in the office at 6 wks pp... that is just not right.
A midwife who turns her back on a woman is probably scared of something... being turned in for transporting, being sued for doing (or not doing) something, so infantile in her own evolution that she cannot pull her head out of her butt enough to TALK to the client, to LISTEN to the client and her pain and fears and concerns and sadness... to CRY with her, hold her... face to face, and act like an adult, or just amazingly ignorant of how her client feels (I think this option is the least likely, btw).
And one small note about when I (we) reach out and hear nothing back. What did I do? What did I say? What happened that I didn't see? It's hard on this end, too.
I am pained by what I read of the frequency of this happening. How sad... such a sad state of midwifery un-care. I pray it doesn't have anything to do with economics and haven't heard anything like that even behind closed doors, but I wouldn't put anything past midwives sometimes.
I'm sorry for all of you women left without resolution. It is a major reason I am going to school working towards a degree in Psychology with a focus in birth trauma - traumas such as this included.
Don't discount your feelings, beautiful women. You are right; it is abandonment.