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Dec112005

Postpartum Abandonment by Midwives

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.

References (6)

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  • Response
    Response: Namita Chittoria
    - Navelgazing Midwife Blog - Postpartum Abandonment by Midwives
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    - Navelgazing Midwife Blog - Postpartum Abandonment by Midwives
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    - Navelgazing Midwife Blog - Postpartum Abandonment by Midwives
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    - Navelgazing Midwife Blog - Postpartum Abandonment by Midwives
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    - Navelgazing Midwife Blog - Postpartum Abandonment by Midwives
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    - Navelgazing Midwife Blog - Postpartum Abandonment by Midwives

Reader Comments (11)

Abandonment happens.....and it hurts everyone involved. I know.

December 12, 2005 | Unregistered CommenterWash Lady

I am so sorry.

Remind me to add your site to the links, eh? I forgot to add you when I revamped the pages.

Thanks for being here and reading still. Thanks a lot.

December 12, 2005 | Unregistered CommenterNavelgazing Midwife

The first homebirth I ever attended, the midwife shot out of there after 90 minutes, before the mama had even gotten up to pee! She left her with a badly torn labia, and then wanted my client to go to HER for the three day visit - 2+ hours away!

I am still angry about this birth, and frustrated too that this mama went back to her for the six week visit, despite how absolutely enraged she was after discovering how badly she was torn. By the time she and her husband looked, it had healed too much to be repaired, and she will need cosmetic repair now. :(

Is there no mechanism for midwives to police themselves? If they don't find some way to start being honest about what negatives are going on, someone else will step in and do it for them- and goddess knows there is PLENTY/too much legal intervention into midwifery!

So sad, and Barb, I just respect you so much for speaking courageously on things for some reason, other birth professionals aren't. I try to do the same. :)

December 12, 2005 | Unregistered CommenterKristina

I still email my midwife, and we live thousands of miles away. :)

December 12, 2005 | Unregistered Commenterbirthstudent

I agree but sometimes--things like distance transport-- so that baby and family are 100's of miles away- no way to phone and parents are not in touch with mw--
or what about hospitals that have doctors who refuse to treat clients as long as the mw is there-- this happens in some rural areas-
depending on the area some women get better treatment if the mw is not seen around- hospital staff can have some real biases- maybe not so much in a big urban area but in rural areas this can be the case- legal or illegal --
there may be some other things like if the transfer of care is because there is a falling out during labor between mom or dad or any other family member and the mw-- I can think of a time where drunk/drugged dad is agitated and then mom transfers to hospital- does not want follow-up care or wants it but does not want conflict (not my clients but still..)
but with those exceptions stated it is best to follow up even in the most difficult situations- even if it is painful for you as a person- even if what you have to do is be very humble .
I know that the mws who get kicked out of the hospital order/buy pizza before they leave so that the parents have some food on the way -and they tell the clients ahead of time what the situation is-- and do follow up after the parents leave the hospital

December 12, 2005 | Unregistered CommenterAnonymous

I'm reading through old entries (I told you I would) and this one really stuck out at me. I think a lot of transfer moms feel abandoned by everyone. It seems like people don't visit because they just don't know what to say. I wonder if that discomfort affects midwives too.

The only people who visited me during my stay were my dad and my stepmom, who normally are not good at maintaining contact. My half sister was born at home so I think my dad was more comfortable and familiar with homebirthing.

April 28, 2007 | Unregistered CommenterJess

Way late to the party -- but thought I'd let you know this post reminded me that I wanted to write a note to the midwife who attended my daughter's birth (9/04) to let her know again how much I really appreciate the effort and time (and love!) she gave me. This time around (baby 2 due 3/08) I'm in the medical model for prenatal, purely because we're moving out of the country, and I'm researching midwives in Vienna. My midwife spent at least an hour with me every. single. appointment. She visited me daily for the first few days postpartum, and when breastfeeding initially seemed torturous, she guided me through it. This time? I see the CNP or doc for perhaps five minutes per visit.

What a difference. Pardon the blog-stalking, but as I move farther along in my pregnancy, I'm trying to remind myself what I do (and definitely don't) want for a birth this time!

October 9, 2007 | Unregistered CommenterAllison

Not blog-stalking at all... you're just reading. And I'm following along. :)

NgM

October 9, 2007 | Unregistered CommenterNavelgazing Midwife

I am really greatful to read this discussion. Over twenty years ago, my wife and I had a horrible experience being abandoned by our midwife and her assistants, having our baby die at birth, and then having to cope with our midwife's inability to discuss what happened honestly. It is my opinion that our midwife (and her assistants) may have been suffering from their own shock and grief, which they were unprepared to deal with as much as they were unprepared to deal with ours. Unfortunitely, our midwife's being in denial manifested itself as talking down to us with demeaning, pop psychology admonitions.

Most of what we read about midwifery is positive, but at times it seems airbrushed, as though it is taboo to admit that there are any problems which need to be addressed.

Over the years I have encountered midwives who were sympathetic and real with us, and that has been gratifying. I feel that training of midwives should include preparation for tragedy. Even with an exellent survival rate, a midwife who delivers hundreds of babies during her lifetime is likely to have to deal with stillbirth simply because it is a statistical likelihood. As far as I know, learning about grief and preparing to deal with it is not a required part of the midwifery cariculum, but it should be.

I am very greatful to see this site, and for the opportunity to share our story with midwives.

Steven K-Brooks
Brattleboro Vermont
vtbroker@buyer-brokerage.com

January 22, 2008 | Unregistered CommenterSK-B

I know this is an old, old post, but I'm skipping around reading stuff while my 5-month-old tries to eat my hair. :p

I had two choices of homebirth midwife (neither legal in my state). I chose one because I had heard that the other had abandoned patients at/after transfers. And what did my chosen midwife do? Oh yes.

I had a difficult labor and just didn't progress past 7-8 cm for 10-12 hrs. I wouldn't have consented to cervical checks b/c my water was broken...but I was in labor as soon as my water broke, so I didn't think to worry about infection. After about 21 hours of labor, my contractions were back to back, I was beginning to run a fever, I couldn't keep food down (not the whole labor), and I had been on my feet--the only way I could handle the contractions--for my entire labor. Laying down to rest was out of the question, as soon as a contraction hit I'd pop up like a jack in the box. Anwyay.

The midwife told me that she, my mom, and my husband had decided it was time to go to the hospital, the hope being that I could get an epidural and a nap and finish dilating, which is just what happened.

But my midwife left the hospital after we checked in--checked in, mind you, claiming to have planned an unattended birth--and while she asked me to call her to come back for the delivery, quite frankly, I didn't want her there. The hospital experience was *better* than the homebirth experience, and I didn't want my midwife around to ruin it.

So, it's not even that she abandoned me at the hospital. It's that we never developed the sort of relationship we needed to to begin with.

I will say in her defense that I was her third delivery back to back in 4-5 days and she was just too exhausted to care for me. Why she didn't have the good sense to call someone to relieve her, I'll never know.

She saw us at her office at 2 weeks postpartum and didn't want to see us at 6 weeks (I think she disapproved of my having gotten stitches and didn't want any responsibility for them), and I've only seen her once since then (at a birth-related public event).

I don't even know what to do from here, other than tell my birth story over and over and over until everyone's tired of hearing it, because I need to hear (over and over) that a) I worked really hard for a really long time and b) my next birth WILL NOT BY GOD be like that.

If I thought it would be, I wouldn't have more children. I'm not exaggerating.

January 22, 2010 | Unregistered CommenterAmelia

Please let me know, Amelia, if I can take your comment and make it a post. It needs to be heard, but I don't want to betray a quiet confidence tucked deep inside my blog.

January 22, 2010 | Registered CommenterNavelgazing Midwife

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