Remember when I talked about intuition vs. premonitions? How it can be hard to tell what is what and wondering if I should listen to those inner thoughts or not?
Just as it happens with regards to birth, it also happens beforehand, with some clients.
I'm not too bad at seeing red flags, but what I am terrible at is acting on them. I know they are there, but think I can dye them a different color or or think I can remove and replace them without anyone noticing or seeing.
A client comes to me telling me she isn't sure she wants to birth at home or not... or, more classically, her partner doesn't. She thinks that, with time, he will come around. In prenatal visits, he seems mildly interested, but when it comes to talking about the actual birth, he shuts down. No amount of talking to him elicits the true feelings. I never try to convince anyone to birth at home - ever - because it just isn't safe to do so. But, mom will email me, telling me he is 100% on-board and I will breathe a sigh of relief; until the next visit when the same semi-apathetic father sits on my couch.
A mom wants to choreograph every second of her birth. She wants to know what books to read to make sure her birth is perfect and won't settle for a few books in the vein of Birthing From Within or Spiritual Midwifery. Even after seeming to understand that homebirth is different than the defensive stance of a hospital birth, she remains en guard. She believes if she knows how often she will need to pee or exactly what foods she will be "allowed" to eat, her labor will progress in exact steps that are measurable and predictable. No amount of explaining the unfolding of labor and birth seems to increase her understanding.
A mom comes in very late in the pregnancy, having wanted an unassisted birth, but has gotten scared now that the moment is drawing near. She demands that I do nothing. Even if she or the baby need help. If someone is supposed to die, then let them. Explaining what a midwife is - and who I am as a midwife - leads them to nod acquiescingly, but in their eyes I can see the mistrust and even disgust. They still ask me to attend.
A woman comes in telling me she wants a homebirth and through a great deal of interviewing, I learn she wants to avoid "The System" because of a history of drug use, but is promising to be clean now. Erratic behavior ensues, yet mom, straight-faced, swears she is not using drugs.
A raw foodist with extreme anemia insists she is eating more variety and taking her supplements, yet her hemoglobin stays in the toilet.
All of these and more have happened to me or others around me. Sitting in Peer Review, we present the cases and watch the reactions of our sister-midwives. When it comes to Red Flag Women, we are point blank asked, "Why are you keeping her?" I'm able to justify my reasons, but they sound so hollow as they come out of my mouth and float around the room. What was I thinking?
I am so bad at listening to red flags, I have enlisted another midwife, her apprentice and now my own apprentice to be voices of reason and remind me of previous cases that started as red flags and ended up train wrecks.
The common thread of the red flag scenarios is one of trust.
It takes a LOT of trust to allow a midwife into a woman's pregnancy and birth experience. Now, I am aware of women's trust issues because of birth abuse or their own histories of abuse. But, there comes a time that trust needs to occur or the situation can deteriorate in an emergency. How am I able to do what I was hired for if, in a crucial moment, mom or dad is asking, "Do you have to do that?" (It isn't like I assault women with a vaginal exam or pull on their placentas... I am talking about resuscitating a baby or staunching the flood of blood coming after a placenta is born. Similar life-threatening situations.)
When a client trusts, they answer my request with movement/action. Similarly, when they ask me to do something, I will do the same for them. Trust isn't just their doing what I ask, but also my believing in their own inner knowledge and listening to it - especially when it comes to something not being quite right, or conversely, when they say everything is perfectly fine. When I trust - and they trust - it all works beautifully.
I know it isn't unheard of for doctors to refuse care to lawyers or their families. I also know plenty of doctors (the majority, in fact) who refuse care to women wanting a homebirth. I've known OBs to fire women who insisted on taking Bradley classes. These red flags seem absurd to many of us who work with natural birth clients... lawyers, physicians, Bradleys, or otherwise. But, aren't we permitted our own red flags? I am sure the above scenarios will sound silly to some midwives or clients, but they aren't sitting in my place of responsibility and, having been burnt by similar situations, I am wary.
I want to serve everyone. I tend to be a midwife others come to when no one else will take them. It pains me to have to turn someone away that has been midwife-hopping because of their struggles or personality difficulties. But, because of past experiences in not listening to my own red flags and paying dearly for it, I am trying to do better at saying, "No."
It's a struggle every single time.