“There is a Higher consciousness that serves us all, and to act like we KNOW how things need to turn out is just plain arrogant and egotistical. Who’s to say that a woman needs or should have a certain kind of birth? How is that respecting the path that she walks? It is not my job or my goal to affect change on anybody’s path. We each have our own to walk, and our own lessons and trials and triumphs.”
It’s a lovely self-reflection about a midwife’s desire for her clients to have their babies at home and the subsequent feelings in both midwife and mom if the birth moves into the hospital. At the beginning of the piece, Maryn says:
“I’d like to approach the delicate subject of transports to the hospital from home; mainly for my own reflection and processing. I say ‘delicate’ because for many (midwives and mamas alike), a transport conveys the ‘failure’ of someone or something. In the past, I’ve been the midwife that, I’ll admit, has heard other midwives’ transport stories and thought indignantly, ‘You transported for THAT?’”
I’ve found that, with time, all midwives eventually come up against this reality check. It really is pretty easy to second-guess another midwife’s actions, especially when not a midwife yourself. But when the woman and baby are in your charge, the scenario can look entirely different. I believe it would be a fairly immature midwife to not look at this issue with a brilliantly bright light and a daringly sober attitude several times over a career.
Through the years, I’ve revised my Statement of Purpose as a midwife when the situations led me to do so. At the moment, my Statement of Purpose is:
My main role as your midwife is to keep you and your baby alive. However that unfolds, I am here to serve you.
As Maryn and others have also experienced, the feelings of failure, of being a not-good-enough midwife have splashed about my ankles and calves. I’ve even had times when the guilty waters have, tsunami-like, threatened to take me under the waves. But, I force myself to remain in a place that does not include self-pity. There’s a difference between wishing things were different and beating one’s self up; the former can be productive if processed correctly –the latter is wasted energy.
I’ve had my share of transfers (going to the hospital in a non-emergent fashion) and transports (going to the hospital in an ambulance) and I think with all but the clearest of reasons (i.e. placental abruption and posterior face presentation are two that come immediately to mind) I have wondered “Could I have done anything more?” There have even been a couple of births that haunt me, wishing I would have done things differently. While it might be a woman’s path to be in the hospital, perhaps if I had <fill-in-the-blank>, it might not have been in her cards in quite the same way. Blessedly, no mothers or babies were lost in the process, but I do believe at least a couple of women have been (cesarean)-scarred by my decision to move to the hospital. My heart aches with that belief.
When I became licensed as a midwife in 2005, I’d had many years of experience as a doula and a few as a midwife in a birth center and even fewer as an assistant and then primary in the homebirth setting. During my homebirth apprenticeship, experienced homebirth midwives would say, over and over, homebirth was a different animal than hospital and birth center births. Really, all I could tell was it was a lot slower and gave the woman a ton of one-on-one care, especially compared to the high-volume Casa de Nacimiento birth center. I mean, wasn’t birth birth? Didn’t all women labor the same, birth from the same body part and have the same needs? It was even easier in the more relaxed settings because women didn’t have to struggle with The Establishment over her autonomy. I grew tired of their repetition… “Homebirth is different.” For goodness sake, most of them didn’t have nearly the number of births under their belts that I had.
But they were right. Homebirth is a different animal than birth center and hospital birth. (I thought it would be a bitter taste in my mouth to say that, but it actually came out easily.)
Now that I’m five years into being a Licensed Midwife, I feel I am just now coming into my own as a homebirth practitioner. I know that probably sounds ghastly, especially to past clients. I don’t mean I was a bad midwife before, but feel I am now a more mature midwife… less skittish than I’ve been in the past. All those years of erring on the side of extreme conservatism; was that really necessary? I’ve not heard other midwives speak about this learning curve, so I’m left wondering if this is a solitary experience… these feelings of previous inadequacy. (If you have written about this topic or know someone who has, please point me in the direction; I’d love to hear from others.)
I don’t believe this was a technical lacking in my education or training. It is more of an intuitional process that can’t be taught… that place of balance between trusting all of my capabilities implicitly and knowing the exact moment to hand over the reigns to a medical professional. I’m not sure if this perfection is ever achieved, but I know I could have come a lot closer to the mark.
I know this sounds crazy, but it is now that I wish I could apprentice with an experienced homebirth midwife. It is now that I know what I’m watching for in a domiciliary experience. I’m finally (I think) more balanced in my knowledge of all births, homebirth included. That doesn’t mean I still don’t have slews of things to learn, by any stretch of the imagination. It doesn’t mean I won’t still waver on the cusp of uncertainty. What an apprenticeship would do is validate my decision-making skills, allow me to say, “I did know everything to do after all,” or show me my blind spots, forcing me to acknowledge “I hadn’t thought of that; I will remember next time.”
I would be more patient in an apprenticeship now. In the early 2000’s, I couldn’t wait to be on my own, really believing I didn’t have all that much to learn… perhaps how to do longer prenatals or organizing a birth kit… but not so much about birth itself. I wonder if I wasn’t arrogant even. I might have been at times, but think I was simply naïve more than anything else.
Maryn says that even as she brings up the topic of transports…:
“… I am trying to prove something, or maybe it’s to disprove something. That my transports (or lack of) somehow indicates my worth as a midwife. As if I am in control of the outcome, as if these births I attend are all about ME and how skilled, intuitive (substitute your favorite midwife attribute here) I am. These 2 transports, the most recent in particular, have shown me how ridiculous this mindset is. And how if I (or any midwife) operates under that notion, birth becomes ego-centric and also totally disempowering to the woman.”
To me, midwives are in control of at least some of the transports. If they (I) don’t have certain skills, then some situations can be out of the scope of practice for the midwife… and a transport becomes (almost) inevitable (unless she sallies forth, trusting the knowledge is there and will pour out of her brain into her hands). While the outcome itself might not be in my hands, by making certain decisions, the selection of outcomes narrows. By making the decision to transport, I have removed the option of having a homebirth and, in all likelihood, thrust the woman into the pool of an uncontrollable cesarean rate.
I have said, more times than I can count, “Who knows why your baby needed to be born in the hospital/by cesarean.” I’ve toddled along, counseling women after their complicated births, helping them to reframe their experiences into some (possibly) pre-destined ordeal. With Maryn’s unwitting help, it is this attitude I am questioning. Perhaps by believing birth is already written even before labor begins… by believing in fate… might not that absolve the midwife from any culpability? Isn’t that the selfish and egotistical notion? Might the midwife not accepting her role in the outcome be the disempowering factor in the mother’s attempts to make sense of it all? Might this attitude not be a subtle way to blame the victim for her own circumstances?
I agree; it isn’t All About Me when it comes to a woman’s birth or her transport to the hospital because of a complication, but I feel there must be room for the client to ask, “What could you have done differently?” I mean, the woman hired me as a consultant in her birth, didn’t she? Even women who want autonomy, if they’ve chosen to have a midwife at their births, they (often) look to the midwife to make the ultimate decision to transfer/transport. If we/I can accept that our/my actions might have pulled the laboring mom down the path towards Intervention World, perhaps that creates the space for women to find their power surrounding their births. Perhaps this acknowledgement is the tipping point between a woman’s self-flagellation and the ability to retain/regain her sense of self-confidence… an attitude that, most assuredly, spills over into her mothering.
None of this is meant as a recommendation for making the midwife the scapegoat in a transfer/transport… something I have seen happen before. But, as with all things, a balance of responsibility allows room for learning, explaining and even asking for forgiveness if that is appropriate.
Just writing this, I have uncovered places where I now want/am ready to accept responsibility for my actions and apologize for them. I know it can’t fix the outcome, but it can, at least, acknowledge their own niggling questions about their births, letting them know their births were an integral part of my continued education as a homebirth midwife. Not many pregnant/birthing women would purposefully want a midwife learning on her, but, in a way, aren’t we always learning by caring for women? If I could do some of those births differently, I would. The fatalistic part of me says we chose each other; me to learn… they to teach.
But I can’t help but wonder, is that my justifying all over again?
(photo by Nova Bella DeLovely)