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Thursday
May132010

Being Un-Midwife'd: Beyond the Butt-Hurt

Recently, I was un-midwife’d. A client, whom I’d already been a midwife for a couple of years ago, during her present pregnancy, relieved me of my duties. She didn’t tell me herself, her new midwife did. I cried. 

My first reaction was to pick apart her behaviors, look at the signs she’d given off over the last few months. I made assumptions about her motives and nodded to myself, “See? She just <fill in the blank>.” 

When I’d mentioned I was un-midwife’d in Facebook, I received kind comments from other midwives and doulas, commiserating with my situation. Seems I’m not the only one to have been fired.

And then a wise midwife talked about how, when it happened to her, it took some time, but she knew she needed to look at her own behavior, see what she had done to bring about the dramatic shift in the relationship. All of a sudden, all the blame for my previous client paled in comparison to my own actions.

I could see where I’d been confrontational and even flippant. I didn’t take my role seriously enough, relying instead on our friendship to propel the pregnancy forward. I’d hijacked parts of her prenatals, talking about things unrelated to her care, assuming we were visiting. I wasn’t terribly professional.

I like to believe that even if I hadn’t read that comment from a FB friend, I would have eventually gotten to the introspective part, but I really appreciated her pushing me in that direction a lot faster.

None of us enjoys being turned down or not chosen, but in midwifery, it’s important to come to terms with that reality since the very basis of our work is making sure client and midwife are a good fit. It really is important to me to have potential clients interview at least three midwives; if they don’t know their choices, they have no choices. (Don’t we say the same thing about childbirth practices in general?)

When I first became a homebirth midwife, it didn’t take long for the Which-Midwife-For-Me contest to begin. Knowing full well how things worked… the on-line exploration or word of mouth referrals, the email and phone call exchanges and then the free consultation interview… the next logical step was the client picking who was the best fit for them. It’s what we all want, right?

But, what happens when you totally connect with a family and then never hear from them again? It’s an odd feeling… a not-consummated relationship you expected would be a really good time. The thoughts dash about:

-Did I say something to offend them?

-Was it the Diet Coke? Did that drive them off?

-I thought we had so much in common. I guess being lesbian, swirly skirt and Birkenstock-wearing woman just wasn’t enough.

-Who are they going to find to be a better fit than me?

(Oops, that’s where the ego slips in; hard to tame that ego sometimes.)

Just this week, I’ve been rejected (if you want to call it that) twice. One was an old previous client; she chose another midwife without so much as a phone call or an interview with me. And then, a client I’d monitriced for, chose another midwife, again without an interview. What the heck?

I’ve got all kinds of (childish) “they don’t like me” thoughts running through my head.   

When I have asked (and it takes an act of superior strength to do so), the answer comes back, “You weren’t the right midwife for this birth.” This confuses me. How am I the right one once and not again? Did I do something wrong? Have I changed that much? How come I am the right midwife for some women through multiple pregnancies, but not as a repeat in others?

One of my clients told me she evaluates what she and her baby needs for each pregnancy. She’s had two hospital births, then a UC and then hired me for the next baby. As much as she loves me (she says), she will still evaluate what the next baby needs and follow him/her wherever that takes her. She said it could very well be to another midwife or another UC. My heart twinges thinking I might not be her midwife next time, but isn’t it something I insist on? That women tap into that intuition and listen to what they know in their souls?

I need to believe and accept what the women say. Perhaps I am simply not the right midwife for those babies’ births. It is a selfish desire to be at consecutive births when I do truly strive to serve women. As a midwife, I serve women. I serve even when it isn’t comfortable, when, if it isn’t a matter of life and death, is a decision that wouldn’t be one I would choose. Part of serving women is laying low, sitting quietly in the corner, giving mom the space and time to walk through her pregnancy, labor, birth and postpartum. More often than not, this excludes me –and isn’t that supposed to be the good thing? The right thing? If a woman is tapping into her own strength and that of her partner, isn’t that when the most beauty is born? Women radiate blazing light as they tap into their own power and inner knowledge. It’s important for me to respect that knowledge and tuck my bruised ego into a place the women never have access to. Well, unless they read this, of course.

Knowing I’m not alone, that even the most wonderful midwives and doulas I know have been rejected, helps me unslump my shoulders, wipe the tears and believe the Universe has something else, equally magnificent, to attend to instead.

I eagerly await my assignment.

Reader Comments (28)

Of course it happens to all of us, and of course it does hurt. But hey, it makes us grow. It's important to always check inside to make sure we're doing our best, and to let things flow according to the woman's desire. Without a few walls to push off and rejections to live through, we could get lazy. You're still a rock star.

I get it and love this post. There's nothing I can add at all. You said it all for me :)

May 13, 2010 | Unregistered CommenterCiarin

Thanks for posting this. As a doula, I've had the "connection" to possible clients...only to never hear back again. When I take away the ego, I know that the right person for them just wasn't me and that's okay. I put the contact information for other doulas up on my website to ensure that families *know* there are options. I sincerely hope I can keep that perspective as I learn more and go deeper into midwifery.
On the flip side, as a pregnant person, I toiled with the decision of whether to re-hire my previous midwife. Yes, she was great. Yes, I loved her. Yes, she did everything I asked her to do. But I wanted something different that I just couldn't get from her. I knew that. If I had had the chance to tell her, I think she would have known it too. It wasn't personal AT ALL. She just wasn't the right midwife for me at that time. Sort of like your one mom said, the she and the baby choose what they want/need at the time. It was an extremely difficult decision though (and one we never fully made, as my pregnancy ended at 7wks.), and loving her as a person made it all the more hard.
In the birth world, we talk a lot about "firing" the doc, but not so much with the midwife. I think it should apply to midwives as well. It's harder though because the relationship runs so much deeper and there is a genuine caring (usually) for both sides. How do you say to someone who cared for you during such a precious time that you just need more/different this time? How do you hurt your friend? Or how do you not hurt your friend and be true to yourself?

May 13, 2010 | Unregistered CommenterSummer

Thank you so much for this post, i often wonder whether my midwife would be offended or hurt if i chose another midwife for my next pregnancy. Now i know the answer

May 13, 2010 | Unregistered Commenterdelma Moreno

I think it is so important to be able to say, "it hurts and I am gong to shed some tears". Then move on. For me it is easiest to put myself in their place. "Walk in the shoes"

Being a midwife I know a lot of absolutely wonderful, beautiful, smart, fabulous midwives. There are a great many that I would be proud to call "my" midwife. Now if I was pregnant and had to choose a midwife for myself what a task that would be. There are so many that could fill the role and be in essence perfect. The only thing I could do was choose the one that was most perfect for that pregnancy at that moment and hope that all the others would understand that it is just a choice for that moment and that I still love and admire and adore all of them.

May 13, 2010 | Unregistered CommenterConnie

Trust me, I really hope I win the lottery before my next pregnancy, because I would fly your ass out here in a heartbeat to be my HBAC midwife. You are the only midwife (that I know online and IRL) that I would trust to get me through an HBAC. Unfortunately, unless I hit the jackpot, I will continue to wish and plan a VBAC at the local hospital.

:)

(As an RN, I know what it's like to be "fired" by a patient. It sucks. But you love your job and you know you're good at it, so getting over it isn't hard.)

May 13, 2010 | Unregistered CommenterAndrea

Well, THAT just made my night! :) Thanks for the vote of confidence. *huge smile*

May 13, 2010 | Registered CommenterNavelgazing Midwife

I think it would be great for clients to discuss with their midwife/doula if they are starting to lose confidence in them as the right caregiver to attend their birth before firing them, but I guess that could be stressful for some clients. If I had a previous relationship with a midwife/doula from a previous birth, and I didn't like the care I was getting in a subsequent birth, I just feel like I would have spoken up earlier. Saying something like this to your midwife, "Can we stick to business for pre-natal checks and maybe chat after." or "I feel like you aren't listening and are being flippant sometimes." can tell the midwife what you are unhappy about and help her consider and change her behaviour. If a client doesn't get a favourable response back, then it makes it easier to move on while also letting the midwife know the reason for changing care provider.

I discussed with my OB some of the problems I had with his policies and when it couldn't be resolved I switched to another OB a few weeks before the birth. At least he knows why I chose someone else and he can reflect on that.

It is very important that caregivers reflect on why they were left by clients, but sometimes without some clear indication, it can leave caregivers guessing wildly about why it happened.

May 13, 2010 | Unregistered CommenterB

This was such a revealing post. I made the mistake of not getting a midwife for my six births. I had an OB/GYN that was perfect for me, but she retired early due to a disability. I had two other male OB's who I fired after those births. I explained to each one of them why, but it took me two years to explain to one of the OB's why. Still, I felt he should know why I left his care, didn't return for my six week check up and went elsewhere for my last delivery. I realized I hadn't given him the benefit of the doubt and that he would've cared that I was unhappy with my delivery and his poor management of it, including his rude bedside manner. I really regretted not going to him sooner. I think as birth providers, when you have a relationship with a patient, you're owed an honest, gentle explanation as to why the professional relationship is terminated. But many pregnant women don't know this, or it's so uncomfortable. Wouldn't it have helped so much had that former client explained why she left your care? I'm sorry you're hurting. My last doctor seemed shocked, hurt, and angry when I told him I was leaving his care immediately. I had very valid reasons for doing so, and he shouldn't have been surprised, but I understand why he was so hurt. I realize now how important professional demeanor is, but pregnancy and birth is so personal and close to the heart. Hang in there! I'm sure your next couple of births and clients will be healing, affirming, and encouraging!

May 13, 2010 | Unregistered CommenterLaura

Well for what it's worth, here's my perspective. As much as I loved my last midwife and would refer women to her in a second (Heike Doyle at Puget Sound Midwives & Birth Center) I'm pretty sure I'll choose a different midwife the next time around. And she didn't do anything that sways that decision one way or the other. As I see it midwives are people. Everyone is different and everyone brings something different to the table. Some are more touchy-feely, some more willing to use herbs and natural remedies, some more medicinalized, and some in between everything else. Being me, I want to sample everything at the table. I'll interview/ have consultations with a few that I'm interested in (by referral or reputation or research) and then go from there. I'll look for the midwife I need for that pregnancy.

If it makes a difference I'm someone who likes change, and I have a hard time with permanent or long term choices. I the flexibility to change my mind if and when I need. In my first/only pregnancy I met the 2 local midwives closest to me thinking I had to be super close. The midwife I chose ended up yelling at me on a phone call about something trivial and making me cry. I never went back, (called back to say I was going elsewhere) and found Heike who was about 40 mins away from me. Due to some crazy U/S techs who obviously had a problem with me being 11 days past EDD I ended up being induced by my midwife's midwife who she transfer my care to, in a hospital. Seeing as I've already had 1 pregnancy and seen 4+ midwives why shouldn't I keep looking at more? Who knows, maybe I'll find a "perfect fit" and have her deliver my next 3 babies ;)


(And I think OBs might be a little more 'similar' so women don't interview/change/hop around quite as much. But I haven't used an OB so I really have no experience here and I'm just guessing)

May 13, 2010 | Unregistered CommenterLisa

Babs,

I am in the UK and never needed a Midwife but I have strong NHS/Medical background and am forever in the national press/TV/Radio etc being gobby about the NHS LOL.

My own GP and 2 of Hospital Consultants have an unusual relationship. Consulotants say they can throw protocols out the window and they need to treat me as an individual. My GP is now a personal friend so again our Consultations are a a long the lines of visiting a friend. She talks about issues in her life along we me discussing issue in mine with whatever the medical issue is thrown in somewhere

I have to say that is why I like it. What works for one patient will not work for another. You cannot be all things to all people.

May 14, 2010 | Unregistered CommenterJane

I understand how as a provider you can feel hurt when a client leaves without explanation.

But can you see it this way? Imagine you are pregnant and you've returned to your midwife that you used in a prior pregnancy. You've birthed with her, she knows you rather intimately (ahem), and you've become quite chummy.

You may have a variety of reasons why you can't or don't want to continue to use this midwife (insurance change, move, religous change, medical factors, personality differences, etc.).

My personal fear is that a midwife with whom I'm friendly, when told I was moving to a different provider, would ask me why, and if the reasons were personality or care based, would then try to "convince" me that they were going to do whatever it is they needed to in order to keep me as a client/patient.

Great. The problem is that feels coercive. If I've already made a decision, now I'm in the uncomfortable position of still having to tell amidwife who I also consider a friend thatthe answer is still no. No one wants to rejector hurt a friend.

Let's say I stay with the midwife. In the back of my hormonal pregnancy mind I AM concerned that maybe the midwife is insulted by what I've told her and will unconscously take it out on me or my baby. I'm not trying to be negative here, but everyone has an ego and can be hurt.

All that being said, I have many personal friends who have become midwives and doulas over the years. There is only ONE I would ask to be my doula (and now she's moved overseas). I personally LOVE my midwife. And yes she has said things that have offended me over the years, butmost of the time they don't affect my care and I know I can disagree with her. The only way I would leave her is if a) she stopped taking my insurance and even then it would be very hard and b) by some miracle I could be medically cleared for homebirth.

May 14, 2010 | Unregistered Commenteraidelmaidel

Thank you for this post. I am a Doula not yet certified. A close friend is having her 1st homebirth in October and I will be her Doula. Even before the preg. we talked on the phone everyday but your post has reminded me that even though I was her friend first, I need to do my Doula duties too.
Thank you and I am sorry for you feeling rejected. Hugs

May 14, 2010 | Unregistered CommenterMidwifeAtHeart

I unmidwifed our 'first pick' with this pregnancy. There were quite a few reasons one being was that she was SO rough around the edges. I kow that I saw that in the interview...but for some reason I felt or thought i felt she was the right one. The very first midwife I interviewed is the one we should have gone with and the one we have now. I couldnt be more thankful for switching and I am so glad I did.

Sometimes its just personality flaws, wanting change, the client changing as a person...etc.

May 14, 2010 | Unregistered Commenterrandine

Ack. This is one thing that always intimidated me about the midwifery model. I'm nice, I don't like hurting someone's feelings, especially if I feel like we're friends or have "bonded," or that they are somehow emotionally more vulnerable to rejection. Yet decisions about care need to be very self-centered. It's hard for women to be self-centered even when we have to be, so this can make things very complicated.

I risked myself out of a planned second homebirth. I had changed providers late in the game (long story) and then developed a complication that my new midwife was comfortable handling at home, but *I* was not. She wanted me followed by MFM OBs and to deliver at home with her, I was horrified at the thought of what could go wrong in that scenario. So nicely, I told her that I was just going to deliver in the hospital with the OBs, because I was uncomfortable homebirthing. I thought we were still friends and when my baby was born, I sent her an announcement and thanked her for all she had done for us. She was more upset that I had "given up" and had a c-section, than she was grateful for the thanks...I still don't get it. If I've ever had an MD feel that way about being "rejected" by me, I've never known. And I know I've had to "fire" a couple RNs (mostly in the NICU) who probably took it badly but they knew better than to say anything or it'd get back to the charge. So it's intimidating to have to deal with a care provider's feelings in that kind of situation.

(FWIW you and I exchanged some comments on here while I was in hospital for pre-e and baby's anemia a few weeks ago, she was born three weeks ago at 33w and is "feeding and growing" in the NICU. Thanks for your supportive comments that day. :) )

May 15, 2010 | Unregistered CommenterLily

I think it's good that you can (now) see that you may not have been 100% professional - we all slip sometimes.

All you can do is be the best you, and the babies that are meant to be yours will come.

I was thinking of you last night actually - a friend of mine invited me to "Tweet" her homebirth. It starts on her account, and then moves to mine:

http://twitter.com/refashionista // http://twitter.com/soire

You'll have to scroll to the bottom of the page and do the "More" button a few times to get all of our tweets If you're interested. Thank you for having such an awesome place to read and learn.

May 16, 2010 | Unregistered CommenterRae

@aidelmaide - I absolutely see it from the mama's side! In this piece though, I was sharing the perspective of the care provider.

I wish I had a magic phrase that would help women feel strong when speaking up for their needs; believe me, I totally understand that women are taught to subjugate their needs and desires in our society. It gets even more complicated if she is an abuse survivor or from a different culture that *literally* subjugates its women.

I've changed care providers at least a dozen times... from PCPs to GYNs to therapists and psychiatrists; I totally understand why a woman might get rid of someone. Toxicity knows no boundaries and doesn't give a whit about letters after a name.

Not that I believe I was being *toxic*... but, definitely wasn't the right one for those women. It's a bitter (and humbling) pill to swallow, but I'm doing it.

May 16, 2010 | Registered CommenterNavelgazing Midwife

Barb, I was in this same situation, but even more complex. I used a midwife, we had a love/hate, then for the next pregnancy I didnt call her and tried a UC. Long story. Then next pregnancy we did hire her and it went toxic, really fast. There was a ton of unresolved stuff floating around about not hiring her the last time, stuff left over from the first birth, etc ad nauseum.

Some people just get triggers and who knows what it was about for your client. But it isnt about you, it is about her, in her hormonal state, and you are really as someone put earlier, a ROCK STAR and strong and I love ya!

If was havin anymore babies I'd walk across the country to do it with you.

May 17, 2010 | Unregistered CommenterAnonymous

For the record, I've not had a midwife present for any of my childbirths.

Reading your post, I have two thoughts.
1- All women, births, embryos, fetuses (fetii?), zygotes, etc., are different. Even you will say all women and all births are different! The only thing in life that has any commonality are the elemental atoms themselves, and even they differ by neutrons and electrons.

Just because you were not "the right fit" for a subsequent birth has no reflection on your skills. It just means the woman (or the babe) was confident enough in themselves to select the right care provider, even if unassisted. Because you empowered them the first time.

2 - You not being asked to midwife for a second, third, eighteenth (have any Michelle Duggars in your practice?) could mean that you have empowered a woman at her first birth to do it without you for subsequent births. When only the best will do at the first, you have learned enough for the second and the discount/generic product is just as good at this point. Look at the women who use only all natural organic cloth diapering for the first, organic unbleached disposables for the second, and who cares anymore for the fourth and just uses cheap store brand might as well be a fast food napkin diaper?

The point is that you can take your "fired" and turn it in to something positive. You may never know the true reason. And hope it is not a trend. Maybe your clients were afraid your skirts and birks were contagious. But I only see positive from your post about the negative. So you weren't told by the person firing you. We don't all have that kind of confidence to boldly speak our minds, without shame or guilt, or embarassment.

That is, unless, you were caught wearing patchouli. If that were the case, then yes, you should be stripped of your licensure and run out of town on rails, ya hippie.

Best, Barb
bmajorsncm@yahoo.com

May 17, 2010 | Unregistered CommenterBarb

"What works for one patient will not work for another. You cannot be all things to all people."

I agree with whomever said this above.

And while I think it is helpful to reflect on your behavior, should a mother so happen to give you a reason for her departure, I also believe that you should let that person walk with no hesitations. Let them carry that energy elsewhere instead of harvesting it into your practice and manifesting it in her birth (her, not you, but it could be you, as someone also stated above). You are the great midwife you are because of the sum of your experiences. It would be unwise to put on a facade or recreate an image that doesn't suit you.

So, let them go. Smile. Don't sweat it.

May 18, 2010 | Unregistered CommenterdBSM

I've been meaning to reply to this, the time gets away from me lately!

I wanted to send you big hugs. I know it was rough last week, for all involved. And I know she was holding off, wondering how to tell you and spare your feelings if at all possible. And that's because she does love you. :)

I can definitely understand needing a different midwife at a different birth. I certainly enjoyed Jamin and La Shel, and they never wronged me. They were just what I needed for that pregnancy, and it turned out wonderfully. I don't know that I would go with them again if there's a next time. Not every midwife is "for" every woman, and again not "for" every birth. I hope that in time you can mend and continue your friendship. <3

May 18, 2010 | Unregistered CommenterStassja

I'm not using the midwife from my previous home birth because, among other things, she sat in the corner most of the time.

Don't change the way you do things. Some women want a midwife who sits in the corner and others want one who holds their hand the whole time. It's not about how you can change your practices to fit your clients, their ability to choose the midwife who will serve them best.

May 20, 2010 | Unregistered CommenterNik

Barb, I wanted to reiterate what a couple previous commenters had touched on and hopefully add to giving you encouragement! I have had 3 pregnancies that ended in 2 live births. For the first, I had a wonderful CNM. Then we moved and I had a wonderful OB for my third. And if we get pregnant again in the future, even if we still live in the same city, I might consider going to someone different. Even though I had a wonderful experience with this OB, every pregnancy is different and I'm open to whatever I need for that particular pregnancy and birth. I am also glad that b/c of our move, I couldn't see my previous CNM. Likewise, I had a wonderful experience with her, too. But I needed a change.

Additionally, I had doulas with each of my births. The first doula was not the best fit for us, looking back, but she helped us achieve our goals at the time. My second doula was awesome. And even so, I would still be open to having a new doula for any future births. Same type of reasoning...my needs change as circumstances change and that same doula, even though she is wonderful, may not be the right doula for me in the future.

I know a mom from the local ICAN group who had a c-section, then an attempted HBAC-turned-CBAC for her second. And she said when she got pregnant with her third, she and her husband were in total agreement that they wanted to find a different midwife and doula. The reason? Because they wanted "a fresh start" (her words). Her previous midwife didn't do anything wrong or offend her in any way...she simply wanted to start this new pregnancy with a clean slate.

I hope makes sense! But I can understand that it is probably difficult not to take things personally, esp when you've invested in women and their families. During my first pregnancy, I was not happy with the CNM I was seeing at the time and was interested in switching...but to the other CNM at the same office! I did not expect, however, that the first midwife would actually call me to ask why I switched! I totally chickened out and didn't have the heart to tell her that I thought she was abrupt, rude, and uncompassionate!

May 20, 2010 | Unregistered CommenterSarah Baker

Please know, all, that I can *totally* and easily see the issue from the client's side. I was writing from this side of the equation. It's really easy to speak for the client... we've ALL been there. But there were many students, doulas and a couple of midwives that encouraged me to write about it from the standpoint of a care provider.

I do not fault any of the women... in the world... who choose whichever provider they want. But, it doesn't mean it doesn't sting. I just wrote about the sting.

Please do not feel you have to defend why YOU chose a different provider.

And, fwiw, the client who changed at the end of her pregnancy *did* tell me why (which I will keep between she and I); I was forever grateful for her candor. Sarah, I can understand the midwife asking... I think we genuinely want to know what we did "wrong". Hopefully, someone will be able to tell her someday.

Along with all of this, that I didn't write about, is The Birth Survey. I don't have 5 stars and most San Diego midwives do. I *know* that after I wrote the Janet Frasier piece, 2 women went and rated me horrible. No amount of trying got the reviews removed from my reviews, so I am stuck with them. Most of the other midwives have 5 stars; I have 4. What they heck does that make me look like? (Oh, *sigh*... ego here. Grrr.) If women are un-midwifing me and not choosing me... anyway, I'll stop whining here.

Best left for therapy. *laughingsigh*

May 20, 2010 | Registered CommenterNavelgazing Midwife

Barbara,

Thank you! I feel like you wrote this just for me and I couldn't agree more. You just amaze me!

May 28, 2010 | Unregistered CommenterTracey

Thank you very much for this incredibly honest reflection. The thought I am left with is that at least the women you work with have the choice...whether to have you as a midwife or not. It is a tragedy for the women in the world who have no choice at all.

I am using this post as a 'teaching aid' for student midwives - to help them think about the relationship they have with women...hopefully they will drop by and say 'hello'. All the best, Sarah

May 28, 2010 | Unregistered Commentersarah stewart

don't forget, we get to bear witness to people being human
at childbirth. we see how folks put down all their defenses
and we see them as they are. In the truest sense, naked.
and yes, neurosis really blooms around these intense times.we have difficult and beautiful work and put ourselves out there, sometimes
as lightning rods. We have to let ourselves be vulnerable in order to be
the midwife we want to be. I have found the folks I worked for the hardest are afterwards the ones that write in a review that i didnt elaborate enough on breast hygiene.
go figure ! Praise and Blame, it comes and goes like the wind

July 17, 2010 | Unregistered Commenterangelika nugent

all I can say is that women in your area are very lucky to have a choice of midwives. Where I am you have to call the minute you become pregnant to get in with a midwife, let alone having a choice. I ended up with a midwife/dr. team after calling and finding out all the midwives had waiting lists a mile long already for the month I was due.

October 6, 2010 | Unregistered Commenteramelia

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