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Saturday
Jan012011

Midwife to Monitrice

Today begins a new chapter in my life.

For those that know me, that is hardly unusual; I almost thrive on new beginnings! I’ve started and stopped several adventures since I’ve been back in San Diego these last eleven years. I thought about making a list, but simply reading through my blog, you can recount many of them for yourselves. laughingwink

But this new start is more profound; doesn’t include learning additional skills or investing in a start-up kit. Instead, this undertaking capitalizes on the very best of who I am –as a woman and as a midwife.

Today, I’m setting aside my homebirth midwifery career. In this moment, it seems long-term, maybe forever, but, as a woman and as Barbara E. Herrera, LM, CPM, I reserve the right to change my mind.

While my homebirth practice is being set aside, my midwifery licenses, knowledge and passion for birth remains intact.

I’ve been attending births for 28 years now (the anniversary is in two days) and over that time, I’ve been able to observe myself in a variety of childbirth settings and roles… from hospitals, birth centers and home… to doula then midwife. I’ll be fifty years old in two months, twenty-eight days; I know myself pretty well by now and it’s time I utilize my strongest attributes.

Today, I offer myself as a Monitrice and Doula to women birthing in the hospital. 97% - 99% of women have their babies in hospitals and, as most of us know, that can mean traversing a maze of technical and mechanical obstacles if one desires a more peaceful, physiologic birth experience. Even while choosing to (or having to) have their babies within the confines of a medical institution, I believe women have a right to autonomy and a peaceful, enlightened and empowered birth. I will not be conferring peace, enlightenment or empowerment, but I want to be a font of knowledge and skill from which a woman is able to drink.

It’s been interesting, this mental shift from midwife to monitrice/doula. I’ve wrestled with not seeing what I’m doing as a step backward, but a step sideways. A wise woman pointed out that I surely felt as if I was going backwards because so many of us in birth see being a monitrice and doula as a stepping stone to midwifery. But, perhaps the phrase, when asked if she’s a midwife, a woman says “I’m just a doula” needs to be abolished. What if we were able to say, “I’m a doula,” “I’m a monitrice” or “I’m a midwife” with equal pride and delight in our voices. (Hear me talking to myself?)

As a monitrice, I will be hired to help a woman who’ll be having her baby in the hospital, but who wants to stay home in early-to-mid labor safely. She’ll begin contractions (or her membranes will spontaneously rupture) and then call me. Once she’s begun her labor in earnest, I’ll go to her home and, for all intents and purposes, I’ll be her midwife as long as we’re there. I will keep a chart on the mom, monitor fetal heart tones, the mom’s vital signs and if she desires, check cervical dilation periodically. Then, when mom says, “It’s time to go in,” or if I say, “It’s time to go in” (either because birth is becoming imminent or there is a concern for either mom’s or baby’s safety), we’ll head into the hospital and there, I will become her doula, attending to a woman in all the wonderful ways a doula takes care of her client.

When a mom hires me as a doula, I will meet her once she’s in the hospital and laboring actively. As with the most doulas (who’re worth their salt), I will not interfere with the medical aspects of her labor, but will be the emotional and physical support she needs and wants. The benefit of having a midwife-as-doula is I recognize and understand the plethora of technical and medical lingo as well as the actions that go along with them. If a mom’s able to maneuver within the medical constraints, keeping the baby and herself safe, I’m utilized at my highest abilities. I know how to work those monitors, keeping them on mom and baby, holding the transducer on the baby’s heartbeat if I need to. The technology in the hospital doesn’t intimidate or scare me; I know it all well. (And, I know! I should have been a certified nurse midwife! Alas, in another life.) I know how to support the nurses so they’re better able to attend to my client. I’m comfortable seeing myself as an ally with the medical staff as opposed to an enemy, as someone hired to protect a woman as if I were a castle wall. I know, because I’ve seen it, that kindness and understanding between doula and nurse helps a laboring mom far, far more than antagonism and distrust. I’ve listened to doula after doula tell me how they despise hospital births, how they’re burnt out from watching birth violence and being so helpless to do anything about it. I’ve watched as doulas fall by the wayside of hospital births, some even saying they will now only doula with certain hospitals, doctors or even only for women who’re having homebirths. My heart asks, “Who helps the others? Are those that might need a doula most be left wanting… nay, needing… someone to, at the very least, bear witness to the assault upon their bodies and hearts?” I have a knack for helping women process difficult births; maybe I’m supposed to be one of those that replaces an overwhelmed, traumatized doula.

I believe in the benefits of birthing in a hospital. While I absolutely believe many, if not most, women can birth safely in the home, the reality is that isn’t happening –and doesn’t seem to be happening anytime soon. Hospitals, to me, are not The Enemy, but can be vital links to connect a family to their newborn. I believe the System as it stands now can totally use some re-vamping, some areas even in very dramatic ways, but unless someone (many someones!) stands within and humbly (or even arrogantly!) offers solutions, nothing will change. I don’t know if I’m that person and, honestly, it isn’t remotely on my agenda as I step into my new roles, but who knows what affect any of us has on another person… or institution… unless we do something.

I wrote “When You Buy the Hospital Ticket, You Go for the Hospital Ride” years ago. Sadly, it’s still a common refrain for most women to endure. I am only one woman… one old-ish, fat, loving, smart birth-loving woman… but, even I want to make my mark in the world. Imagine the stories I’ll now be able to tell! It doesn’t seem that homebirth midwifery was my (only) path. I’m setting out on another and from what I can see from here, the ways seems brightly colored, flower scent-filled and gloriously luminous. 

Once again, here I go.

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Reader Comments (21)

I am proud of you Barb. It takes some serious ovaries to look at your life and realize you need to make changes when they seem so counter intuitive. And I agree with every word you wrote. I think you're going to make an amazing impact on the "System" even when all you're doing it focusing on your client and what they need. You're going to be a stepping stone toward empowerment and change, I can feel it. :)

January 1, 2011 | Unregistered Commenterchantel

And many blessings on that journey!!

January 1, 2011 | Unregistered CommenterKristina

I see this as a much needed and intriguing idea! I love thebenefits for the mom while she is at home. I'm wondering how your boundaries will differ (or be the same) from a doula in the circumstance that another practicioner is recommending something before labor begins that you disagree with - I.e., an induction for macrosomia or something similar?

January 1, 2011 | Unregistered CommenterKristina F.

What a wonderful post! In the last year, I've decided I want to pursue a CNM. I'm working on a doula certification until my husband's job settles us in a place for more than one year at a time and I can start school. I specifically want to work in a hospital setting, for exactly the reasons you describe above. There are many women who will not seek out a birth center or homebirth experience, and I want all women to have access to the midwifery model of care, no matter where they birth. Bravo on your decision!

January 1, 2011 | Unregistered CommenterChristine

You are a very powerful woman, I think it is so awesome to know where your talents are needed. We are all here on this earth for a reason, I think, to give back in this fashion, will be life changing for you and the women whose lives you touch! I'd want you in my corner Barb!!!

January 1, 2011 | Unregistered CommenterMaryjane

Thank you! As a woman, and long time homebirth proponent, who doesn't have access to a safe bomebirth experience, I have had to learn to find my own peaceful, beautiful experience within the walls of my local hospital. Your words have been a major blessing on my journey as you have helped me see that it is possible. Now I'm looking forward to a #3 birth, once again in a hospital, and I am deeply grateful for a kind, loving, care provider who is willing to work with me to have a dignified, beautiful natural birth. Thank you for joining his ranks, and for honoring women no matter where they choose to birth.

January 1, 2011 | Unregistered CommenterVanessa

Amen!

January 1, 2011 | Unregistered CommenterEthel

Wow! I think what you are planning is so NEEDED. I applaud you for not only taking a good look at yourself and your abilities and desires but also taking a look at the world around you and thinking about how best to use those needs and desires to SERVE OTHERS. Whether using the title midwife or not I'm sure you will truly be "with woman." Can't wait to read as the new adventure unfolds :)

January 1, 2011 | Unregistered Commentermrsculpepper

I'd hire you--and wish you the best in this new year! There are lots of us who may need a hospital birth for valid reasons, but would love to have the support that you could bring to the birthing suite. I interviewed a couple of doulas who were so passionate about going all-natural that I knew, instinctively, they would not be a good fit for this birth and for me. I like your point about working with the nurses vs. a totally oppositional approach.

January 1, 2011 | Unregistered CommenterMeredith

Yes. Because as a woman who has had 7 births in the hospital, an advocate like you at a momma's side can make every difference in her life and in her child's life. What a blessing to momma who want to and deserve to have a birth experience in the hospital that they can trust. So many times we doubt ourselves, we doubt our medical professionals. If there is a person in the room with good knowledge that can be trusted, a woman can hear the worst and yet be able to stand through it with confidence. To not have to go it alone, wow (and I bet the dads will be happier too).

Blessings!

January 1, 2011 | Unregistered CommenterDawn

Wow! That's great! I'm comforted to see someone as experienced as you and realize I'm thinking like that. I'm in pre-med now, because I want to be an OB that can support home birth and physiological birth in the hospital. Like you said, 99% of births are in hospitals and 90% are with doctors. I'd like to be an OB who is an ally to birth.

January 2, 2011 | Unregistered CommenterMeg

Congrats on a beautiful new beginning, and a well-written explanation! So interesting that I have recently been along the same lines, that perhaps being a doula is just as important and valuable as being a midwife. I have long thought that my doula-ing and birth prep teaching was a stepping stone to eventually becoming a midwife - but now I am starting to think that perhaps I can do just as much, for individual women, as a great doula and educator...it is very inspiring to hear that you, whose opinion and expertise I bow down before, are also thinking similar thoughts!!
And - gorgeous photo!!

January 2, 2011 | Unregistered CommenterNicole

Thank you! And I *love* that picture. I still have to write about that birth. That was a HBA2C attempt that ended with a placental abruption (slow, so we got to the hospital) and the hospital dawdled, eventually seeing the abruption blood, too and then she *flew* down the hall... and had a beautiful baby boy.

This picture was when we were in triage, mom in kick-ass labor. We'd just gotten there, about 15 minutes after I saw the splash of blood and heard fetal heart tones dive... and the triage nurse ignored my explaining why we were there... that the baby was in distress and suspected placental abruption. I squirmed for about 2 minutes while she took mom's BP, temp... and still ignored me.

I went around the table, pushed the nurse out of the way, turned on the monitor and put it on mom. You can see me holding it on her at the bottom of the picture.

I didn't give a shit if I got yelled at. I was going to monitor that baby one way or another.

I didn't get yelled at.

January 2, 2011 | Registered CommenterNavelgazing Midwife

Are you willing to travel to NZ in August?

January 2, 2011 | Unregistered CommenterVW

Wow. Wow. Wow!

You know, I never would have thought of that. But it's brilliant!!! I think that the path you are taking will do as much or more for homebirth, good hospital birth, and midwifery care everywhere than working as a midwife could. What an awesome method of outreach and of helping women in the hospital setting. Will you keep us updated?

Blessings as you start your new path!

January 2, 2011 | Unregistered CommenterDiana J.

Hi Barb: I seem to have lost you on FB somehow; about 11 people just disappeared from there about two months ago and, honestly, I haven't been brave enough to ask anyone if I had been "unfriended", including you. But I've continued to read your blog and (no surprise I'll bet) I made exactly the same decision this last year and haven't regretted it for one moment. As you know, my struggles with "Midwifery" in terms of the politics and the issues and all the rest, led me to decide not to attend births in any capacity a coupld of years ago, but over time, I realized that I still have a knowledge base and skills to offer and the Monitrice/Doula work seems to allow me enormous lattitude and freedom that I wasn't feeling anymore as a Midwife. I too struggled with the "stepping down" aspect, finding it amusing, in some way, that even I am subject to thinking hierarchically but, like you, I've realized that it's not really about a distinct role so much as it's about emphasizing various aspects of the same role and this, for me, works very well. Blessings to you in the New Year and I'll certainly keep reading to see how it all goes for you. Yours, Michelle.

January 4, 2011 | Unregistered CommenterMichelle Wilbert

Fabulous. Love how you've redefined your scope and reach; i the processes capturing a win win for all!

January 5, 2011 | Unregistered CommenterBliss

Yay, Barb! I am so excited for you and these women you will serve. You are right, the hospital is not the "enemy" but one still could use a wise guide to navigate a hospital birth. Best wishes to you.

January 7, 2011 | Unregistered CommenterMaryn Leister

That is wonderful that this is a viable option for women in California and congratulations on your new career!

This is a much-needed role, but sadly where I live and work as a doula, I don't think this would ever be a possibility. Women either birth at home "underground" or they work with CNMs within the medical model. I cannot envision the CNMs or OBs around here supporting montrices that weren't officially sanctioned by their practices.

I hope you have lots of success and that this model can be used as an example elsewhere to help improve the experiences for women who choose the medical model of pregnancy and birth care.

January 9, 2011 | Unregistered CommenterVanessa

Michelle! I've missed you, too... and thought you UnFriended ME!

Wow wow wow on the Monitrice/Doula track. We should co-write an article!

I love and miss you and am glad to have found you again.

January 14, 2011 | Registered CommenterNavelgazing Midwife

This makes so much sense. I am moving into the part of my life where children are in the picture, but I struggle with the issue of birthing locations and circumstances. On the one hand you have home birth. Pros include that I live right next to a hospital so travel times in the event of a transfer are small. Cons include issues with transfer due to doctors not taking midwives seriously and a neighbor that could be as inhibitory as any OB (she shows up with complaints at the worst moment every time) and no insurance coverage. I also have some concerns about how to identify an adequately trained midwife as complication rates definitely vary with training. There is a local birth center, but the cost is higher than homebirth, I still have no insurance coverage for it, it is further from hospitals for transfer and I am not a priori confident in the training of their midwives either. A hospital birth is an option (and that is covered on my insurance) but the C-section rate terrifies me and I am very concerned that I am going to be very negatively impacted by hospital policy (especially no eating and drinking in labor as I have a history of reactive hypoglycemia and I crash when I haven't eaten for too long). One of the standard pieces of advice for reducing C-section risk is to stay home as long as possible however this seems directly opposed to the (seemingly reasonable) concern about complications in labor as you effectively have to decide to go unassisted until you go to hospital and have to judge for yourself when is the right time. The idea of having a trained assistant who is able to recognize signs of complications while you are laboring at home in early to mid labor seems like an excellent idea.

Truthfully I am probably somewhere in the middle of the spectrum of attitudes towards birth. I totally understand the idea that labor is a natural function that proceeds just fine without interference most of the time and that interventions can create problems. On the other hand, I also understand that there are really risks to mother and baby in pregnancy labor and delivery and that a skilled attendant can save one or both lives where they might be lost. As such, I want to find an environment where labor can proceed with a minimum of interference, but also want a highly skilled and experienced attendant who can not only support normal labor and help it to go more smoothly with appropriate suggestions and encouragement, but also is able to recognize and respond appropriately to emergencies. I am in favor of judicious use of prenatal testing identify and mitigate risks (weighing risks and benefits) and want to be in an environment with the capabilities to respond to emergencies. I find it difficult to balance all of those concerns and the more so when you throw in concerns of cost and insurance coverage.

Sorry this is kind of rambling. Suffice it say that I think what you are doing is great and needed (and wish you were in my area) and would welcome your thoughts on or off list.

January 19, 2011 | Unregistered CommenterTricia

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