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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.