I gave up on the blog years ago and find I am amazed that it still exists in the blogosphere.  Shows some things never disappear, there is a lesson to be learned in that.  I am now retired from my midwifery days but perhaps not as a midwife.  I try daily to leave it behind as there was so much I wish I had done better and so little I felt I really understood about myself and my patients.  Birth is so sacred a passage for the woman going through it.  I often feel I failed to understand that adequately.  For a medical person who is assisting that in a hospital, hurried atmosphere it so often gets lost among all the technology and correct practice that today's medicine requires if one is to keep practicing.  There are often no right and wrong answers to a dilemma.  Like the mother, the midwife must feel her way, use experience and knowledge to provide the best care she can.

The problem I found for myself was I tried to be there for too many patients at once.  I felt I was the best midwife.  I had worked so hard and educated myself both in hospital and natural childbirth that I owed it to take care and help as many women as I could who came my way.  Good care can not be spread in that way and I was not always the best midwife for some women or situations.  This was a lesson I constantly needed to learn.  

Since retirement I first threw off my clock of midwifery.  At first I wanted to leave it behind totally as my last experiences were particularly devastating and made me examine my beliefs.  Now 6 years past I find I have knowledge that I could contribute to others and should not be buried.  I am still not sure if this is the best place to record that but I am considering it and slowly want to return to some form of working with mothers as I know I still have much to contribute.  

I've thought of starting a question and answer forum or being a doula, though I know that later would be difficult.  I experimented in the past with help mothers in labor and then watching someone else do the delivery and that is incredibly difficult for a hands on person such as myself.  So this blog post is way of considering my options and contributing once again but I wish to stay anonymous in order to be totally truthful without repercussions.

Reading about women’s issues is something I do both for my job as a midwife and occasionally for pleasure but it is a rare book that will keep me up reading well past the hour I know I should be in bed in order to rise for my 4:30 work wake up call. Recently two books I stumbled upon have turned out to be exceptional in both categories and have had the added bonus of expanding my understanding in areas that directly affect my midwifery practice. I'll just write about one here and add the second later.
The first book, “An Exact Replica of a Figment of My Imagination” a memoir by Elizabeth McCracken is the beautifully written story of the events surrounding the Ms McCracken’s 1st pregnancy at age 39 that results in a stillbirth at term. This book is written over 2 years later when McCracken has successfully carried a 2nd child to term and speaks of holding the warm living infant on her lap during much of the writing of the memoir. The chapters go back and forth in time focusing primarily on the first pregnancy, the shock of the baby’s, called affectionally “Pudding” by the couple, the death of the child, the induced delivery and how the couple handles the grief and their lives during next few months. While an excerpt of the book first appeared in Oprah’s August 08 issue, reading just a piece of the story made me hungry to know the rest. It is not a especially kind to midwives as McCracken begins her 1st pregnancy wanting, “things simple, easy, low intervention” (page 46). In rural France during the pregnancy she changes from Physician to midwifery care but opts for a hospital birth with a midwife. Sailing past her due date by 10 days raises little concern but when she goes to the midwife complaining that the baby has stopped moving she is given a non-stress test. Though the non-stress test is non-reactive (by McCracken’s description) she was already scheduled for an induction at 5 p.m. that same day so is sent home with the reassurance that the non-activity is nothing to worry about. This course of action agreed on by both the M.D. and the midwife ends tragically and the couple cannot but help be somewhat bitter at all concerned. Having myself been involved with couples having a present or previous stillbirth I found this book to give me profound new insights into the parents concerns and feelings surrounding this type of event. The writing is done so honestly and well that each page relays events that while strikingly personal can in some aspects be universally applied. It is a book that can be easily read in one sitting but whose details will linger. A great book on a sensitive subject.

Monday morning thoughts

It was in the New York Times yesterday, the U.S lowered its infant mortality rate but remains 29th in ranking with other industrialized nations

It made me start thinking once again—a daily preponderance—as to how and why when we have so much, we seem so unable to make progress in this area.

I've thought about this state of affairs many, many times. At first I blamed it on American women and our soft society—no one really wants to suffer or have to work at something—we all want it to come easy—to have the big car and the big house and the perfect family and the money to live comfortably. We want everything to be perfect around us and for us but don’t understand how our own actions contribute to that. When things don't go as hoped we are quick to blame others.

But in working with pregnant women and helping them to deliver their babies everyday I’ve come to see that the medical establishment is as much if not more to blame. We are in the business of fixing things and when you try to fix birth—the most obvious thing to fix is the pain. A few years back the nurses in the hospital where I work began to use a pain scale of 1-10. Now every Labor and Delivery nurse knows that a woman having her 1st baby probably has no idea what the pain of labor is going to be like so when she comes in, with the menstrual cramping that is early labor and defines it as a 10, the nurse will say, "No, No, what you are having now is about a 2 or maybe a 3, a 10 is as if a car ran over your foot". Now very few women have had that experience either but it is something they can quantify and so lower their rating of their present pain. The problem is that every 2 hours the nurse will once again ask the women to rate her pain along with taking her other vitals. Now that we believe we have successfully adjusted her understanding of her pain we take her rating as gospel.

This constant concern and emphasis on the pain, skews the woman’s and the nurse’s concern about what is important. We are not asking her how to help her get the baby delivered; we are focusing only on the pain and how much she feels she has. In all this pain, the true focus, the baby, gets lost. All we want to do is get rid of or mask the pain and for most women I see this is how they approach labor. Not, how can I work with my body forces, what can I do to assist this process but how will the pain be alleviated. The standard medical answer now is with drugs—either through the IV or in the epidural. The other standard answer, “It is perfectly safe.” Is just a little too pat. In many and most ways we do not know this to be true. Yes, we can in someway say that we do not know of direct effects on the baby although even this is sketchy at best but we certainly DO KNOW that in most cases it will upset the process and IN TRYING TO get the birth process back on track Medicine will next recommend the use of many other drugs and procedures. The combination of these things escalates things in varied and unpredictable ways. But wait we have a solution for that as well CESAREAN SECTION. (any wonder it is now over 35% in most hospitals)

And so I feel it is the medical people who have sold a false bill of goods to today’s women and most women do not want to know about it. They want the baby but without any pain, suffering or time involved. Too many want to be induced before the baby says it is ready (what else is induction), c-section on demand, any and all drugs available but in a beautiful room with all the conveniences that money and modern medicine can offer. That in our country is what state of the art medical care is all about. And so we give this to them—as complicit as they are in loosing the focus on what is most important, giving a healthy baby the best start possible in life.
Is there any way to get back on track??

A Longer Introduction

I didn’t come to midwifery in the usual way or at least what I assume is how most midwives get to the profession. I didn’t have an amazing home birth experience of my own or even witness one that changed my life. I entered the field of medicine due to a great book I read at the age of 8 which convinced me that a career in medicine would be possible for a young girl of the 60’s and a desire to be independent and earning my own way. I graduated from Nursing school in the early 70’s taking from that hippie era a strong belief in alternative medicine and a grounding in respect for the environment or Mother Earth. I started my R.N. career working in the Intensive Care Nursery. It was a new area of medical care, one in which few experts yet existed and I saw a chance to be in on the ground floor of a field that was drawing young physicians at the top of their class. It was all of that and more. I followed the best of the best to the West coast at the University of California, San Francisco and Stanford. In five years in the field I moved to the top or as far as that was possible as a R.N.

While I loved all the front line action, open heart surgeries on babies smaller than your hand, the development of breathing machines to help premature lungs carry oxygen and found I had a natural talent working with machines of every type I found the area of medicine that I’d devoted myself to far from my heart. I’d pictured myself preventing the medical problems I was now busy treating, and while it was noble and cutting edge it was not where I wanted to be. So I left, left it all and took a year off. Single and free I roamed and thought. Went overseas, explored America and let my medical mind wander. I discovered midwifery in my reading and suddenly visualized the answer of working to prevent the very problem children I’d been in the work of treating but at the time with only 12 certified midwife programs in the U.S. and few jobs I knew it was going to take some doing to get where I wanted to be. I also had no labor and delivery experience a requirement before admission to advanced programs. I looked at going the apprentice route but felt it would leave me with less options and I didn’t want any legal limitations standing in my way after investing time.

So back to school and work for three more years and finished with a CNM that seemed to open only a few doors as the late 70’s were still not a time that believed in or saw a place for a modern midwife. I tried private practice, but felt I saw too few patients to learn what I needed to. Went to a large inner city hospital which eventually burned me out but in 2 years taught me more about delivering babies than most midwives could learn in a lifetime. There were nights when I delivered 16 babies in 24 hours, delivered twins, breech babies, learned how to do vacuum deliveries, turn babies both externally and internally to get them to slip through the birth canal, learned how to say push in five different languages and sewed every type of laceration and episotomy. I learned the limits of my own knowledge and read daily to push those limits till I felt comfortable assessing pregnant women and handling all the types of deliveries that came my way. I learned to work fast and efficiently, training myself to feel confident in my decisions and to make corrections if first impressions proved wrong.

The work was exciting but mentally and physically abusing. Once again I was not quite where I wanted to be. I was getting closer but there was no time or energy to influence outcomes. I felt like a fireman with a hose trying to put out fires but with no time to teach people about playing with matches. The mid eighties presented some new possibilities, the natural childbirth movement having taken hold, Lamaze, homebirth, Leboyer. Opening my eyes I found it all around me. So I moved out of hospital. Now with only a nursing assistant I began teaching, following patients and delivering in a non-medical atmosphere. I learned how to work without fetal monitors, pitocin, and drugs. Most was available in case of emergency (all except fetal monitors) and there was always the hospital transfer. I found new ways of assisting mothers, using positioning, practicing patience that I’d never experimented with before. I read everything I could get my hands on about natural childbirth, use of herbs, took advanced courses in resuscitation of infants. I began to see how my work with infants came in handy. How feeling comfortable with newborns gave me an edge in understanding when a delivery was best done in a hospital or when an infant needed to be transferred after birth.

It was a good eight years and gave me the foundation I needed in natural birth methods that have since stood me in good stead. To this day I miss it but there were times I felt alone, very alone in the decisions I made, times when I had to push patients to the point that they found me mean but got the job done. I asked patients to dig deep and some were not up to the task. I was good at what I did but not always loved by my patients and I found this difficult. When I got pregnant myself at the age of 39 I choose an in hospital birth with midwife friends and experienced first hand so many of the aspects of birth that I watched others go through.

After delivery I took a year off to nurture my own child and motherhood and slowly returned to work in a new local. In the 19 years since that move I’ve seen many changes in maternity care and have done my best to serve my patients in all the ways demanded by modern medicine and the changing generation who has a different view of childbirth but all the same love of their children, wanting the best for them but not always very knowledgeable about what that is with all the mixed messages proclaimed by the media.

Now I work in a large hospital with epidurals, a rising induction rate, and a c-section rate while still much below the national average is still much higher than just 5 years ago. Patients are expecting c-sections on demand, painless vaginal childbirth, and fewer and fewer women having the time, energy or belief in childbirth preparation. Breastfeeding while known by most patients to be best for baby is pursued by only about 30% of our population for more than 6 months. Most of my patients return to work by 6-12 weeks post delivery, most infants cared for by relatives or home childcare givers where up to 6 other infants maybe under the care of one babysitter for 8-10 hours per day.
This is not a home birth, touchy feely midwifery. This is midwifery in a modern high tech environment. This is where the majority of American women give birth. The stories in this blog will reflect that modern atmosphere and the families I meet and work with here. I hope you will enjoy them. I am still a midwife and will demonstrate how I keep to my own philosophy intact in what can only be called at most times a modern but hostile atmosphere.

Short Introduction

I have been a midwife for 28 years assisting women throughout their pregnancies and with giving birth both in and out of hospital. This blog is an attempt to share with you some of the many things I have learned from my patients and perhaps to provide stories of courage, grief, amusement or just slices of my everyday life as a midwife that have left an impression on me. No doubt many will be opinionated but that said I hope they will be of interest not only to pregnant women and those preparing for childbirth but to women of all ages and I hope will give readers some insight into the constant miracle of birth that is all around us and that we all have some part of whether we are fathers, mothers, grandparents, brothers or sisters.

Currently I work for a large organization seeing somewhere from 20-25 pregnant women per day in my office and on hospital days actually assisting anywhere between two to five babies into the world. I have always felt my role as a midwife was observer and protector rather than savior. I work to prevent interference in the natural process of birth, to allow families to achieve the unique birth experience they desire and hopefully to inspire and involve them in the powerful energy that comes from doing an extraordinary task well.

I have few preconceived notions about the best way for women in general to give birth. I strive to see each of the families I interact with as individuals who will approach this experience in their own way. I do have well grounded opinions on what works and what doesn’t in particular birth situations and will use this knowledge to help families understand how the choices they make both in pregnancy and during labor or delivery will directly effect their child’s birth.

Because I will be sharing actual patient stories I will remain anonymous and change all names and occasionally shade events. Any resemblance to actual persons is purely a figment of the reader’s imagination and/or the fault of the storyteller. I look forward to any comments you may have complimentarily or critical. After so many years or even just a long day at the end of many delivery beds it is easy to lose the initial excitement and awe that originally drew me to this profession. Through this writing I hope to not only give you an insight into the profession of the modern midwife but to reflect myself on all I love about what I do.