Tuesday, March 1, 2011

So This Is It... (Or, "The Medwife")

This is my last week with the Midwife. This is bittersweet; of course, there is some relief - the last few weeks have been incredibly stressful and long. But, I will also miss the many beautiful clients I have grown relationships with, as well as several of the nurses and other staff members I have met along the way.

In the end, there is no way around it. The Midwife and I are just too different. You could say she's more XBOX and I'm more Atari... In some ways, I hope that some day I gain some of the Midwife's qualities - she is prompt, she can answer any patient questions without a stumble, and she is assertive. On the other hand, I need to be true to myself and the true heart of midwifery. I will never be an "aggressive" person, nor an aggressive midwife; I will continue to look tired for a few years yet, at least through I adjust to this midwifery gig and my kids catch on to letting me sleep at night (seriously, Mini's --- you're 2.5 and 4.5... get it?!). I will never be someone who appears at events, and the office, an hour before I need to be there. I try to do too much with my time, end up misjudging the clock and how fast I can get to point A from point B, and wind up running a few minutes behind. These are things I have accepted and will continue to work on - but can't change overnight.

The Midwife is, in essence, a "Medwife". She practices with a group of OB-GYN's, she has never practiced outside of a high-risk setting, and she views birth as an occurrence that is one step away from disaster. While I recognize and respect that even in the most normal, low-key labor and birth, something can always go wrong; (I think) I have a healthy dose of the "what if's", especially for those labors that are going smoothly... I am afraid to be lulled. I don't think either perspective is right or wrong, just different.

Will I offer elective induction to my patients at 39 weeks? Probably not. Do I see where the Midwife is coming from, when she gives that option to her patients? Sure. Does it work for her, and for the majority of her patients? Yes, it seems to. Do I agree with her statements after some of these births, that "It's a good thing we induced now rather than waiting because..."? Not always, but that's not my place to argue. If mom and baby are happy and healthy, and were given the choice to make the decision - with full informed consent - I can't, as a student, jump in and point out potential flaws to that logic. As a "green" CNM, fresh-eyed and optimistic - with my views on birth and outcomes unblemished by malpractice insurance, peer reviews, and "bad" babies (or a history in high-risk OB), I still lean more towards the hopes that by giving good care, thorough information and honest explanation of risks and benefits - rather than practicing "defensive medwifery" - the relationships I cultivate with my clients will be close and trusting. (Do I think some of these perspectives will change - probably within the very first year or even months that I am practicing? You bet. The Midwife does what she does, for a reason. But... maybe not. Another good reason that another site, a different site, seeing a different population - might be helpful.)

Because with labor and birth, honestly --- who knows? The most wonderful looking baby on the EFM can come out floppy and blue, needing a full resuscitation, while the baby who looked miserable for the longest time, with a short and scrawny cord comes out wailing and pink. The 9-pound chunker of a primip delivers easily, without a scratch - while the G2P1's barely-seven-pounder gets hung up on the shoulders (unlike the larger older sibling a few years before). A common disclaimer in obstetrics: "We just don't know": a simple way to explain that so often babies are doing their own things, and our bodies - which are made to carry and nurture those babies - will instinctively protect those babies... but also a smooth segueway into a conversation encouraging (with different levels of "encouragement") various interventions that may or may not be truly necessary.

The mystery, and beauty, of birth is that every baby writes his or her own story; as midwives (and nurses, and doctors, and doulas, and mamas and daddies), we are just along for the ride, wild as it may be.


  1. “Trust yourself. You know more than you think you do.”

  2. Completely agree. Go with a midwife who shares your philosophy! I'm driving 1.5 hours each way to precept with a midwife who is the ONLY OB provider in a family practice office, who also does home births, and maintains a low epidural and C-section rate (and a small practice of 10-12 women due per month). And it is SO worth it. I was going to be with a 14-midwife practice in Boston and yes it would've been convenient and I'd be done with clinicals in like 4 months, but this is soooo infinitely worth every month and minute. Down with medwives! That is NOT who I want to be, ever!

  3. sorry, this is Kristina from Frontier :-)

  4. Feel the support of all of us that are at the same point in our journey. Use that strength to get out when the getting is good. You have so much to offer so many and it will not be able to grow and learn in this environment.

  5. I want you to come to Colorado and be my midwife for my next kiddo... For serious!

  6. julia, i have seen a few postings in CO and have tried to google you to see how far away you were ;) but they are all on the other side of the state... boooo!

    kristina... i'm so glad you made the right choice. in retrospect, i should probably have kept searching, although my initial choice might have had me in the same boat (a large hospital in western WI, with high risk pts -- but at least there would have been a pool of midwives so I would have had some balance).

    thank you all, always... xo

  7. So glad to hear you are moving to a different site. I could not have done my clinical rotation with a "medwife". I don't know how you made it as long as you did.
    The whole point of your training (and mine!) is to train you in the art and practice of midwifery, not medicine. There is room for varying opinions and types of practice and one type isn't necessarily better than another, however, I think midwives who choose to practice more according the medical model than the midwifery model should somehow make this known. Both to potential clients AND to potential students.
    Best wishes to you at your new site! I sincerely hope you find a midwife that meshes better with your personality!! You will make a wonderful midwife!