THAT midwife... (Or, let's just be honest, eh?)

You know. THAT midwife - the kind that schedules elective inductions, has short prenatal visits, tells laboring women, "if we break your water, it may help speed this process up a bit." {{shudder}} I disdain that midwife --- or doctor, or whoever --- and rolled my eyes at her throughout my training. No way would I disrespect my clients or gamble with their health and well-being.

Oops.

I might as well get it tattoo'ed right across my cheekbones. It's me!! I'm her! I'm THAT midwife! *sob* I realized last week how blurred the line has become for me; of the babes I've caught since I've come here, only half (give or take) have been spontaneous labor. The ones that have been induced have rarely been for good, solid medical reasons. Epidurals run rampant - and I don't talk mamas out of them. Initial prenatal visits include a pre-canned speech including reassurance that choosing a CNM-assisted birth does not automatically rule out pain medication or epidurals; women whose eyes widen at the thought of going into spontaneous labor on one of the six days in a given month when my partner or I are not on-call are quickly comforted with a subtle promise, "depending on how you're doing and how favorable your cervix is..."

Who have I become?!

Part of me bristles at this recognition. I don't want to be a "medwife". For every 5-10 minute, tummy check/dopple/how-ya-feeling? prenatal visit, there are four times as many that last three times as long (not to mention the "well" woman visits, gyne exams, and primary care...) As a general rule, our patient population needs *midwives* , not medwives; so many of our families are wrapped in generations of epidemic substance use, alcoholism, violence, and broken families. To be "with woman" consistently - providing unbiased, compassionate care for months and years without fail - seems like the best gift to offer these women, both those who seem to be desperately seeking it and those who push it away. On the other hand, to balance this, time gets away... the "good" patients get quick visits... and unfortunately sometimes things get missed. (I know that this has to happen --- the quiet, sad-eyed primip? During a brief, mid-pregnancy visit when I'm focused on the drug-addicted mama I had just seen --- or worrying about the postterm multip who had again been a no-show --- I might miss the cues that she's giving that something is wrong. I might not ask the right questions, give her the time she needs to feel comfortable to open up to me. Shit.)

But - the realistic part of me knows that some of this had to happen. Inductions happen; so do epidurals, and so --- knock on wood --- will c-sections. Without generalizing the women I am so blessed to work with --- I don't practice in a population that will (can?) embrace the granola-crunchy, no-interventions-please philosophy. (Happily, they don't generally fit the "yes sir, whatever you say, Doctor" mold either... these mamas are strong, and will do whatever they know is best in their situation).

My hope is that I can continue to cultivate growing relationships with each woman and family I work alongside, as well as the community itself, to find the "right" plan for her situation. No glibly tossing out the "I" word, giddily skipping down the L&D hallway to pop a bag o' water, or passing out epidural tubing and meds like candy at a 4th of July parade - simply trusting the relationships and our communication to find the path to a healthy, happy end.

Long time gone...

Hey, nice to see ya! Where've you been?!  Oh, wait, I guess maybe it's where I been, eh?

So, needless to say, this post is loooooong overdue.  I think this blog's last posting was somewhere around, oh, six months ago?  Huh.  I guess it's been a busy half-year.  Since our last rendevous, old friend, I've packed up and picked up everything to move half a days drive away, officially gaining entry into the world of a practicing (and paid!!!) nurse-midwife, and gloriously helped a powerful mama pull her newest into her arms, standing alongside her bed... (my first out-of-bed birth - woohoo!). I've said goodbye to so many friends --- and in a heartbreaking moment that doesn't end, to my baby brother, standing alongside each of my family members as we realize the swiftness with which goodbye can be missed; I've lain awake at night and struggled with my own internal guilt, fears, remorse, anxieties - both professional and personal.  I worry about meeting the expectations of my clinic administrators, meeting the needs of my clients, about being thorough yet not over-ordering or falling behind; I fret about when the golden hospital privileges will finally be mine, how stressed my partners are in the meantime while they await that day and how tiring it must be to have to back me up until then.

And, of course - I yawn, I drag, I sleep only halfway 98% of the time, hoping/not hoping my pager will go off... if it does, if that next mama's water finally breaks, it will be one more babe closer to independent privileges and a bit of relief for everyone all around (but if it doesn't, of course, it means a bit more sleep for everyone on the home front.) Officially, I'm on call something like four nights a week - but unofficially I've been sleeping with my pager under my pillow just about 24/7 since starting in April - or at least since getting permission to get near hospital patients a month or two ago. It doesn't beep at me often ... yet I still dream that it does, or that it did and I slept through it, or that the batteries died and someone's been frantically trying to find me, yadda yadda....

Oh, but the catches - the sweet, slippery, lovely babes!  (Really, isn't that what it's all about??) When it's down to that moment, the rest of the stress, the worrying, the anxiety melts away.  Until, that is, the hemorrhaging afterwards... or the placenta sticks... or mama passes out later on.... you know, those sorts of things....  But the catch itself, usually, is a rush!
 
I pledge, from this point forward, to stay more loyal to this blog.And I hope you'll stay here, too.  Like any good things, any journey worth taking, it may be a long road, but hopefully worth the travel....

My "birthingway" necklace ... or "mamalove" necklace... or "I Catch" necklace" ... or ??? 
(I'm open to suggestions!) ... for every babe, a bead <3