Thank God for Midwives

(And mama's, and babies, and supportive dads/aunties/grandmas/friends, and doulas...)

But, at least for me and at least for this week --- thank God for Midwives! If you've followed along at all, you might remember how intense (is that a good word??) things became at my last clinical site. I won't go into all of the details again - because frankly, it makes me feel pretty lousy and I also start to feel a little badly for the women who really want a midwife and don't realize (until it might be too late) when they've actually found a medwife - but it was rough.

Rough on me a student, as a person, and even as an OB nurse. That site caused me to question a lot of things both about myself and the way I have been prepared to practice as a CNM; the Midwife was motivated, she was popular, and she was good. But - she was also (either by choice or by necessity) very much a medwife. As a learning experience, it was good; the four months I spent with her allowed me to begin the hands-on learning I needed to grow as a new midwife, and the last few weeks (along with many, many weeks thereafter) gave me pause to reflect on ways that I myself need to grow my personality to better perform in that role, as well as on the pieces of the Midwife's practice that I did and did not want to take with me into my own practice.

It wasn't until today, though, that I realized how deeply I felt wronged in my previous site. My faculty advisor has been working hard to help me find a new clinical site; this process, which originally seemed as though it would be fairly quick (I had another preceptor in mind, who was happy to work with me) ended taking 2 and a half months. Obstacles with policy, administration changes, and just enough little roadblocks to keep things from progressing have kept my hands from officially (as a student nurse-midwife, that is) welcoming a baby into the world since March 1st. (And it has been kiiillllllllling me!) As things continued to stall, my advisor suggested I come to a site that has welcomed several of my classmates in the past; while at first I was hesitant (as this site is a 3.5 hr drive from home) eventually it got to the point where any site was perfect, and I jumped at the chance. The midwifery group agreed to work with me, the paperwork was approved, and plans were made for my arrival early this week.

And, it has been amazing. Amazing for the births I have attended - 9 so far since Tuesday (and I missed several others one day when I finally had to admit that my body and mind needed rest), including two glorious waterbirths, two VBAC's, and a handful of other triumphant displays of mama-power. Amazing in the fact that the midwives and nurses have welcomed me with open arms, eager to help me blossom as I work my way towards becoming a beginning-level midwife. I've had "scary" moments - a decel that wouldn't come up (while my precepting CNM and the OB on-call were in the midst of a c-section and completely unavailable), a shoulder dystocia that didn't resolve easily with McRobert's maneuver and suprapubic pressure - but made it through them. I've been allowed to be more independent in four days, with four different midwives, than I was in four long months with the Midwife: when our dystocia baby's shoulders didn't ease out shortly after his head, the CNM I was working with that day didn't push me aside to take over... instead, she stayed back (as hard as it must have been) and allowed me to identify the situation as a shoulder dystocia and to work to resolve it. When my efforts weren't quite doing it, and I looked to her for help - she was there. The trust that I've found from these midwives - each of whom I have met for the first time the morning that the call shift begins - literally brought me to tears as I finally took some time today to reflect on this first week. It takes a momentous amount of trust to stand back and allow a student to be in control of a situation - especially one that is as intense as a shoulder dystocia or prolonged decel. I can't even begin to fathom how difficult it is to stay back and just "be", while a student works to resolve something that can so quickly develop into disaster. And yet - the true mark of a good teacher is to understand that without allowing a student to take the next step towards independence, the student will ultimately never succeed, and both teacher and pupil end as failures. In labor and delivery, with the life and well-being of a longed-for baby on the line (as well as the mother's safety), the amount of trust and courage in takes to do this is multiplied ten-fold... with the rewards equally as impressive.

I'm not there yet - a part of me froze up in those tense situations, and it took longer than it should have for the little voice in me to say, "this is what you do... remember?". But the gift of being allowed to wake that little voice up, to do my best, and to know that I had a supportive preceptor right behind me --- rather than pushing me to the side immediately --- was worth more than anything else. Then, the bonus of constructive feedback and open communication - rather than quiet, tired frustration - after each incident: What should I have done? What might have been a better way to do that? And - what did I do right?

As I wrote what was supposed to be a quick update to my advisor, letting her know how incredible of a learning experience this has been so far, I found myself reflecting back to the days with the Midwife and comparing the feelings I had at the end of that rotation (inadequacy, doubt, fear, shame) and the ones that have emerged in just a few days here (confidence, readiness, calmness). Sitting on the back porch of the midwife who so graciously invited me into her home, smelling the lilacs with songbirds for a soundtrack, tears rolled down my cheeks as I typed on and on. Where my hands were rarely able to catch without the Midwife's covering them before, they now have eased 9 new lives into the world with very little guidance; when I reluctantly began to perform certain skills in the way that I had been taught from the Midwife (but had never been comfortable with), I was reassured that there was another way, and that the way I learned was not necessarily the best practice; what had been frustrating in the past (lack of expectations, absence of any real rapport) was nowhere to be found among these midwives.

So, thank God for midwives... the midwives I've worked with this week, who took my hesitant, injured confidence and allowed it to begin to heal; the midwife who opened her home to me, with its peaceful quietness (no television, no cell phone reception) and country beauty; the midwife (my advisor) who spent so much time working with me to find this happy place again. And even the Midwife, who started me on this journey and puts this all into perspective.

My Town

My town is (relatively) rural, "under-served", and ... beautiful. There are days that I find myself awestruck at the innocence of the people here, the young families working so hard to bring about the change that we need, the grandparents so active in the younger generations, and the community programs that are so involved in so many areas of our growth. Two Native American reservations adjoin the region, sharing a wealth of rich tradition and cultural diversity.

Even after nearly thirty years of living within thirty miles of the same spot, I still have moments of wonder at the physical world around me as well. My home is a mixture of fertile, strong farmland - capable of bearing grains most months of the year - and rolling hills and thick, tall stands of trees. Rusty tractors and beat-up cars dot the highways and country roads; anything shiny and speedy is less likely to be seen. Deer are everywhere (driving home from my mother's today, I had to hit the brakes twice to avoid last fall's scrawny doe-fawns), with wild turkeys just as present and pesky. A bear loping across a country road is a much more sacred experience; bald eagles are a daily, humbling, occurrence.

(Now, of course - don't get me wrong. There are so many areas that could be improved on; there's the same old political drama as any other area - the community is older than the average town, with a very conservative tilt - as well as tension from a so-called "religious cult" that has had ongoing legal claims against the city government over the past five years or so. Racism/ethnicism between "whites" and Native Americans (as well as members of the religious group mentioned above) does exist in the area despite commitment by many organizations to work towards common goals of unity. Business is always business: our small, not-for-profit, community-run hospital recently "merged" with a larger health care system, and competition continues with other clinic systems in town and with the "bigger, better, newer" facilities located slightly further away. My town may not be perfect - but it may be perfect for me, anyway.)

And yet, with all our imperfections, all our arguments and all our petty squabbles - we really do have it good. On our small, four LDRP obsetretics unit - in which each room has banged up doors, peeling wallpaper, and so many aesthetic no-no's that it's becoming painful to give tours during my childbirth classes - we've celebrated the birth of not one, but two sets of vaginally birth twins in the past few months. In the years that I've been a part of 'my' team, we have had several more sets, both to primiparous and multiparous mamas. (I have not be lucky enough to be present at any of these births yet --- can you tell I'm a bit peeved?! --- but am still so excited/proud/any-number-of-adjectives-fits-here that the diagnosis of "twin pregnancy" hasn't automatically equaled "cesarean section" for our mama's; generally, as long as Twin A is vertex and the pregnancy is otherwise healthy without factors contraindicating vaginal birth, trial of labor has been offered/attempted, and as far as I know - all have been successful with wonderful outcomes.)

As a nurse, I've had the joy of holding patients' hands, helping them breathe through contractions and ease their way to the births of their sweetest creations; I've been blessed enough to have to catch babies (when the doctor didn't quite make it to the room, or even to the hospital in time), and instead of being reprimanded or frowned upon, I've been thank

ed and even praised because of how well things were handled. One mama had a vacuum assisted delivery with her first babe, and a massive laceration with repair; she was terrified of pushing and delivery. With the doctor down the hall, ready for the call, she tried her first push - and with just a little encouragement, gentle support, and the right words... she delivered her beautiful daughter by herself, into my hands, before the doctor could make it down the hall to us. No lacerations, no need for any assistance - only her own strength.

Much of this truly comes down to my own inner calmness. As a new nurse - starting directly into OB/L&D nursing, I was terrified of having a mama "precip" on me. And, of course, two of my first handful of mamas did just that. (At that time, I was new enough that I still had a precepting nurse with me, and I basically froze, leaving her to jump in and catch.) From that point, I had such o

f phobia of having that happen again that I became hyper-vigilant of when a mom might suddenly progress to delivery rapidly - and so I began calling the doctors to come in very, very early in second stage. (Now, if they were midwives they would probably already be there... but that's another story...) La la la da.... fast forward a couple years, I became more relaxed and understanding, intuitive, and comfortable with idea of catching if need be - and, I was entering midwifery school, so the idea of catching was a little more addictive at this point! - I had no precips, because I had finally gotten it down pat of when to call the MD's in so they would get there *just* in time. (Drats!) But, finally, I realized, if and when a baby delivers - I'm all right with that. I no longer frantically instruct a mother to "Stop pushing!" or "Pant! Breathe through this one!" ... if she is going to push because the baby is right there, I am not going to stop her. I don't plan to catch any babies in babyland - but, if they come to my mamas and there's no one else around to catch 'em ... mama and I are going to do it!

I live in a town without high rise buildings, with no Starbucks or malls to call my own; "my" unit has only four labor beds, with peeling wallpaper and drab furnishings, and no OB/GYN's to be found. My countryside is, well, just that - fields, tractors, and farms. To be blunt, summertime smells like cow-shit... but also the sweet smell of lilacs, alfalfa, and fresh-cut grass.

And - I like it this way.