Why I Love Being a CNM.

Let me start off by saying that I am first and foremost a Midwife and I have learned that life often takes us to places we may never had anticipated. When I first decided to commit to this journey and become a midwife, I was absolutely going to become a CPM. I had zero interest in working in a hospital and never wanted to become a nurse.

Then I started to look for a preceptor and quickly became acquainted with this well known struggle! Eventually, I found an experienced homebirth midwife who would consider taking on an apprentice. However, I quickly realized that we had diametrically opposed philosophies, and that a relationship would not work. While I re-started the search for another apprenticeship opportunity, it also became clear that as a single mother to a young child keeping the schedule of an apprentice midwife would be nearly impossible. These factors caused me too look at other options. I started nursing pre-requisites at a local community college; reasoning that I would learn good information on A&P, microbiology, etc that could be useful as either a CPM or a CNM. I kept up the search for an apprenticeship and become involved in the local childbirth community. I still hoped, prayed and worked toward becoming a CPM. Then seemingly before I knew it, I was done with the pre-reqs and had to choose whether or not to apply to nursing school. I begrudgingly filled out the nursing school application. In my area of the country, in 2002, it was nearly impossible to get into a nursing program and it was common to spend a couple years on a wait list. I assumed that if I even got in, it would be on one of these wait lists.  To my complete shock and awe, I was accepted on the first try! After some serious contemplation, I decided to take this as a sign, made a HUGE leap of faith and went to nursing school.

Fast forward many years, trials, tribulations, a new marriage, joys and sorrows, a new baby, a few more years and I came out re-birthed as a Certified Nurse Midwife. In hindsight, which is of course always 20/20, everything worked out perfectly and as it needed to. I am thankful for everything that being a nurse taught me and I am proud to be able to call myself one. When I started this path, I had starry, rose colored glasses and was high on the idea of birth and babies. I had no idea how much I would also fall in love with full scope women's health care. I appreciate that, in many years, when the realities of being on call will become difficult I can choose to still serve women, just in a different capacity. Additionally, the security of being able to practice in any state or even internationally is comforting.  The past few weeks, and these cases, have exemplified why I love being a CNM and why I love working in a free standing birth center;

• A sweet first time pregnant person at term calls to report that she thinks her water broke. A couple hours later I have her come in to the center and confirm that, indeed, the bag of waters has broken. We do an US to confirm that baby is cephalic (yes, I also did Leopolds and knew that babe was head down, but in these cases we also use the US) this way I did not do an internal, cervical exam. Because she is not in labor, we also do a Non-Stress Test or NST and the baby looks gorgeous. After a good discussion on all the risks and benefits and answering all their questions, she and her husband go home with some herbs to try and encourage labor to start. Several hours later, they call in a great labor pattern. When they arrive to the center, it is clear that she is in active labor and is entering transition, I do not do an internal cervical exam. We labor. A little while later, while in the birth pool she begins to spontaneously push and shortly thereafter gives birth to a beautiful baby. She never, during the entire course of her pregnancy, labor or birth had an internal cervical exam and I love that! 
• Recently, one of my midwife sisters had a client in for a Well-Woman exam who wanted a photograph of her cervix. We were excited and made that happen, it didn't even phase us.
• I have collected a pap smear while a toddler was latched and nursing and placed an IUD with the entire family present.
• A few weeks ago, I had a couple come in for a Preconception Counseling visit. The client has a long and difficult history with some past drug use and mental health issues. She has felt judged and mistreated, "labeled", in traditional medical systems and practices. I was able to sit with her, spend a lot time and make her feel safe and comfortable. It was very likely her first ever positive experience with a health care provider. And she is now on track to plan a healthy and much wanted pregnancy.
• A little while back, we had a client present for an annual well woman exam. Her physical exam lead us to do some blood tests to assess her thyroid function. These came back abnormal and we referred to a specialist. She was quickly diagnosed with thyroid cancer and had surgery to remove her thyroid, luckily the cancer had been caught early and there was no spreading of it to other organs or systems. She is now home and healthy with her sweet family.
• There were two families at the center who had given birth and there were two families at the center in labor. The midwife on call received a phone call; a serious family emergency with one of her own children. I immediately sent her out to go to the hospital to be with her family. The other midwives in our group quickly stepped in and provided care to these families. This process was seamless and incredibly quick, the families did not even realize what had happened.
• I have provided care to a woman who had never been sexually active, then met a wonderful man and counseled her on contraception and safe sex practices. Before their wedding I placed an IUD as they no longer needed to consider "safe sex" but contraception only. Then after they had been married and were ready to start a family, counseled them on preconception planning and removed her IUD. They then came to our center for their pregnancy and birth.
• For the past year and a half, I have been providing care to a client with a significant history of abuse. She desires children some day. With time, care and the absence of any type of pressure we have worked up from our first meeting which had to take place out of the clinic to her being able to come into an exam room and have a partial physical exam. With the same care and patience, I have faith that we will be able to work up to a full exam.

All of these stories and many more make me grateful that my path took unexpected twists and turns, leading me to my current position. I truly appreciate every stage and aspect of being with woman...in all the ways that women need me.

#NursesUnite

I am a midwife and that is how I introduce myself. However, I am also a nurse and am a Certified Nurse Midwife. Here I am with two of my "doctor" stethoscopes, one for Mom and one for Baby. Not pictured here are my fetoscope and Pinard horn.

A Poem for New Midwives

A dear colleague of mine is starting on the path of becoming a midwife. Last night, some midwife-sisters gathered to wish her well and share encouragement. I quickly jotted down some words; through my sleep and today, they have expanded and I share them here with her but also with all folks who are starting on this road.

Births will be glorious.
Births will be ferocious.

Babies will be welcomed through joy, laughter, gratitude and prayer.
Babies will be welcomed through weeping, sorrow, heartbreak and prayer.

Families will be wondrous.
Families will be tumultuous.

There will be unfathomable beauty. 
There will also be blood, urine, amniotic fluid, mucous, poop, sweat and tears.

Being 'with woman' is all engrossing; it requires tenacity, intellect, passion and grace.
Be mindful and feed your soul as well, do not become consumed.

Being 'with woman' is all rewarding; it will give you peace, community, strength and pride.
Be humble and remain rooted, do not become boastful.

Remember that you are not alone.
There is a history of ancestral knowledge behind you.
There is a circle of support around you in the now.
There is a place for you at the table in the future...and the view is glorious!

This post was recently republished on Birth Wisdom, a resource for maternal health advocates by Birth Institute. Want to become a midwife? Check out the Birth Institute Holistic Midwifery program

Obstetric Violence (trigger warning)

We sat at her kitchen table drinking coffee. The sky was a clear blue with a gentle breeze. As often happens, when women hear that I am midwife, she wanted to share her birth stories with me. When this happens, I try to listen attentively and remain open to their sharing. Her children are 50 and 51, yes born very close together, 11 months apart to be exact. As she tells her stories, she becomes visibly upset and even agitated. For her, these things happened yesterday. In my experience, this is a crucial part of dealing with birth trauma; it always feels so current, the pain is often just below the surface. She is angry and confused, still not understanding the things that happened to her. She remembers very little, just snapshots really. She was "drugged" and felt out of her body, something "cold and hard" was placed inside her to "pull" out her children. She was treated "like an animal" there was no compassion. The next day, she had bruises and abrasions on her wrists. For years afterwards, she would wake in the night terrified and feeling as though she were dying.  She still deals with pain "down there" all these decades later. She asks me; "Do you know what happened to me?"
Do I tell her? Do I tell her about 'Twilight Sleep', women being strapped down to tables, episiotomies and forceps and the assembly line that was a labor and delivery unit? I ask her; "Do you want to hear my answers?" She responds that she does. So, I tell her, I tell her everything that likely happened to her. She is calm and quiet for a time, occasionally nodding to herself. Eventually she says, "Now at least I finally know that I am not crazy."  We two women looked at each other with silent tears on our cheeks and finished our coffee.

This is the truth behind the history of obstetrics in this country. This is the reality of what the knowledge is based upon. This is where "they are coming from" and we can never forget. Have we struggled, fought and toiled to make great strides to improve the care given to women during birth? Yes! Are we done? Hell No! This is why we must continue. Just because things are much better now does not mean that the work is done. I share this story so that we don't forget, so that the new advocates and activists remember the history, know the past and never forget where they came from.

#LifeOfAMidwife: Birth Happens

Birth Happens! Sometimes it happens so quickly that you barely have time to catch the sweet baby, let alone make it all the way inside the birth center! This handsome babe kept his parents in suspense, with a couple trips to the center with "false" alarms but then when he decided to make his move for real we didn't even get through the front door and only made it to the top of the stairwell. Both baby and Mama were fantastic and healthy, the baby was even born en caul. We quickly moved inside after the birth and they had a lovely postpartum recovery. This is a picture that I took later of the "aftermath" of the quick, beautiful birth. Then I had A LOT of scrubbing to do.

What is The Worth of a Midwife?

This is a question that I often find myself contemplating. What is my worth as a midwife?  I wish to be able to give my knowledge and support to every person who would want it.  The reality is that that is not really possible. This is a fine line we walk as midwives. We wish to serve all but realistically we simply cannot. Here are some of my thoughts on the issue of why it is important to be “paid” in some way. I spend hours, days, weeks, months, years serving at the feet of my clients. I do so, willingly and with respect, but that does not make it easy. I do not expect to live a life of luxury, in fact, my life is pretty minimalist but I do expect and dare I say deserve to be able to provide the necessities for myself and my family.

·         Balance: work-life balance is a serious issue. In order for me to be the best midwife possible, both clinically and emotionally, I need a balance. Quality time off to spend with my own family, to practice self-care and to simply relax and have fun. I am no good to anyone if I run myself into the ground by working too much.

·         Energy exchange: providing quality midwifery care is energy intensive. Being open, available and supportive while at the same time monitoring the health of each client requires focus, time and strict attention to many details. This energy output deserves to be reciprocated in some way; this does not have to be monetary however, in our current society this is how the exchange of energy is most often handled.  Believe me, I see the value in a barter/trade system for goods and services but in the current culture I can’t make my car payment (and I need a car to be able to get to my clients) within that framework.

·         Time spent studying: I spent years of my life dedicated to learning my craft and I continue to spend a good amount of time staying current and continuing to learn. To go to midwifery school, I had to take out student loans and those need to be paid. Now, is there a big problem with our current educational system that saddles people like me with huge debt? Absolutely! Do I still have these payments to make? Yes.

·         Time away from my own family: to me, this one of the biggest ironies of midwifery. Midwives strive to support families in all that we do, we fight for people to be able to have the best choices and care available. We are focused on helping to foster strong, healthy families and yet we’re often doing so at the expense of time away from our own children and family. If I am going to be away from my own family and children, I need to be bringing something back with me, like; food for the table, helping to provide the roof over our heads, clothes for my family, the ability to have some fun as a family every so often, etc.

·         Marginalization of women: this is a big one for me. Historically speaking, women have been marginalized in our culture. While we are in a much better place now than we were, say 100 years ago, we are still marginalized. Our work is often undervalued and under paid. Midwifery is a classic example of traditional “women’s work” that is undervalued and overlooked. As a midwife, I am also a woman and I need to be able to provide for my own family. Again, in our current system, that is done through the exchange of money. Are my clients also in this marginalized group? Yes. And is there a huge problem in our current health care system in regards to access? Absolutely! We as women need to stand up and demand better. We as women need to stop “taking it” and subvert the dominant paradigm. Through my work, I hope to be working towards this goal by empowering and fostering strength in my clients and their families. The other side of the coin is the reality that I must also function in our current currency driven society.

OK, there are some of my current thoughts on the topic of “giving it away”. What are your thoughts?....


This post was recently republished on Birth Wisdom, a resource for maternal health advocates by Birth Institute. Want to become a midwife? Check out the Birth Institute Holistic Midwifery program. 

Choices

I have some soap boxes to get on today. There is a lot of "doctor or hospital blaming" that can happen in the natural childbirth community. Some of it is deserved and some of it is not. What is becoming clear to me is that for any real change to happen, the women must stand up and demand it! Money talks and if women start taking their money to where they will get the care they want and deserve, change will eventually happen. One of my pet peeves is that many people seem to spend more time researching which TV to buy than on where and with who they will give birth. To this end, here are some of my thoughts.

In order for a person to have the optimal birth experience for themselves, it is CRITICAL to choose your care provider and birth setting accordingly. If you desire a natural, physiologic birth you need to hire a provider who aligns with that desire and then works in a setting that supports the process. If you would like an epidural, choose a hospital that has 24/7 anesthesia available. Research these issues; be sure that your provider and birth setting truly have and offer what you are looking for. Ask around in your community; what is the cesarean section rate at the local hospital, what is the epidural rate? Ask your provider how they feel about your wishes; are they supportive or dismissive? It is not unusual in the current culture to experience the "bait and switch" of having a provider say one thing early on and then start to change their tune as the pregnancy progresses. If you want a physiologic birth then the first step is to be in an environment, surrounded by people, that will facilitate natural birth. When a birthing person is well supported, they will feel comfortable and can more easily relax. This will in turn increase the release of endorphins and decrease the release of stress hormones; it will hurt less and progress more effectively.  Planning a natural, un-medicated birth in a hospital that has a very high epidural rate may be like fighting an uphill battle as they may not be equipped to support the process. Birth should not be a battle, you should not have to go in ready for a fight. You should be welcomed with compassion and support.

Another point to be made: you have hired your provider, if the relationship is not going well do not be afraid to change providers! Prenatal appointments should make you feel supported and comfortable. You should have time to ask questions and those questions should be treated thoughtfully and fully answered. Going to care should not be a battle that you have to gear up for...if it is, leave and find a new provider.

Don't forget about the postpartum period. Many first time families have a tendency to only focus on the birth itself. Really, that is only the beginning. Think about how you want those first few precious hours to go. Uninterrupted skin to skin time is crucial for long term breastfeeding success, does the birth setting you choose support skin to skin care? Will the baby be left in the room with you or will they be removed to a nursery for an exam and observation? What types of routine procedures are done? Research these issues, ask questions and be persistent. These are reasonable questions and should be easy to answer. This is your baby and you have every right to know these things.

Essentially, here is my truth: Be Honest about what you want, Research your options and Choose a provider and setting that will truly support you.