midwife needing to whine

[mothercat]

I know that this will pass, but before I go to bed after three very long days that resulted in two transports and doctors being very irritated with me along the lines of "Have you no common sense?" I just need to have a small pity party.

Nothing disastrous has happened, but all my skills could not prevent these two transports and one was a repeat C/sec. I hate having to defend the care I provided knowing that although it was probably not what the physicians would have chosen, it was still backed up by the literature, my knowledge and experience as a midwife, and was in line with the clients' wishes.

After all my bravado about "birth works, just trust the process", I came to the point tonight of saying that wishing and hoping just aren't enough. This temporary crisis of faith leaves me thinking my clients would be better off in another midwife's hands, because I have obviously misplaced my gift.

As a local politician said earlier this week, "It just sucks to be me today."

Linda

[MCatLvrMom2A&X]

:

[doctorjen]

But Linda, do you really think the outcome for these clients would have been better/different/whatever with another midwife? Sometimes we do the absolute very best we can and things do not work out the way we hoped and that doesn't make it wrong to have done your best, that's just how it goes.
Remember that at the end of a very long, exhausting labor for the birth attendant it is so easy to look back over those many hours and find things you feel like you should have done differently, or even to be sure you made unwise decisions, or whatever, but having the advantage of that 20/20 hindsight makes things look different than they do from the front end. I catch myself as a birth attendant blaming myself for my role in a challenging birth and forgetting the other players - baby and mama - who are of course far more important that I!
Because an individual, or even a string, of births end up requiring intervention does not mean that your belief system is completely wrong. The majority of the time birth unfolds best when least intervened, when the birthing family is supported and encouraged and things that have never been shown to help anyway are not used (monitors, scissors, etc.) Recognizing when a birth has left the realm of normal - or even just when the mama needs/wants more help - is an important skill, too.
I know it's hard as a birth attendant who values normal birth and being able to help your clients have that, to see their births end up something they didn't want, and then to be belittled by medical staff on top of it, but you are not wrong here!
Do some things today to fill up your own cup. Soak in a bath. Go for a run. Let somebody wait on you a bit. Tell the stories to a birth worker friend and acknowledge your part in them, but remember every one else's parts as well. Remember some beautiful births you have attended that unfolded perfectly and would have not been as well supported if you weren't there. And then move on.

[Peppamint]

Linda

[momma earthical]

[OliveJewel]

You are exactly the kind of midwife that I would want to have! Someone who fully supports mom's wishes and believes in the process of birth. I had no idea that the midwife would get belittled just like moms get belittled. My heart goes out to you and just know that you are EXACTLY what we moms are searching for in a midwife.

[MsBlack]

Yeah, definitely, what DrJen said!

We all have these moments of doubt, and it is no coincidence that they come on the heels of such experiences. Hard enough to have the transports occur, with that question of 'how might I have failed here'...but that self-doubt is most definitely emphasized by what you rightly name the need to defend your care at the hospital. We should not have to do so--but on their turf, a major part of their power game is to assume that 'what they would have done' was necessarily better/safer for all concerned. No one even has to say it--we all know that the attitude is present and broadcast into the air.

Take it as a mere reminder of human frailty (the frailty of all concerned, not just your own), and the fact that birth is as safe as life gets....and ONLY as safe as Life gets, no more or less--no guarantees. Take it with thanks that all came through ok, and ask to understand whether or not there is anything in future you could/should do differently--maybe there is, but maybe not! Take it knowing that with every birth, all kinds of 'karma' is being enacted...not punishment, just the effects that follow upon causes...and that that karma is personal for each individual, *as well as* generational and cultural on a larger scale. We are all subject to some degree to the psycho-social-cultural influences of our era--so, *maybe* on a physical level, these births 'could have been better', but could have been no different than they were when it comes to those karmic/cultural influences.

THese births might fall into the category of mysteries whose reasons may never fully be known to us. So go ahead and question things, review, consider--but don't take it too personally. Certainly not to the extent that you actually question your gift, and its value to this world!

You are needed. We are needed. Rest in that as you heal from doubt and disappointment.

hugs to you sister!

[mothercat]

Thank you all for the hugs and kind words. After several hours of good sleep I had to go in to the office this morning for several appointments and then to the hospital to visit the mom. In between I got a call from NICU confirming my address so they could send the paperwork for the transport and outcome. Baby will be in NICU for a few days. He was 11 pounds and is having enough blood sugar issues to require a D10 drip.
Mom doesn't feel too bad after the C/sec and is very accepting of the events. She feels I gave her every chance to help this baby out. She came from out of state to stay with family nearby so she could attempt a VBAC. In her home community it would not have even been possible to try.

I also talked with the first transport mom. The labor and birth at the hospital happened for a reason in her eyes. I wasn't sure what that might be until the placenta took 90 minutes to release and mom's H&H yesterday was 7 and 22. She's not symptomatic and didn't look like she lost that much blood.
If anything else good came of that, it was the student nurse. Here was the mom laboring away, making good use of the monitor stand by leaning on it during contractions, and in between answering the student's questions about what the contractions felt like and how she could cope with them. Shortly before the birth, mom was sharing her experience of living in Europe, and then two pushes and out comes a pink, obviously healthy 9 lb 5 little girl. What an eye opening experience for the student to see NCB like this.

So, in the end, my perspective of how I failed the moms must be tempered with the good that may ripple out for some time to come.

Tonight my husband is making dinner for me and hopefully tomorrow I will have a chance to have a good run before the midwife stuff starts.

Linda

[reikitiki]

Linda,
I am glad to hear you are feeling better about this. Your focus is always on what's best for the mom and the baby, like you said, "these moms hire me so they know they have a safe out-of-hospital birth", suggesting a transport before the conditions become extreme means that these moms still end up with a safe birth... even if it wasn't what they originally envisioned by coming to the birth center or staying home. You offer your knowledge and expertise tirelessly. You offer suggestions and information that help women to make empowered, knowledgable choices during their entire prenatal period and during the birth itself. You offer what every women needs and deserves! And you call me in when you need me to do the soft, earthy, mushy stuff!!!!!!!!!

[applejuice]

As a homebirth mother four times over, I thank you for your service! I am sorry that you are feeling so down. I hope there is a positive birth experience waiting for you at the next call. It is a full moon next week!

[Defenestrator]

Don't discount how subtly humiliating being in the hospital can be for you -- just because the choices that you and your clients made led you there doesn't mean that their way of doing things is always better. I always feel very disempowered after spending time at a transport -- give yourself a little time to refocus and look at the birth through midwifery eyes.

[mwherbs]

so you have one baby in the NICU- sounds like you made the right call- I don't think I could have served the family any better- the other who knows we are trying to err on the side of caution , just happens.
hospital birth or a C-section are not the worst things to happen in a birth things we try to avoid but not at all costs- homebirth midwifery can be so isolating but you are doing the best you can and providing a service
take care

[mamallama]

I'm glad you're feeling better.

[BirthFree]

Thank you for posting this thread... I have just been questioning my own abilities as a doula this week... I needed to read of your struggle, thoughts and recovery. Wishing you every kind of peace and refilling. I admire the ability to shoulder a responsibility far above mine and STILL recover with difficult circumstances. I just had two births that left me feeling very UNable to help and it has been hard to swallow... they were back to back and my last births for a while... I wish that we could change the outcome sometimes - but sometimes our only role is support... and that's enough.

Hugs!

[jengacnm]

Hi mothercat-

I was in your shoes this past summer. Heck, I'll try to dig up the link-and how wonderful it is that we can come here for support!!

Originally Posted by Defenestrator

Don't discount how subtly humiliating being in the hospital can be for you -- just because the choices that you and your clients made led you there doesn't mean that their way of doing things is always better. I always feel very disempowered after spending time at a transport -- give yourself a little time to refocus and look at the birth through midwifery eyes.

I have the good fortune of being in a home and hospital practice where I can seamlessy transfer-so I can "transfer" my clients to me, and the nurses usually don't know that we intended to be at home, since about half of our clients wanted to be in the hossy in the first place.

Even with that, transporting can still be demoralizing. It's not what the client wants and not what we want. That being said, I can tell directly and otherwise from your posts-your clients felt well taken care of by you, and you gave them every chance they had for the birth they wanted.

Take care of yourself, sleep, get a massage-and prepare for a stream of butter births!

Hugs-
Jen

[jengacnm]

Well, isn't this funny....

So I went back to that post I started last summer when I was a mess from a string of c sections-and I got all kinds of wonderful loving support from everyone here. And whaddaya know-the post that brought tears to my eyes for how sweet it was was from none other than mothercat.

Consider this paybacks. You're wonderful at what you do. Let yourself heal and may your incredibly important work bring you joy again soon.

[kltroy]

As a mom - but not a childbirth professional - let me say that we wouldn't have a NEED for midwives and doulas if birth always worked perfectly every time. As your clients, we are comforted by knowing that there is someone there who knows what to expect, trusts the process, and knows when to get help. Who could ask for anything better? Yes, birth works most of the time - and when it doesn't what we really want is some expert help Sounds to me like you did a great job.

[mothercat]

First, thank you all again for the support.
I know it's a passing feeling of "what else could I have done?" However, I have thought quite a bit since my OP about why this bothers me and here's the crux of the matter.

I don't want to be the midwife who blames her clients for how the birth turns out. But, I need to back up a step further. I don't want to not have the skills or knowledge to give her the best possible chance at the birth she wants.
It is so easy after a birth that went poorly to say, "I did everything I could", but I always wonder if that's true. Was there some physical or psychological or emotional thing that I missed that would have made a difference? Have I just not investigated or studied enough to be sure that I know everything that would have made a difference?
Like Shelly (reikitiki) posted, I call her when I think the mom needs mothering during labor. Hand holding is not always my strong suit. I just think that although women need emotional support during labor and birth, it is still a path they must travel alone. Only they know how best to give birth.
The problem is that I know midwives who have what, in my opinion, are limited skills for dealing with difficult situations. They have a few things they will do and if that doesn't work it becomes the mom's fault when the labor doesn't progress. She is blamed for emotional blockages related to prior sexual abuse, ambivalence about motherhood, problems with her partner, not wanting the birth badly enough, and probably a whole host of other things.
When I am really tired and frustrated by my own lack of being able to change the physical situation, I have found myself wondering if there isn't something of that nature going on. What I have found every time I begin to think that way is that there was a very good reason why the birth wasn't straightforward and it usually had something to do with what the baby was doing. Things like being asynclitic or posterior, sucking on fingers, being really long bodied in a short waisted mom (think accordion fold rather than curled up).
The baby is the one person we can't do much about. I'm not positive that the mom's emotional state has all that much to do with the baby's positioning. I am sure that baby position has everything to do with how mom labors. It just doesn't seem fair to blame mom when she doesn't have any more control over the baby than we do, yet that is what sometimes happens.

I always regret afterward when I forget that point and have found myself thinking that mom's intentions for the birth were not what she told me they were. I can't think of a birth that ended as a transport where there wasn't truly some baby position thing or cord wrap thing that was actually the problem. And, I absolutely hate the idea that I may have doubted the mom's intentions and she feels blamed (like being broken) for something she had so little control over.

Like I said above, I don't want to be the midwife who blames her client for how the birth went. I may not be the most touchy-feely midwife, but I want women to know that I believed in them and their ability no matter what happens.

Linda

[MsBlack]

Hmmmm...

To me, all elements of a birth work together, come together to create the whole. I guess I do believe that the psycho-emotional-spiritual level of a woman's life contribute to positioning of baby and the entire course of labor. Of course, baby's size and shape, mother's size and shape also contribute--as does the woman's relationship dynamics w/partner, and the partner's and other participants' energetic input. To me, the world is more than a physical thing; the world and what happens in it is always as much about the 'invisible/non-physical' realm as it is about the visible/physical realm of existence. Sometimes what happens is MORE about the non-physical, imo--and of course there are those who believe that all of what happens is directed from the non physical realms of our beings.

I'm thinking now of a birth that was an SD. Head showed the turtle sign, baby would not rotate, and withdrew further when Mom tried to push. Mom moved to hands and knees, and rotation started, sticky-slow, and then stopped before completion. Then Mom lifted one knee and put that foot flat--got into runner's pose--and rotation completed, she pushed baby right out and all was well. If I hadn't known to help Mom into h&k, and then into runner's pose, the outcome could have been much different (nuchal hand on top of a 15" chest!). It was clearly a case in which understanding the mechanics, and having some knowledge, helped the birth go right. And I can think about that birth--nothing especially psych-emo about it, just mechanics.

So sure, sometimes it is mechanics and adequate knowledge of mechanics and how to work mechanically with different moms and babies. But I don't think that is always the case by any means.

And sure, it can be a 'lazy way out' to tell yourself that a birth ended in transport--and maybe even csec--because of mysterious and impossible to firmly identify psych-emo issues. Such thinking can help a mw justify a failure to keep learning, a failure to figure out what mechanical knowledge/skills she lacks and go get that for herself. Or heck, a failure to learn how to do good enough therapy with those kinds of moms you named, to help them remove their psych-emo blockage....

But on the other hand--I do believe that the world and what happens is more than just physical, that birth manifests all levels of a mother's/family's (and even the culture's) being. Even if it turns out that there is some new physical, mechanical thing you can learn, that might prevent similar situations from repeating in future, still--each of you was present in those recent events for a reason. It can still be said that that mom/family needed you to be exactly the mw you were at the time, because that is the birth that was needed, the birth that was called to them, that was created out of their physical, emotional and spiritual lives on the whole. And that that experience came to you, too, out of the whole of your own reality as well.

Each experience is complete unto itself--and is also just another day in life, just another step along the path of our lives. It can take time for us to fully grasp the meanings, the blessings, and the lessons in any experience.


I hope you will count the blessings fully, and ponder the meanings and lessons without too much guilt or self-recrimination...and see yourself as a very skilled and very experienced mw who is yet still on a path of discovery, becoming more with every step along the way.

[mothercat]

I agree that sometimes there are other issues and the karmic influences that you wrote about earlier. There have been times when I have questioned mom if there wasn't something they were concerned about that might be slowing down labor.
The answers have included fear of what comes next (mom with previous birth experience), concerns about not loving the new baby as much as the older child, worrying that DP wouldn't make it in time for the birth, and the always popular, not laboring well until all the children were taken care of/asleep so mom could labor in peace. There have also been the women who chose OOH birth by default. The one I remember best ended up as a hospital vag birth. When we talked about the birth at the 6 week visit, she told me that next time she would choose a hospital birth because now she knew she could say "No".

It isn't that I ignore those things, and frequently, I am surprised by the things women tell me that weren't at all related to what I asked. I'm only saying that all of that included, I don't want to take the easy way out and blame the woman for how things went.

For the mom that had a C/sec. last week. I found out after the fact that her diet was a whole lot worse than she told me. Her mom told me about the incredible amount of weight she had gained in the last few years. I learned about this as her mother was trying to nicely tell her that if she had another baby she needed to lose a lot of weight and get in better shape. Getting ready to transfer to the hospital and knowing a C/sec. was the likely outcome was not my choice for the best time to discuss this. It felt a lot like blaming the mom for what was about to happen.

That is the part I want to avoid. Mom may have issues that she can't or won't resolve that affect the birth, I just don't want to add guilt to the work she will have to do.