This has been an incredibly busy week personally and professionally, though I’m realizing that I will start saying this every week. It’s a great feeling, but some posts I have been working on deserve more attention before putting them up in this space. Thus, I bring you another journal entry from my residency/integration earlier this year (others can be found here and here). For those new to the blog (thanks to Radical Doula for the advertisement!), I completed my integration at the same site where I am now working. Even toward the end of my time as a student, I did not plan to return here and take a job. The moment I returned to school, I knew that I had to come back here, to work change from the inside, despite all the frustrations. The post describes one of those frustrations. (As always is the case when I refer to patients, many details have been changed for privacy.)
Earlier this week I worked with another Midwife, one who I’ve enjoyed working with before. She has a unique relationship with the doctors, and “covers the board” while they are away at a mandating teaching session, despite an attending being paid to be on the floor and monitoring the MD patients. On this particular shift, the in-house Attending was sitting at the board with this Midwife and myself, when one of the MD patients was ready to start pushing. He told my preceptor to do the delivery and he’d be there to watch. This was not a Midwife patient, and in no way was she responsible for that patient’s care. She asked if I could do the delivery, and he said no, that it’s an MD patient, and he’ll be Attending her during the delivery, but that I could observe. She’s been a Midwife in this setting for over a decade, and he essentially had her acting as his Resident. Apparently they have done this dance before, because she already knew what he would want her to do. She broke the bed, prepped the patient with betadine as I’ve seen the doctors do in this setting, and told the woman to push (a young first-time mother). After a little while of pushing and the head moving down, the Attending instructed my preceptor to cut an episiotomy, immediately cut the umbilical cord, and hand the baby over to the nurse. This Attending’s preference for very active management of the placenta was unsuccessful, and the Midwife was instructed to manually extract the placenta after 15min, and then the Attending told her how to manage the hemorrhage that followed. The Midwife did the repair under the Attending’s gaze. Throughout the labor she (M for Midwife) playfully interjected suggestions, in a light-hearted voice, shaking her head every time the Attending (A for Attending) ignored her practice suggestions. (M): Why not let her push for a few more minutes? (A): No, cut the epis. (M): Congratulations take your baby, let’s do skin-to-skin! (A): No, no, no let the nurse clean her up, you’ll have 18 years to bond with him. During the hemorrhage, I even suggested she breastfeed to aid in the spontaneous delivery of the placenta. (A): Well that won’t be happening in this room today. After the hemorrhage was controlled and the floor started to become busier, the doctor went into the room to see if the woman was ready to be transferred to postpartum, and said to the nurse, “Do you think she’s done bonding with the baby now? Let’s get him upstairs to newborn, she can meet him up there in a few hours.”
This Midwife is a spitfire, is an incredible arguer with the doctors, will defend my desire to encourage natural birth to its very end, and yet she followed this Attending’s orders to their inappropriate end during the entire process of this birth. I was shocked.
I have spoken with classmates who want to stay at their sites until the very last day, returning to school the night before we have to start studying for comps. I feel so torn, so frustrated that this site is not what I expected, so frustrated that I feel as though I’m not trusting the natural birth process anymore, so downtrodden in my hopes for collaborative relationships, so confused by watching strong midwives cave to awful care under MD pressure, direct or indirect. I want to get out of here as soon as possible. I am positive I want to leave at the end of March and hopefully have those two weeks before school restarts to recoup. This site is a spirit-silencer. Midwifery lives here in spurts.
Later in the day on that same shift I had a beautiful birth, quiet, crowning of the head slow and without rush, didn’t gown and glove until just the right time to facilitate head flexion and birth. The nurse commented that it’s the quietest birth she’s ever attended. The mom was incredible, the baby vibrant. It was beautiful. It’s what she deserved, all that was needed in that situation, and similar to my thought from last week, I would be crushed to know that could have been taken away from her given another Attending on the floor, one heart variable and an uncertain Resident, or another nurse who was impatient with the process. I don’t want to stop doing this. If anything, those moments during which I see others’ spirits silenced, mine rages on. I fear the day that I realize a student is looking at me with the same concern I have for some of my preceptors here. How to keep that midwifery flame going? How to make sure I convey my passion with women, and spread it to other providers? How to get a job and keep rolling with the current energy? Hoping a bunch of shifts this week allow some sharing of energy between myself and the midwives on the floor. It’s going to be a good week, I can just feel it.