I have written before about my world of midwifery. Though I might change my work environment eventually, I currently do not practice at home, in a birth center, or even in a traditional midwife practice. I work in incredibly busy outpatient clinics in the inner-city United States, where I see 15-30 patients per day and speak another language 90% of the time. I work at a hospital where birth may forever be named delivery, where midwives are an afterthought for other clinicians and for the patients, and where discussions around such things like hydrotherapy and nipple stimulation and other ‘alternative approaches’ are dismissed in assumptions about cultural preferences and sexualization. My role in my organization is lumped into the category of “mid-level” provider instead of recognized by name. Administration doesn’t understand why they are paying two providers to be at the hospital when MDs can do both vaginal and surgical births, and why midwives don’t just want to work in the clinic when there is more opportunity to “bonus” financially with more outpatient visits. There is no knowledge of the evidence basis of midwifery care, the historical nature of birth as primarily midwives’ work, or consideration of midwives as the first line provider for healthy women and pregnancies. I never see another midwife in my day-to-day or week-to-week work unless I make a lunch or dinner date with a friend: not even in the change of shift at the hospital. I go to work each day knowing that, for the most part, I am the, the midwife and I represent midwifery and I better not mess it up because I have only myself to guide me down the path of good midwifery care. I love caring for women and being their midwife. I think the women I serve are the most powerful energy source this world will ever see if only we all take the time to embrace and love and encourage them and each other. This first year has thus far been lonely and beautiful and tragic and full of self-preservation and confidence and doubt. I am so thankful for this outlet and for this community that I could scream, in the hopes that you all could hear me. And I know there are others out there working in environments just like this, succeeding and failing and trying again, and I hope that you know that you are not alone and we are doing this together.
I spend a large portion of my days, and sometimes large portions of each visit, discussing what a midwife is, what we do, how we are different from MDs, and then try to wrap up with a few words about why we are so great. Most of my clients have never heard of midwives, and assume they heard me wrong and still call me Doctor. Other women know of midwives but in an outdated or uncommon sense, and are confused by my introduction. Many women are seeking care for the first time in years, and come in with concerns well outside the midwife scope of practice. Others who start out appropriate for midwifery care develop changes that require transfer to a specialist. It has taken months for me to find a graceful way to discuss why I need to refer them to another provider, to give them the specialized care appropriate for their situation.
Last week, in still muddling through this speech, I heard myself say, “I am going to refer you to another provider, because I am just a midwife and I am not the best person to take care of you at this point.”
And then my heart broke. And I panicked.
How could I say such a thing? Have I already become such a product of this anti-midwifery system that I doubt my own worth? Do I no longer see my unique role? Do I no longer understand how to describe the importance of midwifery in the complex healthcare system? Do I some days believe that my only benefit is being nicer to someone than they have experienced before in healthcare and then I proceed in providing care the way any other provider would? How do I know if I am still providing midwifery care when I am never surrounded by other midwives? When and how will I know if I’ve lost my way? Will I ever be confident enough or knowledgeable enough or holistic enough to work in a truly great midwife practice and be a midwife they believe in? Do I still practice normal birth? Am I still understanding the hallmarks of midwifery care? Am I a growing and passionate and knowledgeable provider? Or am I “just”a midwife?
There is healthy pondering in all of these questions. There is important self critique and practical exploration and vital doubt. And there is growth.
I am not just a midwife. I am a midwife and I specialize in caring for women. I believe in you and your body. I trust women. I trust birth. I believe in choice. I am honest with you about what I know and what I don’t and what you know better than anyone and what we both need to look to someone else for the answers. I know when a concern is outside of my knowledge base and I refer you to someone I trust and know will take care of you like I would. I check up on you. I call you if I said I would. I channel the sages of my midwifery upbringing to provide you with the best care I know to give. I laugh with you, cry with you, hold you and massage you and rock you, and midwife you through each experience. I encourage your obstetricians to remember that birth is normal and beautiful and unique. I teach your medical students that there is another way to learn and to be, because caring for healthy people is different. I answer your pages and your texts and your phone calls at any and all times. I consider you a part of my family and a part of my experience, because you are. I am your midwife.
Today I am working on the labor floor. I received a text from a close midwife friend that she is also working with laboring women today, and that we are catching babies together and she’ll be thinking of me.
Next, during board report, I questioned why the residents suggested AROM and then internalizing a normal laboring patient, and the MFM team supported my line of inquiry.
Then, during rounds, while the obstetricians introduced themselves and the residents by name, and glossed over my presence along with the medical students, a patient’s family member asked, “Where is the midwife?” She wants to become one and wanted to talk with me more. In the following room, the obstetrician introduced all of the doctors, then laughed and said, “Oh, and this is our midwife.”
Some days are great, some only have moments of greatness, and the rest become part of midwifery that requires that little bit of extra. Extra effort, extra bravery, extra emotion and extra learning.
I am not “just” a midwife. I am a midwife, I am her midwife, I am your midwife. And I am my own midwife. And I am working alongside all other midwives out there today, tonight, and tomorrow. And we are working hard. And “just” doesn’t do any of that justice.