I know I could have done things differently. I know I should have done things differently. But that’s the beauty, and the fuckall, of hindsight. It’s precision clear in the wrong direction.
As a midwife in practice a little over 18 months, I have a lot of things I know that I don’t know. I’ve heard tales from others more experienced, tales which house grand truths about true and difficult births I have yet to see. I have a limited and fortunate history of my work. And I have textbooks filled with scenarios I’ve yet absorbed as possibilities, but know they could be. Alongside this knowledge of what I don’t know, I recognize that I also have a lot I don’t know that I don’t know. And that’s the scary part of this work. Therein lies my anger with hindsight.
Midwives practice emergency scenarios, with hands, with words, with models, with memory. We practice it over and over again in school, and when practicing, often with our teams, to ensure a shared mental model and group preparedness. We know that these events can happen, and that we should be completely ready, for the sake of those entrusting their care to our work. Hemorrhage. Shoulder dystocia. Cord prolapse. Abruption. Uterine rupture. Breech. Abnormal fetal presenting part. Previa. Neonatal resuscitation. We practice language. We practice hand skills. We practice leading and supporting. We practice a collaborative approach. We practice informed consent with little time and complex understanding. We practice knowing what to do, and how to do it, because that is what we are trained to do, and what our calling demands of us.
There are scenarios which can never be practiced. For many, this is a beauty of birth: there are always surprises. Sure, on the easy-peasy end of the spectrum, a surprise quick birth with glowing mom and baby who smiles within seconds of life is a lovely shock. I have had plenty of those, and each time I am surprised: I laugh and compliment everyone on their strength and love of life that throws us the unexpected, beautiful curveball. I welcome those surprises with open, midwife arms and hands. But then there those type of surprises that we wish we could have prepared for, those surprises separate from the quick list above. Even if you knew nothing about birth, that list would seem too short to cover all of the tough surprises, right? I mean, really, it’s birth: there’s got to be more to it than that, within the midwife scope of practice that then refers to the next level up. Naively, like a teenager whose parent shakes their head at them for all that they don’t know they don’t know, I am shaking my head at my hindsight self for assuming that somehow I thought I had it all covered.
Then, as these things go, I experienced a birth that I could have never practiced beforehand. No schooling, or reciting, or models, could have prepared me for the situation at hand. Mom and baby are fine, and I am thankful for that. But in my processing of the situation, in my hindsight, I realize that’s not the point. The point is that I felt out of control, in a situation where, besides the mother, I was supposed to be the person in control. The true error was one between providers, our communication, our power differential. A series of events ensued, during birth, that had very little to do with the birth itself. And I didn’t do all that I should have. My midwife hindsight, even five minutes outside of the very fast turn of events, knew differently than what my fastest midwife mind knew in the moment. I should have done differently, and my hindsight won’t let that guilt go. If I could know what should have been done within five minutes of the wrongdoing, how did I miss it right away? I’m smarter than that. And my hindsight won’t let me forget it.
But I am working on my own forgiveness. In the knowledge that hindsight is, by definition, solely an ability to review what happened, in the past, with a present and clear mind, to be allowed to think differently, hindsight could not have changed my actions. I did all that I knew to do, all that my mind could come up to do, at the time. In the subsequent moments, I continued to do all that I knew to be appropriate and professional. And I took the time to allow hindsight to take its course. I have examined the situation and the outcomes from many angles, and can see many opportunities to have acted differently.
Likely, that exact situation will never come to pass again. Like all surprises, the unique circumstance of that exact birth was a culmination of the personalities and knowledges and powers in the room, and even the slightest change would have grand consequences for the speed of a butterfly’s wings on the opposite side of the earth. Perhaps the strength of midwifery hindsight is to have a broader examination of the scenario, and recognize for that particular situation, it wasn’t the minutia, but the grandiose, that mattered. It is the use of my hindsight to recognize my knowledge, to feel the strength in its truth, and to utilize that truth to change my future actions, even when, in a similar situation, the small pieces feel crowded. It is hindsight that reinforces my belief in my own midwife intuition, which has yet to steer me wrong, but in this past circumstance I chose not to follow. It is dedicating time to my hindsight that makes my foresight stronger.
Sure, I cannot practice every birth scenario. Sure, it’s a short birth emergency list, and I will always be wary of that which I don’t know that I don’t know. Sure, I will, in time, forgive myself of the guilt I currently feel over not doing everything I should have, because, in reality, I did everything that I could have at that point in time. Sure, hindsight serves its purpose, because it gives me foresight for the next time, and the next, and the next. And, those birth surprises? I’ll still laugh and rejoice at the beautiful ones. And I will continue to learn about my intuition with the toughest ones, only letting my midwife hindsight prevent my midwife foresight until I identify the minutia, the grandiose, name the roles of each, and recognize the lessons learned to create strength in the path forward.