Doubts and questions

I’ve been feeling very frustrated lately about a lot of the choices I’ve made (not all of them school or work related, but certainly a few of them are). I feel like I will never be a midwife. Yes, I know I’m in midwifery school, and that the eventual outcome will be me as a midwife, but everything we’ve done this semester has been so medical: primary care, health assessment of women. I’ve learned more about hyperthyroidism and breast disease and urinary tract infections than about pregnancy and birth. Next semester I’ll be taking antepartum and well-woman gynecology, so at least in antepartum we’ll be dealing with pregnant women, as opposed to non-pregnant, but even so…labor and birth is still a long way off. Sometimes I wonder if I went about this the right way. My heart lies so clearly with homebirth, and being a homebirth midwife someday, but the path I chose is going to teach me a lot about hospital birth, and the two are completely different species. I’ve seen hundreds and hundreds of hospital births in my work as a nurse. After a certain point, they’re all the same. The women get epidurals, they watch TV, they polish their nails, their water is broken, they get pit, they push on their backs, the doctor cuts an episiotomy, the baby is born, usually everything is fine, and sometimes, if you’re lucky, you have time to help the mother nurse before she is whisked away to postpartum. Sometimes I am able to make a huge difference in a woman’s birth, but a lot of the time, she doesn’t want anything different. She wants to be treated with care and respect, certainly (and sometimes it is a real fight for her to get even that from her caretakers), but she wants exactly what she thinks her friends have had—she wants that hospital experience. She wants the ritual of birth in a hospital, the rite of passage we’ve developed: the hospital gown, the epidural, the painful stitches and ice packs afterwards, the grandparents and husband looking so cute as they peer at the baby through the glass of the nursery wall. 90% of women in this country give birth in a hospital, and most of them are perfectly content to have thier babies while numb up to their waists; a healthy baby and minimal pain is all they desire from the experience.

Birth can be so much more than that, though! I’ve seen the rare natural childbirth in the hospital, and I’ve seen several births at a local birthcenter. I’ve seen the woman in transition, unmedicated, her face glistening with sweat, her body glowing, working harder than she’s ever worked before, her eyes with a dreamy, far away look. I’ve seen women overcome the pain and the relentlessness of the contractions. I’ve seen them rise above, and do something they dind’t think they were capable of. I’ve seen births where I am so obviously in the presence of Deity. I’ve watched babies crown, and sometimes it’s like staring at the unmasked face of the Goddess. Having birth while medicated is like having meaningless sex your entire life, with someone you don’t care about and aren’t in love with, and thinking that that’s what sex is, without ever once dipping into the Mystery of it, into the incredible beauty of two souls entwined, without ever once making love. It’s the same kind of energy. Birth is making love in a different way—and who would want to make love while numb up to their waists? True, this may not be the best metaphor in the world, and true, birth is not always (or even often) a pleasurable experience, but it’s still one that I think you should feel.

When I started my work in the hospital, I was excited about being able to reach so many women. I knew that the majority of women give birth in the hospital, and I felt like that’s where my presence would make the most difference, but now I am starting to wonder. By the time a woman gets to the hospital, she’s already taken steps down a road that’s very difficult to get off of once you’ve started down it. If I want to reach out to women and help them have better births, I should probably be reaching out to them before they even get to the hospital. Meeting them at the doorstep and telling them I’ll be their nurse is probably not the best way to affect change. Educating them before they’re pregnant…teaching them about other roads before they’ve made their choice…would probably much more effective. So many women don’t even know that there ARE other options, let alone that they would want them. How do you open women’s eyes?

And of course, there are those women who don’t want their eyes open. Which is fine. That is their choice, and if you are committed to caring and respecting women, that includes respecting their choices. When I have patients like this, it’s so easy to be their nurse, and give them exactly what they’re looking for: make the usual banter, ask them what they’re naming the baby, explain what the epidural will feel like—and that’s all it takes to make them so satisfied with the experience! If my path is truly to become a midwife, and not a childbirth educator, then maybe what I really need is to apprentice myself to a homebirth midwife. Maybe I shouldn’t be pursuing a CNM certification after all, but a CPM instead. If my calling is to assist women through the long, exhausting hours of labor—to wipe their brows and support them while they contract, and tell them over and over that YES, they can do this, and YES, they’re doing great, to be the silent gaurdian at the doorway—then maybe I shouldn’t be working at a hospital.

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  1. kyrap
    Posted December 4, 2005 at 2:11 pm | Permalink

    WOW. It is so fascinating to hear you talk about this. I’m light years away from being a midwife, but have been going back and forth about whether to be trained as a homebirth or hospital midwife for what seems like months.

    Isn’t it still possible to do homebirths as a CNM? I know it’s rare, but I haven’t figured out why. Or couldn’t you open your own birth center as a CNM? It seems to me that CNMs have much greater flexibility (especially legally) than those who are trained as homebirth midwives. Or do you feel that you’re missing key things that you would learn through CPM training?

    I can imagine it would be hard to see the light at the end of the tunnel when you’re focusing on well-women’s health. I’m sure you’re anxious to get to the good stuff!

    I’ve been leaning towards pursuing CNM training for many of the same reasons you mentioned. It seems that you’d have a greater impact on more women. But if they are not looking for that difficult, yet sort of spiritual experience, I’m sure they won’t be very receptive to it. And then it becomes medicated and very routine.

    Hmm. I wish you luck as you think about it, and it’s definitely making me think harder, too!


  2. The Student
    Posted December 4, 2005 at 11:07 pm | Permalink

    Hey, Kyra:

    I do think that CNMs have more flexibility and legality than CPMs, and yes, I’m sure a committed CNM can definitely find a way to do homebirth. I think it’s just more rare because if a CNM is trying to work legally, she’ll need malpractice insurance and contracts with collaborative doctors who will back her up, and practice protocols, and etc. etc., and it’s very very difficult to get all of that put in place for homebirth. Just look at all the licensed midwives in the capital region of NY who have to practice underground and illegally, just so they can deliver babies at home. I also think it’s more common for CNMs to be shunted into working in hospitals and doctors offices and birth centers. I guess if you’re going to go the legal route, and try to work with the system, the system limits you and keeps you in check. That’s probably why so few CNMs do homebirth. I feel like those who choose to become a CPM are already taking a large step outside the system, and choosing to work closer to the fringe…not necessarily backed up and not necessarily having malpractice insurance (although I’m sure it does happen, occassionally), but being okay with that. I’m not sure. I still have so much to learn about the legal issues and business issues of being a midwife, but these are just my suspicions. Any midwives out there, CNMs, CPMs or otherwise, who’d like to comment?

    Anyway, I think I’m just getting really sick of hospital birth. After a certain point, you’ve got to look at what you’re doing and ask yourself: is this really where you want to be? And lately, more and more, when I look at the hospital that surrounds me, the answer to that question is usually “no”. Once upon a time, when I first started this journey five years ago, I used to think that delivering at home was crazy. Lately, I’ve begun to think that delivering in a hospital is absolutely insane.

  3. Posted December 5, 2005 at 12:40 pm | Permalink

    I just wanted to tell you that I hear you. I went back and forth lots in the beginning, and in fact, I still do.

    I enjoy your blog. Your training and journey, which is very different from mine, gives me a glimpse into what exists on the other side. I admire ones drive to persue school and make the sacrifices that that entails. Hang in there. You’re doing a great thing and it will pay off soon.

  4. rima
    Posted December 6, 2005 at 12:28 pm | Permalink

    Dear Student,

    My heart went out to you when I read your doubts and questions entry this morning. Feeling unable as midwives to give fully of our particular gifts and skills to women and families because of institutional or political barriers is certainly a frustration shared by many, if not all, midwives. Even greater at times may be the pain that accompanies the realization that some women and families are not open or able to receive all the kinds of care and wisdom that we as midwives want so much to share. It doesn’t make sense to us, and in the extreme can throw us into a crisis of faith, in our profession, in our political and health care systems, and in our culture at large.

    I am a certified nurse-midwife who has attended births in homes, birth centers, and hospital settings. I have worked in public health clinics and within the military health care system and now I am at the national ACNM office. I have come to believe that being a midwife means taking your unique perspective, your special skill set, and your commitment to humane and equal relationships with you into every setting. Part of being a midwife is being an agent for change. I think that one of the most effective ways to do this is by embodying the qualities of midwifery wherever you go. By going as many places as possible to bring your midwifery skills and midwifery ways of knowing and relating to light, you contribute to a greater understanding of what midwifery represents and has to offer in all of these settings. To me, one of the most important aspects of the midwife is her role as bridge, or as you put it, guardian at the gateway. Being a certified nurse-midwife affords you access to places where the wisdom and the spirit of midwifery is really needed. There it is up to you, drawing upon the support of your community, to hold your center and bring your example there.

    The ACNM strongly supports home birth, and the right of women to choose how and where they want to give birth. On the ACNM website, in the Quick Info section found under Practice Resources, there is a summary of ACNM homebirth resources, including the ACNM Position Statement on practice settings, how to get the ACNM Home Birth Handbook, and links to the ACNM Clinical Bulletin #7 on Home Birth, as well as critical information on homebirth research, legal implications, reimbursement and insurance coverage. There is a very active Home Birth Committee at ACNM and I have no doubt that there are members who would be eager to speak with you and offer you support, advice, and solace.

    Being a student is incredibly frustrating at times, often disorienting and sometimes disempowering. It can be very hard to remember that you are not losing your self, rather you are gaining skills and tools that you can integrate into your essential core to be used in line with your values and mission. Viewed in this light, each of your experiences is the perfect teacher. Your calling is already that of a midwife—now is the time that you are honing your skills and collecting the tools you will need to practice as one.

    Bless you, and let us know how we can help midwife you through this labor of love.


  5. The Student
    Posted December 9, 2005 at 4:41 pm | Permalink

    Lady Elms: Thank you! I enjoy your blog too, and in many ways, I’m a bit envious of your training. You’re up to your 8th birth by now, and homebirth at that! How lovely. Good luck with your own path and journey. It’s so nice to meet other travelers along the road.

    Rima: Thank you SO much for your kind words, and all of those great links to the ACNM homebirth section! I had never explored the Quick Info section before, but there is a wealth of information there, definitely worth checking out. It’s so nice to hear words of encouragement and comfort from people who’ve gone down these roads before us. Thank you for reminding me that being a midwife is not just your job, but who you *are*, in all arenas of your life, and that change is slow, and happens one woman/birth at at time. My dream still seems so far away, and I sitll have so much work ahead of me, but I’m getting a bit closer to it every day, with the help and love and support of so many people. Even readers online, whom I’ve never met before. *hug*

  6. rima
    Posted December 13, 2005 at 11:49 am | Permalink

    Dear Student,
    Big hug back, and please call or email us at ACNM whenever you need to check in, get information, find support…that’s what we are here for! We have a small, but extremely committed staff and our goal is to be here for you. I’d love to hear from you!

  7. niamh
    Posted December 17, 2006 at 9:45 am | Permalink

    Dear Student,

    First, I want to say it is with much admiration and respect that I leave you this note. And also that I feel strongly but alas, am not the most talented writer. But here it is…

    I think the hospital birthing system with little exception is abusive, damaging and beyond repair.

    Having, along with countless others, spent years attempting dialog with medical professionals and being met with condescension, distain, denial, avoidance and when really striking a note, personal attack and insults, I have realized that any sort of “coming to terms” or “compromise” is far from likely. And as long as fear-generating misinformation and half-truths infiltrate most possible sources of information for expectant mothers, faith in doctors and hospitals will prevail unless we are willing to step out of this deceitful system and forge our own.

    As I am sure you know, every indication is that things will get worse for mother and baby in the hospital setting. For example, many OBs are predicting a c/s rate of at least 50% in the next five years despite many indications that the current alarming rate is causing more harm than good to mothers and babies. It is indisputable that the current rate is atrociously high in terms of the needless risk to mother and baby but rather than stating this prediction with regret it is sadly more often uttered with what can most accurately be described as callous amusement. The fact that the establishment so commonly resorts to exploiting a mother’s most basic instincts with the “be glad you have a healthy baby” tactic to squelch any protest to their current approach to “care” shows just how exploitive and dishonorable their position.

    I think it is important to step out of this system where doctor’s/hospital’s interests are first and foremost, so very often at the expense of mother or child or both, and into one in which the health, safety, respect and honor of mother and baby are the priority.

    Working from within what is fast becoming a dangerous, defensive, bitter, vindictive and often downright abusive system, will deny many a wonderful midwife (and student) the opportunity to offer women the gifts she has to bear but instead result in the slow wearing away of her soul (perhaps melodramatic but so accurate a description for so many…)

    I think although difficult and sometimes even frightening, it is an incredibly important and much needed step – to step out. Step into truth. Your truth.

    To whom must we pay penance?

    Instead of battling from within what is in many ways a monster, eschew towing the line (however you put, that is what you will do at least a good part of the time) and choose to begin in a position of empowerment.

    I don’t think hospitals deserve a woman like you, I think women and babies do.

    Go with your heart!


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