A Servant's Heart

M. the amazing midwife I met at my last onsite admonished us to approach our studies and preceptorships with a servant's heart. She made us laugh about how prior generations of students from school were instructed to shave their legs and use good deodorant and not eat too much garlic before attending a woman in labor. I guess some of the women reacted with anger that they were being asked to conform in this way, which for some of the more hippy-esque types was counter to their counter-cultural tendencies. I understand that. I have no problem shaving my legs or using deodorant, though I hadn't thought about that being an obstacle as a midwifery student. but I guess if I were to think about it, if a midwife or a doula showed up at one of my births with B.O. or nasty coffee/garlic breath then I'd probably object strenuously. While women can sometimes (often?) be expected to be sweaty and smelly and unkempt while birthing, it makes sense to me that a midwife shouldn't be any of those things!

Anyway, back to a Servant's Heart. She said we should seek to serve and be humble, for women know how to birth and can almost always do it very well on their own. She, like many midwives spoke to the midwife's art of doing nothing, really well. We bring to each birth a giant tool box which we work very hard never to have to open. It spoke to me. Because I think I believe in this on a gut level. The more you mess with women as they birth, the greater the likelihood that things will go bad. The cascade of interventions is a case in point. Continuous fetal monitoring can lead to decreased mobility, which can lead to a slowing of contractions, which necessitates pitocin, which necessitates (frequently) an epidural, which can cause a drop in blood pressure, which necessitates continuous IV fluids. Epidural can cause mom to spike a fever which necessitates antibiotics in case it's an infection. Pitocin can cause hyperstimulation of the uterus which can stress the fetus which necessitates a c-section... It can be a veritable (and horribly common) trainwreck.

We've been discussing the ethics of informed consent at school - something which midwives are very big on but sometimes not the medical model. If you want real informed consent about "routine" things like GBS testing, or continuous fetal monitoring or induction then you have to go buy a book by Henci Goer. In my experience your OB is unlikely to offer you the full picture. That bothers me acutely.

I recently took on a new doula client. I struggle so hard with my clients to help them with the informed consent stuff. I want my client to know that the OB practice she has chosen includes two amazing OB's who I'd be delighted to birth with myself, but also one physician who (nurses report surrepticiously) is almost single-handedly responsible for the hospital's not insignificant c-section rate and abusive horror stories from teenage and other under-served mothers. I can't tell her this. I fear for my hospital birth clients more often than not. I have been sifting through why that is, why I just can't relax. I am aware that part of my anxiety springs from my own experiences birthing within the American medical model and also the births which I have attended as a Doula. I'm thrilled that my clients love their primary OB. I worry myself sick that her doctor won't be on call when she presents at the hospital and that the nasty one will. It's a sick, twisted lottery which defies acceptable explanation. But it's how things are done here. I can't share this with my clients and it leaves my heart heavy and my stomach sour. I hate that so frequently my role, intended to be that of dedicated support and love for the laboring women, so often requires me to stand witness to some awful, awful abuses of women and their babies.

I will busy myself though encouraging her to read widely and educate herself about her choices. I'll remind her husband of his job to speak up when his wife cannot. I'll sit back and repeat silently to myself "it's not about me, it's not about me". I'll pray that one of the great nurses is on call when she does present at the hospital and that we'll be able time the transfer to "slide in" a few minutes before she delivers, so that all whoever is on call can do is glove up and catch. I hate that my clients feel they have to actively avoid spending more time at their chosen birthing location than is absolutely necessary so they can avoid being messed with. Why can't they just rock up as they would to friends house or a birth center and just continue the process? Why must they be subjected to the monitoring and the IV and the stupid hospital gowns? None of this crap improves maternal or neonatal outcomes, so what is the point? Why can't we just let women labor?

It's bizarre to me that for so many women birth is so tightly bound with fear. I understand all the reasons why but I also know that it simply shouldn't be this way. The system, from medical school on down is actively creating fear, and too many people are going along with it.

I can't figure it out.

In the meantime though, I'll keep working on my servant's heart, keep reminding myself that it's not about me. I'll work hard with my client to help her have something like the lovely birth she imagines and I'll wait quietly for the July homebirth of my friend, with the midwife I hope will one day be my preceptor. When I can be doula in a space where I don't have to genuinely fear for my client as she walks the intensely vulnerable path of the laboring women. I won't have to fear that her baby's first moments will be filled with violence, bright lights, harsh noises and needlesticks. It will be my first birth in which her wishes will be quietly and gently met and her baby (Goddess-willing) will slide gently into warm water, into the hands of someone who loves him or her, surrounded by family.