Tread carefully, Grasshopper.
Way interesting week at school. After some interesting, rather cryptic comments being cast my way (and the way of one of my preceptors) I found my "spidey sense" tingling at varying speeds throughout, and was blogsided not once, but 4 times at our state capital, including by the executive director of school. It was going to happen sooner or later. I think now I have an explanation for why this was.
This blog of mine has steadily been getting more and more attention, which peaked pretty dramatically after some posts which addressed a passion of mine: VBAC. In my blogging (and student midwife) naiveté I attracted attention from quarters I most definitely was not seeking, and to those who were upset by this I'm more than happy to apologize. My intent was, as I've mentioned in several places to keep this topic at the front of everyone's consciousness. I'm not going to let VBAC slip off the table while our national cesarean rate continues to rise, unabated, to say nothing of the sea of of interventions we all seem to swim in. I'm glad that people are thinking about VBAC (from all it's many angles) and, even better, for a short while folks were actively debating their positions in various places around the blogosphere.
Yesterday a senior midwife in my community let me know that my blog is on the radar of not only many of the local midwifery community, but it also has raised some eyebrows among some folks in the medical scene too. This in itself doesn't bother me, blogging by it's very nature puts ideas in the public domain - I've always known that. What did upset me was that apparently the tone of a couple of my posts was misread and perhaps some amount of offense was taken. It's not clear to all of you that I'm Australian by birth and as such my sense of humor is sometimes a little flip. This, added to the 'holes' which are left by the written word, did not adequately express that while I may have, at times, disagreed with points of view presented by lecturers at school (guests and our faculty) this by no means indicates that I intend any disrespect. This was absolutely not my intent. further, I am willing to accept that (again, in my naiveté) I may have overstepped my bounds in some posts in addressing a case which I have no knowledge of. I had thought I was clear enough in those posts (and the comments that ensued) about that, but this doesn't seem to be the case. In any event I have decided to remove the posts in question (before you all go looking for them) and will not be referring to it, or any other specific case moving forward.
All of this, and the lobbying efforts I've been involved with recently, and simply the care which I participate in at my preceptor site/s have me giving deep thought to ways in which this weird, dysfunctional gap between hospital and OOH birth can be narrowed, or (dare I hope?) even closed. I have, believe it or not, come a long way in my understanding and empathy for our medical colleagues practicing in hospitals. I have an idea of where the fear comes from, and how that shapes perspectives. I've tasted that fear myself these past few months. It is very difficult to explain what it is to be responsible for the lives of other people, and how terrifying it is when the membrane between life and death is punctured. I tried to explain it the other day this way: I have dipped my toe in that fear, folks in the hospital take a bath in it daily. I can understand how this shapes how you practice - I know that one day it will shape mine.
With that said I truly have come to understand that while I believe in my heart (and have seen!) that in the vast majority of cases birth is normal and safe in out of hospital settings, I also acknowledge openly that as midwives, there are times when our clients (and therefore ourselves) truly need the bells and whistles, high-tech care which our medical system offer. Where those opinions and belief systems interface is crowded with enormously different perspectives, shaped by educational routes, a certain amount of fate in the experiences we encounter, politics, insurance - you name it. I know though that while there are factions on both sides who clash when they meet, there are also midwives and docs who work superbly together (Navelgazing Midwife and Dr Wonderful offer a brilliant and quite public case in point). Here in WA there is a brilliant team of docs and midwives working to create comprehensive guidelines for home to hospital transport. This could conceivably radically improve the experiences of women who, for whatever reason need hospital care during birth. I do believe that while our perspectives on how excellent care is best achieved may differ, our desire for excellent outcomes for our client's/patients is absolutely shared. I like to think that midwives and docs need each other; that the mothers in the maternity system need both pieces of the whole. Midwifery knowledge is old, and it's rarely fancy. It is time-consuming and exhausting, it's smelly and noisy and sometimes messy and invariably poorly paid. Medical knowledge is so much more modern and shiny, and can absolutely save mothers and babies in cases where midwifery care cannot but clearly an "all- medical" system is flawed too: The C-section rates in excess of 30%, where they were 6% 30 years ago, routinized, impersonal care which predominates in our current hospital system are testament to that.
Somewhere in here in this tangle of caring and fear and culture and love and expectation there must be a middle way: a place of respect where our two paths and ways of believing and doing will compliment each other. As a student midwife who anticipates practicing in this lovely leafy corner in the not too distant future, I want to be a piece of fixing our broken system, for the benefit of the women who we within it serve. To that end I will continue to speak up and to blog. I will however be more circumspect and diplomatic in my choice of words. Some readers will disagree with what I have to say, and that's ok. I'm not asking you to agree. What's important here is that we're talking, and, more importantly, listening to each other. Because when that stops, when the conversation ends, when there are words to be said but no one is listening, this is when everyone loses. Especially our mothers and babies.
All that said, I'm human. I'm young, I'm passionate and of late (after months on call) I am very, very tired. Sometimes I'm gonna say stupid stuff. For those moments in the past I apologize, and please call me on them in future. To the docs (and nurses) who have been reading, to the midwives in my community whom I love and value beyond words - even when I don't agree with you, and to the women who continue to challenge all of us who do this birth work to listen to you more, to serve you and your babies better - I'm here to stay. Let's keep talking.
The grasshopper will continue to sing but she will tread more carefully.
This blog of mine has steadily been getting more and more attention, which peaked pretty dramatically after some posts which addressed a passion of mine: VBAC. In my blogging (and student midwife) naiveté I attracted attention from quarters I most definitely was not seeking, and to those who were upset by this I'm more than happy to apologize. My intent was, as I've mentioned in several places to keep this topic at the front of everyone's consciousness. I'm not going to let VBAC slip off the table while our national cesarean rate continues to rise, unabated, to say nothing of the sea of of interventions we all seem to swim in. I'm glad that people are thinking about VBAC (from all it's many angles) and, even better, for a short while folks were actively debating their positions in various places around the blogosphere.
Yesterday a senior midwife in my community let me know that my blog is on the radar of not only many of the local midwifery community, but it also has raised some eyebrows among some folks in the medical scene too. This in itself doesn't bother me, blogging by it's very nature puts ideas in the public domain - I've always known that. What did upset me was that apparently the tone of a couple of my posts was misread and perhaps some amount of offense was taken. It's not clear to all of you that I'm Australian by birth and as such my sense of humor is sometimes a little flip. This, added to the 'holes' which are left by the written word, did not adequately express that while I may have, at times, disagreed with points of view presented by lecturers at school (guests and our faculty) this by no means indicates that I intend any disrespect. This was absolutely not my intent. further, I am willing to accept that (again, in my naiveté) I may have overstepped my bounds in some posts in addressing a case which I have no knowledge of. I had thought I was clear enough in those posts (and the comments that ensued) about that, but this doesn't seem to be the case. In any event I have decided to remove the posts in question (before you all go looking for them) and will not be referring to it, or any other specific case moving forward.
All of this, and the lobbying efforts I've been involved with recently, and simply the care which I participate in at my preceptor site/s have me giving deep thought to ways in which this weird, dysfunctional gap between hospital and OOH birth can be narrowed, or (dare I hope?) even closed. I have, believe it or not, come a long way in my understanding and empathy for our medical colleagues practicing in hospitals. I have an idea of where the fear comes from, and how that shapes perspectives. I've tasted that fear myself these past few months. It is very difficult to explain what it is to be responsible for the lives of other people, and how terrifying it is when the membrane between life and death is punctured. I tried to explain it the other day this way: I have dipped my toe in that fear, folks in the hospital take a bath in it daily. I can understand how this shapes how you practice - I know that one day it will shape mine.
With that said I truly have come to understand that while I believe in my heart (and have seen!) that in the vast majority of cases birth is normal and safe in out of hospital settings, I also acknowledge openly that as midwives, there are times when our clients (and therefore ourselves) truly need the bells and whistles, high-tech care which our medical system offer. Where those opinions and belief systems interface is crowded with enormously different perspectives, shaped by educational routes, a certain amount of fate in the experiences we encounter, politics, insurance - you name it. I know though that while there are factions on both sides who clash when they meet, there are also midwives and docs who work superbly together (Navelgazing Midwife and Dr Wonderful offer a brilliant and quite public case in point). Here in WA there is a brilliant team of docs and midwives working to create comprehensive guidelines for home to hospital transport. This could conceivably radically improve the experiences of women who, for whatever reason need hospital care during birth. I do believe that while our perspectives on how excellent care is best achieved may differ, our desire for excellent outcomes for our client's/patients is absolutely shared. I like to think that midwives and docs need each other; that the mothers in the maternity system need both pieces of the whole. Midwifery knowledge is old, and it's rarely fancy. It is time-consuming and exhausting, it's smelly and noisy and sometimes messy and invariably poorly paid. Medical knowledge is so much more modern and shiny, and can absolutely save mothers and babies in cases where midwifery care cannot but clearly an "all- medical" system is flawed too: The C-section rates in excess of 30%, where they were 6% 30 years ago, routinized, impersonal care which predominates in our current hospital system are testament to that.
Somewhere in here in this tangle of caring and fear and culture and love and expectation there must be a middle way: a place of respect where our two paths and ways of believing and doing will compliment each other. As a student midwife who anticipates practicing in this lovely leafy corner in the not too distant future, I want to be a piece of fixing our broken system, for the benefit of the women who we within it serve. To that end I will continue to speak up and to blog. I will however be more circumspect and diplomatic in my choice of words. Some readers will disagree with what I have to say, and that's ok. I'm not asking you to agree. What's important here is that we're talking, and, more importantly, listening to each other. Because when that stops, when the conversation ends, when there are words to be said but no one is listening, this is when everyone loses. Especially our mothers and babies.
All that said, I'm human. I'm young, I'm passionate and of late (after months on call) I am very, very tired. Sometimes I'm gonna say stupid stuff. For those moments in the past I apologize, and please call me on them in future. To the docs (and nurses) who have been reading, to the midwives in my community whom I love and value beyond words - even when I don't agree with you, and to the women who continue to challenge all of us who do this birth work to listen to you more, to serve you and your babies better - I'm here to stay. Let's keep talking.
The grasshopper will continue to sing but she will tread more carefully.
posted by Louisa at 9:21 AM
15 Comments:
Dont change too much, Mama--too many sizzling hot amazing blogs are getting blander safer boringer and then the people stop writing.
hugs
I am bowing to you...in honour of your strength, courage and passion. It is because of blogs like yours that people are talking and dare I say...thinking & just 'possibly' re-thinking their truths. Each of us has our own thoughts and opinions but, every now and again someone or something comes along and for that moment you stop and say 'hhmmm?' Little by little, one woman at a time, trust in birth will be re-established/strengthened with the help of women & midwives just like you.
Carry on, Morag...and your sleepless nights are most appreciated by moms & babes.
Judy
Lots of love to you Morag. You are wonderful, and I hope you can find the line where you are provocative enough to encourage discussion without being provocative enough to earn any actual community/school censure. I don't want you to lose your passion or your willingness to talk about this, but neither do I want you to get in trouble with a system that we still need to navigate. Good luck finding that line.
As a hospital employee, working with mothers, I think you have room to greatly influence and affect the perception of your client regarding hospital staff in the event a transfer is necessary.
Something I have experienced on occasion is this misdirected antagonistic attitude that is projected onto the hospital staff from home birth transfer parents. Not that this isn't warranted at times, that I wont deny. There are times when patients (intended home birth and intended hospital delivery patients included), are treated poorly, that is not to be tolerated.
I was recently the recipient of some highly misdirected antagonism from a mother who was transferred and ended up giving birth by cesarean. I am sensitive to this situation and recognize how fragile the emotions may be in these circumstances.
It didn't help the situation one iota that the patient's home birth midwife had prepared her for 'how the hospital staff is' and the patient assumed a completely uncollaborative spirit once I was called into offer her assistance (not delivery related). Her spirit was so inflammatory toward me, and the result of some completely misdirected frustration at 'the system' and 'how we are'.
This made for an interesting and initially intense situation that may have not resulted if the patient had been offered some reassurance that not all hospital staff are insensitive, bored employees looking for reasons to intervene and complicate the birth experience.
It was clear that there was some leading the witness involved and the patient's midwife had found it necessary to transfer her disdain for hospital staff to this patient, which subsequently did nothing but add to the patient's anxiety once a transfer became necessary.
The mother verbally expressed that the situation she was facing was her 'last hope' for holding out to achieve anything close to her expectations for her birth and postpartum experience.....I heard what she was saying, and I acknowledged the same....but her insistence on holding out on addressing the circumstance we were discussing was ultimately being paid by her infant....I offered her options, and told her and the father I would return in an hour to discuss what they had chosen to do (which included doing nothing)...and subsequently spent my lunch period consulting with co-workers about the case.....wondering........well just wondering, a lot.
In order to build bridges and not walls it may help if midwives could diplomatically express some value in the services offered by hospital if transfer is necessary rather then paint the circumstances as destined for an awful experience....this would go a long way in fostering positive relationships between hospital staff and the transferring midwife and her clients.
Personally, I'm disappointed that you have been pressured by those folks in your various "communities" to self-censor comments and subjects in you personal blog. I ,for one, am grateful that you listened and offered feedback regarding midwifery, homebirth and VBAC, even when discussions got a bit prickly.
I have frequented several blogs in the past few months, in part trying to understand the homebirther's philosophy (and the negativity toward hospitals and OB's), and I must admit there are some wacky gals out there! However, my impression of you is much more positive because you seem so much more open to LISTENING, which strikes me as a very good quality for a midwife to possess. So.... I'm really kind of sad for you.
On another note, I'm very sad for you and your entire family regarding the loss of your sweet puppy. It is always so difficult to lose a pet, especially with small children (and it is often their first exposure to a death of a loved one). There is a wonderful book that can help, "The Fall of Freddie the Leaf". Do you know it?
Again, Morag, Thank you fou your insights and my best to you and your family.
Diane
There are always gonna be people who "don't get it," no matter how hard you strive to make them understand. They will read your words however they want to, and use it against you. Go ahead and let that be their prerogative, because truthfully, they are few among the ones who love what you have to say!
And boy, do I know how you feel about being "young" and "naive" and "saying stupid stuff sometimes." But ehhh, that is me. I won't censor myself or try to write differently just because someone might laugh at me.
I wish there was a "middle way" too. All I see these days is hostility on both sides: from OBs to midwives, from the homeopathic community to the allopathic community. We really shouldn't waste so much time being angry with each other, but it's hard, because we strike out in fear against what we don't understand.
We often learn more from our students than our teachers. Teachers are stuck in the way things were and not the way things are going to be. I admire your courage in fighting for VBAC, knowing that women are being coerced and forced and so few are doing more than preaching to the choir or cowering in fear behind losing their backups, signoffs or practices. If we do this, we are no better than the OB who sections women because it's easier than getting sued or changing ACOG or giving informed consent. Have the courage to fail big but go down fighting.
Ah, your passion is refreshing! If you get a moment check out www.daraluznetwork.com. Your post could be a press release for our organization which we are working steadily to expand. Perhaps, in your spare time (HA!) you could look into staring a chapter in Washington. Excuse the shameless promotion, please. Feel free to email me at robyn@daraluznetwork.com if you want more info. Here's to fighting the good fight.
So much to address here...
As always, thanks for your comments. I will respond in a post shortly.
cheers.
M.
bravo to you!
our voices cannot be censored - and the huge fists of our sisters comes from a place of knowing that your truth is what they should be able to speak (if they weren't afraid themselves).
xoxoxo
Keep speaking your truth, Mama. It is yours and yours alone.
YOUR VOICE IS WAY TO IMPORTANT. don't silence even a bit of it. your exploration and offerings are so crucial, no matter how tired you are.
much love
m
Please keep speaking; you're in an uncomfortable place, but your voice is sorely needed.
I would say to the professionals reading this who "raise their eyebrows"; there are LOT of us women out here who have been hurt, and badly, by the system as it is. We are tired of being chastised and blamed for our own pain. A woman in labor is incredibly vulnerable, and a brief look at the history of obstetrics (lithotomy position, scopolamine, and nowadays the continuing maddening refusal of most hospitals to help women labor in a sensible upright position without being tied down by monitors or prevented from keeping up their strength by eating) might be helpful to remind you of what it's like on the receiving end of obstetric care. There is a long history of abuse here, and it is far from over.
In other words, no matter how good you, personally, as an OB or nurse may be, if your client has had any previous contact with the system, they may be carrying quite a few scars and fears already, fully justified. Be angry at the ones who hurt them first, not at them for being hurt. And then do something about it.
"It is when we all play safe that we create a world of utmost insecurity”
I apprecite anyone who takes up causes with passion- wether I agree with them or not.
It is your right to do so.
And if you ARE on someone's radar, isn't that better than being a blip on another screen?
:) Keep writing, Mama. The world needs more honesty.
I hear you on the censoring thing - my fellow students regularly chastise me for being outspoken, and I sometimes wonder whether I should post about x or y for fear (oh, that word pops up even here!) of reprisal. But we fight the good fight still.
I am so sorry to hear about Chilli as well.
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