22 January, 2011

Midwives Are Human Too, Part Two

The day after the birth, shaky hands doctor called our midwife to tell her about the hemorrhage. And I think, but I’m not positive, our midwife may have called my husband to talk to him. But I didn’t talk to her, not in the hospital, not after I returned home. In fact, the first person to show up at my home to begin the six weeks of “after care” that was part of the package with my midwife’s plan, was an assistant I’d never met before who asked me “what’s his name?” when she arrived. I was so tired, hurt, and angry that this unknown woman was at my door, I choked back tears and growled, “my baby is a girl.” I let her weigh and check my daughter, since after a week I wanted to know from someone else that my newborn was gaining weigh and thriving. But even then, I watched every move. I may have told this other assistant about how the birth went. I can’t quite remember, I was so mad. I know I didn’t let her do the “stone massage” she was supposed to do on my stomach, my abdomen still so tender from all the trauma, and the fact that she was there so abhorrent to me. She said to me, “it seems like [my midwife] really should come see you.”
“Duh,” I thought, but didn’t say that.
When my midwife finally came several days later, she did listen to me as I cried and told her the whole birth experience was so disappointing to me and the complications that had already happened made being a new mom all the more difficult. I wondered if she thought the fact that I had a c-section was a personal affront to her whole belief in natural birth. It certainly was an affront to me. She checked out my baby and said she was doing great, we talked a bit about breastfeeding and her still-attached umbilical cord, and then, eventually, we broached the issue of the assistant/doula’s personal crisis. I told my midwife that the assistant’s presence might have been a hindrance not only to my birth experience but to the woman’s before me. My midwife understood what I was saying and proclaimed she needed to “sage out the birth center” from all that energy. Somehow, to me, that gesture felt a bit too little too late and I knew then that the trust I felt for her was gone.
The next well baby check came from the assistant herself. She walked in, her hair perfectly groomed and shiny, her body thin and her clothes tight and cute. She carried with her the accoutrements for the stone massage and said she was there to help me, and how even though my belly was sore, the massage could feel good. I don’t remember my daughter being around, but the assistant probably checked her out. What I remember is laying on my couch, and the assistant lifting one warm, heavy stone at a time from a plugged-in crock pot filled with lavender oil and water. She placed the stones, one by one, on my still-swollen, still-sore belly and rubbed them inside the perimeter of my ribs. As I lay there, the assistant apologized to me for leaving the hospital before the birth and for her personal crisis.
The position I was in, literally, was extremely uncomfortable. I felt vulnerable and angry, yes, but at the same time I felt empathetic. I felt like the stones felt on my body; painful, yet soothing. This moment was simply one of the paradoxical moments of life. All my years of professional training about unhealthy interpersonal relationships kicked in – that and the fact we simply were two vulnerable women, human to human, both in hurting and sore and sad – and so I listened to the assistant tell me her version of her story. And then, as she cleaned the stones and I sat up on the couch, quite surprisingly to me, I gave her information about her situation. I let her know that alcohol and violence were two different problems. One problem can exacerbate the other, but just because someone was a drunk didn’t mean he also had to be abusive. I let her know, gently, the negative affects of the crisis on her children. I let her know about resources in our area. I listened more than I talked, and I tried to be sincere, but to be honest, part of me wondered if this situation was karma coming back to me, or if I was simply helping another person. The assistant said I was a great woman, helping her like that. I shrugged my shoulders. I had to wonder.
The last part of this story happened a few weeks later, when I heard, because I live in a small community, that my midwife’s assistant’s crisis reached its climax. I had thought the climax had been reached when she left the hospital during my labor, but, no, there was more wreckage and damage to be done. I called my midwife, ostensibly to set up our sixth and last well baby check, but also to ask her if what I had heard was true. She confirmed. And then she went on to tell me about her past, when she was younger and living far away, and how she had experienced a crisis so similar. Suddenly, for me, many of the pieces of this puzzle clicked together. Of course. In the hospital, my midwife had to tell me all about what the assistant was going through because she was reliving the trauma herself. I knew about secondary trauma, and I saw, in hindsight, that connection clearly. My midwife never did come for our last appointment and I took my daughter to the local health clinic for a check up.
Months later, during that time of my delayed post-partum depression, I wrote my midwife and assistant a letter. I didn’t intend to send it, but some wise people in my life encouraged me to, and so I did. The letter explained my experience and my disappointment with their shortfalls. I sent the letter to help heal my depression and to help them, if it was possible, to become better at being midwives. I told them I didn’t want a reply and that I wished them well.
In the letter, I took care not to blame my midwives for the outcome of our birth and I took responsibility for many aspects of our birth experience. Here’s just a few:
That odd pain in my groin during the birth could have been my daughter’s head descending asynclitically, her little skull pressing on a nerve in a way that wasn’t normal for birth. I, like most women, have mostly forgotten the level of pain I was in for labor, but still, when I think about it, that strange pain in my groin is what I recall, and why that pain occurred is an unanswerable question, but that shooting, stabbing pain took me by surprise and I never really found a center from which to labor. To be clear, I don’t blame myself either for not getting on top of the pain, because to do so would kind of be like blaming a guy for not getting on top of the pain when he gets kicked in the nuts, over and over, for, oh, say, three days in a row. So, I don’t blame myself for not getting centered during my labor; I’m just saying I never did.
Also, I think now I shouldn’t have pushed when I did. At the time, I felt so much like pushing, but I may have pushed too early, which perhaps pushed my baby’s head at an even odder angle down the birth canal, in a way that was irreparable. After all, when the doctors went to do the c-section, that nurse had to go back up my vagina to shove my baby’s head upward, she was stuck in there so bad. I may have pushed too hard.
And finally, I may have expected my midwives to help me more than they could have, even under normal circumstances. In the letter, I said that while I wanted my husband at the birth, of course, I knew in my heart, because he was a man, I thought of him more as a supporter, not as the person who would help me get the baby out. I thought my midwives would do help me get the baby out and I perhaps relied on their help more than was feasible. At the birth, I didn’t tap into my own inner strength enough, didn’t look inside myself enough to birth my baby in the natural way.
A midwife, it could be argued, should be the one to help get a laboring woman get centered and calm and get on top of the pain, should help, especially a first time mother, know when to push and when not to push, and should help a woman get inside herself and tap into her own strength. In these areas, I would say, because of their own personal humanity, my midwives did not, and perhaps were not able, to do their job.
However, many medical providers, because of their own personal issues, do not do their jobs. Several hundred Western medical providers simply have the mindset that their job is to drug pain and do c-sections after only a few hours of labor. A labor is a stressful thing, usually a long thing, and as a provider, to keep one’s own center and to forget all worldly demands over the course of many hours is a lot to ask. No one’s perfect. People have background lives all the time that affect their jobs. Regardless of my birth story, I still truly believe midwives are much, much more likely than traditional doctors to be patient, kind, helpful, supportive, knowledgeable, and present during the pain of labor. For all those laboring women out there, my wish for you is that you have this kind of help.


marthagoudey said...

I just came across your blog, so I'm catching up. Like I said in a previous comment, I became a midwife to help women have the birth they wanted after my homebirth didn't turn out as I wished. But no matter how hard we tried, perfection was illusive. Many women had beautiful natural births, some in the water, with lovely bonding experiences with the family. But others had footling breeches. "Failure" to progress. Hemorrhage. Transport. Not all those women have the gift of writing to share the story. Thank you.

Nancy Slavin said...

Thanks, Martha. Blessings to your for your life's work....