Lately I've been really questioning my decision to become a midwife. There are probably at least a thousand reasons I'm wondering wiether or not this should be my "career," because becoming a midwife is nothing like becoming say, a tax broker or a dog groomer or a chief. Becoming a midwife is, in many ways, like choosing to "play god," as decisions I make could indeed mean the difference between someone living or dying. Can I really handle this responsibilty? Is this something I can really do?
I'm the type of person who has trouble balancing a checkbook. I frequently have minor car accidents because I'm a nervous wreak when it comes to driving, I get nervous when there are too many people in a small room. If I can't even handle a four-yr old crying for more then twenty minutes, how will I handle a mom bleeding to death while her newborn baby struggles with respirtory distress. If a simple bus ride is enough to overwhelm me sometimes, how am I going to deal with these larger issues?
Also, I'm one of those people who doesn't really see every pregnant mom as some saint who is sacrificing her own body to continue the human race. I feel the world is really overpopulated, and many of us should simply STOP BREEDING. But before you get all huffy with me, remember that I chose midwifery because at the core I do love pregnant and birthing women, I do see birth as a mircle, and it certainly is one of the most spectacular experiences I've been privilaged to participate in; but at the same time, clearly many of us should not be producing more of ourselves. Because of the abysmal state of the world, I myself can't justify having a baby to statisfy my ape-like need to breed. I do think when people make the concious choice to bring another baby in the world, they should have a homebirth with a midwife.
I'm a cynical person, and because of that, it is sometimes really hard for me to see the joy in events/things others take great joy in. I don't feel all warm and fuzzy inside when I see many newborns; in fact, I think some are downright alien-ugly looking (and annoying to boot.) I also am not sure about where I stand with many ethical decisions I'll have to make as a midwife; like do I rush a mom who is 23 weeks pregnant and in labor to the hospital in an attempt to save her baby, or do I let "nature take its' course?" How do I help the grieving parents? How do I tell a parent their child has Down's Syndrome or Hydrocephaly or some other disease? How would I live with myself if I made a fatal mistake?
Sometimes I think becoming a back-alley abortionist would suit my ideals/cynacism a bit better then becoming a midwife. I could drive around in my shady van, giving suction abortions to people in dark alleys. I could give men visectomies while I was at it.
Maybe it is time to take a break from midwifery school. I feel like I need to sit back and question all my ethics and seriously look at this committment called midwifery and study wiether it is right for me or not....it certainly isn't something just anyone should get into; maybe all the "signs" I thought I saw along the way directing me down this road wheren't actually signs at all; maybe I was mistaken.
Love ya,
Carrot
You had good answers to many of these questions a couple of months ago in another blog. I was truly impressed by them.
Maybe you should go back and re-read that stuff.
Point taken, jackbenimble, but at the same time I do believe that the doubts and concerns you have raised are valid. Listen to them.
By that I don't mean drop out of midwifery school because you're starting to get cold feet. I mean take the time to seriously think through your concerns. Are they the result of minor stress and anxiety, or are the a sign of something larger under the surface? Are you questioning yourself because classes are hard and frustrating or because you really have lost your passion for it.
Along the lines of abortion...perhaps you ought to look into a general reproductive health clinic, like the Feminist Women's Health Center in Atlanta. Places like that provide both types of services, along with a ton of others, so you can help both women who want to bring new life into the world and those who aren't ready to do that at the current time. Maybe that would help satisfy both your idealism and cynicism.
and point to your character. People who venture into any type of medical field, or offshoot thereof, and don't have thoughts like these shouldn't be doing it. Coming to grips with the reality of the weight of the responsibility of such a position is all part of the process.
From what I have read of your knowledge and experience, I am confident that you can do it, and I also think that you should. Of course, you have to deal with the questions yourself, and you may come to a different conclusion.
I truly admire your choice to study midwifery. As a nurse, I chose not to pursue labor and delivery, or ER, or pediatrics, all because of the scenarios you describe. I know how to handle to psych issues, and I don't mind working with adolescents that have survived some serious trauma, but I know that I would have a very hard time dealing with medical trauma when kids are involved.
I had a hard time watching drug addicts give birth, and an even harder time when I had did my ER rotation and received a 9 year old who overdosed on Benadryl because his parents were fighting and talking about divorce. I couldn't even handle strapping a 13 month old into one of those papoose straightjacket things they use in hospitals, so we could put skin glue on a cut over her eye. Hearing kids scream in pain and terror is not something I do well. It rips at my core.
We are all "cut out" for different things, and sometimes, I think, if we can handle it, we should do it, otherwise, who is going to? I know a lot of wonderful and proficient nurses who can give babies chemo, but can't handle dealing with a schizophrenic with poor boundaries. So, I stayed in the field where my natural talents are needed. If I didn't do my job, what kind of person would be there in my place? There are a lot of nurses in psych who don't belong there.
think about your experiences you have had so far. Was there ever a time when you knew that you the perfect person to be in a situation, when you knew that for whatever reason, you brought something to the situation that someone really needed? My feeling is that you bring with you into a birthing situation a basic sense of understanding of the birth process, and of the female body, that you would be able to calm a nervous or fearful soon to be mother. I have said elsewhere, that if I do have another child, I would ask for your services, and I mean that. Giving birth to my daughter was the hardest thing I have ever done, and I feel that i was totally neglected by the medical staff that were there. I am certain that had you been there instead, I would not have suffered so much, and neither would my baby.
Your cynicism might just be the best indicator that you are cut out for this, without a healthy dose of it, how else would you manage?
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As always, your comments inspire and uplift me...
Yesterday at school I was reminded of the talents I do have; for example, I do very well in IV skills class and hematology, whereas many of my classmates have small panic attacks while trying to do these skills. I'm very good at suturing as well.
I was also thinking about the births I've attended thus far, and yes, I think I have a natural talent for calming and comforting birthing mothers. Some people I talk with say things like "yuck, birth, I could never work in the birth field...how can you do that..?" Or a trauma surgeon I'm friends with says all the time to me "I think birth is so boring; most of the time everything goes ok...how can you just sit there hour after hour with a laboring woman?" She obviously, is more cut out for emergency medicine, whereas I really enjoy labor sitting long hours, sometimes for many days and nights, with a woman.
This semester and last have been particularly hard for me because we've been covering Complex Situations I and II. While the things we are studying right now do happen, they are more rare then the straightforward, run-of-the-mill "boring" labor my trauma surgeon friend likes to talk about. I think, the once-in-awhile emergencies I will have to deal with I'll be able to handle; I've been thinking lately like the emergencies would be at every birth, but now that I think realistically about it, most labors and births are pretty straightforward.
Love ya,
Carrot
most of the time things are okay. I am even more convinced that what you are experiencing is totally normal within the institution that you are learning in. One thing you have with midwifery school is that you get to be totally submerged into that field, and all of your training is focused around one aspect of life. Of course, that aspect can always bring others into it, and you have to expand your awareness to be sensitive to those things.
Nursing is more difficult to learn, because you are exposed to a number of types of nursing, and get to a dabble for a few weeks in each specialty. You come out with a better idea of what you like and want to learn more about, but you are not really proficient in any one thing. Most people choose a specialty they enjoyed and get an entry level, new grad job in that field. Then they make a bunch of mistakes until they figure out what they're doing. It's a learn on the job kind kind of a thing.
What school teaches nurses is how to use good judgment and critical thinking. Few nurses remember all the meds they spent hours researching for care plans. Few remember all of the diseases we learned. What we do learn is to understand the intricacies of the human body and how it works. We develop a deep and fundamental sense of how things are supposed to be. We learn how to recognize when something is not right. And then we learn how to communicate our assessment to doctors who tell us what to do.
Of course if the doctor doesn't hear you correctly, or wasn't paying attention, or just gave you instructions that were wrong for your patient, it is going to be your ass too, so you better be sharp enough to call him out when he's wrong. And confident enough to handle being belittled in return. That's okay, the first time you do it, and you are right when he is wrong, he'll be kissing your ass from then on, as long as you didn't make him feel stupid in the process. Remember, don't ever go for the ego, that's like going for their balls.
Anyway, I don't how midwifery compares, in terms of the structure of hierarchy. When you finish school, will you be practicing independently, or under someone else's license? That makes a big difference. On one hand, i see the immersion style of your training as very positive, and think you will be quite capable. On the other, if you are going to be totally on your own, there is a bigger liability. At the same time, if you are the shit, and you know it, you are better off than being at the mercy of hospitals and institutions that hire cheap labor at every level, including the ones who give you orders.
All in all, what matters is that you grasp every nuance of the "normal" birth, and handle that perfectly. Next, that you know what to do, step by step in the most common emergency situations. From what I remember, there is premature labor, placenta previa,
placenta abruptio, and ineffective labor (either because of a small pelvis, or position of the baby). There is also the risk of hemorrhage.
For the baby there is the risk of meconium aspiration, or infection if birth doesn't happen in a timely manner once the water is broken. Hypoxia, due to either compression of the umbilical cord, or the baby's airway at birth. There is also the risk of the baby sustaining injury during the birth, due to mechanics. One of the most common injuries that occurs is shoulder dystocia, where the arm is permanently damaged to bone and nerve compression.
Of course then, neonates have other potential problems like hypothermia when they can't regulate their body temperatures due to premature brain development, and jaundice, when their blood type isn't compatible with the mother's. (All I got in my peds rotation were billi babies. I wrote way too many care plans on it.) Of course major defects are always a problem, but I wonder if you would treat those as a midwife? Heart defects are easy to detect before birth, and there is usually a team of surgeons and specialists ready in such circumstances. Most physical defects can be diagnosed antepartum. Also, hyper/ hypoglycemia can be an issue, especially if mom has gestational diabetes. Then there are drug babies. Again, I don't know if you would have many of those as a midwife.
Would most of your clients be private, and would they be paying you, or would you workk in some sort of community program? I really liked what you shared about your experience with the adolescent mothers in the shelter. You would have a higher chance of complications with that population, as you would with multiple births and moms who underwent fertility treatments.
Anyway, I know you know all this, and I partially just trying to remind you that you do. And to say, that even someone like me who hasn't dealt with any of that as a student for 5 years, I still have a basic understanding. Now, it would be much harder for me to tell you exactly what to do in each of these instances, but, if it I were going into it as a new grad, or even now, I would be damned sure I had my Taber's and drug guide downloaded on my PDA, and i would have someone I could call for help if needed. I wouldn't want to be on my own until I felt sure of myself.
All of that adds up to what is called having good judgment and critical thinking skills, being able to know when to act, and how to act quickly. If you have a solid core understanding, you can do the job. If you enjoy it, all the better. If you help someone out, even better. If that someone happens to be a baby, that's the best!
One thing I would love about your job is the teaching component. i would love to teach moms about breastfeeding, and caring for their newborn. i would love to teach adolescent moms especially. I think you have found a field that has so much potential for affecting peoples' lives forever. If you were in my field, you would understand that teaching a teenage girl that shaking a baby can kill it can be one of the most important lessons you could ever teach a person. That is a sad realization, but then it just becomes very important to do that, and everytime you do, you start to understand the power of knowledge, and how many people are not afforded it. You also start to see the good in people. Most people, when equipped with adequate knowledge, do make good decisions. Most poor decisions, especially in regards to parenting, are made in ignorance, and sadly, innocence.
Just out of curiosity, have you seen my blog Zaideh's House? http://progressiveu.org/blog/50997-zaidehs-house-my-personal-dream
In another blog, "Teen Moms: Research Supporting Zaideh's House" I talk about the effects of the quality of lives of children born to teen moms. Jackbenimble might be interested, since i discuss the dependency of these women on welfare and other state assistance. Any way, I said there, http://progressiveu.org/blog/50999-teen-moms-research-supporting-zaidehs..., that
"Health related consequences to the children of the teen mothers will be addressed by providing access to adequate prenatal medical care, as well as education to our pregnant mothers."
I would love to hear or read your thoughts, A project like that could use a person like you.
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a commercial for a Showtime movie, called "the Business of Being Born." It's coming up on May 6 at 9 (pst I think?) It's airing through 6/03.
"Description
Executive producer Ricki Lake and director Abby Epstein take an unflinching look at the American medical industry's childbirth practices and how they are often intended to benefit profit and professional convenience over the health of mothers and newborns. Included is an examination of midwives and their crucial role in other countries such as Europe and Japan."
http://www.sho.com/site/schedules/product.do?episodeid=134642&seriesid=0...
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I actually own a copy of the Business of Being Born; it was great to see a semi-celebrity promoting home birth and showing her own birth in a bathtub at home...plus she interviewed some of the biggest "stars" in the midwifery world, Ida May Gaskin, Michel Odent, etc.
Birth really is "safe" and "normal", 95% of the time. This is what I need to keep in mind as I go through these classes which are focused on dealing with birth when it isn't "normal" or "safe," while remembering how important it is to know about how to deal with these situations when they do come up.
I definitely enjoy the education piece of the job a lot as well. I feel like the few small things I get to share with the teenagers that actually "stick" are well worth it; for example, one girl had a baby who was extremely small and falling off the growth curve charts; we began talking weekly about protein and the importance of a good pregnancy diet and suddenly, the baby was growing with leaps and bounds and was catching up in growth to where he should be..so that is just one of my little success stories! Amazing how just a bit of education goes a long way!
Maybe I'll just devote my life to education; I feel really stressed out thinking about being at a homebirth maybe by myself or with a midwifery partner and trying to deal with a mom hemorraging or a baby having trouble breathing, or both at the same time. So maybe I'll focus on activism and education, I don't know.
Love ya,
Carrot