There is no such thing as a perfect birth

I watched; amazed at the woman in front of me. Brave. Courageous. She pushed her baby magnificently. She listened to her body. She owned the moment. It was perfect. She had worked hard for this. She had done all the research, she had read all the books, she had eaten all the right foods. She was beautiful and I was so amazed watching her that I had to fight back tears.

In spite of my awe, I also noticed that something was not quite right. In the next 20 minutes this woman and her baby suffered several complications which had us traveling to the hospital via ambulance arriving before the first hour ever passed.

Next, I stood in the tiny hospital room. Covered in her blood. Watching her on a gurney. Brave. Couragous. She calmly answered the hostile doctor's questions. She withstood the rolling eyes and the belittling comments. I fought to hold back the tears because I wanted her birth experience to be all that she had fought for it to be.

A week later I stood at her door. When it opened I braced myself. In front of me stood a woman with a baby in her arms. Shining. Strong. Vibrant. Rejoicing. She got the point of it all. She empowered herself because in that experience of her birth she learned that there is no perfect birth only imperfect ones which we learn much about ourselves in. I learned from her. I learned to grieve a little less about the complications. I learned to rejoice in the power of the journey.

Do I still have to pay you if I transfer?

I get this question pretty often at consultations. The short answer is: yes. The why of that is the content of this blog post.

Most people hire a homebirh midwife to provide prenatal, antenatal, and postpartum care. That care includes all of the really fun and crunchy stuff like preparing sitz baths and herbal teas but it also covers the midwife assessing if her client's pregnancy requires medical intervention. If a midwife transfers a client to physician care or refers for physician assessment because of a physical or emotional condition she is doing her job. She should get paid for doing her job.

I won't speak for all midwives, but I will speak for most when I say that we struggle over demanding payment for our services. We develop a relationship with our clients and usually don't have a big staff who can do all the sticky stuff for us. We know that young families struggle to pay us. We know that when birth doesn't go as expected it is an emotional blow as well as a financial blow.

Yet, midwives leave our own families to take care of our clients. We incur expenses in order to care for our clients. Most of us can't work for free. In my midwifery 'practice' I ask for full payment for care that goes past 36 weeks. Most folks don't realize that if I break down the costs I am only making about $500 for each birth, the bulk of what I do is done prenatally. So yes, even if you transfer out of my care at 36.5 weeks you will owe the whole fee. Sometimes, I will extend a courtesy discount, but I am still planning to attend your birth (if I am not leaving another laboring woman without a midwife) and give you postpartum care as long as it is appropriate to do so. I am still your midwife.

I appreciated the perspective of a family I cared for. They had to transfer out of my care late in pregnancy when complications developed. They were devastated. For awhile, our relationship took on a tense nature. I was able to stay with them through the labor, birth, and postpartum experience. While they were still somewhat disappointed about not having the birth they had prepared for in time they found peace with it and let me know later that they are grateful for the care that they had during their pregnancy and we have remained in contact. In fact, I count them as friends. It was a huge relief for me that the relationship that we had did not disintegrate over a tough decision.

Money is a difficult issue for midwives. We work from our hearts not in respect to our wallets. Yet, we live in the real world and can't provide care to women if we are expected to devote ourselves to them without compensation. I have made the mistake of being too flexible with payments. Because of this, I have yet to pay myself a wage for the work I do. I still have to pay for my rent, my assistants, my supplies..etc...so even if I work for free the work I do is not free. I have learned this lesson the hard way to the extent that my future clients will not be extended the same graces that some of my former ones benefited from. Most of my families have not taken advantage of my leniency...but some have and it only takes a few to put you in the red.

It breaks my heart to transfer clients and the few times I have had to I had to steel myself in order to do the right thing. I sought advice, researched, and searched my heart to come to the inevitable answer if it was a prenatal transfer and if it was a transfer during labor or the early postpartum hours I was doing a LOT of praying for a resolution before I called it. This is not an area to be flippant with. It is also not an area to be meek about. As a midwife, you have to make tough decisions. You have to think of the safest scenario. I am not God, I don't even work for him...but I do work for the families and I respect the position they put me in when they ask me to care for them. I also realize that I can be wrong; that is the nature of hiring a human. I realize that I may transfer someone who ends up having an uneventful experience...it may mean that I was wrong or it may mean that what could have happened didn't. Great!

All of this when the short answer should suffice. :-) Yes, pay your midwife!

It is okay not to like it...

Birth is not pain-free for most women.

I know this is not a secret, but it seems to be a thing in the natural birth community to sugar coat the physical sensations of birth. There are many, many benefits to giving birth naturally and even ecstatically (Thank you Sarah Buckley!), but in trying to encourage women to give birth naturally we are working too hard. We even border on lying. It is okay not to enjoy all the sensations of birth. It is okay not to like it.

I have only had one woman transfer for pain relief and she did so after a very long labor. It is my belief that women who are able to have an unhindered birth (privacy, freedom of movement, and unobtrusive support) will be able to cope with the normal pain of labor quite well and that belief has been born out in experience. I haven't found it to be necessary for women to have a whole bunch of rules or methods to give birth successfully either...relaxation is definitely key, but not much else.

There is nothing I would love more than for women to not feel guilty for not enjoying all the aspects of physical challenges that motherhood brings. I think we would all be a lot better off if we felt that we could say "labor hurts...but it is worth it" or "breastfeeding stinks sometimes, but I am glad I did it and wouldn't have it any other way". I also think that if we want to truly support each other we should do a better job of letting our friends or clients complain a little. It is okay and healthy.

The best part (in my humble opinion) is that we can whine a little, then go on to do a very amazing thing with our bodies. Women are awesome like that.

On the road again...

Midwifery has helped me to see the world!! Well, not the world exactly. I have seen a few states that I hadn't been to before. I have seen the region that I serve VERY well...this happens because: I have had clients in most of the cities surrounding my home, I make wrong turns, and because my navigation system has a sick sense of humor. My Starbucks and Panera seeking abilities are amazing. I just get a feeling that a Starbucks is nearby and I am usually right. It is part of the uncanny intuition that I have developed as a midwife. :-)

This month in particular has been a traveling month. Currently, I have two postpartum moms and two moms who are due (and they really thought that they should have a baby by now) all living close to each other, but about an hour and 40 minutes from my home. So, I have been doing a lot of driving. I fantasize about hotel rooms a lot and even considered staying at a weekly rate hotel. Last night, I went to a movie at 9:55 pm in the city where most of them live just in case someone went into labor. I was already down there and they were having enough going on to make the drive home seem daunting if it meant I had to come back again. Crazy? Yes and no, this will pass. All these beautiful moms will cease to need me and I will move on. I will have added another story to my stable, the one about that crazy month when I lived in my car.

I love what I do. I even love driving because it shakes up my rural life a little and because I usually pass a Trader Joes. My sacrum disagrees...but car time is good and a lot of chiropractors have home births which means I have a chiropractor in every just about every city too. I listen to books with an app on my phone. I take phone calls. I visit my buddies at Starbucks. I do errands sometimes. I practice rapping. I know where all the cleanest bathrooms are and which gas stations I like the best.

Even though I see ladies primarily at my office, I do see them at their homes at least once and more often a few times. I love to pull up to the house of a mother in labor and already know which chair I like to sit in or where her bathroom is. I know that she is comfortable with me being in her home and that I can set-up for birth without distracting her from the work that she has to do. I love that we have already spent hours with each other in conversation and that now we can settle into a comfortable silence and be focused on her alone. After her baby is born and I leave her tucked into bed, I look forward to the return visits to her home when I get to see the transformation that the family has made and I get to finally hold that baby for a little while longer than just the few minutes it takes to do a newborn exam. I get to settle back and hear how she feels about how her labor went and laugh together about some of the things she said or felt. It makes it worth all the time I spend in my car...very worth it.

Full of Grace Birth Services, Bettie Sheets, Midwife

Full of Grace Birth Services, Bettie Sheets, Midwife

The above link is to my listing on Naturally Born, please consider leaving a review if you have had a home birth with our practice. Thank you!

Knowing what you don't know...

It comes up all the time in conversations about homebirth midwifery. The "what-ifs". "What if you have a complication?" "What if you need to transfer". Sometimes the answers are quite simple, like "No, a cord around the neck isn't automatically an emergency...it happens a lot in normal birth." Sometimes it is this hard to explain phenomenon of knowing what you don't know.

When you are blessed enough to witness women giving birth normally and get exposed to all the normal variations which occur in birth, you become quite comfortable with normal. The vast majority of homebirth midwives do not hesitate for a second to transfer someone who develops an obviously serious complication or who do not quickly resolve with a complication that is troubling. There is no desire to try to treat what is a medical issue at home...because we are not medical practitioners. We know our limitations and concede that when birth becomes a medical issue that a hospital is the best place for a woman to be.

Sometimes, knowing what you don't know comes up in other less obvious ways. A midwife may have a client who has social, emotional, or physical issues that the midwife may have no ability to understand. We may do our best to try to find a way to relate to this woman, but we may find that the best way to support her is to empathize without knowing. It is okay not to know what to say. It is okay to say "teach me".

I had a great compliment from the mother of a client recently. She thanked me for sharing a less than flattering fact about myself. She said that when she met me she had automatically put me on a pedestal because I was a midwife. She assumed I had to be practically perfect (my own Mary Poppins version of her words). She said that because I was willing to share my imperfections I suddenly became more human but no less special. I am not afraid to be human to my clients. I am not afraid to admit when I don't know. I am also not afraid to be off the pedestal and back down to servant status where I belong.

I realize that I don't know a LOT. When I know everything it will be time for me to retire...I have heard this and I believe it to be true. So, I keep on plugging.

Islands in the Stream

I have been singing this song for weeks, every since I heard it playing in the bathroom at Cracker Barrel when I was there having breakfast with my kids. It is a magic combination of Kenny Rogers and Dolly Parton singing the lyrics of the Gibb brothers (Bee Gees). It was a favorite song of mine from childhood. I was 9 or 10 and it spoke to me. The truth is, it still does. Especially the part that says "No more will you cry, Baby I will hurt you never, we start and end as one, in love forever" Very simple, yet encompasses so much. I can't help but relate it to pregnancy. We know the the mother/baby bond is strong and lasts a lifetime. In a perfect world, we would all be like islands in the stream, man, woman, and little baby islands who eventually break off and make their own islands.

Sadly, it is not always that simplistic. We have broken units...partners split, parents who abuse. We have mental and physical illness. Sometimes many of us have become our own little islands, nobody sailing away with us to another world. Some of us are surrounded by islands and but feel that we have nobody to teether ourselves to.

Good news,  we have legs and can walk...we can leave our locations and move. It is never too late to change our circumstances. I sometimes have women call to hire me who are ready to give birth at any moment. They are listening to their inner voice telling them that the the lack of satisfaction they feel with their current plans for birth is more than just a whim. It is more than just desire for an experience. It is a need deep within them that they can't ignore. I love these brave women. They do what I didn't always do when I was pregnant. They listen to that voice and respond. Amazingly, they find doors open for them. Location is just location. We can survive a bad birth or a c-section. Sometimes it isn't even a bad experience, it is just wasn't "right".  Our desire for better than that is not selfish or petty. When we listen to the primal woman inside us, the one we were designed to be we aren't lying to ourselves anymore.

Women are very good at creating community. The birth community often amazes me. So many of us broke away and anchored our islands to another who would understand and support us and just "get it". It is so incredible to see women from all different backgrounds and belief systems share a commonality with each other. We can be hard on each other for sure. People who are brave enough to drag their islands upstream are not always mild mannered! Still, when you share that community you have to be amazed that in this crazy world such a thing exists.

As we create these communities, we find better examples of families too. Women who anchor their babies to themselves, breastfeeding, co-sleeping...questioning the the status quo. I see families being lifted and supported by other families...imperfectly, but supported nevertheless.

Sail away with me...to another world....and we rely on each other ah ha