Midwives of the Revolution

Explorations, analysis, and reflections on women's health, midwifery, and politics from a feminist, marxist lens


1 Comment

Reflections on Birth and Immediate Postpartum Life

Well, this is now six months late…but I’m a new mom! And a full-time working nurse-midwife! I’m finally ready to dust off the keyboard and start blogging again! So, to kick it off, here’s a post I started right after the transformative experience of welcoming my baby into the world and finally polished off this week. It was fresh when the birth smells were deliciously enveloping my newborn, and fun to revisit now. Enjoy.

* * *

My daughter is now just over a week old. The heat of late summer has broken,  and the kids are back in school at the elementary school across the street. Her umbilical cord stump has just detached, and my bottom and other muscles are gradually returning to normal. I’m generally following the advice I so emphatically dish to my patients: sleep when baby sleeps. Now, I’m taking a breather and making note of what this whole birth thing was like.

Empowerment: I made labor and birth affirmations so I could hear my own midwife voice assuring me during challenging times. My partner drew on this principle several times during labor a few times by asking what I would say to a patient at that phase, when needing reassurance or guidance.

One of the inspirations I had in the week before birth was to make myself affirmations to look at when things got hard during labor. I had been thinking of turning to my friends who had had natural or home births and asking for advice I could use to prepare. While I did receive some good advice (both solicited and not) from such sources, it started to feel strange to me — after all, I’ve attended dozens of births as a student and as a certified nurse-midwife: I know what to expect! Granted, many of the births I’ve attended since beginning professional practice have been in a highly medicalized environment, and few of my patients choose unmedicated birth — fewer have the resources for prepared childbirth.

Yet, I knew the chief thing for me to be successful was not just hearing positive birth stories — and I have read and viewed many — and connecting with the friends and family who were there at my Blessingway, provided beads for my labor necklace, or who were lighting candles for me both near and across the country during my labor. Even having the best labor team possible — which I was fortunate to have — was not a guarantee that I would be okay. No, what I needed more than anything was to be able to hear it from the most authoritative voice I know, my own from my heart as a midwife and my own strength as a woman. For what good is a labor team if the mama isn’t the most willing and capable member?

Though I didn’t look too consciously at the pictures I created, they helped promote a good birth environment — my support team would recite the mantras I had written: Ya mero! Fierce mamas believe in you! You are going to get huge! Yes, yes you can. Trust your body, and so on…And more than anything, I was grateful for the opportunity to make them in the days I was “overdue” and making my nest and heart ready for my baby.

The days after birth, I kept reliving the experience. I was so exhausted and overwhelmed with love and sore in ways I never thought possible. Tears would flow every time I remembered how I felt when my little girl was wet and warm and just screaming her little head off, fresh out of the birth canal on my chest. I had heard and taught women about the “baby blues” on countless postpartum rounds. This was more like a spiritual high, of connection that nourished the parts of me that had been longing for this moment of readiness for years.

I also woke up this week in a panic, realizing that I am probably at high risk for postpartum depression. So I called up my doula, who had mentioned that she does placenta encapsulation, and I ordered up an edible form of the afterbirth to ward off the very real possibility of falling prey to the dark side of new mama life.

IMG_0374

Tree of life: placenta print

I had been hearing about placenta encapsulation for a few years, and knew it hadn’t been studied much. Searches in scientific literatures brings up little of substance, mostly concluding that more research needs to be done. But I also knew that loads of mamas and midwives swore by its powers. I had been planning to plant the placenta in the garden, but when I had a major panic thinking of returning to a very challenging work environment just 10 weeks after the birth, I thought why not give this a chance? Most mammals eat their placentas (seemingly more for survival reasons relating to evading predators), and the power of the oxytocin and progesterone gave me hope it would do more good than harm to try it out. So my lovely doula came over and picked up the placenta a couple days after the birth, and generously returned two days later with a beautiful jar of the capsules and extra home-made herbalist goodies.

In spite of my fears of impending depression, I mostly can’t help but think about how lucky I am to have experienced the birth I did, and how well this network of birth and postpartum support is setting up my little family for a bounty of love, patience, and joy. I had one of the most highly skilled midwives in my area at my birth, who worked with me through a fairly long labor and helped me achieve a normal birth. In almost any hospital, I am certain I would not have had such a nice outcome. Being denied freedom to move and oral nourishment, while being strapped into continuous monitors, I imagine my baby and I would have become very stressed, and a surgical birth would have likely ensued.

Since even before deciding I wanted to be a midwife, I knew home birth would be for me, and now having done it, I feel so strong and powerful as a mama, but also even more convinced of the importance of preserving normal, natural birth. At no point would drugs have helped my labor. At every point, my preparation and support team — my mother, partner, doula, and the midwife assistant — helped me more than any drugs normally administered during labor could. Every laboring woman deserves this type of set-up. How much better for me and my baby (therefore also for public health) that neither of us was too stressed physically during labor, so that we could have such a good, non-interventive birth?!

I know that not every laboring person desires unmedicated birth, but if given the tools and support, it seems many more might at least feel they could make that choice. It seems likely that this could be so helpful in lowering our national rates of surgical births, now more than a staggering one third of all births.

Yet birth is only the beginning. After bringing new life into the world, you have to keep sustaining it! And protecting it for many years!

People have asked me how pregnancy, and now how birth, has changed me as a midwife, but I think that piece, the postpartum and parenting piece has been the most humbling as a women’s healthcare provider. Now, I have pushed this baby out into the world, and now I am responsible for her. I am lucky that I have experience with babies and that I feel so confident in caring for her after this magical birth experience. But if it weren’t for my mother staying with us the first week, the meal train organized by other parent friends, and living in a supportive community, I don’t know I would feel capable of doing hardly anything this week! And I have mamas I care for who have hardly any such support — single mamas, teenage mamas, and mamas with unhelpful or unavailable families. It hardly makes sense to leave new moms alone as a society to figure out recovery from birth and caring for a vulnerable newborn baby.

And then there’s breastfeeding! What a major

BFing linocut

Image borrowed from Rachel Epp Buller’s book cover Have Milk Will Travel

commitment! And I knew it was something I wanted to do, and in fact had literally had dreams about for years. But then doing it is another thing all together. So far, so good. I love how it feels to snuggle this little person and I love how cool it is that my body is making the only food she needs now. I also love how my midwife and doula prepared me to deal with the pain in my nipples the first few days, with ointment, exposing them to air, and the homeopathic medicine. But again, how humbling to have worked with dozens of women to initiate the process immediately postpartum, and then realize how hard it is in real life to keep it up, all hours of the day and night. And a crying newborn. How much patience and calm it takes to keep on loving and caring for a needy newborn. No wonder, with such little support from friends, family, and healthcare providers, so few women in this country actually do commit to breastfeeding for any length of time.

I guess that’s it. Just sharing my thoughts on being a new and breastfeeding mama of a beautiful baby girl that I’m head over heels in love with! And of being a transformed midwife with a new appreciation for birth, the yoni, midwives, doulas, and mothers of all kind everywhere and of every time.

 

Advertisements


6 Comments

The Loneliness of the First Trimester

On Thursday, I was pregnant. Seven weeks and six days of gestation. This was a very carefully timed, meticulously planned, and surprisingly quickly achieved pregnancy. On Thursday, I was happy. I had attended a meeting after work, hearing a report back from a protester that had been in the streets of Ferguson, Missouri, and analysis of police violence and the new phase in the struggle against American racism and police terrorism.

And then, I was bleeding.

I didn’t know, I couldn’t know, at first, if I would be the one in two women with first trimester bleeding, or the one in ten pregnant women overall, that would have a miscarriage, or spontaneous abortion. But I knew enough to identify that sign of bright red bleeding that doesn’t stop, when I had no risk factors for other causes of first trimester bleeding, meant I was losing this pregnancy. 

And so, by Friday, I wasn’t pregnant any more. 

And, since I’m not allowed to take any days off work until I’ve been at my job a complete six months (and I’m just three weeks shy of that), I went to work caring for women on Friday, while my uterus emptied. I felt myself bleeding while listening to a young mom’s baby’s heartbeat for the first time, celebrating with her and her beautiful partner. I patiently explained the speculum exam to a terrified young woman, and did a six-week postpartum checkup and got to coo over her gorgeous baby. I counseled an older woman on the risks and benefits of sterilization versus long-acting reversible contraception. I tried to have a normal day, when I wanted to be home, mourning. 

It’s only Saturday, and I’m still pretty devastated. I was supposed to attend my city’s SlutWalk protest, where a year ago, I had given a rousing speech tearing apart sexism. I wanted to be standing with my sisters and comrades in the streets. But more so, I need to heal.

***

I have been musing quietly about the loneliness of the first trimester since I peed on the stick weeks back and had the delightful moment of reading “pregnant” on the digital screen. The feeling was so different from the myriad other times in my life when I had taken the test in anguish — especially the one other time when I had a positive result, in midwifery school, and knew I was going to have an abortion. I was, this time, elated. 

But there is convention in our society to stay quiet about that positive pregnancy test until the second trimester, regardless of which choice we plan to make about the pregnancy. We know that people won’t really understand the complexity of our feelings about the pregnancy, and that we don’t want to tell everybody the bad news, if we end up needing or wanting an abortion, or if the pregnancy ends in a miscarriage. And so we tend to suffer through many discomforts of the first trimester, in silence.

I remember telling some of my comrades and friends what was going on, when I had the unplanned pregnancy years back. Because I am part of a community that embraces reproductive rights, I was fortunate that it was fairly easy for me to tell people at the time that I was planning an abortion, or that I was still dealing with some of the medical issues related to my abortion the few months after it started. I have since publicly spoken out about my abortion many times, working to de-stigmatize the experience that three in ten women will experience before the age of 45

Telling abortion or miscarriage stories can be a powerful way to break the silence. But it will take more than telling stories to break the stigma.

Telling abortion or miscarriage stories can be a powerful way to break the silence. But it will take more than telling stories to break the stigma. Art by Favianna Rodrigeuz, Just Seeds Cooperative

At that time, however, I didn’t talk openly about what was going on outside my activist network. But I did have a fellow midwife student classmate and friend who turned out to have an unplanned pregnancy at the exact same time as me. We turned to each other one day after class with our secrets: “I’m pregnant.” Neither of us felt good about it. We were both in the first of our two year program, and planned to go full time. There was no time for pregnancy, birth, and parenting, and both of us had partners that were full time graduate or professional school students. It was terrible timing. We each made different decisions, however. I ended my pregnancy, while she continued hers and is parenting this beautiful child, who is almost three now. 

The other difference between us was that none of our classmates knew that I was pregnant or had an abortion, while they eventually found out about hers, when she started showing and eventually had the baby during the program. We both knew that even in a midwifery program, people weren’t emotionally intelligent enough to deal with a sister midwife’s pregnancy to respond appropriately to our news. So we both kept quiet, attending class while coping with our own pregnancy challenges.

I have wondered sometimes if we would have felt that way if we were attending school in a more politicized or radical time, say at the height of second or third wave feminism. Interestingly, I was able to talk about it with my faculty and preceptors, who all had trained as midwives in more political times and were very accepting of my decision.

If a group of midwife students can’t be mature enough to be present with each other during pregnancy, who can be?

***

This time around, I spent much of the initial weeks of pregnancy being silently excited. I talked about it with few people: my mother, my partner, my nurse-midwife team, and one friend, whom I had asked to be my birth doula. It was strange not revealing the news when talking to friends and family about this big thing that was going on in my life. Many times, I wanted to tell more people. It was humbling to now be experiencing life as a “pregnant patient,” much as I had appreciated the experience of being the “abortion patient,” knowing that this would make me a more compassionate nurse-midwife.

And I continued with my life — bicycling, gardening, going to protests, working long hours, cleaning my house — while thinking about the little life growing inside me. Fantasizing about the home birth I expected to have in early April with the fabulous team of midwives I had chosen to care for me. Talking with my partner about changing the guest room into the baby room over the winter. Getting excited about the cousins our baby was going to have, given that my sister in law is pregnant with her second, and my brother and his wife might be trying to conceive soon. Planning with my partner how we were going to cleverly announce my pregnancy on Facebook and to friends in person. Looking forward to the excitement and congratulations we could expect from family, comrades, and friends. And trying to imagine what it would be like to meet that tiny creature my partner and I had created. 

***

I was starting in some ways to relish the privacy of the last couple of months. It has meant more time for introspection, self-care, and focus. I have needed that inner space to deal with some significant changes to my body and my changing life priorities. 

Like sobriety. I chose to stop drinking around the time that I believed I was ovulating, in the first cycle we tried to (and did) conceive. I genuinely enjoy beer, wine, and the occasional cocktail, but since beginning my new job for the last few months at my job, I had also relied on that delicious glass of wine after work to help me unwind. Being sober means having to actually face all the trauma I see at work, and process it in some other way. And this is a pretty drug- and alcohol- heavy society we live in, so not drinking or partaking in any drugs can be pretty challenging, socially and personally. I have loads of patients that aren’t able to cope with life without substances, and continue drinking and using (marijuana, mostly) during pregnancy. Like many women facing the prospect of complete sobriety for 40 weeks, I worried that I would be tempted to drink and felt guilty for even thinking it might be hard to stop.

Fortunately, I have felt pretty good about not drinking and have enjoyed the challenge of sobriety. But I also dreaded social situations in which I would normally be drinking, worried someone would ask why I am not having my customary glass (or three) of wine. What would I say if someone suggested I was not drinking because I was pregnant? Would I choose to tell them? Would I lie? Would I tell them I didn’t want to talk about it? Fortunately it never came up. (For the record, peeps: Don’t ever ask someone if they are pregnant! They will tell you if they want you to know!)

Another major chemical change occurred in my body as I prepared my body for pregnancy by weaning myself off the anti-depressant I had been taking the last few years. That drug had really helped me through some major difficulties the last few years, from completing my midwifery program, to facing my midwifery board certification, to an extended job search, to the major transition of this new and difficult job I eventually landed and accepted. I am fortunate that my depression is well enough managed, and I am stable enough to face stress without the help of this wonderful pharmaceutical product or alcohol. Mostly I owe that to years of therapy and yoga practice that have enabled me to access pretty decent coping skills, along with an extremely supportive partner. Nonetheless, it felt very difficult to stop drinking and to stop taking this antidepressant at the same time. In hindsight, I may have done it a little differently, but it worked out OK. 

Mainly, the changes in my body with the new pregnancy made me feel extremely vulnerable. I knew I had little control over if this pregnancy would continue successfully or not — knowing what I do about rates and causes of miscarriage. For the first few weeks, I could hardly believe I was really pregnant! Every trip to the bathroom, I feared seeing blood on the tissue paper. Every little tiny cramp or feeling in my pelvic area felt like it could be something wrong with the pregnancy. And since I only experienced momentary twinges of nausea, I looked forward to them, as proof that I was in fact pregnant. I caught myself looking at my breasts in the mirror and sometimes touching them to make sure they were really growing, and tender enough. Loads of women face extreme nausea and vomiting in the first trimester and are completely miserable, whether or not the pregnancy is desired or if she plans to continue it. I’m fortunate I was at least feeling well. 

And when the proof was there, out of nowhere — sustained bright red vaginal bleeding, cramping, and passing tissue — it was clear that it was all over, in a flash. One day, a pregnant patient, the next, a “miscarriage patient.” And I had to believe there was nothing I could have done differently. It wasn’t my fault. It just wan’t going to work out this time. 

***

These are some of the things we don’t talk about when we talk about pregnancy, planned or unplanned; desired, undesired, or ambivalent; spontaneously aborted, continued successfully, or electively aborted. These are some of the things we don’t talk about because we have internalized the messages of the war on women. This war psychically imposes a social and cultural expectation that all women naturally 1. want to become a mother and should embrace every chance at motherhood, no matter the circumstances; and 2. adjust and cope in a healthy way to the emotional and physical challenges of pregnancy. And if they don’t, there is something wrong, or even criminal in her thoughts or actions. Yes, lawmakers have proposed criminalizing miscarriage. Yes, every year, dozens of laws in every state of the United States are proposed and pass regulating women’s bodies and restricting abortion. Yes, laws primarily aimed at Black women  criminalize drug and alcohol use in pregnancy (see Dorothy Roberts’s Killing the Black Body).

Yes, this impacts popular opinion, and shapes how people–even and maybe especially women themselves–understand and talk about pregnancy, abortion, miscarriage, and motherhood. And mostly creates the circumstances for not understanding what it is to be pregnant, or how to empathize with a woman who is pregnant, or wants, does not want, or who cannot achieve pregnancy or parenting. 

***
I was grateful I was pregnant on Thursday, and still sad that I’m saying goodbye to that little embryo that I hoped would become a fetus and eventually the baby I would get to parent. I am nervous about what happens next. Will I be able to get pregnant again right away? What kind of loneliness and fear will I face the second time around? Will I make it past the eight week mark next time? Will my readers and friends respond compassionately to this post? 

I feel like I’m in a good enough place emotionally to be able to share my miscarriage story, alongside my abortion story. And like coming out about being queer, or about having had an abortion, I hope that by telling my story, I can contribute to de-stigmatizing something that our deeply misogynistic society doesn’t understand. 

But it takes more than being able to tell the story, for those of us for whom it is safe to do so, to change cultural values around pregnancy and sexuality. We have to end the war on women if we want to shift people’s consciousness and foster solidarity with the challenges people face during pregnancy and parenting. How could we do that? It means opposing every state/federal/local law and institutional policy that aims to decrease women’s bodily autonomy and impose control over women’s sexuality. It means being in solidarity against every form of sexual violence and coercion. It means fighting to end the New Jim Crow. It means demanding comprehensive sexual education for all children. It means standing up for a living wage, the right to union representation, and dignity on the job. It means building a movement for immigrant rights and to tear down the borders. It means calling for free quality childcare and the valuing of care work. 

Some of these things might seem far-fetched and maybe even only tangentially related to my story. Maybe you think I am coming out of left field?

But there used to be a saying in the women’s movement that really meant something, though it has ceased to bear any resemblance to its original meaning: “The personal is political.” In its best sense, it meant that our personal struggles as women or as women of color, weren’t ours alone, but a reflection, or a symptom, of the broader racism and sexism in society. In the era of neoliberalism, we are meant to see our problems as isolated from each other’s, and mostly as a reflection of our own personal weaknesses and inner failings.

More and more, however, I am seeing my personal struggles as intimately related to the structures of social oppression, and I’m tired of bearing them alone. When I fight against the war on women, or against the war on the poor, or the war on people of color, it’s personal. It’s deeply political, as well, but when I think about the circumstances of my reproduction, it’s also deeply personal. 

***

The last women’s movement, like the civil rights and Black Power movements, changed culture dramatically — but throughout my entire lifetime, the right wing has undertaken a sustained attack on the progress those movements made possible. It is my hope that we can build new social struggles from the ground up, that take up some of the demands I mentioned above, and more. Yet most of all, my hope and my argument is that the voices and demands of ordinary people as we struggle with our “personal” issues must be at the forefront of these movements — rather than the tepid Democratic Party politicians and NGO leaders who have been too afraid about upsetting the right wing that they have done nothing but compromise while our rights are under attack.

After all, it was- not well-meaning liberal politicians that made Roe v. Wade possible, but the fact that women took to the streets to tell their own stories about illegal abortion and forced sterilization. Those movements put women first — not the careers of politicians or career “activists.” Change happened, then, and it happens now, from the bottom, up. Or, as the late, great historian Howard Zinn put it, “What matters most is not who is sitting in the White House, but ‘who is sitting in’ — and who is marching outside the White House, pushing for change.” 

I don’t think the first trimester, or any part of pregnancy or parenting, has to be lonely. I know that people can develop deep empathy and solidarity with each other’s struggles — and we see a glimmer of that in every mass movement, from the revolution in Egypt to the capitol occupation in Wisconsin, to Occupy Wall Street, and even how people looked after each other in the immediate aftermath of Hurricane Katrina. We have to foster that in our communities as much as we can, but more so, we have to organize movements for reproductive justice that put the demands, voices, and strategies of ordinary women and other people who can get pregnant at the forefront.

Being part of those social movement traditions is what makes me feel a little less lonely as I grieve my lost pregnancy and look forward to the future.