Midwives of the Revolution

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


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Transition

It has been so long since I have put anything in this space. So much has happened over the last year for reproductive rights, workers, immigrants, healthcare access, the political mood and movements, and my personal and professional life has not let me keep up with it here. Though I have had my best work-life balance of my professional life so far over this last year, I’ve had a hard time squeezing in time for writing about my experience or my thoughts about what’s happening in the world.

A lot of what is hard is that my dear mother has really been on my case about protecting my professional identity, and about being ever so careful about how I present myself on the Internet, in spite of my attempts to remain as anonymous as possible here. It’s incredibly hard, as someone who has so many damn opinions and for whom my profession is a major passion of my life, to figure out how much I can say about what I think about things, while preserving myself professionally. Are there enough disclaimers in the world to cover me and protect me from losing my job, or offending my clients, or not getting some job in the future? Probably not. So I hold a lot of ideas in my mind and wrestle with what is appropriate enough for me to put into print.

Hopefully this is.

Well, I’m doing it. I’m transitioning. A very welcome, but also a terrifying change, from intrapartum care only in the hospital to not only full scope (GYN and OB) care but to homebirth. I have been working over almost the entire last year mainly in a very large private academic medical center that I previously thought of only as my city’s “baby factory” because so, so many people deliver there. I have also been moonlighting in a similar role in a small Catholic community hospital in my neighborhood that primarily serves Black and Latinx patients. These were both very welcome changes from the major challenges I encountered at my previous position, and my life over the last year has allowed me to settle into a fairly reasonable routine that works well with my family and activist lives.

But now my dream job has started, and my world is being uprooted, but for the better.  in the most delightful ways. champagne

Why am I making this change? I’m giving up a 36 hour workweek with hardly any stress about my job, for being on call 20 days a month for a position that I care about deeply and find spiritually satisfying. I’m giving up about 100 miles a week in bike commuting (often schlepping my daughter on the bike trailer) for having to always be close to my car and driving all over a large metro area to I can get to labors and births in a timely manner. I’m giving up a position that allowed me to make a midwifery stamp and positively impact my patients during their labor, as I provide physician extender service as part of a resident team, for one in which I will partner with a team of midwives to develop relationships with our clients, who have invited us into our homes for the most intimate moments of childbearing. I’m giving up watching how the medicalization of childbirth, while “evidence-based” and in highly skilled and talented hands, so often leads to much higher rates of complications than one should see in otherwise healthy people, for a birth setting in which emergencies can still happen, and the operating room or assisted delivery or complicated resuscitation is still a 9-1-1 call away.

Sure, I’m giving up some personal comforts (and admittedly, proximity to emergency help), but I am leaping into what I am hoping will be a tremendous adventure that will train me to be so much more skilled in what I care about: normal birth with healthy people. It’s a tremendous honor to be seen for my skills and potential, and to have been chosen for this practice. There’s only one way to know if this is my perfect fit, and it’s to try! So, here’s to doing my best at trying!

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Updates Galore!

I have made it past the 3 month mark…it’s hard to believe it’s only been three months. Almost four now, but still…

Here are some highlights and lowlights from my world these days…

1. Looking forward to the Socialism Conference.

It’s this weekend — an extended conference this year, it started today. But I can’t take any days off work until my six month work anniversary, so I’ll only be attending Saturday and Sunday. Here are some talks and featured events this year that I’m looking forward to:

Special Education & Disability Rights

Marxism and indigenous feminism

Women, race, and class: A history of Black feminism

Who needs gender? A Marxist analysis

Capital’s missing book: Social reproduction theory and the global working class today

Who cares: Work, gender, and the repro­duction of labor power

From criminalization to “rape culture”: Re­thinking the politics of sexual violence

From restrictions to criminalization: The fight for reproductive rights today

Capitalism, socialism, and mental illness

What should socialists say about privilege checking?

Microbes and Marxism: Capitalism and public health

“Obamacare” as neoliberal health care reform

…OMG there is so much! Obviously won’t be able to make it to all of those sessions, but those are some of the ones I thought might be of particular interest to readers, and which speak to some topics I’ve been thinking about/excited about lately.

2. I’m sick of the judging.

I feel like everyone I work with is burnt out and cynical. I’m sick of victim blaming, slut shaming, poverty-ignoring, moralizing attitudes coming from people I work with. Especially the OB I work with. It’s poisonous, and trying to figure out how to respond with fierce compassion. Patients and staff deserve to feel human. 

3. Getting into the hospital…

This will of course bring new challenges. Now, I kinda have it good. Getting used to being in clinic full time, getting to know my patients, learning what basic and expanded skills I need to have for clinic. But it will be nice, come September (fingers crossed!), to have hospital privileges so I can actually start to be present with my patients in the hospital. I still have to have a bunch of deliveries supervised by the aforementioned physician, and hopefully by some midwives I’ll be working with, but it’s good to know it’s on the horizon. 

4. Got a rad shout-out by the fabulous Feminist Midwife!

My friend, mentor, and trail-blazing hero over at Feminist Midwife gave me and a fellow red midwife a lovely mention in her recent post here, honoring the work of sharing the journey via the blogosphere. Thanks, FM!

5. Feeling appreciated

Though every day is emotionally and clinically challenging, it is also rewarding. I am feeling every day that I make a difference when I provide good care, and I can see it in my patients’ faces and in their continuing to come in for care and opening up to me. Another perk is outside of clinic — being known among friends, fellow activists, and family, as someone who knows some things about reproductive health — and who can be trusted to ask about it. Maybe it’ll get old one day, but I doubt it. I love those calls/texts/FB messages about family planning, pregnancy, and sexual health. So, thank you to those folks who have come to me with those questions, and I hope I have been helpful. 


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How I Got Here; Or: Why I Am a Nurse-Midwife

Now that I’m here, I’ve jumped through the hurdles of getting my degree, passing boards, getting licensed, and becoming employed, I thought it would be nice to reflect on how I got here. It’s easy to take for granted sometimes, now that I just wake up and go to work every day. But I’m doing what I set out to do! I’m midwifing! So…how did that happen?

Back in the day…

My background is in languages and literature. I studied English and Spanish in undergrad. Like many undergrads, I had no idea what I would do when I grew up…Like many women, I thought I was “bad” at science and hadn’t really taken myself seriously in that regard. When the nursing shortage blew up in the mid-2000s, my mom suggested I look into nursing. I didn’t really think it was for me. I had the old-school pre-feminist movement (and very middle class) idea about nurses as doctor’s handmaidens and couldn’t see myself doing it. But then I started looking into it, and taking my prerequisites for nursing school (adventures to tell of another day), and more and more found it seemed like the right next step for me. Hands + heart + science + possible unionism + healthcare activism…that I could get into.

I originally planned to be a WHNP. When I started nursing school, I had never attended a birth, and I really didn’t know much about midwifery. I liked the idea of working with women, but I didn’t want to try to get into a program/field that I wasn’t as passionate about. I knew folks who were planning to be midwives, and they were excited about Ina Mae Gaskin and doulas and home birth. But I was in my mid-twenties, and no one I was close with had had a baby yet, and these topics were remote from my experience. The abortion world was more my bag, and I knew that as a WHNP, I could possibly train to provide early aspiration abortion or at least do lots of cool family planning work.

Trust Women Tiller

Then, I fell in love with birth and also realized that, as I later saw expressed beautifully in the documentary After Tiller, trusting women and being pro-woman/pro-abortion was midwifery. The issues of birth and family planning and abortion are inextricably linked. And, from a practical standpoint, I realized that it made sense for me to provide pregnancy and birth care as well as the other family planning and gyne care I would do as a WHNP. Why hand off patients to another provider to attend the birth, when I could actually be the one to be there for the whole lifespan? So, during nursing school I asked the women’s health department if I could switch to midwifery. They OK’d me.

An Alternative Route

For a variety of reasons, my path to practicing midwifery has not been traditional, at least how it’s done “typically” by CNMs. According to tradition, an RN works in labor and delivery, then goes to midwifery school, then works as a CNM. When I finished my nursing program, nursing jobs in labor and delivery were hard to come by. I got one interview on a hospital unit but did not get the position. I applied to dozens of others. I also had put out my feelers for work in abortion care and managed to get a position through a student colleague connection, at the abortion service in the county hospital.

My first nursing position was a nightmare, but it paid the bills for my first semester of midwifery school and gave me valuable insight into the lives of women seeking abortion in fairly desperate situations. I then got a scholarship so I didn’t have to continue working as a nurse during my program, but it required me to complete it in two years. I babysat for a wonderful family and watched their family grow throughout my graduate studies. Then, as I was completing my final semester of my masters program, I landed another position in abortion care, which eventually turned into a broader family planning nursing role. That is the last job I held until beginning this current job.

After I passed my boards (got certified by the American Midwifery Certification Board), I again looked for jobs around my city. This time around, I had more interviews and got a lot more interest, but still, employers and even my mentors questioned if I could work as a full-scope (meaning: catching babies, not just working in the office) CNM without having worked as a nurse in labor and delivery. Some suggested that I should swallow my pride and try to get such a position and then try again in a year or two for a full scope  job. It was a full six months between my initial interview and my start date for the position I landed, and there were times that I considered this option. Luckily, this position came through, and I got to do things the way I originally thought I could (more or less).

Acceptance

What is midwifery? Is it only possible to be a midwife if you’ve been a nurse during hundreds of births, many of which were probably complicated or high risk? I don’t think so.

It’s hard being one of the handful of people who graduated from programs like mine, that allow you to graduate without having to work labor and delivery, having to prove that you belong and that you can hang with the more experienced nurses. But I am not alone, and I’m grateful for others who blazed the trail before me — whether they intended to or not.

Midwifery is a whole lot of things.* True, the only births I’ve attended are the ones where I was doing the baby-catching (or doing labor support in a few instances). I haven’t seen a ton yet. My career is young. I am humbled by all I have to learn. But I have also worked in women’s health for over six years, and have learned compassion and to not judge women’s lives and choices. Midwifery is trusting women, it’s listening to women, and it’s being present with women. You can’t learn that from a textbook or demonstrate that on a board exam, but you can show it in the type of care you give. I am confident that, as one quarter of women in the United States will have an abortion before the age of 40, my background in abortion provides a ton of useful clinical and emotional skills to be a good midwife. Good midwifery care has to include all phases of the reproductive lifespan, including abortion. (And hopefully one day CNMs will be legally allowed to provide spontaneous and elective abortion care in all states!)

Now

Tomorrow will mark three months as a practicing CNM, but I think I’ve been practicing the midwifery model of care for more than that. I respect that other midwives took other paths — and they may have done so out of their own necessities. I hope that as I enter the birth setting again in a few months, when I get my hospital privileges, I can continue to safely develop my labor and birth skills and humbly continue my journey with new mentors and teachers.

 

*There are, of course, other paths to midwifery outside of nursing. I respect direct-entry or certified midwives, but I don’t claim to know much about their paths. I can only speak as someone that went the CNM route, and know that non-nurse midwives have their own contributions to women’s healthcare that may differ from where CNMs might be coming from (e.g. Ina Mae Gaskin).


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Calling on the Saints

I am an atheist. I’m not a person of faith, though I was raised Christian. Despite my parents’ best efforts and wonderful role modeling of spiritual life, god doesn’t make sense to me conceptually or as a foundation for my world view. I have dabbled in Buddhism and attended a Unitarian Universalist congregation, I practice yoga, and there’s some Pagan stuff that speaks to me, but the only philosophy that I have been able to commit to is revolutionary marxism. A smidgen of woo-woo and commitment to personal growth is as spiritual as I think I’m gonna get.

I remain a bit of a black sheep in much of my family for not being part of any church, though I know they love me unconditionally (and pray for me often). My mother, a mystic secular Franciscan who converted to Catholicism when I was in high school, has never given up on me returning to theism. She is quite subtle in her attempts to spark faith back in my scientific mind and heart. She is not an evangelist in any sense, but she knows and works with my soft spots, like the work of Anne Lamott — she gave me that author’s most recent book for Christmas last year (haven’t read it yet).

My mother’s most successful breakthrough in getting me to open up spiritually came when she and my step-father took a trip to Ireland, where my mother discovered this beautiful cross on people’s thresholds and in some of the local shops and churches. They had been to Ireland a few times before, but she had never noticed it before. She asked around about the meaning of the cross and came to find out that it was St. Bridget’s cross.

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St. Bridget’s Cross, traditionally woven

Bridget, whose feast day is my birthday. Bridget, who is a patron saint of midwives, healers, brewers, and poets. Bridget, who by one account, may have brought the miracle of abortion to a woman in need. Bridget, who is recognized by Celtic paganism as goddess of fertility and earthly fire.

When they came back from the trip, I met my mother for lunch. I was having a hard time — I had failed to pass the certification exam for nurse midwives and was feeling a little lost, doubting myself and fearful of not being able to continue to pursue my dreams. My mother was beaming as she slid this small tissue-wrapped gift across the table to me, and as she told me about Bridget while I opened the package. It was perfect.

I have come to adopt a bit of reverence for and connection to saint/goddess Bridget. I may not believe in god, but I do find it useful and calming to call upon the “spirit” of Bridget and to work to embody her legacy when I am struggling. I keep the cross my mother gave me on my desk at work, and I wear her cross on a necklace some days. I may even get a Bridget tattoo one day. It’s not magic, but I began calling upon Bridget as I prepared again to tackle my midwifery board exams, and I continue to do so to help myself get grounded. I have adopted (and adapted ever so slightly) this traditional prayer and find myself reciting it as my mantra when I find myself stressed, worried, or needing to find strength. I’m glad Bridget’s got my back.

Brigid.
You were a woman of peace.
You brought harmony where there was conflict.
You brought light to the darkness.
You brought hope to the downcast.
May the mantle of your peace cover those who are troubled and anxious,

and may peace be firmly rooted in our hearts and in our world.
Inspire us to act justly and to reverence all God has made.
Brigid you were a voice for the wounded and the weary.
Strengthen what is weak within us.
Calm us into a quietness that heals and listens.
May we grow each day into greater wholeness in mind, body and spirit.


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Tears

Some days, I come home on the verge of tears. This is my body’s way of telling me that I am soaking up a bit of secondary trauma. I am good at being an emotional sponge, but that is not going to work for me long term. Here is a short list of some things my patients shared with me, that made me tear up at work and once away from work in the last two weeks:*

  • Partner being incarcerated during her entire pregnancy
  • Being set up and attacked by a group of people that she thought were her friends
  • Being intentionally burned as a small child
  • Child sexual abuse
  • Partner sabotaging her birth control
  • Being told that since she had two abortions, she wouldn’t be able to have healthy pregnancies

There is a choice that caregivers must make when witnessing others’ trauma — we can absorb others’ trauma/let it overwhelm our own emotions, we can distance ourselves from it/numb ourselves, or we can find a middle way, to walk with the trauma.

I aim to walk that middle way.

And it’s really not taught in nursing or midwifery school. If we are lucky, a friend, classmate, or colleague tells us about theoretical and practical work around secondary trauma, compassion fatigue, vicarious traumatization, and trauma stewardship. These are all different ways to say that people who take care of people that experience trauma also need to be taken care of. I am lucky that I learned about this field of research/practice among caregivers some years ago.

…Because if you don’t realize how bearing witness to others’ trauma impacts you, and work on it, it can take over. One who was once empathic, laughing easily, and finding meaning in life and work can fade into someone cynical and burnt out…someone who is ultimately not only unhappy in life but also an ineffective caregiver. In other words, it should be taught in nursing/midwifery/medical/PA/education/PT/OT etc. school — and supported by healthcare (and other) institutions.

I’m glad I’m tuning into this two weeks into seeing patients, and not, say, two months or two years. Because I have my emotional work cut out for me, not to mention clinically, as I develop competencies as a new provider — and I’m ready for it.

And that’s why I love and am honored to be a midwife. 

*I also laughed and smiled with loads of patients, and many told me they hoped I’d be there to catch their baby or to see them in clinic next time. So it’s gratifying in fun ways too!


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Another Beginning

I started seeing patients today…on my own. 

I have been through many beginnings, from deciding to become a nurse, to attending community college for my prerequisites, to moving to a new city for nursing school, to deciding to become a midwife, to being a student midwife, to working as a nurse, and now, beginning my new practice. 

I am thanking all my life midwives as I transition…my mother, my teachers, my mentors, my patients. 

I hope to use this space as my professional life grows to share my journey and my own and others’ analyses and thoughts about the world of women’s health.