• Kim Pekin, CPM

The Midwifery Rollercoaster



Yesterday was a day like any other day, I suppose. I guess yesterday actually started before yesterday. I'm in a group practice and had just gone off call. My phone didn't ring even once during the week I was on call. While you'd think that was relaxing, it wasn't entirely that way. Being on high alert and waiting for a phone call that would jolt my life into a different trajectory is not quite what I'd consider to be relaxing. That constant state of alert - where's my phone? is it charged? do we take 2 cars to dinner tonight? can I be the one to count on to pick up my son from camp? - is anything but relaxing. I did manage to get 7 consecutive nights of uninterrupted sleep though, so I'm not complaining!


When the next midwife went on call, her phone started ringing (of course!). When it rains, it pours babies. As usual, as soon as I woke up, I logged on to our electronic health record to see if anyone was in labor. I saw there were 2 people having their babies at the same time. One was super quick. Pretty much just came to the birth center and pushed out her baby in record time. The other was exactly the opposite - long, drawn out, marathon of a birth. This one ended up transferring to the hospital for some pain relief.


While the other midwife was helping this mama at the hospital, I did office visits. First up was a 6-week postpartum visit. When I first met this woman prenatally, I was taken aback at her attitude about becoming a mother. She absolutely did NOT want this baby. She made it clear that she resented the impact having a baby would have on her life. She definitely did NOT want to breastfeed her baby (this was a first for me!). She said the baby was her husband's responsibility. That prenatal visit really shook me up. Her attitude was so unlike what I had ever seen before, and I knew we had our work cut out for us. Fast-forward to her birth. She had a typical long and challenging first-time mom birth. She struggled to get through every bit of it, but she had a room full of support around her, and she found the strength within herself to push her baby out on her own terms. As I helped her bring her baby up into her arms, I wondered, "will she come to love this baby?" And, in that moment, she was like any other mother I'd seen- she embraced her son, cried tears of joy, and held him like he was the most precious gift she'd ever received. A short while later, I told her I knew she hadn't wanted to breastfeed, but wondered if she might give it a try just while she was there at the birth center. She said, "I think I can give it a try." Instantly, her baby latched, and there he stayed for the rest of her time at the birth center. Fast-forward to her 6-week postpartum visit. They're still breastfeeding, and she's even more in love with her baby now. When asked what she thought about her birth, she said, "It was really hard, but if I ever have another baby, I would definitely do it this way again. Even if I move away to another state, I'll come back here and have my baby with you." I told her she blessed me even more than I ever could have ever blessed her.


I then got a text message from the other midwife at the hospital who said they were getting ready to start pushing. So excited!


The rest of the visits yesterday were all over the spectrum of pregnancy experiences. There was the financially-challenged mother who needed help figuring out how to stretch her WIC and food stamps in order to make healthy choices for her pregnancy. There was the woman who had a miscarriage and came in for bloodwork and some support as she worked through her grief. There was the mother who heard her baby's heartbeat for the first time. There was the happily pregnant mother who wanted to talk through her birth plan. There was the father who was completely tuned out during the visit until we talked about how he could maybe be the one to "catch" his baby at the birth.

I then got an update from the midwife at the hospital. Normally, when we have a hospital transfer, everything is smooth and the hospital staff is supportive and welcoming. Every once-in-a-while, we get "that doctor," the one everyone dreads and knows will be a challenge. Today was the day we got "that doctor." Rather than working together as a team, he marked his territory by kicking out the doula and student midwife. While her midwife was able to stay, his temper tantrum caused the removal of key people on her support team, and this mother needed all the support she could get.


Then, we had our "Birthday Planning Meeting." This is a once-a-month event where people who are about a month away from their birth bring their support people and come to meet each other and learn about what to expect on the big day. We do a quickie prenatal visit for each of them, and then we all gather together in the classroom to go over our PowerPoint presentation. We cover everything from signs of labor, when and how to call the midwives, what to expect when they arrive, what happens if we need to go to the hospital, postpartum care, breastfeeding, and baby care. We also go over what to do if the baby comes before the midwife is present. It's, as I say, a firehose of information. People come out of the meeting feeling prepared for anything, confident they know what to expect.


Then, I get a text message from the midwife at the hospital. After being with the mom for 36 hours straight and doing "all the things," they're taking the mother back for a cesarean. So disappointed for them all, but especially for the mother who had worked so hard and had planned such a different birth for her baby. Now, it was time to take a deep breath and move forward. I know we're going to need to do a lot of loving postpartum care with this mom and help her process her birth experience.


After the Birthday Planning Meeting, we chit chat with the attendees and answer any other questions they may have. One person came up to me and said, "I just want to thank you for what you've done here. This birth center is such a huge blessing for our community. We need this place so much, and I love it here." She told me about the horrible care she had with her OB for her previous pregnancies, and how the care she received at the birth center was night and day different for her. She expressed her gratitude for us accepting her into her care, despite the fact that she'd had a cesarean with her first baby, and how we treated her pregnancy as normal, rather than a catastrophe waiting to happen. Humbled, I told her I was grateful for her and that there would be no birth center without her. Inside, I felt unworthy of her praise, as I thought of the mother at the hospital who was now recovering from her cesarean.


Today, I reflect on yesterday. It was a rollercoaster of emotions. From the super high of the mother with the unplanned pregnancy who had come to embrace motherhood, to the low of the frustration and sadness I felt for the mother at the hospital, to the anger I felt towards the doctor who, rather than show us his best side, decided to show us why people who experience his care end up coming to us for their next birth. I'll keep working on him. And, I'll keep working on us and the care we give to the people we serve at the birth center.

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