I haven’t written much since starting my new job because I really haven’t known what to say. I am in a place of such intensity, filled with great opportunities for learning and experience. Every day, I know more than I did when I go to bed (assuming I get to go to bed that day…!) than I did when I got up. This is even more true than was the case when I was a student. The patients I am seeing now are my patients. They are on my schedule. I am responsible for their care in a way that I was not when I was working under another midwife.
I was concerned to some extent what it would be like to be the only midwife in an OB practice. So far, my experience has been overwhelmingly positive. I feel like I have great support from my OB-GYN colleagues, and that we are already functioning as an interdependent team. During my two weeks so far of experience being on call with them, we have had an inordinate number of high acuity situations to deal with, and they have provided great support and leadership for me.
It has been a challenging few weeks, to be sure. I come home from clinic ready to shower and eat and do nothing productive until I collapse into bed, not so much from physical exhaustion as from mental overload. (The physical exhaustion is there, to be sure, but usually more after a long day/night/full weekend on call rather than in clinic.) There is so much I am working to integrate.
The population of patients here is quite different than the one I dealt with as a student in a practice just 15 minutes from here. I am seeing people with more issues, be they health-related or psychosocial or due to poverty or racism or lack of access to the resources they need to take care of themselves and their families. I have many patients who present for prenatal care at the end of the second trimester or sometime during the third, and others that show up in the hospital in labor with limited or non-existent care. This is something I honestly do not remember seeing much of as a student, though it is possible that I was just not given these patients to see. But now I’m seeing them, and far from judging them for not coming in sooner, I am gaining a nuanced view into their lives and the worlds they live in and the access they lack to the resources that I have taken for granted.
If you are an immigrant with limited English proficiency and low health literacy and knowledge of how to access the system that controls health coverage (hell, I am a part of that system and I still don’t even entirely understand it!), if you are stuck in poverty by a racist and classist system that is weighted against you getting out, if you are working two or three or four jobs to make ends meet and can’t take time off to get to your appointments, if you do not own a car and have to catch three buses to get to the clinic but you miss one of them or it is running late, if your community has had bad experiences with health care providers and people encourage you not to seek care, if you have little hope of anything being different… of course you would miss your appointments!
I have already seen heartbreaking outcomes in such cases. I have entire books full of stories in my head, just from these past couple of weeks alone. I am in such a place of privilege that people entrust their stories to me. These are stories of hope and of fear, of joy and of heartbreak, of successes and of challenges. They give me momentary glimpses into worlds I’ve never lived in. People tell me their stories, and I do my best to listen and validate and offer resources.
I wish I could introduce you to some of the people I’ve met. Hearing these individuals explain their lives to you would help you understand why they’ve made the decisions they have, and how they feel about them, and how they ended up in the place where they are, and where they want to go from here. Sitting in my little clinic room with them for fifteen minutes, or thirty, or forty-five, I understand miscarriage, abortion, infertility, stillbirth, unplanned pregnancy, ectopic pregnancy, chlamydia, syphilis, cervical cancer, herpes, and so many other reproductive health issues in ways that newsworthy sound bytes can never capture.
In the past few weeks, I have had to deliver very bad news, and I have been in the room when parents got to see and hear their baby-to-be for the first time. I have held people’s hands while they sobbed, and I have wiped their brows while they vomited, and I have rubbed their backs while they groaned through contractions, and I have cheered them on while they pushed with all their might. I have gone home at the end of intense days and wondered if there was more I could have done, but ultimately I am a human being working within a set of parameters that does not make it possible for me to do it all. I cannot fix everyone, nor is that my job or my calling.
“Let us be the healing of the wound,” my tattoo says. My hands, surrounded by wiser and more experienced hands, gently cradle the world. The call is not to heal the world; rather, the call is to embody healing myself and bring it with me wherever I go. This is a very different goal than that of repairing some deficit. I am actively promoting wholeness.
It feels so impossible to keep wholeness in mind sometimes, when it seems that so much is broken. When babies die due to likely preventable causes, when serious diseases are caught too late, when people are caught in cycles of addiction and abuse and trauma, when people are filled with despair that anything will ever be better for them, when there is so much that needs doing and so little of it that I can actually do, it is hard for me to hold space around that. I do it, however; I breathe deep breaths and dig in deep and pour out every last ounce of compassion I have. I consider myself a container for people’s stories, a storycatcher as much as a babycatcher. I firmly believe that this is important work, and that just in giving someone permission to tell me her story, I am offering her the soil in which to plant the seeds of hope she has been carrying around with her, and in the everyday miracles of soil and water and sunshine, seeds send down roots and sprout leaves and grow.
There are so many stories I wish I could share, but I cannot. Someday, I may be able to fictionalize them and bring them into the world that way, but for now, they are bursting my heart open with love for my life, as hard and exhausting and sad as it is sometimes. I love being a midwife so much, and I feel like one now. Not just like I’m pretending, playing dress-up in scrubs and a lab coat and a stethoscope. This week, when a baby slipped into my hands and I had been responsible for its well-being throughout labor from start to finish, with nobody telling me what to do or how to do it, with nobody standing over my shoulder ready to swoop in and take over if things got tricky, I felt like a real midwife. Not for the first time, but it really settled in. Everything that I have been working towards has brought me here, and I am so beyond grateful.
I read this poem by Rainer Maria Rilke (from his Book of Hours) the other day, and it so perfectly encapsulated my experience as a midwife thus far that I feel compelled to share it:
God speaks to each of us as he makes us,
then walks with us silently out of the night.These are the words we dimly hear:
You, sent out beyond your recall,
go to the limits of your longing.
Embody me.Flare up like a flame
and make big shadows I can move in.Let everything happen to you: beauty and terror.
Just keep going. No feeling is final.
Don’t let yourself lose me.Nearby is the country they call life.
You will know it by its seriousness.Give me your hand.
I certainly feel sent out beyond my recall. I have been letting the beauty and terror happen to me, and I have kept going. I am making big shadows and going out to the very limits of my longing, out to the country they call life. I am doing my best to embody the divine in the ordinary, moment by intense moment.
I sometimes wonder what I have gotten myself into. Whatever it is, I am exactly where I should be, doing my work in the world. And at the end of the day, I cannot ask for more.
