Wednesday, August 4, 2010

Standing on the Precipice...

Posted by D

This is it. The last big hurdle, outside of taking the NARM exam next year. This is what I have been waiting for and wanting, for many many months. I feel like I am standing on the precipice, waiting to jump off and either land on my face, or find out I can fly. Sure, I have 6 more weeks at Casa, but Casa right now feels easy and familiar, and much like a vacation to me now.

So, what is it that I am referring to with such trepidation? Last week the midwife I have been hoping to apprentice with called me and asked me if i was interested in working for her doing postpartums and birth assisting as a paid "nurse." Apparently, her most recent nurse quit after 2 months. She was hired when the previous nurse quit after 3 months, and she was hired when the previous quit after... Yes, I've heard stories. Stories about being yelled at, stories about how wonderful she is, stories from doctors about the "crazy" things this midwife does. And it all intrigued me until recently. Until she asked me to come work for her until she is able to hire a "real" nurse. So, today I went and met her and spoke at length with her one long term nurse. We talked aboutthe schedule and expectations and we also talked about the practical side of surviving working with this midwife. I've been warned. It will be rough. She will yell. But...she is also a great teacher and I will learn a lot.

Aside from the anxiety of workign with this midwife, I also have questions in my mind as to how this will actually work since I will actually be working with TWO midwives. This new one and the one who I've been going with for the last two months. I've logged a good 30 births in the last two months with the other one. She's VERY laid back and is so easy to get along with. She trusts me (for as much as she knows me) and she is very open to a student finding their way and figuring out what works for them. In other words, she's easy and comfortable for me now.

So, we worked on the schedule, which will be four days with one and probably two to 3 days with the other. There is some flexiblity in that, but it will be a lot of time on call. And though I remind myself that it is temporary, it is pretty clear that for the next year, or at least a good six months, my entire life will revolve around birth. It basically has been for some time, but it hasn't been with the commitment that it comes with now. Scheduled=paid=commitment.

The other thing that gives me pause is the fact that this population (Plain- Amish and Mennonite) is so different from the typical homebirth population that I would generally plan on serving. The general population is basically healthy, well-educated about health and hygeine, and they have doctors and the Internet readily at their fingertips. They take a huge responsibility to know their options and exercise choices in decision making. Many people (myself included) refer to these families as higher maintenance with their birth plans and ideas for the perfect experience. but at the same time the level of responsiblity they take on themselves is freeing to their care provider. The Plain population is easy in terms of birthing and choices, but they also rely on their midwives for information and care outside of the general scope of practice of a midwife. For example, this new midwife typically gives the MMR vaccine to the babies. Already I have seen families call the midwife when the baby is in the car seat and is pushed off the woodstove (cold woodstove) by the older sibling. Or a 2 year old who falls 8 ft from a barn ledge and hits her head, fracturing her skull. They call the midwife (who tells them to go to the ER). And I know of midwives who suture children after accidents that require repair. All of this makes me so nervous. In this practice that sees 18-20 babies a much can and WILL happen. And will I miss something that I should have found. Will I miss a blood clot or a heart murmur? Genetic anomalies are common...will I miss a clue to a lethal something that could have been prevented. I've already been told that they typically attend 2 to 3 funerals a year. WHAT??? That definitely is not your typical homebirth population. And just as I had to rephrase my assumption that babies will choose breathing over eating , I am going to have to remember that much of the assumptions that we take for granted aobut birth being safe, really need to be balanced with the idea that things can and sometimes will go wrong.

For the time being, I am holding my anxiety in check. I know thiat this journey has been anything but boring to this point, and that there is a reason for everything. I'm confident that I can come out of this experience a better midwife and a better person, even if parts of it may be quite painful,

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