Saturday, October 5, 2013

Guest Blog: How being a midwife helped me be a better physician

I stumbled upon this blog post the other day and I had to share. As many of you know, I am very PRO-Midwifery. So thanks to Aviva Romm for this insight - Rejoicing in the Present

I have many professional titles and roles: physician, midwife, herbalist, author, teacher.  Of these, being a midwife most informs and enhances all of what I do and who I am.
Midwife literally means “with woman.” But it also means, “to bring forth.” Midwives listen, coach, cheerlead, care, reassure, support, and speak truth. At my best, I am a midwife in all contexts – not just to the women I serve, but to my partner, my children, my friends, my patients. At my best I bring forth their best – their strength, confidence, and belief that they can do it. And as a midwife I am able to be patient about whether this happens quietly or with loud screaming! At my best I am deeply present and listen closely to what the people in my life are telling me. And I listen to the unsaid, as well.

When I graduated from medical school at Yale I was given an award as the most promising primary care physician in my state for that year. This was not a result of what I learned during my medical education. Being a midwife for 20 plus years prior to medical training imbued in me the art of caring that should accompany doctoring but too often doesnt. As a physician I care for my patients with the compassion, deep presence, and heart of a midwife, whether they are giving birth or being treated for pneumonia, whether they are trying to nurse their newborn for the first time, or have suffered a stroke, leukemia, or are in their last days of their life. And because the demonstration of presence and compassion is more rare than common amongst physicians, it was noticed.

It is my understanding and internalization of the midwifery model of care, which places a partnership model and a patient-centered model first and which treats the body as wise and self-healing rather than as a machine that requires repair that makes me the physician I am. It is being a midwife that informs the care in the health care I provide to all of my patients. And it is this true caring that inspires me to do what it best for my patients, and to truly know who they are as people, not diseases.

I not only midwife my patients, but their families at their hospital bedsides and in clinic rooms. I care just as I would for an anxious expectant father or other children at a birth. I bring the whole family in.

One evening a young woman came into the hospital in imminent labor with a 28-week pregnancy. It was the mother’s own birthday. She’d been out to dinner with her family to celebrate when her water broke and she began having back-to-back contractions. She arrived at the hospital “feeling pressure” and was found to be 9 cm dilated – nearly complete and ready to push. The baby was coming fast, and given it’s small size, didn’t even need full dilatation to emerge. We were in a small community hospital unequipped for the care of a severely premature baby, so it was quite a chaotic scene – trying to stall an imminent birth and arrange medical transport for the about-to-be newborn.
Obstetricians, nurses, and neonatal care specialists were frenetically running in and out of the room and the woman’s family had been brusquely asked to wait in the hallway outside of the delivery room. There were so many harried care providers in the room that my assistance at the birth was superfluous. So instead, I turned my attention to the laboring woman’s very scared family – her parents, sister, and best friend, explaining in detail what was going on, and what would happen – that mom was fine, baby would be born any minute and would be resuscitated as needed, and transported to a higher level care hospital. Mom could go with baby, and they could accompany her. I apologized for the chaos, and reassured them that I would keep them apprised. For the next 30 minutes, I did exactly this, stepping in and out of the room periodically to provide reassuring updates.
After baby was born (he was healthy and ultimately did quite well) and safely transferred to a larger facility, and the family was getting ready to leave, the sister came up to me. Unbeknownst to me, she was a hospice physician at a major hospital. She told me that what I had done was the most compassionate care she’d seen, and she wanted to commend me to the hospital. I thanked her and told her this would not be necessary. Isn’t this what midwives do? Care for the whole family?
To be a midwife requires one to step outside of the confines of self and selfishness. To be awake and present and loving and creative and generous and trans-personally connected even when we would rather be in the comfort of our own beds, deep in our own private dreams. It requires one to become truly present with those in our care. Being a midwife allows us to go deeper into the primal relationship of being human than any other experience – other than perhaps hospice, which comes close, and being a mother, of course.

It means letting the fears, dreads, concerns, worries of another wash over you and allows you to take all of these and spin them into a neat ball of confidence, courage, and grace that you hand back to the woman – and remind her that this was hers all along. And it is having a strong enough sense of self that we take no credit for the success of those we’ve midwifed – we are happy to be the invisible wind beneath their wings.

Midwives, in our professional roles, truly see everything life has to offer. We see sorrow, joy, triumph, suffering, loss, and ecstasy, and we see women work so hard it makes our own teeth clench just to watch. We see birth, death, and everything in between. I have comforted women in the hours of a miscarriage, through news of a late pregnancy loss, when an older child in the family is dying of brain cancer, when the story of their child, drowned in a pool accident years before resurfaces at the time of birth, when tormenting memories of child abuse, long buried, resurface in pregnancy, when a husband’s on-going extramarital affair becomes known weeks before a woman herself is about to give birth to same husband’s baby. And we know the intense resilience of the human spirit. We see people go on. And this is a powerful gift in our own “going on.”

We go to homes where there is not a clean surface in site and accept that cup of tea and drink it, regardless. We suspend judgment. We clean the house, wash the dishes, throw in a load of laundry.  Sometimes we do deeper cleaning too — of the heart, the mind, the soul.

We know that the woman’s story is all important to her pregnancy and birth experience and outcome. Unlike many physicians who generally tend only to the physical, we go deeper into the lives of our families, and are witness to aspects of the human experience that few know, in the intimacy of this process that is pregnancy and birth process. We translate this into all of our relationships. And we know when to suspend “being the midwife.”

I am so pleased to see midwives coming into popular cultural consciousness with deserved respect – midwife Ina May Gaskin winning the Right Livelihood Award, midwife Robin Lim being recognized for her work in Bali with a CNN award, Call the Midwife, the popular BBC series being aired by PBS and receiving popular acclaim. This world needs midwives – to care for women in childbirth – and to care. I would love to hear stories about your experiences with a midwife.

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