Ode to the IUD

Inside the uterus, we’re little T’s

Small and versatile are we

Teenagers come from their pediatrician

Determined to have safer sex, they are on a mission

Postpartum parents of all stripes

Love this flexible little device

Three, five, or ten years they’ll have you covered

Good for the monogamous types or those with many lovers

(As long as you cover the snake or the fruit,

you’ll have contraception for your passionate pursuit)

Not only good for baby prevention

The IUD is is a versatile type of invention

For those with Adenomyosis or for the pre-menopausal,

The IUD is great to help fix those periods that are awful

For the transman who wishes to be done with menses

The Mirena’s localized hormones has few consequences

And for high risk folks, or the hippy-dippy types

Those with the Paragard have (only a few) gripes

But if I’m being honest, I think the Skyla is silly

It’s only good for three years

And the box is pink and frilly

But no matter the type you choose, if you want long term contraception

The IUD will get the perfect reception!

 

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On Choosing to Be a Clinic Midwife

My pace of life is different now. There’s less sprinting from labor room to labor room. There’s fewer tears, less pain. My path is different, but my stride feels the same.

Being a midwife who doesn’t catch babies is a strange thing to explain to someone. They look at you like you don’t do what you say you do. Like your life should look like something it doesn’t.

I’ve explained before that I don’t think “midwife” is a descriptor of what one does, but is an attitude and a philosophy with which one delivers care. After the birth of my joyous baby E, I just could not imagine returning to a world in which I would be gone for 6 days out of the month completely, and another 6 in which I am exhausted and sleep for half the day. In short, I couldn’t imagine being a mother to an infant and mother the mothers, and be absent from my child’s life literally half the time.

It is the unfortunate reality in the U.S. that most full-scope midwifery positions do not offer a very good work-life balance. In other parts of the world midwives work 8 or 12 hour shifts, get adequate rest, and are able to have the kind of life I knew I couldn’t have. My partner and I thought long and hard about a change in my career path. Would we be able to make it work financially? Would this be a backwards step to all the hard work I had done to learn to be a baby catcher? In the end I chose my family, a great group of providers to join, and a return to the days of more gynecologic care and birth control work.

I still see people when they are pregnant, but no longer have my own patients, which has been the hardest thing to grapple with. I no longer watch families form, a cohort of women coming and going, changing like the seasons.

What I have gained though is the space to bring midwifery into places that midwifery usually doesn’t live. First pelvic exams. Well woman care. Contraception. Pain with sex. Menopause.

I’m given the space to listen deeply, counsel thoroughly, and talk with my coworkers about what midwifery is and why it is important.

I am about to insert my 100th IUD since January. I’m not sure when it will happen, but I’m on track to do it some time this month. Contraceptive work is one of my favorite parts of my job because it hands direct control of a fertile person’s future into their hands. It’s the reason I love abortion work as well, which I have also joyfully returned to in the last few months.

I worked a long day at our local abortion clinic a few weeks ago. I love listening to the stories of where pregnant people are in their lives, how old their other babies are, and where their plans for the future lie.

I talked with a young woman recently, not much older than myself. She had four children, and didn’t want a fifth. She had multiple health issues that put hormonal birth control off the table. She didn’t want an IUD. And she couldn’t find a physician to sterilize her. We live in a world that infantalizes women. We can’t make our own decisions to terminate a pregnancy. We can’t make our own decisions to know when our families are complete. In this moment, I had the joyful experience of being able to make my worlds meet. I knew the physicians I work with would help this young woman at my other day job. I just had to get her through her abortion today.

I had the wild and also completely normal experience about a week ago of catching a baby, completely unexpectedly. I was hanging around in the hospital, waiting to assist on a cesarean birth and a labor nurse ran in to grab me. The doc I was working with was tied up at the moment and they needed someone, anyone who could catch a baby. My reflexes sprang into gear and like a midwife lightning bolt, I followed the nurse down a long hallway. Not running, but doing the quick stride we all learn that says, “I’m in a hurry, but I am composed. Everything is fine, I will not run. Running signals an emergency. This is just an unexpected event.”

I saw a packet of gloves on the table, ripped them open and got them on just in time before a sweet, pink babe had made its way into the world. Catching that baby was at once like a reflex and incredibly foreign. My brain screamed at me that I don’t do this anymore. My heart yearned for the joy and pain, the relief and elation of a birth.

The days following this surprise baby had me wound up. Did I make a mistake? Did I leave birth too soon after starting down its road? Why did I give up learning its wily ways, its’ secret predictability, coming to it again and again like a long-lost lover?

The emotional high that follows birth eventually faded, as it always has done for me, and I was left with a clear heart. That world is still not for me. Not at this time in my life. I keep reminding myself that careers are long. There are many babes that will be born into my hands, but when I am ready again. When I have embraced the sweet early years of my son’s life and he needs me less. When my heart has fully healed and the disasters I have seen are distant memories, not still nightmares that play out when my brain finds unexpected triggers.

When I talk to patients in the office, they often ask if I might be one of the people at their births. I jokingly reply that I have hung up my baby catching hat. Hung up, but not retired. The hat I wear now is one that brings me immense joy, and is one that is called the Mamma hat. It’s the one that wipes tears and runny noses. Rocks softly in the twilight before bed, carries the hiking backpack up a mountainside, and watches a small person explore our world for the first time.  I wish I could wear all the hats simultaneously, and that the sexism of our society didn’t make me feel less than for prioritizing my child’s needs above an idealized career goal.

Baby E turns one next week. Just writing out that statement brings up an immense emotional response, but in this first year, I can’t imagine not being there and missing him fiercely in the long, lonely nights midwives often face.

The more I talk about leaving birth to focus on clinic work, the more midwives I have found that have done the same. Midwives that work in academia. Midwives that are experts on HIV. Midwives that do abortions. Midwives that are now hospice nurses. This is the beauty of midwifery. It’s is literally cradle to grave care, versatile and touches families throughout their lives. Right now, midwifery is just what I need it to be, and that is providing care that allows me to come home at night, sing my baby to sleep, and be there with him as the sun comes up.

 

 

 

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Birth

Dear Baby E,

I woke up crampy and tired the morning I went into labor with you. Sleep had been interrupted for weeks and our five year old IKEA mattress was not doing my back any favors. I tried to get back to sleep, but the cramps continued. Then I felt a trickle, almost a pop, and I knew it was starting.

You were always an extremely active baby in your watery pool. Now that I have gotten to know you Earthside I firmly believe more than ever before that certain aspects of personality and temperament are just something you’re born with. You continued to roll and kick, poke and prod, and I had faith you were starting to make your way to us.

The cramping stayed irregular, and it was a bright, sunny day. The heat had broken, and it was a cool, beautiful summer morning. We decided to walk to the coffee shop up the hill and see if I couldn’t get things moving. Through the day the cramping came and went, but was steadily picking up and getting more uncomfortable.

That afternoon we started watching a documentary about baseball, but it was starting to become difficult to concentrate. Things picked up quickly and I knew we needed to start the drive to the hospital, which, in the best of traffic would be a 45 minute journey. That day it took almost two hours.

By the time we reached the hospital, my contractions were starting to get intense, but I was prepared. We had done classes and practiced. We had our birth preferences written on a neat little sheet, and I believed deeply in birth. I am a midwife, how could I not?

But my confidence in the process had been shaken when I was pregnant with you, Baby. I saw terrifying emergencies of placentas detatching, a baby of a woman I cared for deeply in pregnancy stillborn into my hands, and  I witnessed a sweet babe leave this world after just hours with us.

These tragedies were difficult to shake while I labored with you. I snapped at the nurse when she couldn’t find your heartbeat with the doppler. My labor intensified, and my memory of this time becomes hazy. I know I walked. I know I moaned. I know I labored and labored and labored. I got nauseated. I felt exhausted. I felt the intensity rising. I had been in labor for about 18 hours, and I was sure the finish line was approaching. No one had checked my cervix yet, but when my midwife looked up at me I knew she had awful news. I hadn’t dilated much more than I had when she saw me in the office a few days prior. It completely devastated me. I felt so far from you, Baby, so far from the sweet, normal birth I wanted.

So I walked and I labored. I pulled all the strength and reserve I had to continue on, to force myself forward with every step that brought the contractions closer together and more intense. In those wee hours before dawn, I began to come undone. I felt as if one more contraction might be the end of me. I hadn’t slept and had hardly eaten in 24 hours. It was time for some relief.

Everything around this time has stayed hazy to me, but the sleep I experienced after the epidural was the most relaxing and rejuvinating sleep I can remember. While I slept, they pumped my body full of hormones to make my contractions more effective and open the way for you into the world.

Around noon, I felt some pressure, and significant progress had been made. I was elated. You were plugging away, your heartbeat always steady and sure on the monitor, so strong and clear. That evening all my cervix had melted away, and it was time to push you into our arms. The epidural made it difficult to work with the natural urges of my body, and after three long hours, you had hardly budged.

Then my midwife started having the conversation with me that I have had with so many women. The talk that starts, “You’re doing so amazing. You’re working so hard to get this baby out. But they’re not coming. I’m going to talk with my back-up physician.”

In some ways, I had always had a feeling deep down that I would need a cesarean birth to bring you safely into the world. Your Papa wanted this least of all, because he hates blood and surgery.

We moved into the operating room in the early morning hours, and your Papa stood over the curtain to tell us what I had knows from the time you were the size of a lentil: that our baby boy was here.

They placed you right on my chest, and the first thing I noticed about you was the dimple on your right cheek, your dark, downy hair, and that you were a full three pounds heavier than anyone thought you would be! My midwife told me you were a stargazer, your face lined up with my bellybutton instead of my back, which helped to explain the long, difficult labor and contractions focused deeply in my back.

The next few days were long and painful ones, mostly because of your tongue and lip ties, and our trip to Children’s Hospital, where we waited 48 long hours to try to find out if you had a life-threatening infection or if you were just dehydrated from not being able to eat.

When you made your way into the world, Baby E, a little bit of my heart left my body and is now living on the outside. Motherhood has challenged me in ways that I could never have imagined, as has given me the most intense feeling of solidarity with all other mothers I know or have ever known.

It has been 8 extremely long and, at the same time, incredibly short months since you wiggled into our lives. Our routines are starting to make sense again, with your added joyful smiles and belly laughs lighting the way.

I made a promise to myself long before I became your Mama that I’d continue being me, and hitting the 8 month mark and realizing that I had abandoned my writing hit me hard. I think I was trying to figure out a way to write your birth story in all its joy, its pain, and its heartache. To write what happened and feel proud instead of shame that my body had failed you and me.

Today, I buckled you into your carrier and walked to the store to get something sweet for after dinner. It started to rain and you arched your back and looked at the sky as the big raindrops started to hit your button nose and your cheeks and your sandy hair. A big drop hit you right between the eyes and a look of shock and astonishment crossed over your face that looked exactly like one of my own expressions. I see myself in you every day. I see you starting to grow into the gorgeous human you will become, and now, 8 months later, I can only feel proud.

Welcome to the world, Baby E.

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Liminal: The State of Betwixt and Between

I was texting with a friend the other day about the state of being almost. Almost done but not quite. She compared it to being at mile 20 of a marathon. You’ve completed so much already and there’s only six miles left. But after 20 aching, limping, unending miles, those last 6 miles might as well be 100 for as far away as the finish line feels.

I use a lot of sports metaphors in my midwifery practice. During IUD insertions I tell women we’re rounding third base after measuring the uterus and there’s just one more step between them and solid birth control for 5-10 years. I tell women who are facing down transition, that state right before pushing their babies into the world, that we’re almost at the top of the mountain. I often use the marathon metaphor to describe pregnancy. I have never run a marathon, but I did bike from Seattle to San Francisco after completing midwifery school. Pregnancy feels about as close to the most physically and mentally demanding thing that I have done short of that nearly 1,000 mile bike ride.

Everything I have experienced in this pregnancy has been absolutely normal, and I feel so incredibly lucky to not have faced significant complications that many women I care for face. My job and ability to support my family has not been threatened by my pregnancy, no matter how much I have whined and complained about the nausea, hip pain, back pain, exhaustion, difficulty sleeping.

I have changed a lot of how I talk to the folks I care for over the past 9 months. I didn’t anticipate my own pregnancy changing my practice so much, but, just like pregnancy, you can’t know it until you’re in it. I feel more deeply, listen more closely, reassure more thoroughly, offer more hugs and grounding touches.

I haven’t written much throughout my pregnancy, and not because I haven’t had anything to say. It’s that there’s too much to say, and I cannot write about it in a public forum. Those who are closest to me know that through much of the spring I carried the weight of bearing witness to incredible traumas in my professional life, which severely impacted my ability to feel deeply the emotions of my own pregnancy, bond with our soon-to-be-born little one, and helped me to recognize that I was suffering from prenatal depression myself.

After a lot of talking with my partner, finding a great counselor, reconnecting with good friends from both within the midwifery world and without, and lots of tears, I am finally starting to feel ready to enter my own birth space while having released and processed the trauma I have seen these past few months.

Up until this week, I used to lightheartedly remind women at the 36 week mark that they should be physically and emotionally prepared to be pregnant for another month at least, possibly closer to 6 weeks. After a full night of crampy on-and-off-not-doing-anything-but-being-annoying contractions, and knowing that I myself, possibly am facing down that much more time of pregnancy, it no longer seems like something I could say lightheartedly. It’s actually possibly the worst thing that I could have been telling women all this time, at least, it feels like it to me.

I feel almost blank. A tabula rasa, only knowing what has lead me to this point and not knowing what lies beyond as I entering this time in between; not yet a parent and not quite not a parent. In anthropology, we refer to this time as being in a liminal state. In my pre-midwifery life, I studied anthropology and was a student of ritual, rites, and was especially interested in the process of social transformation.

Rituals all around the world generally involve three steps: first, separation, then liminality, and finally reintegration. In the separation stage, the initiate, or person undergoing the ritual is in some way separated or made different from his or her peers. The liminal state represents transition, and finally, the initiate is reintegrated into their society or social circle with their new status.

Liminality is a state that is marked by a lack of structure, and often thought of as a powerful or even dangerous time in a person’s life and always temporary. It is a state that is, as the anthropologist Turner described it in the 1960s, as “betwixt and between.”

There are a few other times in my life I have stood in a state of liminality: those first shaky breaths prior to beginning my first reading of the Torah at my Bat Mitzvah, standing under the chuppah at my wedding, and now I feel I have entered yet another intense state of liminality before the birth of our first child.

Bringing a baby into the world is one of the largest rites of passage that we experience as human beings, yet in our modern world, there is little ritual associated with not only the birth of a baby, but also with the birth of the mother. There is little space made for women and families not only to prepare physically, but also mentally for this new journey in life. There are many jokes made about “hormonal” pregnant women who will cry and laugh and act “crazy” at the end of their pregnancies. What I believe we are experiencing is the intense emotional and physical separation from our peers while we enter this liminal, dangerous, and unstructured time at the end of pregnancy but before parenthood. This is what I feel I must now convey to women. That they are feeling on the edge because they are. That this is normal, and that this stage of liminality is essential to their preparation for the next part of this journey.

When we rode our bikes out of the door of our too-tiny apartment and clamored onto the ferry to take us across the water to begin our bicycle journey three years ago, we had no idea what the journey would be like. I imagined that it would be hard, but I couldn’t anticipate the deep fear I felt of failure, the intense physical experience of climbing upwards and upwards, mile after mile, hoping we were strong enough to make it all the way down the coast. Half the time I wished we had never hatched up this insane plan to begin with.

But then the day came, warm and bright as we packed up camp for the last time. We serenely pedaled along the lagoons of Point Reyes Station, entered Marin county, and climbed the steep ramp to the Golden Gate Bridge. The wind made it impossible to hear our whoops and hollers of joy and I had never felt so triumphant.

The best metaphor I can think of for this pregnancy has been that bike trip, as strange as it sounds. At night I would lie of my sleeping bag, stare up at the orange interior of the tent that I had gotten to know all too well and picture what it would feel like to cross that bridge. It is what kept me pedaling through rain and dampness that didn’t go away for days. It’s what kept me pedaling after I had a breakdown on the side of a busy Oregon highway, declaring that I just couldn’t do it anymore.

Now, as I lie awake at night, little feet adorably jamming themselves into my ribs, I picture what this new little life will look like. Will they have my hazel eyes and olive skin? Will they have the bright blue eyes of my partner, his laugh and wide smile? What will it feel like to pull this baby onto my chest, triumphant, at the end of one incredible journey, my liminality ending, and integration into the world of motherhood beginning?

Just like all the women who have stood at this place before me, I don’t know what lies ahead, but having intimately watched the strength of birthing women for years, I can only trust in my body and this little body inside me to know what to do when we pedal up to the bridge.

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Baby Blues

I could feel myself backing up into the corner of the room as a newly postpartum family sat sprawled out on the bed talking with my mentor and sage midwife, Ciska. I was trying to shrink, make myself as small as possible; I was an alien observing the overwhelming and unfamiliar emotions flooding the room.

Everyone was crying. The new mother was sore, exhausted, milk just starting to come in. The new dad was gingerly holding his baby with the sweetness and unfamiliarity of not knowing exactly how to hold on to this squirming new creature. The baby was wailing and hated the scratchy velcro straps around her hips and legs, a common sling used to help rectify newborn hip dysplasia.

“Oh sweetie,” said Mom through tears, glancing over in my direction, “Everything’s fine. Just normal stuff.” I tried to tamper the surely wide-eyed, terrified look in my eyes and scooted a few feet closer. I watched with awe as Ciska skillfully and easily asked about aches and pains, breastfeeding, sleep deprivation, and navigating splitting baby care between the new parents. These parents were three days postpartum, right when the “baby blues” can really start to hit. Everyone’s exhausted, no one has slept in at least the last three or four days, and the reality of life with a new baby is starting to sink in.

Roughly 80% of new parents experience the Baby Blues, periods of feeling overwhelmed, completely out of your element, and having immense emotional highs and lows. Most of these feelings resolve by about the two week mark, but its when they don’t that we see the Baby Blues morph into postpartum depression or anxiety. All the studies we have tell us that we do a terrible job of taking care of postpartum families–medically, emotionally, socially.

Up to 20% of birthing parents experience postpartum depression, and roughly only 15% of those ever receive treatment. Most large practices see women for postpartum rounds at the hospital, which,  even in the best case, last about 15 minutes and are focused mostly on the birthing parent’s physical well-being. We then release new parents with their tiny cargo into the world until their six week visit with some loose guidelines on when to call and some big red flag warning signs.

I sat with a woman four weeks postpartum last week, other young children running around her ankles, pulling things out of drawers, her postpartum screening score (a tool with which we use to diagnose postpartum depression) through the roof. The lines under her eyes were almost as deep as the folds of the blanket surrounding her month-old infant.

“I don’t know about that, I really think I’m fine. I’m just tired, that’s all,” she kept insisting to me again and again. Her insurance doesn’t cover counseling. She isn’t open to using medication. Her support network lives on the other side of the country. I have a thirty minute visit to discuss the benefits and risks of starting medication and common misconceptions about postpartum depression, while also assessing her stitches,  discuss breastfeeding problems, bleeding, figure out a birth control method, conduct a full exam and a pap smear if she needs one.

We are letting our postpartum parents out of the plane without a parachute. Not to mention the sparse care we give to new parents, I often have patients calling my office for notes to go back to work 10 days, two weeks, three weeks after giving birth because we live in the only industrialized nation not to provide any paid parental leave to new parents. It almost seems like a cruel joke that we wonder why our postpartum depression rates are so high and our breastfeeding rates are so low when we, as a society, do absolutely nothing to support new families in one of the greatest transitions that they will experience.

I take all this in, hold it close, and think about what my own postpartum experience will be like. I have the incredible luxury of a partner who is willing, able, and excited to care for our baby once I go back to work.  I will be honest though. Most days I am completely terrified of missing out on my budding family’s life, the little milestones and small joys, and I think of the long days and nights I will spend with a breast pump instead of feeding my baby while I care for other people’s families.

So how do we fix this? Below is my Postpartum Wish List. Some of them feel pie-in-the-sky unrealistic, some would simply be expansions of current programs that I see offered to (or can be afforded by) some, but only those with means.

  1. Fully paid parental leave for the gestational parent and their partner (if they have one) like every other industrial nation (compare to other country’s policies here)
  2. Postpartum doula support for the first few weeks to help with laundry, cooking, cleaning, and errands
  3. In-home postpartum visits by a nurse or midwife at 3 days, 1-2 weeks, 3-4 weeks, and 6-8 weeks.
  4. Universal, free access to groups like PEPS (Program for Early Parent Support), which, according to their website is “a session of 12 weekly PEPS meetings brings parents together to share the joys and challenges of parenthood and develop confidence in their own abilities. PEPS stands apart from other new moms groups or dad groups by providing ongoing neighborhood-based resources and peer education, facilitated by trained volunteers. During one of the most vulnerable periods for new parents, PEPS provides immediate and accessible support, creating “extended families” that often last a lifetime.
  5. Single-payer insurance which would fully cover counseling services for parents needing counseling for either postpartum depression or anxiety or for the transition into parenthood.
  6. Once parents return to work, in-office, free childcare that can continue to nurture breastfeeding relationships and family bonding.
  7. Comprehensive sex-education, universally available and accessible contraception and abortion services to help ensure that every child is born to parents who are ready, willing, and able to care for them.

I imagine a world in which I get my wish list fulfilled and think of all the joyful, strong, and confident families I would see at my six week visits instead of so many where I feel as though I am sticking my finger in a dike.

Reproductive justice has many points it addresses, but encompassed in its definition is the full care of families when they do chose to have a child. We have yet to see paid parental leave and many of the other things on my wish-list emerge into reality, or even to be discussed in most spheres. So for now, I’ll keep dreaming, talking, and agitating for a world in which my wish-list is a reality.

 

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On the other side of the exam table

Well, the cat is out of the bag with our friends and family that I’m pregnant!

Half the reason the blog has been so quiet lately is that this pregnancy has been affecting every waking moment of my life, and if I were to write, I couldn’t not write about it. Even in this short time it has affected how I think about my profession and changed the way I practice and discuss things with the folks I care for.

From the day I found out we were pregnant, I began my long (and on-going road of) constant, daily nausea. I’m talking every-single-minute-of-every-single-day-and-even-when-I-wake-up-at-night kind of nausea. I write about this not to complain, or garner sympathy, but to underscore exactly how difficult pregnancy can be physically and emotionally. To be completely honest, I have been humbled at the feet of this great unknown in the past 11 weeks or so.

When I think about the way I used to think about or recommend remedies to the women I cared for, I think, “I would have slapped me If I had been my midwife. Just stay hydrated? Oh, have you tried ginger, and saltines before you get out of bed in the morning? Try eating small frequent meals. Try all of that first before we jump to the bigger guns of prescription medications.” Yeah.

None of these things has worked for me. None of these things tend to work for pregnant people who have severe, unrelenting nausea. Even zofran, which is a prescription medication that is given to chemotherapy patients, has not been helpful. I have had to step out of exam rooms, delivery rooms and operating rooms to try and control my nausea before re-entering.

I discuss these unpleasantries with such frankness because I know that what I am experiencing is normal and common. Close to 80% of pregnant people experience nausea and vomiting. What this knowledge has left me with is an unrelenting awe at the power and strength of pregnant and birthing people.

In some ways, I already felt this reverence and awe, but truly knowing the physical and emotional toll such illness can have has further increased that feeling. For the first time in my life, I can empathize with the people I am taking care of, not just sympathize.

Most people’s early pregnancy symptoms dissipate by 12-14 weeks of pregnancy, coincidentally when it is conventional for couples to share their good news. So what does this mean? That we, as a society, by convention, leave pregnant people to keep their suffering to themselves. Many pregnancy apps and blogs have “helpful pointers” on how to hide the fact that you’re not drinking or how to keep your needed trips to the bathroom at work concealed from the suspicion of co-workers and bosses.

Not only does that mean that we are leaving women to suffer in silence and without support, but it also means that we are leaving people to miscarry in silence and alone. Most miscarriages occur prior to 12 weeks of pregnancy, and this woman’s devastating tale of grief  and her thoughts of feminism following her miscarriage was deeply moving to me. She writes:

For us (in American culture), miscarriage is a solo and secretive happening. Women miscarry alone, isolated by the 12-week rule: Don’t announce your pregnancy until the second trimester. The thinking here is sensible. One in four pregnancies ends in miscarriage; most in the first three months. A woman who does not announce her early pregnancy will not have to announce its loss. She can move on in privacy, as if it never happened…

The more I considered it, the more I became convinced that the silence around miscarriage was connected to feminism’s work around abortion. How could I grieve a thing that didn’t exist? If a fetus is not meaningfully alive, if it is just a collection of cells – the cornerstone claim of the pro-choice movement – what does it mean to miscarry one? Admitting my grief meant seeing myself as a bereft mother, and my fetus as a dead child – which meant adopting exactly the language that the anti-choice movement uses to claim abortion is murder.

While the feminist circles that I run in definitely don’t take such a hard line that would leave people to believe that the grief people feel after miscarriages is unjustified because a “fetus is not a person,” I do believe that this author is scratching the surface of battles that are not often fought by the feminist movement.

This rough first trimester has made me an even more staunch advocate for reproductive justice and free abortion access than I ever was before. It has also made me deeply ponder the purgatory that couples who are facing fertility issues, or for whom a wanted pregnancy does not come quickly or easily experience. I know so many kind, wonderful people who have desired parenthood for a long time, and have had to try so hard, that it almost makes me feel guilty that this thing came so easily to us.

The beginning of this journey has also changed how I talk with people about their fears or lack of knowledge surrounding their own bodies or their pregnancies. I have always tried to convey empathy for those who are scared or who have seemingly infinite questions, but even through my best intentions I sometimes think to myself, “Can’t they google this?”

Being on the other side of this journey, being the one going through it has given me fresh eyes with with I view all the pregnant people I care for. I had one day of light spotting a few weeks ago and my heart raced and panic set in before I could remind myself that this was absolutely normal. I have found myself re-googling which fish are safe to eat and in what quantities, and I still worry when I forget a day or two of prenatal vitamins. I am awash constantly with these feelings, and I am the so-called expert on these things! In a world where so few people know the ins and outs of their own bodies, let alone what is normal or not normal for a pregnancy, I have tried to reset my mind. Hear my own, panicked voice on the other end of the phone.

So now I speak slower. I listen deeper. I make sure to ask how my patient is feeling and offer condolences, understanding, before the advice. Because sometimes everyone’s had enough of advice. Eat this. Don’t eat that. Have you tried this? What about that?

What about just listening? Just connecting with another human being who will take in your frustrations, all your fears and your feelings and has known them herself?

Midwife means “with woman,” which I have always loved, always held so dear to my practice. As I enter my third year of midwifing, I’m excited to experience the childbearing year along with the families I take care of and bring new meaning to being “with woman.”

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How I learned to get over my social anxiety and love group prenatal visits

One might ask, how is it possible to have social anxiety and work in a field where you are constantly meeting new people,asking them to tell you about the most intimate details of their lives, and form meaningful, trusting relationships in 15 minute visits?

Excellent question, dear readers. It has taken many years, lots of self-talk, and lots of practice.

There is a myth that seems to exist that those who go into the health professions and midwifery especially must inherently be outgoing and comfortable in social situations. Rewind to the night before my first midwifery clinicals:

I am sitting on my bed, rocking back and forth, terrified about being in a room alone with a patient come the next morning. I was a nervous wreck, envisioning myself stumbling over my words, unable to explain basic concepts, dreading forgetting to ask important questions because I was so nervous. But above all else, I was scared that my patients would see me as scared, awkward, and stupid.

Spoiler alert: midwifery students are often scared, awkward, and stupid. And they are supposed to be. They are full of knowledge and passion, but maybe haven’t figured out how to not slime themselves with ultrasound goo all day long. Instead of dreading this very reality, it took nearly the whole of my first year through school to stop comparing myself to people who have been practicing for years to embrace the awkwardness that comes with learning this profession.

Through school my biggest help was role play with classmates, practicing little shpeils in my car on the way to clinical, running scenarios in my head, and attempting to find ways to make myself comfortable so that I could make the women and the families that I cared for comfortable (hint: fake it ’till you make it is a real strategy).

There was no easy fix and I felt awkward (and still do sometimes) well into my first year of practice. Why do I tell this story? Because just as I was beginning to feel comfortable and competent after moving from the GYN world back to working in OB, I was asked to do something no one with social anxiety likes to do: facilitate group prenatal visits.

My practice recently began a Centering Prenatal Care program, as described from the CenteringPregnancy website:

 Centering is a multifaceted model of group care that integrates the three major components of care: health assessment, education, and support, into a unified program within a group setting. Eight to twelve women with similar gestational ages meet together, learning care skills, participating in a facilitated discussion, and developing a support network with other group members…

Through this unique model of care, women are empowered to choose health-promoting behaviors. Health outcomes for pregnancies, specifically increased birth weight and gestational age of mothers that deliver preterm, and the satisfaction expressed by both the women and their providers, support the effectiveness of this model for the delivery of care.

I first learned about Centering while still a student and loved the idea that prenatal care could not only be something that women engage in individually, but that provides for a social connection that is so often lost regarding pregnancy in our society. Gone are the days of elder mothers and grandmothers who guide us through this vulnerable time, leaving most women to feel like they are in a singular journey.

Not only did I love that prenatal care could occur in a group setting, the entire philosophy of this care is focused around the notion that instead of having the “Expert” (midwife or doctor) give all the answers to the questions of the “learner” (patient), this model recognized the diverse life experiences of women and their families. In Centering it is not my job to provide answers and make sure that the question gets answered in the most quick and correct way, but instead to elicit the knowledge and experience of the women that I am in the group with.

Furthermore, women take their own blood pressure, weigh themselves, keep their own shadow-chart so they can track their pregnancies. Not only does this de-mystify what we do on our end, but also gives women a greater sense of control and engagement in their care. It very much embraces the Montessori model of “teach me to do it for myself,” which is another philosophy that I have come to love.

The Centering model mirrors a radical pedagogy of education that I hold dear and that is put forward by the Marxist philosopher Vygostky. His theories are mostly related to child cognition and development, but profess that social interaction and culture are large parts of how people learn and also emphasizes a group, facilitation-style learning model. This is starkly different than the “banking” model of education, which assumes that knowledge can simply be explained by an expert and “banked” into the knowledge bank of the learner. If you’re feeling industrious, I definitely recommend reading this article on Vygotsky’s revolutionary theory of psychological development  

So, as we have established, in theory, I could not be more excited to participate in this model of care. In reality? I was nearly nauseous during the Centering facilitator training I did a few months back, envisioning awkward group conversations, groups spinning out of control, and yet again, ended up rocking back and forth on my bed basically trying to figure out how not to feel like this:

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I have now had two group sessions using this new model. I can wholeheartedly say that, while mildly awkward the first night, the vibrance, excitement , and diversity of experience the women and families that are in my group bring far outstripped my fears.

In the first two nights I learned more about these women, their families, and their pregnancies than I often do after working with folks for the entirety of their pregnancies. Everyone laughs, brings food, and even though the folks in my group come from very different backgrounds, watching them bond over their shared experience brings me so much joy.

It is easy to see now why this model has so many positive outcomes, including fewer preterm births and higher breastfeeding initiation and continuation rates. My patients bring so much insight and excitement into each group that it is easy to see how women become more empowered and feel more in control of their own care and their pregnancies.

I’ll keep you all updated over the coming months working with this new model of care, but for now, this is how I’m feeling about our blossoming Centering practice:

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