Back into the World of Birth

“That’s the way, all the way down. Down and through”

The words flowed out of my mouth naturally, fluidly, like it hadn’t been a year and change since I last said those words to a woman about to meet her baby. The thump-thump, thump-thump of the fetal heart monitor played mindlessly in the background; a familiar, joyful sound track. It almost felt like I had never hit pause on the baby catching part of my midwifery practice.

But some things were off. I struggled to get my gloves on quickly, my hands sweaty. The nurses hesitant, wary of this new unknown midwife. I sorely longed for the familiar smiles, my comrades in birth who could read my mind and my face. Who I trusted implicitly in the scariest parts of the night.

Today, right after I gave a woman medications to help soften her cervix prior to terminating a pregnancy she asked me what I like about my job working in an abortion clinic. I paused a moment. Patients don’t often ask me this question in the abortion world.

“I’m a midwife,” I replied. In my mind, that answer was self-explanatory. “I love guiding people through transitions. Abortion. Birth. Miscarriage. Menopause.”

I was looking at a picture of myself five years ago today. My wild, waist length wavy hair flaps in the breeze at Deception Pass on a spontaneous day trip. I was different in every part of my being. Half way through my final year of midwifery school, living in an apartment so small the two foot table we used for dinner had to be folded up during the day, broke and falling deeply in love with an equally broke, adventurous bike-riding Northwest man. I squirmed in my own skin the way early twenty-something women do when they’re always the youngest person in the room.

I look around my home now. My ketubah, a contract signed on my wedding day with my husband (the bike-riding Northwest man) hangs on our walls among family photos. A small table and a tiny chair sit pushed up against the wall with a little vase full of vibrant violet flowers picked by my son’s joyously chubby fingers. Board books and fairy tales have infiltrated my bookshelves previously packed with Marxist and feminist literature. I speak up firmly and confidently. I have the answers and this time I know I’m right. My body looks different; it has made the transition from maiden to mother.

So many of the changes we experience in life are gradual, each day changes us in small ways, so much so that at the end of five years I look back at that picture of the dreamy-eyed student midwife and I hardly recognize myself. But our lives also follow a bit of Darwin’s theory of punctuated equilibrium. The things that really change us, that force us to adapt, are often sudden and stark. There is a before and an after, and we are left to make up the difference.

A squalling, brilliantly pink babe emerged just moments after my encouraging words above. The flood of hormones and adrenaline protecting this new mother’s brain from the full comprehension of how drastically her life has now changed. Not all moments us midwives live for are these heart-stopping, dramatic changes–we love all the little transitions, too. Ushering someone through a first pelvic exam. Their first birth control method. Starting to try to get pregnant. Discovering their sexuality and coming out for the first time. We love it all: the molasses-slow changes that happen year to year and the giant, flashbulb-memory type changes.

I left birth because I needed my transition into motherhood to be the focus, not helping others through this one particular transition. As I pulled home from the hospital that night, I heard my key click in the lock and could already hear the cries of, “Mama!” from behind the door and I went through my daily transition from midwife to mama.



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I stare at my blinking curser, long after my last patient has gone home. I can see the long line of cars on the highway from my office window, their red tail lights like a swarm of angry insects. Everyone is on their way home. Everyone but the midwives.

I have spent my day counseling, asking delicate questions, touching people as gently as I know how, joyfully listening to baby heartbeats or delivering unexpected news. And now I have to write it all down.

If you had asked me to describe to you what my life as a midwife would look like before my training, I doubt I would have told you that roughly half my time would be spent sitting at a computer, fighting technology, and clicking buttons in a charting system. So many buttons.

Some days I am able to keep up with my charting and right after the visit am able to put my thoughts to “paper” and can swiftly move on to the next person. This has become a distant notion from the days when I was still building my practice. Now, I routinely see 15, 17, 19 patients in an eight hour day, many with complex gynecologic issues. It has also been made all the more impossible by having a delightful, but extremely time consuming, midwifery student this quarter.

Having a green midwifery student this quarter has forced me to slow down my usual rapid-fire pace of reviewing histories, asking questions, and conducting full exams in the blink of an eye. It has also forced me to take a hard look at all the things I do, say, and write about my patients.

The medical record has long been a sacred document that not only allows us to write down our observations about the people we care for, but allows us to show our thinking process and engage in the applied science of nursing. Every nurse also knows the old adage that if it isn’t charted, it didn’t happen. Charting serves as a way to communicate to ourselves for the next time we see the patient and show progress, or lack thereof, in treating a health issue. It also allows us to communicate with each other about our plans and a person’s overall health. It is also extremely time consuming and tedious.

As a teenager I sat on a cold table, the paper beneath me crinkling with every movement. I think of all the words I have seen in other patients’ charts. Psychosomatic. Dramatic. Non-compliant. Argumentative. Drug-seeking. Many of these words lie in my own chart from over a decade ago. I saw neurologists, endocrinologists, internists, chiropractors, psychiatrists, acupuncturists, and finally a rheumatologist, before a diagnosis explaining the cause of my chronic pain finally came.

These words riddle the charts of women. These words undermine patients and their stories before they even walk in to see a new provider. It is easy to write, “patient refuses. Patient will not. Patient defensive.” This style of charting exposes the deep power imbalances and systemic sexism and racism that are rampant in healthcare.

The words we chose in our charting matters in how we think about the care we provide and the provider/patient relationship. I tap away of my keys madly while my midwifery student watches every word appear upon the screen. “Patient states…” appears. And slowly I hit the delete button. “Sharon says…” This simple act of writing down names in our charting rehumanizes the people we see day in and day out under a deeply dehumanizing healthcare system.

It is easy to lose track of this deeply human aspect of healthcare, tucked behind our computers, typing away on a screen. For this reason I refuse to do my charting in the room. This flies in the face of what every single administrator has told me since I have been in practice. It’s more efficient, they all say. Put your lab orders and tests in right there, as you talk! Type out the patient’s history as you chat.  I have so many buttons to push and i’s to dot and t’s to cross in order for my charting to meet both billing guidelines and nationally mandated “meaningful use” measures that I cannot safely and competently conduct a visit while doing all these things. In order for most of us to keep up with our busy schedules and run relatively on time in our day and not leave an hour (or more) of paperwork at the end of our day, many of us do chart in the room. But I think a certain part of the intimacy of providing health care disappears with their use in the room. 

As I teach a budding midwife all the aspects of midwifery, not just what happens inside an exam room, but outside of it, has me recommitted to infusing my charting with the feminist principles that I hold so dear. How hard is it really, to write down a name? To explain that a patient declines with informed consent? The patients we care for bare their souls to us, terrified of judgement, and we owe it to them to be respectful and kind in our retelling of their stories. 

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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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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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