When I was a student midwife I always wondered what kind of midwife I would be.
Would I be one that takes a special interest in breastfeeding medicine and become a lactation consultant? Would I conduct research and go into academia? Would I be a bright, shiny midwife who cares for low-risk women who want no intervention and lotus births?
Five years into practice I have found my home as a grief midwife. In my first two years of practice I saw more heartache than many midwives do over the course of their careers. Part of it was me working with high-risk women, both socially and medically that lead to me seeing what most midwives don’t, but a big part of it was bad luck. I always seemed to be the midwife with the most miscarriages at New OB visits. Always on call with the family experiencing a stillbirth. The unlucky midwife who had seen too many codes.
This scarred me for a long time. Lead me to want to pull out of birth, out of creating deep bonds with women and families so that I wouldn’t get so hurt if things went awry.
I’ve dealt with my own grief. Grief so big when I was so young that it changed me. I let my grief as a new midwife overwhelm me and pull me apart. That grief coincided with my own journey with perinatal and postpartum depression leaving me barely able to take care of my own mental health let alone deal with the situational traumas I was witnessing in a healthy way.
Now, five years into practice, I have found my niche in caring for the grieving; for that too is a transition that needs midwifing as well. I am building a practice that allows me to specialize in caring for those experiencing miscarriage, depression, loss. I have supportive colleagues who are teaching me and learning with me as we break into new territory on what midwives can do.
I’m a sympathetic crier. Always have been. I used to think the empathy that overflowed from my heart was a weakness in my ability to care for those grieving, but the longer I do it, I realize it is a strength. So much of loss around pregnancy is so medicalized–made clinical and sterile. Miscarriage is the opposite of sterile. It is messy, both physically and emotionally. It is painful. It is raw. And sometimes all you need is someone to be really there with you, raw and vulnerable and sit with the fact that the bottom just fell out of the world.
I started my certificate in perinatal mental health today and our instructor warned us before starting the lecture that we were diving right in and that we’d be dealing with some hard stuff. The first slide loaded on the screen declaring that suicide is the third most common cause of death for women in the year following birth. We talked about misdiagnoses, dismissal by well-meaning primary care providers, and postpartum psychosis.
My mind immediately jumped back to an oddly quiet exam room. A patient insisting to me that if she went outside with the baby the shadows would follow her outside and she wasn’t sure if it was safer to stay or go, to disappear into the night. I desperately called our local perinatal psych unit asking to speak to a psychiatrist, any psychiatrist so that I could make sure my patient could get some help.
“Any other questions?” she asked me as my still-shaking hand had written down all of her advice and medications to send my patient home with.
I paused, not sure how to ask the terrifying question rolling around in my head.
“How do I know she’s not going to hurt herself or the baby before she can see you?”
A big sigh on the other end of the line.
“You can’t. You can just do this, and get her to follow up. I know it’s scary. But you did good. You caught it.” I set the phone down oh so gently on the receiver.
Diving into the dark and twisty world of midwifery isn’t for everyone. Hell, most people in their right minds run from it and try to remember that the darkness is weighed out in more than equal measure of joy and dreamy newborn lips. Just like we need experts in normal birth and joy and prevention we need midwives who are experts in loss. Experts in prescribing the big scary psych meds. Experts in walking through the dark valley, not leading, but being true midwives. Just walking along side. A witness. Just being with and among the grief.