As the sands shift in my own life and I make choices about what to move towards and what to let go of I feel like a river rafter, looking ahead for the big turns and also dealing with all of the waves around me.

Last week the direction of my path through midwifery training changed somewhat.  My preceptor offered to train me for a position as a midwife assistant, which would give me an avenue to attend more births as well as giving her a support person trained in specific skills.  This role differs somewhat from that of a student midwife at a birth.  A student does a lot of observing and a lot of filling in the gaps as needs arise.  Her goal is to learn the spectrum of midwifery skills and competencies by staying in the flow of births as they unfold, learning what she can, and doing what the senior midwives ask her to do.  A midwife assistant has certain responsibilities of her own which she generally performs without direction.  She is less available for the broad scope that the student is open to.  Of course, there are times when extra hands are needed for something beyond her usual duties, but for the most part her role is more specific.

It is an exciting prospect for me to train as an assistant because my status as a student not yet matriculated in an academic program keeps me from attending births with a midwife as her apprentice.  But as an assistant I can attend births freely, and even have the potential for being paid for my work once I reach a certain level of skill, whereas students are essentially doing work trade for education and are not paid.  I know that I will take pride in having my own role to play and in having useful, even critical skills to offer to my preceptor, the birth community and the families I will serve.  And it takes off some of the pressure I had been feeling about quickly finding a way to finance the academic program as a single mom who struggles somewhat with keeping my several part time income streams compatible.

The top priorities at the moment are getting to more births and consolidating and increasing my income so that I can get back on my feet some more and gain more financial independence before I enroll in school.  (Thank goodness for child support, but I do look forward to the day when I won’t be so dependent on it.)  To that end, my preceptor has also offered me some paid part time clerical work in her office.  True, clerical work is not the most glamorous of things, but it does help me greatly to understand in depth the behind the scenes workings of an independent midwifery practice.  And the addition of that income will mean that I can let go of my massage job at a chiropractor’s office, which will in turn mean a reduction in the stress of worrying that I will be called to a birth and have to cancel, reschedule or even compensate massage clients there.  I am so fortunate to have wonderful, understanding clients in my private practice who are willing to be flexible with my call schedule (you know who you are!).  And I am feeling very grateful for my preceptor’s thoughtfulness and support in finding a way to make midwifery training work for me.

With all of this comes also the necessary development of beginning to look into preschool or part time day care for my two and a half year old daughter.  Up to this point I have made a very high priority of being home with her myself as much as possible, and I have been blessed with friends and family who have generously given their time to take care of her when I needed help.  She is reaching an age now though, and I am reaching a point professionally, personally and in my studies when it is time to look for something additional in terms of childcare.  She’s such a social little girl, I think she would enjoy the company of other children and the stimulation of shared activities with new people.  And I have more work than I can really do in the hours available to me (not to mention actually trying to have a social life beyond mother’s group and the local park!).  So I’m hoping that I will be able to find the right balance of a place she and I both love for her and which I will be able to afford.  If only Montessori had a scholarship plan…  :)  Perhaps as I gain birth experience what I can earn as a doula will make that easy.  Or perhaps the other new direction in my life (a side venture as a distributor of some really awesome, medical grade healthy chocolate) will open some doors for me and my little one.  Keeping my fingers crossed.

As I’m writing all of this, an image persists in my mind.  It is of a midwife at the feet of a birthing woman, ready to catch the newborn child as she emerges.  At that moment, there may be several things going on in the room, and there are certainly many things going on in the hearts and minds of the other people in attendance.  Movement, voices, emotion.  The midwife holds an awareness of the experience as a whole, and yet at the same time, her direction is clear.  Her focus is right in front of her, with the woman and with the child about to be born.  An art.  And a science.  And a great inspiration for me.

After a long week of seeing bodywork clients, going to meetings and interviews, doing book keeping and business development,  studying, and continuing to mother my daughter through her current difficult patch, I jumped in my car early Saturday morning, headed to Oakland (about an hour away), where I taught a massage class for nine hours (I am on staff at the McKinnon Institute of Massage).  I managed to get my toddler to bed around 10:30pm, and actually went to bed myself before midnight for the first time all week.  Then I somehow got myself out the door again this morning, accompanied by some ferocious menstrual cramps, and headed off to spend five hours doing prenatal visits with women whose upcoming births I will be attending as their doula.  After all of this, I am exhausted.  And I didn’t even have a birth this week.

It is a blessing that I love my work.  I love it enough to burn the midnight oil at the computer or at the side of a laboring woman, then turn around and entertain and love my little girl all day, then nurture, comfort and support my bodywork clients in the evening.

Regular patterns of sleep and work must be let go of to a certain degree for anyone working with birthing women.  I never know when a client will go into labor or how long the experience will last when she does, or what the process will hold for any of us.

I remember being at a birth assisting my mentor doula a while back, sitting in the hospital waiting room at 5am while the mother we were attending got some rest.  It was the second birth within 24 hours for my mentor, and she was feeling pretty wiped out.  Then her phone rang.  It was another client of hers in labor.  She skillfully and compassionately counseled the mother and made a plan of action.  Then she hung up the phone, closed her eyes and said “I am in hell.”  She hadn’t slept in the last 24 hours, and the prospect of sleeping in the next 24 had pretty much just evaporated.

I could not really understand at that moment how she was feeling – how the privilege of attending these three women was not cancelling out her fatigue.  I was green!  :)

About ten days later I was called to another birth, this time with one of my own clients.  I put my own daughter to bed, then went to the client’s home and spent hours helping her cope with the pain, making suggestions about comfort and positioning, providing emotional and informational support, and all of the other things that are part of the work of a doula.  Then, as morning approached, I realized that she was not truly in active labor yet and that we would not be nearing the birth for quite some time.  And I thought, “I am in hell.”  So there it was, my own physical and mental fatigue coming face to face with my passion for birth, and, for the first time, the fatigue won.  It was not that the desire to support this woman and her partner had somehow decreased.  It was just that my body was reminding me of my own needs, and I discovered in a new way what kind of self care is necessary in order to provide good care to the families I serve.  Fortunately for me, on that occasion I was able to rest a bit in another room and return feeling somewhat refreshed, but that is beside the point.  I will face moments like that one many times in my career I’m sure.  Hopefully I will learn from them and move through them with relative grace, and hopefully I will become more skillful at taking care of myself while I also become a better caregiver for others.  A big part of that is releasing the desire or, really, the reflex to judge myself for having the need.  It is easy for me most of the time to be without judgement for the needs of my clients, yet when it comes to myself I seem to think I should be limitless.  A good example of that is the first time I watched and epidural being placed:  I felt like I was going to either throw up or pass out or both, yet I was so concerned about not not leaving the woman’s side that I almost didn’t make it out of the room on my own two feet once I admitted to myself I needed some air. The truth is, making those choices and taking the actions that support me in those situations is actually the most supportive thing for the family too.  I’m sure that having the doula momentarily absent was much less disruptive than seeing the doula hit the floor!  I suppose the challenge is in striking the right balance.  After all, the desire to forgo or forget my own needs comes from the same intense commitment to women, families and the birth process that will make me a good midwife.

As a midwife but also as a single mother and entrepreneur I will always walk hand in hand with fatigue to some degree, whether it be the intensity of sleep deprivation and being on my feet in a hospital all night long or simply the tasks and responsibilities of daily life in my shoes.  My hope is that the fatigue will help me remember to invest as much in my self (and my family and other aspects of my life) as I invest in my work and the amazing women I serve.

Waiting is an idea and an experience integral to the birthing process.  It begins for some before pregnancy as they wait for conception to occur.  During pregnancy there is often a very impatient waiting for morning sickness to abate, for the right moment to share news of the pregnancy with family and friends, for the first perception of the baby’s movement in the womb, for the day when a trip to the maternity clothing shop is in order.  And later of course there is expectant waiting for labor to begin.

Waiting is often quite a big part of labor and birth, which I think comes as a surprise to many parents.  There are usually several hours or even days at the beginning of labor when not much is really going on aside from some often infrequent or irregular contractions which, though they call the mother’s attention when they occur, don’t ask her to do much in between.  Mothers (and fathers) may find it difficult to know what to do with themselves during this time, and although midwives and doulas will almost always advise restful, relaxing, nourishing activities, couples often have trouble complying with that in their great excitement over the coming birth.

As labor progresses, the well being of mother and baby are monitored, and in most situations there is at least some sense waiting for the mother’s cervix to reach full dilation (at 10 cm).  Certainly many mothers in the midst of coping with the challenges of labor find themselves wondering when they will reach that point.  I myself remember clearly wanting so much to ask my support team “how much longer?” while laboring with my daughter, even though I knew they couldn’t tell me.  Care givers too await full dilation, the completion of what we call the First Stage of labor, not being able to predict with much accuracy when it will occur, as we prepare ourselves and the birthing space for the birth itself.

The Second Stage of labor is the pushing stage.  This is usually a much more active and less lengthy part of the process.  The mother works together with the strength of her uterus to move the baby down through the birth canal.  Midwives and other support people expectantly watch and monitor well being as the baby descends.  As the baby crowns, the most difficult aspect for the mother may not in fact be the act of pushing the baby out, but rather the act of waiting and resting even with so much intensity of sensation between contractions to allow the perineal tissues to stretch and the baby to rotate.

And then the baby is born, and we enter the Third Stage.  We wait for the first breath and sounds.  We wait (briefly) to assess the mother’s bleeding.  We wait for the placenta to be born and perhaps for the umbilical cord to stop pulsing as it delivers blood to the newborn.  We wait for cues from the baby that it wants to begin to breastfeed.  And so on.

So much of the time duration of pregnancy and birth is not spent in action or fulfillment, it is waiting.  What is the greater part of the experience then?  Of course, perception of these is individual and varies greatly with circumstances.  To quote part of Albert Einstein’s explanation of relativity, “Put your hand on a hot stove for a minute and it seems like an hour.  Talk to a pretty girl for an hour and it seems like a minute.”

It appears to me though that there is something extremely valuable, if less tangible, in the quiet spaces in between milestones.   We are standing on the edge of Mystery in those moments, and, especially as labor intensifies, we are challenged to surrender beyond what we previously thought possible.  Growth also tends to take place in the space between things.  Children in fact do most of their growing while asleep, their inner resources and energy rallying without the need for conscious direction.  Perhaps it is the same with birth.  If we can only allow ourselves to release into the quiet space, we can experience it’s potential.

I think that’s true for me too and my own process of waiting.  When I allowed myself to soften into the in between-ness this week I found that I suddenly had space to enjoy time with friends, remember my inner world, and even get a pedicure!  And there is a lot of good in that.

I was talking about what these words mean both to me personally and in a broader sense this morning with a wise friend (my mother), and she brought a perspective that made a lot of sense.  She pointed out that courage, commitment and love all have a lot to do with choice.  She is absolutely right, of course.

Courage is all about choosing to move through a difficult, frightening or painful situation.

Commitment to anything or anyone involves the choice each day to continue.  It is not something which can be decided once and settled forever.  It is a living agreement.

Love may be born spontaneously within us, but we must choose to foster it, fortify it and allow it to guide us.

Choice is also at the very heart of midwifery care.  One of the most important roles of the midwife is to support women in discovering their options, present well rounded information, and provide guidance in decision making that is centered in the woman, rather than outside of her.  Every woman and every family is different, and learning to provide truly personalized care is what I think of as a heritage skill in midwifery, and one that is so important to revive in the face of today’s medical care structure.

I personally had never experienced actual informed consent in health care before I received prenatal care from a midwife.  And it felt revolutionary when I got it!  The fact that I was treated as equal in intelligence and competence was such a surprise (which is a rather sad commentary on contemporary medical practices).  And the fact that I was not only “allowed” to make decisions about care for myself and my baby but expected to make those decisions instead of quietly “following procedure” was a powerful learning and growth experience.  I am sure that I have become a more confident and curious parent because of it.

The idea of choice in becoming a midwife has a slightly different flavor.  There are many midwives who feel that going into midwifery for them was not a choice as such, but rather a call that they were unable to resist.  I have heard midwives say “Sleepless nights, so much responsibility, so little respect in society, so much time away from family, no vacations, not much money.  Who would choose this?  It must be an undeniable call or else you’ll never make it.”  Of course, you have to balance that with the joys and honors of a midwife, like witnessing women at their most vulnerable and most powerful, being present as children enter the world and their mothers’ arms for the first time, having real and fulfilling relationships with the women we serve, assisting families in realizing their own resourcefulness and speaking their desires.  Sharing the intimate and transformational experience of birth is no small reward.

But even if midwifery is a vocation, choice is a theme and a practice that is ongoing.  There are many paths to becoming a midwife, so there is an important choice at the beginning.

In California, there are three main pathways.  One is to go to nursing school and then complete a specific program in midwifery.  The result is a title of Certified Nurse Midwife.  CNMs most often work in hospitals, but birth centers and home birth are also available to them.  The next is to enroll in a MEAC accredited academic program (to be completed as a distance program since there are no local brick and mortal schools) and to complete clinical training as an apprentice to a Licensed Midwife.  Upon completion, you are a Certified Professional Midwife, and are eligible to take the Licensing Exam.  If you pass, you are an LM.  The last pathway is to do gain all of your skills in a hands on setting without doing an academic program, and then completing the California Challenge to demonstrate knowledge and proficiency.  That then makes you eligible for the Licensing Exam, which, when passed, results in the title of LM. Licensed Midwives in California may work in birth centers and in private practices doing home births.

I am pursuing the middle path of apprenticeship paired with academic study, and it feels like a good fit for me.  I really enjoy both aspects of this type of education, although I haven’t yet begun the distance portion of my academic program (I have completed some in-person classes thus far), and I’m a bit nervous about how I’ll handle so much independent study.  Fortunately there are other students in my area for me to collaborate with.

I could go on all afternoon about choice in midwifery, but I think I’ll leave it here for now.

I’d like to leave you with a favorite quote of mine having to do with the idea of choice.  May it inspire you as much as it does me.

“There are two ways to live your life.  One is as though there are no miracles.  The other is as though everything is a miracle.”  –Albert Einstein

Courage.  Commitment.  Love.

All three are needed, in generous amounts, by students and experienced midwives alike.  And all three have many layers of meaning, subtleties which bloom with time and experience, as the midwife herself does.  Of course there are many other words I could have chosen.  The themes and demands of this work are abundant.  But these three words in particular strike me as a good place to begin.

I hope to express what these powerful words mean to me as well as to the amazing women and families I work with, and in so doing, honor the call that brought me here, the curiosity brimming in my mind and heart as I begin, and the deep gratitude I feel for all of the wise women and men who have come before and left me such a rich inheritance.