It is hard for me to believe, but I have finished (survived!) my first year of practice as a nurse-midwife. In school, everyone told me that the first year is intense, and I expected that, but I had no idea just how much I would learn and grow and more fully become the midwife that I am.
I have caught 80+ babies born vaginally in the past 12 months, and assisted on 40+ c-sections (some scheduled, some urgent, some emergent), and managed dozens of other labors, and seen goodness-knows-how many patients in triage (for everything from UTI and pyelonephritis, to appendicitis/abdominal pain/gallstones/nausea/vomiting/dehydration, to pre-eclampsia, to threatened preterm labor and actual preterm labor, to vaginal bleeding in pregnancy [from abruption or previa or having had sex the night before], to possible ruptured membranes, to vaginal discharge [pick your favorite reason for it, and I’ve seen it in triage!]).
I’ve had 1500+ individual patient encounters in the past year. Each time, that involves me reading through a patient’s chart, coming up with an idea what’s going on, making a plan in my head of what I might do, knocking on the door to the clinic room the patient is in, introducing myself (if we don’t already know each other) and my role as a midwife, asking about their health and any concerns they have, going through their medical history, allergies, current problems, medications, smoking status, sexual history, screening for warning signs, performing a physical exam, prescribing medications, discussing the plan with the patient, washing my hands, and going back to my desk to chart on everything I just did. Often I do all of this in 15-30 minutes or less, 15-25+ times per day. Holy moly, is that exhausting!
I have all of these incredible stories that I have collected inside my head over the past year. An aggregate of the specific issues I managed or helped to manage does not begin to delve into the full intensity of connecting with each individual and their loved ones during each of these events, but sometimes it is the best I can do here on my blog when I am so done after telling a patient’s story in their chart that I don’t have the creative energy left over to extract its essence in a form in which I can share it publicly without compromising my patient’s privacy.
Also, it’s been quite a year for me personally. I moved to a new city for a job, not terribly far away from my friends in Seattle but far enough that commuting back after work just never happened. I started that job, and fell in love with my work. I met an amazing person who became my partner, and we just recently moved in together, in an epic process of combining all of our stuff and our excessive quantity of animals into a single living space. Which necessitated another move, back to Seattle. Less than a month in our new home, and we had a break-in, in which a lot was stolen and my sense of safety was shaken. I developed a fistula and had surgery for it, and I was in the most pain I’ve ever felt in my life (which is saying something!). I am working on healing from that, still, and am reconnecting with myself and my body in very profound and important ways.
As a midwife, in the past year, I have gotten a rich variety of exposure to almost every condition I could imagine. (I say that now, and just watch–next week, something entirely new will show up on my schedule!) I have had the immense privilege of being present with people during incredible transition periods in their lives, as well as caring for them during the normal times.
I have sat with dozens of women as they labored to bring their babies into the world. I’ve held their hands, wiped their brows, held their puke bags, supported their perineums, welcomed their babies, delivered their placentas, sutured their lacerations, congratulated their families, and went to bed a tired and happy midwife.
I have slow-danced through contractions with tired mamas eager to meet their little ones, their babies in utero kicking me as we swayed.
I have caught babies coming at me from all sort of pushing positions: squatting, supine, side-lying, and hands and knees.
I’ve supported the use of hydrotherapy, birth balls, peanut balls, and birth stools in a hospital system, not to mention skin-to-skin, intermittent fetal monitoring, and early initiation of breastfeeding.
I have assisted surgeons in dozens of cesarean births and a few other surgical cases. I feel it is my job to make the OR feel a little less cold, more comforting. These hands of mine have touched skin, subcutaneous tissue, fascia, muscle, peritoneum, and organs. I have suctioned blood to keep the surgical field clear. My strength, from the outside, has pushed these babies out of their mothers’ bodies. I have gripped their now-empty uteruses, massaging them firm to minimize blood loss, then holding them in their outside-the-body position so they can be sutured closed. I have helped suture and staple bodies shut after surgery. I have assisted in tying Fallopian tubes when the time for baby-having is over. My feet feel grounded in the OR, and I consciously breathe in the antiseptic air, grateful that I can play this role, though surgery is not at all why I went into midwifery. (I really like the low risk, normal patients!)
I have seen hundreds of people in clinic for routine annual exams, and I feel the weight of holding their health in my hands. I have assessed their health risks, asked about their sexual well-being, screened for domestic violence, examined their breasts for masses, Papped their cervixes, and palpated their pelvic organs. I listened to their fears about their health and helped promote their well-being in as holistic a way as I can, recognizing that wellness neither begins nor ends exclusively in the body but involves the entire person (mind/body/spirit) embedded in their sociocultural framework. Individual wellness cannot be separated from social justice.
I have performed hundreds of vaginal exams, and I have gotten consent every.single.time. No exceptions.
Three sets of twins gave me the honor of helping to welcome them.
I caught two babies born in the caul. Lucky little kiddos, those ones.
Fetal heart tones in the twenties is without a doubt one of the worst sounds I can recall.
I have seen what happens to fetal heart tones when the placenta halfway detaches from the uterine wall during labor and blood flow to the baby drops drastically. Can I just say…YUCK!
Numerous women with scars on their uteruses victoriously pushed their babies out into my hands.
I know what a true crash c-section looks like, and what it means when every second counts. I have shed happy tears when a baby we were very worried about came out screaming and peed all over me.
I have witnessed a severely hypertensive woman’s mental status change just before she began seizing from eclampsia, and I rushed to help the team save her life and that of her baby.
I have seen many women before, during, and after their miscarriages. I have held a tiny pregnancy sac in my hands, and have gently extracted retained placental tissue that was causing bleeding after an incomplete miscarriage. I have sat with devastated clients who lost much-desired pregnancies, as well as with confused or relieved clients, or people feeling many things at once. Loss is complex, and heart-wrenching, and it evolves on its own timeline. Early pregnancy loss is very common, and despite the fact that I know my clients will very likely be able to have a healthy pregnancy in the future, I can sit with them in the intensity of losing this unique and irreplaceable pregnancy and hold space around that with them. And I do, usually at least once or twice per week.
I’ve worked with folks who wanted to be pregnant and were not. I’ve worked with folks who were pregnant and did not want to be. I worked with folks who were not pregnant and wanted to stay that way. And I worked with folks who were pregnant and were delighted about it. My job was to support all of them, and provide them the highest quality reproductive health care possible, regardless of which category they fell into. I’ve helped folks prevent pregnancy as well as plan for it as well as navigate the ins and outs of it once they had a positive test. And I feel honored every time.
I have seen placentas do all kinds of normal and funky things, from velamentous insertions to true knots in umbilical cords, to retained placentas requiring surgery or manual removal, to bits of membrane left behind causing too much bleeding, to cords avulsing (snapping off). I have a profound respect for this phenomenal creature, the only organ in our bodies that was intended to be truly temporary!
I’ve felt the presence of my midwife grandmother standing in the corner when a baby came out with terrible APGAR scores and I found myself running my first neonatal code blue.
I have inserted dozens of long-acting reversible contraceptives for people who want a highly-effective form of birth control for now and still to reserve the option of future fertility. The flip side of that is that I have counseled numerous women on contraception and have had quite a few come in to me for prenatal care a few months after I gave them birth control pills, but none of my patients (so far) have gotten pregnant with IUDs or Nexplanon. I am passionate about educating everyone that comes to me about effective contraception!
A young woman came in laboring only to discover that her baby was no longer alive. She still had to do the arduous work of giving birth, compounded by the enormity of grief. She pushed her stillborn baby into my hands, hands which had never touched a dead body until that moment. I came to visit her the next morning and she asked me to hold her baby, who had been in the room with her all night. I cradled the infant in my arms, marveling at the tremendous beauty of this child and at the utter wrongness of babies and death coexisting.
I have worked with numerous sexual abuse survivors in the clinic and in labor, and I do my best to ground myself first (knowing that with my own rather extensive sexual trauma history, I could get triggered and need to focus on good self-care) and then to be as aware of the special needs of this population as I can. I am able to show up and hold space for someone who comes to me in clinic for STI testing shortly after an assault, or to help give control back to someone in labor who feels out of control of her body. I feel very proud of this work that I do.
I have helped folks in abusive domestic relationships find resources to help them with whichever stage of the process they are at, whether they need a safe place to stay immediately, or a listening ear to talk about previous abuse.
I have learned that cancer is a hard thing to tell someone that they have. It doesn’t matter whether it is in their breast, their cervix, their uterus, their ovaries, or their vulva–saying, “The tests came back positive for cancer” never gets easier.
I have seen what an entire blood volume looks like on the outside of someone’s body. I would like to never see that again, but I know that my career will (hopefully!) span another few decades, and any number of things can happen in this time. Including postpartum hemorrhages.
I have seen almost every STI that exists, most within my first month of practice. I have encountered people with syphilis, gonorrhea, chlamydia (so much chlamydia!), herpes, trichomonas (so squirmy under the microscope!), hepatitis B and C, HIV, HPV, scabies, and molluscum contagiosum. I have treated pelvic inflammatory disease, cervicitis, vulvar abscesses, and more.
Oh, and BV and yeast–pretty much every day.
I have watched a strong young woman push out a gorgeous baby into my hands and then placed in the hands of the adoptive mother, who had dreamed of this moment for years. I have cried with both of them and sat in the midst of such intensity.
I have had to step aside from work for weeks, focusing my attention on my own body and my own healing. I have endured the most excruciating pain I have ever known, and have marveled at my body and its ability to heal. I have had to put on hospital gowns and identification bracelets and be a patient in my own hospital system. I’ve been wheeled down the hall into an operating room and given permission to someone else to cut me open so that I could work on putting myself back together. Healing is still a work in progress, always in progress, with ups and downs, but I am so grateful to be precisely where I am.
I am coming to understand in a deeper way that I need to clearly define where I end and where my patients begin. I am so empathetic that I can too easily take on someone else’s experience, especially when it resonates with mine, but this is exhausting for me. I am learning how to draw invisible lines around myself and say, “This is my body. This is her body. This experience is happening to her and not to me,” and this saves me a tremendous amount of emotional and physical energy.
These hands of mine routinely are the first contact a new person makes with the outside world. I have the privilege of, in the words of my friend Simon (who wrote an amazing poem on his becoming a midwife), “touching people inside people and calling them out.”
I have been a little hard on myself for not blogging more often like I did when I was in school. Then, last week, during a call with my amazing life coach, I had a moment of realizing that maybe being exactly where I am is just fine. Maybe just going to work, doing a great job caring for my patients, and coming home to my partner is enough. Maybe I don’t have to have extra creative energy right now. Maybe it is okay for it to feel different as a provider than it did as a student. Maybe I can be flexible and compassionate with myself in this time of transition, just as I was before I became a midwife. Maybe all that I’ve done over the past year, collecting these stories in my mind and body (if not very often on my blog), is sufficient for now. Maybe I am enough, exactly as I am now.