This was an assignment for a recent course that I found particularly helpful. Sussing out how we might react to experiences as student midwives before they happen can help us navigate the hardships that come along with midwifery as a career. I hope sharing this might be helpful to other student midwives and even doulas and birth keepers. We cannot keep others without first addressing what we ourselves need. And this goes beyond surviving, because we want more for our clients and communities than to just survive.
Prompt 1: As a midwife, you should promote to your clients the benefits of self-care, which can be challenging in the best of circumstances. What plans do you have for maintaining a healthy lifestyle myself during this time? Include your plans for routine exercise, healthy eating, proper rest and relaxation, visits to your healthcare providers, spiritual/mental wellbeing.
Scenario two asks the student to identify self-care strategies and plans for maintaining a healthy lifestyle as a birth professional. Though this is an area I have been working on for some time, I believe some shifts are still needed in order to feel more balanced as a busy midwife. I currently exercise about two or three times each week and see a need to increase that to at least five days a week if my body is going to sustain a taxing career like birth work. My current go-to for exercise is an affordable gym in my neighborhood that takes about five minutes to drive to. Though I enjoy my time at the gym and even feel motivated to go there more often, it is often inaccessible as a workout location because I drive all over the county for births, prenatal visits, postpartum support visits, and more. In my ideal world, I could just take walks and stretch on the grass at a park or the beach nearby. However, I am fair-skinned and burn within minutes in the sunlight that Orange County is known for. So, I recently began speed walking inside local malls and have been enjoying that.
Of course, this solution only applies to daytime hours. Therefore, I intend to incorporate yoga practice into my routine when on overnight visits with postpartum doula clients or during a break at a birth. I don’t need a mat or even much space to practice a short standing flow, which means I have no excuse to stay immobile when my body is calling for action. Yoga practice has been a part of my life for many years now and I even became an Orange County Yoga Teacher in 2015. It is the only thing that routinely brings my mind to a relaxed state when I am anxious or busy-minded. Integrating simple breathwork into my daily life has helped me refocus in stressful moments more times than I can count; I aim to set reminders in my phone or on my watch so I can take a three-minute mindfulness break every hour where possible and believe this will aid my overall mood and temperament.
My diet is one area that I finally feel solid about. After years of health issues, including a bezoar and lack of naturally occurring acids to break foods down, I now have a well-rounded diet centered around real, whole foods. I protect my gut bacteria by eating prebiotic and probiotic foods such as yogurt and kefir, pickled vegetables, and raw dairy products. I also traded in conventional grains for more vegetables and the occasional sprouted bread. Add quality protein and organic produce to the mix and I am feeling pretty good about my foods for the first time in years. Luckily, Orange County is full of farmer’s markets, organic farms, and grocery stores that provide access to quality foods. I am also fortunate in that my spouse is a homemaker and takes the lead on shopping, preparing foods, and packing my meals. Whether I am headed to an overnight postpartum visit, a birth, or clinic day, I know I have enough food with me at any given point to last many hours or even a couple days. I also keep high quality meal replacement bars and copious amounts of water in my vehicle’s emergency bag.
The areas I need the most improvement include sleep and routine healthcare for myself. My sleep is often broken up because of my work schedule as a postpartum doula and I am positive this will continue as I move forward in midwifery school. To ensure I get enough when I am in a clinical placement, I will need to scale back drastically on the other work I do within my business. I just will not have enough time for all the various appointments on top of overnight doula support, prenatal clinic days, and births. Even in a slower apprenticeship, I can see how quickly the hours will slip by and I know I do not learn or perform well without adequate sleep.
In terms of healthcare for my own body and brain, I can fully admit that I am inconsistent at best and negligent at my worst. I let things like dental work get pushed for months or even years when I get busy. This is made even more complicated by the fact that I do not have dental insurance, so no access to care here in Orange County, and must travel half a day to Mexico when I need a cleaning, filling, etc. One way I plan to remedy this is to be up front with my preceptors about my need to take a couple days off every other month to attend to medical appointments. I cannot afford a dental or medical emergency mid-semester while I am in an apprenticeship, so I need to get ahead of it when I can and schedule wellness visits at routine intervals.
Prompt 2: Your neighbor has hired your preceptor as her midwife, and you have been anticipating the birth for months. At 32 weeks, the client makes a request to your preceptor that you not attend their birth. You will still be seeing them occasionally at prenatal appointments. How will you balance your disappointment (and hurt feelings) in a healthy way and maintain your professionalism?
Scenario six introduces the possible situation where a student midwife is asked not to attend a birth by a client. I feel like this is likely to happen at some point and am appreciative of the opportunity to explore my feelings around it ahead of time. Since I am so early on in my program, I cannot say for sure what I would experience in this situation; I am positive, however, that my feelings around losing a birth I planned to count would probably depend on the stage I am at as a student. If I was an assistant midwife at the time, I could see myself being a lot less disappointed and frustrated than if I was a primary midwife under supervision. I might even go as far as to say devastated when describing what I would feel if I was asked not to attend a birth in the primary phase.
This is partly because the light at the end of the tunnel would dim a bit if I missed out on a birth. I also think it would make me question whether I had the skillset necessary for midwifery as a career if I was asked not to be at a birth when I had been acting as a primary midwife during the prenatal visits. I would have to process this with my preceptor and objectively assess what I was lacking, if anything, that created an unsafe relationship between the client and myself. I also recognize that the choice may not be about me or my skill level as a midwife at all. It is entirely possible that someone would be uncomfortable for personal, private reasons. Perhaps being a neighbor feels too intimate or like a boundary would be crossed if I was an attendant at this birth. Or perhaps she just does not like my voice or overall presence. It is also possible that there could be no specific reason and just a general sense from the client that I am not a good fit for them.
No matter the reason, whether known or not, I would have to find acceptance for the client’s preferences and choice. Ultimately, I believe people should be able to choose who attends their birth, sees them at their most vulnerable and most triumphant, and gets to share in those private and special experiences. This is something that hurts my heart in hospital settings; clients never get a choice in who shares or influences their birth and knows their story. Reminding myself of this value would be important if I was asked not to attend a birth. Repeating to myself that the person is simply exercising their right to be as comfortable as possible with their birth team would be helpful in processing. And as far as professionalism goes, I would gently validate at the next prenatal visit (if my preceptor approved) that it is 100% okay to select your birthing team carefully and that I understand. I would not want there to be any feelings of guilt or awkwardness experienced on the part of the client if I am to attend future prenatal visits.
In order to get ahead of this type of situation, I intend to strategize with preceptors to address any inconsistencies in care styles as I know this is one factor that would create challenges as a student. I know that clients hire the midwife, not the student, so helping them see me as part of that midwife’s team is key early on. This is something I have a bit of experience in working as in a doula team. My doula partner and I spent a great deal of time and energy getting on the same page or working to approach and communicate things similarly enough so as to never create a dichotomy that led to clients leaning toward one birth doula over another. I truly feel that figuring out where I differ from my preceptor in speech, beliefs, and actions-and then discussing these differences early on-will help limit situations like these.
Amanda Cagle is a professional doula, educator, and student midwife located in Orange County, CA who offers comprehensive services to growing families and birth professionals alike. Amanda can be reached via email at firstname.lastname@example.org or through www.yourbirthteam.com.