whitewriter | 5 things i dislike about midwifery and 5 things I like about it (Reply)

Been trying to find time to craft this post over the last few days, but time has escaped me. I was aiming for 10, and I'm trying to avoid hate. So then I decided that I must equally think of things I like about the profession as those I dislike.

So here's 5 things I dislike about midwifery and 5 things that I like about it.

Things I dislike:

1. The difficulty of advocating for women when you've just met them.

To really know their needs and wants -- or to think you know them because you've been presented with a birth plan that they wrote, with who knows what understanding or knowledge, and they get there -- and everything they said they didn't want to have done, ends up being what they chose.

2. That you tell people best practice, and either you couldn't convince them or they had other ideas about what you said and they just do their own thing.

I get that people make their own choices that suit their own situations or belief systems. But often I do wonder that my words just fall on deaf ears. or I haven't said them at all. Or the person just wants another explanation and instead of saying "can you explain it again" to the next person, they out right declare that no one has talked to them about it.

3. The debate about should women have set ideals of what they want or if they should go more with the flow.

Some midwives have said: you plan for a good birth. It doesn't just happen.

And others have said-- if people just quit whining and just got on with it, it wouldn't be so hard. I'm in two minds about this. Both of the above camps usually come from women who have had children before themselves. I sit outside that camp so I haven't yet really made my mind there.

4. Vaginal exams

Just the idea of having to do them on a timely schedule. To invade womens bodies at times when they may not need them, just cause its policy, or just cause we're running an IOL, and therefore now that we are interfering with nature, we need to check things are going as they should. VEs are a tool that I think, is overused at times. Its a very crude tool that you only learn how to use from experience of doing them and then conferring verbally with someone else who is more experienced than you that then, performs the same test. So open to interpretation and subjectivity that with time, should improve. Coming from a science background, -- and whilst I knew what a VE was, I just didn't realise how frequently we'd have to do them. The amount of screaming and carrying on and crying the woman does at times when we are "having" to do these, can be tantamount to us, midwives feeling like we are raping these women.

What a horrible feeling. Yet we need to put on that hat where we need to know whats going on, and therefore, this is a test we need to do to get the info.... So either other midwives don't feel that horrible feeling and instead see it as a necessity. Or others just override that feeling.
Or you can be like me and just feel like shit and sick to your stomach when you know you have to do one and you're really really worried you won't accurately get the answer and therefore it needs to be redone. When you're inside, and doing the VE, and fishing, and you just can't find it and you try to give yourself that extra minute to get the answer and all the meantime your sweating bricks, feeling like no... you haven't got it, wait, try the corner. or the right corner. or the middle. or just nup. -- The lady is watching you and feeling you and it's at best uncomfortable! And you pull out like some sort of impotent clinician. Answer unknown, horrid test to be repeated.

5. The emotions involved

You'd think ICU is emotional, and it can be. But there's nothing like the emotion behind people experiencing the creation of their first family. They're fully alert for the experience and remembering (at least for the period that your there) everything you say, and do for them. There's often tears involved, either because things are going right (and the baby's here and everyone's happy - happy tears) or because things are going bad and the woman is scared and we're going for an emergency procedure (trial of forceps or c-section). The anxieties about birth. The husbands face some fears, hiding behind the bed sometimes. Or sometimes, right next to you, learning your every move, some of it on film aka. Mrs Philippines that wanted 12 kids from last week(not sure which is worse).

Women trying to elucidate from you the best decision regarding c-section or no c-section for a multiple pregnancy: I've had this come up twice now (this is a topic I want to be able to discuss more fully with someone ... but I need to put it on my research list). It's like I can't make the decision for you lady. I don't have to live with the consequences of either choice. I still feel their emotion and I can just see it tick in their heads -- and that feels really painful.

In ICU a lot of the consultants will make the decision for the family or at least word it in a way where there isn't really a choice. In midwifery when the doctors do that I feel like they're robbing a woman of their ability to advocate for themselves. That morally they're forcing a decision on a woman that impacts her life whilst in ICU it feels more like the doctors are taking away some of the awfulness of the situation, by not giving them much of a choice. Feels more clear cut towards a morally correct standpoint (at least by my morals) compared to obstetrics.

This may be something I dislike, but the ethics of it all --- is extremely interesting and something i do like.... perhaps to understand it more in a academic context rather than right in my face as it happens.

Things I do like:

1. The camaraderie of Hospital midwives.

We can bitch to each other about the difficulty of certain women, about weird phone inquiries we get to each other and have a lot of understanding about how that feels -- even if its non-women ed chat. Some women and or their families are nightmares, and that's got nothing to do with "woman- ed" but everything to do with no one is perfect. And culture clash is a thing, everywhere. I should know, I experienced it all throughout childhood with my parents and didn't realise it at the time until after the fact. Midwifery overall is a lot like nursing (which isn't a good thing for the profession considering the overall goal of a midwife: to promote normal, natural birth and breastfeeding, to promote best practice that's evidence based, to promote women's choices). Nurses always have an army full of "there was this one patient" stories. The midwives are not a bad lot at SSH. They're going through a rough patch at the moment, but overall they're doing their best. They don't feel like the manager is on their side, and that can't really be helping the situation right now. But overall, they're a pleasant bunch. They're probably the best part of my day.

2. Having an amazing birth happen right in front of me. A rarity, given this demographic and population of SSH. But it does happen.

3. When it's quiet, it's really quiet. (Then when it's busy it's really busy)

I sort of enjoy both camps. I would probably prefer busy (that's probably why I like the MAC cause every day its constant. It's rarely quiet). Busy is good because I'm challenging the brain.

4. Every day is different and you never know what's going to walk in the door or get assigned to you.

In ICU, if you're rostered to work Monday, Tues, Wed. The patients don't really change between those days (except if they're 1 day stayers) so by wed you pretty much know the floor, and can pretty much also predict who pre-shift who you'll get and know what it'll be like to have them based on what others have said about their patient. My classic make a conversation starter in the tea room "who do you have?" -- let them ramble for 10 mins...Or when I used to do incharge (best if it was a Tues: cause I could gain an understanding on Monday, and then use that on Tuesday) , then I'd know who's whose and what's what and if I wasn't access on the Wed well I knew what the day would be like. Women rarely stay in the birth unit beyond 12 hours, they might make it to 18.. a few times 24 hours... but it's probably going to go c-section and ward admission well before then. So the turnover is much higher. You're gonna have a different woman, every day. This can be a negative going back to how do you build advocacy and rapport in 5 mins. You can end up seeing someone a few times in MAC and then have them in BU. It happens. It seems nicer to me when that happens, because then you know a little something, and they know a little something about you too.

5. It's women's health and intrinsically I find the topic very interesting.

There are some ragingly interesting topics like borderline viability. Or IUGR v SGA. ... or just how the health system works with funding regards private v public patients and transfers to other hospitals if needed (like the woman who birthed privately, at 32 weeks and then had to have her baby sent to the public hospital because it wasn't covered by insurance... so she was privately covered but the baby wasn't - and they ended up separated in 2 different hospitals. Was this something she thought of, prior to this situation occurring? Did she actively choose not to spend the money? -- or wasn't keen on having the baby in the private SCN? What was the thinking here...). Overall health of women and their children and families and how the system itself works is an interesting topic.

There's this lady everyone's been talking about. I've only met her for about 5 minutes because I helped the midwife taking care of her set up the epidural line. I've been horridly un-women centered and I call her the urine lady. It sorta keeps her anonymity but also degrades someone to a single defining feature of their stay at SSH, but I can say that if I said her name most people might say “The urine lady” everyone knows exactly who I'm talking about. When I met her she was laying on the bed and she looked fairly normal. She's of some sort of Indian descent. Everyone's been talking about her because there's just something not right about her.

She comes from a family of 5, she's the eldest. This is her first baby. She's incontinent by choice (according to her family). Her sister sleeps outside her room incase she needs help going to the toilet. She wears incontinence pads constantly and or pads on her bed. Because even though she can hold in her urine, (supposedly) she doesn't? This has been demonstrated in front of staff where they're like "let me help you to the toilet" and then she's like no its ok I'll just do it here (and she peed on the floor in front of them)...

She's a citizen of Australia (migrated, I'm pretty sure) and her husband is stuck overseas (bad timing or did they marry for the paper? Wow. I am a horrible person but this was my first thought...). She ended up with a vacuum delivery (impressive, everyone was like just book her for a section) -- and theres social work involvement because there's real concerns she won't be able to care for the baby.

Post birth she refused to leave the bed "until she stops bleeding " (Well that could take 6 weeks lady, not to mention how will she clean her episiotomy and sutures - hello infection) and the grandma who apparently is a midwife, was helping her to breastfeed by squeezing the nipple into the baby's mouth... (we all know nipple feeding is not breastfeeding) ..It boggles the mind, how some people have children (apparently --- the method was also interesting. I'll have to ask the midwife that found out this story and come back to tell it. I wonder if "urine lady" and her husband did the point and shoot method and just "hoped for the best". That whilst others who desperately want children, and have perfectly normal everything - just don't even get the chance.