I talk about boundaries all day every day. Boundaries are absolutely essential for our well being: physically, emotionally, spiritually and mentally. I know the benefits, teach the concept, and encourage the formation of boundaries to women all the time. However, when it comes to my own life, boundaries are often blurred, obscured or completely absent.
My career is my passion but sometimes also my nemesis. Days are filled with working as quickly and efficiently as possible without giving the slightest impression that I am hurrying or not listening intentely to womens' concerns. I pray that I don't miss something in my pace or in my fatigue. Often my days are split between the office and the hospital, with my heart in both places but obviously physically present in only one. It's conflicting to say to a laboring woman that she is my priority when I am called back to the office, but women in the office have pressing needs that deserve my attention as well. Afternoons and evenings are often times a blur of finishing paperwork, returning phone calls, back and forth to the hospital and trying to find time to see my husband before he leaves for work. Nights are a toss up on if sleep or labor will come. Moon phases are on my radar like I never imagined.
How do I draw boundaries for myself without letting something slip? How do I keep my sanity and not fail to meet the needs of the women I am honored to serve?
Self-care is essential but seems out of reach and sometimes only wishful thinking. Burn out for midwives is extremely high and I'm sure there are a multitude of reasons. Low numbers of midwives providing care, lack of equal reimbursement for services provided, personal commitment to level of care women deserve and oftentimes do not receive from other providers, and a love for the miracle of pregnancy, labor and birth. These are just a few of the reasons that come to mind immediately.
While I struggle with these questions and with lack of sleep, I also know in my heart that I could not imagine any other path for me right now. So I press on and pray for strength, understanding, patience, wisdom and discernment. And most of all, right now as I head to bed, I pray for rejuvenating sleep!
Thursday, September 22, 2011
Saturday, September 17, 2011
Birth Trauma
Birth Trauma is an unfortunate reality in our world. Whether a woman enters her pregnancy with past abuse or experiences physical or emotional trauma during her current labor & birth, it is an issue of utmost importance and should be respected as such. It is multi-faceted and can have more of an impact on a woman's life than many people realize.
Birth Trauma can have its origination in past sexual, physical or psychological abuse. A woman may have repressed this abuse only to have it resurface during pregnancy, labor or birth. The vulnerability of labor may break down the walls of protection a woman constructed around herself, and can have tremendous impact on her birth experience. For some, the feeling of their baby moving down through the pelvis is so overwhelmingly negative that they physically and psychologically fight against it. I saw this happen with a young woman who never disclosed her history of abuse. Her labor was relatively quick for being a first time mother, and she quickly progressed from 4 to 9 cm dilated. When she started feeling the pressure of her baby's head moving down, and realizing the fact that her baby would pass through her vagina, she reacted with panic and fear. Within 30 minutes, her cervix closed to 6 cm and never opened again. Her eminent vaginal birth converted to a cesarean birth. In follow up care, she revealed that past abuse memories surfaced and were so overwhelming when she felt the pressure that she couldn't allow herself to move forward in birth.
Birth Trauma can be physical or psychological trauma that occurs during labor or birth, perpetrated intentionally or unintentionally by nurses or providers. It can also result from the physical nature of birth. While we all desire a calm and peaceful passage for babies, sometimes events unfold that can cause trauma. Vacuum and forceps are tools used occasionally to facilitate an operative vaginal birth. These tools can cause physical trauma that may lead to long-term problems for women. Unfortunately, there are people who attend women for labor and birth who intentionally cause trauma that can last the rest of her life. A woman I attended for birth came to the hospital with no prenatal care because her past birth trauma was so severe. Her 3rd child's birth was attended by a physician who is now in prison for sexual abuse of his patients. While 11 years passed from that time until the birth of her 4th baby, the damage from that experience greatly affects her still. She was unable to seek prenatal care due to fear and presented to the hospital 15 hours into labor. This was already longer than any of her other labors, which was concerning to her. Her labor was 28 1/2 hours in length and, especially during the time her baby was moving down, she appeared to emotionally distance herself from what was occuring in her body. The birth of her precious girl was a welcome surprise since her other children were boys. I pray that the care we provided to her will help to heal the past trauma in some way.
Birth Trauma can be psychological for women, especially if their labor and birth is not what they hoped for, planned, or expected. I find this most evident with women who prepare well for childbirth and then their labor ends with a cesarean birth. Unfortunately this type of birth trauma happens more frequently than it should because of our society and the elevated cesarean rate in the U.S. I feel that this type of birth trauma is addressed more frequently and many organizations exist whose purpose is to support women and help heal this trauma. I've also seen this type of birth trauma experienced by women who have, in my perspective, a beautiful and 'perfect' birth. One of my most memorable births was a first-time mom who had a waterbirth. One of my partners was also in attendance and we both felt that this birth renewed our spirits and exemplified what birth can be. We were both shocked when, upon her 2nd pregnancy, she discussed how she was traumatized by her previous birth experience. She felt so out of control, in so much pain and fearful that she would die that she was very anxious about repeating this process. A good portion of her early prenatal care involved processing her past experience and helping to heal and move forward with confidence and anticipation instead of fear and trepidation. Her 2nd waterbirth was so similar to her first, even down to the words of encouragement I spoke to her, and was an empowering and healing experience for her.
Birth Trauma is real and can be devestating. Interestingly, I find that subsequent labor and births can be the most healing experiences for women when they have past birth trauma. By respecting women, by respecting the impact their past experiences have had on their lives, and by honoring their wishes and their bodies, we have the opportunity to impact their lives in a positive way that only another birth can provide.
Birth Trauma can have its origination in past sexual, physical or psychological abuse. A woman may have repressed this abuse only to have it resurface during pregnancy, labor or birth. The vulnerability of labor may break down the walls of protection a woman constructed around herself, and can have tremendous impact on her birth experience. For some, the feeling of their baby moving down through the pelvis is so overwhelmingly negative that they physically and psychologically fight against it. I saw this happen with a young woman who never disclosed her history of abuse. Her labor was relatively quick for being a first time mother, and she quickly progressed from 4 to 9 cm dilated. When she started feeling the pressure of her baby's head moving down, and realizing the fact that her baby would pass through her vagina, she reacted with panic and fear. Within 30 minutes, her cervix closed to 6 cm and never opened again. Her eminent vaginal birth converted to a cesarean birth. In follow up care, she revealed that past abuse memories surfaced and were so overwhelming when she felt the pressure that she couldn't allow herself to move forward in birth.
Birth Trauma can be physical or psychological trauma that occurs during labor or birth, perpetrated intentionally or unintentionally by nurses or providers. It can also result from the physical nature of birth. While we all desire a calm and peaceful passage for babies, sometimes events unfold that can cause trauma. Vacuum and forceps are tools used occasionally to facilitate an operative vaginal birth. These tools can cause physical trauma that may lead to long-term problems for women. Unfortunately, there are people who attend women for labor and birth who intentionally cause trauma that can last the rest of her life. A woman I attended for birth came to the hospital with no prenatal care because her past birth trauma was so severe. Her 3rd child's birth was attended by a physician who is now in prison for sexual abuse of his patients. While 11 years passed from that time until the birth of her 4th baby, the damage from that experience greatly affects her still. She was unable to seek prenatal care due to fear and presented to the hospital 15 hours into labor. This was already longer than any of her other labors, which was concerning to her. Her labor was 28 1/2 hours in length and, especially during the time her baby was moving down, she appeared to emotionally distance herself from what was occuring in her body. The birth of her precious girl was a welcome surprise since her other children were boys. I pray that the care we provided to her will help to heal the past trauma in some way.
Birth Trauma can be psychological for women, especially if their labor and birth is not what they hoped for, planned, or expected. I find this most evident with women who prepare well for childbirth and then their labor ends with a cesarean birth. Unfortunately this type of birth trauma happens more frequently than it should because of our society and the elevated cesarean rate in the U.S. I feel that this type of birth trauma is addressed more frequently and many organizations exist whose purpose is to support women and help heal this trauma. I've also seen this type of birth trauma experienced by women who have, in my perspective, a beautiful and 'perfect' birth. One of my most memorable births was a first-time mom who had a waterbirth. One of my partners was also in attendance and we both felt that this birth renewed our spirits and exemplified what birth can be. We were both shocked when, upon her 2nd pregnancy, she discussed how she was traumatized by her previous birth experience. She felt so out of control, in so much pain and fearful that she would die that she was very anxious about repeating this process. A good portion of her early prenatal care involved processing her past experience and helping to heal and move forward with confidence and anticipation instead of fear and trepidation. Her 2nd waterbirth was so similar to her first, even down to the words of encouragement I spoke to her, and was an empowering and healing experience for her.
Birth Trauma is real and can be devestating. Interestingly, I find that subsequent labor and births can be the most healing experiences for women when they have past birth trauma. By respecting women, by respecting the impact their past experiences have had on their lives, and by honoring their wishes and their bodies, we have the opportunity to impact their lives in a positive way that only another birth can provide.
Saturday, September 10, 2011
Provider
I am a healthcare provider but there are times, such as this morning, when I am humbly reminded of who the true Provider is in this world.
Some women are surrounded by friends, family and supporters during their pregnancy, labor and birth. Others quietly ask if someone would be available to be with them during their labor and birth because they may not have anyone able to come with them. I answered yes, absolutely, to this question and then hoped that I would be on call when her time came to birth her baby.
Weeks pass and more time is spent caring for this motherbaby duo - and the hope continues to grow that I will be there for her. It's hard to express the feeling of connection and compassion for many women who trust me with their healthcare needs during their pregnancies, but it is definitely present with this precious woman.
As her baby's birth day approaches, she is amazed at how God is providing support that she didn't think would be possible, that she was afraid to ask for, being offered to her willingly. I am excited to know that I am on call when her baby's time comes. As he is close to making his debut, there are some concerns and I do what I can - pray that God will protect her and her baby and continue to encourage her during those last few moments before he takes his first breaths. He is soon swaddled in his mother's loving arms and I am thankful to God for providing safe passage. Later in the day I am told that she prayed for me to be with her when she labored. She tells me that the words I spoke to her during those final moments were the only words she could hear and that they were exactly what she needed.
And I am so humbly reminded that I am not a provider. I am simply a vessel for God to work through, for God to speak through, for God to provide care to women in those intimate, precious moments. And I am thankful and grateful and awed by our amazing Provider God!
Some women are surrounded by friends, family and supporters during their pregnancy, labor and birth. Others quietly ask if someone would be available to be with them during their labor and birth because they may not have anyone able to come with them. I answered yes, absolutely, to this question and then hoped that I would be on call when her time came to birth her baby.
Weeks pass and more time is spent caring for this motherbaby duo - and the hope continues to grow that I will be there for her. It's hard to express the feeling of connection and compassion for many women who trust me with their healthcare needs during their pregnancies, but it is definitely present with this precious woman.
As her baby's birth day approaches, she is amazed at how God is providing support that she didn't think would be possible, that she was afraid to ask for, being offered to her willingly. I am excited to know that I am on call when her baby's time comes. As he is close to making his debut, there are some concerns and I do what I can - pray that God will protect her and her baby and continue to encourage her during those last few moments before he takes his first breaths. He is soon swaddled in his mother's loving arms and I am thankful to God for providing safe passage. Later in the day I am told that she prayed for me to be with her when she labored. She tells me that the words I spoke to her during those final moments were the only words she could hear and that they were exactly what she needed.
And I am so humbly reminded that I am not a provider. I am simply a vessel for God to work through, for God to speak through, for God to provide care to women in those intimate, precious moments. And I am thankful and grateful and awed by our amazing Provider God!
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