I am coming up on completing my first year as a licensed midwife here in the Sedona area of Northern Arizona. Yay! Some days I am still in disbelief that after five years as an apprentice, I finally “finished” and am actually on my own. The absolute best part of having my very own practice is that I am “allowed” to evolve as a midwife and create, from scratch, my own version of the “art and science”of midwifery as I see it. And it’s really as I see it now- another favorite of mine is to read, learn and study all I can and be open and changeable to new ideas, research and tools that will make me an even better midwife. I am not afraid of change and would rather not get set in my ways!
So much to reflect on this first year. One interesting observation which I would like to explore further is the idea, practice and theory of vaginal exams in labor. I realized in looking back that in attending births this year, I think there were only 2 births where I actually did one. One of these mamas requested it, and the other I was happy to be able to do because it was tricky figuring out what was going on. I don’t say this to brag; in fact, I don’t really know what it “means” since it wasn’t something I planned or really tried super hard not to do. But, having the kind of views I do about birth and labor (and life:) that I do, I actually think it is pretty cool.
However, if there’s credit to be given, it goes largely to the mamas that I serve! They are, as a whole, very aware of their bodies, confident in them and trusting of the process. If there is any other credit to be given, it goes next to the relationship that we establish over 9 months of prenatal care. I believe that these women feel safe and loved, and feel guided (not controlled) by my presence at their birth.
And along those same lines is my developing ability to not just “walk with” but be with these mamas in labor. It is a subtle difference that I am eager to develop and use even further. I have certainly studied how labor looks, feels and sounds from the outside, and that is a definite help in minimizing or avoiding the need for vaginal exams. But more importantly is the spiritual connection to these women; developing a sense for those things you can’t see, feel or hear. Really being that mama in labor, while still maintaining my role as “midwife”. Understanding where she is at because I am there too, in a sense. Connecting with her in an unspoken way, or with her baby, to see what can be gleaned without words. I realize that this is my most valuable tool and am excited to see how it shapes my practice “style” even further. I believe strongly in the didactic skills (such as vaginal exams) and technical tools (doppler, ultrasound) that I have available to me and I do not and will not hesitate to use them when there is a need. And for the record, I think there are situations in birth where vaginal exams, for example, can prove really helpful and be very useful. But perhaps the most skill I would like to refine the most is this developing sensitivity.
That said, it’s not that I think vaginal exams, for example, are evil. In fact, I remember being pretty excited to finally learn the skills needed because the first midwife I apprenticed with never did them. But it was likely there, in her practice, that I began paying attention to other ways to determine where a mama was in labor, or what her body was trying to do. I am greatly appreciative of this training. It is ingrained in me, because of her, that there is no routine. As midwives we must have the skills and know-how. But there is nothing that has to be done or performed routinely on every woman at every labor. I think most midwives I know would “agree” with that statement, yet so many of them do perform vaginal exams at every labor. So, to each her own. Maybe I will have changed my tune by next year, who knows. But for now, it is refining the skills I have to connect with birth on a deeper level and to serve women in a more intimate way.
