When I was a student midwife, I asked one of my preceptors what her favorite bit about midwifing was. I fully thought and expected that she would reply that catching slippery wet new human life was her favorite, so enamored was I of that at the time. She thought for a long minute and replied simply “When I leave”. I think I stood there gaping not quite understanding. She then explained that, for her, leaving a new family tucked up in their own bed, warm, fed, new babe at the breast, house tidied and quiet was the best bit about her job. I totally understand this now after a few years of practice. Those moments are absolutely golden.
This week though as I did prenatal and postpartum visits in clients homes, surrounded by a gaggle of breathlessly excited and curious older siblings and neighbor children and even another homebirth mom who’s last baby I had the privilege of touching first, I found new joy in my work. For a moment I wished that I could do all my prenatal visits in my clients homes, surrounded by their things, their loves. It felt a bit like I was in that beautiful children’s book Welcome With Love. Of course I can’t do every visit in my client’s homes, there aren’t enough minutes in the day. Its nevertheless something I adore about my work, the quiet, personal time I get to spend in my client’s homes. Really getting to know them, and they me in the gentle sharing of tea before blood pressure and measuring and leopolds on their own bed or couch. In showing little fingers how to squeeze the bulb of the blood pressure cuff, or hold the tape measure, or listen to heart tones with a fetoscope. In those moments I feel the generations of midwives and physicians before me who also had the honor and privilege and responsibility of being invited to care for families in their homes.
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Then this week as well, spurred by yet another evil third party insurance contract requirement (and yes, I DO think that the fact midwives are required to jump through these hoops is at best obnoxious and at worst offensive but anyway), I plucked up the courage to ask a local physician who I’ve had the pleasure of working with occasionally these past three years, if they would be willing to act as a reference for me. This is a giant hurdle for midwives, as professional liability carriers prevent physicians from entering into formal consulting agreements with individual midwives. So for years, midwives have had to rely on the assurance of local training hospitals who will document that they will consult with and accept transfers of care from any provider. Sometimes this suffices, and sometimes it doesn’t. Regardless I have worked hard since I’ve been in practice to show up and prove to my physician colleagues that I’m actually committed to the same endeavor they are (healthy moms and babies) and that I am sensible, careful and transfer care appropriately. I learned a long time ago that where the baby comes out isn’t the be-all and end-all. I don’t actually care where the baby comes out. Its lovely when it’s at home, or at a birth center but it IS possible to have a divine birth in the hospital either because a change of venue becomes a good idea OR because the mom simply wants to have her baby there. From a practical perspective it’s challenging for a homebirth midwife as I don’t get paid when this is where we end up but that’s food for another post. Midwifery care is about more than where the baby is born. We’ve all proved that over, and over. In any event, I really needed a physician to be willing to answer a phone call from an insurance wonk and say “Yes, I’ve worked with her, she’s good people”.
This doc was graciously quick to tell me that they were. This is a lovely gesture of professional goodwill on their part, and it will make the lives of my clients easier as we will no longer have to pursue separate authorizations for my care every. single. time. It tells me that I’m seen (and I’ve felt invisible a LOT as a homebirth midwife on hospital turf). It’s just one midwife, and just one doc but it also makes me hope quietly that we might actually be getting somewhere. Three years working in this community, and I feel like I’ve found a little spot where I’m seen and vouched for as a colleague. It feels really, really good.
Homebirth Midwife 