When I was pregnant this time last year, I lived in my own archives, which is to say, I spent a not inconsiderable amount of time reading, re-reading, and re-reading again entries I had written on LiveJournal during my three prior pregnancies in 2007, 2009-2010, and 2012-2013. I did this as though divining the tea leaves or translating ancient hieroglyphs, so desperate was I to predict when I might be through the worst of my so-called morning sickness. I was following my own crumbs through a forest plagued with creatures with sharp teeth and horrors such as vegetables, which seemed as dangerous to my hormone-pumped body as a candy-laden house with a witch inside
If you followed my pregnancy on Instagram, you’ll know all of my revisiting was for naught: this pregnancy was my outlier. While I was sick for only 15, 19, and 13 weeks with my others, I remained brutally nauseated and medicated for the entirety of the pregnancy this time (though the nausea lifted, as if I were Dorothy entering Oz after nine months of grey, the literal moment Hanif was born).
But even as I could no longer rely on my own trail of breadcrumbs, even as I could not ground myself in that self, I still returned to her, continuously. I smiled over memories I had recorded of my now teens and tweens when they were toddlers;1 I recognized the spiritual elements of pregnancy that had remained the same even as miserable as I was this time; and I reflected on the self who made the enormous leap from academic to midwife with so little acknowledgment of how much of both faith and fear that entailed. I had never worked in any kind of health care setting before I went to midwifery school; all the work I had done in my life had been incredibly heady, even beginning with my very first job as a 16 year old intern at the New York State Psychiatric Institute, where I served as a data entry minion for a research study, a position I’d won after applying for a National Institutes of Mental Health grant. Talk about following bread crumbs through a forest: all of my interest in midwifery had been purely theoretical or incredibly, intimately individual, borne of academic research (where I sort of stumbled across accounts of Black midwives in the south while studying cases of infanticide during slavery, of all things) and my own life-altering, psychedelic births. I had zero evidence I could be a midwife, let alone a good one; I did not even make the choice many birthworkers do, to be a doula first (I knew, intuitively, that it was not the place for someone with political leanings like mine). I had been to all of 3 births — 2 of them my own, one my dear friend Mary Catherine’s. Still, I finished my dissertation and was granted a PhD, and, without fanfare or even going to my graduation, just…switched gears entirely (disappointing a lot of my academic mentors in the process).
In all of this I neglected, mostly, to journal about how frightening such a leap was. Mostly, this old me is matter of fact about it, announcing a massive life change as though sharing that we’d planned to try camping at a different location than usual this summer. If I discussed my trepidations at all, it was always about leaving academia, never insecurity about midwifery or making a career choice based on nothing but a hunch, something completely out of character for a perfectionist like me. As I wrote while in the midst of finishing my dissertation:
The big elephant in the room is that I am working my butt off for a degree I will likely never use. And no matter how cynically or pragmatically I've viewed my doctoral work — I always told myself that this was a job that I enjoyed, rather than a career, given the odds of getting a tenure-track position — this transition is going to be tough, and I need to be honest about that. Yes, I got paid (very little, but enough to survive) to think and talk and read and write about things I enjoyed — for eight years! — and I always viewed that as an awesome end to itself rather than "training" for something else. But this feels like more than just your run of the mill career change. You have to really invest yourself in doctoral work, really believe in it, to make it through. Because it is a lot of hard work for very little payoff. Because, at the end of the day, you have to constantly convince everyone that you're meant to be there….So you can't do it without convincing yourself of [your work’s] worth -- in my case, its political/cultural/social value -- no matter how hard you try. At least that's been my experience. I am invested in my work. I love it, and I genuinely think I could go on to do some really interesting and unusual things (not least of which is because I am an inordinate level of patience for the kind of archival work other people don't seem to want to do anymore), if I decided I wanted to be an academic.
It also pays me to write. Which, if you know me at all, is a pretty core part of my being. Moving from a career that allows me to write to one that doesn't is a pretty terrifying proposition.
So in some ways it is hard to give it up, and it is perhaps not surprising that I am getting cold feet about leaving.
But when the time came to make that transition, though I did say, “It kind of makes me want to weep when I realize my online community college biology class begins the same week as my doctoral defense. Like, beyond the tragic comedy of it, do I not get a fucking break?” I simply move on to journal about my new path as though it is totally normal and unremarkable.
My grade school teachers did always say I was “adaptable,” I guess.
Once in midwifery school, I do journal about insecurities somewhat, particularly after I began my intrapartum courses and clinicals. I did this first year of clinicals in a busy NYC public hospital, one that served a primarily Black American and West Indian population. Almost all of the OBs, midwives, and nurses were Black and Brown as well, but it did not mitigate the truly racist care being provided there. We had a maternal death literally the first week of my intrapartum clinicals. Some of these entries, as a result, are almost physically difficult to read, with me recounting stories of obstetric violence, of babies alone in warmers, of my own despair at every being able to figure out how to maneuver in such a place.
I wanted to share one of these entries here, because I know I have so many students and new midwives and aspiring midwives who read this newsletter and I want to normalize what many of you have likely experienced, are experiencing, or are worried about experiencing.2 I think if nothing else the abundance of CAPS LOCK phrases in this entry gives you a bit of a hint about the dysregulation I felt for the entirely of my rotations there.
School is fine. Had a test this week and did great as usual. Feeling like the semester is winding down even though technically I still have three written exams and one more perform exam (shoulder dystocia!) left, which is a good feeling. MY LAST SEMESTER OF COURSEWORK. Oh praise be.
I have been feeling pretty despairing about clinicals lately, on the other hand. I'm really surprised by my experience thus far. When I did clinic…the midwives were basically autonomous. And they were so busy I got an insane amount of experience — I did something like over 100 pelvic exams in 20 sessions. So I feel pretty secure in my pelvic exams and, in general, in my clinic skills in general.
But L&D? The midwives are NOT autonomous, at all. The attending basically call the shots completely, so there is no meaningful midwifery management experience to be had (I can think of only a handful of reasons why I'd admit a 38 week primip who is a fingertip dilated to L&D but the attendings find reasons to do it all the time although ALHAMDULILAH I triaged just such a case on Tuesday night and they let me let her go). The residents want experience so they strong-arm their way into cases that should be midwife-managed. And the attendings come and hover over every midwife's birth like they're students or something.
Tuesday night I labored with this unnecessary induction all night. We were doing well and though at first the progress was pretty slow going, she went from 3 to fully in less than 2 hours (!!). I got all ready to catch, and of course all of a sudden the attending, two residents, and extra nurse, and a medical student SWARM the fuck in. She was pushing beautifully but they all forced her into McRobert's (knees to chest; oh her poor perineum...I could feel how much more stress it was under as soon as they did that) even though the midwife and I kept saying "you don't need to do that! Please don't exaggerate her legs further!" They kept yelling at both her and me and I totally lost my connection with her. I just...couldn't even talk to her anymore.
I don't know if others learn well in this environment but I DO NOT. I could barely think straight. The whole time baby was crowning and then while I was waiting to deliver the shoulders (a couple of seconds, tops!) I was like, "is everyone seeing something I'm not?" because of the way they were literally screaming PUSH PUSH PUSH at her and barking "UPWARD TRACTION! POSTERIOR SHOULDER!" at me. I was like, dudes, settle the fuck DOWN, and just caught the way I was taught to...WAITING for restitution and external rotation of the head, WAITING for another contraction to deliver the shoulders. Straight skin to skin (despite the fact that everyone seemed flabbergasted by this choice — it was the one second no one was screaming until the nurse said, "OMG, give me warning before you do skin to skin!" WHY?! What weird medical intervention needs to happen for skin to be on skin?!). Trying to delay cord clamping even though the attending was still yelling "Just clamp that cord! Just clamp that cord!"
I mean, it was just obvious that everyone in the room thought I was a moron...like, slow in an intellectual way. And truthfully? I felt like a moron. All the paraphernalia of a hospital birth is still foreign to me. Gowning and all the specific pads and chux and the stupid fucking mask I can barely see or breathe in but that I'm forced to wear and what I can touch with sterile gloves and not...it all feels so labored and confusing, especially when there are a hundred pairs of eyes on me. And then trying to think through all the steps I'm supposed to do when people are SCREAMING is just...it's not how I learn. I KNOW all the things I'm supposed to be doing but I literally can't hear it through all the noise.
I sutured for the first time too and that was a nightmare. I can't imagine how I will ever get good at such a thing.
I don't know, I'm just feeling really discouraged. Really, really discouraged. There is so much to learn and so much to get really GOOD and COMPETENT at and I just don't see how that's ever going to happen. I mean, even just cervical checks are sometimes straightforward and sometimes COMPLETELY impossible. And everyone keeps saying it's a skill that takes time and practice to really "click" but I just want to know whether I'm progressing the way all students should or if there's something wrong with me that it hasn't clicked 100% of the time yet. I want people to give me timelines. WHEN? HOW MANY? How many cervical checks will I do before it clicks? How long will it take for my hands to stop shaking when I suture? Will the fucking hospital garb ever be second nature for me? How the fuck will I ever estimate blood loss?
I know these are not fair or answerable questions. I just feel like I'm having trouble keeping the faith.
Good things:
- Laboring with that mom, and tending to her during the birth and postpartum, was a joy. She was so funny and sweet and also completely sassy. She was alone, because her husband was with their two boys, 7 and 4, who still sleep in a family bed. This birth was with her third son, who yelled every time anyone took him away from mama (yes! fight the power!) but was a sweet, alert peanut whenever in her arms. She was SO mean to me, in the funniest way, at various times during the birth and SO apologetic afterwards. I just adored her.
- Before the birth, I triaged that aforementioned young mom. She clearly had A LOT of anxiety going on. I did the whole visit with her, did a physical and vaginal exam ( during which time I identified the baby was posterior via abdominal palpation which I think is KEY because she kept coming in complaining of back pain), managed her, presented her to the attending and proposed my management, etc. I felt really good about the whole interaction, about listening to mom and being sensitive and and just giving her a space to cry and release some anxiety and feel heard andy understood. When I closed the door to do her exam, she was like "Oh, you closed the door! Thank you! Last time I was here they left the door open and I felt like a million people got to see my cooch and no one even apologized!" Because — yeah — there is no attention paid to this at all (and multiple times when I've shut a door people come in and are like, "why is the door shut?"). Afterwards my preceptor was like, "You are going to be an AMAZING midwife, Robina." And it is nice to hear that. But at the same time, I feel like — yes, I am good at talking the talk. I do feel like I am good at listening and being "with women" in a sensitive, respectful, caring way. But that is not enough. Can I walk the walk? I need the clinical skills to keep my patients safe and healthy. And right now I'm feeling pretty deflated about my ability to get there.
I want to wrap my arms around this version of Robina, to tell her that the truth is all those clinical skills she worried about were a matter of repetition more than anything else, that they don’t truthfully take skill so much as exposure. That all the gowning and sterility was more performative than anything else, not even required in any other setting in which she’d practice, and certainly not a measure of her intellectual worth. That the kind of being and thinking valued in that setting were white supremacist fetishes of mechanistic knowledge, authority, and urgency — the kind of being and thinking that harms birth more than helps it — and FUCK THAT. That at the end of the day the real thing that could predict her own future strengths as a midwife, that the real sign of her potential, was that even as an overwhelmed and discouraged student, even with her relative lack of power, she closed the door even though people asked her why and discouraged it. That she put a baby skin to skin (again and again and again) even as the people with power over her were frustrated by it. Made someone feel safe enough to cry, or got to know a laboring person well enough to know their family’s bedsharing arrangements in a setting where people are often criminalized for such behavior (and therefore aren’t usually willing to disclose it). Those are much harder things to embody. Those are skills harder to learn and harder to maintain in a setting where providers are perpetually worn down and discouraged from holding onto them. That as an experienced and trusted midwife nine years later I’d read those things and feel so proud of that baby midwife version of me.
I want to hug the version of Robina who left academia and refused to be vulnerable about it, too. I want to tell her that the little voice inside her that she refused to really acknowledge — the “this is fucking crazy” voice, the am I being naive? voice — was actually true, that she was making an objectively and absolutely “fucking crazy decision.”3 But that, also, it took a strength and a courage to take that risk that she should be proud of. That, yes, she was in fact idealizing midwifery and that she had no idea what she was in for. That, yes, she was right her work would feel more meaningful and her instincts that she’d be a good midwife were correct AND ALSO that she would at moments regret her decision, deeply. But that that was okay too. That it was okay to follow her gut, even it maybe it would be wrong. That it’s okay for the outcomes of that decision to be ambiguous. That her choices would lead to experiences both unimaginably joyful and devastatingly painful, that those experiences would build a new version of herself and she would grieve what she had lost and love who she’d become just the same — and that the same thing would have happened if she’d stayed an academic, too, because we are always changing all the time. That the fairy tale ending where we find exactly the perfect life and then don’t have to think about it anymore doesn’t exist. And that even if it was a fucking crazy choice, it was the only one to make, the only one she could make, because it was the one she did.
The entries just abound with delightful anecdotes such as this one of 18 month old Illy:
Ilan is in an 'I like to antagonize my big sister' phase. Today he kept chucking things at her head in the bath. After repeated warnings, I took him out and got him dressed. He went back in there, took off his pants, and threw them at her.
or this one, of two year old Jo:
Josie is full of hilarious phrases these days -- "da hourminutes" being one of them. Any amount of time is "da hourminutes." "Josie, do you need to pee?" I'll ask, and she'll say "No, I peed da hourminutes already." What else? "Ever ever" and "in my yife!" are other big ones. "This is the best bear I ever see in my yife!" to a stuffed animal. Or "I no eat that eva-eva!" She's so hyperbolic, this toddler. We were walking in the park on Monday and every person who passed us on the path was yelled at by Jos: "Watch out!!! WATCH OUT PEOPLES!" I kept reassuring her that no one was going to walk into her, a tiny bean on a giant path. Then a man walking by said, "Maybe she's telling us to watch out for her." Possibly!
or this conversation in 2015:
Me, reading aloud: "For every species today, there are probably 1,000 that have died out or gone extinct." Wow REALLY? Did you guys know that?!
Andy: Makes sense.
Wren: It's so sad that so many animals are extinct.
Robina: Yeah! Like the Sardinian dwarf elephant!
Andy: I'm surprised you went with dwarf elephants there.
Ilan: If they weren't extinct, we could have one as a pet!
Robina: Elephants are so smart and they really love humans!! A dwarf elephant would make a fantastic pet.
Wren: Neeley [our old dog] would love a Sardinian dwarf elephant.
<long pause>
Wren, thoughtfully: I wish we still had our tails.
It makes me so sad I don’t have a dedicated space to record such anecdotes anymore! I will have to figure out how to do this for Hanif, because we all love returning to these stories now. What say you, comrades? Should I do a periodic family anecdotes post?
I would be most happy to share more of these kinds of entries if they’re helpful for y’all so be sure to weigh in in the comments!
I want to acknowledge here that the word “crazy” can be perceived as ableist, but it’s a direct quote and I hope people can read it as the anachronism it is meant to be.
Just a quick note to say I adore the contents of your posts and your beautiful writing. I am an aspiring midwife (and also 35 weeks pregnant with my third child and planning my first home birth) who finds every word you write to be so incredibly helpful on multiple levels - please continue to share excerpts from your past experience as a student/new midwife!
Beautiful. I love how you advocate for your patients now but also then, when you were just starting out and knew better. I think it’s amazing that you use your voice to teach others in your field and the layman just wanting to have a respectful birth, just how we should be treated. It makes me so sad knowing most people will never have a caring hands like yourself looking after them on one of the most important days. But I’m so glad you’re writing and teaching others. ❤️