When it's not the midwifery that exhausts me, but the culture I practice the midwifery in
On risk and responsibility in birth
Happy Sunday, friends!
This week on Instagram, I did a Q&A, where, as always, I got more questions than I could ever possibly hope to answer, some of which were too impossibly complex to tackle in the short form of an IG story. One of the latter was this:
Have you ever considered stopping work as a midwife because of the hours/lack of sleep?
I could have, of course, responded with a short, pithy answer like
Every time I have an overnight birth!1
But it would have been dishonest or, at least, woefully incomplete. Certainly there is a peculiar sort of irrational, existential dread that sometimes comes with being up all night at a birth, particularly after an accumulated sleep deficit over the course of years. Andy and I have learned to be very strict about what we call “the two sleeps rule,” which means I am not allowed to question anything in my life until I’ve had two sleeps following an overnight birth. I also prefer to avoid any kind of scheduling until after two sleeps because, inevitably, one look at my calendar or attempt to puzzle together the pieces of our life will send me into an overwhelmed spiral of despair (but sometimes that’s not possible when pregnant people whose appointments you have canceled to attend a birth are waiting for you to reschedule).
I didn’t answer with that pithy response though, because actually, the answer to this question, in its simplest form, would be “no.” Yes, it’s a physical job, one that is shockingly hard on the body in ways I don’t think people always consider (it’s more than the toll of just not sleeping, though that is indeed real). Yes, being perpetually on call is exhausting, and planning your life nine months in advance kind of sucks. Yes, knowing you could be called to a birth at any time has the potential to really limit your life. These pressures and stressors are a big reason why many midwives choose to work in group practice in the MIC2: they prefer or need the predictability of a schedule. This may be a matter of temperament; I actually found MIC hours much more depleting than I do, overall, the hours of a community midwife, even a solo practice one. The worker-bee repetition, the clocking in day in day out, the certainty of a night shift every week: it was much more draining to me. I actually rather like the unpredictability and heterogeneity of my schedule now, the ebbs and the flows of it, the fact that I can set my own visit days (and that they don’t involve seeing 20-22 people in 8 hours). The plus side to nothing being guaranteed is that neither is a night awake under fluorescent lighting every single week, which feels like an acceptable trade off (until it doesn’t: see the two-sleeps rule). I was physically and emotionally exhausted as an MIC midwife, a fatigue I felt deep down in my bones, though it was as much the endless cortisol and urgency and interpersonal navigating as it was the schedule. (I love and resonate with this depiction of medical burnout as the result of “the trauma resulting from the forced assimilation into whiteness and the white supremacy culture embedded in medical training’s hidden curriculum” and it's relevant here). Somehow, I don’t feel that kind of exhaustion as a community midwife, even though I do sometimes go more consecutive days with less sleep (but, because. my practice is small, those birth storms often mean a period of relative rest and sleeping through the night afterwards).
This is not to say that I don’t sometimes consider stopping work as a midwife, though. It’s just to say that it’s not the hours or the sleep that leave me considering it, not really.
A couple of weeks ago, a friend and fellow midwife called me to talk over a case. I took a walk as I chatted with her, wandering around until my phone battery got low, and then continuing the conversation curled up in the space between my bed and the wall where my phone was charging. She was tender about the facts of the case, wanted feedback on her clinical judgment (it was strong, and everyone was fine), but also needed to speak aloud that she was, quite frankly, kind of “over” midwifery: that she barely looked forward to births anymore, that most of the time she felt dread when she got a labor call, that she felt guilty about feeling the way she did. She wondered if maybe there was something wrong with her, when so many other midwives seemed to just “really love birth.” I listened to her, the sun shining down on me in that little corner, and I felt a bit like a teenager, twirling the cord of my landline, listening to a friend talk about a boyfriend you knew wasn’t really good for them.
“Well,” I said. “It’s kind of a shitty job in a shittier culture.”
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