Work update!

I have a new job!

I still have my old job too.

Since I returned to work I’ve been seeing patients in the office 4 days a week, the fifth day is a day of appointments- therapist, chiropractor, acupuncture and general mental well being. I took a significant pay cut to work this schedule, one that kept me out of the hospital, and I am thankful that my practice was able and willing to accommodate me. But the “(when) will I go back to births” question always hung over my head. When I first asked to be an office-only midwife, I left the door open to return to birth, but with no time line. I still like having that option, but my practice needed something a little more definite. I honestly thought I’d be back by the holidays (Thanksgiving and Christmas) so I could repay my co-midwives for unexpected holiday time they put in for me last year. But I soon realized that goal was unrealistic. It caused me a lot of stress to even hear my co-midwives even talk about holidays and schedule, knowing they had more to do because of my absence from the hospital. When the topic came up at our winter midwife meeting, I conveniently had to use the bathroom at that moment. In addition, my practice wanted to know whether they should hire another midwife to replace me or if I’d be back soon. Well I finally was able to give them an answer.

As of April first I took on a part time position as Program Director for Hope After Loss, my local non profit helping those who have experienced pregnancy and infant loss. The organization runs peer-led pregnancy and infant loss support groups in four towns, does outreach and education to hospitals, medical providers and anyone who asks, and provides burial or cremation financial assistance to those who cannot afford it for their babies.

Taking on this new position means I plan to remain in the same capacity at my other midwife job- no call. I gave them the go-ahead. Hire another midwife! Takes a huge burden of guilt off my shoulders. I know my colleagues are sad to hear I’m not doing birth in the near future and I’m sad too- there are some things I miss about it, certainly the hospital staff I almost never see anymore! But I know I’m not ready. Some may call it avoidance, but I call it self-preservation. I need to still work on enjoying midwifery in the office and finding fulfillment there before I can return to joyful birth in a place that holds so many memories for me.

This wonderful new part time position has kept me a busy bee these past few weeks, hence my absence from the blogosphere.  But my dear friends, I have missed you!  And I”m trying to be back.  I have much to tell.

Six week check up

I went to my six week postpartum exam and got my clean bill of health- I’m back to normal.  So it’s official, my pregnancy period is over.  This was a hard day for me.

My midwives have two offices.  I went to the one I had rarely gone to in pregnancy, on purpose- fewer reminders.  I have two memories of that office.  The first is the day I got the call telling me Mabel had Down Syndrome.  I stopped by that office on my way home from work to meet with one of my midwives.  I remember sitting in the waiting room; it was after hours- the other patients and staff had gone home.  It was just me and my midwife and a box of tissues.  I cried about the Down Syndrome but I also cried about her bladder.  On the ultrasound a few days before, her bladder was enlarged.  During the weekend wait for the results, I had poured myself into research and learned that an enlarged bladder at that point might be an early sign of a fatal bladder condition.  I was so scared that her bladder would grow and grow and eventually rupture, killing her in the next month or two.  I was worried enough that we booked an extra ultrasound to evaluate it early (in 2 weeks instead of 4).  I sat in the waiting room of that office crying about her bladder.  Who knew that in a month we would find out her bladder was fine, but in three months we would find out her kidneys were not.

The second time in that office I sat in an exam room with another of my midwives crying again.  This time I was further along.  I hadn’t felt movement yet, so I was worried about hearing the heartbeat.  My midwives quickly became accustomed to me asking to listen first thing.  I cried at this visit because I was still adjusting to envisioning my life as a mom to a child with Down Syndrome and I was still worried about loss- miscarriage and stilbirth.

This time I sat in an exam room crying for a different reason.  The last time I had been there, I had been pregnant.  I had been worried but there was still hope- hope that my baby would survive.  That hope is gone now.  This would be the last scheduled visit I have.  While I was waiting for my midwife, her student popped her head in my room to grab the doptone and my heart just sank.  Someone else gets to hear her baby’s heartbeat.  Someone else is sitting in the other room, hopeful and happy.  Someone else is picturing the baby she’ll bring home instead of wondering if she’ll bring home a baby at all.

And being there, with all the equipment, the sights and sounds of an OB/GYN office, I was thrown right back into the world that is work.  It’s not my office, but it’s an office and offices really aren’t all that different.  I could picture myself grabbing the doptone, greeting patients, charting.  I didn’t like it; I wasn’t ready for that.  I had a sinking feeling in my stomach and my heart was beating fast.  Perhaps this explains why my blood pressure was high that day.

I asked my midwife about my cervix and how it looked.  It’s now a parous cervix (a cervix of someone who has had a baby) and she said it looks it.  As one of my commenters, Stacey, reminded me: the os (opening) of a parous cervix looks like a curved line instead of a simple dot, as it is on a non-parous woman’s cervix.  My midwife said my cervix was smiling at her.  Mabel put a smile on my cervix.

As I left, another patient was coming in, clearly for her postpartum check up too, because when she arrived empty handed she was greeted with smiles- “Where’s the baby?”  When I arrived empty handed, I was greeted with sad eyes, “I’m so sorry to hear about Mabel.”

Everyone has a Purpose

Today a colleague told me “everyone has a purpose.”  Not the “everything happens for a reason,” which I’ve gotten so many times before.   Both comments are made with such good intentions, but hers really hit home.  We are all put on this earth with some purpose.  She has shared life changing moments with people.  Moments that might not have come to pass if she weren’t there.  I’ve had those moments.  As a midwife,  I have those moments almost daily.  I am the first hands that greet a child on her way into the world.  I have made women feel welcome and listened to. I have let women cry about the baby they know if going to die.  I have cried with women about the baby that died for no good reason.  I have helped women feel comfortable with their bodies and in control.  And this is just my work life.  I do volunteer work on the side.  I am a good friend.  I have had many purposes and have many more.  This baby has a purpose too.

There are some things I just can’t think of a reason for.  Why do children die?  Why do some people who work so hard still struggle?  Why do some women who would make such great moms, face infertility? Why do I, who consciously planned this pregnancy- took my folic acid, timed my ovulation, wished and hoped for a baby- have a difficult diagnosis.  While others who don’t even want to be pregnant have a baby without any issues?

I’m learning not to compare- everyone has their own struggles and I’m not sure I’d trade mine for theirs.  But my own struggle is not happening “for a reason.”  It makes me feel like somehow I deserved this.  Tell me, what is the reason if my baby ends up with open heart surgery?  What is the reason if I lose my baby- tomorrow or in sixth months?  There is no good reason to make children suffer.  Or parents suffer for that matter.

Whenever I heard, “everything happens for a reason,” I would cringe on the inside.  I tried to respect the good intentions behind the statement, and so respond in some benign way.  Now I think I’ll respond- “I’m not sure if everything happens for a reason- some reasons are unknowable.  But I like to think everyone has a purpose.”

Loss

As a midwife, I spend half my time working with gynecological patients- doing pap smears, checking for STDs and infections and prescribing birth control.  The other half of my job I am working with pregnant women during their prenatal appointments and catching their babies.  I’d say 95% of my job is happy.  I help people- curing their infections, attending births.  But there is a darker side.  People think of midwives catching babies all the time, being an integral part of a memorable and joyful time in a family’s life.  We also help them through hard times.

Stillbirth.  The word I fear most in obstetrics.  Miscarriage is heartbreaking. I’ve cried with patients when they miscarry in the first trimester.  Stillbirth has no words.

For some clarity, pregnancy loss is classified depending on gestational age.  Miscarriage is used during the first and second trimester.  Sometimes second trimester loss is referred to as late miscarriage or mid-trimester loss.  Once the fetus is viable, or can theoretically survive outside the womb, traditionally 24 week (though arguably as early as 20 weeks these days), loss is called stillbirth.

Stillbirth is uncommon.  Happens in less than 1% of pregnancies.  But the effect is so huge, that those of us in the field can’t help but worry about it for our patients. There are several factor that can increase the risk- age of 40, morbid obesity, history of stillbirth, uncontrolled diabetes, clotting disorders and chromosomal abnormalities, to name a few.

So here I am, with a prenatal diagnosis of Down Syndrome and a risk for loss.  It was the reason I opted for testing- wanting to know my risk (more concerned about trisomy 18, where the risk is 50%).  It was the first question I asked the genetic counselor after the diagnosis- what is the risk of loss?  The numbers I have are 20% in the second trimester and 12% in the third.  These are general numbers- they aren’t broken down by week or by other conditions babies with Down Syndrome face, like growth restriction and major birth defects.

I feel like everyday I am facing my worst fear.

In the beginning, my sadness was palpable.  I would cry frequently. I worried about telling people I was pregnant.  I borrowed a doptone from a friend to check for a heartbeat.  I didn’t want any baby stuff like ultrasound pictures or early baby gifts around, in case I lost the baby and then would be reminded.

I know I have no control over the risk, but a part of me thinks if I can just let the universe know I am so happy to pregnant and I will love this child, maybe I’ll get to meet him or her.  If I’m good to the universe, it’ll be good to me.  I’m hesitant to complain about the pregnancy because I’m afraid somehow karma will come and take it all away.

There is no easy way to handle this fear.  Stay optimistic. Just don’t think about it. Meditate. Distract.  There’s nothing that takes the fear away completely.  It’s a little easier now that I’ve had ultrasounds with good news, now that I look a little pregnant and now that I feel movement.  It makes it more real.  I can’t pretend I’m not pregnant- I have to accept it and pretend everything will be fine!  If I act that way, sometimes I begin to think that way.  And it’s a lot more enjoyable being pregnant, surrounded by pregnant women, to think everything will be fine.