the *with* in with woman and how the postpartum ties it all together

My own theory of how the spirit of being a midwife came into me,  or maybe passed through my genes, is through my mother.  Oh, such a tricky relationship during certain years, but half the foundation of me that I am thankful for each day. I watched my own mother care for the sick– emotionally and physically– my entire life.  She was a teacher with a full time job she cared deeply about for most of my childhood years.  Nevertheless, she found a way to sacrifice whenever the call went out– that there was a need.  Whether that need was physical, emotional/psychological, or even financial… she made the way to help.  To serve.  She went sleepless, ate and made bizarre foods, was at times away from us when I’m sure she would have rather been with her immediate family, and she traveled far, took care of those physical needs for others they normally can handle themselves, and handled the coordination of round the clock care for those in need or in the passing stages between here and their loss of life.

She did this all without a moment of complaint or mention of her own needs and stresses.  She taught me to never, ever, ever leave anyone alone who is in need– even if it means a schedule of rotating loving caregivers; this was my first understanding of the job of a doula, without that word in my vocabulary for many years to come.  The never-alone rule especially applied in a hospital (though she is quite trusting of western “cures” and treatments).  When I grew in age, I became one of the women on this list of humble servants to bring food, to clean surgical wounds, arrange travel to appointments, run shifts of cot sleeping in the hospital, to hear doctor’s statements and ask questions if needed, and most importantly– though unstated– to monitor the spirit (keeping it light or being the punching bag) in addition to body of the one you are caring for.  The women in my family rarely assumed medical roles– we were servants and witnesses to the experience.  It was only important to be there.  Warmth and seriousness weren’t required.  Presence was the primary job and then the humble tending to physical needs.  I thank my mother for this example, for service and sacrifice are not things you can teach– they are traits you must exhibit yourself and hope they’ll be picked up by those watching.

My mother has also facilitated my journey to midwife by emphasizing the importance of natural birth since I was young enough to remember.  My favorite story was always the tale of my own birth.  Before bed each night, after being tucked between Snuggles and Lucy and a mountain of covers, I would beg for the story of when I came on the scene.  My parents took Lamaze classes in 1979, bringing along my 13 year old brother Michael with them so that he would be prepared to attend the birth alongside them.  This was essential preparation for my mom whose first birth in 1966 was traumatic– by induction, ending in a forceps delivery with a major episiotomy.

The Sunday morning of December 16, my mother woke to her membranes (bag of waters) breaking without any contractions.  She said she felt no discomfort and wanted to continue on to the family’s Sunday meeting (church) and wait to see what happened.  My father was more conservative, suggesting a stop by the L&D unit of the hospital to check things out.  She was in transition when they arrived, and there was much scrambling and attempts at persuasion to allow my prepared brother into the delivery room.  The doctor slipped around the commands of the floor’s charge nurse and brought my brother up the doctor’s elevator. Mom’s only memory of discomfort is at crowning, when she says she exclaimed, “I think I changed my mind about this natural birth!”  She experienced no tearing or stitches and was able to hold me right away, and I went straight to my father and then brother as they worked to get mom freshened up and transferred to the postpartum area.  I never thought to ask until I became a midwife, but I was indeed taken to the nursery between nursings until we were discharged the next day.

My mother also shared with me how important breastfeeding is and was to her.  She experienced pain that was undiagnosed (I suspect thrush) but nursed despite it until weaning at nine months at her doctor’s advice due to mastitis.  In my early days as a nursing mother her encouragement was invaluable.  I had books, and I knew I could call La Leche League, but I wasn’t yet ready to let a stranger into my little cocoon.  She did not ever criticize my efforts or suggest supplementation; when I winced in pain at the bad latch we had in our early days, I remember her face twisting into such empathy that she appeared to feel the pain with me.  Sometimes she cried too, but she always repeated, “Just keep going.  It will get better; I promise it will get better.”  She didn’t have the tools to counsel me specifically, but her encouragement was enough to keep me going.

Perhaps because we disagreed on many aspects of the education and discipline of older children (this topic was common since her grade level when teaching was middle school), I assumed that we would take up arms when it came to all my great big, brand new, well researched baby raising ideas.  I was going to do it just so.  Low and behold, my mother shocked me by her philosophies and behaviors towards babies being almost identical to my own.  I had some updated research to share where she was relying on instinct and logic, but we both agreed: hold babies when they cry, nurse them whenever they need to, let them sleep wherever everyone gets the most rest, hold them as much as you want, make their lives magical– not yours more convenient.  We disagreed over little things like when to give water and just how and when to use a pacifier, but I got tremendous support as my mommy wings grew in; criticism is the last thing a new mother needs, and I was incredibly fortunate to not only have the absence of that but the opposite.  I heard, “You’re doing great! This is hard work, but you’re doing it!  You’re a great mommy!” She was my physical and emotional support the first few weeks after each birth  and months later even took time off of work on more than one occasion when I had mastitis and couldn’t care for anyone, even myself.

Mom gave me the model for taking care of a postpartum mother by the way she cared for me in the postpartum and the way I saw her care for others in our family during their “confinements” 🙂

*the job of the helper is to keep the mom’s focus on the baby and rest; not to play with the baby

*prepare nutritious foods and make sure the mom has that and hydrating fluids nearby her at all times

*try to clean and tidy the home according to the new mother’s normal preferences without being asked and without troubling the mom with details

*run errands if necessary

*keep the restaurant server’s mantra “full hands into the kitchen, full hands out of the kitchen”… meaning busy yourself quietly and minimize trips

*offer to hold the baby only when the mother wants to nap alone or shower, stretch, eat with two hands, etc.

*keep the mother company if she does desire someone to talk to; listen to her birth tale and admirings of her new baby beauty as many times as she wants to repeat them

*check criticism at the door … phrases to never utter include  “Are you sure you’re feeding the baby enough?”  “It’s ok to let the baby cry for a little while; s/he needs to get used to it.”

“Why don’t you let me watch the baby while you…”  “Are you sure that’s the right way to …”  and  “You look exhausted!”

Before I decided to study midwifery I began by helping my friends and family who had babies.  One of my most precious memories of this transitional time– from receiving help to giving– was with my niece.  My brother called and told me she was having problems and asked if I would try to help.  She is a shy one anyway, and I knew she would be reticent to outsiders observing her transition to nursing mom.  I stayed with her throughout most of that day, her first one home, helping to relieve her engorgement and adjusting the baby’s latch.  I shared a few books and websites with her, as well as as much encouraging information I could squeeze in without overwhelming her.  As an 18 year old, I knew her odds of nursing for long were small.  However, I knew she had seen me nurse my older daughter through toddlerhood and was familiar and comfortable with the idea.  This amazing mama is now the mother of three, all of whom were nursed until they were toddlers, and she also had the experience of tandem nursing.  She has served as an amazing example to other moms in her group, and defied all expectations with her intuitive and natural mothering despite her age.  As a side note, she is one of the few lucky ones who has managed two! VBACs at AnMed hospital.  I hope I contributed in some small way to her confidence in nursing during those early days, for I know she gave me the confidence to help other mothers directly.  It was the first hurdle I crossed with moms– touch.  It is sensitive to intervene into the new nursing couple with your hands, and the hands must be tender but sure.  Both mother and baby can tell if you are nervous or unsure.  Because she accepted my help without fear or tension, I was able to begin a tactile understanding of breastfeeding management for another couple.  I knew by then how to help myself, and all the theory, but not how to put my hands on others and show them how to correct their own discomforts and make the baby feel confident in nursing.  This experience was the turning point.

It ballooned into that mama (and my family and friends who knew my passion for nursing) sharing my name and information with strangers… who began calling with questions about their new babes and requests to come and help if I was willing to try.  I attended La Leche League meetings and learned more about how to help as a layperson.  I eventually began and finished the initial training required to be a leader but did not finish the final steps as I simultaneously began a babywearing group (as well as selling various carriers) with other mama friends.  Then, at the suggestion and encouragement of several of those ladies, decided to begin my midwifery studies.  The first assignment I had as an apprentice was to follow the breastfeeding couple (I tried to ensure the breast crawl was undisturbed) and to help in cases where difficulties arose.

During my apprenticeship, I not only helped the clients of my preceptors but also women who were the clients of other midwives, doulas, and doctors.  They came to me through various contacts, websites, and referrals.  I learned a great deal about the way breastfeeding issues spiral into much more complex concerns if they aren’t dealt with quickly.  They can become a web of interconnected problems that create a picture whose root may require much work to uncover and correct.  It is so much simpler to have the continued care of a midwife or doula after the birth and especially when milk “comes in”  than it is to hire someone for lactation after difficulties arise.  Often the web is strung together by other postpartum struggles like a lack of sufficient rest or hormonal changes.  Support, beyond the technical latch tricks or ways to relieve engorgement we can learn together, is the key that will keep the newly nursing mother going!

By six weeks almost all mamababys are settled into a routine, knowing one another and trusting each other, and the majority of early nursing questions and methods have been refined… if mama can just make it until then!!  No matter what the particular issue may be, if you are chosen to attend a mother in any capacity during the postpartum period (whether for moments or weeks) remember that if you can simply help the mother stay in a blissed out postpartum state (called “taking in” in Western Medicine) and encourage, encourage, encourage, her then you help to lay the groundwork for a wonderful breastfeeding relationship and genuinely happy postpartum memories.  That time doesn’t have to be wrought with constant cries and no sleep… it can be filled with cheerleader style love, encouragement, and the blissful feeling of falling in love.  It helps to prepare beforehand for helpers to rotate care and not leave the new mom alone until she is completely adjusted and happily nursing and resting; even then, continue checking on her emotional and household needs for several more weeks.  This is the ancient tradition of women throughout the world and facilitates faster healing and less feelings of depression and isolation.  I think it is also wise to have numbers on hand of lactation helpers– LLL leaders, private consultants or IBCLCs, or books and websites for reference.  Again, a midwife, labor and/or postpartum doula will also have the skills to help with the early days of the postpartum.

The postpartum is so important because it’s what everyone has been waiting for! The baby is here! All that buildup of practitioner choice, informed consent, birth plan research, nursery picks… it’s all ready for use at last! As much as I love pregnancy and birthing time, the postpartum is what we have been preparing for the most… the integration of a new life into the family.  It is of the utmost importance that this not be shuffled off as the social goodbye for a practitioner.  Continuity of care dictates we care, we are present, for those women adjusting to a new life dependent fully on them.

In closing, I thank my mom again, for without her postpartum support I would have had a discouraged and overwhelmed experience as a new mom and would have probably never learned the importance of caring for other moms in that space… which is what brought me to the path of midwife; with woman.

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