Inuit or I Knew It

This is a post about the profession of midwifery. It is a bit of a window into our world—all are welcome to read and give feedback, leave your comments below! Somebody give me a little CPR—this is my first post with one space after each “.” It feels cramped! It’s a new world, blogosphere!

Midwives are often viewed as mystical. We are touted as having been “called” to this work, perceived or harassed as wise women, seers, or my errgmmm least fave of all time, “hippies” which I think implies just really earthy and soul-driven. I can’t speak for all midwives–I am fresh off of a conference of a few hundred of us and can speak only so far as to say that there is a huge variety of the kind of people and types of practices in our field today. Leadership in some locals is very state focused and in others very nationally or globally or village focused. I could go on and on but here’s the best way of explaining it. When you meet an Engineer in Washington, or Tennessee, or Australia, or Uganda, or China you’re hiring someone with the basic kind of education that each of their counterparts has. Their experience, bias, and framework will be individualized for the geography, setting, and environment they work in as well as the one they grew up in. Same goes for educators, lawyers, and yes, even us midwives. And for the record, most educators, engineers, civil servants, and even lawyers I know felt drawn to their profession, so I don’t think that sets us apart in any meaningful way. We’re just people trying to get paid to do what we love.

Our profession overall is shifting–with many of us dedicated to maintaining an apprenticeship based model, self-regulated in practice, and outside the mainstream health systems. There is a newer model blooming, responsive to the pressures of technology and societal norms in education, standards of practice, and accountability. It is designing itself to function as an innate and integrated part of the healthcare system in the US as midwifery does in so many places globally. Those of us working in this model are engaged in legislative efforts, systems change, policy-building, education reform, and standardization. These midwives will be seen as educated (many with a Master’s degree in science), working in professional settings like community-based clinics, birth centers, and hospitals. They might wear scrubs every day or some will wear the clothes they’ve always worn because they believe that scrubs can create a sense of power differential and are committed to health care in partnership in all ways—starting with the perception of power. Some of those in street clothes will exude power and some in scrubs will create an art of shared-decision making. Most midwives will fall somewhere along the spectrum of this vast continuum and move up and down it over the course of their day, year, and career. I’m not here to tell you what’s right or wrong for you as a midwife or which midwife a consumer should absolutely pick. My opinion is that there is a mother for every midwife and I suspect we will always have a midwife for every mother.

I’m an evolving human being and my sense of where I am and where I want to be in my career has evolved as well. If you’ve hired me or worked with me or read anything I’ve written you can probably figure out where I fall in. You can always ask me if you want to, I’m open about my views on all this evolution in our profession.

But wait, what’s all this got to do with intuition?  I want to recap a great discussion I had many years ago which taught me one of the most valuable lessons of my professional and personal life. I admit to being one of these people who pops light bulbs in my vicinity on the regular (literally). Need a watch killed?  I’m your girl. Unsure about dating a certain someone?  Gimme 5 or 6 minutes tops and I’ll have them read. I don’t know why I do these things…I’m not always right and my willingness to participate in the world by thinking and feeling my way through has gotten me into some trouble but overall, over time it has served me just fine. For a long time people called me “intuitive”. I could “sense” things about people, or the course of events. But here’s what a very seasoned midwife laid out for me. I promise you know her and you think she’s a hippy.  She might be!  And she’s a smart, savvy, well-studied, educated and engaged learner also. She pays attention. I called her to review a difficult case I had. As I recalled the care and birth of this mother I said, “I knew that xyz was coming”. She asked me, “Jodilyn, how did you know that?”  ” I just knew it–I sensed it–I…”  “Intuited it?” She asked me in a rather forceful manner. “I suppose so. Yes, I guess that is what one would call it. I intuited it.”

She proceeded to walk me back through incident, and had me identify, step by step what I saw, smelled, heard, noticed, thought of, and did. As I did so I built a profound stack of scientific evidence that, when put together, would undeniably lead to this outcome. According to every text book ever written since the beginning of obstetric text books. “So you see,” she chirped pleasantly, “you didn’t intuit anything. That’s crap. It’s an undersale of your knowledge and abilities. You have three dozen pieces of proof for your diagnosis and you don’t need anybody’s permission to know that you were right.” Three dozen pieces of proof. She was right. I did. I knew my stuff and I knew where this mom was headed and that she needed intervention. I took the right steps and got her into the care she needed in time and just as I saw coming, she had extreme need of high level intervention. But at the time, I couldn’t explain to the doctors how I knew what I knew. Forget them, I couldn’t explain it to the family, or even to myself.

After that incident, I began to peel apart my “sense of things” and force myself into a tedious exercise. Doulas are usually massively equipped with this “sense of things” skill–walking into a room to find a laboring mother, her partner, family, providers, and nurse. Each with their own emotional experience, needs, goals, desires, and fears. The music is on and people are having side conversations. The room smells like a lot of bodily fluid (often the depth of those smells is a sign itself of how far along labor has progressed) and a lot of sterilization chemicals. In an instant that doula sizes up the room, the tone, the interactions, the body language, the mother’s noises and movements, who is holding stress in what parts of their bodies, the tension, the love, the energy, the gaps in energy, who is driving the intention in the space. Then, she matches all of that up against what she knows are the mother’s wishes, hopes, worries, fears, and dreams. And she meets every single person in that room exactly where they are with hardly a word. She seamlessly integrates and harnesses the parts and pieces needed for the family that is relying on her. It isn’t long before everyone–provider, nurse, family–everyone is in love with her. They all feel seen and understood by this woman. And that was how I trained my brain for years and years and hundreds and hundreds of births before midwifery.

My mentor set me on the path to train my brain to quantify all of the dozens if not hundreds of data points along the way that were my teachers and to let myself be informed primarily in bullet points instead of feels. At first this process gave me tremendous headaches. It was a slowing down that took discipline and discomfort. I had to stop seeing myself in one way, and open up to myself in this whole new dimension–smart, savvy, educated, knowledgeable, prepared, and capable.

I remember the first time I took a mom to a physician because of the same condition as the one that started me on this path moving from Intuit to I knew It. The physician asked me, what are you seeing that leads you to believe this?  I said here’s what I know and why I know it. I believe you are here to help this mom but I know what she needs and that’s why I’m calling. And I gave her my list of evidence. And she agreed. And mom and baby were healthy and fine because I identified a simple physiological disruption long before it ever got a chance to manifest as a diagnosable pathology.

Now I’m old (which I enjoy!) and I’ve embraced not needing anyone’s permission to know that what I see–labs, signs, symptoms, constellations of symptoms, are of great import and can make a real difference in the health of a family I am working with. I happily consult colleagues, teachers, and mentors and work with them to hear fresh ideas, consider possibilities, and to build a care plan.

But I needed the intervention of a surprising midwife to find my way. It taught me to stay waaaayyyy open to what all midwives have to offer, to trust that even if it’s not how I practice, or we don’t share cultural, social, or especially here in the south, religious ground, we share the work of mothers, babies, pregnant people, families, and ourselves. How do you Intuit? How do you Knew It?  How do you seek the knowledge and wisdom of others to help inform you as you grow and learn?  How can you leave space for others to practice in a way that is genuine to them and continue to be yourself? What pieces would you want us all to pay attention to?