after birth pains

There are a few other titles I could choose from for this piece.

• Was it the mom? (too judgmental)

• The meaning of birth? (too esoteric)
• There are no guarantees! (borders on discouraging)

The truth is that something, probably the recovering perfectionist in me, compels me to analyze what happens at any given labor and birth. I have postings on Mothering that discuss ethics and competence. One research study I read said that most incompetent people don't realize they are incompetent. The same skills required to develop mastery of a subject or skill set are the same ones it takes to recognize competency. I would think that a willingness to examine shortcomings is probably one of the subsets to recognizing competence.

In a long winded way that brings me back to what I started out wanting to write about: when things don't go as planned is anyone at fault? I have heard other midwives, nurses and physicians blame the mom. I am sure that there may be a few cases where the mom has serious issues that she can't deal with that effect the labor, but we have no control over the baby and it certainly doesn't come with emotional baggage. I think it is too easy to assume that the mom has issues she doesn't wish to deal with and that that is slowing labor. I've heard it in such phrases as:

• She couldn't let go.
• She didn't want the birth bad enough.
• The baby is probably feeling her anger/ambivalence and that's why it turned breech.
• She's just immature and won't listen to me.

As a nurse I cared for a teenager who had a long history of sexual abuse. The doctor wanted to induce her and the poor girl couldn't tolerate even the mild cramping caused by the lowest dose of Pitocin. She was frantic about the pain it caused. I remember hearing another nurse and the anesthesiologist talking about her acting like a typical teenager- turning away from the nurse when she tried explaining things, spending time on the phone when they tried to talk with her, or watching television incessantly, etc. I finally asked if they were aware of her history of abuse and that her behavior was actually dissociative in nature and a coping mechanism for dealing with the past abuse. (Insert light bulb here)

I think that often this judgmental attitude is a coping mechanism for us as birth workers. We don't have any control over the mom or baby and, as a friend wrote, have no idea what karmic forces are at work in the woman's life. When we run out of ideas for helping her get the birth she wants, it is much easier to blame the mom than to admit that no matter how good we are we can't fix everything.

• We can't untangle a cord before the birth
• We can't make the cord grow longer
• We can't fix every malpositioned head
• We can't make a baby smaller
• We can't fix a heart defect
• We can't reseal the bag of waters once it breaks
• We can't always turn a breech
• We can't make mom labor only during the day after a good night's sleep.
• We can't make it happen by wishing and hoping when our skills fail us
• 
  

Our failure to help a woman meet her goal is not a reflection on us as providers although most midwives, at some point, think it is. In most cases the fault lies in circumstances beyond anyone's control.

But our frustration needs an outlet and it is so hard to admit we don't know everything, so we turn to the next best thing. This happened to a laboring woman I know. She had a baby that was poorly lined up in the pelvis and causing extreme back pain. The midwife didn't appear to have the skills needed to adjust the baby's position or to admit that what she did do wasn't helping. Rather than admitting these things (even to herself) she blamed the mom for not cooperating in what she wanted to do. The midwife went so far as to set up the story on a midwives' board to make herself look like the rescuer, but that mom didn't want to take responsibility for her part in what happened. The midwife then shared their "blame the victim" comments with the mom to prove her point.

When I talk with women who are considering becoming a midwife, I ask whether they are strong enough. Maybe what I should be asking is if they are mature enough to understand the concepts of the Serenity Prayer without blaming anyone.

God grant me the serenity

To accept the things I cannot change;

Courage to change the things I can;

And wisdom to know the difference.