March 15, 2015

This is the system in which I work:

At a recent meeting I heard that midwives are valued because they are a cheaper alternative to doctors.  No mention that their (well-documented) care is superior and outcomes are better, even in high risk situations.  No mention of that.  We are cheaper because we are paid less and we work hard, and, up until now, were doing more of the work for no more of the money. There seems to be a glimmer of consideration in the expression, that, hmm, maybe we should consider another midwife, they are cheaper…..oh, but then the expression of acknowledgment that, oh, right, the doctors don’t want that. (They want the money, not the extra work….right.  Forgot that part.)

I snap the elastic band on my wrist and swallow that one.

I say, “But there are women who can’t get here for care.  They don’t have the money for gas. They are going without prenatal care because the clinics have stopped providing it. If we had another midwife we could do that. We could go to them. It would be better care for an entire region.  They could come here to deliver, but would stop being ostracized for not showing up for their appointments.”

I am asked how I know this would happen? I have to admit, I actually don’t know.  It just makes sense to me.

I point out that our current relationship, though, healthy and excellent in the past, has been poisoned and is now rancorous and unfair and unacceptable. In a group of three, when two of the families “come first” that means someone’s comes last, right?  Oh! Right! But we don’t acknowledge that because it is only the selfless midwives, who have always put their demanding jobs first allowing everyone else’s families to “come first.”  Well, someone has to work, right?  Someone has to be available for the women who, despite the best efforts by science, still have babies at irregular hours!!!  And on holidays!  And, God forbid! during the summer!

And now I am changing the dance. This is throwing a major wrench in the works. It’s starting to be amusing to watch. Amusing and depressing and scary, because I know what I have to do.

But doctors have school aged children who have the summer off! Consider that!  How can one be expected to work when their children are home and free and need a parent to play with? And the ones whose children are preschool age have spouses who teach! They have the summer off, too!  Can’t expect the spouse to sit home with the children all by themselves, can I?  Think of that!  How inconsiderate of me (a lowly midwife) to expect time off when others need it so desperately.  Think of the camps that were bought as second homes that will lie empty on the weekend!  Did I ever consider that?  How cold and inhumane could I be?

I sit snapping the elastic band on my wrist. This has been my life. This was the job I always dreamed of, a full scope practice in a small town in a beautiful place. A place where being part of the community is an integral part of caring for it. Women are so much more than just their body parts.  That was the message when we campaigned for a women’s center all those years ago. Yes, the system accommodated women, but not in a healthy way. Women were forced to submit to a system designed for men and the convenience of doctors trying to fit as many patients into a time slot as possible. That was the most productive and lucrative way to give care. Oh, they’ll deny it.  They’ll say it isn’t true.  But it is. It’s just couched in more caring language. But the truth is, they make more money if they see lots of people in a short amount of time.  So get real.  Stop with the delusions. It was true then and it’s true now.

We’ve allowed insurance companies and administrators to dictate how we give care. Cookie-cutter health care is as efficient as it is inappropriate. We’ve allowed regional protocols to dictate our own (seriously, if a nearby hospital doesn’t offer a VBAC then we don’t have to) and with a straight face, people with 14 years post-secondary education, use this a serious argument. I ask, “When your kids were teenagers, did you say, ‘Well, ok, if everyone else is doing it, go ahead.  I know it’s not right, but if the regional protocol is to drink and drive, then ok.’?” Really?  Did you say that? Because that’s what you are saying now.

Know what the response is to that? Eye rolling, “Uggh, Linda.  Stop being difficult. You are angry and inappropriate.” And you know what?  It’s true. I am angry. And I don’t know what’s inappropriate anymore.  If my temper tantrums haven’t changed things by now, I guess I am inappropriate.  Maybe walking away is more appropriate.

This is what I know for sure:

1. I am frightened about what is happening to women’s services in this state and country.  They are disappearing.

2. I want to work with a true peer.  Another midwife with the same philosophy and devotion.

3. I’m not ready to give up.

4. The dance has changed. I’m not doing those steps anymore.

After that, I’m not sure. I think and pray the answer will come.  I don’t want it to be dependent on someone other than me.  I have the power to change only my own life, not the whole system. I don’t have someone helping with the bills. I find myself having to squelch old resentment about that. Other women get to work part time! or not at all! and pursue their dreams! Other women’s husbands stayed true to their commitment! Yes, I remind myself, but I am not those other women. Like I used to say to my daughter when she would throw that argument at me, “But other mothers ——— !”(fill in the blank, whatever it was she wanted me to agree to.)  And my response was always, “Right.  But unfortunately for you, you didn’t get one of those mothers.”  And here I am. I didn’t get one of those husbands.

So my self-pity on that note is brief. I need to pay the bills.  I need to have family time. I need to have days when I know I will sleep. I need to have someone I trust caring for women on those days.

Maybe I need another adventure.