April 12, 2015

I look out this window at a small, charming chimney, wide at the bottom, tapered at the top, the brick lines curvy, as if a child built it. The house is small and tucked into the earth and I can’t take my eyes away from it. I imagine elves or hobbits living there. The morning air is cool and clear.  Hummingbirds flit in and out among the bougainvillea, then pause for refreshment at the feeder outside the kitchen window.

It’s a residential neighborhood in Oakland. It’s quiet, eerily so, I think, and I don’t see people outside these cute little houses. I wonder who lives in them, what the inside of that fireplace looks like, what they do for a living, what they have for supper, how long they’ve lived here.

I’m making some major life changes and am looking for where I belong.

After pushing my stances uphill for too many years, I am leaving my job.  It’s a biggie. I’ve thought long and hard about it. I’ve considered how much of my persona is caught up in my role as small-town midwife, how much I love the women I care for, how I have no other home, and I am very clear I am making the right decision.

I’m tired. I’m tired of having to be available all the time. I’m tired of having to beg administrators to provide care for the women who need it. I’m tired of having my life revolve around other doctors’ families. I’m tired of missing out on my own family’s events. I’m tired of having to fund-raise for essentials and educational offerings. I’m tired of having to apologize to women for how expensive our services are. I’m tired of watching our resources utilized in a way I don’t support. I’m tired of having people with no leadership skills facilitate meetings that go nowhere.

The average time-span before burnout for midwives is seven years.  I made it thirty.

Our medical system is ridiculous. We have more administrators than patients. We are required to sit through meeting after meeting where nothing gets decided and more meetings are spawned. We are trying to run a humanitarian service with a corporate model and we are failing miserably. Greed prevails. Women suffer.

With the midwifery profession there is the difficulty of the job itself.  There is much joy and satisfaction in this calling, but it is physically difficult to be up at all hours, contorted in ways that hurt our backs and knees for hours on end.  My friend told me recently that she knew the day she had to retire was when she had to have a nurse help her up off the floor after doing a delivery on a birthing stool.  She said, “I did this beautiful delivery, delivered the placenta, got her all set, then couldn’t stand up!”  Ok, so there’s that. Then, we have to continually fight to be able to practice despite all the data and evidence showing we give safe, quality care.  Our outcomes are better than physicians’ outcomes, even in high risk populations (they always throw that defense in there), the cost of the care we deliver is lower, women have higher satisfaction rates, breastfeeding rates are higher, it goes on and on. Even with all this, we are continually fighting for fair compensation and working conditions. And though we have come a long, long way, it just seems like same shit, different century. We no longer get burned at the stake for witchcraft, we just get burned out from the witch hunt.

So after five years of begging for another midwife to practice with, I’ve decided to stop enabling, whining, complaining, and being resentful and put my considerable energy elsewhere.  Now to decide where elsewhere will be.

I’m on a twelve day book tour. I am so blown away by the response I get from the story of Shamwana.  The audiences are people in all walks of life, from cardiac surgeons to elementary school students. I tell this story and watch the faces of the listeners and am very clear that this is part of what I am supposed to be doing. I don’t want to over-think it, but Beatrice and Gerardine are a catalyst. The medical students I spoke to this week were riveted. They wanted to know how to shape their careers to make a difference. I told them that our system works hard to discourage them. They may graduate with tons of debt and make career decisions based on that debt.  I told them to keep these women in their minds when making those decisions. Work to change things.

The ripples are small right now, but I feel the circle widening.