For better or worseBirth doesn’t wait. Not for traffic, birthdays, baby showers. Not for other deliveries. And certainly not for good times. In 21 years as a midwife, I’ve witnessed pregnancy proceed through desertion by spouses, death of loved ones, job losses, homelessness, and yes through pandemics. Its never-ending persistence is both tragedy and hope. Obstetrics is kind of a weird specialtyWe tend to be in a bubble from the rest of the hospital, yet everything passes through. Disease, accidents, grief, abuse and all of life and medicine don’t pause for pregnancy. And, midwifery is somewhere between medicine and art. It’s the only job in the hospital where most of the time I have a duty to actively do nothing. To honor the wisdom of the body, and protect the ancient process from outside influence while also minimizing risk. It’s normally a tightrope that hospital-based midwives walk gingerly. Since Corona, I feel the tightrope snapping. Birth is above else a letting goThe less safe a woman feels, the less her body is able to toil through the work of labor. Worry is always part of the price of parenthood. When women tell me they’re worried about being a good mom, or worried that something will go wrong, after listening to their concerns and making sure they don’t have real anxiety, I reassure them that worrying is how I know they will make good mothers. It is our mother bear instinct that made me, a woman who handles babies for a living, worry about dropping my newborn son as I carried him up the stairs. The normal worry of motherhood is work enoughMy first rule for my patients is not what they eat or how much they lift, it’s “no googling”. I started as a labor and delivery nurse in 1989, and too much information, especially bad information, always caused more angst than it was worth. Back in the early nineties, the culprits of this excess of data was your mom, your co-workers, or your aunt Linda. As I’ve told my patients, in 21 years of midwifery, not one woman, according to her coworkers, has ever been the correct size. Most are “huge”, some are too small, but I’ve never had a woman tell me, “you know everyone tells me I look perfect for my gestational age”. However, the more modern barrage of internet experts and social media opinions makes for plenty of crazy. It's all about CovidNow we’re faced with many women home, on devices or TV, and it’s all Covid, all the time. And after 21 years of saying, no, the media, or web MD, or aunt Karen is blowing the risk way out of proportion, I now have to say, this time it’s real. If a pregnant woman becomes infected, she knows what the worst case scenario is. The thing about this epidemic is, even the best case scenario is somewhat dismal. Much of it has to do with the environment of birth which has suddenly shifted under our feet. For the first time, women may have limited or no support persons with them in labor. Family that was supposed to come help with other children are now quarantined in other locations. Women that were just visiting are now stranded here away from home, family, and their own healthcare providers. Women who test positive are told they must be separated from their newborns. I know many of us are postponing life events. As heartbreaking as it is to postpone a wedding, graduation, or vacation, birth doesn’t wait. For most of us, the most significant event in our life can no longer be shared by fathers, wives, or grandmothers. The missed, precious first few days of our children’s life can never be recaptured. Difficult decisionsBoth pregnant women and health care providers are left with agonizing decisions. Should we cut down on prenatal care? If she has abdominal pain, which 99% of the time is normal and 1% is perilous, does she come to the hospital? And then there are the women who have the virus. Everyone else who has mild symptoms is being told to stay home, but birth won’t wait. As the rest of the hospital is organizing around the epidemic, separating into “corona” wards, labor and delivery continues to pulse through the rhythms of labor, birth, complications, and cesarean sections, whether we have an isolation room or not. Like the rest of healthcare, like the rest of the world, we grapple with questions which have yet to be answered. What happens when our first patient goes on a ventilator? Who takes care of the baby after? The mothers who test positive are being separated from their infants, but by definition, aren’t their other family members at risk for being carriers? I sat with a patient to take her history, and for the first time in my career, instead of shaking her hand or giving her a reassuring pat on the shoulder, I sat on the other side of the room. We weren’t wearing masks yet for symptom-free women, because we didn’t have enough. She was alone, had the trepidation of any first-time mom, and instead of getting a midwife, a word that literally means “with woman”, she got a bank teller. This is not our first pandemic ...... and won’t be our last. Birth doesn’t wait. Not until we have enough masks, not until we have enough nurses, and not until we feel safe to take our infants home. It won’t wait until your husband can share it with you, or until your mother can help you at home. It has persisted through war, slavery, and poverty and disease. Birth is humanity persevering from our ancestors to our grandchildren. Birth is hope when we feel hopeless.
