by Jennifer Hoadley, CNM/APRN
I get asked this question all the time, “why did you become a midwife?” Let me tell you, Midwifery was not where I had planned to be. I was maybe 3 years old when my fascination with human body and all things medical began. I would check out any and every book in the library I could find that would teach me about the body and how it worked. I would proudly tell every adult who would listen how babies were made (usually church people…oh, my!). I was probably about 8 or 9 years old when I had firmly and resolutely decided I was in fact going to be a Cardiac Transplant Surgeon. I committed the path of blood through the body and heart to memory. I read the biography of Dr. Denton Cooley. I researched the best undergraduate programs and medical schools. I took every advanced math and science class I could find. I went to summer school (in elementary school, voluntarily) to learn more and be prepared. In high school I made sure my college applications were perfect, my resume was flawless. I was doing community service, sports, clubs, student government (President of course), music, theater and going to college while in high school – I was making sure I had the most impressive application for college I possibly could.
The summer before my Senior year I was accepted into a program in Washington D. C. called the National Youth Leadership Forum on Medicine. It was a 2 week summer camp at Georgetown for super nerds who want to grow up to be doctors. We visited the National Institutes of Health, we did a cadaver lab at George Washington University School of Medicine. We met doctors and medical students. I met a cardiologist – a surgeon; he explained to me that my dream was a 16 year educational committment and close to three quarters of a million dollars in student loan debt and a lifetime of missed birthdays and Christmases. He also explained that I wouldn’t just be doing cool transplants in the OR every day. I’d be seeing lots of old men with congestive heart failure and high blood pressure. That I’d be putting in stents and lecturing stubborn folks about their diets. Suddenly, this plan sounded super lame.
So at 17, I found myself completely lost. I had no idea what I wanted to do. I knew I still loved medicine and science. I knew I couldn’t actually afford to go off to a big fancy expensive university. So, I decided to go to nursing school. I was the youngest person in my class at the University of Alaska, Anchorage. Nearly every other nursing student was a middle aged woman who had finally finished having babies and got them off to school and could just now start focusing on a career of their own. I was so glad I had go straight from high school to college. I watched these ladies struggle to get back into a routine of studying and classroom time, while juggling kids and husbands and well life. I just did school and worked a little bit. And, honestly it was pretty easy.
In 2004 I graduated and started work in a pediatric clinic. I was NOT excited about that, as far as I knew, I didn’t like kids. I didn’t babysit growing up, I didn’t change diapers, I didn’t like kids. I wanted to work in labor and delivery. Labor and delivery looked fun, exciting, happy healthy people celebrating the best day of their life!! However, no new grad is getting a job in Labor and Delivery. That’s a job reserved for those who pay their dues in other units and earn their way in. So to pediatrics, snotty noses and diaper rash land I went.
It didn’t take long for me to learn, Pediatrics, it isn’t really about kids. Its about moms, and dads and families. Its about explaining things to them in a way that is reassuring and understandable. And like all medicine – each sick kid is a mystery. I like mysteries – they are fun. I found myself piecing together symptoms and guessing the diagnosis. I would start to anticipate what tests or medications would be ordered and be prepared for when the doctors asked for them. I even got good and figuring out what kid wasn’t going home, but was going to be admitted to the hospital. I didn’t know this at the time, but that was my introduction in to wanting to be more than a nurse.
Fast forward a few years and 2 babies later and I moved to Spokane, Washington where I finally got a job in labor and delivery. I learned a lot. I made sure to always take the most complicated, sickest, high risk patients. I wanted to learn everything I could and become the best labor nurse I could. I spent time learning labor, delivery, postpartum and even spent time in the NICU. I didn’t know it then but my experiences in Spokane were very and I mean VERY biased. Every labor client I saw was induced. Pretty much no one came in “in labor.” And those that did show up contracting, got epidurals and pitocin to augment their contractions. I helped in cesareans nearly every shift. I thought this was normal. I also was indoctrinated into believing out of hospital birth was dangerous and stupid. No doctor at the hospital liked or respected midwives. Every “failed home birth” I saw was a “train wreck” with poor outcomes. I thought birthing out of the hospital was innately dangerous and even stupid.
Then, I moved to Seattle – and what a lesson in normal birth that was. I went from high intervention chaos to straight up evidence based birth and labor care. No longer was I starting IV’s on every mom. No longer was I strapping women to machines to monitor the baby and contractions. No longer was every client getting an epidural at 3 cm. Literally no one was induced without a medical reason. Every mom with a previous cesarean section was ENCOURAGED to attempt a vaginal birth if medically appropriate. I worked with community midwives. I worked with hospital midwives who also were community midwives. I saw babies born in water. I learned what a doula was. I saw better outcomes. It took a minute for me to really understand this was a better model of care. In fact, it didn’t fully hit me until I came back to Alaska and went back to work in a high intervention, low-science labor and delivery unit.
Once back in the world of starting IVs on everyone and monitoring everyone excessively and starving women in labor, I was miserable. I didn’t feel like a good nurse, I was not a patient advocate. I was a hospital policy pusher. I would print out research studies and policies from other countries and even other US based hospitals and show them to the doctors and powers that be…. but no change could be had. After numerous run-ins with with bosses for being morally unable to follow hospital policy (like telling clients they could refuse treatments such as IVs) – I decided I didn’t want to work in the hospital any more. It hit me all at once. I could walk away. I could be a midwife. I could practice in a way that suited my moral compass. I could return the power of birth to women. So I left work one morning (I was a night shifter) and applied to midwifery school before going to bed.
And that my friends – is how I decided to become a midwife. Now I have the freedom to present clients with information and allow them to choose their level of intervention. I have the best job in the world. I get to be With Women as they find their power, choose their birth and they LET me join them on their birth journey.