With overwhelming emotions, I want to share that I accepted a midwifery job at Oregon Health and Science University (OHSU). In addition to the clinical components of midwifery — seeing patients in the clinic and catching babies in the hospital — there is a faculty element of the position where I will be an instructor in the College of Nursing. This will involve research and writing, and I’ll have the responsibility and privilege of teaching and training the next generation of midwives.
This opportunity surfaced organically during an encounter with one of OHSU's midwives in what felt like a watershed moment of my career. It feels like a full-circle moment as OHSU was my top choice for midwifery school, but I never made it off the waitlist. Swipe to see the photo I took in June of 2016, hoping to post as an announcement that we were moving to Portland — more thoughts on that pic in a minute.
Admittedly, Portland hasn’t been all we dreamed it would be in 2016, but we anticipate this change in my job having a significant positive impact on our life as a family. I have negotiated to work 80 percent instead of full-time as I am desperate for better work/life balance. I’m eager to have time to nourish friendships and reignite my passion for cooking, cycling, strength training, gardening, and writing, and to discover what it’s like to exist without being in overdrive.
I hardly recognize the energized and enthusiastic woman in her mid-20s from the photo above. She was so full of zeal and hope in pursuing midwifery. Little did I know, it’s a high-burnout career that has been more draining than I ever could have imagined. Nothing could have prepared me for the toll it would take on my physical and mental health.
For many reasons that I won’t fully get into here, out-of-hospital midwifery requires an additional level of passion and commitment that overtook me. The schedule is much more demanding, and insurance companies don’t reimburse as well as they do for hospitals even for the same services. This work proved to be unsustainable in this season, and I lost myself too early in my career and my life.
That said, I remain very pro out-of-hospital birth for low-risk people. Birth centers and home birth will always have a special place in my heart, and stepping away from it comes with substantial grief. If I were to have a third baby, I would absolutely opt for a homebirth again as the model of care truly can not be matched.
I have deep gratitude for my out-of-hospital work experience. Having a foundation of physiologic birth is the heart of midwifery and unfortunately is becoming a lost art. I am looking forward to bringing my experience into the hospital setting where I can show up for people that need or want to give birth in the hospital, and make changes to the system when or where needed.
Content warning: The rest of this post may not be helpful reading material for pregnancy. If you are giving birth in the near future, consider checking out some of the following material instead:
-Ina May Gaskin’s Guide to Childbirth
-Mindful Birthing by Nancy Bardacke
- Expecting Better by Emily Oster
The experiences I encountered as an out-of-hospital midwife have also given me a new perspective and appreciation for hospitals and helped me see the time and place for interventions. Prior to practicing as a midwife, some of my experiences in the hospital during midwifery school left me wondering if we, birth workers, were causing more harm than good. I had this idea that if we left birth untouched, complications would be few and far between. In part, that is what drew me to a birth center.
But fairly soon into my time at the birth center, I remember being somewhat taken aback by the amount of medical care involved: labs, MFM consultations, iron infusions, risking people out for preeclampsia and cholestasis. It was all absolutely necessary and felt very safe, I just wasn’t expecting it. I naïvely thought that if we sat on our hands and avoided the cascade of interventions, it would all happen seamlessly. Birth would quickly prove me wrong.
The first birth I attended at my new job was a shoulder dystocia. The third was a uterine rupture. The sixth birth was a retained placenta where the mom lost 2.5L of blood. By the time I attended my eighth birth, three of the babies had need resuscitation.
Of course there were beautiful births too, but they seemed few and far between. The months flew by and in May of 2022, after a very straightforward and beautiful labor, I had a baby born in my care, nearly lifeless with a APGAR of 2. There were no warning signs that he was in distress.
A few weeks later, I resolved a shoulder dystocia that resulted in yet another massive hemorrhage. It absolutely rattled me and I will never get the image out of my head watching her bleed as if a fountain was turned on full force. I rode in the ambulance with her to the hospital — my hands compressing her uterus to manually stop the bleeding. I provided emotional support to her as doctors transfused her with blood, re-dosed all of her medications, put her under general anesthesia and performed a D&C to stop her from continuing to bleed out. I had to step out of the operating room as I felt faint thinking that someone came close to dying on my watch — again — even though I’d done nothing wrong.
I snapped a picture of myself in the hospital bathroom while she was still in the OR to remember the time I first asked myself, What the hell are you doing?! It was June 29, 2022. I then frantically googled “CNM job Portland” only later to be graciously talked off the ledge by my work partner and other dear support people in my life.
But less than 24 hours later, there was another shoulder dystocia. And then more hemorrhages. The list goes on. Emergency after emergency and non-emergent hospital transport after transport left me frustrated, disheartened, exhausted, and anxious. The voice in my head went from this is my dream job, to, this is not what I signed up for.
I don’t know why birth has seemed so broken. Early into the pandemic I had only attended about 50 births, which isn’t a great sample size, but anecdotally I hear seasoned midwives say that birth is one of the things that seems to have had devastating impacts from COVID-19. It’s still too early for research to show precisely the ways in which this vascular disease and global stress have impacted pregnancy and birth, but I imagine the ramifications are partly on display through the experiences I’ve described at work.
I vacillate between feeling like a traitor — like I’m selling out to the corporate hospital system, and also feeling proud of myself for knowing what I need and being wise enough to prioritize the health of myself and my family. My start date at OHSU is eight weeks out and until then I will soak up the time I get to spend doing hour-long prenatal and postpartum appointments where I can give highly individualized care. I’m also spending this time working through significant imposter’s syndrome and going through EMDR and Brain Spotting Therapy in order to prepare myself for the hospital environment which can be overstimulating for me.
For most of our marriage, Josh and I have felt as though we are treading water. Throughout the last nine years, together we have managed an unplanned pregnancy (Dawson!), a cross-country move, unemployment, midwifery/grad school, another unplanned pregnancy (Adelaide!), financial insecurity, mental health challenges, the pandemic, and another cross-country move. Of course there are pockets of deep joy woven throughout, but through it all we have craved stability and security. This job change will bring both of those things, and for that I am deeply grateful.
Cheers,
Taylor
