Pedestals
by Katherine Jensen

[Editor's note: This article first appeared in Midwifery Today Issue 15, 1990.]

Being adored is one of the delights of the profession and simultaneously, one of its hazards, for adoration must be dealt with. We are with a woman during the most significant rite of passage in her life; it is natural for her to love us and to invest us with power far beyond what we deserve.

But dealing with such a gift—graciously accepting a client's love without getting caught up in her adoration—is not always easy. It feels wonderful to be honored for what we love doing, but pedestals are certainly easy to fall from.

The precarious balance required of midwives became evident to me when I met Sarah. Sixteen years old, she was pregnant and scared. I had convinced myself over the years that I didn't like teenagers. (When I was in midwifery school, teen clinic was an option. I opted out!) I wanted nothing to do with those mouthy, sullen young women—or so I imagined them. I could not relate to the midwives who considered their teen clients to be the most rewarding part of their work.

Sarah was a case. The product of an abusive home, she had been in several foster homes. Her boyfriend was also abusive and mostly absent. She was one hard cookie—dyed, ratted hair, wild, disheveled clothes, long, painted fingernails. She didn't have much to say to me, and I just did my job.

Her birth was outrageous. We had our first conflict when the lab technician walked in to draw her admissions lab work. She refused. I tried to be kind and appeal to reason, explaining why it was important, all the information it gave me, how it really helped me take good care of her. I ended up telling her that if she didn't let the tech draw her blood, I wouldn't assist at her birth. My patience was not great.

Her labor was quick and uneventful. She delivered a beautiful, healthy baby boy. Unfortunately, she needed stitches. I subtly drew up the local and brought the syringe toward her perineum. The next thing I knew, she was sitting on the headboard screaming at me, pleading with me to not stick her. She had a second degree laceration. Back to the sweet and gentle explanations, the importance of stitching the gaping wound in her perineum; then I had to resort to distractions, and finally, pleading.

I had never been so frustrated in my life. I left the room and let her family talk to her. In the end, they were able to convince her that she would heal faster, with less discomfort, if she let me stitch her up. It was a long and tedious process, but it was accomplished.

I left that birth fairly disgusted, both with her and myself, further convinced that I had no business dealing with teenagers. I really didn't expect her to keep her postpartum check-ups, and she didn't.

It wasn't too long before she was back in the office, pregnant again. Different boyfriend this time, cockier, but obviously still battered, at least emotionally. She obviously loved her baby and was doing her best to care for him even though she had no examples in life for good parenting. By the time her second son was born, 18 months after the first, she had another boyfriend, and he became the father of her third son, born 13 months later. By the time her third child was born, Child Protective Services had custody of the first two, and with much counseling, Sarah had decided to give her second and third child up for adoption.

Sarah was genuinely afraid to tell me about her decision, afraid that I wouldn't like her anymore. Child Protective Services had convinced her that the only chance she had of getting her firstborn back was to let go of her other children. She wanted her little boy back. Her children had been taken from her when they were found locked in a car while her babysitter was in a bar. Though Sarah had not harmed them, the state agency believed she had made a poor choice in providing their care. Now she had to prove she was capable of making better decisions. She was taking parenting classes, and really trying.

Because I'm adopted, I have a deep respect for mothers who make such difficult choices in their lives. I was there when the adopted parents arrived at the hospital to take custody of Sarah's little boys. What a joyously happy family they were. What hopeful, open hearts embraced these little people with such dreams for their futures. I cried a lot. I could not imagine giving away my children, or having to choose between them, to give two away in order to get one. Sarah said it was hard, but she didn't show much of what she was feeling inside. Suddenly, Sarah's real strength hit home hard.

For the third time, she didn't keep her postpartum appointments. I saw her occasionally for gyn care and birth control. She had custody of her firstborn again and a new boyfriend. It wasn't long before she was pregnant, hoping a fourth time for a girl. She was 20 years old when her fourth son was born. Ultrasound had prepared her for the gender and she was loving and accepting of this little boy. During her pregnancy, she brought me photographs of her second and third sons, sent to her by the adoptive parents. The photos were a year old, treasured, fingerprinted from much looking. Beautiful, happy little boys—and she finally was able to share her sadness about losing them. She said she hopes they will come find her when they are grown, that they will understand. Her oldest came to all her prenatal visits, always dressed neatly, hair spruced up, well-behaved and happy. Sarah obviously loved him, and was proud of him and of herself.

She was different this pregnancy. She kept most of her appointments. And somehow, she wasn't a victim anymore. Nothing had gone easily for her; even her pregnancies, though medically uneventful, were not easy. She gained too much weight, had nine-pound babies, and summer pregnancies where she suffered with the heat. This time, though she had lots of back pain and general miseries, not much got her down. Where other clients would leave the office crying and complaining because they were overdue and miserable, Sarah took it all in stride, good-naturedly ready to be done with it all, but doing it nonetheless, with strength and dignity. And she kept her postpartum appointments!

A month before her last delivery, I received a letter from Sarah. It was the sweetest outpouring I have ever received from a client, and I was really moved by what she had to say, especially since our relationship had begun in such resistance on my part. It was still more touching because—though I had long ago opened my heart to her and loved her in spite of myself—I hadn't realized how much I meant to her.

And it made me nervous. If she gives me this much power, then there is that much potential to disappoint her. If she delegates this much power, will she see her own? I thanked her the next time I saw her, but it took me two months to actually write her in response to her loving note:

Dear Sarah,

Your words to me were so sweet. I felt your love in every one of them. I'm glad I've been able to be such an important person in your life. But I want you to know some things—I really don't have this kind of connection with every person I've been involved with. Sometimes I'm just too tired, sometimes there just isn't time, sometimes personalities just don't mesh like ours did, sometimes I disappoint women and I'm not who they need to care for them. I am not to everyone what I have been to you, nor are all my clients what you are to me. But the way you described me is just exactly what I want to be to all my clients; it's exactly who I want to be as a midwife. I want to be loving and affectionate. I want to be a helpful teacher, guiding my clients to understanding around their bodies, their emotions, their pregnancies, the changes that happen as we age. I want to be accepting and non-judgmental so that women will feel loved and accepted and safe in my care. That I was able to be that person for you is an incredible gift to me. That I am part of your family is an honor.

What you feel from me, in addition to my love and caring for you, is my commitment to my work. I love what I do. It is such a privilege to get to receive new life into my hands, to be able to guide women through such incredible rites of passage. My family is not always supportive. They have often been hurt and resentful that I give so much of my life to midwifery. It's been a hard choice for me, but life is filled with hard choices. Sometimes you have to make choices to follow your heart even when you don't have the support of the ones you love best in the world. I really believe that if you listen to your heart, it always leads you down the right path. Sometimes it is a lonely path, but always one worth walking.

You see, Sarah, I'm very idealistic. I really think each of us can make a difference. When I give my heart and soul to a client and her birthing, and she comes away feeling like you do, then I feel like there's hope. She will take the love and pass it on to her family. That family will then be strong, and pass strength on to the community, and from there to the planet. I am convinced that each of us can make such a difference. You already have.

My life is better for knowing you.

I love you. Love, Katherine.

Sarah was married in August, to the father of her last son. How I hope that her life unfolds as she dreams it, that she is always loved and that her children grow strong and healthy in her loving. May she continue to open and fly! And may each of us—as we are showered with our clients' love for what we so joyously get to be in their lives—may we strive to give back to these women the power they give to us.

Katherine Jensen is a CNM in Oregon.


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