Crossroads

The past several months, I've focused on living in the moment with my kids, but I've also been looking back at the past several years to try to glean the life lessons I learned.  In the past few weeks, I've increasingly been looking forward at the paths I can choose for my career and how they would impact my family life.  Right now I see four:

1.  Home birth midwife.  Despite this having been the ultimate goal of the academic and apprenticeship program leading toward my California midwifery license, at this time, I find this to be the least likely choice.  The six months away from call has impressed upon me that my family life did suffer while I was on call and that my desire to be off call came from more than pure burnout.  On the other hand, perhaps six months simply wasn't enough time to recover, so I'm not going to take this option off my list yet.

2.  Hospital midwife.  I always had an ultimate goal of serving women in the hospital.  When I began my apprenticeship, I hoped to practice home birth midwifery for 15 to 20 years and then return to school to become a CNM, switching gears to hospital birth.  I believe that the 99% of women who give birth in the hospital deserve compassionate, evidence-based care just as much as the 1% who birth at home.  I'm also clear about the challenges of being a CNM in the hospital:  the lack of independence, the protocols that defy the evidence, the reduced time with clients.  Those challenges are not the only stumbling block I would have to choose to overcome;  after spending 3 years working toward obtaining my license, there is little appeal to starting from scratch and working through 3-5 more years of school to get my MSN and certify as a nurse-midwife. The upside of this option, other than the call to serve, is that I would have a schedule.  It also pays well enough that I could work part-time and still contribute financially to my family, and offers malpractice insurance. 

3.  Birth center midwife.  There is a birth center in the north bay, and ones in various stages of planning in Berkeley, Napa, and Modesto.  Some of these would entail quite a commute, but I could see myself working one clinic day and one 24-hour period of on-call work by staying in the town that day, for example, if any of these birth centers needed that type of help.  This option would have the benefit of the schedule (including scheduled, limited call time) and of working within the model of midwifery care rather than medical care, but would likely pay little and may have some of the drawbacks of hospital care, such as lack of time with clients or continuity of care.  Plus, like all other licensed midwife options, there's no safety net of malpractice insurance.  I would need to learn Spanish for two of these birth centers - which is actually a plus. 

4.  Consultant midwife.  My biggest short-term idea for a career path is to begin my own business providing supplementary care to women planning hospital birth.  This would not involve care during the birth - they could also hire a doula if they wanted birth care - but would entail several prenatal and/or postpartum visits in which I would provide all the care that home birth midwives provide their clients that OBs and Kaiser midwives don't have the time (or in some instances, such as holistic options, the knowledge) to provide.  I would also provide home induction services to help women start labor without hospital intervention.  I am very excited about this idea, as I think there is a huge need for this, particularly in the bay area, where there is a large number of women who desire the kind of self-mastered, education-driven health care that our current hospital maternity care system is ill equipped to provide on its own.  I would make my own hours and be my own boss, which highly appeals to this child of freelance musicians.  However, I would be giving up attending births, and after six months of sabbatical, I already miss birth.

There are also some other ideas floating around in my head, such as lactation consulting, which I'd always intended to do next after getting my license, though burning out ended that idea in the short term.

Much to consider, and I'm leaving all these ideas open.  My current plan for the remainder of the year is to work on a model for the consultant midwife business, and try to enroll in one class at a junior college or CSU East Bay to start finishing the prerequisites for the three nursing schools I would apply to if I decide to go that route.  I also hope to be called every now and then to assist any midwives within striking distance, to keep my skills and sensibilities fresh.  I just got a lead on this today, and surprised myself by tearing up with relief and happiness at the prospect of getting to attend another home birth sometime soon. 

Clarity would be nice, and sometimes I get frustrated that I'd really like to both be a home birth midwife and the kind of mom that I am when I'm not on call, but looking at all the options available to me, I feel blessed to be able to have these choices to make, and comforted that regardless of the path I choose, I will be serving women and families.  I'm also grateful for what clarity I have managed to glean that has helped me refocus my priorities on my family.