Wednesday, May 1, 2013

LM/CNM considerations, Part 1

Part 1:  Being on-call and the age of the children

In the early days of being a 24/7 professional, and even before then, I made an assumption that as the children aged, being on call would get easier.  The idea was that the intense needs of the toddlers and preschoolers would give way to more independent, self-sufficient children, who could understand what being on call meant, which would lend itself to an easier time with call for everyone.  Experienced doulas and midwives with children assured me that this was true.  The opposite became true for me.

When my children were small, their concept of time was not yet concrete.  The future could not be anticipated, plans could not be pinpointed.  Almost every parent has made the mistake of telling their child something exciting is going to happen in the future - whether Disneyland in a month or a playdate later that day - and regretted the decision throughout the interim.  For the on-call professional, this means that being called away on a moment's notice is not that different in their young child's eyes than leaving for work at 8am five days a week.  On the other hand, school age children tell time and have created inner expectations about the way their days will unfold, which means that these older children will know the routine of a parent's scheduled work, but have to adjust suddenly when a parent is called away.

Additionally - and for me, more importantly - small children do not have scheduled events at which their parent's presence is meaningful to them.  Older kids have school plays, music recitals, field trips, sports tournaments, graduations, and they actually know when their birthdays are, so there's no fudging and moving it a day later when a new baby gets the same birthday.  For professionals that are on-call a couple of days per week, this generally works out:  in this modern era, partnered physicians assist each other in making sure each is there for important events in their family's lives (versus the previous era in which male doctors often missed out but the stay at home mom was there for the child).  Occasionally, they may not be able to manage it, and a parent may have to take call or stay at work and miss the event.  But for professionals that are on call 24/7, this leads to a constant state of limbo.

The following conversation took place several times in the months before I went off call:  "Sorry, honey, I can't drive your field trip.  No, I don't have clinic that day, but if someone goes into labor, I can't abandon you and your classmates 30 miles from your school."  Then, on the day in question, whichever daughter had the field trip would come home after school and say, "Did someone have a baby today?" and I'd say, "Yes," and feel relieved and justified, or I'd say, "No," feeling horribly guilty, just as I had during the hours of the field trip.

So, is this uncertainty a problem or not?  It depends on the mother, and it depends on the child.

Many of the midwives I know who do not have a problem with this have a partner or close family member who has full or nearly full availability for the children.  My husband has some flexibility in his work, but works 60-90 minutes away four days per week.  Our families live just far enough away to not be helpful in this regard, either.  We always had babysitters and friends who helped with the availability for childcare, but this doesn't help with the emotional availability factor - having someone who cherishes the child available for important events.

As a child, there are certain things you want both parents to witness, and sometimes, you really want your mom.  I've always wanted to be there for those times.  I don't care whether I'm the one to drive to soccer practices or wave at the kids as they walk into school in the morning, but I don't want to miss the moments that are important to them.  Shortly after I went off call, Eliana led her school's daily prayer services for the first time.  She was in 3rd grade, eight years old.  In the morning, she asked me, "Mom, are you coming today?"  I said yes.  The best part of my day was saying yes instead of maybe.  Witnessing her lead tefillah was awe-inspiring, knowing that I was there for her was great, but the best part was saying, for the first time in years, "Yes, I will absolutely be there for you."

There is beauty in "No," too.  I'll never be a fully stay at home mom again;  right now I am taking one class, and it's going to become 2-3 classes next year and full time school shortly thereafter, followed by a job that will hopefully strike a balance between meaningful work and a meaningful home life.  So, I don't imagine that I will be there for everything that is important to them.  But I will be there enough.  And I will be able to say yes or no.  This year, the girls have each led tefillah twice.  I missed one time for each of them.  They knew in advance, and they knew in advance that I would be there on the days that I was able to make it, which included Kesenia's first time leading tefillah ever.

As for it depending on the child, I didn't anticipate that my children would be stressed by the on-call lifestyle.  They are very flexible kids - my one blessing in a cluster of challenging temperament issues for one child who shall remain nameless here.  Yet it became clear to me that their stress levels were rising.  We were undergoing a lot of changed mixed up with some serious limbo, so the constant limbo of 24/7 call was a detrimental addition to their lives.  Recognizing this was one of the main points in deciding to take a sabbatical.  Recognizing all of the above was one of the major reasons I started to re-examine the type of midwife I wanted to be on a longer-term basis.

I sat my girls down about a year ago and told them honestly about the two paths I was considering.  At the time, I was very unsure of what I wanted to do.  I didn't include any of my reasons for being interested in home birth or hospital birth, or being a LM versus being a CNM.  I only wanted to talk to them about their lives and our lives together.  I told them that I had two choices.  With one, I would work very few hours on a regular basis, probably one day a week, maybe two, but I would be on call all the time.  With the other, I would have one year of being very unavailable to them (the accelerated BSN year of school - more on that in a future post), and then after that I would work hours that would let me see them more than they see their dad, less than if I did the first choice, but that they would always know when, and that I would be able to say yes instead of maybe - but sometimes no - when they wanted me to make a commitment.  I made it clear that although I was asking their input, it was my decision, and that there was more to my decision than its impact on our time together.  They both wholeheartedly asked me to choose the option with the schedule, even though it meant less time together.

Now, I have doula and midwife friends telling me that they're still too young and that it will still get easier as they age, once they are old enough to be home alone and I don't have to worry about childcare anymore.  I have to disagree.  Teens may be happy to be left alone, but it's not necessarily good for them.  They may also be playing it cool and not necessarily as happy to be independent as they are letting on.  (When my dad came to see my school play when I was 16 - for the first time in 4 years, since he is a musician and had gigs in the evening when my plays were - I was so happy that I cried, but I tried to hide it from him.)  I've also had some mom friends with teens tell me that they feel that teens need their moms even more than school-aged kids.  I think that the reliability that I felt was utterly lacking in 24/7 call is integral to what teens need from at least one of the important adults in their lives, and that reliable adult is going to be me.  In my case, it's true that if it isn't me, it will be nobody, but it's also true that I want to be reliable for them.

I think - I hope - that work with part-time call or no call will help me meet my career goals while meeting my expectations for my relationships with the people I cherish.  I can be the role model for my kids that I hope to be by demonstrating a good work ethic, pursuing my goals and dreams, participating in tikkun olam (repairing the world - by having a job that helps people), and prioritizing the most important people in my life.

Many people will react to this post by wondering why I don't just get a partner LM and go on part-time call as a home birth midwife.  It has been - and continues to be - considered.  Part 2 and beyond will give you some more information on why I lean away from it.  Hang tight, I'll get there.

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