Well, crap. I may have painted myself into a corner.
I’m looking for a job in Toronto now, and my prior life has given me a good deal of clarity in what I want: a full scope, shared care practice in the city. Full scope-meaning maintaining care for a client requiring oxytocin or an epidural-is all I’ve known in the hospital setting. Shared care, contrasted to primary care, means I share a caseload of clients with one or two other midwives, whereas primary care means 24/7 call for a caseload of clients that are “mine”. Each practice does things a tiny bit differently, but advertise themselves as one or the other.
I’d ruled out primary care as an avoidance measure of my former life, despite two Ontario midwives having encouraging words for me. One is a midwife who is also from Illinois and is happily working in Ontario now. I told her my biggest fear is working alone again. She said, decisively, with direct eye contact, “Jen, you’re never going to work alone again.”
Another said, “Y’know, Jen, some primary care practices still have an every other weekend off setup. Don’t rule out a practice based on that label.”
I dismissed what she said because “primary care” and “every other weekend off” are contradictory and mutually exclusive.
In the past year I’ve learned a lot about semantics and investigating assumptions behind my decisions. What do I think when I hear the words “primary care”?
Here’s what comes to mind:
1) “Primary care” means the only time I’m truly on vacation is when I’m at a festival with no cell phone reception.
2) “Primary care” means that when I am on vacation but reachable by cell phone, I get a phone call from my nurse. A client in her early third trimester has another UTI, and the midwife who had agreed to cover me was unwilling to call in a prescription for someone she’d never met. Not an unreasonable position to take, and not a big deal in the big picture of things, but here I am, being reminded of point #1.
3) “Primary care” means doing three births in a row and being awake for 48 hours, with the exception of a few naps. It means that while doing the recovery of client number 2, when client number 3 (a first time mom) calls me and cheerfully reports every five minute contractions, I say, “OK, here’s the plan. I’m going to finish taking care of this woman and stop at your place for a check. If you’re less than five centimeters, I’m going home for a little sleep. If you’re five centimeters or more, I’ll need some food, a shower, a change of clothes, and a bed for a few hours.” She knew, from a phone call the previous evening, that I had been at another labor, and when I said this was a second birth in 24 hours, she assured me that her family would help me.
Upon arrival, she was five centimeters.
I got everything I asked for. Her family was completely gracious. My nurse managed her labor for a few hours and got me up when the client began showing signs of being ready to push.
4) Remember that festival from 1 and 2? I’ve gone the past seven years out of nine. One of the years I didn’t go, I was, silently to everyone, waiting and hoping that That One Client would have her baby by 41 weeks. I’d taken her on as a client when I thought I would have a partner.
If she had her baby by 41 weeks, I could go. If she had her baby by 41 and a half weeks, I could go to a part of it.
She went into labor at 42 weeks, hours before her scheduled induction, and had her baby at 42 weeks and one day.
The morning she was in early labor, while on my way to a postpartum mother needing a home visit for a problem that wasn’t quite bad enough to go to the hospital, I got into a minor car accident. After the police took the report and the postpartum client’s husband, disregarding my protests, came to the scene and changed my tire (he was a mechanic), I did the home visit. All was fine by the time I got there.
Then I went to the early-now-active labor of the first time mom. She labored overnight, slowly and steadily. Not long before she started pushing, I got a call from another first time mom who had broken her water but hadn’t started labor yet. All the better, then, that I hadn’t gone to the festival.
The first mom pushed beautifully, had a great baby, and finished her recovery just in time for the other mom to have her first real contraction. I went home, took a shower, and went right to her labor in the mid afternoon. She labored overnight and had her baby at around sunrise.
All told, this was another 48 hours. One car accident, one self correcting postpartum problem, and two new mothers and babies.
So there you have it. This is what I think when I hear “primary care”. I’m not complaining or fishing for sympathy. I love my clients, but in those moments I felt victimized by my job. It’s a strange thing to feel victimized by a concept.
Each of these births was wonderful in their own way-the short ones were wonderful for their straightforwardness, the challenging ones were wonderful for the work all of us did resulting in happy and healthy moms and babies. And, without question, I couldn’t have done it without my birth assistants.
This is a picture, a snapshot, of my experience of primary care. If I work for a primary care practice, my lizard brain tells me, I’m signing up for the possibility of these scenarios happening again.
My rational brain tells me I’m wrong. I have statements from several sources that these scenarios won’t happen up here.
If I choose to believe my former-Illinois-now-Ontarian fellow midwife, my version of primary care bears very little resemblance to Ontario’s. It’s fairly common, she and others tell me, for primary care midwives to work for five months and be off for one month.
Two months of vacation time per year?
Guys, I haven’t had that much time off in the past three years combined.
The practices I’m interested in say four to six days per month off. Just like the other Ontario midwife told me.
Four to six days per month off?
It’s sinking in that I may be afraid of a boogeyman, of the distorted shadow of the words “primary care” with the light of my previous experience shining on those words.
Through my inaction, I’ve already walked past a position that offers a two weeks on, two weeks off schedule. Two weeks of working hard followed by two weeks of whatever I want to do. I could have had this job had I shown more interest. She didn’t hear from me after our first conversation, so she hired someone else.
What’s wrong with me? I’ve paid my dues. I can have a full time job with half time hours. I can travel, play, enjoy a work/life balance that’s more life than work.
As vehement as I was about wanting a shared care practice, my actions are demonstrating that I want to be professionally challenged. I want to be amongst midwives that are movers and shakers. If I am, I can bring the moving and shaking I’ve already done into a system that supports what I have to offer.
I’m willing to change my perspective based on a different operational definition. I’m willing to do something I am afraid of because several sources that I trust tell me that it is a different “something” than I think it is.
Dear universe: I’m willing to take primary care for a test drive for one year. If, despite lots of time off and having a team of supportive midwives around me, I decide it’s still not for me, then I can thank and shake hands with the primary care practice, find one of those two weeks on/two weeks off practices, and enjoy a life of relative leisure.