This summer I was thrilled to be a Midwifery Fellow with Midwifery Care NYC
(MCNYC). At MCNYC I was incredibly fortunate to have midwives Carol and Shar as
my guides, teachers and safety net.
It has been an exciting whirl-wind summer: I passed the American Midwifery
Certification Board, became a New York State licensed midwife, attended 5 incredible
home deliveries, provided prenatal and postpartum care, and . . . oh, managed to get
pregnant myself along the way!
While the births I attended were certainly the pinnacle of my summer I want to highlight
some things about my fellowship that really made an impression on me.
Having the opportunity to be present and observe the care and attunement during
MCNYC’s homebirth prenatal care was very special. Each visit with Carol and Shar is
about an hour long. When compared to my training clinicals at SUNY Downstate (where
we would see patients for 15 minutes), MCNYC’s time frame alone makes such an
impact on the quality of care. During the prenatal care, Carol and Shar would discuss
anything from the common discomforts of pregnancy, to how the client is doing
emotionally. Topics like nutrition, exercise, sibling involvement, sex, and worries get
discussed at length. The best part about the individualized care that Carol and Shar give is that everything is done with full consent and understanding of their clients. Rather than routinely sending a client for test, a discussion of what it is, the risks/benefits, what you learn from it and actions you would take with that information precede any decision. This puts the client in power to make a fully informed decision that will best suit their family. This might be par for the course in the home birth setting but it was refreshing to witness first-hand. It was inspiring to see that no matter what decisions a family made, Carol and Shar listened and surrounded the clients with love and support. From my observation, Carol and Shar’s sensitivity, mutual respect and authenticity empowered client’s agency and confidence.
The calmness that both Carol and Shar exude and bring with them also left a long-lasting
impression on me. As a Labor and Delivery nurse, I have witnessed many extremely
high-stress situations. During my Fellowship with MCNYC, I was encouraged to see
some of these very same stressors diffused in the home birth setting. While some
emergencies in the home require drastic action, other high-stress moments can be
successfully resolved with the acumen of a gifted midwife. One example that comes to
mind was when we had a baby who was having some trouble transitioning and was
working a little harder to breathe than normal. Rather than clamping and cutting the cord and whisking the baby to the warmer to start neonatal resuscitation like we do in the hospital, Shar calmly gave 5 breaths next to the mother with the cord still intact so that baby could continue getting oxygen from the cord. Everything was explained and parents and everyone in the room remained calm. The baby almost immediately started to breathe better. At another birth that I attended with Shar, the head was out before the body for longer than I was used to normally waiting. In the hospital setting, there would have been full panic, shoulder dystocia called, putting pressure on the neck/head without waiting for a contraction and tons of people in the room. In this case, Shar calmly coached the client when to push and how to change her position. Baby was born crying with no resuscitation necessary and I was introduced to a new variation of a normal delivery.
One of the things that I loved about this summer is seeing how hands off birth can be. In
my graduate school’s rigorous academic program, we learned that there is no statistically
significant difference in tearing between the hands-on and hands-off approach to delivery technique. We had a couple of births that were almost completely hands off and it was amazing to watch the baby maneuver the way out of the pelvis just like we had learned. I can’t help but compare this to hospital birth where hands are constantly in the vagina (often without consent) during the entire pushing phase. The majority of births I
witnessed this summer did not require suturing and the clients were pushing only when
they felt the urge, listening to how their own body was telling them how to push. In the
hospital, you will most certainly see the provider instruct someone to be on their back,
holding their legs up, take three breaths and hold for 10 seconds each. Everyone requires
different support during childbirth—still, it is refreshing to see directed pushing does not
always have to be the default.
One of the gifts of being a midwife is to know normal so well that when something is
abnormal, you can spot it right away. I still have so much to learn it can feel daunting at
times. This summer’s fellowship provided me with a critical lesson in what ‘normal’
looks like. It is difficult to witness ‘normal’ in the hospital setting when there are so
many competing factors and interventions. Learning from Carol and Shar gave me the
confidence as a new midwife to deeply trust birth. I am so thankful for my time with
them this summer and look forward to launching into my midwife career surrounded by
Hannah Hadi, CNM
Summer Midwifery Fellow