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Month: January 2017

My First Week Away From Them

My First Week Away From Them

I just spent a week away from my boys–the longest time I’ve ever been away from them since my eldest son was born five years ago. I went skiing with some good friends, entirely on my own, while my partner held down the fort in my absence.

I think I’ve been dreaming about this week away for nearly five years now. In the early, bleary-eyed days of new motherhood, when I was certain the exhaustion would kill me, I dreamed about mere hours away.  A week was unimaginable, but I would fantasize about someone taking my son and holding him for three hours while I took a nap. And in all fairness, there are several occasions when I can remember exactly that happening. My in-laws would babysit every now and then, or my partner. Once two work colleagues took him for a walk for two hours while I slept on the couch, and once, in desperation, I went to a friend’s house 10 blocks away and slept in her bed for three hours, as I found it nearly impossible to sleep–really sleep, deep and undisturbed–if the baby was anywhere in the house with me. Even his slightest whimpers, faint snufflings in his sleep, would set me bolt upright, in those early days, so any chance of a real nap would have to be done away from him.

And then, as he grew older, I began to dream about entire days away, and even entire weekends. I would imagine how glorious it would be, how unfathomably luxurious, to have an entire day to myself. To do the things I used to do, the things I took for granted, before I had children. To sleep in late, have a lazy morning in bed reading the paper, showering for a full, uninterrupted 20 minutes, enjoying a leisurely brunch at a local restaurant, lingering over my coffee–hell, on some days even an uninterrupted 5 minutes on the toilet felt luxurious, the stuff of fantasies.  I couldn’t imagine an afternoon spent browsing through bookstores or watching a movie, cooking a complicated meal from a new recipe book, knitting while watching TV, drifting off to bed whenever I felt tired, rather than trying to sprint through the evening’s interminable to-do list with the bed at the finish line and the distance between us growing longer and longer.

My partner would leave, often for work but sometimes for pleasure, and I would think about how much easier it was for him to have a week or weekend away. He was less tethered, his life carrying on in many of the same ways that it had before children, whereas for me my post-kids life was unrecognizable to my pre-kids life. I was often unrecognizable to myself.  Some days I would cry bitter, jealous tears about this. Some days I felt like I was the default option, taken for granted. He could head off on stag-dos and weekends away because I was at home, maintaining the routine, ensuring that naps were had and noses were wiped, food was cooked and cleaned up and cooked and cleaned up again, bodies bathed, teeth brushed and bedtimes kept. Needs were met. That was partly where the bitterness came from; that needs came before wants for me now, and that there was never time or room or energy for my wants, whereas my partner could still occasionally fulfill some of his wants.

But little by little, I started to have opportunities to leave. First an evening out with girlfriends after putting the boys to bed, so that they never even knew I was gone, and then an afternoon here, a morning there. A day spent at a conference now and then. I started working again, one day a week as an IBCLC at a breastfeeding drop-in (strangely enough, my day spent “working” often felt like a holiday), and then I began working two days a week, and then three. An avid runner, I began to train for another marathon about a year after my second son was born. I spent hours away, running. And then, for the race itself, I left for an entire weekend away with my partner, while the grandparents watched our children. Brief glimpses of my former self, snatched here and there like an exhausted swimmer coming up for air.

But now, for the first time, with a five year old and a two year old, I am finally in a place where I can go for a week and not feel like my absence will be harmful to them. In fact, I feel quite the opposite–that it would be good for all of us.  Good for me to be away, good for them to realize that they can manage without me (for a little while, at least), good for my partner to be on his own, and understand what it feels like to be the one left behind, holding down the fort, and good for them to see their daddy not just helping me, but single-handedly doing all of the tasks I normally do.  Good to change the routine and remind ourselves that we’re all flexible, that we can adapt. And for the record, my partner is an incredibly capable and involved dad. Leaving him alone with the kids for a week is by no means beyond him, or even a stretch for him, and I had absolutely no qualms about it. They’re in good hands.

And so, here I am, on my own for a week…and it’s been WONDERFUL! But it’s also felt like I’ve had an arm chopped off. I keep feeling the phantom twinges of my family all around me, as if I’ve lost something really important and keep forgetting what it is. I walk into restaurants and start to ask for a high chair before remembering that it’s not needed.  During dinner, I keep feeling like I should be doing a gazillion different things besides just eating my meal and enjoying the conversation. I should be reminding the older one to use his cutlery, reminding the younger one to sit still or he’ll spill his water, trying to get both of them to have a few more bites or else there won’t be any pudding, snapping at both of them to stop harassing each other, refilling plates and making pointed reminders about using napkins, cutting meat and retrieving forks off of the floor etc. etc. It’s as if I’ve gotten used to juggling eight balls while also eating a meal, and now all of a sudden the balls have disappeared…but I still feel like I should be juggling.

And how strange it’s been to move through the world unencumbered again!  To only have to think about myself and my own needs. To be the one traveling light, to sail through airport security in a matter of minutes. To board a plane on my own, with a good book to read and no mental checklists involving emergency snacks and drinks, knowing exactly where various toys, books, games and Lovies have been stowed, checking the batteries on the iPad which is the inevitable emergency back-up to the games and books, and making sure that nappies have been changed and wees had before boarding. To just get on a plane, sit down, put on my seatbelt and be ready to go. How unbelievably decadent! I can roll out of bed and be ready to go 20 minutes later, whereas usually dressing, cleaning, feeding and preparing my children to leave the house is a 1.5 hour long endeavor. The freedom and ease is staggering!

Our culture is really good about focusing on the positives of motherhood and glossing over the negatives, but in truth, motherhood is usually always a mix, and it’s important to acknowledge the dark as much as the light. So much love you feel like you’ll burst (!!), on a daily basis, but also so much uncertainty, responsibility, tedium, loneliness and isolation (and in many cases, depression and anxiety as well). Lots of dark in addition to the light, and rarely a perfect balance of the two. And in those first few days and months, nothing can prepare you for how swift the bulldozing of your identity and former life can be! I feel like the process of becoming a mother razes your identity to the ground, and then, in the wreckage of your former life, you slowly begin to rebuild your identity from the ground up, trying to figure out how to reincorporate all the pieces of who you used to be into this new shape.  And bit by bit, over time, you remember the things you used to enjoy and do on your own before motherhood, and learn new ways to do them again. But this week has made it very clear to me that you never go back to being the person you were before you had kids, even when you do get to the point that you can leave them for a week. All of those months and years fantasizing about time away, so that I could be who I used to be, even for just a little while, is impossible.  That person is gone. Those things I used to love to do before children, I still enjoy, but now they don’t feel like they’re quite enough for me, on their own, because I guess it takes more to fill me up now.

And I miss my kids like crazy. This time away has been nourishing and vital, and very eye-opening, but I feel like what it’s done more than anything else is give me energy to plunge back into the fray of parenting again. And be a better mother for it, as well. I can’t wait to see them again!

NMC threatens Independent Midwifery again

NMC threatens Independent Midwifery again

Back in 2013, Independent Midwives (IMs) in the UK were facing a crisis: a new EU regulation was coming into effect in October of that year which would require all IMs to carry malpractice insurance (and would therefore make it illegal for IMs to practice without indemnity insurance). At the time, it was difficult to find an insurer willing to cover IMs, and given that the pool of IMs sharing the costs of insurance was small, the quotes from insurance companies at the time were prohibitively expensive. Thankfully, after several petitions, protests outside of parliament, and a long and drawn out campaign by IMUK, a resolution was found in early 2014 that enabled self-employed IMs to purchase insurance through a pooled indemnity scheme set up by IMUK itself rather than using a third-party insurance company, which allowed IMs to continue to practice legally.

However, this past Friday (the 13th, no less!), the Nurse and Midwifery Council (NMC) made a decision that the IMUK indemnity scheme does not provide adequate coverage (i.e. sufficient funds), particularly if a serious case of malpractice was ever brought against an independent midwife using the scheme. From the NMC’s statement on their website:

The NMC’s investigation found that the indemnity scheme provided for IMUK members was not able to call upon sufficient financial resources to meet the costs of a successful claim for damages for a range of situations. These include the rare cases of catastrophic injury, such as cerebral palsy. This could have the effect that mothers and babies who suffer injury through the negligence of an attending midwife are not properly compensated for their injury. (NMC, 2017)

Which basically means, that as of Friday 13th, 2017, any independent midwife using the IMUK scheme is now considered to be practicing illegally, unless they can find a different indemnity insurer to cover them ASAP.

As you can imagine, this has created quite a bit of chaos. Women who chose independent midwives for their care and have developed trusting relationships with them throughout their pregnancies are now being told that their chosen midwife can’t attend their births, and that they’ll have to find alternative arrangements, in some cases with only days to go until their due date. Even more cruelly, the NMC has specified (on Page 2 of their guidance) that IMs using the IMUK indemnity scheme will not be allowed to attend their clients’ births in any capacity, even in a non-midwifery role, which is particularly harsh given that the general standard of care during home to hospital transfers is for the IM to remain with the client in a doula/ emotional support role even as the midwifery role is transferred to NHS midwives.

In an urgent letter written to the NMC on Friday the 13th, Rebecca Schiller, CEO of Birthrights (the human rights in childbirth charity) expressed her dismay over the NMC’s decision, criticising many of the  implications of this decision:

While we are aware that some women may be able to transfer to local NHS home birth services, we are concerned about the safety implications of this. Local NHS home birth teams will not have antenatal records relating to women who book later in pregnancy and there will be a very limited opportunity for a named midwife to build a relationship. In some areas there are limited, unreliable or no home birth services at all, which may have prompted the woman to use the services of an independent midwife. Furthermore, many NHS home birth services are unwilling to support women who are making an informed choice to birth at home outside of guidelines. In these cases we believe that women will be unable to give birth at home with appropriate clinical care.

As the regulator for the midwifery profession in the UK, it’s certainly important that the NMC sets and enforces clear safety guidelines. However, the amount of indemnity coverage a midwife has does very little to ensure safety. All it ensures is that in the event of a tragedy, the affected family will be able to sue the IM who did the delivery for a larger amount than they otherwise would be able to.  As Richard Chappell at Philosophy.net succinctly summarised in his article about the decision:

NMC Chief Executive and Registrar Jackie Smith has responded with the claim that “The NMC absolutely supports a woman’s right to choose how she gives birth and who she has to support her through that birth. But we also have a responsibility to make sure that all women and their babies are provided with a sufficient level of protection should anything go wrong.”

In other words: nice as a women’s right to choose might be, what’s really important is that she can sue for many bucketloads of money (not just a few bucketloads) if anything goes wrong.

BirthRights has also questioned the timing and manner in which this decision has occurred, as it’s left many women who had booked independent midwifery care without a clear way forward.  The NMC has been particularly opaque about what amount of coverage would meet their safety standards, despite both IMUK and Birth Rights asking for clarification. For example, in the NMC’s own policy guidance on indemnity insurance, they state:

We are unable to advise you about the level of cover that you need. We consider that you are in the best position to determine, with your indemnity provider, what level of cover is appropriate for your practice. You should seek advice as appropriate from your professional body, trade union or insurer to inform your decision. You need to be able to demonstrate that you fully disclosed your scope of practice and to justify your decisions if asked to do so. (NMC, 2017, Page 3)

Therefore, they are raising an objection to the amount of coverage IMUK decided upon, while simultaneously stating that the amount of coverage can be determined by professional body, insurer or trade union (i.e. IMUK)–not exactly helpful in terms of figuring out what amount of coverage would satisfy requirements.

The NMC’s press release also implies that the NMC has been in talks with IMUK about the inadequacy of their indemnity cover since 2014 and that if their clients now feel suddenly surprised by this decision, it’s the fault of the IMs for not updating them about this issue. However, the final decision was only reached 3 days before Christmas, which left IMs and their pregnant clients scrambling for alternative care arrangements over the holiday season.  Additionally, in the NMC’s press release on their decision, they go out of their way to stress that this only affects a small percentage of midwives in the UK (approximately 80 out of 41,000 midwives), as if that makes it ok.  But this small number includes nearly every independent midwife working in the UK, and the women the IMs are caring for are as equally entitled to their chosen provider and manner of birth as any of the other women cared for by the 41,000 other midwives in the UK. As Milli Hill wrote in the Telegraph back in 2013 when the insurance coverage was first threatening independent midwifery as a profession:

If … Independent Midwifery becomes illegal, this will be a grave blow to birth freedom in the UK. The NHS will be left unchallenged, a monopoly, and a system that already seems to be over-stretched and flawed will be left to continue without an alternative for anyone to compare it to. Women who seek an different option to the mainstream will have no choice but to birth unattended, or perhaps in secret with an midwife practicing illegally. Will this really improve birth safety?

Independent Midwifery provides the gold standard of midwifery practice in the UK: trusting relationships, continuity of care, respectful, informed choice, and freedom to birth where and how the woman would like, and is therefore something that needs to be protected, even if the number of women choosing this type of care is ultimately small.

As it stands right now, talks are ongoing between IMUK and the NMC, and IMUK has filed a legal challenge to the decision, while IMs are seeking out alternative indemnity cover. The RMC has also proposed that honorary NHS contracts could be a solution for IMs in the short term.  If you get a chance, please sign this petition in support of IMUK. This post also explains more of the history of independent midwifery and the insurance issue that has come up since 2013, and of course, you can continue to follow IMUK and Birth Rights for further updates. Hopefully a resolution will be found soon!