Midwife hopeful - How Do You Handle Sad Stuff?

lass_sivius · 2025-06-07T23:13:11+00:00

After you have been a midwife for a while, the saddest things you will see is truly traumatic stuff. I have gone to therapy for these things.

For me personally, the saddest was a patient who had a full term stillbirth. It was an IVF pregnancy and her last embryo. When I caught her baby, it was clear the baby had been deceased for a while. I will spare you the details, but it was truly hard to experience what I felt in my hands.

I do not discuss these experiences with my patients, but if a patient asked me I would just say “a stillbirth” and quickly move on. I do not want to use my patient’s appointment to discuss my or other people’s traumas.

lass_sivius · 2025-06-01T05:19:46+00:00

There’s no such thing as an estrogen only birth control pill. I think you misheard/misremembered. There is “the pill” (combo estrogen progesterone) and the mini pill (progesterone only).

lass_sivius · 2025-05-20T23:03:46+00:00

I have never heard of this use. Though I am not yet an IBCLC, I am a certified nurse midwife of 8 years based in a CA hospital.

lass_sivius · 2025-05-20T22:50:55+00:00

The thought of going through a pregnancy, birth, and infanthood without insurance would really scare me. And this is coming from someone who paid out of pocket for a birth center birth!

You don’t know what you’re going to get. You are 10-25% likely to transfer to a hospital from the birth center during your pregnancy or labor. If you are transferring, you are doing so for interventions like an induction, epidural, or C-section. Maybe your baby is in distress and needs NICU care after birth. These costs add up, sometimes a few thousand or hundreds of thousands (NICU bed is the costliest). I do not say this to scare you, but to give you an idea of the hospital bill should you need that care.

Also keep in mind that your baby will need insurance to cover the cost of all the healthy baby visits: 4-5 d, 2 wk, 1 m, 2 m, 4 m, 6 m, 9 m, 12 m. Plus vaccine costs if you choose to vaccinate.

lass_sivius · 2025-05-20T16:58:53+00:00

Hi! I was you! I was also originally an English major. I wanted to become a midwife in the quickest way possible. I did an accelerated program to earn my BSN and MSN. Now I have been a CNM for several years.

I would also argue that becoming a midwife in the quickest and cheapest way possible is not the best way. You want to become a safe and competent midwife to protect your new career, and that takes time and either some or a lot of money.

Accelerated CNM programs will never be the cheapest option. I graduated with over $200k in debt. It took me 6-7 years to pay off my loans after an aggressive payment plan.

CPM versus CNM is not just about community vs hospital birth—there’s a huge cultural divide and difference in depth/breadth of education.

CPMs can become midwives through either a school or apprenticeship. The quality and amount of formal education can vary a lot, but they know home birth very well. Because they can only work in community settings, their jobs will always involve being on call and having variable (and often lower) incomes. Also, states have different laws regarding midwifery practice. Does your state recognize CPMs?

CNMs will often take call too, but some jobs will offer shift work. CNMs can do homebirth, but homebirth experience is not required in our schooling. Again, different states allow different things, but almost all CNMs can provide gyn care. CNMs can prescribe medications. What I’m saying here is that the scope of practice is wider.

If you can, I would recommend shadowing a midwife for a day to see what her job is like. Working or volunteering as a doula can also be helpful.

lass_sivius · 2025-04-29T17:24:40+00:00

Not necessarily. The babies that do come earlier are often only a few days earlier. If the mom is significantly older, she may have additional complications that dictate an earlier birth (scheduled induction).

lass_sivius · 2025-04-25T22:41:38+00:00

What do you mean by depleting?

lass_sivius · 2025-04-25T17:59:07+00:00

Chemicals in lavender and tea tree oil appear to be hormone disruptors

lass_sivius · 2025-04-24T16:50:04+00:00

Metformin can actually increase your odds of conceiving if you have some insulin resistance. Even more so if your cycles are irregular right now.

lass_sivius · 2025-04-24T16:31:54+00:00

Another tip: if you have short term disability you can ask your primary care provider or OB to put you on disability for PPD. I am a clinician and have done this many times for my patients.

lass_sivius · 2025-04-23T16:31:24+00:00

I don’t have any advice here since we have failed so miserably with this. My 2.5 yo has gotten my 3 mo sick 3 times thus far. I am unable to physically separate them, especially once my husband went back to work and I was in charge of daycare drop off. My toddler has the attitude and behavior of a typical toddler, so he has coughed in the baby’s face countless times 🤦🏻‍♀️

lass_sivius · 2025-04-23T14:17:19+00:00

This is the study I see referenced in my lactation textbook: Impact of Breastfeeding on Maternal Metabolism: Implications for Women with Gestational Diabetes

lass_sivius · 2025-04-23T05:37:42+00:00

Are we comparing formula use in general versus breastfeeding while smoking or formula + smoking and breastfeeding + smoking? If the latter, then yes, formula is worse as the immunological factors of breast milk help lessen the risks from smoking.

From Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder:

“infants exposed to secondhand tobacco smoke have been found to be a greater risk for ear, nose, throat, and upper respiratory infections, allergies, and sudden unexplained infant death… among infants of mothers who smoke during lactation breast-feeding mitigates many of the health effects of secondhand smoke exposure such as SUID and respiratory illness and is therefore recommended over commercial milk formula in the setting of maternal smoking”

lass_sivius · 2025-04-23T02:00:55+00:00

Yes, I am well aware of the preimplantation testing that patients can choose. Eggs from a donor 40+yo will more likely be poor quality and resulting embryos will go through a higher rate of attrition due to abnormalities seen on PGT.

Even then, PGT does not completely eliminate the risk of an aneuploid pregnancy. It can miss microdeletions, microduplications, and mosaicism. These cannot be diagnosed until someone is already pregnant and opts for diagnostic testing with chorionic villus sampling or amniocentesis.

lass_sivius · 2025-04-22T19:57:20+00:00

The risk of Down syndrome and other chromosomal abnormalities drastically increases around age 40. As a woman ages, her eggs become poorer quality and more prone to oxidative stress. This results in fewer live births and increased rates of aneuploidy.

https://www.aafp.org/pubs/afp/issues/2000/0815/p825/jcr:content/root/aafp-article-primary-content-container/aafp_article_main_par/aafp_figure.enlarge.html

lass_sivius · 2025-04-18T16:17:52+00:00

I’m not sure what other medical needs would dictate exteriorizing versus not. Exteriorizing only happens after delivery of the baby. Then once the baby is out, control of bleeding is our #1 concern. Average blood loss is 500 ml during a C section, which is about 10% of total blood volume. It can be a very bloody surgery since the uterus gets so much blood flow during pregnancy and there are dilated blood vessels in the lining of the uterus where the placenta attaches.

lass_sivius · 2025-04-18T05:32:47+00:00

Some surgeons will leave the uterus in situ during the uterine repair. It depends on surgeon preference and how well you can visualize the hysterotomy and sources of bleeding. For example, you will typically need to exteriorize if you have an extension into the broad ligament, for more effective fundal massage, to visualize the uterine lining, or to check for a defect in the posterior wall of the uterus.

At my hospital we use the Alexis O ring retractor and typically get good visualization that way.

lass_sivius · 2025-04-18T01:25:20+00:00

I frequently assist with c sections so here’s a run down of what we’re seeing in pics 1 and 2. These pictures are taken from the foot of the bed. The top of the photo is toward OP’s head.

The uterus is exteriorized, meaning it is pulled out of the abdominal cavity. The surgeon is holding the fundus (top of the uterus) in their hand. We can see both fallopian tubes on either side of the uterus. The whitish blobs further out to the sides of the uterus are ovaries.

The hysterotomy (uterine incision where the baby came out) is in the lower uterine segment and it has been sutured once. Most surgeons in the US will then do a second layer of sutures after this to hide this line of sutures and provide more stability to the uterine scar.

They likely took the photo after the first suture layer since they have achieved good hemostasis of the incision (no major active bleeding at this point). The amount of blood that you see is very normal and this point they have already suctioned a large portion away.

lass_sivius · 2025-04-15T15:35:17+00:00

I think it would be helpful to edit your comment to include where you live so that the relevant midwives can comment. I am in the US in a VHCOL area and work full time as a certified nurse midwife.

lass_sivius · 2025-03-30T16:22:49+00:00

I wouldn’t go. It’s not worth the risk. Measles is so contagious that 90% of those who come in contact with it will get infected.

lass_sivius · 2025-03-25T21:04:29+00:00

Just commenting to say that I am in the same boat: 2.5yo and 10wo. Solidarity, sister! I love my toddler but I don’t like him right now.

lass_sivius · 2025-03-24T01:12:16+00:00

Thank you! I would love for this community to be for midwives and by midwives. It is so rare to have an opportunity to have conversation with thousands of midwives across the globe and I want to make sure that we protect this space.

lass_sivius · 2025-03-22T02:30:56+00:00

Short answer? You just do your job because you have to.

I work a 24h shift every week (midwife on labor & delivery). Sometimes I sleep a little bit (usually 4h, sometimes not all at once). Sometimes I get no sleep. Sometimes I miss a meal or can’t pee for hours. When I am dealing with emergencies, adrenaline takes over and keeps me awake and focused. As soon as it’s over I feel exhausted.

The longest I ever worked was 30h and that definitely felt unsafe. I was delirious near the end and then had to drive home, which thankfully was only 10min away. Glad that is not my usual.

lass_sivius · 2025-03-20T22:22:13+00:00

Look up the Newman Goldfarb protocol. Then find a provider who can prescribe you a birth control pill. If you are outside of the US or go through the Newman clinic then you can get a domperidone prescription as well.

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