Midwife means “with woman”, and improved birth outcomes for low risk women are achieved by being “with women” throughout their labor and birth. This practice is one of the hallmarks that makes the midwifery model of care different than the medical model. Obstetric care in this country generally involves the patient presenting to the hospital in labor and being cared for by the nurses throughout their labor, with the physician arriving in time for the birth. This practice allows the physician to attend to patients in the office during the day while their patients labor at the hospital, go to the hospital for the births leaving the office patients waiting for undetermined periods of time, and then return to the office to continue with their scheduled patients. This type of care is contrary to the midwifery model, and quickly became a bone of contention for me. I wanted to be with my patients, both at the hospital and during their labors, but how could I accomplish this? The Corydon office was 25 minutes from the hospital, and not nearly as busy as the Jeffersonville office, so I would reschedule my office in order to attend laboring women if needed. But when I was in the Jeff office, many times I would run back and forth to the hospital in order to spend some time with my laboring patient and keep my office patients from waiting. I longed for the labors that occurred outside of office hours, and I loved being able to sit in the room, coach them through contractions, and just watch the miracle unfolding in front of me. I quickly learned that women are strong, and amazing, and resilient, and that labor progress can be assessed by watching and listening to their verbal and visual cues. I felt that my presence, dimming the lights, encouraging calming music, speaking in soft soothing tones, and giving positive encouragement and guidance, helped women achieve the birth experience they had longed for, and increased my satisfaction with my job. I couldn’t get enough of it. I spent countless hours, days at a time, with women. And women were appreciative. Anytime I was out and ran into one of them, they would praise me for the wonderful birth they had. And I loved the accolades. I was making a difference for women, and I was feeling appreciated for my presence and support.

Meanwhile, my family went without. My teenage daughters were raising themselves, relying on each other for rides to school, to practices, to visit their friends. When I was home I was often tired, rushed, frustrated with the housework that wasn’t being done. My husband was working at an over the road trucking company, and was gone for a week or more at a time. Our time together was minimal, and strained. After one particularly heated discussion about our jobs, a decision was made for him to switch to a job that would allow him more home time in order to help more with the girls, and for us to have more time together.

My husband transitioned to working at a trucking company on the evening shift, giving him more home time. I felt certain that we could return to more of a normal family life. Upon returning home from work one day, I found my cell phone bill among the pieces of mail on the counter. When I took the bill from the open envelope, the amount due took my breath! How could it be that high? Looking through the pages of the bill I could not see how the balance could be correct. Then it occurred to me, this wasn’t all of the pages of the bill. There were 10 pages missing, and they were the pages that contained my husbands phone calls! Where were the other pages? I checked the rest of the mail, looked in the trash, looked around the house, no sign of it. I called the phone company, “I need to check my phone call list, can you look at the calls placed by this number and tell me if there is a number that was called multiple times?” “Yes m’aam, this number was called many times.” I was filled with fear. Did I dare call the number? Did I want to know who was on the other end? I called the number, no answer. My heart was pounding. Is this what it seems like? I paced the floor. My mind was reeling. I was angry. My phone rang, “hello.” “Hello, who is this,” the female voice asked.” “Who is this?” I asked. “This is Tina, who is this?” she answered. “This is his wife,” I told her. “Ah oh,” was her response. Click, she hung up. So many images started to come to mind. One night Kayla had fallen down the stairs and called me because she thought she had broken her ankle. “Where is your dad?” “He already left on the truck,” was her answer. Why was he gone early, he didn’t need to leave until morning? Sometimes he wouldn’t answer his phone when I called, then would call back later and say he didn’t hear it ring. Sometimes when I called he would sound very business-like, not saying he loved me at the end of the call.

Rage filled me. I drove to his job and sat in his truck and waited for his break. When he came out he was surprised to see me there. “What’s up?” he said. “I just talked to Tina,” I answered. “Tina who?” he asked, like he didn’t know. I let him have it! I cried, screamed, blamed, threatened. How could he do this to me, to us, to our family? I worked so hard to get us to where we are! Yes, I did. I worked so hard, and so much, and such long hours, and put my job ahead of my family. I spent time away from my kids, and my husband. I was always tired, and grumpy. I made my job, and proving myself, more important than anything else. How could he not? After a long weekend of talking, and fighting, and crying, it was determined that he did not want to leave, that it was over with her, and that we would work harder to make our lives better, and stay together.

I tried to get a better work/life balance. Whenever possible I would go home for lunch. I tried to encourage the nurses to spend more time with my patients, encourage them to ambulate, dim the lights, play music. Some of them were receptive, but many times they would be resentful of my requests. Several of them still did not believe that my way was beneficial or even safe. So i felt torn…stay with my patients to ensure their birth plans were honored, or spend more time at home. If I ever wanted to have more midwives to help I needed to grow the practice, and to do that I needed to have more patients and increased patient satisfaction. And darn it, I wanted to be with women in labor! The reason I had gone to school was to make a difference! So slowly but surely I started to spend more time at the hospital again.

Dr. Miller hired another doctor so my request for another midwife would have to wait. In the medical business world there was an unwritted understanding that when hiring another provider it would take 1-2 years for them to become established and providing enough income to justify hiring yet another. Adding a new doctor also meant proving myself again. He had never worked with midwives, so I spent countless hours educating him on my scope of practice, the midwifery model of care, the way I managed patients. He was much more of a micromanager than Dr. Miller, he would ask the nurses to notify him when I had a patients, and I felt like I was being tested most of the time. While Dr. Miller had the attitude, “Don’t dig a hole I can’t get you out of,” Dr. Catalano was more of the school of thought that I should’t even have the shovel in my hands. That I should consult him for all patients. So I worked to continue providing the best care for my clients, build my clientelle, and prove to another provider that the practice of midwifery was a safe alternative for women.