Observational Patience and the Art of Not Doing

I am under the belief that midwifery education must integrate the art of not doing and begin to name, mentor and teach observational patience before we lose our craft in the midst of didactic lists in what is considered “knowledge.”  We must mentor self-reflection, awareness, and intuition as an art that is integral to supporting the family. With our presence and understanding of birth, we can bring tools, if needed, towards restoration of normal.  For we know what that is and we know what that feels like.  We feel it in our bones.

We have acknowledged that students who learn certain skills look for the time to use them.  By highlighting the skills in normal birthing, they can look to those as well.  The adage that everything looks like a nail when your holding a hammer plays true in a culture that keeps the busy mind occupied.  This stimulated mind cannot be ignored as it has been shaped and will continue to be shaped by the overculture.  As Janine Parvati Baker once told me, apprentices learn the new interventions or skills and they keep looking for the moment in which they can use them.  This looking for the use of skills and doing can be routed into the art of not doing through the act of observational patience.

The craft of midwifery has been laid upon patience and design in a way that repetition and knowing has been passed down through experience and presence.  For the next generation of midwives who may have less experience with this in daily life, we must shift our focus to actually teaching presence and skills of just being with the knowing of how to not do.  If “not doing” isn’t broken down into a skills subset, parts of the craft might be lost in the fray of those looking to do something.

As midwifery educators, we understand normal is pivotal.  The hormones, the cardinal movements, the learning to be at a birth and feel it.  The knowing that without doing anything  –  just through hearing, seeing and being aware of our own body’s feelings – all is normal.  We feel that …and model that… and know that for a moment in time. Yes, things can change, but as a student sitting with birth has important skills including feeling the birth space, modeling the presence and trust for the mother, and understanding that we influence her parasympathetic nervous system.  We must also understand the dialectical benefits of listening from within for when our intuition is talking we do affect the birth space.  We can become aware of our internal reactions and processes which may be the first indicator of complications or shifts in labor.    The variations of normal also are myriad – and challenges lie in finding this knowing in normal and in a range of what hasn’t been experienced.

It may be hard to imagine that presence may be different and unusual for many.  However, in a busy culture we are continually being rewired.  In this era, we could lose the value of normalization, even within the midwifery community.  It is the observational patience that keeps us present at the births that we attend.   We could exchange the being still or self-reflection for the external checklists of exceptions.  As a Spinning Babies Trainer and Resolving Shoulder Dystocia instructor, students are looking to use the exercises and techniques for labors.  But we must truly teach the normal things to look for and not just assume that they know them.  The cardinal movements of labor, the reassuring signs for both a head down baby and a breech baby, what things feel like from the perspective of the care giver when nothing has to be done, just witnessed and held.  We learn it, speak to it, and listen as we know it in our bones to be passed on to the upcoming generations.  How do we begin to find words to things that may never have been named but have always been there?  This awareness that may have been replaced by a checklist of externalized exclusion.  Is this how parts of the craft of midwifery  have been lost in previous generations – not having been named and being erased by cultural erosion?  Maybe it was named and the language was eliminated or lost.

Observational patience is different than passive patience.  One is actively engaged in the experience of normal, intuitively as a birth worker and externally when looking to the birthing mother and family.  Observational patience informs the art of not doing through the senses.    And although we can create the seeing, hearing, feeling, smelling checklist of birth for normal, we must turn these internally as well to develop subset of skills that includes intuition.

What does normal feel like?  How have you gotten to know it or feel it in your body? Where in your body do you feel it?  What are you telling yourself about this birth?  What births or baggage before this here and now may be reflected in these feelings?  And how, without doing, do you use the senses in that place of knowing?  What does a normal, vibrant baby sound like (not just the numbers, the quality)?  How do you develop a connection with this baby and family?  How are you informed or not informed by this relationship?  What are the variations of a normal laboring mother sound like, feel like, move like?  Where do mothers report their feelings in their body?  Do you know when things are unknown or unusual but are still reassured?  How do you respect the baby’s process and ability to find its way?  How do you use observational patience when the head is crowning or restituting?  How do you respect that golden hour or the time before the placenta?

Even in the dark, especially in the dark, with or without tools, how do you know deep down that all is well?