The Holistic Nurse: Keeping the Meaning in Birth and Death

We spent the month of April discussing pregnancy and fertility – birthing new life. Today we’ll complete the circle and talk about how we both enter and leave this world. Gretchen Brauer-Rieke is a retired nurse-midwife and the founder of CodaConversations, an educational service for end-of-life health care decision-making. She is also a certified Advance Care Planning Facilitator and she devotes her time and energy toward advocating and educating that we all have those important conversations with our loved ones and our providers about our end-of-life wishes. 

Gretchen’s essay about the transitions we make into and out of this life is powerful and thought-provoking. I hope her words will encourage you to pick up the phone or sit down a family member and start discussing your own preferences. It’s never too early to start the conversation.

When I offer public presentations on end-of-life health-care decision-making, participants often find it curious that I am, in fact, a retired nurse-midwife.  They wonder why it is that someone who spent 23 years delivering babies would now be teaching people to plan for their own death.

To me, it makes perfect sense.

We live in a country where the medical system is highly “westernized” – technology, pharmacology, and surgery reign supreme in a model based on diagnosis and treatment of disease.  In a culture where pain and suffering isn’t tolerated for any duration or any reason (‘we can treat that”), we expect that modern medicine will not only cure our ills, but keep us from experiencing discomfort.  Every condition becomes medically managed, with extensive diagnostic testing and aggressive treatment – even birth and death, our transitions into and out of this life.  Both are natural processes that have become grossly distorted by the best efforts of our medical system to somehow “improve” the natural process or “make things easier” (or safer or faster or slower or more convenient or more profitable…)

In the process of “improving” birth and death, we have successfully sucked out the sacred, creating medical events that leave no room for the mystical, the meaning, the learning, the growing, the work, the reward that comes from moving through the discomfort to bring about something new in our lives.

As a nurse-midwife, I spent most of my career working with women and families who sought to experience birth naturally, in their own homes, without unnecessary medical intervention.  For years, I worked to hold back the tide of pressure to test and treat and medicate and immobilize and disempower – protecting women’s choice to move through pregnancy, birth, and early postpartum following their own inner wisdom, feeling fully the sensations of birth.  I educated, offered choices, supported, watched, waited, and rejoiced as baby after baby came into the world calmly, their mothers exultant.  Midwifery was about teaching assertiveness skills to families – how to say no in a medical system that wants to control a natural process.

And this work is the same at the other end of life.  Again, our dying is often micro-managed by the medical system – aggressively diagnosed and treated to the (usually bitter) end.  Patients and families, disempowered and overwhelmed by medical decision-making, end up abdicating to the system and die deaths that they wouldn’t have wanted in settings that they would not have chosen had they been empowered to make choices.

I’m no Pollyanna – I know that neither birth nor death always goes as one would plan or hope.  Sometimes the process, by the luck of the draw or simple circumstance, becomes complex and difficult, moving past the ability of a person to cope without medical assistance. For those people, we must have compassionate competent medical care, using appropriate available tools to alleviate unnecessary suffering.

Still, the majority of us can birth naturally – and do so more effectively without the intervention of modern medicine – and most of us can die naturally, in our homes or alternate comfortable settings where the normal process of death is validated and respected instead of fought and drugged.

Our culture tends to resist trusting in the innate knowledge of our bodies.   We are afraid – we want experts to manage us and we believe that somehow those experts will make it all okay for us in these scary, stressful times of transition.  We too often accept surgical birth from numbed bodies as norm at one end of life, and expect that our health-care professionals will fight our inevitable death with every tool at their disposal at the other end of life.  In doing so, however, we risk losing the opportunity to push past our fear, to draw on our inner strength, to open ourselves the inevitable transition that our bodies are undergoing – to fully say hello and fully say goodbye.  We give up the opportunity to delve into what it means to let go and move on to something new, instead hoping that professional medical management will protect us from fear and discomfort.

My passion is helping people gain confidence in what their body already knows how to do, and I’ve seen, over and over, the amazing difference between the naturally-occurring life transition and the medically-controlled life transition.  I’ve seen people who have changed, stretched, and grown as they learn that they are much stronger, much more powerful, more open than they ever knew before when they are allowed to be fully aware, active, and present during transitions into and out of life.

I believe that more of us can make good choices – can learn to trust ourselves and our bodies – setting boundaries that keep the medical system from encroaching into our natural normal life transitions – to maintain the potential for meaning – to hold space for the sacred.  In birth.  In death.

For more about opening up the conversation and for additional resources, please head to the fabulous WIHI broadcast about this topic by the Institute for Healthcare Improvement.

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