After my 3-month internship (115 births), I didn't feel ready to leave, and luckily, I'd bonded enough with the staff AND they were short-handed still. At that point, I had qualified for licensure (remember, I'd had a 2-year apprenticeship prior), and I remained at Casa as a licensed supervising midwife teaching the incoming interns (after a period of being supervised myself). I was there for 14 months (300 births) before returning home, and the Casa experience so well-prepared me for starting my own practice. 300 births is about 10 years for a lot of students in a homebirth setting.
I often refer to it as the M*A*S*H unit of birth. Nobody doubts that the MASH units did amazing work during our wartime, they did what they had to do, often in creative ways, usually with excellent results. Yes, the experience was very different. I learned things I might NEVER learn in a homebirth setting, yet things that maybe, just once, I might really NEED. I learned things that I threw away.

I learned so much from having to handle cases for women whom I'd never met. I had to learn how to bond quickly when women walked in pushing whom we'd never seen before; I had to learn how to ascertain sometimes in just a few minutes what risks they might have before they pushed out their babies. Sometimes, they walked in crowning, despite being high-risk. I caught babies of families who were doctors and lawyers, and I caught babies from families who lived in cardboard boxes on the sides of mountains. A grateful Mexican doctor-daddy invited us over to his side and gave some of us suturing lessons. I attended as many as seven labors at one time, with as many as five births in an hour, even clearing out my own bed for women we didn't expect. We also spent days bored without babies being born. We feasted on extravagant meals from some grateful families, and we cooked our own food for families who obviously had none. Besides the mostly-average people I worked with, I caught babies of: women who'd never had sex; women who'd been raped; women who didn't know how they got pregnant; women who'd gone through infertility treatments to get pregnant; women whose fathers were the fathers of the babies I caught; women who gave their babies up for adoption; women who were mistresses of men whose wives birthed in the clinic the same day as the mistresses; 13-year-olds and 50-year-olds; first-timers and twelfth-timers; abused women and idolized women; women who lived down the street, women who bussed in from the deepest regions of Mexico and women who showed up wet, having SWAM the disgusting Rio Grande IN LABOR, illegally crossing, dodging border patrol, just to birth on "our side." There is so much to be learned from a family who manages to pay SEVERAL MONTHS' salary (still only $500-700) just to have their child be an American citizen.

Still, there were many opportunities for continuity of care, albeit different than the home setting. I worked really hard to be sure I was the continuing caregiver for as many women as I could. That's hard in a place like Casa, but it's possible for a determined individual. I also learned how that is so important, but it's not everything. Most women got prenatal care with us, some starting as early as their first month. Women bonded with me (and others) like they do in homebirths. They brought us pastries, gifts, wrote us cards, invited us to their homes. Some continued writing to me after I left.
As a student, I didn't like the way SOME of the staff midwives at that time "did" birth. I do not ignore this part of Casa in any attempts to "pretty it up," because it's often what makes people (who'd never been there) gossip about the place. I was there as a guest, and I made a conscious (difficult) decision to respect that. I learned how to keep my mouth shut and my ears/eyes open. I learned the humility one needs to be in someone else's space; to honor THEIR ways of doing things for the gifts that are inherent, even when they are hard to understand; to know that I cannot walk in and change things just because I think my way might be better; to be open to ideas that might be different, but might very well be valid; to learn how to quiet my SELF and LISTEN, even when some of me was shouting from the inside. I learned these things from the midwives who did things in ways I hated. And any experienced midwife here will recognize that those are lessons we must have to be good midwives with our families. This deep humility is part of what makes me the excellent midwife I know I am. I learned many things I did not want to repeat, and I deeply understood from observing them WHY I didn't want to repeat them (which is more valuable that having someone TELL me). I also earned respect for my ways, and when I was a supervising midwife, I was given reign to do things in those ways, so I was able to be part of teaching the interns "homebirth midwifery."

For the most part, Mexican mamas birth well and quickly, despite any hardships they may have. Still, with such numbers (30-50 births per month), working with women who may be poorly nourished, with serious environmental pollution, I was witness to complications that I may never see at home. In 2 years of my homebirth apprenticeship, the most difficult thing I'd seen was a baby who came out sorta blue; the midwife rubbed him up, he was fine. In one year and 302 births at Casa, I dealt with hemorrhage, serious hemorrhage, true shock, fetal distress, serious meconium, anomalies, twins, breeches, resuscitation, true postmaturity, serious resuscitation, serious lacerations, serious cord entanglement (x5), shoulder dystocia, car births, shower births, hall births, bathroom births, many precipitous births, retained placentas, cords snapping off (poor nutrition), face presentation, serious malpresentation, hypertension, prematurity, tiny babies....yet during my time there, only 1 baby (Anahi) died after a transport for fetal distress (CS was not done for an hour after her arrival, her placenta ended up being 5" in diameter), and 1 (Oswaldo) died as a result of anomalies incompatible with life.

Like Alison Osborn, I've returned to Casa a few more sporadic times in the last 10 years for 6-week stints to help out as staff when they are short-handed. Over the total course of that time, I've been blessed with the sheer coincidence of having been there for FOUR births each of two different woman, 3 babies each of 3 different women, and several two-timers. That might be better continuity of care than some even get at home ;). And both the woman and I always recognized each other when she came in despite the lapse in time.

The experience of living and breathing birth together with several other birthworkers was so significant, and most of us don't get that in our homogenized environments at home. During my time there, I worked with interns from nine different countries, some as young as 18 years old, some grandmothers in their 60s. I worked with single women, childless women, happily married homemakers, divorced women, unhappy wives, organic farmers, McDonald's addicts, Christians and Mormons, lesbians, PhDs, high school dropouts, nurses, spiritual midwives. We all had a common purpose--midwifery--and since we were living together ON-SITE, we had to learn to work together, to deal with personality differences (and there were many). This all helped prepare me for my future in midwifery.

I came out of there so well-prepared for homebirth (repeat, I'd had a 2-year apprenticeship before entering Casa, and then I LIVED on-site for 14 months), and while I rarely need to employ the emergency skills I acquired there, when I do need them, I act swiftly, quietly and confidently. I learned so many LIFE skills, however, that are priceless. The beauty of those Mexican families is something I still carry with me.

Casa is not for everybody. Some souls are truly way too fragile to handle the intensity of such a place. Perhaps they may even be too fragile to be midwives. But for most people, it is an excellent clinical site if one can understand humility and is open to learning.