Dealing with Death

The little boy I posted about a few weeks ago died on the weekend.  I found out about it yesterday when I went down to do a couple of visits and no one was home.  They were at his funeral.  What a devastating blow for this family, to have a three year old who was apparently the picture of health until a few weeks ago, sucked down and killed by a sudden and horrible disease.  I will go and see them soon, to give my sympathy, to hold a hand and shed some tears with his mother.

It’s not the first time we’ve lost a baby or child in this settlement, but it’s always hard.  And it’s always hard for the parents, regardless of how many children they have.  Their lives are precious, their deaths bring enormous grief, despite their belief that the child is now with God.

I have had the privilege of attending two funerals for children that have died — one a baby who inexplicably died with SIDS and another who had a congenital heart defect.  Like church services and marriages, funerals are held in the home.  Because, for the most part, death occurs at home, and because the Amish in this settlement do not embalm, funerals are held very soon after a death.

First comes the viewing.  It amazes me how quickly rooms will be rearranged to accommodate the many who may come, benches lined up, the downstairs bedroom disassembled to accommodate the body, washed and arranged.  Viewing is expected and, at both funerals I attended, I was asked if I wished to see the baby.  The viewing may occur the day before the actual funeral. Food is inevitably present, and people visit and console those who are mourning.  At the same time, there are many busy hands ensuring that the house and surrounding environment are clean and ready for the service.

The services I attended were held in the carriage sheds, to accommodate the number of people who attended. Prior to the service, the women will be gathered in one area and the men in another, visiting and discussing the sad event.  There are elders who organize in what order people will file into the service, and we are included in that organizing process.  People line up and sit on benches in the shed, men on one side and women on the other, facing one another.  But before that, we view the body, which in the funerals I attended, was displayed in the little casket placed on two chair outside the shed, on the lawn. Interestingly, small children are encouraged to touch the body as they pass by.  Unlike the English, the Amish do not protect their young from the realities of death.

The service is long, and in High German, so almost completely incomprehensible to the non-Amish. (I do understand “Gott” and “Himmel”, but very little else.)  When I attended my first funeral, I visited a pregnant relation shortly after and she asked me if I understood any of it; when I confessed that I did not, she said “I don’t understand it all, either”.  Interesting — because, of course, High German is different from the dialect that they speak to each other daily.  Still, we sit respectfully, kneel down to pray (which is done by facing the benches).  Everyone knows what should be done, and when.

After the service, the body is viewed once more before the casket is closed, and people head to the little cemetery for internment.  At the last funeral I attended, the public health nurse who attended with me and I noted, with some amusement and admiration, that there *is* a system to organize all of the many horses and buggies — the horses and buggies were each chalked with numbers to ensure that the correct horse was matched and hitched up to the correct buggy!

I haven’t attended an internment, but I imagine that the ceremony there and the markers are as simple and “plain” as everything else. Sufficient to meet the need and no more, or that would be proud.

I listened last week to a documentary last week on the CBC on the avaricious and profitable funeral industry.  Interestingly, one of the former funeral directors interviewed is now a midwifery student at the University of British Columbia. But I thought a good deal about how the Amish deal with dying and death, and how we might do ourselves a great service to return to simpler and more respectful ways.

Complicated Pregnancies with the Amish

Some of the most satisfying care that we provide to our Amish women is when their pregnancies are not straightforward.  The Amish do not “doctor” much, but they are not opposed to getting appropriate medical care, when it is needed.  But how we make that happen for pregnant women and new babies requires some navigation.

Historical records tell us that there were approximately 200 founding families who came to Pennsylvania in the first wave of immigration that occurred in the mid-1700’s, as they sought to escape religious persecution in Europe.  From the original two waves of migration, in the 1700’s and again in the first half of the 1800’s, have arisen more than 200 settlements in the United States and Ontario. Although conversion to the Amish faith is not unknown, it is rare (although we find that the more progressive settlement in Aylmer does, in fact, have a number of converts, mostly former Mennonites).  Thus, this is a closed community, with a resultant founder effect.

In Southwestern Ontario, which is home to a number of settlements, midwifery and medicine have forged strong relationships to provide improved care to the Amish, in no small part due to the work of an amazing paediatrician/medical geneticist, Dr. Victoria Siu. Vicky works with tireless compassion with Old Older Amish and Mennonite communities, and has partnered with the midwives who, by and large, provide their pregnancy care, to improve and expedite care for children born with genetic diseases.  If you’re interested in some of her work, read this.

We’ve had some work to do, to develop an understanding in the larger medical community about how the Amish perceive medical care, and to assist in navigating the system with them.  The Amish in Ontario do not, for the most part, accept our socialized health care system and therefore are uninsured by choice.  As one might imagine, this can result in astronomical medical bills if illness strikes.  So, we have had to collaborate and strategize in order to figure out how to provide optimal care with less expensive resources.

So, just this week, I emailed one of our maternal-fetal medicine specialists to let him know that one of our mutual clients who has an unfortunate history of preterm births, is pregnant again.  For the first time, we will be giving her progesterone caproate in an effort to prolong her pregnancy.  The MFM physician will prescribe the progesterone, we will pick it up and administer it to her every week, when we are doing our rounds.  Last year, I did the same thing for a woman whose first two pregnancies had ended at 35 and 32 weeks, respectively, with the second baby having an extended NICU stay.  This time, with progesterone, we got her to 36 weeks, which permitted her to deliver in our less expensive level 1 hospital and have a very short stay.  We monitored her cervical length and estimated fetal weight (she was painfully underweight, with almost no weight gain) at a local community lab whose costs for ultrasound are the lowest in the region, but whose technicians and radiologist are superlative.

Our work sometimes requires us to be advocates, as well. When people live in a world lit by kerosene lamps, with no electronic background noise,  I can only imagine that being in a modern, noisy, brightly lit hospital is a stimulatory overload. So, sometimes, we need to encourage other providers to slow down their explanations and to use plainer language, because although the Amish are fluent English speakers, it *is* their second language and they don’t always have matching terminology.  Those of us accustomed to working with the Amish have had to assist providers to examine their care through an Amish lens, through a cultural lens that places family at the centre, and that doesn’t value the concept that everything medically that can be done, should be done.

I think that, for all of us who work with the Amish, we are invited to be creative, innovative and compassionate in the care we provide, and to challenge our assumptions about what might be the best thing to do. Really, isn’t that what health care should be for all of us?

 

Amish Mothers

In a sense, Amish girls are groomed throughout childhood and adolescence to become mothers.  The family is the core of Amish life, and children are the core of the family.  There is no question that, assuming they choose to become part of the church, Amish girls will have babies, unless they are some of the unfortunate few who do not marry, or who are unable to conceive.  And some of them will have many, many babies.

In the more conservative settlements, birth control is not condoned; in general, the women (and men, for all that) must give themselves up to what God deems to bestow upon them, either good or bad.  And that includes children.  The first few babies are generally very welcome, and the first baby, in particular, makes a couple a family and redefines them.  I recall many years ago, going to do a first day visit on a woman who just had her first baby, and the young father, beaming, greeted me by saying “Welcome to the Miller family!” (and, lest you think I’m breaching confidentiality here, over half the families we care for in one settlement have the surname “Miller”).  He was proud and happy, not because of the demonstration of his masculinity, but because they had now graduated from being newlyweds to becoming a family and participating in the most important aspects of Amish life.

One of the things we taught one of the settlements (who rarely, if ever, sought out regular prenatal or postnatal medical attention prior to seeking care from us) was that breastfeeding the baby would help space the pregnancies a bit more.  It was, early on in our journey caring for the Amish, not uncommon to see a young baby propped in the rocking chair with a bottle, or being fed by an older child. Now, women have spread the word that breastfeeding is not only best for their babies and less expensive, but that it might keep the babies from coming a little less frequently.  Some of them nurse their babies for well over a year!

We have talked to some of the more receptive women about natural family planning, and it has been accepted by a few.  We are fairly certain that some of the couples must be doing something to prevent pregnancy (given the generous space between their babies) but know better than to dig for too many details. Birth control is permitted if it is thought that the life or health of the woman would be threatened by subsequent pregnancies, and a couple of the women we’ve cared for have had tubal ligations, and another consented to use Depo-Provera, but discontinued it after a year because, she told me, she felt “too guilty”.  I can imagine that those who have had ten or more babies must welcome the signs that they are entering menopause.  They love their children, no matter how many, but great grande multiparity takes its toll on the body.  Some accept a new pregnancy with equanimity, others with quiet resignation.  I recall one woman who looked at me and said, when she was lying on the parlour couch being examined for the first time in her new pregnancy, “Well, here we are again!”  We both laughed.

New babies are, however, in general something to be celebrated.  As we do our rounds, we are always astounded at how quickly the news of a birth has spread (the Amish men joke that they don’t have telephones, but they do  have “tell-a-woman”). Although we are careful not to divulge delicate details, the weight and the name of the baby are always something that are sources of endless questioning.  In the case of the Birth House “twin cousins” a couple of weeks ago, each couple wanted to know what the other had named the baby.  It wouldn’t have done to have chosen the same name; at the same time, Amish children are usually named after a family member, so the range of names is narrow.  There are no middle names (presumably that might seem ostentatious) but there is an initial to distinguish families.  In less conservative families, the names are more varied, and more similar to English names, but our conservative settlement contains many women called Ella, Emma and Mary and men called Eli, Jacob, Ammon and John. Naming is something that is taken very seriously, and usually takes at least a day to settle upon.

Amish girls learn to care for babies very early in their lives and, as a consequence, even first time mothers are well-versed in the arts of diapering a baby (cloth is generally always used, in the old-fashioned folded method), and bundling, bathing and soothing.  There’s always someone around to assist in the care. Women who have had several babies before will have a “hired girl” come to work for them for about four to six weeks, tending to the children and doing the cooking and cleaning, so that they can recover and gradually return to their housework and farm chores.  The “hired girls” are teen-aged Amish girls, done with their schooling but not yet baptized; in a sense, this is their apprenticeship in becoming an Amish wife and mother. We often tell our new Amish mothers that we wish that the English women were so sensible, rather than gallivanting around the malls with their five-day-old babies.

For sure, there is uniformity in how babies are dressed and bundled and even spoken to, in gentle Pennsylvania Deutsch (or Dutch) soothing sounds. The older children are generally quite excited by the new arrival, and do what they can to help their mother, fetching clothes and diapers, with the older ones tending to the younger ones.  There are traditions and rituals to childcare, some beneficial, some less so, and we try gentle correction if we feel it might be required.  Mostly, however, I am amazed at love and gentleness shown each new arrival, whether the first baby or the fifteenth, as they are welcomed into the fold of the family.

 

Amish Children

Amish children are beautiful — well, all kids are pretty much lovely beings, but there is something special about Amish kids. I’m not talking about the romantic art of N.A. Noel (although those are very pretty prints), but something else.  I thought about that especially yesterday as I visited one of my babies, now three, who is very ill with lymphoma and undergoing chemotherapy at our local children’s hospital.  He was heavily sedated for pain, and curled up in his grandmother’s lap while she rocked him.  I told her that this was some of the best medicine for him.

We don’t see the children all that much during prenatal visits, especially in the more conservative group.  Even in the more progressive group, they stay out of the way while we visit with (and examine) mom.  Mostly we see them in the periphery, playing outside or in the kitchen. The girls are always clad in their traditional little dresses, and usually wear a black kapp. White is generally reserved for when they are baptized.  The boys are in pants and shirts and wear little straw hats outside.  Their hair is charmingly cut in a bowl cut.  The girls’ hair is never cut, but braided and put up under the kapp.

They are not little automatons.  Although generally well-behaved, they fight with their siblings, and get into mischief like all kids do. They are fairly reserved around the English midwives, in part because before they do not speak any English before they start school (which is one of the reasons that the conservative Amish do not mind so much that they see us, figuring that they don’t know what they are talking about).  However, with familiarity, they engage with us, like all children will do.  I was seeing one couple quite frequently after their baby was born (for reasons I will explain in another story).  Their young son, who at the time spoke no English, became quite saucy with me over time; I think the parents were a bit mortified by this, but I was delighted by his antics.  Some of the kids start to know to bring us cookies when they see us visit.

It took me a long time to figure out what makes them so charming.  When I started to think about it, I thought about kids who are raised with no screens or external stimulation: no television, no radio, no smartphones, no iPods.  But, further to that, mirrors are strictly verboten in the Amish households I have been in.  The only exception is for the men, who use them to shave.  In those cases, the mirrors are hidden in a little shaving cupboard, which have doors that close on the mirror, or a little curtain which is drawn over the mirror when not in use for shaving.  So, I thought about how often we look at ourselves in the mirror, even as children.  How we know to pose and present ourselves to the world.

Similarly, the Amish do not permit photographs to be taken of themselves (the pictures you may have seen are either taken without permission, or taken of Amish in groups that are more progressive/permissive).  So, the children do not know what they, themselves, look like.  Their world is entirely external.  It’s kind of hard for us to fathom what that might be like.  But they connect very closely to their world and the people in it.  They are raised, by and large, in a cradle of love, like that sick little boy, bristling with IV’s and his PICC line, connected to multiple pumps and monitors, curled up in his grandma’s lap, being rocked and soothed.

I’m not saying that the rest of the world is wrong, or that we should all raise kids in an Amish fashion. But the joy of Amish children in the simple beauty of life is something that we should think about.

The Birth House: Part II

The thing about birth is that it is not predictable. That’s what makes being a midwife both fascinating and frustrating. This is definitely not an occupation for control freaks, or for those who like regular hours and sleep.

So: part A of the plan worked relatively well.  Castor oil was taken, I was called, we met at the birth house.  Never mind that after the worst and coldest winter in decades, the frost coming out of the ground had heaved and softened the gravel back roads so much that it felt like I was driving in a mud pit — the road where I needed to go was actually closed, except to “local traffic”.  When I got there, the woman was having some pretty nice contractions, so I called my colleague and warned her about the roads.

She showed up, and I checked the mother-to-be, who was 7 centimeters with bulging membranes.  Those were ruptured, and less than 30 minutes later, the labouring woman said she felt like she was having “push pains”.  Indeed.  In very short order, a lusty baby boy made his hasty appearance at 2 in the morning.  Unfortunately, he arrived so rapidly that he didn’t get a good “squeeze” and spent some time clearing lung fluid and making the noises that go along with that.  But he did start to settle.

So, I packed my birth bag and put it back in the car.  We were getting things tidied up and thinking about getting ready to leave, when my pager went off.  A page at 4 in the morning can mean only one thing.  In this case, it meant that our new mother’s sister-in-law, who was pregnant with her thirteenth baby and due one day later than the new mother, had ruptured her membranes and was having some mild contractions.  And she also was planning to give birth at the birth house.  What to do?

Fortunately, one of the sisters had awakened and said that we could move the new mother into an adjacent bedroom, so that we could tidy up the birth room for the incoming mother-to-be.  I drove over to their place, checked her out, and indeed, her cervix had changed from the previous exam.  So she got herself readied, woke up the oldest child who would run the house while she was gone, and I took them to the birth house.  Both women agreed that they were fine with the shared accommodations, as it were.

So, out came the birth equipment again (good thing we always carry two sets of instruments) and I set up in preparation for birth number 2.  As it turned out, it wasn’t going quickly.  My partner and I alternately napped, checked on new mother number one (who decided to bleed a bit) and the baby, and checked on the next  mother-to-be.  At one point in the morning, we decided that it was safe to leave to get some breakfast, and I bought some orange juice to accompany the castor oil that mother-to-be number 2 was, I suspected, going to require.

My partner drove the first couple and their new baby home early in the afternoon, everyone now feeling well and baby looking great. She visited a couple of new mothers, and a woman who was miscarrying.  The mother-to-be decided to get on with things, and took a dose of castor oil. After a couple of hours, I fussed about whether the second woman was making any progress; but after I left and came back with more orange juice to accompany a second dose of castor oil, her husband announced “we’re in business now”, and indeed, there were some very good contractions in evidence. As the labour picked up, the woman and her husband retreated back into the birth room where we closed the door and quietly readied for the birth.

I’ve known this couple for many years.  I caught her first baby (her third) in 2001 and have been with her through 11 pregnancies and births, including that of one baby who had a pulmonary haemorrhage at 1 hour of age and nearly died, as a result. This sort of relationship builds a bond that inevitably goes beyond provider and client, and is one of the reasons that caring for the Amish tends to entwine your heart with unbreakable tendrils of love and friendship.

The men tend to be somewhat more reserved in their interactions with us, in the beginning.  But I know her husband very well, and even this far into their marriage, I was touched by his loving care for her in labour.  Despite the traditional patriarchal relationships in Amish culture, their marriages are not arranged, and they do fall in love and court before they marry. This woman’s husband, a lean, sinewy farmer, unfailingly and lovingly held her and rubbed her back during her contractions and helped her through her labour.  Finally, at about 4 o’clock, another boy was born, a “twin” cousin to the first.  A bit smaller, but healthy and showing lots of evidence of how he had gotten malpositioned and slowed things up.

The sisters took great care of us all.  They dressed both the new babies, made meals for mothers, fathers and midwives and, in between it all, were outside plucking and cleaning wild turkeys that local hunters had brought for dressing (the turkey hunting season had opened the day before). The index Amish midwifery client is a sister of the maids, and she also showed up to clean turkeys and we had a great time chatting and sharing bits of news of the community. Many jokes were made about the naming of the cousins born on the same day, and questions about how my partner and I were holding up (okay as it turned out).  Much was made of me reading “The Diary” (a newspaper that contains snippets of news from all of the Amish communities in North America) and The Botschaft.

Finally, the second woman was settled and we felt it was okay to leave her and her baby (and husband) to finish resting before they called a driver to take them home.  But first, there was delicious homemade blueberry pie, made by index midwifery Amish client to be shared by all.

Years ago, when I imagined becoming a midwife, I imagined days like this one.  Exhausting, but so incredibly satisfying.

And fun.

 

The Birth House

So, I will be heading out to what we affectionately call “the birth house” tonight.  I have a great grande multip client who was 5 centimeters, not in labour (although she has been having sporadic contractions for a week now) when I checked her today.  She has delivered before we arrived in the past, and she’s afraid that she’ll do it again.  Therefore, she’s going to take castor oil, page me when she does and we will meet at the birth house and wait for a baby.

It isn’t really a house, but a room that two unmarried sisters (known in the settlement as the “maids”) built on to the back of their house as a service to the community.  The Amish in this settlement most often give birth at home (although some think they should have the first baby in the hospital); some of them in the past, however, went into the hospital because they don’t wish the older children to know what is transpiring.  That’s related to the modesty ethic I talked about in my previous post.  And I’ve seen that anxiety be an effective tocolytic — tense and anxious women don’t let go very well to give birth.  They know this, and so sometimes elected to go to hospital rather than have the older kids find out what’s going on. This gives them another alternative.

It’s a cute little room, set up with an old crank-up hospital bed that the sisters salvaged from somewhere.  There’s big table for our equipment and chairs (including a rocking chair).  On cool nights like tonight will be, we leave the door in the main house open to let heat in from the parlour woodstove.  It was lacking a place for the baby, so late last year, I took down the cradle that my late father-in-law built for my husband and me when we were expecting our first.  My three children and two grandchildren have all slept in that cradle, but it’s been languishing in my basement, so I cleaned it up and took it down to the birth house (to be reclaimed if more grandbabies are in my future).  It serves the purpose perfectly.

There’s a separate little privy for the women (and non-squeamish midwives).  Did I mention that this settlement has no indoor plumbing?  There is no running water, other than that provided by a handpump in the kitchen or a tap that draws water with the assistance of a Beatty pumper (that would be a windmill, for those of you not familiar).  The “toilet” is a privy, like those used in more primitive camping grounds — some of the more innovative Amishmen have figured out how to vent them to reduce the odour.  Water is heated in a large metal cylinder heated by wood fire.

Light in this settlement is provided exclusively by kerosene oil lamps (lovely glass lamps with a wick).  I have three of these myself, one of them a gift from a client and two of which are antiques.  They give a lovely warm glow, bright enough to conduct a birth.  The Amish in this group aren’t opposed to flashlights, however (and I have several to light my way in) and headlamps are ubiquitous.  Another settlement uses propane for light, a more risky venture; many were using 20 pound propane tanks (like the ones used for barbeques) in the house, and in Michigan one of them exploded.  The pregnant wife died of her burns (after being delivered by Caesarean section). Lately, this group locally has migrated to using what they call “DeWalts” (which are DeWalt trouble lights with battery packs that they re-charge with gas-powered generators).

Needless to say, none of our equipment is dependent upon electricity, since there is none.  We’ve had to be inventive, and I’m so pleased to have found the convenient little battery packs for recharging cellphones. Lack of electricity is mostly not an issue, other than that we have to remember to bring drugs that require refrigeration with us and have the means to keep them cool.  You might remember the great northwestern blackout of 2003 (which affected all of Ontario and the northwestern USA).  Concerned that our pagers might not work, with the jamming of wireless systems, we went down to let the Amish women who were due how best to contact us.  They were blissfully unaware that anything major was going on (at least, until the less prepared English neighbours came over asking for flashlights…).

Although it’s a small room,we enjoy the intimacy of the birth house.  The sisters have been a little concerned that it hasn’t been used very much, but it is used enough to make it worthwhile to the community.  Not having babies of their own (they are both in their 60’s now), I think they enjoy having new life arrive in their house.  They are very kind to us, and will often make us a meal if we’re there over mealtime.  I’m looking forward to sitting and knitting (that’s another story — the Amish are fascinated by my knitting) and waiting for this baby to arrive.

 

Amish Bat Signals

Remember how Commissioner Gordon used to contact Batman, back in the old days? You know, that big light with the Batman silhouette in it? My very witty and smart practice manager describes the various means that the Amish use to contact us regarding their pregnancies as “bat signals”.  Although, to be honest, they’re not always as straightforward as that.

We’ve worked very hard to get them to contact us relatively early in their pregnancies.  One of the settlements we provide care to seems to be better than the other, but they are also more “progressive” and technology oriented (I just discovered that they have a group email address, for crying out loud!).  They usually call our office from a common phone, located in a schoolhouse.  If no one answers, several of them have voice mailboxes at that phone number, in which we can leave messages.

The other settlement, however, is more conservative and circumspect regarding giving news about pregnancy.  Sometimes we get letters — almost invariably, they are sent using the stamped, addressed envelopes that we send evaluations out with.  They rarely send back the evaluations (no doubt a very “English” thing to do) but will use the free postage to let us know of pregnancies.  The letters are touchingly polite and old-fashioned, written in elementary-school neat cursive, on a thrifty half-sheet of lined school paper:

“Dear Kathi,

Greetings of Love to you this morn.  I would like you to stop in please, I think I’m pregnant.”

But not without a bit of witty slang:

“See ya Soon”

Sometimes we get directions as to when we should show up; she’s having church next week, which means that everyone is there helping to clean the house and it wouldn’t do to let them know she’s pregnant by having us show up.  Or they’re going visiting to (Belleville, Lucknow, New Liskeard) and won’t be home from x to y.

Or, visiting one woman, we’ll get a little verbal message: “Sarah would like you to drop in” (invariably. the message comes a bit late, and we find, to our dismay, that Sarah is already 30 weeks pregnant).

And, they’ll page, like the one I got tonight.  It’s always the husband (except for the very venturesome in the conservative group, the women are generally totally spooked by phones).  “It’s Ammon, at such and such an address.  Edna needs a checkup (translated: she’s pregnant).  Could you come Friday?”  If we’re lucky, they’ll give us a call-back number.

The strength of the modesty ethic varies from community to community.  In one, if there are school-age children, we are to show up only when they are in school.  The pre-school children do not speak English, so they, presumably, can’t figure out why the English woman with the big red bag with enticing zippers is in the house.  In the other, we are welcome at any time, and in fact, it’s nicer if we come when the older children are at home so they can tend to the young ones while we do the visit.  The more conservative groups perpetuate the “myth” that the other children (and the rest of the community, for all that) do not know that they’re pregnant.

We’re betting that they know otherwise.

For years I drove a red Subaru Forester (all-wheel drive is a necessity in Amish driveways in Canadian winter).  One day, one of the kids said something, in Pennsylvania Dutch, to his mom.  She laughed and shoo’ed him away.  When I asked her what he said, she replied “Oh, he said the red baby nurse is here”.  Indeed.

I now joke that I switch out cars every few years, just to keep them all guessing.  They do find that funny, in that lovely self-effacing way that they have of letting us know that we must find their ways very odd indeed.  But, in the phrase we often hear from them, that’s just the way they are.

So, to start…

I suppose that some sort of introduction and context are important to this.  I’m a midwife, have been one for 18 years, and involved, in some way or another, with birth for 30 years.  How I got here is not so important, nor it is a unique story for midwives of my generation in Ontario.  Where it’s led me and what I’ve learned is less simple, and certainly not so clear-cut as some might believe.  If it has taught me anything, it’s about complexity and the absence of easy answers.

So, why write about the Amish? I certainly didn’t know, at the outset, that my midwifery would lead me there (although had I put more thought to it, it would have occurred to me, I suppose).  During my midwifery education clinical placements and in my first year of practice in the Kitchener/Waterloo area, I worked with Old Order Mennonites and met an Old Order Amish woman from the settlement that we serve most.  We’ve attended the births of six of her grandchildren — she being the index Amish midwifery user in that particular settlement.

I certainly don’t consider myself an expert on the Amish, although I’ve done a lot of reading and research and listening.  I do know more than a lot of people, however, and know enough to understand that it’s not possible to know everything about them. Right now, the Amish seem to be in vogue — consider Vanilla Ice Goes Amish or Breaking Amish.  There seems to be some sort of reality television vicarious titillation to being able to peer into their closed lives, or to suggest that they aren’t somehow as good as they should be.  I have no desire to contribute to that and, in general, am generally horrified by the gawk factor of peoples’ fascination with them.

Still, people who live in a way that is so foreign to the English (that’s the rest of us) tend to attract attention, even when they’d rather not. People make assumptions, pass judgments, and generally never really get to know them.  I guess that’s where I come in, because I think the stories I have to tell will, at the very least, bust a few stereotypes, illustrate the complexity of their lives and maybe teach us all something about how to work with the world, even in the 21st century. Some of this will involve birth, but also death. Soome of it may be insightful (or not), trivial and funny (because the Amish I know love a good joke — usually on me).

If you are inclined to learn more, this is probably a good place to start. Just stay away from the reality television shows.