Thursday, November 17, 2011

This One's Not About Midwifery

Most of midwifing is about joy, whether subtle or overt – the excitement of a new pregnancy, the welcoming of a new life into the world, the beauty of a woman as she blossoms throughout the stages of life. The days when things aren’t so easy – long, drawn-out labors, difficult clients, or struggles to understand vague symptoms and nagging ailments – pale in comparison to the wonder of a mother gazing into her firstborn’s wide eyes.

This post, though, is about those days, few and (thankfully) far in between… as a nurse, a friend, and a family member, I’ve seen grief. Grief that sneaks up alongside you, taps you on the shoulder, and then takes you out at the knees; finally helping you up and keeping pace with you, step for step, until you feel as though you can no longer take it. I’ve worked with families who’ve had babies born still – babies born fully developed, perfect in every way; other babies have been lost far too early, months before they were expected to arrive, yet already eagerly anticipated and much loved. I’ve known and cried with families as they mourn the loss of babies diagnosed with terminal illnesses, not compatible with life, and supported them as they honored their loved, tiny infants the best way they knew how. As a midwife – remember, I have only been able to claim that title for two weeks – I have yet to embrace women and their families in those desperate, dark hours… but I will be there.

My grandpa died.

When it comes down to it, that’s what this post is really about. Barely two months ago, my grandpa – my Mini’s “Puppa” – was diagnosed with Acute Myelogenous Leukemia – and given a prognosis ranging from moderate to poor (depending on the treatment regime chosen and the response of the disease to it, of course). One dose of chemotherapy didn’t significantly improve Puppa’s counts, but didn’t drag him down at all, either; he still fought like hell. Even a nasty, raging infection to his IV port didn’t take the fight out – it was only when his oncologist really explained why he had recommended hospice care (rather than continued chemo treatments) that he just gave in, and let go… within a week, he was gone.

To me, Puppa was larger than life – he wore Brut cologne, farmed his entire working life, fished and hunted like a “real man” in the Midwest would, and ate headcheese and liverwurst (ewww). My memory is flooded with treasures from my childhood; this is the man who taught me how to bait a fish hook (and get a fish off the hook, once caught), climb up on a tractor to ride beside him, play cribbage, and to open a glass bottle of Sun-Drop with a bottle opener. I could go on and on – like any good granddaughter – but I’ll keep those memories as seeds to plant for the Mini’s, or if nothing else, for a day when I’m a little more awake, and it’s a little earlier. Memories that they may lose (or have never experienced) like how Puppa always had a teeny Tupperware container in his shirt pocket for them, with just two jelly beans or marshmallows in for them, or how on birthdays, he had a special card just for the birthday kid with exactly the number of crumpled dollar bills as years old you were turning, the envelope and card addressed in his loopy writing… his love of Diet Sun-Drop – but *only* in the old glass bottles, not in cans, and not in the ‘new’ glass bottles. And the dimes – always the dimes…

When death comes, it’s amazing how fast/slow things move. I swear it was just yesterday that my grandpa walked into my living room, showed me the lab results from his recent hospital stay, and asked me what I thought of them (as my heart dropped to the floor). And, just a few days before that – it had to have been – we were all out on the pontoon boat, with everyone healthy and happy. But it seems like it’s been months and months of watching him slowly fade away….

I can’t imagine the pain of losing a child, or a spouse, or a parent… yet I can’t fathom thinking that I’ve “only” lost my grandpa. How do you compare this hurt? I feel selfishly grateful that this is really the first time in my memory that I have lost someone close to death; I’m also so grateful that my family is so close to begin with, and that the Mini’s know their greatgrandparents so well. The very last words that my grandpa really said to me, a few days before he passed away – looking me right in the eye, with a squeeze of his hand – were, “Thank you.” When I asked what he was thanking me for, he said, “For it all.”

To everyone who has gone through this grief, whether the loss of a parent, grandparent, spouse, a sweet child, or the whisper of a child yet to be --- let yourself be embraced by the open arms of those who care. Open yourself to the friends who can offer words of comfort, hope, and love; to the family that shares your memories and knows stories outside of your own. Realize the true beauty of the people who will forgive you when you 'disappear' for a few days or weeks, lost in your own world of clouded thoughts and reminiscences. I feel so blessed and have so much appreciation for everyone who made the last few weeks, especially the last few days, easier than they might ever have been otherwise.

Thank you… for it all. XOXO

~*~*~*~*~*~*~

(P.S. This post formed in my head as I finally took a hot, hot shower, letting the past few days and weeks rinse over me; as I got out and wrapped myself in warm pajamas, I was overwhelmed with the scent of Brut…. *tear* Things always end up all right, don't they?)


Thursday, November 3, 2011

I have been blessed...

I started to write this post last week, and never got around to finishing it. The title was different, and the whole tone of it - it was a little more playful, with an undercurrent theme that mirrored Tigger's theme from the classic Pooh cartoons (for those of you familiar with Pooh's adventures... and aren't we all??) - was meant to be a light-hearted-yet-deep reflection of the wonderful thing about blessings in life.

And I have. Truly, in so many ways, my life and my family, are lucky. As I (finally) sit down to type this, though, I just don't quite have the same levity as I did a week or so ago when I started composing this in my head. I was going to recite the list of changes that have happened over the past two months (comps, graduation, etc, etc...). Instead, I'm quiet; the Warm One is battling a fierce cold, the Littles are runny-nosed and cranky, and I've passed my boards exam. I am, officially and with no holds barred, a certified nurse-midwife.

The colds will clear up, and the Kleenexes and textbooks (and highlighters and scattered notepages) that have overtaken our home will eventually be cleared away as well. Some will be recycled, or tossed; others may be stored in the office "just in case" - who knows if I'll need that text again, or maybe I'll decide to 'recycle' it to an incoming student?

The other blessings in my life are just as clear: my family, who have been so close and willing to step in whenever needed during this journey. The Midwife, even when things became rocky, was a blessing in disguise; I learned things, personally and as a midwife, that I needed to know, from her. From D, and from all of the women and families along the way. From so many close, wonderful friends - some nearby, and some far away... women who I may never have met in person, and yet who I can (and have) shared so many of my deepest fears and funniest moments; these are my sisters and peers, both fellow students and mothers.

And, of course, the Warm One and the Littles (one of my proudest moments so far? When the Bigger Little 'corrected' the younger, who had thought that "Dimbo's" - Dumbo - mommy was being 'naughty' in the movie. The elder of my daughters explained that Dumbo's mother was upset that the other elephants were being mean to the baby elephant and making fun and picking on him because of his ears; that sometimes mommies had to stand up for their babies. It was a touching conversation for a mother to overhear between a 5 and a 3...)

*~*~*~*~*~*

Some blessings are a little harder to understand... in the months since my last post, my family has been stretched apart, and pulled together in an even stronger way. My grandfather, the "boss" of the family, was diagnosed with an aggressive leukemia just before Labor Day, underwent one round of chemotherapy, and has become progressively weaker since then. After a bout with a massive infection and complications due to the infection and its treatment, hospice - and the care that goes along with it - nurses are a daily reminder of the change. It's so hard to see the difference between the strong, capable man that taught me how to bait a fish hook and tossed hay bales into a barn loft, and the saddened man that cancer has made my grandpa. The thought of saying goodbye - along with the pain of seeing my grandfather this way, as well as how it hurts my grandmother - is only soothed by the idea that the time we are gifted by this allows for storytelling, memories, "I love you's".... my family has been together much more in these past few weeks than in the past years (we've always been close), although I don't know if this outweighs the pain that my grandparents are feeling. At this point, all we can do is "Let go and Let God..."

Sunday, September 4, 2011

Will work for Food...

Seriously, I will... I certainly have a bit of a love affair with food. Especially this time of year, with the county fair in town: cream puffs, beer-battered cheese curds, funnel cakes.... Oh, my poor achin' arteries.

And summer. I love summer too. (Can it seriously be Labor Day already?! I want to cry! I do *not* do well with winter... sigh...) Anyway.... this blog has clearly been neglected for the past month or so. Oops.

I've been a little busy, to be fair. Since the last time we met, I scratched off each and every last clinical hour and visit I needed to meet the requirements of my program, as well as having a "declaration of safety" submitted by Dee (signifying that she feels I am a safe, beginning-level practitioner); one of my biggest feats was taking - and passing - the first of the last 3 big tests standing between myself and midwifery. I'm engaged, descended, and flexed - now on to finishing the rest of these cardinal movements, little by little...

(was that too corny?!)

From a personal standpoint, things have also been busy. Family life has been hectic as always, with ups and downs. My bigger-Mini started Kindergarten (!) last week, which seems incredible; I still remember the moment she was laid in my arms and the immense feelings of wonder and
awe I felt to be a mother to such a wondrous little being; my Mini-er is beginning preschool this week (and memories of her labor, and birth, are even more vivid; the moments in the shower, visualizing her path down to birth, and the moment when the Warm One proclaimed her as a "little girl"... so clear!). Harder to work through these past weeks have been the continuing struggles with my brother and his own battles (battles which he alone can fight, but that as a family we have been trying to find ways to support him in...), the diagnosis of Lyme's disease in my father, and acute, aggressive leukemia in my grandfather. It's painful and exhausting to see the toll, both physical and emotional, that's accumulated across the family lines in the past weeks and months; through hopes, prayers, and support (and communication), I'm waiting for a strengthening of the bonds that hold us together.

But, back to the "Work" thought that started this whole rambling... I'm starting to think more seriously about jobs again. (It's getting to be time, I suppose. I have one more "school" test - the competency/completion exam, after which I am officially a graduate nurse-midwife, and the final step is the national certification exam). I've realized, after doing a phone interview or two over the past few months - mind you I haven't interviewed in years! - that I need to brush up on my interviewing skills. I thought maybe I'd toss out a few random, jarbled thoughts on here, if nothing else, to help myself sort out a little more about myself (you know how they - "they" being interviewers, of course - always ask about your strengths/weaknesses, what you would like to improve on, etc...)

About Me...
* I'm not there yet, but I'll be there soon!
* I don't drink coffee... but I anticipate that I will start to do so soon...
* I run habitually late (not much, but just enough to be a few minutes late...)
* But - see above - I'm reliably late those few minutes!
* I learn by doing, not by reading/listening
* I'm quiet - but only for so long. I will open up (you may be sorry....)
* I do have a sarcastic streak... and a good sense of humor!
* I may hold back a bit at first - let my confidence build, and I will shine.
* I trust women, their bodies, their intuition, and their abilities.
* I am a very dedicated, motivated employee.
* I can't even come up with enough to write here! Man, I better hire myself out to a farm or
something instead....

Thursday, July 28, 2011

Just Pickin' Em Up & Puttin' Em Down...


Yep, I think that's what I'll do. Every day, if that's what I need to reduce my focus to, I can do it - one step at at time. Simple, easy, as little stress as can be. Starting with lifting each foot, and then putting it down again a little bit further ahead than it started. I have a keychain that is engraved "Learn in Baby Steps" --- one of my new mottos, I believe.

Sounds easy enough, right?! I can do this - and I know I will. Patience is a virtue... but it's sooooo hard! The end of this road still seems far off, though I can tell it is getting closer. This week has been challenging; Dee has been out of the office for a much-needed vacation - although you can't really call it that since she is still functioning in a nurse-practitioner role, only volunteering her time (though she is at least enjoying herself I think) - and so I am working with some of her backup doc's and *trying* to make a good impression on them so they will agree that expanding her practice and adding a second CNM --- that is, moi --- is a splendid idea.

From my perspective, it's been great; I've been enjoying seeing things from the MD point of view and also observing visits that aren't typical nurse-midwife cases. However, on Tuesday I was hit by the WORST migraine I've had in a long, long time; the timing could not have been worse. How do you make a good impression, when you go from meeting someone and being eager to soak up all their knowledge to begging to go home with an "invisible" affliction in a matter of minutes-to-hours? It was awful; the worst part was, one of Dee's patients (who I've met several times in the office, as well as in the L&D setting) ended up presenting to L&D that day in labor, and the MD I was meeting that afternoon had offered to let me work with her during her labor. Prior to the onset of my killer headache, I was pumped to be able to follow her through, especially since Dee wouldn't be able to... until, that is, the hot flashes, nausea, and vomiting started while I was still seeing patients in the clinic. By the time I made it home that evening (after pitifully and ashamedly declining to accompany the doctor to see this particular laboring mama), I was miserable; the migraine didn't pass until later the next day, after 14.5 hours of solid sleep in my dark, window-less bedroom, with constant ice packs/hot rice bags, multiple doses of vicodin, and several doses of maxalt. Two words: it SUCKED. And, I was not impressed with myself.

(I've had migraines since I was five. They are something that are just there, and for the most part, I recognize that I have to live with them. A year or two ago, I started taking topamax and was thrilled at how well it seemed to 'calm' them; I also found that maxalt was actually reliable for knocking them out if I could take it when I first started getting an aura... these were the first meds that actually worked for me, after 20+ years of trying to find something. Now, in the past few months, they are steadily creeping back. To have two in the past two weeks, however, to the point that they disrupted my functioning - at clinicals no less - is NOT acceptable for me.... so I guess I will be in touch with my care provider.... *sigh*)

On a happier note --- things have been interesting with the MD preceptors. Again, I've seen several types of client cases that I might not normally see as a CNM: complex chronic health problems, many, many well child visits, and ---- wait for it... --- MEN! I haven't dealt with penises longer than a pinky-joint since I was a nursing student. Crazy, huh?

Tomorrow finishes off my week with the docs... fingers crossed that if nothing else, they think having an extra pair of hands could be good for something or other...

~*~*~*~*~

This can be a glass half-empty/half-full kind of pondering.... I think I posted last week that I had sent out an email to the doctors that I work with - as an OB nurse - just to sort of "feel them out"regarding how they might feel about hiring a CNM into their practice (as there are no nurse-midwives other than Dee delivering within 60-75 miles of our area). I received this response from the 'head' of this OB group today, and took it to be a good sign; it's of course impossible to read, but the gist of it is that most of the MD's in the group think that nurse-midwifery care may be a plausible option, but there are questions that would need to be discussed; it does not give any indication that they are not supportive of CNM care, and that they are willing to entertain the idea... the logistics of it may need to be explored, but it "could be interesting". (Again --- this email certainly could be read with optimism or pessimism, since it doesn't go strongly either way... but tiny seeds, no?)

Sunday, July 24, 2011

And what goes around... (on depression and stress, too)

As they say.

Ebb and flow, yin and yang, yadda yadda. After my little meltdown Friday, things eventually lightened up. (If you've followed the blog at all, or know me, I'm sure you know this is nothing new... or maybe this isn't just me personally, but something that is a natural phenomenon of this thing called life. Maybe it's not unique to mothers, or women, or grad school, or th
ose of us who deal with depression. Maybe it is. Does it matter? Not really.)

Anyway. I posted a similar cry for help, bemoaning my situation on Facebook; basically, that the Warm One was at work, I was at the end of my rope with the girls and had no idea what happened to my patience, and the end of the weekend (the Warm One works a weekend program - Fri/Sat/Sun only, therefore leaving the girls and I to our own devices all weekend) seemed ages away. I was desperate.

And out of nowhere, a good friend came to my rescue. She invited the girls and I over, to visit, to play, to stay. It took us hours and hours to get moving and get packed, but eventually, we got there. She opened her home to us, the girls played (she has a daughter the same age as the Mini-est), and we were able to catch up. We spent Saturday together, just hanging out. Was I the most fun and exciting person to be around? No - but I hope I was a better mother and friend than I felt like I had been earlier that week. Little by little, I am crawling out of this miserable, stress-filled hole.

Before the girls and I left, I managed to pull myself up out of my funk enough to send a copy of my resume/cover letter to the physicians I work with as a labor/delivery nurse, simply to introduce the idea of adding a nurse-midwife to their practice (I've been hoping to have the 'right' moment to talk to some of them about this over the past year or so, but it just hasn't happened); I also emailed my nurse-manager to touch base. My fingers are crossed - even though my breath is far from held - that good things could grow from this tiny seed being planted.

The Warm One also came home last night and shared that another doctor, an incredibly sweet family physician working for a nearby tribal clinic, had asked where I was at with my job hunt; she mentioned that the tribal clinic had been trying to fill an open physician spot for the past year, and she was willing to bring up my name at the next physician's meeting to see what the interest there would be. Again, fingers crossed... I've worked at another nearby tribal health organization in the past, and love working with Native populations. The culture and history, combined with the deep relationships between families, make it a community I would be honored to be invited to work within. (I've requested information from the IHS about their loan repayment program, but have yet to complete the application process; it's on my radar as yet another thought...)

*And, if nothing else - this again cements to me the fact that I cannot - at least at this point in my life - function without antidepressants. I know that there are many different viewpoints on this and whether or not medication is something that is "right" or "necessary" but until I have one or two fewer things going on ... I can't let myself - and my family - go down this road. It never fails that when I manage to go without taking the pills for a short period of time - whether because I fail to get a refill in a timely manner, or because I miss one or two, and then tell myself I still feel "great!" - I find myself in a similar murky fog within a matter of days or a week. Someday, I will be able to truly dedicate the time to find other positive
lifestyle changes to experiment against this headgame, but as for now... I'm gonna take the easy way. I need to be able to accept sweet love notes from the Mini and appreciate them; I need to be able to have patience with my girls when they are being kids, instead of being over-anxious and stressed... I can't see the confusion and hurt in their eyes when they look to me for comfort, and don't get it; this parenting thing is hard. I feel like I hardly see the Mini's lately... and when I do, they're not my sweet little girls anymore! They don't listen... they're sassy... they fight. I don't know if it's a stage, or if it's related to not seeing me, or if it's how it's always been (and I'm just seeing things differently because I'm stressed), or if their actions are feeding off of me, or ...?!

Friday, July 22, 2011

Mama Needs a Time-Out

Seriously.

Whatever happened to TGIF?! So much for Friday, I guess... whatever optimism and good vibes I had going into the earlier part of this week somehow dissipated as the week rolled on. In the wee hours of Wednesday morning, while I was gearing up for the clinical week - I usually do clinicals with Dee Weds/Thurs/Fri - I woke up with a killer migraine. (I've had migraines since I was four or five ... nothing new there. They've probably been in the best control of my life for the past year or two, actually; I've found a daily preventative med that seems to help, and for the first time ever, I've found an abortive that seems to actually knock them down when they do kick in. Score. But - that being said - I do still get the occasional nasty f*@!er, but never, or rarely, has one ever woken me in the middle of the night before... so this one sucked!) I did my best to get through the day Wednesday with Dee, but even after taking my abortive, and all my usual knocker-outers, I had nothing and had to leave early ---- which I hated doing. After a few hours of solid rest and a combination of narcotic, another abortive, heat/ice, and some topical cream to my neck/shoulders/etc (which by the way was not a good idea - more on that later), I was somewhat coherent again.

Unfortunately, the arthritis cream that I picked up to rub onto my neck/shoulders/temple (similar to what I usually use, but a different brand... I can't even think of what I picked up that day) was awful. Whether it was the intended effect or not, it caused my skin to feel as though it was on fire - my palms, my shoulders, and my neck raged at me the entire afternoon, evening, and next day, even after scrubbing in an attempt to relieve the sensation. And, of course, smart cookie that I am, I slipped my contacts out (and then tried to replace them the next morning) with residue apparently still remaining. Good gracious golly. Not only was I living in the migraine hangover, I was also fairly certain I was close to blind...

Then, when I got out to my car --- I found it egged. What. The. ... Seriously. Of course, as usual, I didn't have any spare time (why would I?! Any of you who know me, know that I don't generally run with spare time...) to rinse the gook off, much less for a real car wash. Okay, so it was only one egg (or maybe two) on the driver's side door and window, but for the love of mud --- why?! I really, really was NOT in the mood and, as I'm sure you can imagine, would have had some not-so-pleasant things to say to whoever thought sharing their breakfast fare with my vehicle was a good idea.

The rest of the week has pretty much continued as such. Though I am sooooo close to the end of my necessary clinical hours - T-minus 66 and counting - I've hardly knocked any off this week, thanks to the lovely migraine and having to cut out of clinicals early yesterday (Thursday) as I was scheduled to work in Babyland.

So it's been a non-productive, miserable-feeling, blah kind of week. Oh, and that "other" position that I was excited about? I had a phone interview Wednesday evening, post-migraine... I thought it went all right, even though it didn't sound like my "dream" position by any means; while I didn't expect to get hired as they disclosed on the phone that they were doing a second interview for a previous applicant the next day, it still stung today when I received an email telling me that my "career goals didn't appear to be a fit" for the position, and thanking me anyway. Ouch. I guess it just is a downer, all around, even though I had more or less decided that I wasn't all that interested... *sigh*

To top it off, I'm finally home, getting to spend some time with my family --- and my lovely young ladies are not listening to me, I'm incredibly crabby and cranky with them, and I just don't have any patience for them, for myself, or for anything. I don't like how I feel, how I'm reacting to them, or anything at all. In desperation, after too much hollering after too much whining, I sent them to separate rooms for extended time-outs --- but really, deep down, I'm the one who needs the time-out.

Wednesday, July 20, 2011

Just keep swimming, just keep swimming...

It's seriously 99 degrees outside, with a heat index (whatever that is) another 10-15 degrees hotter. Wooooohooo. Swimming sounds amazing, no!?

At least in a symbolic sense (or a Finding Nemo sense), that's what I'm doing. I'm not sinking, I'm not thrashing wildly trying to get through these last few weeks of clinicals, and I'm doing more - at least, I think so - than just treading water. The end is in sight! I've just crossed the 600 hr mark (out of 675 required hours) of clinical experience; most of my numbers are met or very close. "Dee" keeps throwing this hope-rope to me about submitting a proposal to her administrators to add another midwife to her practice; several of her doctors are on board and supportive. I am so comfortable working with Dee, and with the women she sees - I think we are both praying that things work out and they (administration, that is) agree that expanding her midwifery practice would be beneficial all around. I also just had a phone interview - or at least, a short chat - with a midwife from another midwifery practice about an hour and a half from my home... it was encouraging and again gave me hope for a job opportunity in the near future.

So, while I'm trying desperately not to get too excited about any of these possibilities - and trust me, I really want to get excited... how great would it be to stay within an hour or so of our families?? - it does allow me to drift into the occasional daydream. House hunting... comparing elementary schools... thinking about future vacations and scheduling considerations... and, oh yeah, maybe a paycheck! (This whole "9 months of clinicals and little working" thing has really, really hurt our finances... I think anyone who's been in this spot can commiserate!)

Two more weeks - give or take - of clinicals; one more assignment (a client journal that I should have had done long ago, but had to start all over after the abrupt change in clinical sites); several uber-important tests. It's not that much, especially considering how far I've come this far - but when I look at it that way, it can easily overwhelm me. So, instead --- I'll just keep swimming.

(And, on a side-note, I'll keep looking forward to the end of September, when I will hopefully be an official nurse-midwife, and celebrating in Punta Cana...)

Wednesday, June 29, 2011

Our Strength


I've been thinking about strength today. Mainly, because I am feeling wiped out - emotionally, physically, mentally, financially... you name it. And yet - a part of me truly believes that I just need to give in and accept that this is truly part of the process. I'm all right with this; it's just kind of, well, a drag.

Plus side: I started at my new site, officially, today. LOVE it. Everyone, so far, is amazing. Very welcoming. My new preceptor, "Dee", is introducing me to everyone (docs, nursing staff, random folks walking through the hallway...) as "the student midwife who we're trying to convince to stay here with us as a second midwife with our doctors & I". I so want to be that midwife, and am trying not to get my hopes up, but if there was a wishing well in front of me right now, and I had a penny to toss in, do you think you could guess what my wish would be?? (I won't tell, of course... but if you guessed, well, anyway...)

Not so plus side: I'm exhausted. I think I already alluded to that above. I started trying to type this post almost an hour ago, and keep getting distracted. Like, for example, I wanted a cute little pic to post with this (because honestly, doesn't a sweet picture make everything easier to read??) -- that took forever. Stupid picnik.com and it's stupidness. Also, we stayed overnight at this hunting cabin my grandparents have (I actually love it - it's very remote, quiet, and peaceful --- and a *tad* closer to my new clinical site as well --- but, there's always a but, right?) I got NO sleep. Like, very, very little sleep. A combination of woodtick paranoia (if you live anywhere that ticks are prevalent, you know what I'm talking about - nasty little creepy crawly vampire things - I had the heebie-jeebies ALL NIGHT LONG thinking they were stuck on me), not having the migraine-preventative med that I usually take at bedtime (which has a convenient side effect of zonking me out nicely), a less-than comfy air mattress, and first-day jitters (will my alarm go off? will I make it in on time? etc), all added up for a loooong night and weird dreams. I dreamt that I was living in a strange apartment building --- I think it was early 20th century, yet there was an odd open-air elevator to get up to the upper floors; very odd, in fact, in that you wrapped yourself around what was basically a fireman's pole and held on for dear life as you shot up it. If you let go ---- not good. I was doing okay until, all of a sudden, I was almost at the top and realized my arms were very tired, slippery, and I just didn't think I could hold on; plus, I realized I also had another "tier" to go (apparently, somehow, to get to my "level" I had to switch poles?! Very ... odd...). So that was one unsettling dream. Another involved the cottage we were at; we were apparently taking turns sleeping (in the dream) and someone - my older brother, I think, looked out the door all of a sudden and someone had jumped in one of our vehicles and taken off out of the blue. (There was much more to this dream, when I woke up --- at the time, it was very vivid and I meant to share it with the Warm One... but being that it was 0530, I decided to let him sleep, and know the details have faded. Anyway, it was another disturbingly vivid dream, I guess.)

I think, what this all boils down to, is that I need a good night's sleep. But,instead of going to bed at a reasonable hour (10 p.m. or so) as I had planned, it's almost midnight and I'm just deciding to call this blog post a night. It's nowhere near what I had planned to write (is there anything about nurse-midwifery, really?? Not much!!), but it's good enough. Suffice it to say - I feel stressed; I need to work more so that I can pay my bills, yet I need to get through clinicals so I can graduate. I also need to study more so I feel less anxiety about upcoming boards, comps, etc. I also need to work on family stuff - or maybe let it go; a close family member is dealing with heavy stuff (addiction) and I don't know how to help him. And yet.... I think it's all going to be okay....

(and, big cheers to my CKC'ers --- one just got married, one just passed comps, and one is on her way to CB!! Jaeger all around!!)

Sunday, June 26, 2011

Hey! Can It Be?

Can I actually be back in the clinical saddle again? The wild ride continues, apparently... a month after my short stint on the western side of the state (only catching babies - no clinic), and almost four months after parting ways with the Midwife, it looks like I might finally be "good to go" with "Dee" (hopefully a psuedonym I'll remember!), my new preceptor. The wait to start at this site has been such a long, drawn-out struggle... even though everything seems to be ready and in place for me to start this last leg of my clinical journey on Wednesday, I'm still hesitant to really believe it. There have been so many false starts: way back in March, it looked like I would be able to start building up hours with Dee in early April, after she returned from a short medical leave; after weeks and weeks with no communication, it turned out that somehow my paperwork had been lost among the administration team, pushing the process back further. Then, gradually it was May... and now June...

Luckily, the short voyage across the state last month did much to re-energize me and to remind me why I'm doing this all in the first place (although I feel like my clinical skills and knowledge are going to be awfully cobwebby once I finally break my way back into the clinic); my daughters tossing off comments without a second thought - "Mama, when you were a little girl you were like us, but then you grew up and started to catch babies all the time!" - like it's always been this way, only cements that feeling even more.

~ * ~ * ~ * ~ * ~ * ~ * ~

Which, of course, leads to the next step in the journey. If (when) I ever get through this step - clinicals, that is - and if (when) I manage to pass both comps and boards (an overwhelmingly terrifying prospect) ... then what?! The job market for a CNM in my area is bleak. As in - none. Zip. Zilch. Nada. I've been following several CNM search engines --- GetMidwifeJobs.com; the job listings on ACNM's website, the listings on my school's forums, etc. I've sent resumes, cover letters, and CV's to anyone and everyone, to every job that looked remotely interesting; to Alaska, New York, and AZ. With no calls, no emails, nothing. Kind of depressing, to be honest... but I haven't been very aggressive myself - you know? I still have 170 clinical hours, and up until this week, no idea when I would get those hours going.

Out of the blue, though, I got a call this week from a physician in Maryland; we had a nice, 20 minute chat (after I hung up on him initially - oops, the drags of living in the rural Midwest) and I was left with a bit of hope and interest in what could come from the talk. Could I do Maryland? Pro's - Adventure, ocean nearby, change of pace... a job. Con's - Moving across the country, no family anywhere (some days that might be a slight pro... slightly), higher cost of living... and apparently it's a very 'un-rural' area. Not so good, since I have a feeling I might get kind of antsy surrounded by city/urban folk... maybe. (Although living around here in a cardboard box, with loan papers coming in the mail on a daily basis, might making me kind of antsy too - especially when the snow starts flying...)

I hate to even post this here, since a tiny part of me (okay, a good-sized part of me) is superstitious - but when I met with Dee last week, she also gave me a glimmer of hope for a potential position at her site. (This site is about 45 miles from my current home; it's within the same healthcare system I currently work for, and while it would have its own set of pro's/con's to consider, staying within the area would be a huge "pro". ) So, after talking more with her this week, maybe - hopefully - I'll be able to expand on this more...

Thursday, May 26, 2011

The Power of a Mother


~ * ~ * ~ * ~ * ~ * ~

In the past weeks, I've had the opportunity to see a beautiful display of the strength the we, as mothers, hold within ourselves. I have seen two first-time mothers carry twins to term and birth them vaginally (a rarity in today's obstetric world), and I've been blessed to be a part of several beautiful water births. I've supported women as they shed the pain and negativity of their prior births - whether vacuum-assisted, episiotomied, or cesarean - and worked their way to fulfilling, heartwarming experiences this time around. I've coached women through difficult labors, instructing them to push - or not push - at the hardest times, when it was the thing they most didn't want to do (but needed to, for the sake of their baby - whether due to a stuck shoulder, nuchal cord, or other concerning issue). I have seen mothers labor and push for hours, with no analgesia; I've seen mothers who plan to get "everything [they] can get" - but still have intense discomfort... regardless, the strength, and the determination to make it through, is amazing. I've visited women in the hours and days after their births and been awed at the love that's obvious as they snuggle their newborns; the way they hold their nurslings to their chest, cooing and adoring, proudly showing off their babes to older siblings, grandmas and nurses.

*~*~*

Strong thunderstorms and tornados moved through this region - and much of the country - last weekend. The similarity between Mother Nature's power and that of a laboring mother is not lost on me. Surveying the damage of what has officially been deemed a tornado - which moved right alongside of the
hospital - brings to mind the rapid internal changes that occur with labor... Mama feels as though her insides are being ripped apart, ravished by the incredibly intense waves of contractions moving through her. Until labor began, she may not have even realized the strength within herself; and yet, like the buildings and trees damaged from this storm, her body will begin working its way back to normal within hours after baby's birth. (And, in fact, just as a beautiful, brilliant, calm sunset emerged from the storm - mama will almost always emerge from birth with a tired but peaceful sense of wonder as well, with the most beautiful prize to be had.)

Sunday, May 22, 2011

Things I've Learned This Week...


* Suturing actual, living tissue is much more difficult than practicing on, say, cow-tongue or a chicken breast. (Or, for that matter, a foam dummy) You've got a mom who can often feel at least some of what you're doing, there's labia and tissue to hold back, and blood seeps into the viewing field (dab... dab... dab...). On top of this, you're wearing sterile gloves which are almost always tacky with blood by this point. And - I'll be honest here, even though I know how 'forgiving' the perineal tissues are and how well they heal - you want it to look nice. (For anyone who hasn't seen the vaginal/labial/perineal tissues of a woman right after delivery - picture a gooshy, glistening mass of ... I don't even know what. I'm only now, finally, I think getting the hang of what goes where. On that note --- any volunteers so I can practice?!)

* There is a huge range of philosophies/practice among midwives - and that's okay. The things I learned with the Midwife and want to remember/use, I can. The ones that I didn't feel comfortable with at all, I can drop in favor of something that reaches the same goal but feels "right" to me. For example, the amount of traction needed to help the placenta separate and deliver, or the choice to leave a mom's perineum and labia alone as the baby crowns (while still reserving the right to support both, and maybe help stretch on occasion, if needed, rather than for every birth).

* You gotta use a heck of a lot of traction to help resolve a shoulder dystocia.... I always fear that I am going to injure the baby when using excessive traction, but when looked at it from a different, more sombering perspective --- a baby with a broken clavicle or even nerve injury, is better than a baby that never is.

* I got this.

Saturday, May 21, 2011

Thank God for Midwives

(And mama's, and babies, and supportive dads/aunties/grandmas/friends, and doulas...)

But, at least for me and at least for this week --- thank God for Midwives! If you've followed along at all, you might remember how intense (is that a good word??) things became at my last clinical site. I won't go into all of the details again - because frankly, it makes me feel pretty lousy and I also start to feel a little badly for the women who really want a midwife and don't realize (until it might be too late) when they've actually found a medwife - but it was rough.
Rough on me a student, as a person, and even as an OB nurse. That site caused me to question a lot of things both about myself and the way I have been prepared to practice as a CNM; the Midwife was motivated, she was popular, and she was good. But - she was also (either by choice or by necessity) very much a medwife. As a learning experience, it was good; the four months I spent with her allowed me to begin the hands-on learning I needed to grow as a new midwife, and the last few weeks (along with many, many weeks thereafter) gave me pause to reflect on ways that I myself need to grow my personality to better perform in that role, as well as on the pieces of the Midwife's practice that I did and did not want to take with me into my own practice.

It wasn't until today, though, that I realized how deeply I felt wronged in my previous site. My faculty advisor has been working hard to help me find a new clinical site; this process, which originally seemed as though it would be fairly quick (I had another preceptor in mind, who was happy to work with me) ended taking 2 and a half months. Obstacles with policy, administration changes, and just enough little roadblocks to keep things from progressing have kept my hands from officially (as a student nurse-midwife, that is) welcoming a baby into the world since March 1st. (And it has been kiiillllllllling me!) As things continued to stall, my advisor suggested I come to a site that has welcomed several of my classmates in the past; while at first I was hesitant (as this site is a 3.5 hr drive from home) eventually it got to the point where any site was perfect, and I jumped at the chance. The midwifery group agreed to work with me, the paperwork was approved, and plans were made for my arrival early this week.

And, it has been amazing. Amazing for the births I have attended - 9 so far since Tuesday (and I missed several others one day when I finally had to admit that my body and mind needed rest), including two glorious waterbirths, two VBAC's, and a handful of other triumphant displays of mama-power. Amazing in the fact that the midwives and nurses have welcomed me with open arms, eager to help me blossom as I work my way towards becoming a beginning-level midwife. I've had "scary" moments - a decel that wouldn't come up (while my precepting CNM and the OB on-call were in the midst of a c-section and completely unavailable), a shoulder dystocia that didn't resolve easily with McRobert's maneuver and suprapubic pressure - but made it through them. I've been allowed to be more independent in four days, with four different midwives, than I was in four long months with the Midwife: when our dystocia baby's shoulders didn't ease out shortly after his head, the CNM I was working with that day didn't push me aside to take over... instead, she stayed back (as hard as it must have been) and allowed me to identify the situation as a shoulder dystocia and to work to resolve it. When my efforts weren't quite doing it, and I looked to her for help - she was there. The trust that I've found from these midwives - each of whom I have met for the first time the morning that the call shift begins - literally brought me to tears as I finally took some time today to reflect on this first week. It takes a momentous amount of trust to stand back and allow a student to be in control of a situation - especially one that is as intense as a shoulder dystocia or prolonged decel. I can't even begin to fathom how difficult it is to stay back and just "be", while a student works to resolve something that can so quickly develop into disaster. And yet - the true mark of a good teacher is to understand that without allowing a student to take the next step towards independence, the student will ultimately never succeed, and both teacher and pupil end as failures. In labor and delivery, with the life and well-being of a longed-for baby on the line (as well as the mother's safety), the amount of trust and courage in takes to do this is multiplied ten-fold... with the rewards equally as impressive.

I'm not there yet - a part of me froze up in those tense situations, and it took longer than it should have for the little voice in me to say, "this is what you do... remember?". But the gift of being allowed to wake that little voice up, to do my best, and to know that I had a supportive preceptor right behind me --- rather than pushing me to the side immediately --- was worth more than anything else. Then, the bonus of constructive feedback and open communication - rather than quiet, tired frustration - after each incident: What should I have done? What might have been a better way to do that? And - what did I do right?

As I wrote what was supposed to be a quick update to my advisor, letting her know how incredible of a learning experience this has been so far, I found myself reflecting back to the days with the Midwife and comparing the feelings I had at the end of that rotation (inadequacy, doubt, fear, shame) and the ones that have emerged in just a few days here (confidence, readiness, calmness). Sitting on the back porch of the midwife who so graciously invited me into her home, smelling the lilacs with songbirds for a soundtrack, tears rolled down my cheeks as I typed on and on. Where my hands were rarely able to catch without the Midwife's covering them before, they now have eased 9 new lives into the world with very little guidance; when I reluctantly began to perform certain skills in the way that I had been taught from the Midwife (but had never been comfortable with), I was reassured that there was another way, and that the way I learned was not necessarily the best practice; what had been frustrating in the past (lack of expectations, absence of any real rapport) was nowhere to be found among these midwives.

So, thank God for midwives... the midwives I've worked with this week, who took my hesitant, injured confidence and allowed it to begin to heal; the midwife who opened her home to me, with its peaceful quietness (no television, no cell phone reception) and country beauty; the midwife (my advisor) who spent so much time working with me to find this happy place again. And even the Midwife, who started me on this journey and puts this all into perspective.



Saturday, May 14, 2011

My Town


My town is (relatively) rural, "under-served", and ... beautiful. There are days that I find myself awestruck at the innocence of the people here, the young families working so hard to bring about the change that we need, the grandparents so active in the younger generations, and the community programs that are so involved in so many areas of our growth. Two Native American reservations adjoin the region, sharing a wealth of rich tradition and cultural diversity.

Even after nearly thirty years of living within thirty miles of the same spot, I still have moments of wonder at the physical world around me as well. My home is a mixture of fertile, strong farmland - capable of bearing grains most months of the year - and rolling hills and thick, tall stands of trees. Rusty tractors and beat-up cars dot the highways and country roads; anything shiny and speedy is less likely to be seen. Deer are everywhere (driving home from my mother's today, I had to hit the brakes twice to avoid last fall's scrawny doe-fawns), with wild turkeys just as present and pesky. A bear loping across a country road is a much more sacred experience; bald eagles are a daily, humbling, occurrence.

(Now, of course - don't get me wrong. There are so many areas that could be improved on; there's the same old political drama as any other area - the community is older than the average town, with a very conservative tilt - as well as tension from a so-called "religious cult" that has had ongoing legal claims against the city government over the past five years or so. Racism/ethnicism between "whites" and Native Americans (as well as members of the religious group mentioned above) does exist in the area despite commitment by many organizations to work towards common goals of unity. Business is always business: our small, not-for-profit, community-run hospital recently "merged" with a larger health care system, and competition continues with other clinic systems in town and with the "bigger, better, newer" facilities located slightly further away. My town may not be perfect - but it may be perfect for me, anyway.)


And yet, with all our imperfections, all our arguments and all our petty squabbles - we really do have it good. On our small, four LDRP obsetretics unit - in which each room has banged up doors, peeling wallpaper, and so many aesthetic no-no's that it's becoming painful to give tours during my childbirth classes - we've celebrated the birth of not one, but two sets of vaginally birth twins in the past few months. In the years that I've been a part of 'my' team, we have had several more sets, both to primiparous and multiparous mamas. (I have not be lucky enough to be present at any of these births yet --- can you tell I'm a bit peeved?! --- but am still so excited/proud/any-number-of-adjectives-fits-here that the diagnosis of "twin pregnancy" hasn't automatically equaled "cesarean section" for our mama's; generally, as long as Twin A is vertex and the pregnancy is otherwise healthy without factors contraindicating vaginal birth, trial of labor has been offered/attempted, and as far as I know - all have been successful with wonderful outcomes.)

As a nurse, I've had the joy of holding patients' hands, helping them breathe through contractions and ease their way to the births of their sweetest creations; I've been blessed enough to have to catch babies (when the doctor didn't quite make it to the room, or even to the hospital in time), and instead of being reprimanded or frowned upon, I've been thank
ed and even praised because of how well things were handled. One mama had a vacuum assisted delivery with her first babe, and a massive laceration with repair; she was terrified of pushing and delivery. With the doctor down the hall, ready for the call, she tried her first push - and with just a little encouragement, gentle support, and the right words... she delivered her beautiful daughter by herself, into my hands, before the doctor could make it down the hall to us. No lacerations, no need for any assistance - only her own strength.

Much of this truly comes down to my own inner calmness. As a new nurse - starting directly into OB/L&D nursing, I was terrified of having a mama "precip" on me. And, of course, two of my first handful of mamas did just that. (At that time, I was new enough that I still had a precepting nurse with me, and I basically froze, leaving her to jump in and catch.) From that point, I had such o
f phobia of having that happen again that I became hyper-vigilant of when a mom might suddenly progress to delivery rapidly - and so I began calling the doctors to come in very, very early in second stage. (Now, if they were midwives they would probably already be there... but that's another story...) La la la da.... fast forward a couple years, I became more relaxed and understanding, intuitive, and comfortable with idea of catching if need be - and, I was entering midwifery school, so the idea of catching was a little more addictive at this point! - I had no precips, because I had finally gotten it down pat of when to call the MD's in so they would get there *just* in time. (Drats!) But, finally, I realized, if and when a baby delivers - I'm all right with that. I no longer frantically instruct a mother to "Stop pushing!" or "Pant! Breathe through this one!" ... if she is going to push because the baby is right there, I am not going to stop her. I don't plan to catch any babies in babyland - but, if they come to my mamas and there's no one else around to catch 'em ... mama and I are going to do it!

I live in a town without high rise buildings, with no Starbucks or malls to call my own; "my" unit has only four labor beds, with peeling wallpaper and drab furnishings, and no OB/GYN's to be found. My countryside is, well, just that - fields, tractors, and farms. To be blunt, summertime smells like cow-shit... but also the sweet smell of lilacs, alfalfa, and fresh-cut grass.

And - I like it this way.

Monday, May 9, 2011

To My Favorite Mothers... (Every Day)



The moment a child is born, the mother is also born. She never existed before. The woman existed, but the mother, never. A mother is something absolutely new. ~Rajneesh

~*~*~*~*~*~

Yesterday was "Mother's Day", and while I was inspired and truly meant to publish a blog post dedicated to all of my favorite mothers - I never did get around to it. Instead, I spent the day visiting some of those ladies. In the morning, I was awakened (as usual) by my two little Mini's, climbing into bed with the Warm One and I; they struggled to squeeze in between us, fighting over the covers, until they were reminded what day it was. Together they then ran to the kitchen and raced back to me, smothering me with hugs, kisses, and Hallmarks scribbled with their own names (not homemade - but sweet yet for 2 and 4). The morning was spent at the flea market, sharing hot dogs, Sun Drop slushies, and buying flowers for the grandmas; the afternoon was spent visiting grandmas all around.

So, to all of my favorite mothers, today, yesterday, and every day - I wish you a happy mother's day. I hope that each and every mama out there was blessed to spend her day with those she loves - her children, her grandchildren, the children who may not be "hers" but who really still are. To stepmothers, aunties, and foster moms. To the mothers who try so hard and get nothing in return, and those who miss so much for so many reasons - may there be happy endings, in the end. The teachers, the neighbors, the friends. The spiritual leaders and the strong women who stand up to those who hurt children. To all the women who watch children grow, who help them learn and stand beside them, who share their lives and give so much. To the women who open their hands and hearts at the beginning of lives, and who embrace the ends of lives as well. To the mothers I know, to the mothers who have been so gracious and generous to share their pregnancies and birth experiences with me, and to my mothers. To earth mothers, to new mothers and 'old' mothers, to scared mothers and calm mothers. To all mothers - happy mothers day.

Thursday, April 28, 2011

Going back a few steps... to a birth story

One blog I love to follow is "My OB Said What?!" (If you haven't checked it out, and are a fan of birthing/pregnancy/empowerment & advocacy, etc --- I strongly encourage you too! :)

Anyway, the site allows readers to share off-the-wall, rude, demeaning, jaw-dropping, and sometimes just plain ridiculous comments that their OB's/midwives/nurses have made while caring for them. It can sting to read some of the stories shared - but is also eyeopening. As a provider, caring for women and families... it is hard to realize how much impact a few words can have on a woman looking towards you for reassurance, guidance, and information. (I hope that I never end up on MOSW --- unless of course it's on "Thoughtful Thursday" --- but as sometimes we all have those moments when we find our foot in our mouths... *gulp*)

Back to the point, here. Recently, one of the posts revolved around a woman who asked her nurse-midwife why she decided to become a midwife. Rather than sharing her love of women's health, the normalcy of pregnancy, or helping bring new life into the world, the midwife explained something about not wanting to take the time to pursue a degree in medical school.

Doh.

Of course, the comments to this post were varied, some defending the midwife and the current, exhausting med school process, while others were shocked and appalled that this midwife was clearly a doctor in midwife's clothing (if you will). A few were just grateful that she was "honest" about her path to midwifery, which would lead them to quickly switch providers.

But to me, mostly, it led me to ponder... why did I become a midwife? What led me here?

I think, to answer these questions, I have to start with my own birthing experiences... (I'll start with my youngest, as I wrote it shortly after her birth; as I re-read it, some things jump out at me and I think, "my, how things have changed!") More on that, as well as my older Mini's story, soon...

~*~*~*~*~

Birth of the Mini-est

It was early June, and I was miserably pregnant - but still far from my due date! Since my first daughter came right at 37 weeks, I had this faint hope (although I knew so much better) that #2 would also come early. So, once that 37 week mark came and went, I started going insane and feeling ridiculously overdue. Like every pregnant woman, I started examining my toilet paper, panties, poo, and anything and everything watching for the "signs" that labor was imminent. Of course, I had them all... and they didn't mean a damned thing.

I really wasn't THAT miserable, except my pelvis felt as though it was going to crack in half (and made a noise that reminded me of being a kid, and pulling the legs of my Barbie's apart - and then having them 'pop' out of the little plastic sockets, with that white plastic stuff... remember that? Eww) and I couldn't sleep for crap. I was achey, and kind of sick of having to hold my uterus up off my bladder to pee, and puffy - but could have been a lot worse. Still, though, I decided it was time to start working on Operation Baby OUT.

I walked, walked, walked, made my poor dh do things he probably did not care to do with a cranky, swollen whale (sorry about that, dear...), ate jalepeno poppers by the handful, climbed my wobbly self up onto a bike... anything and everything! Finally dh reminded me that the night before #1 was born, we had pulled weeds in the little flower garden out in front of our house. I rolled my eyes several times but decided what the hell... so A and I went out there and yanked half-heartedly at some weeds. Definitely made a dent, but the flowerbed still looked horrible. Had some dinner (don't remember what...!), went to bed (and again made my poor dh make a, um, prostaglandin deposit...?!), and thought about my big to-do list that I had made to keep myself busy and not looking for those aforementioned 'signs'. (The list included a pedicure the next day, calling to take 'call time' the next day at work, picking up some quilts at the dry cleaners, etc, etc)

Around 3 o'clock I woke up... with wet panties. Ewww! But, just like the first time around, I knew that it was amniotic fluid and not just a leaky bladder. To be sure, though, I snuck to the bathroom and fished out the nitrazine swab I had "accidently" liberated from work, and swabbed my gooky underwear - and saw a bright blue response immediately. Of course my heart was racing, and I got all shaky and excited (I had been dreaming of this and playing it in my mind for months, mind you!), but decided to shower before doing anything else... a girl's gotta be properly shaved for these kind of things, you know! So, I took a shower, then got online to kill a little bit of time and logged onto contractionmaster.com to see where my contractions (or lack of) were at. I also turned on the TV, and apparently at 3:30 a.m. there isn't a whole lot on - the old "Roseann" rerun where she's pushing free samples at the grocery store was all I got. Finally, around 4 I woke up dh, got his butt in the shower, and then after informing Jana of the change and rewriting my to-do list (so much for my pedi) we gathered the bags and walked over to the hospital. (I had called to let them know we were coming while dh was showering)

Go there, registered, got up to room 233 - and had the nitrazine now come out negative. Still not having much for contractions, and wondering if we'd even be staying. I was 2 cm at this point and pretty posterior (from my own guesses, I had been thinking I was around 2 for a while already) . But, nurse Angie decided to just put the IV in "just in case" (I was GBS positive this time), and wait and see - this was around 5 a.m. Assumed that Dr. Q would be coming in around 7 during rounds, so dh napped on the couch and I read my book ("No Country For Old Men") to pass the time... eventually reading only between contractions. By 7, I was definitely feeling them, but doing all right - I think it was around then that I put down the book, though; with the bustle of the day shift coming on around 7:30, dh woke up and turned on the TV, and kept asking me what I wanted to watch (not getting that I couldn't care less at this point!). My nurse manager - i.e. boss - came in around this point as well, and I remember talking through a contraction or two while she was in there, and afterwards thinking, "Huh, so far so good - I can still talk through them!". After that, though, they kept getting stronger, and I had to focus pretty intently on my focal point (the upper left drawer pull on the entertainment bureau) and breathe through them; I was also battling an achey back which I blamed on the bed... I started piling pillows on the bedside table and trying to hunch over it during contractions. Once or twice dh and I 'slow danced' through them. Around 8, since there was still no sign of the doc, I decided to hop in the shower both for the relief from the back pain and contractions, and also just for something to do to stay awake. Things got pretty intense in there, and I remember a few times thinking that if I pushed a little it might help... (it didn't). Still no doctor, so I stayed in there and alternated the hot water from my belly, to my back (or as best I could), to right at my perineum. I worked at visualizing that little head stretching my cervix and moving down... until finally at about 8:45 Dr. Q poked her head in to see how I was doing, and told me I didn't have to get out to see her if I was doing ok. By this point, I was thinking that I might be ready for something for pain, if things were moving - maybe nubain?? And I just wanted to know if things were progressing; if I was still only 3-4 cm's dilated I think I would have died, or begged for a c/s. I still felt like I was doing great... just tired!

So, I popped into bed, and she offers to break my water if I want; she also says that she has the nurses mixing up my second dose of ampicillin so we could get it in "just in case". I tell her it just depended on where we were dilation-wise if I wanted my water broke, and that I was maybe getting to the point for pain meds... so she grabs the amnihook and does the check. And pronounces me 9 cm! Since I had this great fear that I was only still 3 cm, I was pretty pumped... especially since I still had this mindset that things still had to get A LOT worse before getting to pushing. She decided against breaking my water, and the flurry of activities started (warmer and table coming in, that last dose of antibiotics being run in over 10 mins, etc) ... once the antibiotics were done, around 9:10 a.m., she broke the rest of my water (strange feeling!) and we started pushing. Pushing was awful! Last time I loved it... this time it killed me. Part of it was due to baby --- which also explains some of the back pain, which apparently was back labor! --- being posterior and rotating during pushing. At one point Dr. Q offered me some lidocaine gel to help with the burning, and I replied "it's not going to help at this point!" and everyone laughed at me... and then with the next contraction and push, I was ready to beg for it (except the head was coming out, and I couldn't get the words out... a little late, I guess!). Again, the best feeling in the world was when the shoulders slipped out and my second daughter was born at 9:15 a.m.

Due to a short cord, it was clamped right away (although I don't think I had even told the doc that I wanted to hold off on clamping/cutting until after it stopped pulsating) and cut by dh, and then she was placed on my tummy. I fumbled with the snaps on the gown, trying to get her to breast, until nurse Terrie said "it's easier this way" and just pulled the gown up from the bottom. Smart girl! She latched on easily and went to town... but I was still in awe of how HUGE she was!

Long story short, it was a very fast, relatively 'easy' natural labor - no pain meds, no unnecessary interventions. We did almost immediate skin-to-skin following birth, and my perineum remained intact with just a tiny skidmark. Recovery was fine, although the cramping was much, much stronger than with my first daughter - it was really worse than the labor was. My back was sore for a few weeks afterwards, but all in all - not too bad!

Olena Marie was born on 6/11/08 at 9:15 a.m., weighing in at 8# 7 oz, 19", and a whopping 35.5 cm head of dark hair.


Wednesday, April 27, 2011

Teeter Totter

Up... and down... and up... and down.

Seems to be the story of my life, lately! I have a strong belief that things always work out the way that they are supposed to, and that it doesn't pay to struggle against what's happening to you... why waste that energy. To quote a song from my high school days (does this date me?!), "Fuck it or fight it, it's all the same..." Or maybe another generation: "Go with the flow, man..." (followed by a haze of some decidedly dubious smoke). Whatever works.

Just after my last post, I made a call back to the clinic where an old co-worker (and nurse-midwife alumni of my school) is employed as a CNM/women's health nurse practitioner. I had already called once and left a message for her on the nurse-triage line - always an iffy way to leave a message - but hadn't gotten a response. When I was able to get through to her this time, she seemed excited to talk with me and we planned to work out all the nuts and bolts of working out a student/preceptor partnership together. Though she isn't doing births (yet) in her role, she is doing OB visits and postpartum rounds, and hopes to be doing births in the future... and (bonus!) may be needing a partner before long. "And of course I thought of you right away!" she said.

(Up starts the swing of the see-saw....)

The next day, I get an email from the new midwife... finally! She apologizes for the length of time between our messages, and explains about the changes that have been happening at their facility. I don't care --- it sounds like the ball is finally rolling. Suddenly, I have not one, but two preceptors on the horizon. I may graduate soon after all! Huge sigh of relief, new fantasies of "life after school", and more worries of comps, boards, and practice... but mostly, glee.

(And so, the top of the teeter-totter...)

This week, emails from the various credentialling offices at the clinic and hospital where my clinical experiences will be held. Forms, forms, forms; lots of blank spaces, spots to fill in, and dates to ponder. Worries about what happens if I don't complete my hours by the end of this term, and spill into next term - what about financial aid?

And then - an email from the facility where my new midwife catches her babies. The medical executive committee there has determined that "provider students present in the hospital are limited to observing patient care activities". Emphasis theirs.

(Huge, tailbone-shattering return to the rock-hard ground. Teeter-totter down.)

How will I complete the births that I need by "observing" patient care activities? That is the complete opposite of what a midwife does; she touches, she sways with, she assesses, she massages, she gently coaxes.... and she catches. Yes, some observing may be observed... but it is so very, very not the essence of the work she does with women.

I'm so hoping that this is just the mumbo-jumbo wording of this policy, that exceptions can be and will be made, and that the big fat policy that caused me to fall so quickly back down will work with me instead, seesawing me back upwards.

Wednesday, April 13, 2011

dreams...

As I was on the very, very verge of waking up this morning, I dreamt I was walking into the Midwife's office. We sat down, and faced each other one last time. She looked older, and nervous; almost on the edge of tears, shaky, scared. In fact, much as I felt as I dropped off the thank-you cards and gifts at the office yesterday (I just gave them to the receptionist - I didn't see either the Midwife or her MA, thank goodness... my facebook friends might have seen my status about "so this is what a panic attack feels like" - that was the emotional/physical storm I found myself in as I approached the elevator). But, anyway, even in my dream state - these changes surprised me. Why was she so anxious? It touched me. The dream was short... but the message clear. She stumbled through the single statement she made to me, asking me, "Is there anything, any pressure, that you think is going to hold you back from being successful in your next area of practice?"

My dream self just sat, thinking carefully of the best way to answer. There was none of the anxiety or self-doubt that filled my last days before, simply a feeling of wanting to give the clearest answer that I knew was my right answer. I don't know if I answered in my dream, or if it was as I was waking up, but it has lingered with me all day: The heaviest pressures that I have dealt with, are the ones I have placed upon myself.

~*~*~*~*~
(later)
I know this is true - and I accept this. Doing so, I promise to myself to let this go, and let myself grow.

Tuesday, April 12, 2011

Unfinished Business

"A peacefulness follows any decision, even the wrong one." ~Rita Mae Brown

~*~*~*~*~*~*~*~

As the days roll on and my birth experiences seem further distant, I realize there are quite a few loose ends that I need to wrap up. I have yet to hear from the 'new' midwife... I wonder, sometimes, if things will fall into place when I take care of the leftover details from my last rotation.

So, on my to-do list today, I plan to pen thank you notes for both the Midwife and her wonderful nurse; I'm going to run these to the clinic and drop them off, as well as small gifts of appreciation for both of them. (I hope this doesn't come off as suck-upish --- does it? Oh, well... it just seems to be the polite thing to do... maybe I'll pick up cookies for the rest of the MA's, etc, too.) I still regret that I never said goodbye to the Midwife's MA, but needless to say, as I walked by her on my way out of the office on that last day - it wasn't the time... she was in conversation with a few other nurses, and I was red-eyed and a mess.

I also have another small package to send off, but that one will have to wait until I find the address I need; this one, too, goes to someone who I feel badly that I didn't follow up with, and who I thought really was wonderful.

Finally, I need to decide if I'm going to give up on the 'new' midwife and desperately hunt for another site. After six weeks of no-baby, no-mama --- I just don't know. I don't like this feeling at all. I feel unemployed, lazy, useless, rejected. The old feelings of paranoia are starting to creep in. Is the 'new' midwife trying to tell me something? Maybe she changed her mind about working with me... but is trying to drop hints by ignoring me long enough that I just go away...

*sob*

(right before I posted, my advisor/faculty "RCC" called me back and we came up with a plan --- I emailed another potential midwife, and she is going to try to call the 'new' midwife to touch base... *sigh*. stay tuned...)

Friday, April 8, 2011

Fading...



sweet slick violet crown...
coaxed smoothly to the crisp light
growing dreams, hope, love

~-~-~-~-~-~-~-~-~

the last baby i caught was on march 1st... today is april 8th. (it seems as though it's been so much longer since i've been blessed with a catch, but as i type this - i know that's right; i remember it very vividly!). as i completed my clinical journey with the Midwife, i knew that there would be a period of time when i wouldn't be seeing women and men transformed into mothers and fathers... and i was (or thought i was) okay with that. a few weeks... i could handle that, right?!

well, at first - all was fine. no biggie. the first week, i think, was Mini #1's "spring break" (really, they have that for pre-K - i kid you not). so, we chilled out, did some family things, and i de-compressed; it was just what i needed after a few really stressful weeks. the next week, i caught up on a forum post or two that i HAD to get in. and then - suddenly - (okay, not suddenly at all - i had all term, and most of you know this, right?!) it was crunch-time and i had to finish The Paper. so, that kept me occupied for the last week and a half or so of March. and i got it done, with flying colors (thanks be to whoever you praise).

but - now that's all done. and this nagging feeling, that's kind of been popping up here and there in the past five or six weeks - is back with a major vengeance. i feel unemployed; i feel like i am sitting around, doing nothing, being a lazy, useless pile o' rubbish. i haven't been less than a full-time student and/or worked less than full-time since, well.... i can't even say when. i mean, it's been a long time, folks. (and i'm not saying this just because i'm pretty sure i'm getting a touch of dementia --- i really am used to working at least 1-2 jobs, going to school, etc, at a crack). sure, i'm still working right now - but i'm a 0.3 FTE. which means - 1 or 2 shifts a week. and - i AM perpetually lazy, which means if i can get "low-census" (i.e. things are slow in baby-world, so they don't need all the scheduled 2 or 3 nurses...) --- i'll often take it, out of habit.

i think i am annoying the "new" midwife to pieces - i've emailed her a few times over the past couple of weeks (mind you, i believe she is just coming back from a medical leave)... but i really, really, REALLY want to get started with her. i'm also starting to get a little anxiety prone. like, i have 260 hrs to go of clinical, and i need (want? should?) to be done by the end of june to be done for this 'term'... if i don't get going very soon, i don't see how i'm going to get all of those hours in. i'm trying so very hard to be patient, but i just w a n n n n a G O O O!!!

it's times like this, that i really could use a little xanax... or a big glass of wine... or gerard butler... *sigh* (for example - my anxiety? see how i'm typing in all lowercase? telltale sign...)

and mostly ---- i just want to get my hands on some babies! *pout* (well, and meet their mama's, too, of course... that really does add a little something to the experience...)

Sunday, March 27, 2011

Birth Story: Nella Cordelia

Have you read Nella Cordelia's birth story? If not, please do (have a box of kleenex handy - fair warning!) http://www.kellehampton.com/2010/01/nella-cordelia-birth-story.html

(thanks to At Your Cervix for sharing this link)

Sunday, March 20, 2011

Long time, no see...


It's been 19 days since I had a delicious delivery, and it's hurting. In some ways, it seems like longer, but in others --- it's not so bad. The time with my family, to catch up on sleep, and to get a few other things that have been dearly lacking (car maintenance, bills, etc) back on track... two thumbs up. Missing the lovely women and experiences of twos becoming threes and families adding extras... not so much.

To keep this short and sweet (and I'll tell you why in two short, evil words: the Paper), I'm gonna to limit myself to exactly two minutes of typing, no more. It's 2038 right now, so by the time my computer hits 2040, I'm publishing this post as is*. (I might however sneak back and add a pic to pretty it up, I do reserve that right.) **I totally lied, it's now 2059 & I am just hitting the submit button. Oh, well... you'll see why...

Anyway, on the 'professional' side - hoping to start my next leg of the clinical journey at another nearby site within the next few weeks. This midwife that I am hoping to work with is much more "my" style, from what I know of her. I am very much excited to work with her, and my fingers, toes, and possibly even fallopian tubes (maybe not - that seems as though that might not be so good?!) are crossed that it works it. Stay tuned!

On the personal side... recently I had the bittersweet pleasure of working with a beautiful family who had the painful loss of their baby shortly after the midpoint of their pregnancy. The loss wasn't expected, but wasn't necessarily a surprise either; going into the pregnancy, there were certain risk factors that they knew increased the risk for stillbirth and/or preterm birth. The grace and strength at which they accepted their child's short life, introducing their older child to his angel sibling and then saying goodbye, warmed my heart. I only hope that I was able to help in the grieving process, or at least communicate the value and appreciation that we all have for the sweet little life that they have had and are remembering. One service that I always forget the name of in these (thankfully rare) situations - and always wish that I could remember, but can't until later - is the Now I Lay Me Down To Sleep organization (http://www.nowilaymedowntosleep.org/home/) , which is a non-profit group of professional photographers that is dedicated to help families who have experienced an early pregnancy (after 25 weeks or so, according to their site) or neonatal death. Though we do take pictures of our babes, they in no way can compare with the beautiful gift that this foundation can offer to their parents.


To all the angel babies, and families who are missing them... you are loved, and not forgotten...

Thursday, March 3, 2011

Birth photography...

... is something that I've always loved the idea of. As an OB nurse and now student nurse-midwife, I always find my mind taking these mental snapshots during labor, birth, and those first few days of each new family. I find myself saddened by the intimate moments lost, the sweet "firsts" that are missed, and the beauty of a partner's touch or a newborn's soft skin slipping by unnoticed. "Where is your camera?!" I scream, noiselessly, to the new parents, or the grandparents, or anyone else nearby. "Don't you realize how precious these moments are? You'll never get them back..."

Part of this melancholy stems back to Mini #2. As I was preparing to host the luncheon for her baptismal party, I was throwing together a photo album/scrapbook of her first days. (Of course, this happened to be only a day or two before the party... but that's another story.) It was only then that I realized - I only had a few pictures that were taken during labor and delivery. But... what about... I don't remember... How come....

Suddenly, it wasn't about the photo album (Heaven knows we had plenty of pictures for that), but the fact that I wanted to remember more. Now, granted, I feel like I remember our labor very, very vividly; my water "sprung a leak at home", I knew it was definitely my water (because, first of all, as an OB nurse, you just know amniotic fluid... and second of all, I had somehow accidentally managed to procure an amnioswab...), went in to the hospital and was deemed to not be ruptured - but still given IV antibiotics "just in case" since I was GBS +... continued to labor, eventually beginning to have "real" contractions and delivering within a matter of about four hours. I remember reading No Country For Old Men early on, I remember the Warm One laying out on the cot next to me and snoring away through much of my labor, I remember my boss coming in about two hours into labor to visit for a few minutes; I remember realizing in amazement that I was using a focal point (a focal point! something I have always discussed in Childbirth Classes, but never actually thought of using myself...) on the chest of drawers, and I remember visualizing my cervix melting away as I waited, and waited, and waited, in the shower. Anyway --- the point of this post wasn't to share my birth story (that's another day) but to mourn the lack of pictures.

But, now the Warm One came in and ruined my train of thought. I'll leave you, instead, with an invitation to visit these friendly blogs that I've come across - gorgeous examples of a touching, sweet birth story, told in pictures:


http://capturingdayone.com/gallery?pid=173 (click through the 16 images)

http://creativelookimagery.com/blog/?p=2441&cpage=1#comment-207 (my favorite - make sure you view the full-screen version, with your sound on...)


Enjoy!

Wednesday, March 2, 2011

Drinking, Resting, and Breathing.

That's all I'm going to do for a while, on the advice of someone I consider to be a friend and a kind of spiritual advisor (she's a pastor, but for some reason, that title seems awkward to me...?). Anyway, her wise words: "Drink lots of water, get lots of rest, and just breathe."

It seems like a good strategy, and the kind words - said at the perfect time, by someone whom I have only had a handful of actual face-to-face conversations with - touched me. Like all of the supportive comments to my blog posts, all of the "likes" and thoughts (both heartfelt and sassy) on my Facebook statuses, all of the texts, emails, and walls posts from friends reaching out to me - it was enough to bring tears to my eyes and warm fuzzies through the rest of me. I'm not someone who has ever had a lot of close friends; usually, I have one or two very close friends that I confide everything to, and then a handful of acquaintances. To have so many people that I feel like are there for me, is an overwhelmingly touching feeling.

Today was officially my last day with the Midwife. As expected, it was bittersweet; now that I am home, starting to unwind and draw closer to my bed, I am becoming more at ease and even relieved. It was time. The Midwife and I finally had a good - not great, but at least a better - talk as I was saying goodbye. We did not, by far, clear up many of our miscommunications - but I think maybe, just maybe, things were at least left on a fair note.

As a student nurse-midwife, I feel like it was a good time to leave this site. The last birth that I attended was beautiful; the couple was strong, dedicated, and so in tune to the birth process and their baby, through the many curve-balls that labor and birth through their way. They were "my" type of client: they chose the Midwife because they wanted a Midwife-attended, natural, low-intervention birth. It was a joy to be with them as they became a family of three and welcomed their sweet daughter into the world, exhausted yet exhilarated. They gifted me with another blessing as I said goodbye, with kind words towards me as a SNM as well as words from another past client.

I wish the Midwife the best; I know that she is dealing with stresses in her life, and I hope that peace and calm descends to her.

For me - it's going to be a lot of just drinking, resting, and breathing.

And ... the Paper.