Saturday, February 5, 2011


"Never ruin an apology with an excuse." ~Kimberly Johnson

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My heart hurts. My brain hurts. My ego hurts. My body hurts. My checkbook hurts. From my eyeballs down to my left big toe (specifically) I hurt. This nurse-midwifery thing is trying - but I have so much faith that it will b
e worth it.

Where to start?! I'll try going from the top and go down... on a light note (looking back now), I had the embarrassment of walking in on the husband of one of my mama's as he was, um, using the bathroom facilities. I had peeked in her bathroom to see if there were pads and lovely mesh undies set out for her, and - seeing that there were none - headed to her closet to grab some. This apparently took a few minutes longer than I expected, because in the very brief time that I thought it took me to turn around and head back to the bathroom... he snuck in. Surprise!!

(Well, that's what she gets for coming in at 4:00 a.m... right? These people should know I'm no good before 10 a.m.!! Ha, let's see how far that excuse ever gets me!)

So, that was the first bruising of my ego in recent memory. I'm sure there has been others, and there will be many more. Patients who do not like me, or prefer not to have a student working with them; personality conflicts, and, of course, staff/physician/etc conflicts.

Moving on. My checkbook. Oh. My. Heavens. I'm not going to go into details here, since I think my very last post spent a little time talking about this --- but it's not pretty. Thoughts of LAC ("life after clinicals") are really becoming time-consuming, including some pretty in-depth fantasies of where I can find or create a CNM position in the local area. More on that topic soon, I think.

My brain. Oh, yes, the brain... or what's left of it. There are days when it is just a-reelin', if you will. Between the ego-beating and financial stressing just mentioned, and then the mind-trips about future career possibilities, I feel like I'm stretching myself pretty thin when it comes time to actually focus on life and clinical critical thinking. While I know I need to push all of that nonsense to the side and get down to business - that knowledge certainly fits in the "easier said than done" category. Distraction has always been a strong suit of mine, and continues to be so...

Where was I??? Oooh, how about my body next? It is sore as heck, many days. I'm loving what I'm doing, don't get me wrong. L-O-V-E. But, as they say (I think I'm hitting every cliche in the book here) --- love hurts. In this case, it's some of the twisting and maneuvering that I do - usually during births - that gives me some aches and pains. Nothing that I think is going to cause any lingering damage (it's already much better than the first few weeks of clinical, and usually is just a little bit of muscle pain for a bit after a looooong second stage); enough to mention in this somewhat-related post, but not worth changing the way I deliver. (The Midwife doesn't break down the bed; she drapes the foot of the bed, and takes her place sitting on the side of it... this is how I catch, as well, and don't think I would have it any other way... sore back be damned). But, there is al
so my bum toe - my left great toe, to be exact. I broke the S.O.B. four years or so ago tripping on my grandparent's step in my trusty flip-flops, and it's given me a fair amount of grief ever since. I'm still looking for the "right" pair of shoes for clinical/L&D; so far, everything I've been wearing (and maybe it's partially due to the nasty, cold winter weather we've been having --- and the fact that I'm getting to be one of those old fogies that blames the weather for everything) seems to aggravate this darn toe. But, cute shoes are worth the pain, right?
And here we are, at the heart of this post. Pain. My pain, really, is not an issue. I can deal with that. I like to think that I can handle pain, as much as I need to. When "my" mama's are in pain, I help them through it as best as I am able and as best to the plan that they had wanted to follow - whether than means using medications, a shower, or screaming obscenities at passersby. (Well, maybe less-violent forms of vocalization are encouraged, depending on the situation... anyway...)
What kills me, though, is pain that I can't "fix". A mama who has desperately lost sight of what's going on, or feels as though her birth experience is being taken away from her. A baby, who may have suffered an injury during a birth. I have felt these types of aching moments as a nurse, and am beginning to see them now as a student nurse-midwife; fellow students are also sharing their experiences in the same way. A rapid second stage; quick birth of a head with massive cheeks - and then apparent progression of the shoulders. Mama's legs repositioned to open the pelvis further, strong encouragment to PUSH! along with gentle traction as the anterior shoulder finally delivers... and a soft but clear pop is heard/felt. The rest of the baby delivers easily, stunned for a moment, then recovers beautifully and transitions to life on mama's chest.

As a student, this kind of scenario fills me with so many questions and so much guilt (just as a laceration has in the past) - Did I cause this? Could I have prevented it? How could this baby - not "big" by any means, and delivered over an intact perineum - be an innocent victim of trauma?

The sinking pit in my stomach, of course, is only stirred up a bit further by the babe, consistently irritable and refusing to eat; moving both arms but certainly favoring one. Though the Midwife - whose hands guided mine, whose hands guided the baby's head into this world - is reassuring that the injury was not "mine" (but rather a part of the delivery) and the prognosis of a fractured clavicle is excellent... my heart aches at the pain that little soul (and the mother) will bear. However this happened, there are no excuses and no reasons why. Little one... I'm sorry.


  1. I think this is a time for you to reflect on the emotions and the actual literary meanings of the words: guilt and regret.

    It is appropriate... and may I even suggest necessary here for you, for any of us students and practicing midwives alike... to feel regret. We feel regretful that the babe is injured (though the prognosis is good) and we we feel sorry that this mother has to endure looking at her little one's pain expressed in such seemingly unconsolable manners.

    However, we must never confuse regret with guilt.

    I will let you reflect on guilt now. On your own... in your own words...

    To everything there is a season,
    and a time to every purpose under the heaven...

    A time to weep, and a time to laugh;
    a time to mourn, and a time to dance;

    A time to get, and a time to lose;
    a time to keep, and a time to cast away;

    a time to keep silence, and a time to speak;


    There is a time for regret... a time for guilt. Don't lose sight.

  2. This post shows why you will make an empathetic, wonderful midwife. {hug}

  3. One of my preceptors told me about the first baby she "caught" that had a fractured clavicle. She said it wasn't that difficult of a birth and she was certain it was fine but one of the nurses was suspicious about the clavicle so she ordered the xray. Came back with a fracture. She was devastated and felt totally at fault. I think that is a normal human response and I have no doubt that I'll feel the same way when it happens to me. After learning of the xray, she went to the mother to tell her, heart in her throat, and the mother (who's first baby spent weeks in the NICU with a fairly serious problem) immediately says, "That's all??" (With a beaming smile.) She was thrilled that this baby only had a minor problem that would heal nicely and she could continue to cuddle and nurse him and take him home with her. She came back to that same midwife for her third baby. Perspective is important! :)