Saturday, January 22, 2011

Have A Little Trust In Me...

"The way you overcome shyness is to become so wrapped up in something that you forget to be afraid." ~Lady Bird Johnson


Before I write anything else here, THANK you! I don't know exactly who or what (well, I do know a few of the "who's" and what's, but I think/feel like there are more that I can't explain...) is behind it, but in the past few days, it seems as though I have been flooded with positive vibes and better feelings. (I think my last few posts have been a bit negative and filled with --- something. Fear and self-doubt seem to be a pretty good description!) I don't like to think of myself as 'that' person, but I am her, when I let myself be. Thankfully, this isn't often (and I should see it coming this time of year, of course); when it happens, though, it scares the bejesus out of me! From the comments on postings here to facebook messages and just support from my family and friends, and even a vivid visit from my favorite great-grandmother in a dream early this morning (is that crazy to post? I just "feel" that it was more than a random jolt of brain currents, and the calming I felt is making me feel like I'm going to interpret it however the heck I want, anyway) I am grateful for the warm blanket of support that I am feeling right now. So, as great-grandma would say, danke schon!

** I have more to write on this topic, but am off to work, so --- it will wait until later I suppose!

Wednesday, January 19, 2011

Be --- Aggressive... Be, Aggressive...

(First and foremost, "aggressive" is probably the last word anyone would think to use to describe me. And personally, when I think of midwifery, it's one of the words that seems the least appealing... who wants an aggressive midwife?!)

But. I'm 1/3rd of the way through my clinical hours, and halfway through the births required for my program (woot, woot!). I'm thrilled about that, but still don't feel like I'm "there" if that makes sense. I still feel like a beginner. A pussyfoot. A lightweight. Dumber than a box of rocks. A little slow. Wet behind the ears. Scared. Mumbly, fumbly, and bumbly.

I can't be sure, but I think I lack confidence. A lot of it.

See, I've always just figured I was quiet, reserved; calm, cool, and relaxed. (And, to be fair - I think this is mostly still true; ".....they call me mellllllow-yelllllow....") On the other hand, my preceptor (we'll call her simply "the Midwife") is full of energy, and has been doing this a loooong time. She's got tons of experience under her belt - as an OB nurse (forever), then as a nurse practitioner, and as a CNM for the past decade. She's understanding - but she's driven. She can easily see 16-20 patients a day, plus manage a labor and have a surgery in the morning before her office hours. Knowledge and good judgment spilleth over her cup, if you get my drift; the woman is wonderful at what she does, and her clients love her. She is a wonderful teacher, but I think it's been tricky for us to work out the dynamics of our partnership; the first couple of months have been awkward and have left me feeling somewhat anxious... I'm two-left-feet-and-balding Barney, who was paired with the gorgeous and talented Ginger-Rogers-esque at the local singles dance class. I so want to learn everything from the Midwife (and to possibly build a lasting relationship, or at least a quality reference), but feel as though I just keep fumbling around at her feet.

I need to remind myself to speak up, breathe deeply, and trust in myself. No more light taps on doors - the Midwife tells me, "knock like you mean it!". No more mumbly little explanations - I need to enunciate, and project, when I speak.

(I don't think these are necessarily "aggressive" things, but rather "assertive". Unfortunately, there is no catchy "Be. Assertive. Be-e-e assertive..." cheerleading cheer, so --- aggressive is what will have to work in my little head, from my little midwife-on-my-shoulder cheerleader)

My RCC - regional clinical coordinator - is coming to visit my site in a few weeks. I just learned this today, from the Midwife. I am petrified, for the above reasons. (See also "Scared to Death"). What are the odds that there will be an impassable avalanche that day, or every single patient will cancel? Dang. A girl can hope (and will keep hoping).

This post, I'm afraid, isn't very exciting or enlightening. I'm sorry for anyone who just started reading --- what a way to join! I promise, there may be better things buried beneath... or to come.

Things To Remember: (Not-quite-pearls)
~ the bag of waters really won't break when it's just touched with an amnihook (usually)...
those buggars are tough!
~ the Midwife LOVES her some goo (so I am starting to love me some too)
~ bulb syringes get very slippery when you have gloves covered in goo
~ bulb syringes bounce (and are no longer clean)
~ Pull those legs back and try to give that cervix a little gentle help...
~ Sit on the bed for delivery - not on my foot...
~ Lower the seat of my stool before starting a spec exam
~ Keep the feet off the footrest (I guess it's *not* for me!)
~ A vagina/perineum is a lot trickier to sew up than, say, a block of foam or a cow-tongue
~ I'm learning

Tuesday, January 18, 2011

Mmmm... the deliciousness of it. (Birth, not tortellini - or at least not so much tortellini...)

So, I promised I would explain the blog title. It really is multifaceted, if you will. The first meaning of a "delicious delivery" is one that only a select group of readers might understand: the midwives, the mamas, maybe some of the fathers, an occasional doctor or two, the OB nurses. I began to feel the hunger for this particular taste when my first daughter was born, and have only realized in the past few months that I can satiate it as a nurse-midwife as well as when I am the birthing one.

The first time I felt the deliciousness of birth, I was 24. I had woken up with a leaking bag of waters at exactly 37 weeks pregnant, self-swabbed it with a nitrazine stick (the perk of being an OB nurse), and - thinking it was negative and not actually my BOW - went about my early labor "on the clock", recovering a newly postpartum mother. Only when I was promising to help her up to the shower did my water break for real. (For future reference, any time I think of the big, theatrical Niagara-Falls-style rupture of membranes occurrences, this is how I will refer to them - "for real") . A quick walk home to get my husband, a short recess while he showered - and while things intensified rapidly - and we were back at the hospital, back in business. Within two hours or so, I had a dose of Nubain, a lovely shower, and a gorgeous baby girl. I also had a new thirst for the feeling of the birth of the shoulders, the sudden transition from baby in utero to baby on my chest, and the simple decadence of shifting the warmth of her presence through my own body. I know there are those who can describe these feelings more beautifully than I can; I wonder if (if anyone is reading along) you have felt this primal hunger.

I felt this same intense fulfillment with the birth of my second. The gentle pushing and easing of her shoulders and body through the birth canal, the act of bringing my slippery babe up to my chest and gazing into those eyes... cannot be described, only felt.

As a nurse-midwife, it's incredible to be able to recreate that feeling and to be share it with those who are experiencing it. The precious gifts that midwifery allows: glimpses of swatches of wet scalp, peeking through a bulging perineum... chubby cheeks gracing the world for the first time... the grasp of slippery, plump upper arms to gently guide new life into the world. Then - the pinnacle - a sudden sleek, sweet heft, caught and swiftly passed to joyous parents. That is a truly delicious delivery.


The second meaning of "A Delicious Delivery" is less poignant, and truthfully - I feel almost silly explaining it after going through the first meaning. Suffice it to say, I like to order out (a lot) when I'm working, and one of my all-time faves is tortellini alfredo from a nearby Italian pizza/pasta place. Well, recently, I ordered the "usual" and all of a sudden (about halfway through my bowl) that my tortellini bore a strong resemblance to rather atrophic, pale and discharge-laden cervices... perhaps yeasty? The only thing that would have completed the mental picture was if my fork was a duck-bill speculum...

Anyway, suffice it to say - I was done eating at that point (luckily - I had tiramasu to make up for it...) and haven't really felt any urge for tortellini since.

(I'd say that one was not quite as delicious of a delivery...)

Sunday, January 16, 2011

I'm scared to death.

Period. End of story.

I thought maybe if I said it (typed it?), it would make me feel better, or at least feel something different - but I am still scared sh*tless, to be perfectly frank. Within six short months (god willing), I'm going to complete my clinicals, work on passing comps, and take my boards. And then, I'll officially be able to call myself a midwife in front of clients - something I've been feeling for months now (or even longer).

And that, dear anyone-who-may-or-may-not-be... almost paralyzes me some days. I am a terrible, awful student. I procrastinate, I get distracted, I prioritize poorly. I don't know when exactly this happened - I used to rock in high school - but at some point over the past few years (maybe once my brain cells started being killed off by motherhood?), my attention span has decreased. Somehow my remaining brain cells get overloaded, and everything I have studied flies out the window - things that I know, that I can explain frontwards, backwards, and upside down. But when it comes to spitting them out for an exam, or off the top of my head for a professor, spur-of-the-moment? Hello, pee-in-my-pants-because-I-got-nothin'! Not. Good.

Don't get me wrong - I'm working on this. (I like to think that I'm smart enough to realize that I can't be successful and still have this HUGE crater in my path). I've talked to other students, I've had study groups. I've gone to counseling. I've got awesome support from the Warm One. Some of my family recognizes how hard this is (full time grad school + working 20ish hours a week + family), others don't... but that's all right. And, I've got the Bears. (More about the Bears later on)

So, most days, I can work through the fear, and I'm good. But. There are other days.

Like, the days when I realize that, holy shit, I need to basically learn (or at least very, very deeply review every SINGLE thing I have learned since starting grad school - not to mention a very good portion of what I learned in my associate's nursing program) in the next few months. Some days - when the Bears are closing in, and I've forgotten to avoid the crater in my path - I let myself get anxious and (again) horrified, realizing that I never really learned even the basics of anatomy and physiology. Autonomic nervous system? What's that do again? Tell me more about the parasympathetic stuff, again... Oh, f*@#!

And then there's meds - I learned them enough, for long enough, to get through at the time. (Or at least - again - that's what it feels like). What's a beta blocker for, again? Double f*@#.

The basis for EVERYTHING I have learned, and need to know, is built on an awful shaky foundation (at least in my own mind). I have been flying by the seat of my pants for the past five years, milking the "fake it till you make it" mantra for all it's worth... but something tells me that as a provider, that won't cut it.

Or, the days where I remember deliveries I've seen as a nurse: moms who come in, with no risk factors whatever. Spontaneous labor, or just something "not feeling right". Baby hasn't been moving as much as usual, a little bit of unusual discharge or bleeding, sharp pains... whatever it may be, or nothing at all. Perfectly normal pregnancies - and then, when the fetal heart tones are doppled or monitored --- a "bad baby" is seen immediately, a crash c-section is called, and a little boy or girl, pulled out a thick, dark meconium is worked on in a curtained nursery for a long, long time by nurses, doctors, respiratory therapists, and finally the NICU team that has flown in. Or, maybe it's a baby that looked fine throughout labor - a nice, normal, happy vaginal birth - and then with no warning, baby just doesn't transition after birth, needs help breathing, and help is an on-call doctor or an ambulance ride away (which, of course, seems like days and days with a baby that isn't breathing).

Or, the days when a baby is suddenly no longer there. Or is found to have an abnormality non-compatible with life. Or anything that will be very, very difficult to share with the parents. I am terrified that I won't have the words or the grace to share these moments with the families that need me to, the most...

Please, please, if anyone is out there and has been in this place (specifically or not), please tell me it passes...!


On "The Bears"

This is a technique that was shared with me during a counseling session when I was struggling especially hard with stress and anxiety (thanks, Dave - I hope you don't mind!). I am most certainly paraphrasing the technique, since I don't really remember how it was explained to me... so please 'bear' with me (groan!).

Setting: Wooded area surrounding a small clearing (perhaps a campsite?) with a campfire, simple block bench, etc
The Players: A handful of the Bears (these symbolize Stress/Anxiety/Fear - any negative or bothersome issues - I always picture them as cartoon characters similar to, maybe, "The Far Side" or something?) and You
(We enter the scene with You sitting on the crude bench near the campfire, maybe toasting marshmallows or a hot dog. Something's troubling you - fear? stress? anxiety? - and you realize that the shadows creeping up behind you are actually several large - albeit cartoonish - bears)

Don't Fight the bears - this will only encourage them to come back (and release adrenaline - the 'fight or flight' hormone - in you... leading to more bears --- and more stress/fear/anxiety) and... Don't feed the bears! (I.e. don't let yourself dwell on the anxiety/fear/stress/whatever's bugging you - that will also keep them coming - it also releases adrenaline) Just look 'em in the eye, say, "Hey bears, I see you there, you're right, I am stressed/freaked out/pissed/etc, and it's okay. I'm not going to feed you, and I'm not going to fight you. I'm just going to be."

It may sound silly -- but to me, it was very, very helpful. (And, in fact, as I typed this I realized how very little I've 'practiced' it lately - which can't be helping the topic of this posting.) On a side note, the ringer of my cell for a while was Mini #1 saying "Don' feed tha' bear!" - from the Adventures of Winnie the Pooh - for a year or so, which made this technique feel even more 'right' for me... every time I was getting myself worked up, her sweet little voice reminded me not to.