Saturday, January 29, 2011

Home is where the heart is...

Sometimes the questions are complicated and the answers are simple. ~Dr Seuss


A few days ago I posted about my wandering mind, and doing home births (or avoiding them and instead cowering in the "safety" of the hospital/birth center setting... however backward that may be). A reader commented on this - the irony that for many women, birthing in the hospital setting is scarier than in the privacy and protection of their homes, away from the germs and interventions housed in the walls of most care facilities. On the flip side, many other women would be terrified of delivering without the comfort they feel is provided by having doctors, nurses, and technology close at hand.

Personally, as an OB nurse and almost-nurse midwife - I LOVE homebirths, and think that for the majority of women (basically, meaning a healthy mom and healthy baby), attended by an
experienced, qualified attendant (whether a nurse-midwife or certified/licensed midwife, etc), they are as safe 0r - in many cases - possibly safer than hospital births. As any midwife (or woman who has birthed at home or attended a homebirth) would attest, for couples who are 100% on-board with home birth - preparing throughout the pregnancy with that mindset, remaining relaxed and positive, as well as hanging out in that mythical "low risk" category - the energy present as a baby meets his or her loved ones for the first time, uninterrupted by routine medical tasks, is indescribable. Relationships are strengthened, bonds are cemented, and a deep sense of family is forever rooted by the experience.

But.... on the other hand.

I am not an experienced nurse-midwife. Yet. The fear that I carry comes from that little detail. I worry that I don't have quite enough critical thinking; nearly enough attention to the little things; the right amount of intuition. The catch-22 of working on the L&D unit is that a person gains an unhealthy sort of dependence on fetal monitors, lab tests, and the proximity of "just in case" scenarios; while it's great to have the collective knowledge of scores of other nurses and
providers (many of whom revere the sacredness of natural birth), it becomes increasingly more difficult to see the clarity of birth
through the fog that is the medical model's view of pregnancy and birth as an accident waiting to go wrong.

This fog is still pretty thick throughout my mind, body, and being. Wisp by wisp, it seems to be clearing - but it will certainly be a gradual process. With each normal, natural birth - devoid of "routine" (read: unnecessary, "provider convenience" or "just-because-because-we-always-do-it") interventions, I feel closer to the births that nature creates.

Will I ever perform home births? I think so... I hope so... When this fog clears, I think that question may be a much less complicated one than it seems right now.
I recently met a first-time mother; she was young, and labor started spontaneously right around 37 or 38 weeks. She had great support from her female family members, although the father of the baby wasn't involved. She progressed wonderfully throughout labor, working with her body and changing positions without directions or suggestions from anyone else; sitting, side-to-side, up to the toilet - she did everything, as her body told her. Other than the minimal monitoring necessitated by protocol (ugh), she was free from monitor belts and IV's (though she did receive 30 minutes of IV antibiotics for a positive antipartum GBS screen). Per her choice she did receive a bit of IV narcotic, but - and this is just my opinion, so please take it with a grain of salt :) ! - I think had she been a little more prepared and a wee bit less scared of the process, she would have sailed through labor just as easily without anything. (Either way, it was, of course, her choice.) Soon she ruptured her bag of waters, rapidly progressed to complete dilation, and spontaneously began pushing in a hands-and-knees position - and delivered a beautiful, radiant baby girl in that same position. No one told her to flip over to her back and yank her legs back (not even the male physician who happened to be nearby and called into the room as she precipitously delivered); no one counted to '10' and directed her to push hard to the point that blood vessels would burst; instead, she was encouraged with cool washcloths, soft words between pushes and cheering during them.

It wasn't a home birth; not by any means. After birth, the cord was clamped fairly quickly, and baby was taken to the warmer to be "dried off" - which led to at least a 30 minute delay in mom/baby snuggling. (The reason? Besides the obvious inconvenience of mom being in the hands/knees position - something that could be remedied rather quickly! - the amniotic fluid had shown itself to be mixed with a fair amount of thin meconium, and baby was mec stained.) So - although babe was quite vigorous - screaming her little head off! - she was across the room getting toasty while mom was birthing the placenta, receiving a few stitches, and being cleaned up. While mama didn't mind - I did (once I had a chance to realize how much time had passed).

But, on the other hand, it was a very, very sweet birth. Home birthers may read this story and think, "My god! How awful that the baby wasn't in that mom's arms!" or wonder about the fact that mama got Nubain... or antibiotics... Other women might wonder why in the world she didn't get an epidural right away. Some women are more than happy to have their babies "cleaned up" (just my opinion again, of course -- but how dirty are they, really?!) before they get that first really good snuggle in... and some are in no rush for a bath.

The important thing was that mama was happy with her birth experience - in that beautiful post-birth euphoria, she glowed when she talked about her day. She had a gorgeous, healthy daughter, and she felt wonderful.


... and the fog just cleared a little more.

Thursday, January 27, 2011

When my mind wanders, this is where it goes...

Today I had lunch with a great friend. We don't do it often enough... and we really, really should do it more often. Hmmm... how to 'dub' this friend? She is full of awesomeness, a truly free spirit, a little bit flighty (like all free spirits should be), and just all-around fun, fun, fun. Let's call her, simply... Friend.

Friend and I have worked together for years... I was a new nurse, and she was the "seasoned" nurse (albeit, still a newer nurse --- but, she had a few years on me, so it all worked out!). She had a little guy who was a year or so older than my oldest Mini, and it seemed as we always had some common interests. Over the years - and many snacks, deliveries, and desserts - I like to think we've become pretty good friends.

(I'll interrupt myself here to say that I don't really have many close friends... or maybe I do. I don't know... what is a 'friend', really?? I think in the past year or two, this has changed a lot... I don't know. Anyway, where were we?!)

So, moving on. Friend and I are both moving towards the common goal of midwifery, but via different paths. While I am pursuing a degree in nurse-midwifery (CNM), Friend is going a slightly different route to earn a Certified Professional Midwife license. Basically - from my understanding (and I would love to be further educated, so please let me know if I have this wrong!) - Friend is learning from "the best", a very well-known and well-respected CPM or "lay" midwife in the area. This midwife has been doing births in our area for the past 30 years, and has welcomed hundreds (if not more) of healthy, beautiful lives into this world in the warmth and love of their own homes. She is active in the midwifery community and - I can only imagine - a wonderful source of perspective and learning for Friend. So while my education is coming from a variety of sources, primarily distance-based (online) until my clinical rotation finally started a few months ago... Friend has been immersed in midwifery since deciding to take the leap into apprenticeship.

There's pro's and con's, certainly, to each method. She's been able to attend births as a midwife - and get her hands (and her brain) - on those delicious, slippery babes from the beginning; I have had to wait until getting successfully past all of the theory behind the birthing. I've had a large community of support from fellow classmates and those who've come before me via my school's online forums; Friend has been cocooned in the intimate circle of the two CPMs that she has been apprenticing with. Friend's coursework is self-paced, whereas my program has traditional terms - with equally traditional (and stressful) deadlines, midterms, and headaches.

Our paths will also determine our future course (as is so often true). As a certified nurse-midwife, I will be - in theory - eligible to deliver clients in a hospital, birth center, or home setting; in my state, though, over 90% of CNMs attend patients in the hospital setting. Friend, however, will be limited to seeing clients in out-of-hospital settings (at least in our state).

This is where my mind starts to wander... I don't know that I am courageous enough to catch out-of-hospital births (that's a topic for another day) - but I like to think that someday I may be. When my mind wanders, though, I think about a modest clinic site offering prenatal and well-woman care, just outside of 'town' (our small town is around pop. 8500); a few exam rooms, a space for education, perhaps room to have a lovely display to sell some "nice" stuff that the kind of mamas that might seek out a midwife may be interested in - cloth diapers, breastfeeding supplies, etc. We could offer childbirth classes, breastfeeding support groups, and - possibly? - one or two birth suites adjacent to the main space; while (in my wandering self) I imagine most women opting for hospital births, Friend would also be available to attend home births, and the birth suites would be available for a birth center birth.

I don't know the logistics of any of this. I have no clue on the feasibility of it. In all honesty, it really is just a mind-fantasy, but such a sweet one. I don't know if Friend would seriously consider "joining the fun" - in the past, we have joked about starting such a venture... but how much was seriousness, and how much was jest is hard to say.

If nothing else... this all gives me a nice bit of something to start with for a lovely, 60-odd page paper that I need to write (and have yet to even start thinking about, by the way) this term, so that I can graduate this spring. Happy trails, on that happy note!

Tuesday, January 25, 2011

Sorry I missed you...

... babe whose heart rate kept dipping precariously with each push, and then became more and more sluggish.

... baby girl, with shoulders that insisted on coming down together, rather than one at a time.

... you, sweet little baby boy, with your funky heart rate tracing throughout labor (but always reassuring variability) - and then sudden easement into the world, while I ran to hunt for a second catheter kit.

... little boy, cord around your neck so snug, with your exposed head darkening as your mama worked so hard to birth the rest of your self.

... baby, sweet, baby, when your mama's water finally broke (after all of those bouts of pre-term labor); instead of being there to meet you, I was snug in my bed, oblivious to the call from the Midwife that you were ready.

To each baby and mama that I've missed
- by fault or by circumstance -
I'm happy that you were in the caring hands of the Midwife...
I only (selfishly) wish that you had been in mine as well.

Monday, January 24, 2011

I'll get you, my pretty... and your sneaky little cervix, too!

For those of you who aren't in the Midwifery/Nurse Practitioner/Medical-kind of fields, I'm going to lay this out there straight - cervixes (cervices? cervix-i? your cervix, and mine, and many others...?!) are tricky little buggers. Oh, sure, sure, sometimes they can be sweet and innocent and just pop right out at whoever may be doing your annual pap-n-pelvic ("BAM!" says your little cervical os... "Nice to meet you, take what you need!"). But, on other occasions - not so much.

Especially, I'm sure - as is Murphy's Law (or possibly Murray's law?) - when the one wielding the speculum is just a wee bit less confident than an NP or MD - or CNM - who may have been searching high and low for the small orbs for years and years. For example, a student nurse-midwife, early in her clinical hours (or, an FNP student, or even a SANE examiner, etc, etc).

Now, as a "good girl" - read that as, "guideline-fearing woman who gets a reminder letter in the mail and promptly grins and bears it"- I have had my share of annual gynecological exams. Honestly, girls... I know, they aren't fun, but really - I've had two kids now, so, I can't complain so much about a silly little plastic (or metal? Is it funny that I can't honestly say what my provider uses? I think it is, a little!) thingamabobber being inserted to allow for one spatula and one brush to gather a few simple cells from my cervix. You live, you learn - and you get scraped. Right?

That being said, I don't necessarily enjoy it when women know that I'm coming at them - as a student nurse midwife (gasp) - with a big, scary metal doodad. (That is, a "speculum"... go ahead, try it! And to tell the truth, the metal ones have really grown on me --- they are nice and warm, they don't 'click' -- eww, right? no one likes the 'click' -- and they don't snag or pinch like the plastic. Anyway, a different topic, for a different day. Back on track...) I know that I don't have the same finesse as the Midwife, and of course so do they. I am immensely grateful to each and every woman who has accepted me for this (by the way, for the few who I have visited with during their exams and mentioned they are nursing/NP students --- my offer still stands and my vagina/cervix are yours for pap/pelvic practice as needed), and I promise that my skills will become gentler and softer as time passes. Wait, wait! Back to the cervix.

(See?! Even NOW, when I'm simply trying to blog about the darn thing, it's avoiding me... what a knack it has!)

I've always thought of the cervix as a nice, perfectly smooth circle; the opening to the uterus. In labor, I know, it gradually opens to eventually - or at least hopefully, and in most cases - allow the baby to birth. It also dilates a slight amount each month around the time of the menses to allow for the shedding of the uterine lining.

All right. Got that. In my mind, when I imagined a cervix - prior to really beginning my SNM clinicals (and the whole tortellini alfredo scene, mind you) - I pictured a perfect, cherry-red LifeSaver. (Minus the "Life-Saver" imprint, I suppose - although that would add a certain comic charm to the whole thing...) The one or two cervices - there we go with that word again, darn plural terms - that I had peeked at throughout my time as an L&D nurse (every now and again we would be expected to do a speculum exam to check for pooled fluid around the cervix, or to do a swab near it to check for leaking amniotic fluid, etc, etc) seemed to cement that image. And, I got no real argument from the DVDs I popped in during childbirth prep classes that I taught, so.... everything seemed right in my little world!

Until, that is, I started with the Midwife.

And realized that cervices (cervixes? cervixi?) come in 103 different sizes, shapes, consistences, and colors. AND they hide. They love to play hide and seek! Who knew?! Up and around, underneath, way over to that corner there.... so many places, and such little area to maneuver the speculum. (And it didn't help that I was focused on looking for that little red Lifesaver for the first two weeks.) Flopsy, firm, red, white, pink, big, little, deep and shallow, innies and outies - I've seen 'em all, and I've barely just begun! I've seen cute, petite little cervices and some that I could care to forget, to tell you the truth. (Not really, I made that last part up --- a cervix really is just a cervix. Do you think a person would really "like" or dislike a cervix? Come on, now!) Sometimes, I've learned, I can play a little game of my own... when the little tricksters are hiding, they leave a little trail of blood and this can be followed; busted!

Now, the Midwife and I are still working on this, of course. We have a ways to go, but I think I'm getting there. I'm 3 for 3 on my last batch of exams, which if nothing else gets me excited. I've caught on to lower the stool right away. I finally figured out how to maneuver the spec with my left hand (not easy for me, at all!) and collect my swabs with my right. My brain and my hands are still playing a little quasi-queasy about how to make the motions that the Midwife explains and demonstrates on scooping and "flipping" the cervix into place. But - I think I'm getting there.

A shout-out for some sweet creativity...

This is a shameless post to thank some folks who are amazingly more creative than I am (thank goodness). As part of my clinical requirements, I need to have a certain number of "continuity" clients - ones that I follow throughout their prenatal course, welcome their baby, and then visit after the birth.

Now, the last part is the part that has bothered me ever since I found out about this requirement. Home visits themselves don't scare me; I've been doing them as a maternal/child health nurse; no sweat! But the thought of basically inviting myself into the homes of these mothers because I need to (not because it is specifically a part of their standard care regimen) - well, that seems awkward to me. The same part of me that feels like I've been imposing on them by being a student "outsider" all along doesn't want to intrude on their home as they are adjusting to new parenthood; I tell all my new moms (as a nurse and as a SNM), "No visitors unless they bring meals or plan to do some housework or laundry for you!". New babies = not having to have a spotless house or put on makeup or entertain company. I worry that if I ask to come visit, that is exactly what these new mama's (and papa's) will feel obligated - consciously or not - to do.

I'm crossing my fingers, of course, that they won't feel this way, and honestly - I don't think it really will be so bad at all. I have a few couples in mind - they are lovely, and we have great rapport. (In fact, I think I will call one of them tomorrow morning to see if I can stop in and say hello!) Buuuuttt..... just to soothe my own silly self, I decided that bringing a little something - totally not indicated by the requirements (and not something that I will use as a a bribe when asking if I can stop by!) - to thank mama and babe both for letting me share in their intimate journey in the first place, and then for allowing me to have another peek into their precious first few days at home. So, I asked the freakishly fantastic folks on (check out the "Alchemy" tab) to help me come up with the perfect, sweet little - but yet inexpensive, for my poor student budget! - somethings... here's what I found:

Thanks to Corrine & Kelly at Nesting Project ( for designing these *spectacular* and funky onesies for 'my' babes, who will no doubt wear them with pride. Soon I will (hopefully) post pictures of the fuzzy, soft little beanies and cozy little earflap hats that a few other Etsians - JadedFlower (, I Crochet Creations (, Precious Elaine (, and My Friend Ginger ( all were excellent to work with and made the sweetest little baby head-warmers you could imagine for me --- thank you to them! I will try to get some pics up!

Sunday, January 23, 2011

On Blogging

This is a little off-topic, but worth the keystrokes. In the past week or so, I have been amazed at the wealth of perspectives out there via blogs and sites dedicated to birth and women's reproductive rights! (If you hadn't noticed, I've lagged a bit on this whole networking thing - it's about time that I caught up, eh?!) The whole blog-roll thing, where you can "add" your favorite blogs and see when they add a new post, right on your own page? Genius! And - even better - the blog rolls on those blogs, which lets you peek (and piggyback onto) at other awesome, relevant blogs, since oftentimes you have similar interests.

Yesterday, I was fascinated reading about anterior lips (really, they aren't so bad at all!) on Midwife Thinking's blog (read it here... please! I'm so glad I did, especially since we had a persistent, stubborn one last night - long story, I couldn't "help" with it, but... I so wanted to after reading this blog!)

I also was sucked into Stand and Deliver's blog. (It started off innocently enough with a journey into some relief measures for sinus troubles - hello, Neti pot!) but then I clicked on an older post - "Birth Around the World, My Alien Baby" is a title that kind of grabs your eye, I guess" ( and was hooked. A great birth story shared by one of Stand and Deliver's blog readers, it was the reader's own birth (her mother birthed her in Azerbaijan) and then the story of her own daughter (which, of course, didn't go exactly as planned). Beautiful writing, and a poignant message. Today's posting ( was similarly heart-hitting - another in her "Birth Around the World" series... I'm loving them, and the perspective they provide those of us just starting out and feeling like we are sheltered in the "same old, same old."

And, of course, there are the "thank god for you!" bloggers -- the ones that I know are right there with me. The student-midwives (or students in general), or new nurse-midwives, who are starting to feel their way through the paths of being "with woman". When so much rests in your hands, it's so comforting to know that there are others out there feeling the same things (a little anxiety, a bit of fear, much joy, love, excitement, trepidation, confusion, and all of the other feelings in the spectrum from here to there) on a daily - and hourly - basis. Life of a Student-Nurse Midwife, With Woman The First Year, Rainbows and Pony Rides, At Your Cervix, and all of the others that I hope to find as time goes on... this ones for us!