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: (click through the 16 images) (my favorite - make sure you view the full-screen version, with your sound on...)


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.

Tuesday, March 1, 2011

So This Is It... (Or, "The Medwife")

This is my last week with the Midwife. This is bittersweet; of course, there is some relief - the last few weeks have been incredibly stressful and long. But, I will also miss the many beautiful clients I have grown relationships with, as well as several of the nurses and other staff members I have met along the way.

In the end, there is no way around it. The Midwife and I are just too different. You could say she's more XBOX and I'm more Atari... In some ways, I hope that some day I gain some of the Midwife's qualities - she is prompt, she can answer any patient questions without a stumble, and she is assertive. On the other hand, I need to be true to myself and the true heart of midwifery. I will never be an "aggressive" person, nor an aggressive midwife; I will continue to look tired for a few years yet, at least through I adjust to this midwifery gig and my kids catch on to letting me sleep at night (seriously, Mini's --- you're 2.5 and 4.5... get it?!). I will never be someone who appears at events, and the office, an hour before I need to be there. I try to do too much with my time, end up misjudging the clock and how fast I can get to point A from point B, and wind up running a few minutes behind. These are things I have accepted and will continue to work on - but can't change overnight.

The Midwife is, in essence, a "Medwife". She practices with a group of OB-GYN's, she has never practiced outside of a high-risk setting, and she views birth as an occurrence that is one step away from disaster. While I recognize and respect that even in the most normal, low-key labor and birth, something can always go wrong; (I think) I have a healthy dose of the "what if's", especially for those labors that are going smoothly... I am afraid to be lulled. I don't think either perspective is right or wrong, just different.

Will I offer elective induction to my patients at 39 weeks? Probably not. Do I see where the Midwife is coming from, when she gives that option to her patients? Sure. Does it work for her, and for the majority of her patients? Yes, it seems to. Do I agree with her statements after some of these births, that "It's a good thing we induced now rather than waiting because..."? Not always, but that's not my place to argue. If mom and baby are happy and healthy, and were given the choice to make the decision - with full informed consent - I can't, as a student, jump in and point out potential flaws to that logic. As a "green" CNM, fresh-eyed and optimistic - with my views on birth and outcomes unblemished by malpractice insurance, peer reviews, and "bad" babies (or a history in high-risk OB), I still lean more towards the hopes that by giving good care, thorough information and honest explanation of risks and benefits - rather than practicing "defensive medwifery" - the relationships I cultivate with my clients will be close and trusting. (Do I think some of these perspectives will change - probably within the very first year or even months that I am practicing? You bet. The Midwife does what she does, for a reason. But... maybe not. Another good reason that another site, a different site, seeing a different population - might be helpful.)

Because with labor and birth, honestly --- who knows? The most wonderful looking baby on the EFM can come out floppy and blue, needing a full resuscitation, while the baby who looked miserable for the longest time, with a short and scrawny cord comes out wailing and pink. The 9-pound chunker of a primip delivers easily, without a scratch - while the G2P1's barely-seven-pounder gets hung up on the shoulders (unlike the larger older sibling a few years before). A common disclaimer in obstetrics: "We just don't know": a simple way to explain that so often babies are doing their own things, and our bodies - which are made to carry and nurture those babies - will instinctively protect those babies... but also a smooth segueway into a conversation encouraging (with different levels of "encouragement") various interventions that may or may not be truly necessary.

The mystery, and beauty, of birth is that every baby writes his or her own story; as midwives (and nurses, and doctors, and doulas, and mamas and daddies), we are just along for the ride, wild as it may be.