Monday, April 1, 2013

two minutes

two minutes 

Two minutes is nothing - a wait in the drive-thru line, a skim through an email inbox, the tidying of an unkempt living room (my life with two schoolage kids). A phone call with an expectant woman. The time between two contractions in hard labor.

And yet, two minutes can stretch into eternity; when you have to pee, and the person in the stall is (apparently) spending her jolly-good time methodically counting out the toilet paper squares into a prime number equal to or greater than 167. When it's *almost* time to leave work - but not quite. When it's just about bedtime, and someone, for some strange reason, taught your offspring how to tell time (leaving no chance of tricking --- um, convincing --- them that it really, TRULY is 8 p.m.).


Any midwife, nurse, doula, birthing woman, goddess with a vague idea of the birthing process may have had an involuntary squeeze in the region of their kegels right there (sorry for any men that might have stumbled upon this particular post --- not sure what kind of physical response will be manifested there!). Shoulder dystocia --- or "shoulders" in the lay terms (that is, talk-fast-because-there-is-no-time-for-the-extra-three-syllables-dammit-get-the-stool-and-get-ready-for-suprapubic-pressure-NOW!!!") is one of the most terrifying, unpredictable, ready-or-not-here-I-come complications that may occur during childbirth. Sometimes you can get an inkling that shoulder dystocia may occur --- moms who have had previous deliveries with the complication, babies that are 'known' (* I could argue this "point" on and on, but we'll just leave it!) to be large, whether from serial ultrasounds or hands-on measuring, suspected pelvic anomalies, funky labor patterns --- but in the vast majority of cases, it's not until the bitter "oh meconium!" (midwife joke - hahahaha. sorry...!) moment that you realize just how deep things are going to get.

Backing up a tad, a quick refresher on shoulder dystocia. If you know all of this, go ahead and fast forward through this part. It's a bone-on-bone issue; while the first instinct one may have may be to cut a big ole episiotomy, few shoulder dystocias will be resolved by this. (The only benefit of slicing the vaginal tissue is to allow theoretical "roominess" in an otherwise snug tight area... more on this soon.) So what happens in a shoulder dystocia, for heaven's sake, if it can't be fixed with a big scissors and blood gushing everywhere?!

(Sorry if that sounded overdramatic... I imagined crazed readers, confused with the thought that a 'pis could fix everything, wildly glancing around at each other trying to figure out what the heck was going on here. I may have illusions of grandeur going on here. Also, there are a few people who could attest that though there was no snipping or clipping at any shoulder dystocias I have presided over... they still end up looking like massacres. In fact, all of the births I attend seem to resemble the Battle of 1812 for some reason. Let's pretend it's my own small rebellion at the outdated hospital curtains and furnishings, and little by little, I WILL get them all replaced...)

 Anyway. Woman labors, baby progresses through the cardinal movements (if you aren't familiar with these, I encourage you to do what any sane person would do and google that #&*%! In particular, look for some of the great videos out there, as well as the sites verbally outlining the process. I LOVE the Spinning Babies website - - both in general and for their nice description of the 7 cardinal movements). So, in a nutshell, the baby has to do some funky dance moves during labor and delivery, and so does mama*. Things tend to go okay if both partners are dancing together and to the same music, but if someone's hearing salsa music and the other is into those love ballads I associate with my junior high dances and sequined, cheesy dresses (think "Stairway to Heaven" with a rapid latino underbeat), things aren't going to work as smoothly as you'd like. In this awful analogy, the love-ballad may be a mom who's not coping with the intensity of contractions, or is *too* relaxed with an epidural on board, or whose uterus is putting out wimpy little contractions for whatever reason (an effort to induce before her due date, or what-have-you). So the dance is on, but it -again, oddly reminiscent of that 8th grade homecoming dance - looks like the short kid with pimples and the gawky, tall girl with braces trying to slow dance to "Mambo No. 5". Then, on top of everything you could have a pair of left feet (does it matter if they're mine? Does it? Does it!?! Oh, wait... Back to the present....) --- or a less-than-ideally-designed-pelvis (did you know there are four basic pelvic types, with each one possibly predisposing babe to "fit" a different way? True story.), and things really get fun. Or not fun, depending on your sense of humor.

So, anyway, the dance is on. If you're rockin' out with a first time mama, the first movement (engagement) could happen days or weeks before labor ever kicks in; with moms who've been to the dance before, it might not happen until somewhere after the punch and crackers are served. Not too big of a deal either way, except Mama will need to find the bathroom more often once it happens, so be ready. From then on out, the dance starts to resemble more of a tuck-and-roll kind of craze; the babe needs to curl up in a snug little baby roly-poly bug (but cuter and covered in amniotic fluid yet), chin to chest - this is known as flexion; next the snug little bug head continues pressing down on the vaginal floor (descent) while rotating into the ideal position to pass through the pelvis (internal rotation). Once through the pelvic arch, the babe's neck extends (appropriately called extension!) and within moments her body rotates - or "restitutes" - to face either maternal side (rather than face down as her face had delivered), allowing first one and then the other shoulder, followed by the rest of her lovely body, to slide under the pubic bone (expulsion). Beautiful! Angels sing! The Macarena plays, everyone dances in unison, arms undulating, baby crying but doing so rhythmically to the music. A successful, textbook birth!

Except when it isn't, of course. Sometimes, for whatever reason (see that bad-dance analogy above...) some of us are tone-deaf in relation to music itself, some of us unfortunately get set up for bad labor/delivery/birth experiences, some of us are blessed to be "lucky" when it comes to baby-birthin' - and (I'm a firm believer in this) some of us are just not quite as lucky. For anyone who gets set up with a bad mix of techno and 1970's country, it can get messy fast in the birthing room. Many times labor will progress veeerrrrrrrrry sllloooowwwwwwwly - but not always. Same thing for pushing - it might take hours and hours and hoooours - but not always. Usually it will be a first time mom - but definitely not always! Sometimes after the delivery of a squashed little eggplant head, it will appear to be sucked back in (the ominous "turtle sign") - but not always.

Once in a while, it seems the baby gets messed up in his dance steps somewhere. Maybe that extra "left" shoe of a pelvis coaxes him into rotating before he descends fully, or somewhere along the line something (toss in whatever you can come up with here ---- history of childhood sexual abuse? chronic low back pain? anesthesiologist who is "on the floor but ready to go home now, so if there's any laboring women who want an epidural, now is the time, and I don't care if she's only 2 cm!"? artificially-strong pitocin-augmented contractions for SROM for 24+hours sans any symptoms of infection? etc) led his mama to get an epidural rather early along the line, leading to weaker-than-expected contractions that needed to be kickstarted again after the anesthesiologist left. Wimpy uterus, lax lower abdominal and pelvic floor muscles = no resistance to encourage flexion.... ? Someone encouraging mama to push too soon ("Oh! You're 10 cm and you don't feel a thing? Let's get you pushing!") or staving off the urge to push ("No no no! Oh no you don't ---- you can't deliver here, not without Dr. so-and-so, what if you had a bay-yuh-bee?!?!") for too long?

Once you have a baby head, and no sign of shoulders emerging --- you have trouble. You call for reinforcements - as many nurses as can roll into the room (something akin to the clowns trying to fit into the tiny car, only with fewer airhorns and absolutely zero humor), your back-up provider, a stool, a pediatric/NICU team if you're lucky - and jump into the HELPERR mode. Believe it or not, this does not mean looks at your helpers and then run like crazy from the room --- but rather calmly and systematically roll through a series of steps meant to (hopefully) dislodge one-to-two sticky little shoulders from one stubborn little pelvic ridge.  After getting that extra help, think about that episiotomy (what the whaaa?), legs waaaaay back, and ask a nurse to nudge babe's shoulder from the outside; if still no-go, you have to take things to the inside (which is where the episiotomy may come in handy - the vaginal opening is only so large, and in order to introduce the bulk of your hands into it, along with sufficient room to work with the fetal body.... you may need a bit of extra space. May.), and/or try to slip the posterior arm out. For some reason, many sources list "reposition" as one of the last "R's" in the handy-HELPERR mnemonic --- even though this can often open the pelvic diameters sufficiently to allow the babe to pass without the use of the  more invasive measures, and even women with epidurals (depending on the depth of the anesthetic block) can many times do this with assistance. Anyway. As an afterthought - and I hope that it rarely, rarely happens - mnemonics usually list "replace"... as in, try to hit the "rewind" button and get the baby's head back through the vagina and cervix, and rush to an emergency (like the ultimate, beyond-emergency-emergency) cesarean.

I've got no good answers, and suppose I've rambled on far too long, and far too far from the original point of this post. Suffice it to say, shoulder dystocia is (a) need-a-bath-and-a-good-stiff-drink (except you'll probably still be on-call, so good luck with that) scary, (b) thank the heavens/god/creator/karma/blogspot/nursing directors for nursing staff trained to jump in like they do it *every* day and be amazing when it happens (as well as to switch out non-scrubbable furnishings like nobody's business), and (c) watch out for those sneaky, rotten little roly-poly babes and their shoulders; they'll get you every time! Thankfully - the majority of shoulder dystocias - when handled appropriately (which includes the provider staying cool and calm -*not* anywhere reminiscent of my prepubscent dances - and great teamwork, communication, and dedication) end with a healthy, albeit crying little pink bug (and midwife). What more could you want?

*warning: bad analogy ahead 

**Genetics, biology/anthropology, diet/exercise, knowledge, mind-over-matter, all of these or none of them, whatever - but I do believe that some of us just are "luckier" when it comes to birthing. That being said, those of us who care for birthing women have the largest responsibility in ensuring that we do all that we can to level the playing field --- avoiding unnecessary inductions, minimizing interventions, providing the education and support that's not there.

Monday, March 11, 2013

what the what, Hudson?!

Please see Stand and Deliver's recent blog post ( regarding new restrictive policies at Hudson Hospital in Hudson, WI. In a nutshell, the hospital is severely restricting the practice of its birthing staff, specifically mandating cesarean birth for all breech presentations (which were previously able to be delivered by a provider with many years of experinece in vaginal breech birth), as well clamping down on VBACs, waterbirths, etc. Below is the letter I'm sending out tomorrow in response to the new policy --- won't you join as well? (Also, please note that Rixa at Stand & Deliver is having a giveaway to thank those who join the campaign advocating for the women who delivery at Hudson --- join in!!) "Dear Ms. Hegelberg, I am writing to you in regards to the recent policy change in relation to birth practices at Hudson Hospital. As a certified nurse-midwife providing care to women throughout the lifespan, I am deeply saddened to learn of the new stance being taken by the leadership and administration at your facility, specifically as it relates to the withholding of informed consent to women during childbirth. According to Hudson Hospital's own "Patients Rights and Responsibilities", provided to each patient upon entrance into the care system, your patients are assured the right to be informed of care options, treatment plans, and alternatives; similarly, the document ensures patients they will be given the opportunity to consent to any procedure prior to its undertaking, as well as the right to refuse any treatment with informed consent. According to the newly released policy, the practice of employing medical interventions is a national standard, and implementing this will allow Hudson Hospital to become consistent with other regional and national centers; yet I am aware of no other facility which denies a patient the legal right to refuse any treatment which he or she deems unnecessary or inappropriate after receiving informed consent. Please recognize, Ms. Hegelberg, that this is a legal and moral right of all competent, informed individuals, and denying it would appear to be treading on a very fine ethical boundary. The announcement that Hudson hospital will be forcing medical interventions on women and infants, regardless of their informed consent or screams of refusal, is unacceptable. As a healthcare provider, I recognize the increasing pressure on providers to perform flawlessly and prevent any errors; I have heard far too many lectures on risk management "from leadership's point of view". Whether these measures are being initiated following increasing insurance rates, in an effort to increase reimbursement rates, or to avoid hypothetical bad outcomes (which according to multiple research articles are much more likely with surgical birth) - they are directly in contrast with Hudson Hospital's purported commitment to providing "excellent patient outcomes". I urge you, and the rest of the board, to reconsider this ban on vaginal breech births, increased restrictions on water births, and forced interventions. Should these restrictions stand, I strongly consider you to make all changes publicly known to the women who have utilized your facility in the past; relying on your obstetrical providers to relay this information to the women and families who will be most affected by these alterations (and who may be most likely to change their birthplace as a result) is neither fair nor appropriate. With respect for the birthing practices that have made Hudson Hospital a supportive, welcoming haven in the past, I will await your reply in the days to come. In the meantime. I will recommend other facilities (including those who support vaginal breech birth, particularly with the experienced hands of skilled providers as recommended by the 2006 American College of Obstetricians and Gynecologists statement on the practice) to area women. Sincerely, {{me}}


A recent CNN article demonized a Pennsylvania doctor who is accused of providing abortions to women in what are described as incredibly filthy, dangerous, deplorable conditions ( Records show that the terminations occurred well after the legal cut-off for abortion, and that the man and his staff repeatedly manipulated records and communication with clients to portray pregnancies as being within the legal allowable limits. Without going into the more gruesome, heartwrenching accusations of the story - nor the spectrum of sociopolitical questions that it raises - I have to admit that I got caught up in the "comments" section of the article. (A bad habit of mine --- trying to defend what I see as the under-defended, unheard, unspoken --- and getting riled up by the trolls who exist simply to do just that online, it seems!)

One comment that particular irked me came in response to a comment I made which offered some defense of the women who may have sought this man's supposed "care" (I use the word lightly --- as much as I wish to presume his innocence until court proceedings are complete... the mama/baby lover in me is broken up reading and hearing the stories of the women who survived procedures at this clinic). In the midst of hundreds of comments calling for the women who had been victimized to be charged with murder, I related that for many women, an unintended pregnancy is not just a momentary emergency or stress that can be more or less resolved once the shock has passed, and resources found, support gathered; I posted details that had been published in several news outlets previously (the story had broken over a year earlier) to clarify that many of the women had been deceived into thinking they were much earlier into their pregnancies, and that several related stories of being forced against their will into completing the procedure after having second thoughts.

Following this plea for understanding and empathy, another commentator argued (repeatedly) that "the idea of 'unintended pregnancy' is the most ridiculous thing I have ever heard" (or something similar - I cannot pull up the actual thread today). This particular person's feeling was that by engaging in sex, the woman was asking for pregnancy and therefore responsible for the intention of it when the pregnancy did occur. And, as with any argument - there was no negotiation. According to my newest friend, the purpose of intercourse is solely procreation; sex = babies, and for any woman to deny that fact - or to deny the product of the act, specifically, by seeking an abortion, is absurd. If you're having sex, suck it up and have the baby, apparently.

Clearly, contraception may be a moot point for this fellow (for the sake of convenience I will imagine this poster was a male, although it may have just as easily been a woman of course). The argument that women who take EVERY single precaution to avoid pregnancy can still become pregnant was irrelevant. You know, like the woman who is taking oral contraceptives (which are supposed to be 95%+ effective --- so pretty darn good --- and doesn't miss a single one) and still ends up missing her period, and ... surprise!! Or, the couple who religiously uses a condom every single time they have sex --- but apparently there is a failure... surprise!!! Or... the mom who has an IUD placed (the one that is 99% effective...) yet still ends up with you-know-what ... surprise!!! Or --- these are always my (not) favorite --- the mother who *just* gave birth, is coming back to the clinic in two weeks for her first postpartum checkup to discuss contraception (and was under strict instructions not to have anything near her vagina until then for several reasons, including but not limited to increased fertility) --- but who is pressured (or forced?) into sex within a few days of birth... surprise!!

And that doesn't even go into the *unusual* cases --- you know, the incest cases, the rapes, the pregnancies which result from forced prostitution or that risk a mother's life...

What would a "surprise!" be in your life? Ten years ago, it would have been --- a surprise, all right! The Warm One and I wouldn't have been married, but I imagine we would've figured it out. Our families may have been a bit disappointed, but as with most families I think a baby can be enveloped with love and understanding --- especially given that (at that point) we had been together several years, well into our college educations, and stable for the most part. A struggle - but okay. Five years ago? Well, five-ish, years ago, anyway --- the Mini-ist would have just been born... the surprise would have been completely overwhelming. I was deeply buried in the shadows of postpartum depression, begging my provider for help and barely mentally/emotionally/spiritually alive. The presence of another life - even the glimpse of that thought in the year ahead - may have been enough to topple me over the precarious edge that I teetered on. Today? A surprise would test us, again, in many similar ways; the fear of coming to that same cliff, pulling the Warm One and the Mini's along (much less another blessed life) terrifies me.

Yet, if my 99.8% effective contraceptive method failed, and our path in life led to these hypothetical crossroads? We'd deal, I think. The same comforting thoughts that come to me picturing that surprise 10 years ago kick in --- family, the Warm One, faith in "what will be, will be..." Somehow, I think, a child would be loved. My sister and her girlfriend? My brother and his wife? Here, with us, to affirm my own faith in my body and mind --- that I am not broken, that I can be a mother even in those first hard weeks when everything fell apart last time?

And then I think about the women I see, and the differences in what a "surprise" means to them.... less food (or no food) for the children they have. Beatings from their partners. Knowing that the growing life in their body is being bathed in chemicals as often as they take them in. Another child,longed for --- only to be taken away "to a better/safer/cleaner home". Lost hope.

How would your surprise fit?

Monday, March 4, 2013



If you've felt the release of the shoulders
then the weight of your babe in your arms...

If you've caught a nine pound son,
or the tears in his father's eye...

If you've grasped the hand of a laboring mom,
then stroked the silky hair so long awaited...

If you've walked away soaked to the knees in birth,
filled to the brim with hope and light...

If you've waited hours and hours with those unknown to you,
then rejoiced alongside to meet the one newest to all...

If you've met the eye of the wise, scared, strong mama,
and seen the deep wisdom in her new babe's gaze...

... then you have had a delicious delivery.

This is one of my *favorite* birth images... I don't know if it has an actual name, but is attributed to Ina May Gaskin and (I believe) the book Spiritual Midwifery. (Which reminds me, I am soooo overdue to do some good, non-work-related reading...!) Someday, sadly enough for the Warm One, this will end up permanently inked somewhere on my skin. The question is, where...???

Thursday, February 28, 2013

Winner, winner...

... Chicken dinner?!

Sorry to post late, but I promise I really did determine the lucky pendant winner on 2/28 as promised. And, according to the roll of the lucky pinkish-red die (it was a nice, small pool of commenters & "likers", so this worked out perfectly!), I'm looking forward to packaging up something pretty and sending it to ...

(( drumroll please ... ))

Reply #1 (it truly is the 1 spot on the die, despite the awful pic making it possible to see --- congrats Rixa!!

But wait!! Since everyone posted such lovely comments & I need an excuse to avoid laundry (shhhh --- don't tell the Warm One!) any of you all who posted a reply or commented/shared on FB about or since the initial "birthy beauty" post will receive a little something with my thanks!

To do so, though, I could use a bit of direction... So email me your mailing address at within the next 7 days. I promise I won't stalk your home, spam your email, or otherwise abuse this info :)

Wednesday, February 27, 2013

tomorrow, tomorrow...

... it's only a day, aaaawaaay!

(and do you remember that tomorrow --- pending any full-moon-babies! --- i'll send a lovely pendant to someone, just for fun?  really, just because i LOVE sending packages, and because i bought these pendants months ago with the intent of sharing TheMandalaJourney's gorgeous birthy art... and they still mostly sit unseen.  Not cool!)

If you want to be in on the fun, post below - or on any of the posts in the last week or so - and we'll go from there.  (see the "Birthy Beauty" post from Feb 19th  - -  for the nitty gritty on this, but it's pretty simple, really, and it's looking like a small pool to play in!)

Tuesday, February 26, 2013

'round & 'round (the circle we're in)

Yesterday the bigger Mini scrawled a whole page full of 8's, and over and over we discussed each one, deciding which was our favorite, our least loved, the most aethetically pleasing, that sort of thing... exactly the way you like to spend time with a girl of about that age.  At one point or another, I spun the dry erase board a bit and rambled on to her about the magic of the infinity symbol and loosely tied the concept into our conversations throughout the rest of the day.  (It's important to remember here, in case it hasn't been mentioned before, I am not a math geek ...  my knowledge of the infinity symbol and the whole "no beginning, no end" idea is mostly gained from jewelry commercials, that sort of thing... but it was still very cool when the Mini caught on to the idea and tied it onto the fact that circles also have no beginning, no end.)

Like health. Like parenting, or life itself, really (when you think about it, can you pinpoint a moment when your life began? What about when it ends?) ... one way or another, for better or for worse, beautifully or morosely, all of these things will blend seamlessly into each other like the sands of the desert for most of us. We can mourn the changes and losses as they happen, fear the uncertainty that lies ahead, or embrace the moment we have.

(Wow. Lying awake at midnight, post-migraine meds, makes me wax philosophical!)

Wait! There was an actual midwifery tie to this post, I promise. Before I veered off into the hazy lands of half-sleepytime dream talk (oops, there I go again), I meant to talk about the beautiful, uncertain, chaotic orb of life. So much of everything seems to revolve in such a cyclical pattern (I'm trying to avoid breaking into "circle of life" a la Disney and The Lion King here...); whether you call it karma, fate, luck, gas, whatever --- what goes around does seem to come around. Pregnancy is no exception; countless cultures celebrate feminine goddesses, ripe with child, as evidence of rebirth - from death, to birth again. The gravid abdomen, round and splendid, is exalted and rejoiced.

In our modern times, we still go 'round and 'round. With all the cutting edge technology, evidence-based medicine (in theory), and "best case" scenarios --- we still meander our way through the same beautiful, uncertain, chaotic orb. We can do all of the testing available (nuchal screening, quad serum testing, even amniocentesis) and expect a baby who will have major chromosomal abnormalities -- and at birth meet a sweet babe with only the very mildest form of Down's Syndrome... or conversely after all of the testing, anticipate a chromosomally healthy baby at birth, only to have a baby born with significant (undetected) other congenital anomalies. Sometimes babies die, or mamas; too many times there is absolutely no good explanation why (or none that can be explained or prevented). Sometimes, on the other hand, babies live and grow and thrive - hormone levels that don't seem to be rising well at all, or ultrasounds that don't seem to show much of anything reassuring, suddenly have an entirely different story just a few short days later. (What an amazing sound that fast heartbeat can be!)

My belief (and I'm quite certain that I adapted this idea, if not stole it outright, from another source somewhere... I would love to cite that source if I remembered where I originally read it...) is that our babies never leave us.  Sometimes, though, it's not the right time - for us or for them - and so they leave us for a bit, until it truly is the right time. Eventually --- even if it's an abortion as a 15 yr old, three miscarriages, and an adoption as a 35 yr old later --- I believe that they always find us. (Maybe even as grandparents.... or neighbors... or anywhere else along the line....)

I'm pretty sure we do just keep going 'round and 'round, and it's all in our own hands, no matter what.



Also, I feel as though I left out a few important details to the "fine print" post. (Mostly, because I usually start writing these blog posts when I'm falling asleep, and then by the time I actually DO write them, they look quite a bit different. Funny how that works!)


My biggest disclaimer? Queen of bad analogies. Like, "pushing is like blowing up a balloon". Right? Because at first you know how blowing up a balloon sucks -- you have to stretch it out with your fingers all crazy (pull it this with and that), then puff and blow and your cheeks get all red and you kind of feel like you could just pass out; you get sort of a headache... then all of a sudden, woosh! there it goes! Isn't that how pushing is?!   (I totally might've stolen that from somewhere too...I probably did...)

Or, how about this one (I think) I just came up with: it's the sunburn-vs-healthy-immune-system analogy. So, if you're healthy, you've got a good diet, decent coping mechanisms for stress, don't smoke or stress your body out with drugs/etc, have good support, things like that --- it's pretty equivalent to wearing a high SPF and probably like a sunhat, maybe even long-sleeve, light-colored shirt at the beach on a super-hot, sunny day. You might feel hot, a little sweaty, but you're fine. If you're stressing your body already (with drugs/smoking, existing health problems you're ignoring, etc), you're maybe sporting some low SPF at the beginning of the day but otherwise nada. If you're dealing with some health issues, overall are NOT healthy anyway --- stressing your body with uber-stress from drugs/AODA stuff, no social support, not putting healthy things in (diet/exercise, mentally), you're sitting there in the hot, glaring sun in a g-string and no sunscreen and frying -- you will suffer every single ray, and an awful lot longer than either of the first two.  (This is my tentative awful analogy for why some people deal with colds/viruses/vaginitis/etc more frequently/longer, etc, than others...)

Oh! And for inductions? (Which, I have probably blabbed on and on about, of course.... another topic... another day, but...) Awful analogy --- Prostaglandins to "preheat" the oven; most likely won't kickstart labor in the same way that an oven at 250 won't bake cookies, but... you never know!


(Don't worry, I've always had such eloquence with words... My hands aren't "cold as ice"...they're "cold as popsicles"...  and such similar oddities...)

Sunday, February 24, 2013

The fine print...

I feel like I owe my potential clients a sort of disclaimer, or a caveat emptor of sorts, before they really jump into care with me. Making a commitment to join together - whether for continued primary care or prenatal care - seems like kind of a big deal.  Maybe not quite as significant as, say, a marriage or civil union, but important none the less. The health care relationship needs to be built on a good foundation of trust, openness, and understanding from both partners, and I definitely don't want to lure patients in with a false idea of who I am as a provider (or a person).

Now, I don't quite think I need to explain to them that I am the queen of running five minutes late (no matter how I try, I can't quite to make it anywhere when I need to be there... I can leave fifteen minutes early, and still hit roadblock after roadblock), or that I crave naps more than anything else in the world. But I do want to pass on other tidbits; I want women to know where on I stand on their care what I have to offer them. I want the women I care for to know that I value them, I acknowledge their pain and their history, that I'm willing to work with them.


I also want them to know - regardless of whether this is perceived as negative or positive - that in caring for them, I'm investing in them. (Side note: I'm not very financially literate - I can manage to sign the right forms with my work-related retirement and, um, usually get my taxes filed on time, those kinds of things, but stocks and bonds are waaaaay out of my sphere - yet even I recognize that when you invest in something, financially/emotionally/otherwise ... you want to see it grow and be well.) I want to see my patients be well; I want to see them improve their health, their families, their relationships. I won't prescribe narcotics or any medications that are known to be abusable to a client that is new to me, and I'm very, very slow prescribe them to anyone in general. I encourage, prod, preach, discuss, promote, celebrate exercise and meditation and the "right" diet and good sleep habits and physical therapy, massage, chiropractor, acupressure, so many other complementary therapies. I empathize with chronic disease, mental illness, family struggles, but also emphasize the importance of working to address problems from a multifaceted approach rather than simply a pharmaceutical one.

As a midwife caring for women during the prenatal and intrapartum period, I specifically want the expectant and new mothers I meet to know that I will be with them every step of the way.* I am honored to walk with them, step by step, as they journey through the path of creation, and ready to meet any obstacle along the way together. We will embrace the normal and address the rest, but together. I won't prescribe Vicodin for low back pain, I won't induce at 39 wks "just because" ... but I will be there.

*(I feel like, maybe, I should also warn many of my prenatal women that, at one point or another during labor and delivery, they will all likely hate me... does that seem fair??)


Medicines are not meat to live by.  ~German Proverb

Tuesday, February 19, 2013

Birthy beauty...

... is always more fun than some of these downer things that have been weighing on my mind.  And since I've been wondering if anyone out there ever actually reads this, or if this blog is just a wonderfully cathartic yet unseen release for me, I'm thinking about doing a little something fun.

So, since I've fallen in love with the gorgeous artwork at The Mandala Journey ( and may have a bit of a shopping habit there on occasion, I would be ecstatic to give away a sweet pendant. I haven't put enough time or thought into this to actually post a picture of the pendant, but I promise it will be both lovely and meaningful.I will post a picture of the actual necklace soon!

To enter, post a comment below about why you would (or wouldn't!) follow a "birthy" blog... and if you have any posts you've found especially profound; if you "like" OneDeliciousDelivery on Facebook, twitter (@hebammema), and/or share this on Facebook, you can receive an extra entry for each.  Winner will be drawn 2/28.

{{ if, really, anyone is reading --- comments, criticism, suggestion would be lovely. we are not alone! :) }}

His name was Gary...

... and he believed in Santa.He was SO excited for the big red guy to come that night, it was all we heard the entire shift - "Santa? Santa Claus?!" - and thrilled murmurs about presents to come.  Between the palpable joy in his voice and his garbled speech, it was tricky to even understand this much sometimes --- but once you figured it out (or if you knew Gary*), there was no question.

He was pumped.  It was Christmas Eve, and as soon as he went to sleep that night, you-know-who would be slipping in to drop off something special.  It didn't matter to Gary that he was stuck in a hospital bed, miles away from his home, or that there was no Christmas tree, chimney, or fireplace near which his stocking could be hung with care; there was snow out the window and he knew. 

Gary could've been any other six-year old that Christmas, except for the IV taped to his arm and the feeding tube inserted into his stomach. 

Also, Gary was in his late forties. 

Every so often I remember that Christmas Eve shift that I spent caring for Gary; I had taken care of him a few times previously on the Medical/Surgical unit of the hospital during short stays, and was familiar with his cognitive impairments.  Confined to bed or a motorized wheelchair, Gary had severe contractures of his extremities, and cognitively functioned at the level of a toddler.  He was always pleasant, but often confused; I rarely saw visitors, though on occasion he would have an older gentleman or few women stop in, who I assumed to be older relatives. I never met a mother or father, sisters or brothers; whether there simply were no closer family members or they lived too far away to visit frequently is impossible to say. As a nursing assistant at the time, I had little background information; I assumed (and still assume) that Gary lived at one of the nearby long-term care facilities. 

Like most holidays, that particular shift was bittersweet; though it's always miserable to be away from home and family during such intimate hours, there is a certain honor to be able to sweeten those same hours for someone who might otherwise have a much less warm celebration (the trend tended to be lower census on our unit, but there was always a few patients with pneumonia, unexpected broken hips from falling on the ice, etc...).  Once I was able to get past the initial crankiness of pulling away from my family --- this was prior to the Mini's, so in retrospect it shouldn't have been so hard at all! --- I made it to the hospital to find a pretty festive mood on the Med/Surg unit. A potluck was in full swing, carols were playing quietly at the nurse's station, and staff were bedecked with twinkling pins and bright scrubs.

I worked my way through my rounds, passing ice water, dinner trays, helping patients up to the potty and down to bed. Families visited, stories were told, and smiles brightened the halls. In Gary's room, especially, the spirit of the holiday was huge. Every visitor - from housekeeping to dietary to nursing - heard about the REAL visitor Gary was anticipating, and his excitement for "pres'nts?" in the morning.

And, so, we played along. Of course Santa was coming!  "Any sign of him yet? Nope?" "Gotta go to bed early, though, Gary!" "Hope you were good this year!" Each question and every statement met with a beaming, toothy grin from Gary's stubbly face.

It was only at about 9 p.m. that we realized... Would Santa come?  Gary had had few visitors, none that seemed to be a caretaker or close relative... Gradually we recognized what this meant - Gary could awake not only to an empty, stark hospital room (bare of Christmas decorations or cards) but also devoid of any sign that Santa had dropped by. Our hearts broke thinking of the spoils of gifts awaiting us in our own homes. We set out on a search of the hospital, able to procure a few small stuffed animals, a child's book, and a bit of candy (useless to Gary and his feeding tube, but something anyway...) to leave from Santa.

Our meager pile seemed so small, but there was nothing else. I drove around for an hour after clocking out at 11:30 p.m., but in small-town USA just before midnight on Christmas Eve, even gas stations and Wal-Mart close. I considered driving home (an hour away) and driving back, but was uncertain what I could scrounge up. In the end, we left Gary his gifts, decorated with a few balloons and a note from "Santa". By my next shift, Gary had been discharged, and I never really learned how his Christmas morning ended.

~ * ~ * ~ * ~ * ~

I'm not sure why Gary's story is here; it's clearly about as far from a midwifery story as you can get, but it has been on my mind as of late. I think, on some levels, caring for Gary on Christmas Eve was the first true experience I had in falling short of what I felt I needed to do... and yet, considering the obstacles, I feel that we (my partners that night and I) pulled together to make Gary's Christmas morning so much brighter than it may otherwise have been.  

And that, I think, is the true spirit of any caregiver. We may not know it all, we may not have all the tools or resources that we need, we may encounter obstacles beyond our control -- but the heart of our profession is by pulling together as a team, then putting forth the best effort possible so that each person we serve is able to have the most positive outcome possible. (I need to remind myself of this often --- I can't "fix" everyone, prevent everything, or do it all myself  but I'm there, anyway.)

* not his true name...