tag:blogger.com,1999:blog-44305066254707075672024-02-02T08:01:59.742-08:00One Delicious Delivery (And I'm Not Talking Pizza...)~ a journey into midwifery ~hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.comBlogger69125tag:blogger.com,1999:blog-4430506625470707567.post-16272116488736398842013-04-01T18:21:00.005-07:002013-04-01T18:58:23.279-07:00two minutes<div style="text-align: left;">
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<b>two minutes </b></div>
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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.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYIT04l3o8c9EtnJM5Qqx_gHE4FmNb8yNakIDz3yQZwE2PK10N3yWVqXdXd4jMlacesxq6SZ1PrjBTCJt5lqLBqNFfXKEMYkPtlswEfPTpoMyMXMGSlUvYXp4Uk_IznWmMk1hmvtLlWvI/s1600/MP900407422.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYIT04l3o8c9EtnJM5Qqx_gHE4FmNb8yNakIDz3yQZwE2PK10N3yWVqXdXd4jMlacesxq6SZ1PrjBTCJt5lqLBqNFfXKEMYkPtlswEfPTpoMyMXMGSlUvYXp4Uk_IznWmMk1hmvtLlWvI/s320/MP900407422.JPG" width="255" /></a>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.).<br />
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Shoulders.<br />
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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.<br />
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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?!<br />
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(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...)<br />
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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 - http://spinningbabies.com/about-spinning-babies/390-how-do-babies-rotate?start=1 - 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.<br />
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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!<br />
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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.<br />
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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?<br />
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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 <i>not</i> 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. <i>May.</i>), 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. <br />
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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?<br />
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<i>*warning: bad analogy ahead </i><br />
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<i>**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.</i> hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com1tag:blogger.com,1999:blog-4430506625470707567.post-90106747972434464392013-03-11T21:04:00.000-07:002013-03-11T21:04:22.579-07:00what the what, Hudson?!Please see Stand and Deliver's recent blog post (<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWMej272gcrnZO0CG01YR_PIqoTsBe_z1D-nU4_dy2mmIWdbt4guZFQpqlLuCAdoofdKd7Rq5Y8pV6L5h1eDNRc5aEdVmdL9QN489IMWlr6vtRXJXjczlOkkoVEpHMV7p808ctYT8wd8Q/s1600/139541288424116060_44iOgpQC_c.jpg" imageanchor="1" ><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWMej272gcrnZO0CG01YR_PIqoTsBe_z1D-nU4_dy2mmIWdbt4guZFQpqlLuCAdoofdKd7Rq5Y8pV6L5h1eDNRc5aEdVmdL9QN489IMWlr6vtRXJXjczlOkkoVEpHMV7p808ctYT8wd8Q/s320/139541288424116060_44iOgpQC_c.jpg" /></a>http://rixarixa.blogspot.com/2013/03/support-patient-autonomy-breech-birth.html?showComment=1363060400394#c2198476714344743307) 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}}
hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com1tag:blogger.com,1999:blog-4430506625470707567.post-90254423834946749742013-03-11T19:29:00.001-07:002013-03-11T20:03:45.422-07:00surprise!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 ( http://www.cnn.com/2013/03/04/us/pennsylvania-gosnell-trial/index.html). 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!)<br />
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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. <br />
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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. <br />
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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!!<br />
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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... <br />
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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. <br />
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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?<br />
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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. <br />
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How would your surprise fit?<br />
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<br/><br/><div class="separator"style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEnj89VtejNeq9PkhXvatVTodl1oAE10-tS6E1tG7ZrwpztU26nNtfRuCAJNHdliTu-bvE-gaWaWLFy4r6WUjsK_3ievr2fxVOJdA6odWtO2YYFxpk-Lcc-jv1jjw20q4XRUjU-q_-cwA/s640/blogger-image--1915267314.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEnj89VtejNeq9PkhXvatVTodl1oAE10-tS6E1tG7ZrwpztU26nNtfRuCAJNHdliTu-bvE-gaWaWLFy4r6WUjsK_3ievr2fxVOJdA6odWtO2YYFxpk-Lcc-jv1jjw20q4XRUjU-q_-cwA/s640/blogger-image--1915267314.jpg" /></a></div>hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com0tag:blogger.com,1999:blog-4430506625470707567.post-52112343739079835442013-03-04T14:59:00.000-08:002013-03-04T15:01:49.709-08:00If<div style="text-align: center;">
<span style="font-family: Georgia,"Times New Roman",serif;"> <u>If</u></span></div>
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<span style="font-family: Georgia,"Times New Roman",serif;">If you've felt the release of the shoulders</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">then the weight of your babe in your arms...</span><br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGKwH6RNjasmSz3F2-0JDxWHnYkiSr72Cvkqsk3Dakv_6eo49V14_mr7JsYSfwZtb5zrYgxTOfPngEYifNa-J2qF9Hvxs_6Zw3nYWszXmVvxckb_CHub4dhpPbN4WkSEAFUEJHlBFqYZg/s1600/daddybaby.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="211" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGKwH6RNjasmSz3F2-0JDxWHnYkiSr72Cvkqsk3Dakv_6eo49V14_mr7JsYSfwZtb5zrYgxTOfPngEYifNa-J2qF9Hvxs_6Zw3nYWszXmVvxckb_CHub4dhpPbN4WkSEAFUEJHlBFqYZg/s320/daddybaby.jpg" width="320" /></a><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">If you've caught a nine pound son,</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">or the tears in his father's eye...</span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">If you've grasped the hand of a laboring mom,</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">then stroked the silky hair so long awaited...</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">If you've walked away soaked to the knees in birth,</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">filled to the brim with hope and light...</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">If you've waited hours and hours with those unknown to you,</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">then rejoiced alongside to meet the one newest to all...</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><br /></span>
<span style="font-family: Georgia,"Times New Roman",serif;">If you've met the eye of the wise, scared, strong mama,</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;">and seen the deep wisdom in her new babe's gaze...</span><br />
<br />
<br />
<div style="text-align: center;">
<span style="font-family: Georgia,"Times New Roman",serif;">... then you have had a delicious delivery.</span></div>
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<tr><td class="tr-caption" style="text-align: center;"><i>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 <u>Spiritual Midwifery</u>. (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...???</i></td></tr>
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hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com0tag:blogger.com,1999:blog-4430506625470707567.post-28859051887379892252013-02-28T23:28:00.001-08:002013-02-28T23:28:19.562-08:00Winner, winner...... Chicken dinner?!<br />
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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 ...<br />
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(( drumroll please ... ))<br />
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Reply #1 (it truly is the 1 spot on the die, despite the awful pic making it possible to see --- congrats Rixa!!<br />
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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! <br />
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To do so, though, I could use a bit of direction... So email me your mailing address at hebamme82@gmail.com within the next 7 days. I promise I won't stalk your home, spam your email, or otherwise abuse this info :)<br />
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<br/><br/><div class="separator"style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzmohXcbjxbLJCUOtSCGxp7hJ3gNGRGd-SoPN66F_VkO1-70-qFgRm6391Qun7HL8J1r0b_n58P7DB0mCZwy3lwg4k9Y5EUsm3HMdwLHfWMYNAUueytSeH-53PYg8KtBbDIpk95uU3oA8/s640/blogger-image--1199528360.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzmohXcbjxbLJCUOtSCGxp7hJ3gNGRGd-SoPN66F_VkO1-70-qFgRm6391Qun7HL8J1r0b_n58P7DB0mCZwy3lwg4k9Y5EUsm3HMdwLHfWMYNAUueytSeH-53PYg8KtBbDIpk95uU3oA8/s640/blogger-image--1199528360.jpg" /></a></div> <br/><br/><div class="separator"style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPD6hrRvBU4Cpoitkcr02grTX4CzL0Pa5p5TCLMolKxfoDvIQHWt2HT6IoxYQqROVxSPh42mPABVg0J3joDs41Sl9EBaZiLvc6U_V8GdERO7wVYU0u3-ZSsnKlcKh_Pcq3QCc09PTdcsk/s640/blogger-image--6095531.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPD6hrRvBU4Cpoitkcr02grTX4CzL0Pa5p5TCLMolKxfoDvIQHWt2HT6IoxYQqROVxSPh42mPABVg0J3joDs41Sl9EBaZiLvc6U_V8GdERO7wVYU0u3-ZSsnKlcKh_Pcq3QCc09PTdcsk/s640/blogger-image--6095531.jpg" /></a></div>hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com0tag:blogger.com,1999:blog-4430506625470707567.post-76829067472913803212013-02-27T20:54:00.000-08:002013-02-27T20:54:10.929-08:00tomorrow, tomorrow...... it's only a day, aaaawaaay!<br />
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(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!)<br />
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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 - http://www.onedeliciousdelivery.blogspot.com/search?updated-max=2013-02-24T19:53:00-08:00&max-results=2 - for the nitty gritty on this, but it's pretty simple, really, and it's looking like a small pool to play in!)hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com0tag:blogger.com,1999:blog-4430506625470707567.post-28466253663643528462013-02-26T22:01:00.001-08:002013-02-26T22:20:02.565-08:00'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.)<br />
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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.<br />
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(Wow. Lying awake at midnight, post-migraine meds, makes me wax philosophical!)<br />
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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 <i>everything</i> 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.<br />
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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!)<br />
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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....) <br />
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I'm pretty sure we do just keep going 'round and 'round, and it's all in our own hands, no matter what.<br />
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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!)</div>
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Anyway.<br />
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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...)<br />
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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...)<br />
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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!<br />
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*sigh*<br />
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(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...)</div>
hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com0tag:blogger.com,1999:blog-4430506625470707567.post-11093775231062777652013-02-24T19:53:00.000-08:002013-02-24T19:54:15.092-08:00The 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).<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUE8LIJ8Qu3xuG54MNuy1yO3yJX5l3jGrFHJ26n-gAMUIrc02IW9EtHWpaSlHsgt9pRVVBeuSX0Pg0-6Xt5KMQp53SPxvPWm0rh9pjS4X8hO_raqJ1vOYZKW0h4_RvYcRRRGp7swZG2Mc/s1600/fa44dbeaab71bf96ed2322236a78baf4.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="396" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUE8LIJ8Qu3xuG54MNuy1yO3yJX5l3jGrFHJ26n-gAMUIrc02IW9EtHWpaSlHsgt9pRVVBeuSX0Pg0-6Xt5KMQp53SPxvPWm0rh9pjS4X8hO_raqJ1vOYZKW0h4_RvYcRRRGp7swZG2Mc/s400/fa44dbeaab71bf96ed2322236a78baf4.jpg" width="400" /></a>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 <i>anywhere</i> 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. <br />
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But.<br />
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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. <i>(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> 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.<br />
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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.<br />
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<i>*(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??)</i><br />
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<span style="font-family: georgia, bookman old style, palatino linotype, book antiqua, palatino, trebuchet ms, helvetica, garamond, sans-serif, arial, verdana, avante garde, century gothic, comic sans ms, times, times new roman, serif;">Medicines are not meat to live by. ~German Proverb<br />
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<br />hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com1tag:blogger.com,1999:blog-4430506625470707567.post-33801187417339041962013-02-19T20:57:00.002-08:002013-02-19T21:03:59.733-08:00Birthy 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.<br />
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So, since I've fallen in love with the gorgeous artwork at The Mandala Journey (themandalajourney.com) 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!<br />
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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.<br />
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{{ if, really, anyone is reading --- comments, criticism, suggestion would be lovely. we are not alone! :) }}hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com9tag:blogger.com,1999:blog-4430506625470707567.post-26253839719990963012013-02-19T20:37:00.001-08:002013-02-19T20:37:59.365-08:00His name was Gary...<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtDYyTJIJunq-UHYpKJom2ufUjIMPOHFqqfDycukNpVSKxOyLfnWEDn0v8j0fFwWeyUfIqgYMYv3OlTMjDckyfI_ZSxWd-HLOpqVnmQm3_SwmIRLeoDqALs8d5zLymyg_JZfDTg-nqtP0/s1600/32ab5b528327622499ea142b5fefc581.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtDYyTJIJunq-UHYpKJom2ufUjIMPOHFqqfDycukNpVSKxOyLfnWEDn0v8j0fFwWeyUfIqgYMYv3OlTMjDckyfI_ZSxWd-HLOpqVnmQm3_SwmIRLeoDqALs8d5zLymyg_JZfDTg-nqtP0/s320/32ab5b528327622499ea142b5fefc581.jpg" width="221" /></a>... 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.<br />
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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. <br />
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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. <br />
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Also, Gary was in his late forties. <br />
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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. <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh64Zmu_daWa7hb30qDx472PQIxyE-2316lTSuz_V9oNlYc5w7esdbbFS9VuQQG5h-4xG054wSDPI3MLJ0EJpNXR4VlYgfif7dDSL0nkYkDVtLpfQj6AN1MrNhwpufdh4blcoKfAWkA3fY/s1600/a1844558c4012669d3708de03a245687.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh64Zmu_daWa7hb30qDx472PQIxyE-2316lTSuz_V9oNlYc5w7esdbbFS9VuQQG5h-4xG054wSDPI3MLJ0EJpNXR4VlYgfif7dDSL0nkYkDVtLpfQj6AN1MrNhwpufdh4blcoKfAWkA3fY/s320/a1844558c4012669d3708de03a245687.jpg" width="212" /></a>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.<br />
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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.<br />
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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.<br />
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It was only at about 9 p.m. that we realized... <i>Would </i>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.<br />
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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.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjI2ItOkb9dirT7zr86DsVNCLyeAh5P3Mk9lR9L3hnIVHN0HNfmJ7cfoTzbRaJ2zjI9i1li0V1zon_UuLNU3K-I7eGyCH3zaVDgOE3NwC7XSzQ8IM0Lqawynmdm5b-zI_0nCTurGi_TqYQ/s1600/982aaa35420707ff591de207226d8bb9.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjI2ItOkb9dirT7zr86DsVNCLyeAh5P3Mk9lR9L3hnIVHN0HNfmJ7cfoTzbRaJ2zjI9i1li0V1zon_UuLNU3K-I7eGyCH3zaVDgOE3NwC7XSzQ8IM0Lqawynmdm5b-zI_0nCTurGi_TqYQ/s400/982aaa35420707ff591de207226d8bb9.jpg" width="300" /></a>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. </div>
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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.)</div>
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<i>* not his true name... </i>hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com0tag:blogger.com,1999:blog-4430506625470707567.post-43477534266010363652012-12-29T13:15:00.000-08:002012-12-29T13:15:09.611-08:00The labor of sitting...I'm sitting here, fingers numb and skin goose-pimpled, with my mind forced to wander aimlessly between the usual time wasters --- Facebook, annoying yet addictive games, checking email. The same sorts of things that I would (to be honest I have to admit this) find myself doing if I was at home right now ... Except I'm not. <br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8q4lFawjXX27yXK98O4KT_oFjYOd3ZB4ltDMMzOSsTiuoM1ebXjsmROKpKEDBWhOOzlBtJGRhGe9xHMhAM8uTJwk1E9CFRgtUtGEcVWX1bp5K06BMrwRtsRZvW3pm-gGwcxamXO1zYII/s1600/labor-delivery-room.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8q4lFawjXX27yXK98O4KT_oFjYOd3ZB4ltDMMzOSsTiuoM1ebXjsmROKpKEDBWhOOzlBtJGRhGe9xHMhAM8uTJwk1E9CFRgtUtGEcVWX1bp5K06BMrwRtsRZvW3pm-gGwcxamXO1zYII/s320/labor-delivery-room.jpg" width="320" /></a><br />
And, of course, my eyes flit (as moths to a flame) neurotically to The Machine. Or, rather, Machines, as they are spaced strategically throughout the Birthing Center so that even if one tried desperately to avoid glimpsing them, it would be nearly inevitable. The Machine dictates the majority of nursing decisions it seems, often causing panic among providers not even involved with a patient's care; the ability to see everything that's occurring within a woman's womb from meters and meters away can cause a flurry of activity and a rush of footsteps to a laboring woman's bedside. At times this may be helpful - at other times, privacy is invaded, quiet moments of solitude shattered, and situations being managed calmly and appropriately are elevated to unnecessary proportions of stress. <br />
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So... I try to consciously remind myself to focus my attention away from The Machine. I'll let the screen-saver take over. I'll read, I'll eat (oh dear, considering the table laden with holiday treats), I'll train these fingers in my newly budding crochet skills.<br />
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Or - I'll look over there again... Log back in...<br />
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And then glimpse at the clock (another Device of far too much consequence in this situation). There's a curve to be followed, although to be fair we fell off of that curve long ago. I don't mind - progress is progress, though slow but steady - although the whispers that provide The Machines and Devices may have other thoughts on this. Is it time to consult? Insert some sort of additional tube or device (even though this mama has just about every other tube and line you could imagine already...)? <br />
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My mind wanders to the peaceful, joyful announcements of my midwife sisters delivering in birth centers and homes: "a baby girl, delivered strong and healthy after a long, hard day's work into her mama's strong arms" ... "After many hours of dancing, swaying, and support a baby boy welcomed into her fathers hands..." I can only wonder, is the emphasis on Machines and Devices at these birth days, or on mamas and babies?<br />
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<i>{ { pregnant ----- very pregnant ---- pause... } }</i></div>
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A day later, a conclusion. Two hours of pushing, tears and four-letter words of frustration later - a big, beautiful baby was cradled into *her* mama's arms. Even with the reassuring picture The Machine showed for every one of those 68,220 seconds (roughly) of the day's work, hands rushed to pull a stunned but transitioning babe quickly from her mother's breast. A steady heartbeat, response to stimulation and mama soothed me that babe -- though initially wide-eyed and breathless -- needed not to be "cut and run" (to the warmer to be "checked out") but rather allowed to remain with cord intact, pulsing oxygen-rich blood to her strongly-beating heart as she opened her lungs and breathed in new life. <br />
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But - again - slave to Devices and cowerer of those who oversee them, I am freshly new enough in my role to not want to step on too many toes, piss off the "wrong" types of nurses, get "that" reputation. I bring young babe to mama's chest, (hopefully, or certainly tried to...) soothed with quiet reassurance of her strong heartbeat and response to a rubdown by the nurse. The cord stayed intact, babe with mom gaining tone and crying lustily, before I fumbled a cord clamp on and gave a tearful dad instructions to cut the tough bond between the double clamps, and finally seeing the break for baby to be removed for "the things we do".<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTlFJAKoAwWlIGxF_PyfL2KJwDNhIaIUI39AbTqpDjkOTczyZh980SmgxHKQTrQV0CJ-BYOQlY4pClohZk4ku_-5QB3DeNI49QOmT1OU46_JrskmQJl3SiCkEj7eLMXSalz7vEgOtJF7M/s1600/time.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="236" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTlFJAKoAwWlIGxF_PyfL2KJwDNhIaIUI39AbTqpDjkOTczyZh980SmgxHKQTrQV0CJ-BYOQlY4pClohZk4ku_-5QB3DeNI49QOmT1OU46_JrskmQJl3SiCkEj7eLMXSalz7vEgOtJF7M/s320/time.jpg" width="320" /></a>It was not the labor or birth that I imagine my midwife sisters in other settings witnessing... But in the same thread, not the same mama, the same support system, the same overhead model of care either. I long for the "just sit on your hands!" keep-out-of-where-you-don't-belong MOA that I've been taught, and yet haven't quite built up the courage to implement it in practice here. In the months and years to come, maybe there WILL be more tea, more swaying, more breathing and back rubs and foot massages; fewer epidurals and elective inductions, less fear if the "what if's". <br />
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And - maybe - smaller clocks...hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com1tag:blogger.com,1999:blog-4430506625470707567.post-37652272199548670012012-12-16T18:17:00.003-08:002012-12-16T18:17:55.193-08:00i am his sister...Months after my last post, I'm back. Even though I've had plenty of themes plotted in my mind, they've never formed beyond that point; after driving home, working late, getting up too early, they all fade into the background.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5tdG4lpbIGSBaUVWL-7BZ3e4q0zpS9Ki5U4j5lkPhAMf3BLAPfPgY61cWefaJQ6FV-YkU2gvHXnsvgKC69-xEtD0EUyDGZT3z3jKbq4Gs1fgmofveIATbO1Zb1CVJ8nNQuwC3JAMZK2Y/s1600/551702_10151096864588451_1279737989_n.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="230" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5tdG4lpbIGSBaUVWL-7BZ3e4q0zpS9Ki5U4j5lkPhAMf3BLAPfPgY61cWefaJQ6FV-YkU2gvHXnsvgKC69-xEtD0EUyDGZT3z3jKbq4Gs1fgmofveIATbO1Zb1CVJ8nNQuwC3JAMZK2Y/s320/551702_10151096864588451_1279737989_n.jpg" width="320" /></a>Tonight, however, in the midst of the holiday baking and planning, I need to stop and write. And, again, it has nothing to do with midwifery. (Or, at least not directly...) Three days ago, media outlets exploded with the tragic news of an attack. Elementary students, teachers, administrators, terrorized only hours after the warm glow of their holiday concert the night before. So many lives broken, with too few answers...<br />
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Together we mourn, a collective heart ache, river of tears washing into a tumultuous whirlpool of angry, confused blame. The mother who provided access to the firearms, the system that allowed the sale of the guns, the school's security system (or lack thereof), the sensationalization of shooters... Anyone, everyone, no one are at fault for the loss of these innocent futures.<br />
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I don't have an argument for or against any of it. But, in reading Liza Long's reflection (http://www.huffingtonpost.com/2012/12/16/i-am-adam-lanzas-mother-mental-illness-conversation_n_2311009.html) I recognized much of my own struggle with last week's events. I woke up several times the night before, dreams of my brother haunting me; the same old guilt, longing, sadness lingering as I struggled out of the fuzzy sleep state and realized that I had nothing to give. Throughout the long night and Friday morning - and intermittently since then - my "little" brother has been on my mind, more so than ever since last spring. Only after reading Long's piece does that really make sense.<br />
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~*~*~*~*~</div>
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If Liza Long is Adam Lanza's mother, I am his sister. My brother never lashed out at me with kitchen knives, never threatened to kill me or routinely verbally assaulted me out of anger - but in the last years of his life, he did frighten me. My brother lost the bright, clear eyes I'd always known; a haze and darkness replaced them. He abused over-the-counter pills, manipulated and stole, and drew further and further from the person he had been. He admitted to hearing voices, feeling as though he was re-living days, in an "alternate" world. At times he was the same old kid - fun, goofy, sensitive and caring, but in barely an instant could spin into an angry paranoia. Filtering truth from lies could be exhausting, and was heartbreaking. Depression, hopelessness, despair filled his days; my brother used knives, hunting guns, pills to mark his pain. Together as a family, both with and without him, we traveled the path of reaching out to help our hurting kin; the ER, the county social service department, involuntary and voluntary behavioral health programs were all approached with little to no avail. Programs were full, or simply not accepting clients, or did not see "evidence" of mental health disease in my brother; with no cause for treatment, he could not be kept involuntarily. Third-party commitment was unlikely to work; in fact, the best likelihood for getting him into a real mental-health facility would be through the criminal justice facility. Pulling away to avoid enabling seemed to be the best option, but in the end, there <i>were</i> no options. <br />
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After going through the same trials over and over, we did pull away. We explained that we were afraid to have the Mini's seeing the fear, the anxiety, the confusion caused by these behaviors in the family, and that until he got help and got clean, he wasn't welcome in our home; in all honesty, we feared for our family, for the Mini's, for my elderly grandparents who said "no" to him, for those who were in his path when he was angered. At the Mini's school, it was known that only the Warm One and I were to pick up the girls - no others. <br />
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I did not fear my brother, but my brother was gone. <br />
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Eight months ago, my baby brother was found alone, dead, in the room being rented for him. My heart aches to think that he took his own life - he was working and seemed happier than in a long time - but deeper within myself, I recognize the loneliness and pain he felt, the struggle he knew.<br />
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~ * ~ * ~ * ~</div>
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But. My husband hunts whitetail deer in order to provide venison, which feeds our family throughout the year; this is not simply sport, but a matter of tradition and stability for families that might otherwise go hungry. Similarly, my father, my grandfathers, my uncles all own guns - all of which are known to my brother. (Even if in locked cases, accessible through broken glass...) If, in a simple cruel twist of fate, this tragedy had occurred in different circumstances, would I be villified? My elderly grandfather? Though the guns were all moved following my brother's attempts to harm himself... though he had never made any attempts to harm anyone <i>but</i> himself... though we had tried, and tried, and tried to get him help until we were desperate ourselves...<br />
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In all of this pain and heartache, there are no real answers. Perhaps that is the real answer. </div>
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Love, prayers, tears to all who hurt...</div>
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<br />hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com0tag:blogger.com,1999:blog-4430506625470707567.post-86987865132070292922012-11-02T21:03:00.000-07:002012-11-02T21:03:18.163-07:00The Guilt Bone<div style="text-align: center;">
<i>~ the hip-bone connected to the, thigh bone... the thigh-bone connected to the, knee bone...</i></div>
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<i> the knee-bone connected to the, shin bone... the shin-bone connected to the, ankle bone.... ~</i></div>
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General anatomy and physiology. Core nursing curriculum for all students pursuing any health care field; after that initial introduction, the bones, muscles, tendons, and major organ systems of the body are again pounded into the student's head another 854 times before the end of the schooling. If you know anything by the time graduation rolls around, you know at minimum where things are and what they (should) do.<br />
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So - where's the guilt bone? I don't remember seeing it in any of the A&P textbooks, and it definitely wasn't in the coloring study guide that I bought (and rarely scribbled in); none of lectures I struggled to stay awake through mentioned this one. None of the multiple pigs that I've dissected over the years have had a distinct ossification by this name - but then again, maybe pigs don't feel contrite. (After all, pigs do what we expect of them - roll in mud, eat slop from a trough, grunt around; there seems to be nothing damning in those days...) I did, however, spend a few timid Advanced A&P labs with a human cadaver dissection-in-progress; granted, I didn't make it through the entire study and could have easily missed a small, delicate prominence, but when taken into consideration with the lack of mention <i>anywhere</i> else in the literature or diagrams, I'm stumped.<br />
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Is it just me? I'm certain I have this 207th bone, this extra verse to the old diddy. My guilt bone is connected to the "I'm sorry" muscle, with an antagonist "I wish..." tendon. Unlike many of my more commonly-recognized bones - possibly teetering at risk of frailty in years to come due to my ambivalence towards dairy - this little fella is strong as they come. I can't be sure, but through some sort of unusual anatomical configuration, it seems as though all of the weight of my shoulders may actually balance on this one small bone... crazy, huh?<br />
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When a laboring mama ends up with the words "failure to progress" scribbled somewhere on her chart and her support person gowning up in surgical gear - the muscles flex, that bone moves. When the charting runs long and calls keep coming, keeping the Mini's from their Mama - I feel the tightening. When the common cold spreads around and obligations aren't met - more tension. The phrases, "I'm sorry...", "I apologize...", "Next time...", slide off my tongue as easily and honestly as a warm hello to a close friend. Unfortunately, their prominence undermines their significance, and the frequency drains me of emotional energy: I know I am not at fault for anything and everything that happens. This life that I chose and path that I'm on is one of beauty, of faith, and of dedication.<br />
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Today, I forgive myself for taking blame that is not mine, and open myself to the world beyond...<br />
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<br />hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com0tag:blogger.com,1999:blog-4430506625470707567.post-28418611028001039112012-10-16T20:42:00.000-07:002012-10-16T20:42:27.213-07:00Don't hate me, I'm pro-choice ... and pro-life....<div style="font-family: Georgia,"Times New Roman",serif;">
<i>(Foreward: --- aka warning --- this post deals with a controversial topic... it's my personal opinion, and I beg you to read it and recognize that I understand and respect all the very personal, intimate feelings about this. There are multiple ethical, moral, and religious aspects, and I grasp the enormity of even acknowledging another perspective - much less trying to be "okay" with one that defies your own personal beliefs. That said....) </i></div>
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Dear friends...</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWMej272gcrnZO0CG01YR_PIqoTsBe_z1D-nU4_dy2mmIWdbt4guZFQpqlLuCAdoofdKd7Rq5Y8pV6L5h1eDNRc5aEdVmdL9QN489IMWlr6vtRXJXjczlOkkoVEpHMV7p808ctYT8wd8Q/s1600/139541288424116060_44iOgpQC_c.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="230" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWMej272gcrnZO0CG01YR_PIqoTsBe_z1D-nU4_dy2mmIWdbt4guZFQpqlLuCAdoofdKd7Rq5Y8pV6L5h1eDNRc5aEdVmdL9QN489IMWlr6vtRXJXjczlOkkoVEpHMV7p808ctYT8wd8Q/s320/139541288424116060_44iOgpQC_c.jpg" width="320" /></a>I love you all. I love your babies, the smooth chubby cheeks, the gurgly giggles and the snuffly coos as they snuggle into a chest for a nap. I ache with you when you share the sorrow of your losses - the babies born still, the grandchildren suffering unfair illness and the sisters desperately hoping for their own babes. My own uterus skips a beat with each sweet, slick gift of life passed from a mother's womb to her arms; there's not a thing I would not do or give to see a smile cross the face of my own Littles, and the thought of seeing them in pain causes an almost physical pain to take seed somewhere deep inside my soul.</div>
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Abortion. (I said it --- I think I had to, right? We all knew it was coming, eventually...) I can't imagine being in the situation of having to weigh the decision myself --- to continue a pregnancy or potentially terminate... and am thankful I have never found myself in that situation. Simply remembering the bungee-cord of emotions that were rampant with both of my pregnancies - enhanced by a history of depression - leads me to feel that much more pain for the burden of fear and anxiety placed upon the hearts of any woman led to consider termination. I was a married, employed, educated woman with a planned pregnancy and resources up the wazoo (and the knowledge to identify countless more), and still scared witless; to a woman (or young girl) without reliable employment or education, a supportive partner or family, limited or any resources, who becomes pregnant, the future may be terrifying. </div>
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This post is not meant to be a religious rant, a political push, a vicious argument against the ardent "pro-life" community. I believe in life. I'm as pro-life as I am pro-choice. I believe in a G*d, some Creator of us all, a balance of all that is right/wrong, happy/sad. Life begins, when life begins. To split hairs and debate the moment of "life" versus living cell seems frivolous, when to the women whose wombs carry those cells are in turmoil. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg80ibXfT_jLQCOZdJ_-bdlowhAU8qDzoLFMKeKFF6FUZeHWY-I_Pu3AcU482Mi3kUu5zKrDzW65NCObqaHE3hWBf5IrGRCGuEn2PMpFTl5D4QBtdaRMncEFQHS7kdHn78SuZqxuSao3R0/s1600/78601955967359354_rVRw5K9A_c.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg80ibXfT_jLQCOZdJ_-bdlowhAU8qDzoLFMKeKFF6FUZeHWY-I_Pu3AcU482Mi3kUu5zKrDzW65NCObqaHE3hWBf5IrGRCGuEn2PMpFTl5D4QBtdaRMncEFQHS7kdHn78SuZqxuSao3R0/s320/78601955967359354_rVRw5K9A_c.jpg" width="320" /></a>I care for women, for families, and for babies - all of these groups, none of them exclusively of the other. I will not, as a healthcare provider, perform elective terminations ("abortions") --- but I will counsel my clients on all available pregnancy options, and never judge them for the decisions that they make. I do not believe I could ever choose to willingly terminate a pregnancy which has taken hold in my uterus... but unlike too many of the women I've met, I've never been gang-raped, never been homeless, never been to the point of opening the door and finding social services peering in the corners looking for evidence of drug use and threatening to take my babies away. The hardest financial "struggles" I've faced have been wondering if I would be able to make my cell phone payment and cable bill on time, or if deferring my student loan payments would be necessary... our family hasn't sought emergency food assistance, or faced cold winter nights without electricity. </div>
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When I close my eyes, and drift into dreams, I imagine a world where every strong "pro-life" family takes in a family coping with an unintended pregnancy (literally or figuratively), providing shelter, support, understanding, hope --- a home for a baby, ultimately, if needed. (Of course this is in a land of lolly-pop trees and cotton-candy clouds... the logistics are nutty and no one's house would actually be large enough to accommodate an extra family - but work with me people!) To be serious, the crux of the matter - at least from the limited viewpoint that I've dealt with it - truly <i>is </i>the lack of support and resources generally available to women who find themselves immersed in unplanned pregnancies. </div>
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Resources, education, support... oh my! I dream, too, of a day when access to contraceptive options (including emergency contraception and preventative care/medical visits to discuss and explore different options) is readily available - without judgement, prohibitive cost, or excessive delay - to <b>all</b> women, with coverage from <b>all</b> providers. My faith is that I need to care for the women and families that I see, giving compassionate, holistic care; for some women, this will be supporting them as they continue pregnancies they weren't prepared for. For others, this will be counseling regarding termination. For all, it will include reliable contraception counseling talks, discussion of support services, and continued communication for months after our initial encounter. Though it is not up to me to weigh the life of the baby-to-be against the mother and family's emotional/financial/physical health and well-being, I have a strong faith that the G*d I trust in will deliver peace to the souls of every life involved...</div>
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<i>Please open your heart and mind to those who hurt... be blessed...</i></div>
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<br />hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com1tag:blogger.com,1999:blog-4430506625470707567.post-27157606152973384612012-10-15T19:22:00.000-07:002012-10-15T19:22:15.102-07:00THAT midwife... (Or, let's just be honest, eh?)You know. THAT midwife - the kind that schedules elective inductions, has short prenatal visits, tells laboring women, "if we break your water, it may help speed this process up a bit." {{<i>shudder</i>}} I disdain that midwife --- or doctor, or whoever --- and rolled my eyes at her throughout my training. No way would I disrespect my clients or gamble with their health and well-being.<br />
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Oops.<br />
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I might as well get it tattoo'ed right across my cheekbones. It's me!! I'm her! I'm <b>THAT</b> midwife! *sob* I realized last week how blurred the line has become for me; of the babes I've caught since I've come here, only half (give or take) have been spontaneous labor. The ones that have been induced have rarely been for good, solid medical reasons. Epidurals run rampant - and I don't talk mamas out of them. Initial prenatal visits include a pre-canned speech including reassurance that choosing a CNM-assisted birth does not automatically rule out pain medication or epidurals; women whose eyes widen at the thought of going into spontaneous labor on one of the six days in a given month when my partner or I are not on-call are quickly comforted with a subtle promise, "depending on how you're doing and how favorable your cervix is..."<br />
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Who have I become?!<br />
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Part of me bristles at this recognition. I <u>don't</u> want to be a "medwife". For every 5-10 minute, tummy check/dopple/how-ya-feeling? prenatal visit, there are four times as many that last three times as long (not to mention the "well" woman visits, gyne exams, and primary care...) As a general rule, our patient population needs *midwives* , not medwives; so many of our families are wrapped in generations of epidemic substance use, alcoholism, violence, and broken families. To be "with woman" consistently - providing unbiased, compassionate care for months and years without fail - seems like the best gift to offer these women, both those who seem to be desperately seeking it and those who push it away. On the other hand, to balance this, time gets away... the "good" patients get quick visits... and unfortunately sometimes things get missed. (I know that this has to happen --- the quiet, sad-eyed primip? During a brief, mid-pregnancy visit when I'm focused on the drug-addicted mama I had just seen --- or worrying about the postterm multip who had <i>again </i>been a no-show --- I might miss the cues that she's giving that something is wrong. I might not ask the right questions, give her the time she needs to feel comfortable to open up to me. Shit.)<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVNzQHSJj8AITfFanwaVLN7e8qtPhyphenhyphengkoO68ZsswnOKWNZZXqwJqVrfhMXOJDVYF2u4UqGLSbcXHw63XCBEoEyL4qhwvtHG7IGXZvJG7n1RN9Tmq1wU7EUKSPNmVvUWTy801eluypOzok/s1600/midwife_500x279.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="222" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVNzQHSJj8AITfFanwaVLN7e8qtPhyphenhyphengkoO68ZsswnOKWNZZXqwJqVrfhMXOJDVYF2u4UqGLSbcXHw63XCBEoEyL4qhwvtHG7IGXZvJG7n1RN9Tmq1wU7EUKSPNmVvUWTy801eluypOzok/s400/midwife_500x279.jpg" width="400" /></a>But - the realistic part of me knows that some of this had to happen. Inductions happen; so do epidurals, and so --- knock on wood --- will c-sections. Without generalizing the women I am so blessed to work with --- I don't practice in a population that will (can?) embrace the granola-crunchy, no-interventions-please philosophy. (Happily, they don't generally fit the "yes sir, whatever you say, Doctor" mold either... these mamas are strong, and will do whatever they know is best in their situation).<br />
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My hope is that I can continue to cultivate growing relationships with each woman and family I work alongside, as well as the community itself, to find the "right" plan for her situation. No glibly tossing out the "I" word, giddily skipping down the L&D hallway to pop a bag o' water, or passing out epidural tubing and meds like candy at a 4th of July parade - simply trusting the relationships and our communication to find the path to a healthy, happy end. hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com1tag:blogger.com,1999:blog-4430506625470707567.post-22968586700582779902012-08-24T18:49:00.002-07:002012-08-24T18:51:44.240-07:00Long time gone...Hey, nice to see ya! Where've you been?! Oh, wait, I guess maybe it's where <i>I </i>been, eh?<br />
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So, needless to say, this post is loooooong overdue. I think this blog's last posting was somewhere around, oh, six months ago? Huh. I guess it's been a busy half-year. Since our last rendevous, old friend, I've packed up and picked up everything to move half a days drive away, officially gaining entry into the world of a practicing (and <b>paid!!!</b>) nurse-midwife, and gloriously helped a powerful mama pull her newest into her arms, standing alongside her bed... (my first out-of-bed birth - woohoo!). I've said goodbye to so many friends --- and in a heartbreaking moment that doesn't end, to my baby brother, standing alongside each of my family members as we realize the swiftness with which goodbye can be missed; I've lain awake at night and struggled with my own internal guilt, fears, remorse, anxieties - both professional and personal. I worry about meeting the expectations of my clinic administrators, meeting the needs of my clients, about being thorough yet not over-ordering or falling behind; I fret about when the golden hospital privileges will <i>finally </i>be mine, how stressed my partners are in the meantime while they await that day and how tiring it must be to have to back me up until then.<br />
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And, of course - I yawn, I drag, I sleep only halfway 98% of the time, hoping/not hoping my pager will go off... if it does, if that next mama's water finally breaks, it will be one more babe closer to independent privileges and a bit of relief for everyone all around (but if it doesn't, of course, it means a bit more sleep for everyone on the home front.) Officially, I'm on call something like four nights a week - but unofficially I've been sleeping with my pager under my pillow just about 24/7 since starting in April - or at least since getting permission to get near hospital patients a month or two ago. It doesn't beep at me often ... yet I still dream that it does, or that it did and I slept through it, or that the batteries died and someone's been frantically trying to find me, yadda yadda....<br />
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Oh, but the catches - the sweet, slippery, lovely babes! (Really, isn't that what it's all about??) When it's down to that moment, the rest of the stress, the worrying, the anxiety melts away. Until, that is, the hemorrhaging afterwards... or the placenta sticks... or mama passes out later on.... you know, those sorts of things.... But the catch itself, usually, is a rush!<br />
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I pledge, from this point forward, to stay more loyal to this blog.And I hope you'll stay here, too. Like any good things, any journey worth taking, it may be a long road, but hopefully worth the travel....<br />
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: x-small;"><i style="font-family: Times,"Times New Roman",serif;">My "birthingway" necklace ... or "mamalove" necklace... or "I Catch" necklace" ... or ??? </i></span><br />
<span style="font-size: x-small;"><i style="font-family: Times,"Times New Roman",serif;">(I'm open to suggestions!) ... for every babe, a bead <3</i></span> </td></tr>
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<br />hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com1tag:blogger.com,1999:blog-4430506625470707567.post-11829733803557124832012-02-29T14:44:00.003-08:002012-03-01T19:36:36.018-08:00Happy Birthday, Memories...<div style="text-align: center;">Happpppy Birthday To You........ (or) I just want to eat sweets!!!<br /></div><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOCd_mM9OQJNghfcXnAsv6rj3kNIZfD6QBL6ZNOwafnYnYla92IS-Njd4lQOamNScHfc960hN4IMe-x5u0wbJURRMot0yIs6NIZ5hnH9PtErPzuInD2UnIJAFGDsgT-cYS32ihzpaLwE8/s1600/mock.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 238px; height: 285px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOCd_mM9OQJNghfcXnAsv6rj3kNIZfD6QBL6ZNOwafnYnYla92IS-Njd4lQOamNScHfc960hN4IMe-x5u0wbJURRMot0yIs6NIZ5hnH9PtErPzuInD2UnIJAFGDsgT-cYS32ihzpaLwE8/s320/mock.jpg" alt="" id="BLOGGER_PHOTO_ID_5715136269739125698" border="0" /></a><br />It's a time for nostalgia. All the inner turmoil (where to go, what to do...) sometimes causes me to curl into a ball within myself, rather than seeking outward direction. Today, in that mode, I happened to click on <a href="http://atyourcervix.blogspot.com/2012/02/currently-researching-and-writing-about.html">AtYourCervix</a>'s most recent blog entry, which begged the question (at least to me): How, as a midwife, can I empower women to be true partners in the pregnancy and birth they want?<br /><br />The more I pondered this, with Judge Judy and a roaring fire in the background, the more I realized I hold this as a cornerstone of my own midwifery philosophy. If women (and their families) don't feel that they are invested and active participants in their own care, how do we - as providers - expect to build a close, trusting rapport that will endure through the long, scary, demanding hours/days/weeks that build up to the actual birth of the precious babe? The emotional, physical, and mental toll that the process can have on a relationship (whether marital, familial, or provider-client) is immense, and only by working together and "sharing the load" - rather than one member of the duo gifting all of the 'power' to the other - can the weight be used to strengthen rather than risk breaking the bonds that tie.<br /><br />Or something.<br /><br />And this thought train eventually wandered off the tracks and into some rocky, dirt lanes through the woods.... to early last year. I thought I could blurb a little something like the above, link to a post from sometime late last winter/early spring, and, voila! But, as I dug back - I realized that I had very, very briefly glossed over the birth I had in mind for this post. The one that so perfectly exemplifies how shared decision making and informed consent could have been (or <span style="font-style: italic;">should</span> have been) utilized -- and very blatantly wasn't. In retrospect - still a very beautiful, touching birth. But from the provider perspective, so very painful. The family --- an amazing, strong mother-woman, supportive partner steady at her side, and longed-for babe finally brought into their waiting arms --- could not have been more incredible. (I've been blessed to be able to keep witness here and there - hopefully in a not-creepy sort of way! - and am delighted that not only has the small family blossomed into a gorgeous example of two loving parents doting on a beautiful young'un --- but they also seem like just so much "fun"! And maybe that's the crux of this whole post; seeing someone who I really identified with, who I could see as possibly being very close friends with, had our paths crossed at another time, hurt in this way...)<br /><br />So, if you'd like to sit back, relax, and listen to a little story about informed consent, shared decision making, and all of that good stuff - let's all take a big step backwards (away from the angst of when-is-the-phone-going-to-ring and blizzards and job worries of my current life, and back to the days of my early clinical rotation...), shall we? Here goes...<br /><br /><div style="text-align: center;"><span style="font-style: italic;">(cue dimming of the lights)</span><br style="font-style: italic;"><br style="font-style: italic;"><span style="font-style: italic;">(maybe a little mood music... something...)</span><br /><br />(Oops, wait - cut the atmosphere. Remember, no real names, no actual pictures of the client, the babe, details changed, etc, etc.... c'mon now, folks! Protecting privacy here :) Okay, rewind back to that warm, cozy story-in-front-of-the-roaring-fire-again... where were we?)<br /><br /><br /></div><div style="text-align: center;"><span style="font-weight: bold;">The Story</span><br /><br /><div style="text-align: left;"> The patient (we'll just call her "Mama" for the sake of privacy, ease of typing, yadda yadda) and her husband (oh heck, why not call him "Papa", eh?) had transferred care to the midwife I was precepting with sometime towards the end of her pregnancy; not at the <span style="font-style: italic;">end</span>-end, but sometime between the end of her second trimester and final weeks of her pregnancy. The couple had learned there was a nurse-midwife in the area and - being well-informed in the pregnancy and birth process, and knowing they wanted to seek a more natural, low-intervention birth experience - were excited to meet her in the hopes of increasing their chance of finding this sort of birth. The pregnancy had been perfect - Mama had no risk factors, no concerns, no red flags. As of the forty-week prenatal visit, everything was as "textbook" as any pregnancy could be classified.<br /><br />Like many babes of first-time Mama's, however, Little One had no particular plan for working its way out. Home -- aka the uterus -- was quite plush and cozy, particularly in the cold Midwestern winter days before spring finally hit. So when that forty-week appointment arrived with no signs of impending labor, my preceptor had already mentioned the possibility of nudging the Little One on its way via an artificial method or two; Mama had politely declined, reminding the midwife I was working with that she and Papa hoped to avoid as many interventions as possible unless <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhE0LRGu2Hb-H-VuG-Cr-vzzOYq_AH82041XcXPRXSHF9oFMC1edKlh76C04GQMKtTLGsRHk0Xc6_d2UjVmbYjma_q6BZS2mVFDQDi_8XtvzCKDB8F8Wi4UAp20bLvU4rTaU_HrTZAVV0w/s1600/mock1.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 400px; height: 266px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhE0LRGu2Hb-H-VuG-Cr-vzzOYq_AH82041XcXPRXSHF9oFMC1edKlh76C04GQMKtTLGsRHk0Xc6_d2UjVmbYjma_q6BZS2mVFDQDi_8XtvzCKDB8F8Wi4UAp20bLvU4rTaU_HrTZAVV0w/s400/mock1.jpg" alt="" id="BLOGGER_PHOTO_ID_5715135483410619442" border="0" /></a>there was a true medical intervention. Since Mama felt good (she was doing amazing at this point, from my outsider's point of view; I remember when I passed the 38... then 39 week mark with the Mini-est -- after delivering right at 37 weeks with the Mini-er -- and thinking that <span style="font-weight: bold;">e v e r y single day d r a g g e d on <span style="font-style: italic;">l o n g e r</span></span> than the one before it. As my due date loomed before me, I know I looked nowhere near as calm and simultaneously energetic as Mama did!) and Little One showed no indications of distress - and there was no evidence-based rationale to push induction at this point - an appointment was made (following a reactive non-stress test) to see Mama back the next week. My preceptor hesitantly agreed to allow the pregnancy to continue and re-visit the induction topic at that point, all depending on Mama's cervical status, how Little One "performed" on the upcoming non-stress test and biophysical profile, and, of course, any other surprises in the meantime. <span style="font-style: italic;">(My memory is hazy at some of these details; I seem to remember, however, that my preceptor's plan -- which seemed to me as more of a begrudging negotiation to Mama's continued decline of her offer of induction -- was to induce at 41.5 weeks at the latest. Again, I may be mis-remembering these details... but in the end, it's more or less a moot point.)</span><br style="font-style: italic;"><br />Fast forward another long/short Midwestern almost-spring-but-still-the-last-hurrah's-of-winter week. <span style="font-style: italic;">(Excuse me a second while I slip into something a little more comfortable ... present tense now...)</span><br /><br />Mama checks in for her scheduled appointment, doing great, no concerns for the assistant who rooms her and checks her blood pressure. A few minutes later, I step into the room and start visiting easily with Mama, who laying back on the exam table resting. I tease that Little One must be a girl; that she's "in there" doing her hair, taking her time to get "all pretty" for the big day, and that must be why things are taking so long. We joke about my freezing cold hands (as always), talk about the usual important questions - any leaking of fluid? funny vision changes? crazy pains? bleeding or baby movement changes? - while I wash my hands and find the tape measure, doppler, gel, and anything else that I usually forget. Little by little, I work my way back to the reclined exam table where Mama is still laying back, resting as comfortably as possible at this stage. Finally, I get my hands on that belly; my inexperienced student hands work to try to determine fetal position and lie (is that a breech? Feels like a back along this side... I <span style="font-style: italic;">think </span>that's a head working its way closer to engagement...), and then go ahead and assess cervical dilation as instructed by my preceptor, who is curious about any changes from the previous week's assessment. Not much of anything. (I don't remember the exact details... Mama was not crowning, anyway.)<br /><br />Finally, after all this goofing around, I make it to the important stuff --- baby beats! Goop on the doppler, doppler on the tummy, beats in our ears. Initially, we hear a nice steady rate --- 120's. And then... <span style="font-style: italic;">Ba</span>-<span style="font-weight: bold;">dump</span>, <span style="font-style: italic;">Ba</span>-<span style="font-weight: bold;">dump</span>, <span style="font-style: italic;">baa</span>- <span style="font-weight: bold;">duuump,</span> <span style="font-style: italic;">baaa</span>-<span style="font-weight: bold;">duuuuuuump,</span> <span style="font-style: italic;">baaaaa</span>-<span style="font-weight: bold;">duuuuuuuuump...</span> <span style="font-style: italic;">baaaa</span>- <span style="font-weight: bold;">duuuuuuuuuuuump...</span> (Okay. I admit it. I haven't quite figured out the best way to translate an audible, deliberate drop from a happy, normal Little One's cardiac reading from an external fetal monitor to an oh-crap-I-don't-know-if-I-like-that-so-much sound. But, if you've worked labor/delivery - I have a feeling you might know <span style="font-style: italic;">just </span>the sound I'm trying to describe here.) Suddenly, my lovely 120's kiddo is picking up in the 70's-80's range; uck. And, unlike those instances where I've had cause to wonder if I might have started picking up maternal, I was quite certain that it was still Little One's heartbeat; I had been picking up a strong, steady heart rate (discernible from the maternal heart rate by the sound), and had heard it fall beat by beat; a quick pulse check from Mama could easily confirm this as well.<br /><br />Well, of course - a decel is a decel, and like any deceleration, it makes an OB nurse think a little bit. My first thought was to get Mama moving a bit (and certainly once I had a few seconds to think straight, a head-slap was directly in my future for setting up the whole situation... but that was later), and off of that laying-back position she'd been hanging out in for probably a good 20-30 minutes by this time. Within seconds, as expected, Little One was giddily climbing right back up and cheerfully chugging along around baseline, anywhere from 120's to 130's. I was feeling better. But. (There's that "but" again... we've talked about that before, eh?)<br /><br />But. My precepting midwife had walked in in the midst of the heart rate, as I was working to help reposition Mama; the decel did not excite her at all (understandably) and she quickly explained to Mama the importance of expediting delivery for the "health of the baby". (By this point, I had not had a chance to explain the circumstances leading up to the deceleration, either to the precepting midwife or even to Mama, who was equally understandably upset by the midwife's reaction to this.) To condense a hectic, emotional office visit, my precepting midwife - after learning of the extended time that Mama was laying fairly flat and likely compressing her vena cava, possibly contributing to the decel (which lasted I would estimate 90 seconds or so) - modified her initial plan of care, which very strongly suggested an ambulance ride to the hospital (about ten minutes away) complete with IV fluids and cesarean prep, to "allowing" Mama to drive herself to the hospital and meet both of us there to begin an immediate induction.<br /><br />(During the commercial break between "this calls for an emergency c-section NOW!" and the latter decision, Mama had been hooked up for her scheduled non-stress test, which was <span style="font-style: italic;">beautiful</span>. Little One never strayed from the baseline s/he had demonstrated in previous weeks, had gorgeous variability, accelerations up the wazoo, and no further decels.) Outside of Mama's door, my preceptor turned to me and explained that "You never, <span style="font-style: italic;">ever</span> let a patient leave undelivered if you hear a decel like that in the office." On the other hand, Mama was on the phone with Papa, trying to relay all of this sudden rush of news; she was in tears, unsure what any of it meant, frantically worried about the health of their baby. In the middle of it all, I was left to try to assert my newly-forming role; I felt on so many levels that Mama wasn't getting the whole story from my preceptor, yet (based on other things that were already happening in the clinical setting) I wasn't sure how aggressive I dared be. I wanted to tell Mama that everything truly was okay; of course we couldn't be 100% sure that there was <span style="font-weight: bold;">nothing</span> going on that contributed to the decel (can we ever be truly 100% about anything?), but the fact that so many things had led up to it - or just the fact that we <span style="font-style: italic;">know </span>variable decels are a part of normal labor and delivery, and if transient/not repetitive/not prolonged/etc, they are usually benign? Or, that if we monitored every pregnant woman continuously from the 24th week of her pregnancy until she delivered - without intervening - we'd probably all pee our pants at the kind of things we'd see that happen on a semi-routine basis (yet that don't actually cause harm). I wanted to tell Mama to question what other options, besides immediate induction, were available; I wanted to offer a biophysical profile to complement her reassuring non-stress test, or, maybe a stay in the antepartum suite overnight with a repeat NST and BPP in the morning for further reassurance. Or a consult with the MFM specialist. Or even simply <span style="font-style: italic;">ask </span>if she and Papa which plan they felt comfortable with.<br /><br /><span style="font-weight: bold;">Sans</span> the "dead baby" card. (For those of you unfamiliar with this ploy, it's basically as straightforward as it sounds... the provider, for fear of liability --- i.e. I am going to tell you that if you don't listen to me and do as I say, your baby could die/have a serious ill effect/etc; this way, if you don't listen, I can say "I told you so!" and my ass is covered... --- , for convenience, or just out of some deep-seated love of power. Or, I suppose, a handful of other reasons. Anyway. Unfortunately, that's what my preceptor did, without using the specific words "dead baby". She tiptoed around the phrase, strongly encouraging (although really, when your doctor/midwife/care provider "encourages" you to do something - particularly if you just had what seemed to be a pretty scary, dramatic few minutes - it's not really encouragement at all... it's an order, a telling, a demand... isn't it?) Mama and Papa that it was time to induce this labor. No, she knew it wasn't what they planned on; but, Mama was now 41 weeks, the placenta was getting old, and the baby was <span style="font-style: italic;">clearly</span> stressed. Opting to wait to induce at this point could be a very bad idea, and unfortunately it's not something you want to look back on with regret when it's your precious baby's life ... do you?<br /><br />Oh dear. Of course you don't...<br /><br />So - Mama and Papa agree hesitantly, but with great love and worry for Little One, to be induced that afternoon. A medication is given to help begin the process (intervention number one), continuous monitoring is done (intervention number two), and a few hours later, Mama's water is broken to help things continue progressing.<br /><br />Throughout these hours, Mama and Papa - with the help of a wonderful support team - are unbelievable. Like few other couples I've seen, they bravely open themselves to each new change in their birth plan as if it is not an unwelcome intervention but rather like it is a glad gift to ease the coming of their babe. Contractions made stronger by the inevitable pitocin (intervention number three or four, I lose count eventually of course) are greeted with smiles of enduring strength rather than requests for pain medication, and hours and hours of long labor - meant to be spent quietly at home, their prepared soundtrack playing them along - pass instead in the fluorescent hospital room, with staff coming and going. Antibiotics, internal fetal monitors - nothing sways this team.<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpLVUGF0-8ehdVi1Cwd1xJdPCQeQm94m7sA5UXfiqHSJahA5n-kpGfboT2TOVc2uc1zRAQS-LBHts31SSaJN72BN50PXaynhR8StohiV5To2YTFvnkII-jFb8o1L8zU0Iu_qfX1ZWAfTA/s1600/mock2.jpg"><img style="float:right; margin:0 0 10px 10px;cursor:pointer; cursor:hand;width: 400px; height: 262px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpLVUGF0-8ehdVi1Cwd1xJdPCQeQm94m7sA5UXfiqHSJahA5n-kpGfboT2TOVc2uc1zRAQS-LBHts31SSaJN72BN50PXaynhR8StohiV5To2YTFvnkII-jFb8o1L8zU0Iu_qfX1ZWAfTA/s400/mock2.jpg" alt="" id="BLOGGER_PHOTO_ID_5715134908367958450" border="0" /></a><br /><br />Finally, the time has come to meet Little One. The babe greets the world as some do, a little surprised and needing just a bit of help getting going - but otherwise beautiful, strong, and looking for Mama. Yet, instead, without skin-to-skin or a chance to feed - it's off to the NICU for "fluids" since the birth must have left a wee one somehow low on fluids, maybe a bit too "blue" for the NICU NP's liking. (I have to butt in here - sorry - but as an OB nurse at a critical access hospital... I was appalled at the number of babies taken to the NICU for "fluids" or because they weren't "pinking up" as quickly as the NICU staff - called often if the staff expected a possible issue at birth - liked... babies would be crying and have great tone, color, and respiratory effort after the initial 1-minute apgar, yet they would end up separated from their mothers for 24 hours for these reasons. Hmmm.... It seemed like - and I heard rumors to this effect - a case of "we have NICU in house, so we have to use them or lose them.") Mama and Papa had worked <span style="font-style: italic;">soooo</span> hard, for <span style="font-style: italic;">soooo</span> long to birth this Little One - only to watch the NICU team wheel the bassinet upstairs, for an unknown length of time. (This, of course - the biggest and most obscene intervention of all; the cascade of the others, from the very induction that should have been discussed as an option along with all other possible alternatives, led to Mama being kept from her Little One for an incredible, infuriating amount of time. She could not see or touch her baby in the NICU until she had eaten, been up to the bathroom, and showered; the nursing staff refused - per policy - to simply assist her to a wheelchair and allow her to go to see her infant.)<br /><br />In the end, like with so many other instances of less-than-true-informed-consent, it worked out: everyone is fine, and lovely. Little one is gorgeous, Mama is happy, and Papa is, well, a proud Papa. My preceptor ended with a healthy mama and baby, and no fear of litigation or a peer review from her collaborating physicians. I, though, ended with a family that still haunts me; I am grateful for the beauty of their birth story - beyond all that was done to them, they remained strong - yet am saddened for the lack of informed consent that took place (and that, truly, exists in most facilities regarding pregnancy, labor, delivery - and inductions in particular).<br /><div style="text-align: center;"><br />~*~*~*~*~*~*<br /><br /></div><div style="text-align: center;">Happy Birthday, Memories!<br /></div></div></div>hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com1tag:blogger.com,1999:blog-4430506625470707567.post-74653672646069834992012-02-28T12:02:00.005-08:002012-02-28T12:53:22.152-08:00North by North West...That - is the question.<br /><br />At the end of the last post, I alluded to some internal conflict between the two sites where I recently had interviews. The first site, dibbed "North", is located about 5-6 hours from where my family has always called home. It's got quite a few things going for it; the pay is nice (relatively - I don't know what the other nurse-midwives that graduated in my peer group are being paid, for the most part, but the rough starting pay I was quoted for this position is about what I was expecting based on my searches for this area). The site is also a <span style="font-weight: bold;">HRSA </span>(Health Resource Service Administration) designated site, and the position is eligible for loan reimbursement --- which means that by committing to work in the role for at least two years, I would say buh-bye to a nice chunk of my student loans (and by working a third year, one more of those big ole monkeys would also take a hike... leaving me just about free and clear on the loan front). My partner would be a midwife who developed the nurse-midwifery practice at the site ten years ago, and has worked to build a great relationship with the handful of family practice doctors who she works alongside (by the way, I LOVE family practice doctors - not such a fan of OB's --- most likely because I simply have worked with very few, but also what I have heard of them hasn't been so favorable...). The main clinic at this site is located in a rural area and is <span style="font-style: italic;">very </span>full-service, offering clients a range of services from x-ray and lab to WIC and massage; the practice also has a secondary site in a large city about 30 minutes away, with limited services (but just as vital care for recipients in the urban area). Call would be shared, possibly 2-2.5 days a week and 1 weekend a month (with an estimated 50 births annually); clinic would be 4 days a week split between the two clinic sites. After visiting "North" --- I felt good, confident, ready to go. I had a strong feeling that I was going to be offered the position, and that I would probably take it.<br /><br />But. (That "but" is always there, now, isn't it?) In the days that followed our return from our visit, a few things nagged at me. At the end of my visit with the midwife at "North", I asked a few questions (thankfully) regarding the specifics of her midwifery practice. <span style="font-weight: bold;">Did she feel that she did a lot of inductions?</span> <span style="font-style: italic;">(She felt like she actually probably did more than she should... </span><span style="color: rgb(255, 0, 0);"><span style="font-style: italic;">red flag?! red flag!! </span><span style="color: rgb(0, 0, 0);"><span style="font-style: italic;">Her rationale? She </span><span style="font-weight: bold; font-style: italic;">did </span><span style="font-style: italic;">take days off - understandable, since she was a solo midwife and had been for the past 10+ years; she stated that she did offer induction at times to her patients before she went on vacation. Hmmm. So - on one hand, this seemed OK. On the other... something to ponder.)</span> <span style="font-weight: bold;">What about continuous monitoring versus intermittent?</span> <span style="font-style: italic;">(Answer: If a woman specifically wanted to be off the monitors, she was good with that - but if there was no preference either way, she didn't push for intermittent monitoring either... </span><span style="color: rgb(255, 0, 0); font-style: italic;">???!!? <span style="color: rgb(0, 0, 0);">Rationale for this one --- The nursing staff tended to be low, and this made IA difficult to impossible at times. The unit did have telemetry, so continuous monitoring didn't necessarily =/= a patient that was stuck in bed --- but then a</span></span></span></span><span style="color: rgb(255, 0, 0);"><span style="color: rgb(0, 0, 0);"><span style="color: rgb(255, 0, 0); font-style: italic;"><span style="color: rgb(0, 0, 0);">gain, MY unit also has a telemetry unit... which sucks. As much as I'd like to say telemetry means a patient can labor while ambulating, or in the shower, or on the toilet or squatting or standing on her head --- not necessarily. Especially if she's on continuous EFM for nursing/provider convenience in the first place. S0 - another thing to ponder. While again I can understand the reasoning behind using EFM versus the additional time necessary to IA --- and am glad she had that explanation rather than that she needed the security blanket of the paper/electronic strip to ensure babe was doing all right --- I still get nervous at the idea of having hours and hours of paper strips staring at the nurse... and resident... and whoever looks at them and starts seeing oogie-boogie monsters in the shadows of innocent variability or the occasional benign decel.) </span></span></span></span>Those were the two biggies on my "hmmm" list... From just a facility point of view, it would take a while to get used to LDRP's that are half the size of the ones at "my" rural critical access hospital, some of which have shared bathrooms. And residents (I've never worked with residents in my life - they seem like a whole different species!). And - while I won't say specifically which states, I <span style="font-style: italic;">will </span>say that "North" is in a neighboring state which has a longstanding, sometimes vicious football rivalry with our NFL football team. And the Warm One is a diehard football fan.<br /><br />So there are at least a handful of things that "stick", if that makes sense. Not that I'm not seriously considering things --- it's just not 100%, yet...<br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiifxWu-BHhATfqvx3V4gdbfgKo_9xKL4qCMzkpqGsTPbHKZ3I_vnybBSK4t1i-zcNgkolZrBOzAlMAmgzQXOJEwARvu5jqjZdwz6m5Z9fvG9wvD4aGubsZHplZlM3dZpkz8Ze4qqm6iZg/s1600/mock.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 262px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiifxWu-BHhATfqvx3V4gdbfgKo_9xKL4qCMzkpqGsTPbHKZ3I_vnybBSK4t1i-zcNgkolZrBOzAlMAmgzQXOJEwARvu5jqjZdwz6m5Z9fvG9wvD4aGubsZHplZlM3dZpkz8Ze4qqm6iZg/s400/mock.jpg" alt="" id="BLOGGER_PHOTO_ID_5714292231103122578" border="0" /></a>And then - there's "West". I flew out there last week and fell in love. I texted the Warm One immediately (or maybe it was after dinner with the midwives - either way, I hadn't been there long) and emphatically told him that I would cry if I didn't get the position. Throughout the course of my two days with the midwives at the "West" practice, my position on the area and their care philosophy didn't change. At all. I want to go there. The town where this practice is located? Beautiful. It's twice the size of the small town I live in; I'm a small town girl, so I can handle that. Their practice? Gorgeous. Clinic exam rooms that are spacious, with huge, full-sized "beds" (seriously, I have no other way to describe them) covered in pillows created for expectant mothers to lounge --- alongside big brothers and sisters, or dads-to-be as well --- and chat, listen to that precious heartbeat, and learn. Beautiful birth-inspired, earthy artwork everywhere. No sterile white walls or ugly, plain paintings meant to be aesthetically neutral. All of my questions - "Do you induce a lot?" "How do you feel about VBAC's?" "Are you open to a new grad?" - are met with <span style="font-style: italic;">just </span>the right answers ... yes, inductions <span style="font-weight: bold;">are </span>necessary sometimes --- but not just 'because'! And they do VBAC's, and waterbirths, and <span style="font-weight: bold;">LOVE </span>students. It's amazing just to pick up the calm, reassuring vibes as they answer questions - to picture these two women as mentors is mindblowing. The call/clinic schedule is specifically geared to give each of the three midwives a rejuvenating period frequently; at least once every three weeks, each midwife gets a 5-day off stretch (that is, five STRAIGHT DAYS OFF in a row. Heaven. No clinic, no call, nothing, for five days.). Clinic and call are intermixed, often with stretches of 3 days off in a row as well. As one of the midwives stated, "When we are on-call, we usually work hard (the group of three midwives delivers between 250-300 babies annually) - but when we're off, we also 'rest hard'." I can dig that. To be able to serve my patients AND my family? Awesome-sauce. And the hospital is about 2-2.5 larger than 'my' OB unit --- so larger, but not as large as "North"; the nurses were great, and loved the midwives. Downfalls? Cost of living! To find a house under $200k may be impossible, and we would have to trade in one of our cars for an AWD or four-wheel drive; the pay "West" is also significantly ($10-$15k - ish) less than "North", with 2 weeks less vacation time and likely less benefits in other areas, particularly no loan forgiveness. Big things the Warm One is concerned about. And, of course, being a plane ride away from Home. Where the hearts are.<br /><br />Speaking of home.... And hearts. It's a hard thought to think of leaving everyone that I/we love behind us. As much as I always suck at returning messages, emails, phone calls, etc --- it's even harder with all of this going on. Part of me wants to ignore that any of this is happening - that any changes are coming - but to do that it also means ignoring any references to change. Whether we go "North" or "West" ... or anywhere else ... it hurts. And it's scary. But it will be okay, too.<br /><br />For the time being, I'm waiting for a phone call. A phone call from "West" could be making a decision that we go that way - throwing caution to the wind and hoping that the cost of living will balance out - or the other way. Or, perhaps, no call, but a "thank you, but no thank you" letter (as they did have two other candidates yet to interview...) leading us "North" ...<br /><br /><div style="text-align: center;">~*~*~*<br /><br /></div><div style="text-align: center;">In the meantime, I'm content to be back on the edge of that abyss, arms wide open, and leaning in, knowing that wherever the fall leads, I will land gently...</div>hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com0tag:blogger.com,1999:blog-4430506625470707567.post-67803749867949807242012-02-25T15:02:00.005-08:002012-02-25T16:03:59.865-08:00Opening<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWoSsVD963wDYjEoAQQn_lDw26cYVUNzvYW37xPfELOTKmwJlco6k0oTww6pJ-yVDgcMLA2llZYZLuytF2WdQxzxhbenVZ3hrAnQ4FC_5VG7aGGrGzTogbIgUQRqDHclBSp4sPnw5AtUM/s1600/mock.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 259px; height: 162px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWoSsVD963wDYjEoAQQn_lDw26cYVUNzvYW37xPfELOTKmwJlco6k0oTww6pJ-yVDgcMLA2llZYZLuytF2WdQxzxhbenVZ3hrAnQ4FC_5VG7aGGrGzTogbIgUQRqDHclBSp4sPnw5AtUM/s400/mock.jpg" alt="" id="BLOGGER_PHOTO_ID_5713228261632014594" border="0" /></a><br />That last post? It was the darkening before the dawn... the cold, bitter rains of March right before springs first tentative blooms poke through the thawing ground... the tensing of every last muscle, stressed, fearful, fatigued -- and then a loved one's arms are there to encircle and release it all to the universe itself.<br /><br />Do I need to step back a mile or three? Maybe that would help...<br /><br />From a career/baby-catching standpoint - you could say that the last post was somewhat colored by the sludginess I've felt in my job search. (Which, in itself --- seems somewhat silly... I didn't expect to come out of school with a job in hand, as nice as it would have been. But still - now that it's been five months, I'm getting a little antsy...) Every day that I go without that delightful weight sliding into my hands, without gifting mothers with the words "here's your beautiful child" ... it weighs on me. Sure - I can still go to work as an L&D nurse; I can still whisper forbidden encouragement into the ears of hardworking mama's ("go ahead... eat some crackers... nibble on that granola bar..." ), but it's not the same. The mothers, the fathers - they know I am the nurse; they have only just met me, and even if we have "clicked" and even if they can sense that I am there for them and their babe --- I am still, just, the nurse.<br /><br />I've sent resumes, CV's, emails of inquiry. I've had an ongoing email chain, complete with an powerpoint proposal, to the physician group that I've worked with for the past five and a half years - a handful of great family doctors who practice <span style="font-style: italic;">this</span> close to the midwifery model of care. Throughout my clinical rotation with Dee, there was the shadow of a promise of her practice adding a second CNM. Nothing. Zipzilchzerozuess. "My" doctors decided that while they felt there would be interest in a CNM in our area, they feared "there would not be enough demand for a full-time position". A few attempts to get in touch with Dee (after a promising email before the holidays that her administrator was going to start the process to try to get the wheels going...) weren't returned. A promising position - complete with loan forgiveness via the HRSA program - seemed very likely and suddenly... *poof*! Que sera, sera.<br /><br />But. On top of this, I live in the Midwest. In winter. A gray, long, cold Midwestern winter. The task of looking for a job - refreshing the same search engines, day after day (many times multiple times daily) - combined with more and more student loan payments being auto-debited as the days stayed devoid of sunshine ... you get the picture. Little by little, negativity begins to replace the fresh enthusiasm of graduation; did I really just sacrifice three arduous years and an incredible sum of blood/sweat/tears/trees/memories/etc (not to mention indebtness to the good old Department of Education/Loan Repayment Program), only to continue to work <span style="font-style: italic;">very </span>part-time as a labor and delivery nurse?! Am I undesirable as a CNM?? Is there something that screams "don't hire this girl, for pete's sake!!" on my resume? Do I need to eat more chocolate - will that help??<br /><br />So - anyway. It was a long couple of weeks, and maybe that post reflected some of that. In the end, I resigned myself -- or liberated myself -- to the old "letting go, and letting God" (or the Creating, or the Universe, or destiny, or karma, or what have you... I'm not entirely sure, myself) take over.<br /><br />And - it worked.<br /><br />Not long afterwards, I heard back from the site that seemed like it could be the "perfect" fit (we'll call that site "North" for the sake of, well, easy-ness). It turned out the midwife's mother had been ill and unfortunately passed away; that had prolonged the interview process, but ultimately within the next week or so I spoke with the midwife and HR folks, and set up a time to go up and meet them all in person and tour the site. I also sent a CV to a second site - this one a private midwife practice out west (we'll call this one "West" for those of you following along), and had some nice back-and-forth communications with them via email. After my first Skype interview (interesting enough), I was invited to fly out there and meet them in person as well. Both visits/meetings went great, and now I sit with one likely offer (from "North", pending the approval of one final committee) and a call back next week from "West", where there were still 2-3 other applicants to be interviewed.<br /><br />My dilemma may or may not be solved by next week's call by "West" ... but that's another post!hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com1tag:blogger.com,1999:blog-4430506625470707567.post-20044630791377305902012-01-27T11:29:00.000-08:002012-01-27T12:50:53.729-08:00The Abyss<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQiPLT5LDfru6byjbu-gNo4Um_nDIABzHasMIeQnrvnko4clV3zosiMWRTfgjXzR412zBQQ2lhi31grUm8nkB9UPldJVl7La79-EBhJzVp1ruUeGDTVzmsaiMemVhWDrlllwACj0Ljxzo/s1600/MP900407504.JPG"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 263px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQiPLT5LDfru6byjbu-gNo4Um_nDIABzHasMIeQnrvnko4clV3zosiMWRTfgjXzR412zBQQ2lhi31grUm8nkB9UPldJVl7La79-EBhJzVp1ruUeGDTVzmsaiMemVhWDrlllwACj0Ljxzo/s400/MP900407504.JPG" alt="" id="BLOGGER_PHOTO_ID_5702415260394115890" border="0" /></a><br />I waver between two different realities. One, I stand on the edge of a total, all-encompassing darkness. My bare skin is chilled - goosebumped - but invigorated. Behind me is all I know, everything familiar, the things that have always been. In front of me is... what? Nothing? The steep, sudden chasm at my toes should frighten me, yet I feel nothing but an overwhelming sense of calm now; that fear - fear that should envelope my entire self - has vanished along with the light from this space. I know that to step off could end everything - but it could also be the beginning of everything. With the slightest step into the unknown I will open my wings and fly to the place of my dreams, or simply land where I'm meant to be: a pillow of soft clouds, the waiting arms of a One who created me, or the place of my family's future. A soft wind's push, a strong legged-leap, a quick stumble... any of these things would move me on, and yet - I pause at the edge of the question marks beyond.<br /><br />Then there's the second place; the place where the Fear lurks. Down a constricted, narrow earthen tube - barely wide enough to descend, long enough to make the late afternoon light little more than a tarnished penny above - lies the insignificant yet crucial room. Constructed of thick steel, lined in double layers of thick and splintering wood, barely larger than a bathroom stall (and certainly less than five feet tall)... it smothers, it suffocates, it shrieks. Time stands still at the same moments that it races by; in the silence of the box, the deafening darkness threatens me with insanity. I stand at this fissure, knowing the only way to complete this journey - to pass this test - is to descend the long ladder downward, to endure my time inside with my Fear, and fight my way back up and through the long, tight passage back... and I struggle, I fight. I know I can do it, and I know I should do it - go down, do my time, and emerge victoriously, proud of my dirt and raw, rubbed skin; I know the struggle is the true origin of my Fear.<br /><br /><div style="text-align: center;">~*~*~*~*~*~<br /></div><div style="text-align: center;">And yet - I still stand here, at the edges. Aquiver.<br /></div>hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com0tag:blogger.com,1999:blog-4430506625470707567.post-36914061148419055392012-01-02T10:39:00.000-08:002012-01-02T12:50:19.008-08:00The Most Wonderful Time of the Year... ~ Or ~ When Things Look Bleak (But Aren't Really That Bad, Right?)<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigXGY-2CfH50-mSE38wfTdLYKdPbVyf2e5lgXxVf03TiCx8_3PZmG7GEqTR-FN9jzNZ8CX4sUE_y5HghsKaB_C6B_VEBW40vFXP6yNv0vSqB0YG2_EQxeINICdhuxGX18w6onTrC3wEHw/s1600/mock.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 269px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigXGY-2CfH50-mSE38wfTdLYKdPbVyf2e5lgXxVf03TiCx8_3PZmG7GEqTR-FN9jzNZ8CX4sUE_y5HghsKaB_C6B_VEBW40vFXP6yNv0vSqB0YG2_EQxeINICdhuxGX18w6onTrC3wEHw/s400/mock.jpg" alt="" id="BLOGGER_PHOTO_ID_5693137406727841026" border="0" /></a>A happy and blessed Christmahanukwanzakah and New Year to all! Pardon my hacking as I make it through the six weeks of dust being knocked off the blog as I start typing through this post *blush* ... (I guess it's been a while. Oops.)<br /><br />Where've I been? Bouncing between the new-found freedom that comes with ((drumroll please)) no more schooling, the excitement of two Mini's and impending snowflakes and thoughts of Christmas time, and the gnawing concern that my baby-catching days are becoming further distant with each day that passes with no job opportunity at hand.<br /><br />(Now, this post isn't meant to be a mopey, woe-is-me sort of thing... what fun is that?? As you may have gathered from previous ramblings, it may just lazily wander around this topic and - hopefully - come to some sort of resolution by the end. Over the past week or two, these thoughts have built into a strong mental blizzard, worrying at me like a six-year-old wiggling a loose tooth. It's amazing, though, how cathartic putting such thoughts out into the universe can be... I'm looking forward to that sense of peace that I know I'll find after hitting "publish" and sharing this with the world, even if no one actually reads this blog any more.)<br /><br />Anyway - back on track. No time for anxiety or worrying too much about the job situation in the first weeks of December; our family celebrates Christmas, so between the holiday preparations themselves (taking the Mini's out to my dad's to find the 'perfect' tree, then trimming the tree and decorating the house, etc) as well as holiday concerts for both girls, cookie baking, the traditional trips to see the big red man, and all the other festivities, I was content to wait. (As of the first of December, I had contact with both Dee and the physicians I work with considering adding a CNM; I also had an interview lined up for a part-time CNM position at a family planning clinic...) It was only after all of the "fun" ended - including the last-minute shopping runs, an unexpected slippery couple of inches of snow (pretty to give us at least a bit of a white Christmas, festivily enough --- but oh-how-slick!), and a surprise attack of fevers, aches, and slug-mimicking for the Mini-est - that everything caught me. And by everything, I mean <span style="font-style: italic;">everything. </span>I realized that just about <span style="font-weight: bold;">ALL </span>of my student loans were suddenly coming into repayment (which, considering I have not only my graduate school loans to repay, but also those for my ADN-to-BSN bridge program, <span style="font-style: italic;">and</span> my ADN program, <span style="font-style: italic;">and </span>the assortment of loans I had as I was waiting to get into a program... it sucks. Did I ever tell you the story of how it took me six years to get my 2-year associate degree, by the way? Good times, good times....). My student loans, and the Christmas bills (which, of course we tried to go low, we <span style="font-weight: bold;">ALWAYS </span>do... but isn't this how it is every year?! Suddenly *someone's* favorite team is selling 'stock' - which by the way is non-transferable and pays no dividends, but does look good on the wall... and who else owns a piece of America's team, right? - and this other thing is on the <span style="font-weight: bold;">best, <span style="font-style: italic;">most SPECTACULAR, *AwEsOmEsT* SALE EVER!!! </span></span>so it needs to be bought now... but if s/he gets that, then of course this one needs this, and yadda yadda.... Oh hey, isn't this Brazil?! How'd we get so far off track here, and can I even use these sweet new snowshoes south of the equator? Where's that map?!) are coming in, and no one was as excited with the gifts that I worked so hard to get *just right* for them, and I was exhausted, and my schedule at work wasn't right and I ended up bawling like a baby because I was exhausted when I saw it to begin with (and I <span style="font-weight: bold;">HATE </span>crying, especially when I'm upset/angry/trying to discuss something...) and why was I on a night shift to begin with on Christmas Eve night - my holiday is Christmas Eve, evening, arrrgh?!? and it was just the longest week ever.... and so on, and so on.<br /><br />And it just kept going. And the family planning job, that I thought I had interviewed <span style="font-style: italic;">fabulously </span>for, apparently was a big bomb. Was it exactly the perfect job I wanted, and was I a wonderful candidate who interviewed like a rockstar? Uh, not so much probably - but on the other hand, I thought I was pretty good and would (all in all) fit in well and enjoy the job. The biggest downside, of course, was the no-baby-catching. My biggest downside - I thought - was that in my typical fashion (ha, ha, pun ahead!) I neglected to actually try on an outfit for the interview until 11:30 p.m. the night before, and the outfit I planned to wear - a sweet little black and teensy, thin blue pin-striped suit... - had somehow gotten a couple of sizes too big (!%@^*), leaving me flustered in the wee a.m. hours trying to decide if I would try to pull it off with some sort of cinching (sans belt loops, of course) or go a little more casual. Anyway, it's starting to look like we're in the tropics again here, so I'm going to leave the interview territory and my fashion deficiencies (for proof of my fashion sense, see right), and go back to my other worries now.<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRfECv0n14cgjo1SflDsS-N30uJKJZMCpg5Csmk6KtM2aW9EIIWX9lHElKte2v2VY7TenM9pvT-NFnb3WuLuC7TIEKOPE5t-ZjSNA7my_IZdwK040Fjr0-7XL6pjjCrMpF7gCcRC_ZiG4/s1600/mock.jpg"><img style="float:right; margin:0 0 10px 10px;cursor:pointer; cursor:hand;width: 277px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRfECv0n14cgjo1SflDsS-N30uJKJZMCpg5Csmk6KtM2aW9EIIWX9lHElKte2v2VY7TenM9pvT-NFnb3WuLuC7TIEKOPE5t-ZjSNA7my_IZdwK040Fjr0-7XL6pjjCrMpF7gCcRC_ZiG4/s400/mock.jpg" alt="" id="BLOGGER_PHOTO_ID_5693138768260271890" border="0" /></a><br />I was assured that I would hear back in about a week about the position, and truly did expect to; the clinic had been short-staffed for awhile, they needed help, all the signals I picked up were a 'go'. I waited... and waited... and waited... (and sent a 'thank you' email...) and waited some more... and nothing. No "thanks, but no thanks" call, no polite "we've gone another way" rejection letter, nada.<br /><br />I've also just been hanging with both of the nearby clinics; I emailed Dee a few days ago, gently hinting that I'd love any updates if she had any from her clinic administrator (who had started the process of checking into adding another CNM around the end of November, and had thought she would know more one way or the other in three weeks...). Checking my email neurotically - the one where messages from either Dee or my current physician group would contact me - doesn't seem to be doing much more than giving me little blisters, so I'm at a loss. It seems to be a fine line between being pushy, persistent, and the perfect amount of persuasive... it's just so difficult to read where things are at.<br /><br />At this point, honestly, I'd just love to not be in this no-man's land. If all three (really, just the clinic groups - I've more or less written off the family planning clinic, although I may call the director just to touch base) facilities would just give me an answer, one way or the other --- I'd be happy, even if it's not the answer I really want to hear.<br /><br />Even working as an RN in L&D is getting to be a struggle now. It's difficult to not step on toes, and to remember my scope of practice... and I <span style="font-style: italic;">miss </span>being the midwife, making the calls, being able to <span style="font-style: italic;">do </span>(and not do - or to be able to say, "we're not going to do this - we don't have to do this, everything is fine.") ... or if a baby is coming too quickly for the physician to make it, having to try to stay back and have another nurse 'catch', or have a mama try to not push --- one of the worst feelings in the world, and not good for mama or baby --- to provide the assurance needed to everyone that I wasn't trying to "take matters into my own hands" on some level. Awkward, awkward....<br /><br />Soooooo, about the IHS.... 23 pages of application for *possible* loan reimbursement, if funds are ever available? Oh heck, why not. What else do I have to do???hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com0tag:blogger.com,1999:blog-4430506625470707567.post-13239074476075702762011-11-17T16:52:00.000-08:002011-11-18T10:52:57.263-08:00This One's Not About Midwifery<div><div>Most of midwifing is about joy, whether subtle or overt – the excitement of a new pregnancy, the welcoming of a new life into the world, the beauty of a woman as she blossoms throughout the stages of life. The days when things aren’t so easy – long, drawn-out labors, difficult clients, or struggles to understand vague symptoms and nagging ailments – pale in comparison to the wonder of a mother gazing into her firstborn’s wide eyes.<span class="Apple-style-span"><u><br /></u></span> <p class="MsoNormal">This post, though, is about those days, few and (thankfully) far in between… as a nurse, a friend, and a family member, I’ve seen grief. Grief that sneaks up alongside you, taps you on the shoulder, and then takes you out at the knees; finally helping you up and keeping pace with you, step for step, until you feel as though you can no longer take it. I’ve worked with families who’ve had babies born still – babies born fully developed, perfect in every way; other babies have been lost far too early, months before they were expected to arrive, yet already eagerly anticipated and much loved. I’ve known and cried with families as they mourn the loss of babies diagnosed with terminal illnesses, not compatible with life, and supported them as they honored their loved, tiny infants the best way they knew how. As a midwife – remember, I have only been able to claim that title for two weeks – I have yet to embrace women and their families in those desperate, dark hours… but I will be there.</p><p class="MsoNormal">My grandpa died.</p> <p class="MsoNormal">When it comes down to it, that’s what this post is really about. Barely two months ago, my grandpa – my Mini’s “Puppa” – was diagnosed with Acute Myelogenous Leukemia – and given a prognosis ranging from moderate to poor (depending on the treatment regime chosen and the response of the disease to it, of course). One dose of chemotherapy didn’t significantly improve Puppa’s counts, but didn’t drag him down at all, either; he still fought like hell. Even a nasty, raging infection to his IV port didn’t take the fight out – it was only when his oncologist really explained why he had recommended hospice care (rather than continued chemo treatments) that he just gave in, and let go… within a week, he was gone.</p> <p class="MsoNormal">To me, Puppa was larger than life – he wore Brut cologne, farmed his entire working life, fished and hunted like a “real man” in the Midwest would, and ate headcheese and liverwurst (ewww). My memory is flooded with treasures from my childhood; this is the man who taught me how to bait a fish hook (and get a fish off the hook, once caught), climb up on a tractor to ride beside him, play cribbage, and to open a glass bottle of Sun-Drop with a bottle opener. I could go on and on – like any good granddaughter – but I’ll keep those memories as seeds to plant for the Mini’s, or if nothing else, for a day when I’m a little more awake, and it’s a little earlier. Memories that they may lose (or have never experienced) like how Puppa always had a teeny Tupperware container in his shirt pocket for them, with just two jelly beans or marshmallows in for them, or how on birthdays, he had a special card just for the birthday kid with exactly the number of crumpled dollar bills as years old you were turning, the envelope and card addressed in his loopy writing… his love of Diet Sun-Drop – but *only* in the old glass bottles, not in cans, and not in the ‘new’ glass bottles. And the dimes – always the dimes…</p></div></div><div><div><div><img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEtRag9I-kS2naoR9S5mvjNoPnRrhV0F4yRs_slXqw1EyKNtfoVaLlj69Vj1RhFTM_0Cn2CQA3YS5Pk8tabej1J6Xh2BvTfF_85UHxmYitwj8P9axGMffV_9n53GKUPPzFDpKSfN7ylFs/s400/IMAG0443.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5676137302972125170" style="float: left; margin-top: 0px; margin-right: 10px; margin-bottom: 10px; margin-left: 0px; cursor: pointer; width: 400px; height: 330px; " /><p class="MsoNormal">When death comes, it’s amazing how fast/slow things move. I swear it was just yesterday that my grandpa walked into my living room, showed me the lab results from his recent hospital stay, and asked me what I thought of them (as my heart dropped to the floor). And, just a few days before that – it had to have been – we were all out on the pontoon boat, with everyone healthy and happy. But it seems like it’s been months and months of watching him slowly fade away….</p> <p class="MsoNormal"> I can’t imagine the pain of losing a child, or a spouse, or a parent… yet I can’t fathom thinking that I’ve “only” lost my grandpa. How do you compare this hurt? I feel selfishly grateful that this is really the first time in my memory that I have lost someone close to death; I’m also so grateful that my family is so close to begin with, and that the Mini’s know their greatgrandparents so well. The very last words that my grandpa really said to me, a few days before he passed away – looking me right in the eye, with a squeeze of his hand – were, “Thank you.” When I asked what he was thanking me for, he said, “For it all.” </p> <p class="MsoNormal">To everyone who has gone through this grief, whether the loss of a parent, grandparent, spouse, a sweet child, or the whisper of a child yet to be --- let yourself be embraced by the open arms of those who care. Open yourself to the friends who can offer words of comfort, hope, and love; to the family that shares your memories and knows stories outside of your own. Realize the true beauty of the people who will forgive you when you 'disappear' for a few days or weeks, lost in your own world of clouded thoughts and reminiscences. I feel so blessed and have so much appreciation for everyone who made the last few weeks, especially the last few days, easier than they might ever have been otherwise.</p> <p class="MsoNormal" style="text-align: center;">Thank you… for it all. XOXO</p><p class="MsoNormal" style="text-align: center;">~*~*~*~*~*~*~</p> <p class="MsoNormal">(P.S. This post formed in my head as I finally took a hot, hot shower, letting the past few days and weeks rinse over me; as I got out and wrapped myself in warm pajamas, I was overwhelmed with the scent of Brut…. *tear* Things always end up all right, don't they?)</p></div></div><div><br /></div></div>hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com0tag:blogger.com,1999:blog-4430506625470707567.post-82231129192031323592011-11-03T07:30:00.000-07:002011-11-03T08:07:27.656-07:00I have been blessed...I started to write this post last week, and never got around to finishing it. The title was different, and the whole tone of it - it was a little more playful, with an undercurrent theme that mirrored Tigger's theme from the classic Pooh cartoons (for those of you familiar with Pooh's adventures... and aren't we all??) - was meant to be a light-hearted-yet-deep reflection of the wonderful thing about blessings in life.<br /><br />And I have. Truly, in so many ways, my life and my family, are lucky. As I (finally) sit down to type this, though, I just don't quite have the same levity as I did a week or so ago when I started composing this in my head. I was going to recite the list of changes that have happened over the past two months (comps, graduation, etc, etc...). Instead, I'm quiet; the Warm One is battling a fierce cold, the Littles are runny-nosed and cranky, and I've passed my boards exam. I am, officially and with no holds barred, a certified nurse-midwife.<br /><br />The colds will clear up, and the Kleenexes and textbooks (and highlighters and scattered notepages) that have <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOVwGS2dfMb6d36oaeheTSVQnKwVYu91uAA8502HdhSNcwQkPJtetXuYtOK4DMPQO7ZZQnYtjL_zjsylM0lD_gUULznuyIXQNVpf9VqlSDjYM9DCb4BYY7v0oU1kSVtCT9RvE5HO9jyHo/s1600/family+098a.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 267px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOVwGS2dfMb6d36oaeheTSVQnKwVYu91uAA8502HdhSNcwQkPJtetXuYtOK4DMPQO7ZZQnYtjL_zjsylM0lD_gUULznuyIXQNVpf9VqlSDjYM9DCb4BYY7v0oU1kSVtCT9RvE5HO9jyHo/s400/family+098a.jpg" alt="" id="BLOGGER_PHOTO_ID_5670785754946123138" border="0" /></a>overtaken our home will eventually be cleared away as well. Some will be recycled, or tossed; others may be stored in the office "just in case" - who knows if I'll need that text again, or maybe I'll decide to 'recycle' it to an incoming student?<br /><br />The other blessings in my life are just as clear: my family, who have been so close and willing to step in whenever needed during this journey. The Midwife, even when things became rocky, was a blessing in disguise; I learned things, personally and as a midwife, that I needed to know, from her. From D, and from all of the women and families along the way. From so many close, wonderful friends - some nearby, and some far away... women who I may never have met in person, and yet who I can (and have) shared so many of my deepest fears and funniest moments; these are my sisters and peers, both fellow students and mothers.<br /><br />And, of course, the Warm One and the Littles (one of my proudest moments so far? When the Bigger Little 'corrected' the younger, who had thought that "Dimbo's" - Dumbo - mommy was being 'naughty' in the movie. The elder of my daughters explained that Dumbo's mother was upset that the other elephants were being mean to the baby elephant and making fun and picking on him because of his ears; that sometimes mommies <span style="font-style: italic;">had </span>to stand up for their babies. It was a touching conversation for a mother to overhear between a 5 and a 3...)<br /><br /><div style="text-align: center;">*~*~*~*~*~*<br /></div><br />Some blessings are a little harder to understand... in the months since my last post, my family has been stretched apart, and pulled together in an even stronger way. My grandfather, the "boss" of the family, was diagnosed with an aggressive leukemia just before Labor Day, underwent one round of chemotherapy, and has become progressively weaker since then. After a bout with a massive infection and complications due to the infection and its treatment, hospice - and the care that goes along with it - nurses are a daily reminder of the change. It's so hard to see the difference between the strong, capable man that taught me how to bait a fish hook and tossed hay bales into a barn loft, and the saddened man that cancer has made my grandpa. The thought of saying goodbye - along with the pain of seeing my grandfather this way, as well as how it hurts my grandmother - is only soothed by the idea that the time we are gifted by this allows for storytelling, memories, "I love you's".... my family has been together much more in these past few weeks than in the past years (we've always been close), although I don't know if this outweighs the pain that my grandparents are feeling. At this point, all we can do is "Let go and Let God..."hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com0tag:blogger.com,1999:blog-4430506625470707567.post-69006015159998548772011-09-04T20:54:00.000-07:002011-09-04T21:50:09.513-07:00Will work for Food...<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAqcgrFACBRiq0pfu0ajDz6Kj5p_pRL5vRbCvVHI_lI6Z61DiDHDsvIAMToEGr-kIHeJI1GuRZec_ahMf4IDE5pLbn0npjDcwvn3UcOnu9LCYgt996Rqa4LQv9VhZExqQY_ckYq5X9TIo/s1600/339425_10150298695038451_632853450_7886182_1217913_o.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="float:right; margin:0 0 10px 10px;cursor:pointer; cursor:hand;width: 191px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAqcgrFACBRiq0pfu0ajDz6Kj5p_pRL5vRbCvVHI_lI6Z61DiDHDsvIAMToEGr-kIHeJI1GuRZec_ahMf4IDE5pLbn0npjDcwvn3UcOnu9LCYgt996Rqa4LQv9VhZExqQY_ckYq5X9TIo/s320/339425_10150298695038451_632853450_7886182_1217913_o.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5648731894168399218" /></a>Seriously, I will... I certainly have a bit of a love affair with food. Especially this time of year, with the county fair in town: cream puffs, beer-battered cheese curds, funnel cakes.... Oh, my poor achin' arteries.
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<br /></div></div><div>And summer. I love summer too. (Can it seriously be Labor Day already?! I want to cry! I do *not* do well with winter... sigh...) Anyway.... this blog has clearly been neglected for the past month or so. Oops.</div><div>
<br /></div><div>I've been a little busy, to be fair. Since the last time we met, I scratched off each and every last clinical hour and visit I needed to meet the requirements of my program, as well as having a "declaration of safety" submitted by Dee (signifying that she feels I am a safe, beginning-level practitioner); one of my biggest feats was taking - and passing - the first of the last 3 big tests standing between myself and midwifery. I'm engaged, descended, and flexed - now on to finishing the rest of these cardinal movements, little by little...</div><div>
<br /></div><div style="text-align: center;"><i>(was that too corny?!)</i></div><div><span class="Apple-style-span">
<br /></span></div><div>From a personal standpoint, things have also been busy. Family life has been hectic as always, with ups and downs. My bigger-Mini started Kindergarten (!) last week, which seems incredible; I still remember the moment she was laid in my arms and the immense feelings of wonder and </div><img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2NYIrZHPMhEGBFOZSUPx0vIHWuJVlIPqNmBIp7Xq3QoPUwEtiqk-E5HhL020kOVvuj5NaoA4Mx4Awk_TC2y5H4z4qmnA6lusKDq2xc8y32tg6AapwejH7HfV4Yndi6AUNMtysERunH-Y/s400/297928_10150292486238451_632853450_7826465_342529_n.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5648731182034434994" style="float: left; margin-top: 0px; margin-right: 10px; margin-bottom: 10px; margin-left: 0px; cursor: pointer; width: 267px; height: 400px; " /><div>awe I felt to be a mother to such a wondrous little being; my Mini-er is beginning preschool this week (and memories of her labor, and birth, are even more vivid; the moments in the shower, visualizing her path down to birth, and the moment when the Warm One proclaimed her as a "little girl"... so clear!). Harder to work through these past weeks have been the continuing struggles with my brother and his own battles (battles which he alone can fight, but that as a family we have been trying to find ways to support him in...), the diagnosis of Lyme's disease in my father, and acute, aggressive leukemia in my grandfather. It's painful and exhausting to see the toll, both physical and emotional, that's accumulated across the family lines in the past weeks and months; through hopes, prayers, and support (and communication), I'm waiting for a strengthening of the bonds that hold us together.</div><div><div><span class="Apple-style-span" style="color: rgb(0, 0, 238); -webkit-text-decorations-in-effect: underline; ">
<br /></span></div></div><div>But, back to the "Work" thought that started this whole rambling... I'm starting to think more seriously about jobs again. (It's getting to be time, I suppose. I have one more "school" test - the competency/completion exam, after which I am officially a graduate nurse-midwife, and the final step is the national certification exam). I've realized, after doing a phone interview or two over the past few months - mind you I haven't interviewed in years! - that I need to brush up on my interviewing skills. I thought maybe I'd toss out a few random, jarbled thoughts on here, if nothing else, to help myself sort out a little more about myself (you know how they - "they" being interviewers, of course - always ask about your strengths/weaknesses, what you would like to improve on, etc...)</div><div>
<br /></div><div style="text-align: center;"><b>About Me...</b></div><div style="text-align: center;">* I'm not there yet, but I'll be there soon!</div><div style="text-align: center;">* I don't drink coffee... but I anticipate that I will start to do so soon...</div><div style="text-align: center;">* I run habitually late (not much, but just enough to be a few minutes late...)</div><div style="text-align: center;">* But - see above - I'm <i>reliably </i>late those few minutes!</div><div style="text-align: center;">* I learn by doing, not by reading/listening</div><div style="text-align: center;">* I'm quiet - but only for so long. I <b>will </b>open up (you may be sorry....)</div><div style="text-align: center;">* I do have a sarcastic streak... and a good sense of humor!</div><div style="text-align: center;">* I may hold back a bit at first - let my confidence build, and I will shine.</div><div style="text-align: center;">* I trust women, their bodies, their intuition, and their abilities. </div><div style="text-align: center;">* I am a very dedicated, motivated employee.</div><div style="text-align: center;">* I can't even come up with enough to write here! Man, I better hire myself out to a farm or </div><div style="text-align: center;">something instead....</div><div style="text-align: center;">
<br /></div>hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com0tag:blogger.com,1999:blog-4430506625470707567.post-30571103950812111052011-07-28T16:58:00.000-07:002011-07-29T09:06:34.960-07:00Just Pickin' Em Up & Puttin' Em Down...<div style="text-align: center;"><br /></div>Yep, I think that's what I'll do. Every day, if that's what I need to reduce my focus to, I can do it - one step at at time. Simple, easy, as little stress as can be. Starting with lifting each foot, and then putting it down again a little bit further ahead than it started. I have a keychain that is engraved "Learn in Baby Steps" --- one of my new mottos, I believe.<div><br /></div><div>Sounds easy enough, right?! I <i>can </i>do this - and I know I will. Patience is a virtue... but it's sooooo hard! The end of this road still seems far off, though I can tell it is getting closer. This week has been challenging; Dee has been out of the office for a much-needed vacation - although you can't really call it that since she is still functioning in a nurse-practitioner role, only volunteering her time (though she is at least enjoying herself I think) - and so I am working with some of her backup doc's and *trying* to make a good impression on them so they will agree that expanding her practice and adding a second CNM --- that is, moi --- is a splendid idea.</div><div><br /></div><div>From my perspective, it's been great; I've been enjoying seeing things from the MD point of view and also observing visits that aren't typical nurse-midwife cases. However, on Tuesday I was hit by the <b>WORST </b>migraine I've had in a long, long time; the timing could not have been worse. How do you make a good impression, when you go from meeting someone and being eager to soak up all their knowledge to begging to go home with an "invisible" affliction in a matter of minutes-to-hours? It was awful; the worst part was, one of Dee's patients (who I've met several times in the office, as well as in the L&D setting) ended up presenting to L&D that day in labor, and the MD I was meeting that afternoon had offered to let me work with her during her labor. Prior to the onset of my killer headache, I was pumped to be able to follow her through, especially since Dee wouldn't be able to... until, that is, the hot flashes, nausea, and vomiting started while I was still seeing patients in the clinic. By the time I made it home that evening (after pitifully and ashamedly declining to accompany the doctor to see this particular laboring mama), I was miserable; the migraine didn't pass until later the next day, after 14.5 hours of solid sleep in my dark, window-less bedroom, with constant ice packs/hot rice bags, multiple doses of vicodin, and several doses of maxalt. Two words: it <b>SUCKED. </b>And, I was not impressed with myself.</div><div><br /></div><div>(I've had migraines since I was five. They are something that are just there, and for the most part, I recognize that I have to live with them. A year or two ago, I started taking topamax and was thrilled at how well it seemed to 'calm' them; I also found that maxalt was actually reliable for knocking them out if I could take it when I first started getting an aura... these were the first meds that actually worked for me, after 20+ years of trying to find something. Now, in the past few months, they are steadily creeping back. To have two in the past two weeks, however, to the point that they disrupted my functioning - at clinicals no less - is <b>NOT </b>acceptable for me.... so I guess I will be in touch with my care provider.... *sigh*)</div><div><br /></div><div>On a happier note --- things have been interesting with the MD preceptors. Again, I've seen several types of client cases that I might not normally see as a CNM: complex chronic health problems, many, many well child visits, and ---- wait for it... --- MEN! I haven't dealt with penises longer than a pinky-joint since I was a nursing student. Crazy, huh? </div><div style="text-align: center;"><br /></div><div>Tomorrow finishes off my week with the docs... fingers crossed that if nothing else, they think having an extra pair of hands could be good for something or other...</div><div style="text-align: center;"><br /></div><div style="text-align: center;">~*~*~*~*~</div><div><br /></div><div><img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsZ2M72cU6iHH_EsMgUMh-pet4hDDMMFHjLmXbMAYoiaiAz0_cDmxqMFkjjde91_3yE5i2IGMnV-FBEoEK0eBawmdBmseqlkSG47ItMnIbGrXsl6Z-s_t0mX-CFmvEHVvklRL2rAI1xDE/s400/IMAG0309.jpg" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 119px;" border="0" alt="" id="BLOGGER_PHOTO_ID_5634567522874982770" /></div><div style="text-align: center;">This can be a glass half-empty/half-full kind of pondering.... I think I posted last week that I had sent out an email to the doctors that I work with - as an OB nurse - just to sort of "feel them out"regarding how they might feel about hiring a CNM into their practice (as there are no nurse-midwives other than Dee delivering within 60-75 miles of our area). I received this response from the 'head' of this OB group today, and took it to be a good sign; it's of course impossible to read, but the gist of it is that most of the MD's in the group think that nurse-midwifery care may be a plausible option, but there are questions that would need to be discussed; it does not give any indication that they are <i>not </i>supportive of CNM care, and that they are willing to entertain the idea... the logistics of it may need to be explored, but it "could be interesting". (Again --- this email certainly could be read with optimism or pessimism, since it doesn't go strongly either way... but tiny seeds, no?)</div>hebamme ~http://www.blogger.com/profile/08708270634154916532noreply@blogger.com1