My own dystocia...

Dys *to * cia : noun

DYSTOCIA: slow or difficult labor or delivery. (From Greek dystokia)

I'm stuck. Like a wayward fetus or a uterus that doesn't quite have it going on yet --- something just ain't right. At times, I feel like I get in my groove and things start moving along; my rhythm is a-rockin'. And then... something happens to knock me right back down.

This makes me wonder, right from the start, how far back I'm going to have to go to "fix" things. Midwifery is supposed to - and I love this - "high touch, low tech". Me, on the other hand... I'm more of a "high tech, low touch" kind of girl... I've never been a hugger, and I'd much rather text or email than talk directly to someone. (Is it just me, or is it a generational thing?) With all of this stuff--- I can't think of a better term for it --- going on with the Midwife in the past couple of weeks, so many friends have been in touch, saying "Call me", "give me a call", "let's talk!", etc, etc... And it sounds sooo good, and promising... but I can't. I just can't. Instead, I send out a pathetic little email or text, promising to call later, or assuring them that everything is "better" now, or that it's figured out...

(If you are one of those who's been in touch --- I love you, you're awesome... please, please don't take it personally. It's definitely one of my flaws, and - like so many other things I have going on - I don't know how to fix it. Keep reading for more on this...)

The Midwife is picking up on this, at least somewhat. "I don't know how to communicate with you." She says. "I don't know if you're coming or going; you have to tell me." My RCC may have noticed; we have only talked on the phone once or twice, very, very briefly. As much as that one phone call reassured me (she called me after catching on from one of my self-evals that I needed to talk) - I still can't bring myself to call her. I know that I need to be the one reaching out, and yet... I can't. It's difficult to explain.

I know that it is holding up my labor, though; after all I have gone through this far, it is stalling my progress.

This week was, again, tumultuous. The Midwife and I just are not in sync. I can't figure out what she wants from me; we are both getting frustrated. I am trying, so hard, to be there early and to try to do what she expects from me, before she asks or prompts me - but instead, I do the "wrong" thing. My self-confidence is crumbling, and my exhaustion and sense of being overwhelmed is growing by the day. As with Murphy's (or is it Murray's?) Law, the three births that we had this week were all "abnormal" - a shoulder dystocia, a cord that abruptly broke from the placenta (which subsequently required a manual removal), and a postpartum hemorrhage following an OP babe. How much of these outcomes had to do with my management (Too much traction on the cord? Did I let the placenta sit a moment too long at the introitus, letting clots build in the lower segment?), and how much was sheer dumb coincidence, is of course impossible to say. (I know the traction was, if anything, light... and the placenta was *just* at the introitus... but I also believe in the whole positive/negative vibes kind of stuff --- and I have not been riding a positive wave lately, believe me!).

So this is where we are at. As we were leaving yesterday - literally, over the course of about five minutes - the Midwife just barely started to talk to me. She asked if I had any questions, and then said she would "email me" again; then started to sigh a bit. It was good, to the point that at least we had some honest, face-to-face communication. It was not so good, of course, for the reasons above; face-to-face communication is not my strong suit. Between the exhaustion, the migraine that was kicking in, and just everything finally catching up - I started tearing up and was soon blubbering like an idiot --- very embarrassing but, on the other hand, I think a very honest reaction. It, unfortunately, made it hard to communicate any of my thoughts/concerns back to the Midwife, and ultimately made it a very one-sided (short) discussion.

Her concerns (think of them as a bit of Pitocin, if you will - hopefully, they will stimulate me to get moving and back on track): I need to keep her updated with what I'm doing, and I need to be more prompt. (I know these things... somehow, the one-hour commute has gotten worse and worse; staying somewhere during the week and only doing clinicals - and then driving home for the weekend - is starting to sound much, much better... As I described in a response email to the Midwife, my children are like sweet little eels, and they hang on me literally as I'm walking out the door most mornings.) I don't seem interested, and I just seem tired. (I don't even know where to go with this. I am exhausted, and I'm overwhelmed. This ain't gonna change, any time soon...) I'm going backwards. (Again, I feel like I'm going backwards in some areas...?!?!)

So, here we are. I've emailed her back; I need to be in touch with my RCC, but at this moment in time, I just can't bring myself to do it. The Mini-est and I are just vegging for now (I'm thinking a late lunch - delivery?), and that's how I want to keep it for a few hours anyway. I've se

nt out a couple "feelers" to try to find another clinical site for another perspective. I've also sent out a couple of resumes for CNM openings around the state - although I'm not especially hopeful about them (my being "ready" by June came up in the brief conversation the Midwife & I had as well...), it did give me something to do - and managed to shower and get myself and the Mini dressed.

I'll keep you posted. One way or the other, things do keep moving forward... I don't think there's an option of a cesarean in this situation (although, maybe being "taken out" of this site and heading to

a different one could being symbolically viewed that way.... I'm not even going to go there...) If you are the kind of person that does anything like this, I could use some kind of confidence/stress-busting/calming vibes... I know that this is the kind of thing that I make ten times worse myself, and I need to knock that crap off and get back on track.

Speaking of, I need to bring the Bears back out... http://onedeliciousdelivery.blogspot.com/2011/

01/im-scared-to-death.html

I'm scared to death.

Period. End of story.

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

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

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

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

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

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

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

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

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

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

~*~*~*~*~*~

On "The Bears"

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

Setting: Wooded area surrounding a small clearing (perhaps a campsite?) with a campfire, simple block bench, etc

The Players: A handful of the Bears (these symbolize Stress/Anxiety/Fear - any negative or bothersome issues - I always picture them as cartoon characters similar to, maybe, "The Far Side" or something?) and You

(We enter the scene with You sitting on the crude bench near the campfire, maybe toasting marshmallows or a hot dog. Something's troubling you - fear? stress? anxiety? - and you realize that the shadows creeping up behind you are actually several large - albeit cartoonish - bears)

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

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