two minutes

two minutes 

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

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

Shoulders.

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

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


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

 Anyway. Woman labors, baby progresses through the cardinal movements (if you aren't familiar with these, I encourage you to do what any sane person would do and google that #&*%! In particular, look for some of the great videos out there, as well as the sites verbally outlining the process. I LOVE the Spinning Babies website - 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.

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

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

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

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

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

*warning: bad analogy ahead 

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

tomorrow, tomorrow...

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

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

If you want to be in on the fun, post below - or on any of the posts in the last week or so - and we'll go from there.  (see the "Birthy Beauty" post from Feb 19th  - 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!)

The 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.

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.

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.

Or - I'll look over there again... Log back in...

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...)?

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?

{ { pregnant ----- very pregnant ---- pause... } }

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.

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".

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".

And  - maybe - smaller clocks...

Opening

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.

Do I need to step back a mile or three? Maybe that would help...

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.

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 this 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.

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 very 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??

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.

And - it worked.

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.

My dilemma may or may not be solved by next week's call by "West" ... but that's another post!

The Most Wonderful Time of the Year... ~ Or ~ When Things Look Bleak (But Aren't Really That Bad, Right?)

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.)

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.

(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.)

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 everything. I realized that just about ALL 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, and my ADN program, and 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 ALWAYS 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 best, most SPECTACULAR, *AwEsOmEsT* SALE EVER!!! 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 HATE 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.

And it just kept going. And the family planning job, that I thought I had interviewed fabulously 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.

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.

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.

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.

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 miss being the midwife, making the calls, being able to do (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....

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???

The Power of a Mother

“We have a secret in our culture, and it’s not that birth is painful. It’s that women are strong.” – Laura Stavoe Harm

~ * ~ * ~ * ~ * ~ * ~

In the past weeks, I've had the opportunity to see a beautiful display of the strength the we, as mothers, hold within ourselves. I have seen two first-time mothers carry twins to term and birth them vaginally (a rarity in today's obstetric world), and I've been blessed to be a part of several beautiful water births. I've supported women as they shed the pain and negativity of their prior births - whether vacuum-assisted, episiotomied, or cesarean - and worked their way to fulfilling, heartwarming experiences this time around. I've coached women through difficult labors, instructing them to push - or not push - at the hardest times, when it was the thing they most didn't want to do (but needed to, for the sake of their baby - whether due to a stuck shoulder, nuchal cord, or other concerning issue). I have seen mothers labor and push for hours, with no analgesia; I've seen mothers who plan to get "everything [they] can get" - but still have intense discomfort... regardless, the strength, and the determination to make it through, is amazing. I've visited women in the hours and days after their births and been awed at the love that's obvious as they snuggle their newborns; the way they hold their nurslings to their chest, cooing and adoring, proudly showing off their babes to older siblings, grandmas and nurses.

*~*~*

Strong thunderstorms and tornados moved through this region - and much of the country - last weekend. The similarity between Mother Nature's power and that of a laboring mother is not lost on me. Surveying the damage of what has officially been deemed a tornado - which moved right alongside of the

hospital - brings to mind the rapid internal changes that occur with labor... Mama feels as though her insides are being ripped apart, ravished by the incredibly intense waves of contractions moving through her. Until labor began, she may not have even realized the strength within herself; and yet, like the buildings and trees damaged from this storm, her body will begin working its way back to normal within hours after baby's birth. (And, in fact, just as a beautiful, brilliant, calm sunset emerged from the storm - mama will almost always emerge from birth with a tired but peaceful sense of wonder as well, with the most beautiful prize to be had.)

Things I've Learned This Week...

* Suturing actual, living tissue is much more difficult than practicing on, say, cow-tongue or a chicken breast. (Or, for that matter, a foam dummy) You've got a mom who can often feel at least some of what you're doing, there's labia and tissue to hold back, and blood seeps into the viewing field (dab... dab... dab...). On top of this, you're wearing sterile gloves which are almost always tacky with blood by this point. And - I'll be honest here, even though I know how 'forgiving' the perineal tissues are and how well they heal - you want it to look nice. (For anyone who hasn't seen the vaginal/labial/perineal tissues of a woman right after delivery - picture a gooshy, glistening mass of ... I don't even know what. I'm only now, finally, I think getting the hang of what goes where. On that note --- any volunteers so I can practice?!)

* There is a huge range of philosophies/practice among midwives - and that's okay. The things I learned with the Midwife and want to remember/use, I can. The ones that I didn't feel comfortable with at all, I can drop in favor of something that reaches the same goal but feels "right" to me. For example, the amount of traction needed to help the placenta separate and deliver, or the choice to leave a mom's perineum and labia alone as the baby crowns (while still reserving the right to support both, and maybe help stretch on occasion, if needed, rather than for every birth).

* You gotta use a heck of a lot of traction to help resolve a shoulder dystocia.... I always fear that I am going to injure the baby when using excessive traction, but when looked at it from a different, more sombering perspective --- a baby with a broken clavicle or even nerve injury, is better than a baby that never is.

* I got this.

Thank God for Midwives

(And mama's, and babies, and supportive dads/aunties/grandmas/friends, and doulas...)

But, at least for me and at least for this week --- thank God for Midwives! If you've followed along at all, you might remember how intense (is that a good word??) things became at my last clinical site. I won't go into all of the details again - because frankly, it makes me feel pretty lousy and I also start to feel a little badly for the women who really want a midwife and don't realize (until it might be too late) when they've actually found a medwife - but it was rough.

Rough on me a student, as a person, and even as an OB nurse. That site caused me to question a lot of things both about myself and the way I have been prepared to practice as a CNM; the Midwife was motivated, she was popular, and she was good. But - she was also (either by choice or by necessity) very much a medwife. As a learning experience, it was good; the four months I spent with her allowed me to begin the hands-on learning I needed to grow as a new midwife, and the last few weeks (along with many, many weeks thereafter) gave me pause to reflect on ways that I myself need to grow my personality to better perform in that role, as well as on the pieces of the Midwife's practice that I did and did not want to take with me into my own practice.

It wasn't until today, though, that I realized how deeply I felt wronged in my previous site. My faculty advisor has been working hard to help me find a new clinical site; this process, which originally seemed as though it would be fairly quick (I had another preceptor in mind, who was happy to work with me) ended taking 2 and a half months. Obstacles with policy, administration changes, and just enough little roadblocks to keep things from progressing have kept my hands from officially (as a student nurse-midwife, that is) welcoming a baby into the world since March 1st. (And it has been kiiillllllllling me!) As things continued to stall, my advisor suggested I come to a site that has welcomed several of my classmates in the past; while at first I was hesitant (as this site is a 3.5 hr drive from home) eventually it got to the point where any site was perfect, and I jumped at the chance. The midwifery group agreed to work with me, the paperwork was approved, and plans were made for my arrival early this week.

And, it has been amazing. Amazing for the births I have attended - 9 so far since Tuesday (and I missed several others one day when I finally had to admit that my body and mind needed rest), including two glorious waterbirths, two VBAC's, and a handful of other triumphant displays of mama-power. Amazing in the fact that the midwives and nurses have welcomed me with open arms, eager to help me blossom as I work my way towards becoming a beginning-level midwife. I've had "scary" moments - a decel that wouldn't come up (while my precepting CNM and the OB on-call were in the midst of a c-section and completely unavailable), a shoulder dystocia that didn't resolve easily with McRobert's maneuver and suprapubic pressure - but made it through them. I've been allowed to be more independent in four days, with four different midwives, than I was in four long months with the Midwife: when our dystocia baby's shoulders didn't ease out shortly after his head, the CNM I was working with that day didn't push me aside to take over... instead, she stayed back (as hard as it must have been) and allowed me to identify the situation as a shoulder dystocia and to work to resolve it. When my efforts weren't quite doing it, and I looked to her for help - she was there. The trust that I've found from these midwives - each of whom I have met for the first time the morning that the call shift begins - literally brought me to tears as I finally took some time today to reflect on this first week. It takes a momentous amount of trust to stand back and allow a student to be in control of a situation - especially one that is as intense as a shoulder dystocia or prolonged decel. I can't even begin to fathom how difficult it is to stay back and just "be", while a student works to resolve something that can so quickly develop into disaster. And yet - the true mark of a good teacher is to understand that without allowing a student to take the next step towards independence, the student will ultimately never succeed, and both teacher and pupil end as failures. In labor and delivery, with the life and well-being of a longed-for baby on the line (as well as the mother's safety), the amount of trust and courage in takes to do this is multiplied ten-fold... with the rewards equally as impressive.

I'm not there yet - a part of me froze up in those tense situations, and it took longer than it should have for the little voice in me to say, "this is what you do... remember?". But the gift of being allowed to wake that little voice up, to do my best, and to know that I had a supportive preceptor right behind me --- rather than pushing me to the side immediately --- was worth more than anything else. Then, the bonus of constructive feedback and open communication - rather than quiet, tired frustration - after each incident: What should I have done? What might have been a better way to do that? And - what did I do right?

As I wrote what was supposed to be a quick update to my advisor, letting her know how incredible of a learning experience this has been so far, I found myself reflecting back to the days with the Midwife and comparing the feelings I had at the end of that rotation (inadequacy, doubt, fear, shame) and the ones that have emerged in just a few days here (confidence, readiness, calmness). Sitting on the back porch of the midwife who so graciously invited me into her home, smelling the lilacs with songbirds for a soundtrack, tears rolled down my cheeks as I typed on and on. Where my hands were rarely able to catch without the Midwife's covering them before, they now have eased 9 new lives into the world with very little guidance; when I reluctantly began to perform certain skills in the way that I had been taught from the Midwife (but had never been comfortable with), I was reassured that there was another way, and that the way I learned was not necessarily the best practice; what had been frustrating in the past (lack of expectations, absence of any real rapport) was nowhere to be found among these midwives.

So, thank God for midwives... the midwives I've worked with this week, who took my hesitant, injured confidence and allowed it to begin to heal; the midwife who opened her home to me, with its peaceful quietness (no television, no cell phone reception) and country beauty; the midwife (my advisor) who spent so much time working with me to find this happy place again. And even the Midwife, who started me on this journey and puts this all into perspective.

My Town

My town is (relatively) rural, "under-served", and ... beautiful. There are days that I find myself awestruck at the innocence of the people here, the young families working so hard to bring about the change that we need, the grandparents so active in the younger generations, and the community programs that are so involved in so many areas of our growth. Two Native American reservations adjoin the region, sharing a wealth of rich tradition and cultural diversity.

Even after nearly thirty years of living within thirty miles of the same spot, I still have moments of wonder at the physical world around me as well. My home is a mixture of fertile, strong farmland - capable of bearing grains most months of the year - and rolling hills and thick, tall stands of trees. Rusty tractors and beat-up cars dot the highways and country roads; anything shiny and speedy is less likely to be seen. Deer are everywhere (driving home from my mother's today, I had to hit the brakes twice to avoid last fall's scrawny doe-fawns), with wild turkeys just as present and pesky. A bear loping across a country road is a much more sacred experience; bald eagles are a daily, humbling, occurrence.

(Now, of course - don't get me wrong. There are so many areas that could be improved on; there's the same old political drama as any other area - the community is older than the average town, with a very conservative tilt - as well as tension from a so-called "religious cult" that has had ongoing legal claims against the city government over the past five years or so. Racism/ethnicism between "whites" and Native Americans (as well as members of the religious group mentioned above) does exist in the area despite commitment by many organizations to work towards common goals of unity. Business is always business: our small, not-for-profit, community-run hospital recently "merged" with a larger health care system, and competition continues with other clinic systems in town and with the "bigger, better, newer" facilities located slightly further away. My town may not be perfect - but it may be perfect for me, anyway.)

And yet, with all our imperfections, all our arguments and all our petty squabbles - we really do have it good. On our small, four LDRP obsetretics unit - in which each room has banged up doors, peeling wallpaper, and so many aesthetic no-no's that it's becoming painful to give tours during my childbirth classes - we've celebrated the birth of not one, but two sets of vaginally birth twins in the past few months. In the years that I've been a part of 'my' team, we have had several more sets, both to primiparous and multiparous mamas. (I have not be lucky enough to be present at any of these births yet --- can you tell I'm a bit peeved?! --- but am still so excited/proud/any-number-of-adjectives-fits-here that the diagnosis of "twin pregnancy" hasn't automatically equaled "cesarean section" for our mama's; generally, as long as Twin A is vertex and the pregnancy is otherwise healthy without factors contraindicating vaginal birth, trial of labor has been offered/attempted, and as far as I know - all have been successful with wonderful outcomes.)

As a nurse, I've had the joy of holding patients' hands, helping them breathe through contractions and ease their way to the births of their sweetest creations; I've been blessed enough to have to catch babies (when the doctor didn't quite make it to the room, or even to the hospital in time), and instead of being reprimanded or frowned upon, I've been thank

ed and even praised because of how well things were handled. One mama had a vacuum assisted delivery with her first babe, and a massive laceration with repair; she was terrified of pushing and delivery. With the doctor down the hall, ready for the call, she tried her first push - and with just a little encouragement, gentle support, and the right words... she delivered her beautiful daughter by herself, into my hands, before the doctor could make it down the hall to us. No lacerations, no need for any assistance - only her own strength.

Much of this truly comes down to my own inner calmness. As a new nurse - starting directly into OB/L&D nursing, I was terrified of having a mama "precip" on me. And, of course, two of my first handful of mamas did just that. (At that time, I was new enough that I still had a precepting nurse with me, and I basically froze, leaving her to jump in and catch.) From that point, I had such o

f phobia of having that happen again that I became hyper-vigilant of when a mom might suddenly progress to delivery rapidly - and so I began calling the doctors to come in very, very early in second stage. (Now, if they were midwives they would probably already be there... but that's another story...) La la la da.... fast forward a couple years, I became more relaxed and understanding, intuitive, and comfortable with idea of catching if need be - and, I was entering midwifery school, so the idea of catching was a little more addictive at this point! - I had no precips, because I had finally gotten it down pat of when to call the MD's in so they would get there *just* in time. (Drats!) But, finally, I realized, if and when a baby delivers - I'm all right with that. I no longer frantically instruct a mother to "Stop pushing!" or "Pant! Breathe through this one!" ... if she is going to push because the baby is right there, I am not going to stop her. I don't plan to catch any babies in babyland - but, if they come to my mamas and there's no one else around to catch 'em ... mama and I are going to do it!

I live in a town without high rise buildings, with no Starbucks or malls to call my own; "my" unit has only four labor beds, with peeling wallpaper and drab furnishings, and no OB/GYN's to be found. My countryside is, well, just that - fields, tractors, and farms. To be blunt, summertime smells like cow-shit... but also the sweet smell of lilacs, alfalfa, and fresh-cut grass.

And - I like it this way.

Going back a few steps... to a birth story

One blog I love to follow is "My OB Said What?!" (If you haven't checked it out, and are a fan of birthing/pregnancy/empowerment & advocacy, etc --- I strongly encourage you too! :)

Anyway, the site allows readers to share off-the-wall, rude, demeaning, jaw-dropping, and sometimes just plain ridiculous comments that their OB's/midwives/nurses have made while caring for them. It can sting to read some of the stories shared - but is also eyeopening. As a provider, caring for women and families... it is hard to realize how much impact a few words can have on a woman looking towards you for reassurance, guidance, and information. (I hope that I never end up on MOSW --- unless of course it's on "Thoughtful Thursday" --- but as sometimes we all have those moments when we find our foot in our mouths... *gulp*)

Back to the point, here. Recently, one of the posts revolved around a woman who asked her nurse-midwife why she decided to become a midwife. Rather than sharing her love of women's health, the normalcy of pregnancy, or helping bring new life into the world, the midwife explained something about not wanting to take the time to pursue a degree in medical school.

Doh.

Of course, the comments to this post were varied, some defending the midwife and the current, exhausting med school process, while others were shocked and appalled that this midwife was clearly a doctor in midwife's clothing (if you will). A few were just grateful that she was "honest" about her path to midwifery, which would lead them to quickly switch providers.

But to me, mostly, it led me to ponder... why did I become a midwife? What led me here?

I think, to answer these questions, I have to start with my own birthing experiences... (I'll start with my youngest, as I wrote it shortly after her birth; as I re-read it, some things jump out at me and I think, "my, how things have changed!") More on that, as well as my older Mini's story, soon...

~*~*~*~*~

Birth of the Mini-est

It was early June, and I was miserably pregnant - but still far from my due date! Since my first daughter came right at 37 weeks, I had this faint hope (although I knew so much better) that #2 would also come early. So, once that 37 week mark came and went, I started going insane and feeling ridiculously overdue. Like every pregnant woman, I started examining my toilet paper, panties, poo, and anything and everything watching for the "signs" that labor was imminent. Of course, I had them all... and they didn't mean a damned thing.

I really wasn't THAT miserable, except my pelvis felt as though it was going to crack in half (and made a noise that reminded me of being a kid, and pulling the legs of my Barbie's apart - and then having them 'pop' out of the little plastic sockets, with that white plastic stuff... remember that? Eww) and I couldn't sleep for crap. I was achey, and kind of sick of having to hold my uterus up off my bladder to pee, and puffy - but could have been a lot worse. Still, though, I decided it was time to start working on Operation Baby OUT.

I walked, walked, walked, made my poor dh do things he probably did not care to do with a cranky, swollen whale (sorry about that, dear...), ate jalepeno poppers by the handful, climbed my wobbly self up onto a bike... anything and everything! Finally dh reminded me that the night before #1 was born, we had pulled weeds in the little flower garden out in front of our house. I rolled my eyes several times but decided what the hell... so A and I went out there and yanked half-heartedly at some weeds. Definitely made a dent, but the flowerbed still looked horrible. Had some dinner (don't remember what...!), went to bed (and again made my poor dh make a, um, prostaglandin deposit...?!), and thought about my big to-do list that I had made to keep myself busy and not looking for those aforementioned 'signs'. (The list included a pedicure the next day, calling to take 'call time' the next day at work, picking up some quilts at the dry cleaners, etc, etc)

Around 3 o'clock I woke up... with wet panties. Ewww! But, just like the first time around, I knew that it was amniotic fluid and not just a leaky bladder. To be sure, though, I snuck to the bathroom and fished out the nitrazine swab I had "accidently" liberated from work, and swabbed my gooky underwear - and saw a bright blue response immediately. Of course my heart was racing, and I got all shaky and excited (I had been dreaming of this and playing it in my mind for months, mind you!), but decided to shower before doing anything else... a girl's gotta be properly shaved for these kind of things, you know! So, I took a shower, then got online to kill a little bit of time and logged onto contractionmaster.com to see where my contractions (or lack of) were at. I also turned on the TV, and apparently at 3:30 a.m. there isn't a whole lot on - the old "Roseann" rerun where she's pushing free samples at the grocery store was all I got. Finally, around 4 I woke up dh, got his butt in the shower, and then after informing Jana of the change and rewriting my to-do list (so much for my pedi) we gathered the bags and walked over to the hospital. (I had called to let them know we were coming while dh was showering)

Go there, registered, got up to room 233 - and had the nitrazine now come out negative. Still not having much for contractions, and wondering if we'd even be staying. I was 2 cm at this point and pretty posterior (from my own guesses, I had been thinking I was around 2 for a while already) . But, nurse Angie decided to just put the IV in "just in case" (I was GBS positive this time), and wait and see - this was around 5 a.m. Assumed that Dr. Q would be coming in around 7 during rounds, so dh napped on the couch and I read my book ("No Country For Old Men") to pass the time... eventually reading only between contractions. By 7, I was definitely feeling them, but doing all right - I think it was around then that I put down the book, though; with the bustle of the day shift coming on around 7:30, dh woke up and turned on the TV, and kept asking me what I wanted to watch (not getting that I couldn't care less at this point!). My nurse manager - i.e. boss - came in around this point as well, and I remember talking through a contraction or two while she was in there, and afterwards thinking, "Huh, so far so good - I can still talk through them!". After that, though, they kept getting stronger, and I had to focus pretty intently on my focal point (the upper left drawer pull on the entertainment bureau) and breathe through them; I was also battling an achey back which I blamed on the bed... I started piling pillows on the bedside table and trying to hunch over it during contractions. Once or twice dh and I 'slow danced' through them. Around 8, since there was still no sign of the doc, I decided to hop in the shower both for the relief from the back pain and contractions, and also just for something to do to stay awake. Things got pretty intense in there, and I remember a few times thinking that if I pushed a little it might help... (it didn't). Still no doctor, so I stayed in there and alternated the hot water from my belly, to my back (or as best I could), to right at my perineum. I worked at visualizing that little head stretching my cervix and moving down... until finally at about 8:45 Dr. Q poked her head in to see how I was doing, and told me I didn't have to get out to see her if I was doing ok. By this point, I was thinking that I might be ready for something for pain, if things were moving - maybe nubain?? And I just wanted to know if things were progressing; if I was still only 3-4 cm's dilated I think I would have died, or begged for a c/s. I still felt like I was doing great... just tired!

So, I popped into bed, and she offers to break my water if I want; she also says that she has the nurses mixing up my second dose of ampicillin so we could get it in "just in case". I tell her it just depended on where we were dilation-wise if I wanted my water broke, and that I was maybe getting to the point for pain meds... so she grabs the amnihook and does the check. And pronounces me 9 cm! Since I had this great fear that I was only still 3 cm, I was pretty pumped... especially since I still had this mindset that things still had to get A LOT worse before getting to pushing. She decided against breaking my water, and the flurry of activities started (warmer and table coming in, that last dose of antibiotics being run in over 10 mins, etc) ... once the antibiotics were done, around 9:10 a.m., she broke the rest of my water (strange feeling!) and we started pushing. Pushing was awful! Last time I loved it... this time it killed me. Part of it was due to baby --- which also explains some of the back pain, which apparently was back labor! --- being posterior and rotating during pushing. At one point Dr. Q offered me some lidocaine gel to help with the burning, and I replied "it's not going to help at this point!" and everyone laughed at me... and then with the next contraction and push, I was ready to beg for it (except the head was coming out, and I couldn't get the words out... a little late, I guess!). Again, the best feeling in the world was when the shoulders slipped out and my second daughter was born at 9:15 a.m.

Due to a short cord, it was clamped right away (although I don't think I had even told the doc that I wanted to hold off on clamping/cutting until after it stopped pulsating) and cut by dh, and then she was placed on my tummy. I fumbled with the snaps on the gown, trying to get her to breast, until nurse Terrie said "it's easier this way" and just pulled the gown up from the bottom. Smart girl! She latched on easily and went to town... but I was still in awe of how HUGE she was!

Long story short, it was a very fast, relatively 'easy' natural labor - no pain meds, no unnecessary interventions. We did almost immediate skin-to-skin following birth, and my perineum remained intact with just a tiny skidmark. Recovery was fine, although the cramping was much, much stronger than with my first daughter - it was really worse than the labor was. My back was sore for a few weeks afterwards, but all in all - not too bad!

Olena Marie was born on 6/11/08 at 9:15 a.m., weighing in at 8# 7 oz, 19", and a whopping 35.5 cm head of dark hair.

Fading...

sweet slick violet crown...

coaxed smoothly to the crisp light

growing dreams, hope, love

~-~-~-~-~-~-~-~-~

the last baby i caught was on march 1st... today is april 8th. (it seems as though it's been so much longer since i've been blessed with a catch, but as i type this - i know that's right; i remember it very vividly!). as i completed my clinical journey with the Midwife, i knew that there would be a period of time when i wouldn't be seeing women and men transformed into mothers and fathers... and i was (or thought i was) okay with that. a few weeks... i could handle that, right?!

well, at first - all was fine. no biggie. the first week, i think, was Mini #1's "spring break" (really, they have that for pre-K - i kid you not). so, we chilled out, did some family things, and i de-compressed; it was just what i needed after a few really stressful weeks. the next week, i caught up on a forum post or two that i HAD to get in. and then - suddenly - (okay, not suddenly at all - i had all term, and most of you know this, right?!) it was crunch-time and i had to finish The Paper. so, that kept me occupied for the last week and a half or so of March. and i got it done, with flying colors (thanks be to whoever you praise).

but - now that's all done. and this nagging feeling, that's kind of been popping up here and there in the past five or six weeks - is back with a major vengeance. i feel unemployed; i feel like i am sitting around, doing nothing, being a lazy, useless pile o' rubbish. i haven't been less than a full-time student and/or worked less than full-time since, well.... i can't even say when. i mean, it's been a long time, folks. (and i'm not saying this just because i'm pretty sure i'm getting a touch of dementia --- i really am used to working at least 1-2 jobs, going to school, etc, at a crack). sure, i'm still working right now - but i'm a 0.3 FTE. which means - 1 or 2 shifts a week. and - i AM perpetually lazy, which means if i can get "low-census" (i.e. things are slow in baby-world, so they don't need all the scheduled 2 or 3 nurses...) --- i'll often take it, out of habit.

i think i am annoying the "new" midwife to pieces - i've emailed her a few times over the past couple of weeks (mind you, i believe she is just coming back from a medical leave)... but i really, really, REALLY want to get started with her. i'm also starting to get a little anxiety prone. like, i have 260 hrs to go of clinical, and i need (want? should?) to be done by the end of june to be done for this 'term'... if i don't get going very soon, i don't see how i'm going to get all of those hours in. i'm trying so very hard to be patient, but i just w a n n n n a G O O O!!!

it's times like this, that i really could use a little xanax... or a big glass of wine... or gerard butler... *sigh* (for example - my anxiety? see how i'm typing in all lowercase? telltale sign...)

and mostly ---- i just want to get my hands on some babies! *pout* (well, and meet their mama's, too, of course... that really does add a little something to the experience...)

Whichever way the wind blows...

... may be the path that I will take.

I haven't blogged in a while. Almost two weeks, in fact. (Crazy!) Not that much has happened in those two weeks, to tell you the truth. Looking back, what exactly have I been doing that has kept me away from blogger.com??

I...

dealtwithtwosickkidsandonesickhusband*hadasitevisitwithmyRCC*boughtfartoomuchgasandtookmanytripsbackandforthtomyclinicalsite

*workedalittlebitandgotpaidforwhatseemedlikeevenless*wastedtoomuchtime*caughtthreebabiestwogirlsandoneboyIthinkorwasittwoboysandonegirl*hadanawfuldayatclinicalandfeltaboutaninchandfiveeighthstallwhenIreceivedsomehardtohearbutprobablynecessarycriticismfromtheMidwife*pretendedthatmyeyeswerejustredandwateryandthatIwasn'tbawlingatclinicalsforthatsamereason*foundapossiblysuspicousbutmostlikelybenignbreastlumporcystwhiledoinganannualexam*amwaitingsomewhatimpatientlyformyownmissingmensesalthoughitcan'tbetoofarremovedasmyBCis99.8%effective*hadsomelongnightsoflittlesleepduetothelittlerMiniwhodoesn'tseemtoenjoysleepinginherownbed*beenstrugglingwiththedilemmaofwhetherto"holdback"theolderMinianextrayearin4Keventhoughsheisacadmicallyperfectjustincrediblyteensyandabitshy*madeitthroughValentine'sDay*passedthehalfwaypointofmyclinicalhourstally*droppedofftaxeswiththeaccountantsinceIhaveNOideahowtodothemmyself*caughtanunofficialbabyatwork(hey,hey,hewasLOA!)*attendedagrantwritingclassandtossedaroundtheideaofstartingajointCNM/CPMbirthcentersomemore*splurgedonanewAndroidcellphonesinceminestartedhavingseizures*taughtchildbirthclass*managedtogotobedonenightat8p.m.andsleepuntil10a.m.mostlyuninterrupted(thankyouWarmOne!!)*hadalovelymassage&scheduledahaircut,highlight,andbrowwaxwhichIWILLkeep*gotthegoodnewsthatagoodfriendhadasuccessfulVBACofa~gorgeous~babyboy*senthappythoughtstootherfriendswhoneedthem*avoidedhomeworkbutmadeateensybitofprogressonmy"big"paper*mayhavelosta$20billsomewherebutI'msuresomeonewhoreallyneededitfoundit*hadlunchwithanawesomefriend*hadsomeveryvividdreamsandwonderedwhattheymeant*learnedmoreaboutmygreatgreatgreatgrandma...didIevertellyouthatshewasamidwifeinthe"old"country(Germany"??)*learnedthatILOVEpecanbarsfromthisrestaurant/bakerynearmyclinicalsite...heaven!*justrealizedhowtiredisuddenlyam...

Does this count as flight of ideas?

"The answer, my friend, is blowin' in the wind, the answer is blowin' in the wind." ~Bob Dylan

Withdrawal

Six days. That's how long it's been since I've had one. To some of you, it might not seem like that long, but god, it sucks! I almost, almost had one yesterday - but I didn't.

I don't know if it's good or bad that I kept my hands off it yesterday. It was SO close - but I held myself back.

I'm dreaming of them; driving to work and clinical, I fantasize about how to get one. How to excuse myself out of the office, for that very reason... In the office, I do anything I can (within reason, of course!) to "help" make it more likely...

(Is this bad?)

All right, all right... the good news is, if nothing else - we have two inductions scheduled Friday morning so I WILL get my hands on one of those long-sought guilty pleasures then. If the multip - who has been so desperately waiting for labor for the past three weeks, and whose membranes I "stripped" a few days ago, hoping it might nudge labor on - hasn't naturally kicked in by then, I think hers will be the first lustily-crying babe I'll get my hands on. I think he'll (we don't know if it's a boy or girl, but I'm banking on boy parts) be a pretty good size kiddo, but she'll do well: her heart will fill with a new love for her child that she allows my hands to catch - such an awesome feeling!

Otherwise, besides the dreams and intense desire to catch one --- no jitters or other symptoms, so I guess my withdrawal isn't as severe as it initially seems. But - just in case... send some baby-vibes this way, please!

~*~*~*~*~*~

The Cost of CNEP Clinicals

So, I finally decided to pop out a calculator and figure out just how much in lost wages this whole clinical thing is costing me. Between clinging, sad kiddos and a dwindling checkbook, I finally admitted to myself that I was having some pretty severe withdrawal from my life as well as the slippery babes. I was shocked, though, to realize just how much we've 'lost' since I cut waaaay back on working to try to plow through clinicals... see below (I won't tell you exactly how much I make, I'm just going to toss out $25/hr as an "average" rate for a newer RN working in a hospital setting in a low cost-of-living area... sound fair?) . So - CNEP program length is 675 hours total...

675 x $25 = $16,875

Holy Bejesus Batman! I knew it would be a lot... but I wasn't expecting that much (I really, really suck at math). Yikes!

And, of course, this nice chunk of change doesn't include mileage/gas costs - I am commuting right around an hour each way to my clinical site, usually 4 days a week, so averaging probably $80-90/wk in gas - or tuition/schooling costs (I want to say this is about $2800 each term, or around $8400 total, give or take, for the three terms of clinical that I will have). Last - and definitely not least - there is the time away from my family and "life"... there is no way to put a price on this, but hopefully, will be a small sacrifice that will be forgiven once time passes.

Who's on Your Celebrity List?

Come on... you know you have one... your list of guilty pleasures. Those five celebs, that you would like to have a chance with - no holds barred. Kind of "freebies", right? I know you know what I'm talking about here, right?!

Wait, wait! I don't mean, oh, Gerard Butler (drool!) or Brad Pitt. Not that list. I'm not going that far off topic (not that I wouldn't mind wandering off topic that way, but... wait, where was I?). Ok, anyway, back on track.

Right. The Five. (I think, to be honest, you can have as many on your "list" as you like, according to the popular version of this list - but for my blogging purposes --- I'm going with five. Thanks.) Five celebrities/well-known folks* that I would love to attend to during pregnancy and birth...

*Just to clarify, this is meant to be light-hearted... I don't hold celebrities to any higher regar

d than you or I, or my neighbors, or any woman I meet on a daily basis. I don't idolize Hollywood faces by any means - but, I figure they probably have their own demons to fight just as we have ours. I suppose they are just people, like anyone else... so the purpose of this post is just that, 'hey, for some random reason, this person [ insert name ] seems like my kind of person --- I'd love to have her/them for a client!'. That's all :)

So. Finally. On with the List.

5. Jennifer Aniston. Honestly, I don't know if she's dating anyone, if she's preggo, whatever --- I don't have time to grocery shop, or get my hair done, so haven't caught up on Star or People (not even the covers!) in forever. *Sigh* But... can't you imagine her as a pregnant mama? I'm totally stereotyping her based on most of the characters she's played over the years, I will shamelessy admit it ... but - based on that - I see her as the sweetest, could-be-my-new-best-friend-who-is-over-the-moon-excited-about-every-single-part-of-pregnancy client. She'd buy every single pregnancy relat

ed book out there, have What To Expect... (groan) dogeared, and have scores of questions that I would love to answer at each appointment. She would just be an all-around warm-fuzzy, brighten-your-day kinda girl.

(I think she would have a realistic outlook, too - she wouldn't go into it with a mile-long birth plan spelling out "delivery by candle light and whispers only" and "absolutely no pain medication", rather, a perfectly normal, non-diva delivery with a requested epidural, rest, and probably a small perineal laceration. Ideal, from a "birth as a normal, non-pathologic" process? Nah. Still perfectly fine? You bet!)

4. Ellen DeGeneres. Again, I don't know much about Ellen's love life these days. (See explanation above.) I believe she is madly in love with Portia de Rossi - yay for them - and if I'm not mistaking, they have a baby... babies? (Really, I am about ten years behind, here...) I am so disgusted with myself that I can't keep up with anything, but when I do catch the Ellen show, I love it! Even when I can't - I am blessed to get snippets and links from friends who have caught segments or shared with me; ever since I was a young'un - not gonna date myself here and give you specifics, I'll just say it was before the Y2K fears came about - Ellen has been a great fave. How fun would she be in labor? (And, not to mention the whole beautiful - in my opinion, of course, and this is a tangent/different post topic - blossoming of the unique family. Not that ev

ery family isn't unique and beautiful ---- here I go again, with the mouth/mind quicksand... I hope you know what I mean. Ugh!)

3. Miranda Kerr. Okay, Orlanda Bloom's (hello, hotness - pardon my distraction back to the "other" list for a moment again...) wife grabbed my attention - and the attention of many - when she posted a gorgeous picture of herself and her newborn son shortly after little Flynn was born. The beauty of it had nothing whatsoever to do with the fact that Miranda is a Victoria's Secret model, or that the babe was a mix of her lingerie-wearing genes and those of Orlando Bloom (*drool*) but that the picture that spread like wildfire over te Web showed her nursing the sweet babe in a sidelying position, aside a statement promoting natural birth and the importance of strong, loving support during labor.

So, Mrs. Kerr-Bloom* - in honor of your handsome son and public service announcement for natural birth and breastfeeding, I will wipe my chin and move on. Thank you.

* I really want to be childish here and make a joke that this sounds a lot like "Care Bear". That seems kind of, well, childish though, so....

2. Oprah Winfrey. Okay. I have to be straight with you here. I don't think Oprah's havin' a baby any time soon. I am totally selling out here because I want a 2012 VW Beetle. I like to think, maybe, if I was her midwife, she'd give me one of her favorite things.

I know, bad midwife. Bad midwife!!

(And yet -- doesn't every midwife need a Beetle?!)

1. P!nk. I relate to every single P!nk (aka Alecia Beth Moore) song out there - don't you? ("Slam, slam, oh hot damn - what part of party don't you understand? ... "But we try to hard, it's a waste of my time, done lookin' for critics cuz they're everywhere - they don't like my genes, they don't like my hair"...) Who doesn't hear a P!nk song and feel instantly cheered up, at least a little?

I think, a P!nk pregnancy, labor, and delivery would be a blast. I think it would be fast, wild, and crazy. Yeah, yeah, there might be some, um, interesting parts --- but what fun is anyth

ing in life if there aren't times when you just have to take a deep breath, hang on tight, and hope for the best? Would P!nk's baby come out with sweet hair? Damn right! I'm predicting - fast, fast labor - one of those intense ones, probably a fair amount of swearing (ah, hell, who doesn't do that in labor though, right?) but a fair amount of tender moments, too... followed by a swift and gentle birth of a little mohawked mini-P!n

k. And, of course, soon-to-be-snuggled in a mini panda hat just like mama's...

~*~*~*~*~

Well, I've successfully avoided (a) housework and (b) schoolwork for the evening... mission accomplished! So who's on your "list"??

Home is where the heart is...

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

~*~*~*~

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

Personally, as an OB nurse and almost-nurse midwife - I LOVE homebirths, and think that for the majority of women (basically, meaning a healthy mom and healthy baby), attended by an

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

But.... on the other hand.

I am not an experienced nurse-midwife. Yet. The fear that I carry comes from that little detail. I worry that I don't have quite enough critical thinking; nearly enough attention to the little things; the right amount of intuition. The catch-22 of working on the L&D unit is that a person gains an unhealthy sort of dependence on fetal monitors, lab tests, and the proximity of "just in case" scenarios; while it's great to have the collective knowledge of scores of other nurses and

providers (many of whom revere the sacredness of natural birth), it becomes increasingly more difficult to see the clarity of birth

through the fog that is the medical model's view of pregnancy and birth as an accident waiting to go wrong.

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

Will I ever perform home births? I think so... I hope so... When this fog clears, I think that question may be a much less complicated one than it seems right now.

-.-.-.-

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

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

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

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

~*~*~

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

On Blogging

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

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

I also was sucked into Stand and Deliver's blog. (It started off innocently enough with a journey into some relief measures for sinus troubles - hello, Neti pot!) but then I clicked on an older post - "Birth Around the World, My Alien Baby" is a title that kind of grabs your eye, I guess" (http://rixarixa.blogspot.com/2011/01/birth-around-world-my-alien-baby.html) and was hooked. A great birth story shared by one of Stand and Deliver's blog readers, it was the reader's own birth (her mother birthed her in Azerbaijan) and then the story of her own daughter (which, of course, didn't go exactly as planned). Beautiful writing, and a poignant message. Today's posting (http://rixarixa.blogspot.com/2011/01/birth-around-world-vbac-in-tajikistan.html) was similarly heart-hitting - another in her "Birth Around the World" series... I'm loving them, and the perspective they provide those of us just starting out and feeling like we are sheltered in the "same old, same old."

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