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...

Long time gone...

Hey, nice to see ya! Where've you been?!  Oh, wait, I guess maybe it's where I been, eh?

So, needless to say, this post is loooooong overdue.  I think this blog's last posting was somewhere around, oh, six months ago?  Huh.  I guess it's been a busy half-year.  Since our last rendevous, old friend, I've packed up and picked up everything to move half a days drive away, officially gaining entry into the world of a practicing (and paid!!!) nurse-midwife, and gloriously helped a powerful mama pull her newest into her arms, standing alongside her bed... (my first out-of-bed birth - woohoo!). I've said goodbye to so many friends --- and in a heartbreaking moment that doesn't end, to my baby brother, standing alongside each of my family members as we realize the swiftness with which goodbye can be missed; I've lain awake at night and struggled with my own internal guilt, fears, remorse, anxieties - both professional and personal.  I worry about meeting the expectations of my clinic administrators, meeting the needs of my clients, about being thorough yet not over-ordering or falling behind; I fret about when the golden hospital privileges will finally be mine, how stressed my partners are in the meantime while they await that day and how tiring it must be to have to back me up until then.

And, of course - I yawn, I drag, I sleep only halfway 98% of the time, hoping/not hoping my pager will go off... if it does, if that next mama's water finally breaks, it will be one more babe closer to independent privileges and a bit of relief for everyone all around (but if it doesn't, of course, it means a bit more sleep for everyone on the home front.) Officially, I'm on call something like four nights a week - but unofficially I've been sleeping with my pager under my pillow just about 24/7 since starting in April - or at least since getting permission to get near hospital patients a month or two ago. It doesn't beep at me often ... yet I still dream that it does, or that it did and I slept through it, or that the batteries died and someone's been frantically trying to find me, yadda yadda....

Oh, but the catches - the sweet, slippery, lovely babes!  (Really, isn't that what it's all about??) When it's down to that moment, the rest of the stress, the worrying, the anxiety melts away.  Until, that is, the hemorrhaging afterwards... or the placenta sticks... or mama passes out later on.... you know, those sorts of things....  But the catch itself, usually, is a rush!
 
I pledge, from this point forward, to stay more loyal to this blog.And I hope you'll stay here, too.  Like any good things, any journey worth taking, it may be a long road, but hopefully worth the travel....

My "birthingway" necklace ... or "mamalove" necklace... or "I Catch" necklace" ... or ??? 
(I'm open to suggestions!) ... for every babe, a bead <3 

 

North by North West...

That - is the question.

At the end of the last post, I alluded to some internal conflict between the two sites where I recently had interviews. The first site, dibbed "North", is located about 5-6 hours from where my family has always called home. It's got quite a few things going for it; the pay is nice (relatively - I don't know what the other nurse-midwives that graduated in my peer group are being paid, for the most part, but the rough starting pay I was quoted for this position is about what I was expecting based on my searches for this area). The site is also a HRSA (Health Resource Service Administration) designated site, and the position is eligible for loan reimbursement --- which means that by committing to work in the role for at least two years, I would say buh-bye to a nice chunk of my student loans (and by working a third year, one more of those big ole monkeys would also take a hike... leaving me just about free and clear on the loan front). My partner would be a midwife who developed the nurse-midwifery practice at the site ten years ago, and has worked to build a great relationship with the handful of family practice doctors who she works alongside (by the way, I LOVE family practice doctors - not such a fan of OB's --- most likely because I simply have worked with very few, but also what I have heard of them hasn't been so favorable...). The main clinic at this site is located in a rural area and is very full-service, offering clients a range of services from x-ray and lab to WIC and massage; the practice also has a secondary site in a large city about 30 minutes away, with limited services (but just as vital care for recipients in the urban area). Call would be shared, possibly 2-2.5 days a week and 1 weekend a month (with an estimated 50 births annually); clinic would be 4 days a week split between the two clinic sites. After visiting "North" --- I felt good, confident, ready to go. I had a strong feeling that I was going to be offered the position, and that I would probably take it.

But. (That "but" is always there, now, isn't it?) In the days that followed our return from our visit, a few things nagged at me. At the end of my visit with the midwife at "North", I asked a few questions (thankfully) regarding the specifics of her midwifery practice. Did she feel that she did a lot of inductions? (She felt like she actually probably did more than she should... red flag?! red flag!! Her rationale? She did take days off - understandable, since she was a solo midwife and had been for the past 10+ years; she stated that she did offer induction at times to her patients before she went on vacation. Hmmm. So - on one hand, this seemed OK. On the other... something to ponder.) What about continuous monitoring versus intermittent? (Answer: If a woman specifically wanted to be off the monitors, she was good with that - but if there was no preference either way, she didn't push for intermittent monitoring either... ???!!? Rationale for this one --- The nursing staff tended to be low, and this made IA difficult to impossible at times. The unit did have telemetry, so continuous monitoring didn't necessarily =/= a patient that was stuck in bed --- but then again, MY unit also has a telemetry unit... which sucks. As much as I'd like to say telemetry means a patient can labor while ambulating, or in the shower, or on the toilet or squatting or standing on her head --- not necessarily. Especially if she's on continuous EFM for nursing/provider convenience in the first place. S0 - another thing to ponder. While again I can understand the reasoning behind using EFM versus the additional time necessary to IA --- and am glad she had that explanation rather than that she needed the security blanket of the paper/electronic strip to ensure babe was doing all right --- I still get nervous at the idea of having hours and hours of paper strips staring at the nurse... and resident... and whoever looks at them and starts seeing oogie-boogie monsters in the shadows of innocent variability or the occasional benign decel.) Those were the two biggies on my "hmmm" list... From just a facility point of view, it would take a while to get used to LDRP's that are half the size of the ones at "my" rural critical access hospital, some of which have shared bathrooms. And residents (I've never worked with residents in my life - they seem like a whole different species!). And - while I won't say specifically which states, I will say that "North" is in a neighboring state which has a longstanding, sometimes vicious football rivalry with our NFL football team. And the Warm One is a diehard football fan.

So there are at least a handful of things that "stick", if that makes sense. Not that I'm not seriously considering things --- it's just not 100%, yet...

And then - there's "West". I flew out there last week and fell in love. I texted the Warm One immediately (or maybe it was after dinner with the midwives - either way, I hadn't been there long) and emphatically told him that I would cry if I didn't get the position. Throughout the course of my two days with the midwives at the "West" practice, my position on the area and their care philosophy didn't change. At all. I want to go there. The town where this practice is located? Beautiful. It's twice the size of the small town I live in; I'm a small town girl, so I can handle that. Their practice? Gorgeous. Clinic exam rooms that are spacious, with huge, full-sized "beds" (seriously, I have no other way to describe them) covered in pillows created for expectant mothers to lounge --- alongside big brothers and sisters, or dads-to-be as well --- and chat, listen to that precious heartbeat, and learn. Beautiful birth-inspired, earthy artwork everywhere. No sterile white walls or ugly, plain paintings meant to be aesthetically neutral. All of my questions - "Do you induce a lot?" "How do you feel about VBAC's?" "Are you open to a new grad?" - are met with just the right answers ... yes, inductions are necessary sometimes --- but not just 'because'! And they do VBAC's, and waterbirths, and LOVE students. It's amazing just to pick up the calm, reassuring vibes as they answer questions - to picture these two women as mentors is mindblowing. The call/clinic schedule is specifically geared to give each of the three midwives a rejuvenating period frequently; at least once every three weeks, each midwife gets a 5-day off stretch (that is, five STRAIGHT DAYS OFF in a row. Heaven. No clinic, no call, nothing, for five days.). Clinic and call are intermixed, often with stretches of 3 days off in a row as well. As one of the midwives stated, "When we are on-call, we usually work hard (the group of three midwives delivers between 250-300 babies annually) - but when we're off, we also 'rest hard'." I can dig that. To be able to serve my patients AND my family? Awesome-sauce. And the hospital is about 2-2.5 larger than 'my' OB unit --- so larger, but not as large as "North"; the nurses were great, and loved the midwives. Downfalls? Cost of living! To find a house under $200k may be impossible, and we would have to trade in one of our cars for an AWD or four-wheel drive; the pay "West" is also significantly ($10-$15k - ish) less than "North", with 2 weeks less vacation time and likely less benefits in other areas, particularly no loan forgiveness. Big things the Warm One is concerned about. And, of course, being a plane ride away from Home. Where the hearts are.

Speaking of home.... And hearts. It's a hard thought to think of leaving everyone that I/we love behind us. As much as I always suck at returning messages, emails, phone calls, etc --- it's even harder with all of this going on. Part of me wants to ignore that any of this is happening - that any changes are coming - but to do that it also means ignoring any references to change. Whether we go "North" or "West" ... or anywhere else ... it hurts. And it's scary. But it will be okay, too.

For the time being, I'm waiting for a phone call. A phone call from "West" could be making a decision that we go that way - throwing caution to the wind and hoping that the cost of living will balance out - or the other way. Or, perhaps, no call, but a "thank you, but no thank you" letter (as they did have two other candidates yet to interview...) leading us "North" ...

~*~*~*

In the meantime, I'm content to be back on the edge of that abyss, arms wide open, and leaning in, knowing that wherever the fall leads, I will land gently...

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 Abyss

I waver between two different realities. One, I stand on the edge of a total, all-encompassing darkness. My bare skin is chilled - goosebumped - but invigorated. Behind me is all I know, everything familiar, the things that have always been. In front of me is... what? Nothing? The steep, sudden chasm at my toes should frighten me, yet I feel nothing but an overwhelming sense of calm now; that fear - fear that should envelope my entire self - has vanished along with the light from this space. I know that to step off could end everything - but it could also be the beginning of everything. With the slightest step into the unknown I will open my wings and fly to the place of my dreams, or simply land where I'm meant to be: a pillow of soft clouds, the waiting arms of a One who created me, or the place of my family's future. A soft wind's push, a strong legged-leap, a quick stumble... any of these things would move me on, and yet - I pause at the edge of the question marks beyond.

Then there's the second place; the place where the Fear lurks. Down a constricted, narrow earthen tube - barely wide enough to descend, long enough to make the late afternoon light little more than a tarnished penny above - lies the insignificant yet crucial room. Constructed of thick steel, lined in double layers of thick and splintering wood, barely larger than a bathroom stall (and certainly less than five feet tall)... it smothers, it suffocates, it shrieks. Time stands still at the same moments that it races by; in the silence of the box, the deafening darkness threatens me with insanity. I stand at this fissure, knowing the only way to complete this journey - to pass this test - is to descend the long ladder downward, to endure my time inside with my Fear, and fight my way back up and through the long, tight passage back... and I struggle, I fight. I know I can do it, and I know I should do it - go down, do my time, and emerge victoriously, proud of my dirt and raw, rubbed skin; I know the struggle is the true origin of my Fear.

~*~*~*~*~*~

And yet - I still stand here, at the edges. Aquiver.

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???

And what goes around... (on depression and stress, too)

As they say.

Ebb and flow, yin and yang, yadda yadda. After my little meltdown Friday, things eventually lightened up. (If you've followed the blog at all, or know me, I'm sure you know this is nothing new... or maybe this isn't just me personally, but something that is a natural phenomenon of this thing called life. Maybe it's not unique to mothers, or women, or grad school, or th

ose of us who deal with depression. Maybe it is. Does it matter? Not really.)

Anyway. I posted a similar cry for help, bemoaning my situation on Facebook; basically, that the Warm One was at work, I was at the end of my rope with the girls and had no idea what happened to my patience, and the end of the weekend (the Warm One works a weekend program - Fri/Sat/Sun only, therefore leaving the girls and I to our own devices all weekend) seemed ages away. I was desperate.

And out of nowhere, a good friend came to my rescue. She invited the girls and I over, to visit, to play, to stay. It took us hours and hours to get moving and get packed, but eventually, we got there. She opened her home to us, the girls played (she has a daughter the same age as the Mini-est), and we were able to catch up. We spent Saturday together, just hanging out. Was I the most fun and exciting person to be around? No - but I hope I was a better mother and friend than I felt like I had been earlier that week. Little by little, I am crawling out of this miserable, stress-filled hole.

Before the girls and I left, I managed to pull myself up out of my funk enough to send a copy of my resume/cover letter to the physicians I work with as a labor/delivery nurse, simply to introduce the idea of adding a nurse-midwife to their practice (I've been hoping to have the 'right' moment to talk to some of them about this over the past year or so, but it just hasn't happened); I also emailed my nurse-manager to touch base. My fingers are crossed - even though my breath is far from held - that good things could grow from this tiny seed being planted.

The Warm One also came home last night and shared that another doctor, an incredibly sweet family physician working for a nearby tribal clinic, had asked where I was at with my job hunt; she mentioned that the tribal clinic had been trying to fill an open physician spot for the past year, and she was willing to bring up my name at the next physician's meeting to see what the interest there would be. Again, fingers crossed... I've worked at another nearby tribal health organization in the past, and love working with Native populations. The culture and history, combined with the deep relationships between families, make it a community I would be honored to be invited to work within. (I've requested information from the IHS about their loan repayment program, but have yet to complete the application process; it's on my radar as yet another thought...)

*And, if nothing else - this again cements to me the fact that I cannot - at least at this point in my life - function without antidepressants. I know that there are many different viewpoints on this and whether or not medication is something that is "right" or "necessary" but until I have one or two fewer things going on ... I can't let myself - and my family - go down this road. It never fails that when I manage to go without taking the pills for a short period of time - whether because I fail to get a refill in a timely manner, or because I miss one or two, and then tell myself I still feel "great!" - I find myself in a similar murky fog within a matter of days or a week. Someday, I will be able to truly dedicate the time to find other positive

lifestyle changes to experiment against this headgame, but as for now... I'm gonna take the easy way. I need to be able to accept sweet love notes from the Mini and appreciate them; I need to be able to have patience with my girls when they are being kids, instead of being over-anxious and stressed... I can't see the confusion and hurt in their eyes when they look to me for comfort, and don't get it; this parenting thing is hard. I feel like I hardly see the Mini's lately... and when I do, they're not my sweet little girls anymore! They don't listen... they're sassy... they fight. I don't know if it's a stage, or if it's related to not seeing me, or if it's how it's always been (and I'm just seeing things differently because I'm stressed), or if their actions are feeding off of me, or ...?!

Hey! Can It Be?

Can I actually be back in the clinical saddle again? The wild ride continues, apparently... a month after my short stint on the western side of the state (only catching babies - no clinic), and almost four months after parting ways with the Midwife, it looks like I might finally be "good to go" with "Dee" (hopefully a psuedonym I'll remember!), my new preceptor. The wait to start at this site has been such a long, drawn-out struggle... even though everything seems to be ready and in place for me to start this last leg of my clinical journey on Wednesday, I'm still hesitant to really believe it. There have been so many false starts: way back in March, it looked like I would be able to start building up hours with Dee in early April, after she returned from a short medical leave; after weeks and weeks with no communication, it turned out that somehow my paperwork had been lost among the administration team, pushing the process back further. Then, gradually it was May... and now June...

Luckily, the short voyage across the state last month did much to re-energize me and to remind me why I'm doing this all in the first place (although I feel like my clinical skills and knowledge are going to be awfully cobwebby once I finally break my way back into the clinic); my daughters tossing off comments without a second thought - "Mama, when you were a little girl you were like us, but then you grew up and started to catch babies all the time!" - like it's always been this way, only cements that feeling even more.

~ * ~ * ~ * ~ * ~ * ~ * ~

Which, of course, leads to the next step in the journey. If (when) I ever get through this step - clinicals, that is - and if (when) I manage to pass both comps and boards (an overwhelmingly terrifying prospect) ... then what?! The job market for a CNM in my area is bleak. As in - none. Zip. Zilch. Nada. I've been following several CNM search engines --- GetMidwifeJobs.com; the job listings on ACNM's website, the listings on my school's forums, etc. I've sent resumes, cover letters, and CV's to anyone and everyone, to every job that looked remotely interesting; to Alaska, New York, and AZ. With no calls, no emails, nothing. Kind of depressing, to be honest... but I haven't been very aggressive myself - you know? I still have 170 clinical hours, and up until this week, no idea when I would get those hours going.

Out of the blue, though, I got a call this week from a physician in Maryland; we had a nice, 20 minute chat (after I hung up on him initially - oops, the drags of living in the rural Midwest) and I was left with a bit of hope and interest in what could come from the talk. Could I do Maryland? Pro's - Adventure, ocean nearby, change of pace... a job. Con's - Moving across the country, no family anywhere (some days that might be a slight pro... slightly), higher cost of living... and apparently it's a very 'un-rural' area. Not so good, since I have a feeling I might get kind of antsy surrounded by city/urban folk... maybe. (Although living around here in a cardboard box, with loan papers coming in the mail on a daily basis, might making me kind of antsy too - especially when the snow starts flying...)

I hate to even post this here, since a tiny part of me (okay, a good-sized part of me) is superstitious - but when I met with Dee last week, she also gave me a glimmer of hope for a potential position at her site. (This site is about 45 miles from my current home; it's within the same healthcare system I currently work for, and while it would have its own set of pro's/con's to consider, staying within the area would be a huge "pro". ) So, after talking more with her this week, maybe - hopefully - I'll be able to expand on this more...

Snow Day

A snow day is EXACTLY what I needed today. Fate, or karma, or G*d, or my daughter's school district (seriously - the 2011 calendar they sent home in December had today listed as a snow day'...?! Wooooooah. Crazy, man, crazy... ), or Ma Nature, or all of the above, agreed; my driveway is covered in drifts of snow ranging from 2-3 feet deep. Since the Warm One conveniently blew a belt on the snowblower this morning trying to dig us out, I couldn't leave the house if I tried.

Shucks.

Such good memories of being a kid, sitting by the radio in jammies and waiting in suspense - sleep still crusting up our eyes - as the DJ's worked their way down the list of schools that were called off on account of the weather. My teachers (and maybe my mom or grandma) will take all the credit for teaching me to read, but I will swear to this --- I learned alphabetical order by hearing the names of neighboring school districts on the radio: "Abbotsford... Bonduel... Bowler... Clintonville... Coloma... Edgar..." Believe you me, when you are a kid and the glimmer of hope for a snow day is there, you learn really quickly how the name of your school fits in with the long list of other districts. And you will listen religiously to that same listing, over and over. And over. And over. (Because eventually, even as the bus is pulling into the school's parking lot, the school may just catch on that the roads are impassable. They might.)

A two-hour delay was acceptable... but a cancellation was golden. The whole day off, for... what? Some days, we kids would just lounge around and watch cartoons (or soap operas and court shows... hey, we were rural and relatively poor - no cable on the farm!). Or, maybe we'd suit up and head outside for as much of the blustery snow as we could handle... because realistically, most of the time by the time the schools were called off, the weather ended up being perfect for snowball fights, sledding, and snow angels. Eventually, we hit the Nintendo stage; then there was books, toys, chores, and all of that fun stuff, too... the important thing was simply that it was an unexpected free day. (Why I never chose to just sleep ALL DAY I don't know. What kind of child was I?! Dear heavens.)

~*~*~*~

Anyway.

I really, really did need a "snow day" today. Last night, when the bigger Mini-Me saw all the snow coming down, she asked me if I had to go to work (i.e. clinicals) today; I mumbled something about that I would probably have to, but it might depend on the weather. She then proceeded to remind me that she was having a snow day, and that she hoped I would, too. (Awwww!) And how she wanted to have three days in a row with me home... and to have "Dad" home, too... (he works a 'weekend' program, so it's rare that all four of us are home for a full day together). That planted a teeny seed in my head, which blossomed overnight - watered by the inches and inches of snow outside - into the pretty firm idea that a day of R&R would really be good for my mental health. I had pretty much decided, then, that I would just stay home and work on homework instead of driving the hour to clinicals (for a short 3-hr stretch of office, anyway), when the morning's news of nasty roads and crazy drifts and winds starting rolling in. Then, of course, the snowblower sealed the deal.

(Well, actually, what sealed the deal was the email response from the Midwife to my email from this weekend... which, of course, brought me down for a while. Whether they were tears of frustration, relief, anger, fear, or something else - I'm not sure. At one point during her email response, she noted something to the effect of "I'm just having a hard time communicating with you" -- and I think this is the crux of our difficulty. Whereas the Warm One and I have two very distinct personalities and they mesh well together, or some of my close friends and I are complete, complementary opposites --- this does not work so smoothly for the Midwife and I. There is no existing history, no extensive trust, no equal sense of giving... or at least this is how it seems to feel. I'm sure for the Midwife, it seems as though there is so much more at stake: these are her patients, this is her practice, and her reputation and her income. And I certainly do have my own large faults at the heart of this matter. Anyway, this post wasn't meant to revolve around the email... I don't think. I'm wandering... maybe another post later, or tomorrow, or something... )

So, all of these things in the end convinced me to stay home, jammies on, and french toast a la Warm One served up. Now, it's the Heffalump movie and job-searching online ( <--- read: avoiding the Birth Center paper).

And, did I mention that I am doing a phone-screen for a CNM position, right down the road, within the next couple of days? (Which may or may not be related to the fact that I called that facility to inquire about possibly doing some clinical hours with the midwives there - who I didn't know even existed - in the upcoming months, for a change of perspective...) ...

When snow falls, nature listens. ~Antoinette van Kleeff

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.

When my mind wanders, this is where it goes...

Today I had lunch with a great friend. We don't do it often enough... and we really, really should do it more often. Hmmm... how to 'dub' this friend? She is full of awesomeness, a truly free spirit, a little bit flighty (like all free spirits should be), and just all-around fun, fun, fun. Let's call her, simply... Friend.

Friend and I have worked together for years... I was a new nurse, and she was the "seasoned" nurse (albeit, still a newer nurse --- but, she had a few years on me, so it all worked out!). She had a little guy who was a year or so older than my oldest Mini, and it seemed as we always had some common interests. Over the years - and many snacks, deliveries, and desserts - I like to think we've become pretty good friends.

(I'll interrupt myself here to say that I don't really have many close friends... or maybe I do. I don't know... what is a 'friend', really?? I think in the past year or two, this has changed a lot... I don't know. Anyway, where were we?!)

So, moving on. Friend and I are both moving towards the common goal of midwifery, but via different paths. While I am pursuing a degree in nurse-midwifery (CNM), Friend is going a slightly different route to earn a Certified Professional Midwife license. Basically - from my understanding (and I would love to be further educated, so please let me know if I have this wrong!) - Friend is learning from "the best", a very well-known and well-respected CPM or "lay" midwife in the area. This midwife has been doing births in our area for the past 30 years, and has welcomed hundreds (if not more) of healthy, beautiful lives into this world in the warmth and love of their own homes. She is active in the midwifery community and - I can only imagine - a wonderful source of perspective and learning for Friend. So while my education is coming from a variety of sources, primarily distance-based (online) until my clinical rotation finally started a few months ago... Friend has been immersed in midwifery since deciding to take the leap into apprenticeship.

There's pro's and con's, certainly, to each method. She's been able to attend births as a midwife - and get her hands (and her brain) - on those delicious, slippery babes from the beginning; I have had to wait until getting successfully past all of the theory behind the birthing. I've had a large community of support from fellow classmates and those who've come before me via my school's online forums; Friend has been cocooned in the intimate circle of the two CPMs that she has been apprenticing with. Friend's coursework is self-paced, whereas my program has traditional terms - with equally traditional (and stressful) deadlines, midterms, and headaches.

Our paths will also determine our future course (as is so often true). As a certified nurse-midwife, I will be - in theory - eligible to deliver clients in a hospital, birth center, or home setting; in my state, though, over 90% of CNMs attend patients in the hospital setting. Friend, however, will be limited to seeing clients in out-of-hospital settings (at least in our state).

This is where my mind starts to wander... I don't know that I am courageous enough to catch out-of-hospital births (that's a topic for another day) - but I like to think that someday I may be. When my mind wanders, though, I think about a modest clinic site offering prenatal and well-woman care, just outside of 'town' (our small town is around pop. 8500); a few exam rooms, a space for education, perhaps room to have a lovely display to sell some "nice" stuff that the kind of mamas that might seek out a midwife may be interested in - cloth diapers, breastfeeding supplies, etc. We could offer childbirth classes, breastfeeding support groups, and - possibly? - one or two birth suites adjacent to the main space; while (in my wandering self) I imagine most women opting for hospital births, Friend would also be available to attend home births, and the birth suites would be available for a birth center birth.

I don't know the logistics of any of this. I have no clue on the feasibility of it. In all honesty, it really is just a mind-fantasy, but such a sweet one. I don't know if Friend would seriously consider "joining the fun" - in the past, we have joked about starting such a venture... but how much was seriousness, and how much was jest is hard to say.

If nothing else... this all gives me a nice bit of something to start with for a lovely, 60-odd page paper that I need to write (and have yet to even start thinking about, by the way) this term, so that I can graduate this spring. Happy trails, on that happy note!