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.

Mmmm... the deliciousness of it. (Birth, not tortellini - or at least not so much tortellini...)

So, I promised I would explain the blog title. It really is multifaceted, if you will. The first meaning of a "delicious delivery" is one that only a select group of readers might understand: the midwives, the mamas, maybe some of the fathers, an occasional doctor or two, the OB nurses. I began to feel the hunger for this particular taste when my first daughter was born, and have only realized in the past few months that I can satiate it as a nurse-midwife as well as when I am the birthing one.

The first time I felt the deliciousness of birth, I was 24. I had woken up with a leaking bag of waters at exactly 37 weeks pregnant, self-swabbed it with a nitrazine stick (the perk of being an OB nurse), and - thinking it was negative and not actually my BOW - went about my early labor "on the clock", recovering a newly postpartum mother. Only when I was promising to help her up to the shower did my water break for real. (For future reference, any time I think of the big, theatrical Niagara-Falls-style rupture of membranes occurrences, this is how I will refer to them - "for real") . A quick walk home to get my husband, a short recess while he showered - and while things intensified rapidly - and we were back at the hospital, back in business. Within two hours or so, I had a dose of Nubain, a lovely shower, and a gorgeous baby girl. I also had a new thirst for the feeling of the birth of the shoulders, the sudden transition from baby in utero to baby on my chest, and the simple decadence of shifting the warmth of her presence through my own body. I know there are those who can describe these feelings more beautifully than I can; I wonder if (if anyone is reading along) you have felt this primal hunger.

I felt this same intense fulfillment with the birth of my second. The gentle pushing and easing of her shoulders and body through the birth canal, the act of bringing my slippery babe up to my chest and gazing into those eyes... cannot be described, only felt.

As a nurse-midwife, it's incredible to be able to recreate that feeling and to be share it with those who are experiencing it. The precious gifts that midwifery allows: glimpses of swatches of wet scalp, peeking through a bulging perineum... chubby cheeks gracing the world for the first time... the grasp of slippery, plump upper arms to gently guide new life into the world. Then - the pinnacle - a sudden sleek, sweet heft, caught and swiftly passed to joyous parents. That is a truly delicious delivery.

~*~*~*~*~

The second meaning of "A Delicious Delivery" is less poignant, and truthfully - I feel almost silly explaining it after going through the first meaning. Suffice it to say, I like to order out (a lot) when I'm working, and one of my all-time faves is tortellini alfredo from a nearby Italian pizza/pasta place. Well, recently, I ordered the "usual" and all of a sudden (about halfway through my bowl) that my tortellini bore a strong resemblance to rather atrophic, pale and discharge-laden cervices... perhaps yeasty? The only thing that would have completed the mental picture was if my fork was a duck-bill speculum...

Anyway, suffice it to say - I was done eating at that point (luckily - I had tiramasu to make up for it...) and haven't really felt any urge for tortellini since.

(I'd say that one was not quite as delicious of a delivery...)