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.

The fine print...

I feel like I owe my potential clients a sort of disclaimer, or a caveat emptor of sorts, before they really jump into care with me. Making a commitment to join together - whether for continued primary care or prenatal care - seems like kind of a big deal.  Maybe not quite as significant as, say, a marriage or civil union, but important none the less. The health care relationship needs to be built on a good foundation of trust, openness, and understanding from both partners, and I definitely don't want to lure patients in with a false idea of who I am as a provider (or a person).

Now, I don't quite think I need to explain to them that I am the queen of running five minutes late (no matter how I try, I can't quite to make it anywhere when I need to be there... I can leave fifteen minutes early, and still hit roadblock after roadblock), or that I crave naps more than anything else in the world. But I do want to pass on other tidbits; I want women to know where on I stand on their care what I have to offer them. I want the women I care for to know that I value them, I acknowledge their pain and their history, that I'm willing to work with them.

But.

I also want them to know - regardless of whether this is perceived as negative or positive - that in caring for them, I'm investing in them. (Side note: I'm not very financially literate - I can manage to sign the right forms with my work-related retirement and, um, usually get my taxes filed on time, those kinds of things, but stocks and bonds are waaaaay out of my sphere - yet even I recognize that when you invest in something, financially/emotionally/otherwise ... you want to see it grow and be well.) I want to see my patients be well; I want to see them improve their health, their families, their relationships. I won't prescribe narcotics or any medications that are known to be abusable to a client that is new to me, and I'm very, very slow prescribe them to anyone in general. I encourage, prod, preach, discuss, promote, celebrate exercise and meditation and the "right" diet and good sleep habits and physical therapy, massage, chiropractor, acupressure, so many other complementary therapies. I empathize with chronic disease, mental illness, family struggles, but also emphasize the importance of working to address problems from a multifaceted approach rather than simply a pharmaceutical one.

As a midwife caring for women during the prenatal and intrapartum period, I specifically want the expectant and new mothers I meet to know that I will be with them every step of the way.* I am honored to walk with them, step by step, as they journey through the path of creation, and ready to meet any obstacle along the way together. We will embrace the normal and address the rest, but together. I won't prescribe Vicodin for low back pain, I won't induce at 39 wks "just because" ... but I will be there.

*(I feel like, maybe, I should also warn many of my prenatal women that, at one point or another during labor and delivery, they will all likely hate me... does that seem fair??)

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

Medicines are not meat to live by.  ~German Proverb

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.

This One's Not About Midwifery

Most of midwifing is about joy, whether subtle or overt – the excitement of a new pregnancy, the welcoming of a new life into the world, the beauty of a woman as she blossoms throughout the stages of life. The days when things aren’t so easy – long, drawn-out labors, difficult clients, or struggles to understand vague symptoms and nagging ailments – pale in comparison to the wonder of a mother gazing into her firstborn’s wide eyes.

This post, though, is about those days, few and (thankfully) far in between… as a nurse, a friend, and a family member, I’ve seen grief. Grief that sneaks up alongside you, taps you on the shoulder, and then takes you out at the knees; finally helping you up and keeping pace with you, step for step, until you feel as though you can no longer take it. I’ve worked with families who’ve had babies born still – babies born fully developed, perfect in every way; other babies have been lost far too early, months before they were expected to arrive, yet already eagerly anticipated and much loved. I’ve known and cried with families as they mourn the loss of babies diagnosed with terminal illnesses, not compatible with life, and supported them as they honored their loved, tiny infants the best way they knew how. As a midwife – remember, I have only been able to claim that title for two weeks – I have yet to embrace women and their families in those desperate, dark hours… but I will be there.

My grandpa died.

When it comes down to it, that’s what this post is really about. Barely two months ago, my grandpa – my Mini’s “Puppa” – was diagnosed with Acute Myelogenous Leukemia – and given a prognosis ranging from moderate to poor (depending on the treatment regime chosen and the response of the disease to it, of course). One dose of chemotherapy didn’t significantly improve Puppa’s counts, but didn’t drag him down at all, either; he still fought like hell. Even a nasty, raging infection to his IV port didn’t take the fight out – it was only when his oncologist really explained why he had recommended hospice care (rather than continued chemo treatments) that he just gave in, and let go… within a week, he was gone.

To me, Puppa was larger than life – he wore Brut cologne, farmed his entire working life, fished and hunted like a “real man” in the Midwest would, and ate headcheese and liverwurst (ewww). My memory is flooded with treasures from my childhood; this is the man who taught me how to bait a fish hook (and get a fish off the hook, once caught), climb up on a tractor to ride beside him, play cribbage, and to open a glass bottle of Sun-Drop with a bottle opener. I could go on and on – like any good granddaughter – but I’ll keep those memories as seeds to plant for the Mini’s, or if nothing else, for a day when I’m a little more awake, and it’s a little earlier. Memories that they may lose (or have never experienced) like how Puppa always had a teeny Tupperware container in his shirt pocket for them, with just two jelly beans or marshmallows in for them, or how on birthdays, he had a special card just for the birthday kid with exactly the number of crumpled dollar bills as years old you were turning, the envelope and card addressed in his loopy writing… his love of Diet Sun-Drop – but *only* in the old glass bottles, not in cans, and not in the ‘new’ glass bottles. And the dimes – always the dimes…

When death comes, it’s amazing how fast/slow things move. I swear it was just yesterday that my grandpa walked into my living room, showed me the lab results from his recent hospital stay, and asked me what I thought of them (as my heart dropped to the floor). And, just a few days before that – it had to have been – we were all out on the pontoon boat, with everyone healthy and happy. But it seems like it’s been months and months of watching him slowly fade away….

I can’t imagine the pain of losing a child, or a spouse, or a parent… yet I can’t fathom thinking that I’ve “only” lost my grandpa. How do you compare this hurt? I feel selfishly grateful that this is really the first time in my memory that I have lost someone close to death; I’m also so grateful that my family is so close to begin with, and that the Mini’s know their greatgrandparents so well. The very last words that my grandpa really said to me, a few days before he passed away – looking me right in the eye, with a squeeze of his hand – were, “Thank you.” When I asked what he was thanking me for, he said, “For it all.”

To everyone who has gone through this grief, whether the loss of a parent, grandparent, spouse, a sweet child, or the whisper of a child yet to be --- let yourself be embraced by the open arms of those who care. Open yourself to the friends who can offer words of comfort, hope, and love; to the family that shares your memories and knows stories outside of your own. Realize the true beauty of the people who will forgive you when you 'disappear' for a few days or weeks, lost in your own world of clouded thoughts and reminiscences. I feel so blessed and have so much appreciation for everyone who made the last few weeks, especially the last few days, easier than they might ever have been otherwise.

Thank you… for it all. XOXO

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

(P.S. This post formed in my head as I finally took a hot, hot shower, letting the past few days and weeks rinse over me; as I got out and wrapped myself in warm pajamas, I was overwhelmed with the scent of Brut…. *tear* Things always end up all right, don't they?)

I have been blessed...

I started to write this post last week, and never got around to finishing it. The title was different, and the whole tone of it - it was a little more playful, with an undercurrent theme that mirrored Tigger's theme from the classic Pooh cartoons (for those of you familiar with Pooh's adventures... and aren't we all??) - was meant to be a light-hearted-yet-deep reflection of the wonderful thing about blessings in life.

And I have. Truly, in so many ways, my life and my family, are lucky. As I (finally) sit down to type this, though, I just don't quite have the same levity as I did a week or so ago when I started composing this in my head. I was going to recite the list of changes that have happened over the past two months (comps, graduation, etc, etc...). Instead, I'm quiet; the Warm One is battling a fierce cold, the Littles are runny-nosed and cranky, and I've passed my boards exam. I am, officially and with no holds barred, a certified nurse-midwife.

The colds will clear up, and the Kleenexes and textbooks (and highlighters and scattered notepages) that have overtaken our home will eventually be cleared away as well. Some will be recycled, or tossed; others may be stored in the office "just in case" - who knows if I'll need that text again, or maybe I'll decide to 'recycle' it to an incoming student?

The other blessings in my life are just as clear: my family, who have been so close and willing to step in whenever needed during this journey. The Midwife, even when things became rocky, was a blessing in disguise; I learned things, personally and as a midwife, that I needed to know, from her. From D, and from all of the women and families along the way. From so many close, wonderful friends - some nearby, and some far away... women who I may never have met in person, and yet who I can (and have) shared so many of my deepest fears and funniest moments; these are my sisters and peers, both fellow students and mothers.

And, of course, the Warm One and the Littles (one of my proudest moments so far? When the Bigger Little 'corrected' the younger, who had thought that "Dimbo's" - Dumbo - mommy was being 'naughty' in the movie. The elder of my daughters explained that Dumbo's mother was upset that the other elephants were being mean to the baby elephant and making fun and picking on him because of his ears; that sometimes mommies had to stand up for their babies. It was a touching conversation for a mother to overhear between a 5 and a 3...)

*~*~*~*~*~*

Some blessings are a little harder to understand... in the months since my last post, my family has been stretched apart, and pulled together in an even stronger way. My grandfather, the "boss" of the family, was diagnosed with an aggressive leukemia just before Labor Day, underwent one round of chemotherapy, and has become progressively weaker since then. After a bout with a massive infection and complications due to the infection and its treatment, hospice - and the care that goes along with it - nurses are a daily reminder of the change. It's so hard to see the difference between the strong, capable man that taught me how to bait a fish hook and tossed hay bales into a barn loft, and the saddened man that cancer has made my grandpa. The thought of saying goodbye - along with the pain of seeing my grandfather this way, as well as how it hurts my grandmother - is only soothed by the idea that the time we are gifted by this allows for storytelling, memories, "I love you's".... my family has been together much more in these past few weeks than in the past years (we've always been close), although I don't know if this outweighs the pain that my grandparents are feeling. At this point, all we can do is "Let go and Let God..."

Will work for Food...

Seriously, I will... I certainly have a bit of a love affair with food. Especially this time of year, with the county fair in town: cream puffs, beer-battered cheese curds, funnel cakes.... Oh, my poor achin' arteries.

And summer. I love summer too. (Can it seriously be Labor Day already?! I want to cry! I do *not* do well with winter... sigh...) Anyway.... this blog has clearly been neglected for the past month or so. Oops.

I've been a little busy, to be fair. Since the last time we met, I scratched off each and every last clinical hour and visit I needed to meet the requirements of my program, as well as having a "declaration of safety" submitted by Dee (signifying that she feels I am a safe, beginning-level practitioner); one of my biggest feats was taking - and passing - the first of the last 3 big tests standing between myself and midwifery. I'm engaged, descended, and flexed - now on to finishing the rest of these cardinal movements, little by little...

(was that too corny?!)

From a personal standpoint, things have also been busy. Family life has been hectic as always, with ups and downs. My bigger-Mini started Kindergarten (!) last week, which seems incredible; I still remember the moment she was laid in my arms and the immense feelings of wonder and

awe I felt to be a mother to such a wondrous little being; my Mini-er is beginning preschool this week (and memories of her labor, and birth, are even more vivid; the moments in the shower, visualizing her path down to birth, and the moment when the Warm One proclaimed her as a "little girl"... so clear!). Harder to work through these past weeks have been the continuing struggles with my brother and his own battles (battles which he alone can fight, but that as a family we have been trying to find ways to support him in...), the diagnosis of Lyme's disease in my father, and acute, aggressive leukemia in my grandfather. It's painful and exhausting to see the toll, both physical and emotional, that's accumulated across the family lines in the past weeks and months; through hopes, prayers, and support (and communication), I'm waiting for a strengthening of the bonds that hold us together.

But, back to the "Work" thought that started this whole rambling... I'm starting to think more seriously about jobs again. (It's getting to be time, I suppose. I have one more "school" test - the competency/completion exam, after which I am officially a graduate nurse-midwife, and the final step is the national certification exam). I've realized, after doing a phone interview or two over the past few months - mind you I haven't interviewed in years! - that I need to brush up on my interviewing skills. I thought maybe I'd toss out a few random, jarbled thoughts on here, if nothing else, to help myself sort out a little more about myself (you know how they - "they" being interviewers, of course - always ask about your strengths/weaknesses, what you would like to improve on, etc...)

About Me...

* I'm not there yet, but I'll be there soon!

* I don't drink coffee... but I anticipate that I will start to do so soon...

* I run habitually late (not much, but just enough to be a few minutes late...)

* But - see above - I'm reliably late those few minutes!

* I learn by doing, not by reading/listening

* I'm quiet - but only for so long. I will open up (you may be sorry....)

* I do have a sarcastic streak... and a good sense of humor!

* I may hold back a bit at first - let my confidence build, and I will shine.

* I trust women, their bodies, their intuition, and their abilities.

* I am a very dedicated, motivated employee.

* I can't even come up with enough to write here! Man, I better hire myself out to a farm or

something instead....

Hello, my name is {hebamme}, and I am a blog-a-holic... (and other confessions)

There.

I've said it, and it's true. I realized yesterday - or maybe it was today, or the day before yesterday (does it really matter?) - that I am addicted to this blogging thing. It's sort of liberating, in a way... I can go on and on, without worrying about the words stumbling out of my mouth (something that they tend to do in real life --- I think I have a bit of a speech impediment!) or if anyone really cares. In the world of blogging, I don't need to wonder if anyone is reading or not.

Sure, sure... it's GREAT to get an email notifying me of a new comment on one of my posts, or to see that I have a new follower. But, I can still imagine that there are people reading my daily musings - or that no one is (sometimes that is just as soothing). I'm certain there is a way to figure out how many 'hits' my site has had over time - but (a) I don't know how to do this, and (b) I don't really want to know. Ignorance really is bliss, as they say!

So, this one is gonna be short and sweet, but a few confessions for you (whether you're out there or not) ...

__________________

1. Blogging is taking over my life - I'm starting to daydream about it, put off schoolwork, housework, you name it, in favor of it. Is this bad (especially since my ramblings really aren't that good?)

2. Deep down, I'm a very lazy person. Given a chance, I will stay in bed until 10 a.m.; I'll walk right by a pile of toys on the floor (they're just going to get dragged out again anyway) and - as I type this - there is a laundry basket of clothes half-folded on the couch across from me. The only reason they are there, clean, to begin with is because the Warm One loves me and does way more than his share of things... I heart him for this.

3. I eat way too much crap. I know I need to eat better, and I want to (mostly), but it's just so much easier to just eat crap - you know? Ugh. Like, I have had Fazoli's drive-thru for the past two days because it was fast and (kind of) on the way home. And, again, see #3. Lazy ass.

I hope these things don't make me a bad person. I hope that these things are mostly related to life as we know it, right now, since it seems like there's a lot going on... I have memories from the not-too-distant past of actually cleaning my house, of making meals and even sitting down to eat them with my family. Fingers crossed that these things will come to pass again, some day...

(P.S. Confession #4 - I struggled a teensy bit with putting this posting up, only because I kind of liked having Gerard Butler headlining my blog... mmmm...)