Last entry

jmacmidwife

I want to think that you will read this and that I will also write something as nice and flowery in a card that I give to you at graduation, but honestly, I can’t think that far ahead right now. It still seems surreal. I still have so much to do in a few weeks’ time.

So, on to the happy but sad part….Again, keep in mind that verbalizing is not my thing– If the tears rolling down my cheeks could talk right now; I think they would say how much I appreciate all that you have done to help get me through this program. I can still remember quite vividly how you went to that bar with me the night or so before I left for Florida. You were asking why I wanted to leave and why one midwife and not the other and maybe had I lost my mind? I was on track to completing all births– to being done and had little guarantee of doing that, if I went anywhere else.  I had few sane reasons to want to go to Florida or at least no good reason to give you except for this is what is supposed to happen—this is what the universe wants me to experience next.  As I searched your face for confirmation—it was comforting to see an expression of understanding, peace, and resolve.

It was so difficult, yet so appropriate that I left for Florida, but your assurance that everything would be alright with your trusty water bottle was all I needed to make it through each amazing day.  Like birth, you let me unfold on my own time. You trusted that the process would allow me to find my own way towards completing and accomplishing tasks.  I don’t know if I would have been able to get through this semester without holding that knowledge close and knowing you were only a phone call away.  While it may have taken a few days to get you to see my perspective on some things, lol, you always were there to guide me no matter how hard or long or difficult I made getting there. I hope the next bunch of students is as equally appreciative, thankful, and awestruck by your guidance, support, time, energy, and dedication to creating midwives. I am truly grateful for your love and support in this adventure. Thank you.

Midwifery psycho babble

jmacmidwife

You learn something at every birth and (un)fortunately sometimes the universe gives us lessons that we need to learn—perhaps we don’t want to learn them or think we have learned them good enough, but there they are again. So, I guess it was inevitable that I go back into a hospital and face the music. I used to think doctors walked on water.  I never imagined they were these egotistical, righteous beasts.   Heck, when I was younger, I wanted to be one.

 It only took about 2 good years of doulaing for me to come to the conclusion that they had elevated themselves to God-like status and liked it, which by the way, is fine with me, until it affects me or the people who I am hired by.  The more I read, the more I believed in birthing naturally, the more I felt the hospital was unjustified in its decisions.  It was not me who could stop them. I could only inform and educate parents on the benefits and risks of doing certain procedures or interventions on the spectrum.  However, some mothers wanted an advocate in the hospital—a voice—while theirs was in labor land.  This advocacy was not unjustified or unsolicited. It was a reflection of the parents’ wishes already agreed upon weeks before when the birth plan was approved and placed in the chart. However, this voice was not to be tolerated in labor. How dare someone try to voice reason when reason was not necessary according to the physician? 

I like to give parents an example of how messed up this whole birthing process in the hospital can be. I use an example of my husband’s outpatient shoulder surgery.  A few days before the surgery, we meet with the physician who goes over the entire procedure and answers all questions.  The surgeon wants to meet your support people so he can give you information regarding care after surgery.  He is polite, unpretentious, and respectful of where you are coming from.  He gets out models and x-rays and essentially provides proof of why he is doing what he is doing. He shows us the tools he is using and how recovery will look down to the sutures he puts in. There is no stone left unturned. He does not want you to leave with an uncertainty whatsoever.  The day of the surgery, every team member who is present in the surgery comes to pre-op and explains what their role is and essentially gets your consent.  Fast forward to a hospital birth where in most hospitals a third of all women will have major abdominal surgery and all they get is one sheet of paper to read and sign stating informed consent—no other info is given.  It’s an abomination to women’s healthcare.

Recently I attended a birth, not really as a doula, although the parents introduced me as one. My midwife introduced me to the doctor as her student so it was more like—here is a person who has been supporting these parents throughout their pregnancy and since the mom is no longer a home birth candidate, now this person is supporting her in the hospital, but she is not trying to save these parents from the abominations that occur in here. We understood that we were here because we needed help from the hospital and agreed to let go of our aspirations for a natural birth. Membranes had been ruptured for many days and we needed Pitocin to get things going. Natural induction methods had already been employed.

 It was only a matter of time before I found myself wishing I had been at an erupting volcano or sinking ship rather than be in that room. My face must’ve revealed my true inner feelings and my lack of enthusiasm for the hospital policies was palpable. It’s not that I was surprised at my behavior, don’t get me wrong, I had acted like this before, but this time I expected to act less childish and more professional because I was older and wiser? However, in the face of hypocrisy and disrespect, I can only clam up and shake my head.  Nothing had changed. Not me, not my ability to play the role of facilitator in the hospital. I outwardly admitted that I could do nothing for these parents. I didn’t want to further jeopardize the midwife’s relationship with her backing physician. I was just praying it would be over soon. I should have said to the doctor that the parents may be needed more explaining of what the choices were, but honestly, I didn’t think I could have spoken nice to them at that moment. If I haven’t been in the hospital that is friendliest to homebirthers and had the backup physician working with the parents—I would have expected the behavior from the hospital staff, but this was different. I wasn’t a doula coming in guns ablazing. I was a midwife—not a colleague or anywhere near equal to him, but a collaborating member of a healthcare system. 

So, here I thought, with more experience and education and coming in with a different attitude that my experience would be different, but no.  Unfortunately this leaves a bad taste in my mouth for my return to Louisiana. I want to be the type of midwife who is able to go into the hospitals with her clients and interact professionally and civilly with the staff. I don’t want to drop them at the door and wish them luck, but I am concerned. Perhaps this is just who I am and I need to accept that I am not good at this and won’t be good at this. Can that be a choice to say I won’t work at it? I just feel that every time I interact in a negative way it does more damage to the relationship with the staff and future encounters. What a sucky place to be. It’s not that I don’t value having healthcare available when we need it. I appreciate it and am so thankful that we have a relatively clean place to go in an emergency where proper medically trained personnel are waiting to do their jobs.  Many places on Earth aren’t so lucky, but I am not going to hump the legs of the doctors just so they treat me or my clients differently. No. I won’t do it. Now, if they happen to get to a place over a few years or months of interacting and feeling comfortable with my ability to catch issues and/or consult then super, but I cannot see myself going out of my way to kiss their butts. I have already decided that I will inform my clients of my relationship or lack thereof with the medical community and if they are not happy with it, then they need to find another provider. I have to be comfortable with my abilities and that is something I just cannot provide right now. I wish I could, but I physically cannot.

Birth takes forever sometimes

jmacmidwife

No one truly understands what it entails. Everyone just watched the Business of Being Born and voila is calling a midwife. Sure they understand that the interventions are different, but the biggest lesson I received from this birth was knowing that the expectation to manage the birth is still there, no matter where they are laboring. These women still don’t want to own their births, they just want to be handled, told what to do, in a way that makes it appear that they are empowered and given choices. Ok, I have to repeal that empowerment comment because I don’t even know if that piece is there.

For many moms, I believe birth isn’t defining them, their character, their future, their image of themselves as mothers and that is ok with them—however mind blowing that is for me! So, huge step in understanding what women want. This mom had been in off and on labor for three days. Yes, I said days.  For my idealistic brain, this mom was savoring her labor, going through the process of birth and unfolding it as it should be for her. Did she want this 3-day labor-no? Did she give a shit who unfolded it-no? She just wanted to tell her FB friends at the end of the day that she had a homebirth.

So, it was like day 2 or something that this mom said to me—I feel pain in my back. Well, hunny. News flash—labor is painful. It was like she was surprised that it was hurting and kept wanted to have her mom, also a chiropractor, adjust her. Fine, you know, I am sure relaxing her made it much more tolerable, but we have to work with the pain not make it go away. Huge lesson. Make sure moms understand and accept this. She was like shocked. It was weird. Next, this baby wasn’t descending. UGH. She was spending lots of time resting and not enough time walking. I wish I would have hired her a doula. I was wasting so much of my time and energy doulaing for her when her DH and mother wanted to sleep. That is not my job—ok—not all the time, especially when you are in what I consider prodromal labor. The good thing to come out of all this was that I had the opportunity to do plenty of vaginal exams. YAY for internal exams. I think I am finally getting the hang of finding these elusive cervixes. I can’t really tell how effaced moms are, but I am sure that will come in time.

My fearless leader finally got bossy with Ada and started stretching her cervix. We made her get out of the tub and walk around, do squats, etc. Nothing seemed to help. During one vaginal exam, I felt a huge caput, which was cool to feel and we later found out it was a combo caput/hematoma. This baby was about 0 station the entire first stage. It would not descend for anything. So, pushing this cervix out of the way was incredibly hard. I think I broke a sweat and made my fingers sore in about three minutes of attempting to hold it back. The midwife said I have to get over this fear of holding these back. It isn’t a fear, it is just a dislike, a huge disservice to my inner hippie, but she will forgive me. Next time for a lip, I think I might pancake flip mom on all sides–through like 8 contractions. Or else I would knee chest her to get that cervix better positioned on the head because reducing the cervix is no fun, but that is the thing I needed to get— mom didn’t care and I don’t have to like it—I am here to serve her in the best way possible within my SOP and rules and regs and within her ideal of a good birth. She truly didn’t care and I wasn’t hurting her like I could make myself imagine I was hurting her if I said hold back the cervix. Like I said, at the end of the day if she had every trick thrown at her in the book, that was fine, she just didn’t want a section. We trusted the process but she only wanted to trust it for so long.

However, I always have to over process right? So, I am thinking of this other couple I doulaed for in the hospital about 5 years ago. I wanted to help the mama and give her all my gadgets and comfort tools and she had to jolt the over-zealousness out of me literally. She said—look—I didn’t hire you to do stuff to me—I hired you to be here and believe in me and trust this process. So, it’s that approach I took, but —that was in your doula lifetime—you are a midwife—completely different. Different approach, totally—I HAVE to manage these births—duh—that is what these are—manages. Dare I say that I hate it? Not midwifery, but the idea of having to manage this outcome when I want these mamas to be slow dancing across a field of daisies and own this process yet surrender at the same time and out slides a baby. Clearly my vision is flawed. My spirit is shaken. Has midwifery really gotten to this point or has it always been here and I just didn’t realize it? Will I still be able to have these doula-type clients or will I be forced to control this process that I pretend is as normal as sneezing? WOW. The midwife did ask me what I wanted to do with this mom—and I had to face my inner love child and tell her—no this mom is not going to sit in the birth pool and have the water birth she envisioned. You are not going to tuck her in bed and hope to God that after she wakes on the 4th night of contractions she will finally get somewhere cervical change-wise.  No, I couldn’t do what I wanted to do; I had to do what needed to be done– AND THAT WAS OK!!! So, this pity party for the midwife-self that I thought I was becoming needs to wrap up and move on. My idealist world will be better played out in someone else’s head. 

Ada, it turned out, had broken her tailbone as a child—why the F this is not one of our questions when taking histories is beside me?! We needed to get her off her bottom and heart tones were worse on the birth stool, so we flipped her.  Mom was working so hard that we gave her blow by, but I wish I had put the adult mask on the end because the mom and FOB were doing a shitty job at holding. She was purple pushing. She looked like she had been beat up. The midwife was arguing with me that I had never pushed a 10 pound kid out so I didn’t understand how to push. WTF? ok.

Which brings me to a good point. Midwives are stubborn, strong women, but if you cannot take criticism please do not become a midwife.

New revelations?

jmacmidwife

I have to preface this entry with– it seems I learn something after almost every contraction. It is amazing. I am so thankful to be here with a midwife who wants to teach and wants me to get it. I appreciate her time and patience greatly.

OK, new birth, New revelation. I am coming to terms with the fact that I am being faced with whatever I need to learn or at least that is how I am coping with it. It isn’t really that bad. It is just these primips!!! A few things. I don’t think we are educating them enough. While yes, this one –I’ll name her Ada—knew about induction methods and wanted a waterbirth. Plus she wants to be a doula and is a massage therapist and chiropractor– a great base for knowing her body and understanding natural practices.

A cornerstone to midwifery care is knowing your clients. While yes, I knew all this cool stuff about Ada and a little about her birth plan—I don’t know until later that she really doesn’t care THAT much about the homebirth that I have in mind for ALL my clients. I have to stop projecting my vision of a quick, beautiful, elegant birth goddess under moonlight in a babbling brook birth onto them. I don’t know where I get this random vision or ideal, but it isn’t for everyone, heck, I have no idea if any mom I meet will ever really want what I want for them. That is lesson one: move on from your ideals. It isn’t about me. Learn who your clients are and know them. While yes, they are in love with the idea of a homebirth, they are not in love with the idea of a 4-day painful, hands-off, non-interventive, midwife sleeping on couch, ineffective contractions, blah, blah, blah. GET WITH THE PROGRAM—these people just want to avoid a section!!! Ok, that might be a little simplistic, but I have to make it that simple sometimes for my brain to wrap itself around this monumental discovery. I hate to say it—but Kombaya is so yesterday.  It’s becoming trendy just to say you had a homebirth.

I should rename this blog– the death of a midwife

jmacmidwife
  1. In what ways do you think this experience might affect you as an individual? In what ways do you think this experience is affecting you as a student midwife?

This experience has made me much more confident in myself. I have never been so outgoing on purpose. Being able to interact with a variety of clients has enabled me to appreciate all of them and really look forward to hopefully working with many different types of people.

I found that I feel comfortable in a clinic setting, but get the benefit of being part of homebirth families.  It is almost the best of both worlds, but I can see how working with affluent families has its perks. Rarely would you have to concern yourself with STIs or hepatitis. You don’t have to be concerned with drug withdrawal or worrying about the wellbeing of the baby when you leave. Plus you get paid pretty well usually.

I never thought I could be this happy doing something I consider work. This has also taught me that I want to pursue more education, maybe not right away, but eventually. I think I will get my MPH or CNM. I don’t know what will happen with healthcare, but it seems like as less OBs are born, more NP, PA, CNM and other supportive nursing personnel will take over the role of prenatals, postpartum and maybe even normal low-risk births. I think if I want to get a piece of the pie, I need to get more letters behind my name.

Just like making a cake

jmacmidwife

UGH. These labs are going to be the death of me or primips—I can’t decide.  So, I have to thank those who opened my mind and gave me a chance. Looking back a year ago, when I was interviewing with the midwife in Minnesota, I thought I had a fairly good foundation for midwifery. No, I didn’t. It is glaringly obvious to me now why she didn’t like me or think I would be worth having around. Heck, I can’t believe anyone found me worthy. Maybe I was a warm body? It’s not that I think midwifery is rocket science by any stretch, but you do need to think quickly and know your shit. You may only use this info a handful of times in your career, but you need to know it, be able to recall it with incredible deftness and confidence. Foresight is incredibly important. Yet, it is kind of like making a cake, you have basically the same ingredients every time, you know about how long it should take depending on conditions and well you check it every so often knowing that every time you open the oven door you may be causing more problems, but your cake should overcome. So, you set up your area –get your plate where you will frost the cake ready and the wire rack where the cake will cool. You have your supplies washed and ready to go and even have in the back of your mind where the fire extinguisher and extra flour are kept in case of a blaze.

Home Stretch

jmacmidwife

Tonight I am worried about finances. Where will I work after graduation? Will I be near my family? How will I afford to pay for the NARM test? I am also considering getting my midwife her CPM so that I can then have another preceptor sign my skills and I will not have to take the Skills exam. At least if I have to take it, I will have several months to say up some money.  Maybe I will return to doula work. Who knows? I do know that I can’t worry about it tonight.

Today we went to a birth of a fourth baby to a mom who had all previous hospital births. They were all fast. This one was not any different, but it goes to show you that you need to know your clients well and be prepared for them and your sake.  I am usually very good at having everything ready when moms get into tubs. They seem to usually go so fast that none of us can catch our breaths, let alone get gloves on. This mom got into the tub when she was like 6 cms, but a plus 1 almost 2 and I think ten minutes later she said her water broke in a scared way. The baby was just so low and was not waiting. Her kneeling position made it easy for me to grab the Doppler and make a sliding motion across the floor to the tub where she labored. I began to get heart tones when the midwife just shouted I need gloves and see if you can feel head. So, I dropped the Doppler (thankfully not in the water) and reached down bare handed in the water between her legs. Now I very well could have been feeling in the wrong place. I hope not since I am a fourth semester student, but it could happen. No baby head so I pulled my hands out and began drying them off. Meanwhile the midwife had her hands in the water, albeit gloved. She said she needed me to support the perineum as an elbow was coming. So, once again, my hands dove back in and supported this motherbaby. It had only been 3 pushes. The cord was short so we got mama and baby out. We were waiting patiently for the placenta when a fellow student took a pulse. She said it was 100. Again, knowing your client is second to knowing your own history.  The midwife and I instantly both reached for this mom’s wrist and counted the pulse rate ourselves hoping we didn’t have an occult bleed somewhere as this mom had minimal bleeding. Thankfully the student just couldn’t count. Sigh.

It is experiences like these where my midwife trusts me and knows I will do what needs to be done that I am feeling more confident. Heck, even the grandmother came over and was talking with my midwife and me and thanked us for being such good midwives to her daughter. LOL. I am no midwife yet, lady—I wanted to say—wait until SWTC is done with me! I am also so thankful to all the women who have helped me learn, inspired me to do better, and taught me a thing or two!

Homeopathics?

jmacmidwife

I am becoming hooked on these homeopathics. It is amazing. You know, honestly, I was sketchy that they worked. I give my kids arnica all the time and well it has mixed results at best. After births, I have seen anti tart and carbo veg get a baby breathing well. I have seen babies shortly after getting these pills perk up and spit up the gunk in their lungs. Pulsatilla, cantharis, and Sabina work wonders for retained placenta.  I wonder if it is the midwife’s belief in them that helps make them as powerful as they are? I hope when I get out there in the world, I will have as much luck with these homeopathics. Maybe it is the brand she uses. Whatever it is—they are amazing. And I am learning that midwifery is just as much belief as it is science. If you put it out there in the universe, often times, it is what you get.

I enjoy talking with the new midwife who works with my midwife. It is great to have a fresh mind that just graduated and passed the NARM nearby. She is really interested in water birth. We have had many great discussions about how to resuscitate in the water, whether we are cutting the cord, or moving mom. She had an interesting idea today about flipping moms over onto their backs onto hands and knees and placing the baby on her back while resus ensued. Would the mom be freaked out that she had a nearly lifeless baby placed on her back and uneasy because she wouldn’t be able to see him or her? I suggested that if the baby is in trouble, usually the mom is also, so I wouldn’t necessarily have my go-to maneuver the hands and knees position in case mom needed some meds herself.

Likewise we compared suctioning experience and how she won’t even open the blue bulb syringe. She doesn’t ever suction. Ironically, she keeps her Delee warmed near the heating pad, in case of major resus, but won’t bother clearing a baby who is slightly in distressed? I think if one is careful and only places the bulb in the cheeks and not in the back of the throat, one can effectively get lots of mucous out without too much trauma or harm to breastfeeding establishment.  Everyone practices differently. We do both agree that most babies need what I have coined the C-section pat. She also gives her babies anti tart –a homeopathic. It works wonders for clearing out gunk. Most babies, after a dose, will cough up or spit up a whole bunch of mucous.

Almost done

jmacmidwife
  1. What did you already know that is proving helpful in navigating this course/semester? Don’t restrict your answer to things learned in this course.

Does knowing the end is near count as navigating this course? It is almost like the end of a 5K when you know you have passed the 3 mile marker and you sprint with everything you have that last tenth of a mile. Well, I feel like I am nearing that 3 mile marker and can see the finish line and am conjuring up all the strength left in me to get this stuff done. I basically have a month left. Six births to go. Six. I can’t say it out loud though because it sounds too surreal. 

I have said it before, but all that I learned in Second semester is here at this clinic. I wish I had learned it while I had been at a clinic like this or could have traveled here shortly afterwards because I am doing all these tests and screenings. I have moms coming in and we are doing urine dips to see if they have a positive pregnancy. Then we are drawing blood to get an HcG level. We are checking progesterone to see if it is low if they are spotting. We are rescheduling another HcG blood draw to determine if they levels are going up.  We are seeing the fetuses on the ultrasound. We are scheduling these moms for fetal survey, size and dates ultrasounds. We have to sign them up for Medicaid or check their insurance or figure out how they will pay. We have to get them signed up with resources like Healthy Families and encourage them to make their appointments. All those power points which seem so surreal when you are not in the middle of it—are coming back to help me get through the end. Everything from drawing up medication to vitamin K shots, to B12 shots, to pap smears, to probable or possible signs of pregnancy. It is all here staring me in the face and I am glad to see it.

My doula experience has also helped me tremendously. Really any real hands-on experience has proven to be invaluable, even seeing births in the hospital.  I have learned more shoulder dystocia maneuvers and seen more drills than I care too, but honestly, it all helps. Likewise, seeing blood loss—what is normal, what isn’t—all helps you get a great idea of when too much is too much. So, simply knowing when the blood loss is too much and coupling it with the new knowledge of what to give or do when that occurs has been exciting. I finally feel like I have a good grasp and foundation on which to finish this race up.

Origami of Birth

jmacmidwife

I am learning amazing things at this clinic. Nothing is ever the same. Fifty million things going on at the same time. The only things consistent are that we eat Thai food all the time.  I continue to learn that I must be super organized at all times. My car looks like a hobo and horse trainer have collided (the birth tub is in there and I keep clothes, towels, blankets, books, food, etc. all in case of births or beach time).  I have the ability to sleep anywhere, think on my feet, and plan ahead, for the most part, at least it is getting easier. I am gaining confidence and managing births, families, outcomes. Although I do like to sit back and watch birth unfold, I am getting over my illusion that birth is going to happen on its own all the time. Women have too much baggage, too many issues, too many expectations, too much money, too many STIs…. I could go on.

This birth is about Celeste, a continuity of care client. She had met me once before, but as we got closer to the birth and we were seeing her weekly, she made sure I was in an appointment. She had to meet me because a friend of hers had a terrible assistant at the birth and she was petrified of this. I met her and guess I passed the test. It was awkward. I didn’t know what to say. I didn’t know what she was looking for. It was this mother who taught me that I have to learn to read people better and put myself aside.  If their birth is important enough for me not to micromanage it—I better know this woman inside and out.  Now, I can be as organized and together as the best of them, but unless I am clued into what this woman needs and wants—it won’t matter if I have all my shit together and yours too.

She really wanted a water birth, but I swear she was pushing off her one knee cap, so we got her out of the tub. Plus, she was afraid of pooping and practically crapped all over my hand for half an hour as I held in her hemorrhoids. She had a wickedly short perineum. I should have gotten her out of the tub and onto the toilet, but was afraid to move her as she was so fragile seeming and honestly I didn’t want to rock her boat, but we had to do something.  As soon as I stopped directing her, the clouds disappeared and all was clear.  It turned out that I was better suited to manage her other child whom she desperately wanted to be part of the birth scene. I finally listened!!! And found out where my role was in this birth story. It wasn’t about all the knowledge in the world or acquisition or demonstration of skills, it was about holding her daughter, comforting her, and making myself available for her family. So, in essence, by me getting out of her way and in the way of her child, it was then that she could do what she needed to. The dance of midwifery, trying to figure out where to poise your hands or who to wrap them around takes none of the skills I have learned thus far. It seems like the more I grow—the more layers are placed, folded, enveloped around existing ones—creating this beautifully complex and confusing, but comfortingly so, origami of birth.