Thursday, December 31, 2009

In which I make some resolutions for 2010

I like resolutions; I like the idea of having a specific starting point for changes. I make good resolutions. You'll never see me resolving to stop biting my nails (HA! ha ha ha ha. That will never happen!) or stop eating chocolate or start working out (I did not have painful weight-loss surgery so I could get sweat in my eyes.) I try to make them achieve-able and positive and fun.


Spend more time with my family. I have LOVED this vacation with Dustin off work for over a week. We haven't accomplished as many cleaning tasks as I'd like to (ever), but it's been very relaxed and I've had a lot of time with Dustin and the kids. And I've enjoyed it.


This isn't really "fun," but I love water so it shouldn't be hard.


Finish Orientation. Move on to my normal course work. Work regularly -- lately I go in spurts of stop and go. I'll work every day for a week and then not open my binder for the next four days.


Cook! I have a dream of one day getting sharp knives, a Cuisinart, and maybe even an apron! Also, I kind of want an electric can-opener and a bread-maker. And I want to make my own cheese.


Continue working with Maizey. Our Beginner Obedience class starts next week and I'm excited. When we finish that, we'll probably move on to rally. Also, work more on handling -- the last time we attended class Maizey barked, chewed her lead, dragged me around, and generally ignored all humans in favor of canines. I'm sure the other competitors will LOVE that when we're in the ring.


Monday, December 28, 2009

In which I write an open letter

Dear Maizey, please stop trying to disembowel the vacuum cleaner. It is not going to literally suck off your fur. Believe me, if it could, I would have tried that already, just like they suggested in Reader's Digest (complete with a picture!)

Dear Dustin, I know you love making cold coffee drinks -- or, as I see it, something that resembles iced diarrhea -- and I know you have to leave for work early. I also appreciate that you want to save time and money by NOT purchasing them from Starbucks. But, for the love of God, must you use the blender at 5am and wake up the entire house?!?!? (I only know this because Dustin is on vacation and therefore not crushing ice at 5am and -- surprise! -- the kids wake up at the much more reasonable hour of 7am. And now, God help me, I just said that 7am is reasonable.)

Dear Sydney, or as you are now officially known, Brute. Please stop being so fickle. I know that it's a definitional characteristic of a 2yo, but you've always been preternaturally sweet and I get enough demands from your three older siblings. Wanting to wear panda-bear pajamas with feet all day? Fine by me. Insisting on rolling in mud followed by tromping through my just-vacuumed house? Not fine by me, and to prove it, I will out-tantrum your two-year-old ass when it happens. Got it?

Dear Allegra, You melted my heart when I took you for a haircut and you asked the stylist to make you look "just like mommy."

Dear Photoshop, You're fun. I like you. Let's be friends!

xoxoxo, Erika

Wednesday, December 23, 2009

In which I briefly discuss a very non-brief birth

I'm just back from attending a birth; I am very tired but I want to get this out.

Leigh told me I will learn something from each birth I attend, and to write it down fast after the birth otherwise I'll forget. So here goes: I learned patience and trust.

This birth was long. Not totally-outside-the-realm-of-normal long, more like the kind of long that as a doula you hope your client doesn't have, because you'll be gone so long that your kids will forget your name and you'll forget your own phone number, not to mention go into credit card debt paying the babysitters. It was that kind of long.

This client wanted to stay home. She didn't want a home birth, but she is a very natural-minded person who had no interest in labor augmentation, pain medication, or intervention.

So we stayed home.

Honestly, part of me was dying to "do" something -- listen to the baby with a fetoscope, get mom's blood pressure, something. But I purposely didn't bring anything with me, because it wasn't my role. I was just there to support.

The dad very strongly believed that his wife could do it. She believed she could do it, but she had moments of doubt, as most laboring women do, and moments of realization that she'd been awake for 48 hours and contracting every 5 minutes of those 48 hours and was very very tired. But he was a real rock for her. Sometimes she would say, "Let's go to the hospital," and he would gently tell her that going to the hospital wouldn't change anything (a concept that is completely foreign to most women. Or, as Leigh says, "They don't have any magical baby machines in the hospital.") I agreed, but it was still hard for me, especially as I became increasingly tired.

But we stayed home -- not until the last possible second, not so long that there was a chance she'd have a car-birth -- but long enough so that I had watched her body go from closed to open, and her baby from high to low, without any assistance, and it was incredible. It was amazing.

Saturday, December 19, 2009

In which I discuss my other hobbies

(Other than birth, breastfeeding, childbirth education, and car seat safety, that is.)

j'aime manger les hamburger

J'aime mon chien

j'aime faire cuire

You would think that since I love to eat, I have always loved to cook. You would be wrong.

Dustin used to do all the cooking. (Yes, after he worked a 9-hour day followed by an hour commute home, including crossing the border from Mexico back into the States. We also used to have a cleaning lady. I, who weighed nearly 300lbs, sat on the couch and watched TV and ate bon-bons, perpetually pregnant. I was THAT wife.)

But now that I've had my intestines re-arranged, I can't eat bon-bons, there isn't much good TV anymore except for Modern Family and Lost, four children is enough, and I like to cook. Here are a few of my recent pleasures, all courtesy of my favorite website,
I have to give some credit to Leigh, who taught me that any "hydrogenated" ingredient is bad, and took me to Trader Joe's; my therapist for suggesting I watch Food Network; and Dustin* for putting a premium on raw milk, grass-fed beef, and organic chicken and eggs. Thank you.

*At some point I will make your Chocolate Chip Cookie Ice Cream Cake that I owe you for your birthday.

Thursday, December 17, 2009

In which I meet Ina May

INA MAY! Or as I kept calling her, "Ina Effing May!" (Her reply: "Yes, that's me. I'm here!")

She was amazing. Really, her statistics on The Farm are amazing. They have so little incidence of complications, transports, and c-sections. Their c-s rate over thousands of births is 1.5% -- up for .5%! This is from a place that does breech and VBAC and twins regularly.

She credited a good diet. She was all about vegetables (local) and protein. She is a vegan. Also, I'm certain that the woman who go to The Farm are really really committed to natural birth.

She seemed patient and wise -- and obsessed with poop. She talked a lot about Americans having constipation and how our diet is to blame, and how satisfying it feels to have a good poop. Um, yeah. It does, I guess. But other than this blog, it's not something I'm sharing with the world!

However, since she was into talking about poop, I decided to ask her about my particular tummy troubles, to which she replied, "Eat more cheese." No problem, Ina Effing May! She also said that if I get sick, to stop eating until I feel better -- something the gastro doc told me, only after I saw him about 7 times (and paid 7 co-pays) and he explored my colon with a tube.

See? Ina Effing May is WISE, I tell you. She told me all that without going NEAR my colon!

I feel like I'm getting into a groove at the Birth Center. Leigh and I see patients every Wednesday, which is a nice way to break up the week for the kids. They have a day with the sitter, and I have a day not wiping butts -- or, at least, wiping adult butts.

I am thankful for good babysitters. A wonderful woman who lives about 6 minutes away from us watches the children every Wednesday. I also have several back-up sitters, including one woman who homeschools.

Meanwhile, when I'm with the kids, I'm also with 6A, a huge assignment for AAMI. I have worked on it at Plaza Fiesta, Discovery Place, and today I may take it to the library.

Wednesday, November 18, 2009

In which I get back to the grind!

I am back to my midwifery studies after taking a break. We had a family situation that required my full attention; things seem to be back to normal now. I missed learning. I put away my midwifery books and instead read some really stupid novels that I did not enjoy although the reviewers on seemed to love them. There's no accounting for taste, apparently.

Something did happen while I was on my break, which was that I attended an interventive birth -- and I didn't feel that upset about it. Normally I feel icky after attending a hospital birth like that. This time I was still so wrapped up in my own situation that I didn't feel much of anything. And that was a blessing. Taking a step back emotionally from my doula clients and their births was a positive experience. After all, they are hiring me because I'm a birth professional, and professionals are able to draw the line.

Today is MAC day. I'm not sure what the acronym stands for -- the M is midwives or midwifery -- but it's for all the South Carolina midwives and two of my friends will be taking their oral exam, the last part of licensure for South Carolina. I wanted to go but paying for all-day babysitting is prohibitively expensive and Dustin doesn't have any more time off work this year (although he will probably be furloughed again in December. Suck.) I'll try to get there next year. I do want to see the peer review process.

So I'm back to the grind. Which means that I'm writing this while Sydney sits in my lap and the dog chews something and I hope that we will all (except the boys) get naps today!

Friday, October 23, 2009

In which I share a video of Maizey Rockstar

Wednesday, October 21, 2009

In which the Carolina Community Maternity Center gets its license!

I'm now a licensed midwife apprentice (yes, that's how it's written, not apprentice midwife; midwife apprentice) at a South Carolina-licensed free-standing birth center run by licensed South Carolina midwives! The Carolina Community Maternity Center!

Happy dance!

To celebrate, the midwives and I had dinner at City Tavern and they toasted each other on getting a birth center up and running in less than 7 months. What an accomplishment! I have to give so much credit to Leigh, Christine, Damaris, and Lisa for going out and getting it done. Helping them has been a learning process for me, and what I've learned is that starting a birth center is a huge totally thankless undertaking that involves lots of people and lots of money.

My contribution? I'm trying to get a small aquarium donated to the birth center. I think it would provide a nice sense of ambiance! I would like to have two fish, named Amnion and Chorion. And maybe they could have babies.

Today I went to a community car seat check. I checked three seats: two convertibles (rear-facing) and one combination forward-facing seat using a seat belt. Unfortunately, none of these seats officially count for me because there was no instructor on site to check off that I did them (although there were two senior checkers, both of whom are licensed to seat-check for special-needs children). But it was experience, and I was reminded -- again -- that I do enjoy being a car seat tech and checking seats. I'm teaching a basic car seat safety class at the birth center on November 12. I plan to focus on what new parents need to know about seats: NEVER put a rear-facing seat in front of an airbag; keep a baby rear-facing for as long as possible; the middle of the back seat is the safest place for a car seat; buy a new seat if possible -- and if impossible, there are programs that provide free seats, or make sure you know the person you're buying from and that the seat has always been used properly and never been in a crash.

I also had puppy school with Maizey today. I love puppy kindergarten. I've learned as much as Maizey has, I've met some great instructors and other dog people, and I've made some contacts in the world of Cardigans for when Maizey and I are ready to show. There are only two more weeks, sadly. After that I'm switching to Handling Class (30 minutes/week on how to show a dog), and then in January I'll start beginner obedience. Yes, dog training is my hobby. When I was a little girl, and someone asked me what I wanted to be when I grow up, my answer was always "a dog." Now I love being a confident, knowledgeable dog owner who is giving my animals a nice life.

Monday, October 19, 2009

In which I finish a somewhat large assignment

This means nothing if you're not in AAMI, but I finished 5A. I take a second to receive accolades for being so awesome... then move on to 6A, which is about four times as long and detailed. And then, I finish Orientation (which will be nothing compared to 6A), and start on my regular coursework and apprentice and then become a midwife.

Yesterday afternoon I went to the movies and out to eat with Emily, and when I got home Dustin said, "I didn't get anything done and the kids drove me crazy!" Really? That's so surprising! I usually accomplish at least... one-third of something I planned on, each day. (And on Friday night, my friend Joanna complained, "And another thing, my children are FORCING ME TO LIVE IN SQUALOR!" Yeah, here too. Squalor + dog hair = my house.)

This week the birth center has its final inspection, by the health department. Once it's approved, we can have births there! Leigh and I met with someone who is due very very soon, and I hope she can have a birth there. It's a gorgeous place, beautiful colors and ambiance, and just a really lovely place to have a baby. Particularly if your own house is full of squalor and dog hair.

Thursday, October 15, 2009

In which I try not to hinder myself

Tuesday night was revolutionary: I didn't have anything planned, and I went to Starbucks with my AAMI book and did homework for over two hours. I got so much work done, I'm almost ready to start on 5A and 6A, which are large, time-intensive assignments.

Doing homework without distraction -- except for the occasional Starbucks employee asking me what I was studying -- was amazing. I didn't have to sit down in front of the computer and worry what the hell Sydney was getting into (right now, I am hearing rumors that she may have spilled an entire box of Goldfish crackers in the bathroom), or break up fights between the boys (even when Dustin is home, they still default to me), or look around the room and wonder what to do about the clutter. I just worked. I loved it. I felt so accomplished by the time I left. I definitely want to get out of the house to study at least twice a week. The problem is finding two night I can do it.

My family is over-scheduled, and I hate it. Monday nights are Cub Scouts (Dustin and boys), Tuesdays are therapy (me) and CSA (Dustin and kids), Wednesdays are puppy school (me), Thursdays I'm teaching CBE (just for this month; then not again for a few months), Friday is Nerd Night (Dustin), and Sunday -- allegedly -- Emily and I go out, although it's been about a month (Emily, call me!) On top of this, the boys have baseball practice two nights a week, and games once a week! Also, I meet with the occasional doula client during the week.

I want to make changes. Baseball and my teaching and the CSA ends in two weeks, thank goodness. I'm happy for the boys and Dustin to do cub scouts because that's only one night per week. As for me, I want to continue puppy school because I love it, and of course my apprenticeship and midwifery school, but the rest - HASTA LA VISTA. Well, except for therapy, but I can probably cut that down to twice a month -- if I cut my schedule, we'll definitely have less to talk about!

What I love about being a doula is helping women have good birth experiences, and that is increasingly more and more difficult in a hospital setting. Yes, a woman can have a good hospital experience, but it's rare, and it involves a lot of fighting, which defeats the purpose. I don't want to stop being a doula, but I do want to be more selective. It's not worth my time away from my family unless the woman is willing to help herself; I can only provide support and advocacy. I'd rather just provide support in a better environment.

I enjoy teaching, and I'm a certified childbirth educator, but I do not feel as passionate about teaching as I do about my apprenticeship or midwifery school. I can teach, I can probably teach well, but it's not really where my heart is, and I'd certainly rather be attending a prenatal or studying than teaching.

So I'm glad that will be over at the end of the month, and in the future I may defer back to Leigh. She taught as part of her curriculum, but I already am a CBE, and I have so many other things on my plate, teaching seems like it's just another thing on my to-do list.

Off to do errands.

Sunday, October 11, 2009

In which I step away from the toilet talk a little about my surgery. Has this extended illness been a blessing? My ass would say NO FREAKING WAY, but the rest of me says, "Well, uh, sort of, I guess." Over the last month I have learned more about my body-after-surgery than I did in the last year. And I needed to learn these lessons.

I chose to have this somewhat complicated surgery that causes malabsorption called a Biliopancreatic Diversion with a Duodenal Switch. I picked this surgery rather than a traditional Roux-N-Y or a Lap-Band because the DS has the most malabsorption -- if not for that, how is any weight loss surgery going to work long-term? That, and at 5 years post op, most DS'ers have maintained 75% of excess weight loss, which is the highest percentage of any weight loss surgery.

Here's a before and after, it's been about 11 months and I'm at goal:

It wasn't until six months post-op that I said I was glad I did it. I kept the attitude of, "I did it, and it's done; it's not good or bad," rather than getting all emotional over it. I save getting all emotional for when I can wear something in a size medium, versus a size 4XL, which I was a year ago.

But of course it's not magic. I take tons of supplements to compensate for the malabsorption. Sixty a day, easily, and that's just the basics (vit A, D, E, K, C, zinc, iron, calcium, mag, copper, and several probiotics). At some point the lack of good bacteria in my gut (since so much of my small intestine is bypassed) plus the malabsorption combined to make me really sick -- and I still haven't gotten the balance back yet, but I'm better.

(By the way, I also keep the attitude of, morbid obesity has its own set of medical problems and issues! Type 2 diabetes, sleep apnea, stress incontinence, high blood pressure, the list goes on.)

But the DS-related illness has affected my midwifery career (ah, yes, I'm getting back into how this relates to midwifery!) I've been at births over the last year where I was feeling kind of sick, and it sucks, or I've had to stay home from prenatals or births because I was sick, and that sucks too. But now I'm finally figuring it out, thanks to about $300 in copays to a gastro-intestinal doctor who has worked with me, and my surgeon. What I do to prevent myself from getting sick:

1. Eat more protein. This seems like a no-brainer, but I think I was getting lazy about it. I'm a long-time carb addict, and since eating carbs didn't affect my actual weight loss, I started eating them more frequently. And then getting sick.

2. Take a pancreatic enzyme. I take enough pancreatic enzyme to... I have no idea what. To be honest, I'm not even sure what a pancreatic enzyme does. But every time I see the GI doc, he gives me this wide-eyed look of horror when I tell him what dose I'm taking and that it's not helping that much.

3. Take a good probiotic, eat yogurt daily. Right now I'm taking Align, which my mom and several DSers recommended.

4. If I start getting sick, stop eating for 12 hours. This was the hardest one for someone like me, who loves to eat (I would say I love to eat more than I love food). I'd get sick and keep eating and get sicker and until I was miserable. The GI doc wanted to keep trying different medicines, but I finally said that I wanted to see if what I'm putting in my body is causing issues. It was another no-brainer. Avoiding food for 12 hours after I'm sick can stop the illness from lasting or continuing, and then by the time I eat again, I'm happy to stick to all protein.

I'm a stubborn woman who likes to do things my way. But this sickness has helped me figure out that I can't do everything my way, I have to do it the best way. So I'm glad I got sick, for that reason, and because I learned how to deal with it. And also because all the time on the toilet got me to goal weight!

Friday, September 25, 2009

In which I receive the book

The book! The curriculum! This is IT!

Okay it doesn't really look like that, but you get the idea. I received my curriculum in the mail. It came later than I expected, but that was fine because, like I said, I've been sick and not up to it.

AAMI is awesome because it's a self-paced program; the state of South Carolina, on the other hand, wants me graduated within three years of starting my apprenticeship, which is around May of 2012. On one hand I have this lovely "take all the time you need" thing coming from AAMI (although you have to purchase curriculum extensions), and that makes me feel confident. I want to finish in three years, I can finish in three years, but if Life or something gets in the way, I can take a bit longer. On the other hand, I have the three year handcuffs in my head with South Carolina. However, I can always ask them for an extension. At this point, SC DHEC takes things on a case-by-case basis. AAMI is a difficult program. It's rigorous, it's thorough, it's intense. I plan to graduate in three years, but I can argue that I may need an extra month to finish the program. Christine, my mentor, nearly killed herself finishing on time.

But this is all moot because right now, this minute, my priority is getting started with the curriculum. I'll worry about the months and years later. Right now I'm reading Gentle Birth, Gentle Mothering by Dr. Sarah Buckley, and Misconceptions by Naomi Wolf. I'm thinking about my specialties: EFT will be one, and maybe newborn safety or care for the other one? I'd like to incorporate what I've learned from becoming a CPST, and maybe combine that with other attachment parenting choices.

Sunday, September 20, 2009

In which I am forced into hiatus by illness

I've been sick for a few weeks now, and it culminated in 2 days at the hospital for dehydration. Was this caused by my surgery? The GI doctor says "not exactly," as he thinks I have a bacterial infection. However, my surgery does make me prone to bacterial infections. So... maybe?

Fun things I go to do while in the hospital:
  • Stay in a 24-hour unit, which for me meant a windowless room on a windowless hall of the hospital, which had a toilet right next to the bed, disguised as a chair. I stared at it, and wondered who came up with such a feat of engineering.
  • Give three stool samples per day. Three. Every day. In a cup.
  • Have a colonoscopy.
  • During the colonoscopy, got Propofol as my anesthetic. Propofol, you may remember, is the Michael Jackson drug! And I have to say: FAIL. First of all, it burned as it went through my IV. Second of all, I didn't even dream! Third, it was over so quickly. I had Dilaudid after my surgery; I'd take that over Propofol any day.
I send a big thank you to my friends Leigh, Marianne, and Leslie for visiting me while I was there, and Emily for talking to me on the phone for hours. Leigh brought me food -- and watched my kids on Monday all day long while I was at the doctor and being admitted! Marianne brought me books and let me use her iPhone. Leslie brought me gum (since I was NPO for the colonoscopy by the time she arrived) and took me on a walk outside.

Once again: I have good friends. Actually I have great friends. I appreciate all of them.

Prior to my illness, I spent four days in Child Passenger Safety class, which culminated in the following initials behind my name: CPST. Child Passenger Safety Technician. It was long, somewhat interesting, and I'm glad I can now check car seats for proper install. My friend Joanna told me that I would learn more about seat belts than I ever thought possible.

She was right. I learned about the mechanism behind seat belts; what part of the belt keeps the child safe; how to add or change things to make the seat safest for the child. I'm still a little confused in my head about ALR, ELR, Switchable, and types of locking mechanisms. Luckily, I have a thick CPS book to help me, as well as the seat manufacturers and the car manufacturers to call if I need help. I was in class with six people who worked for Britax, as their company is here in Charlotte. Three engineers and three customer service reps. And several police officers and firemen.

I'm feeling better now, but definitely not back to 100%. I'm glad not to have anyone due as far as doula clients for a few months. Leigh has someone due but if I'm not feeling up to it, she will ask someone else to help. Also, I'm having some babysitter trouble. During the birth in which I wore uncomfortable pants, I had called my kids' typical sitter for help, and she was unavailable. I pay her to be on-call for me. I was not happy with the situation. I have begun looking at other options in case this doesn't work out.

Saturday, August 29, 2009

In which I learn to trust the process, and wear comfortable pants.

Ohhhhhh mahhhhhhhhhhhh gawwwwwwwwwwwwwwwd, I don't think I could have been wearing less comfortable jeans unless I'd been sweating and they were made of leather. Seriously. It was a pair of jeans that my mom bought me during a super-fast shopping trip while I was in Michigan a few weeks ago -- it was literally hours before the wedding started. I found a really cute pair of jean capris and she went find a second pair just like it, and she couldn't find the exact same ones, so she grabbed a "similar" pair, "similar" in this case meaning "looking somewhat like it except not meant to be worn in any situation where one might have to attempt sleeping in these pants." To give you some idea, dear readers, of the extend of my discomfort, let me say this: there is a belt buckle sewn into the BACK of these jeans. Ugh.

In my defense, I was under the impression that this birth would move quickly. Also, in addition to torturing myself from the waist down, I hadn't washed my hair that day. I think at one point the laboring mom actually looked at me and shuddered at my overall grossness.

After returning home, I immediately got on and bought two pairs of cotton yoga pants, 2 cotton tshirts, and 2 long-sleeved shirts (I'm skinny now, so I get cold, yo). I'm going to make two birth bags and put one in my car and one in my house, and include the clothes, dental floss, travel toothbrush and toothpaste, travel deodorant, hair ties, and maybe some of those face cleaner wipes. Because I really never want to feel as gross during a birth as I have recently.

What I have learned recently: to trust the process.

There is such a huge difference for the mom and the experience when the provider trusts the process versus a provider who does not believe in what she's doing. I can see that a lot of it is experience -- it takes a lot of birth experiences to believe in birth. Sometimes things go wrong -- without any warning -- and often it doesn't go the way it "should," as prescribed by physicians in the 1950s. Here is Friedman's Curve of expected dilation.

The Friedman Curve -- which is adopted by hospitals and written in the blood of obstetricians -- is kind of a hot mess. Here's a quote from BirthSource about dilation

Current definitions of labor protraction and arrest may be too stringent, Dr. Jun Zhang of the National Institute of Child Health and Human Development, in Bethesda, Maryland said at the 2002 annual meeting of the Society for Maternal-Fetal Medicine. "And the long-accepted Friedman curve may not be an accurate description of normal labor progression, according to a new analysis of data from 1,329 nulliparous women aged 18-34 undergoing singleton, vertex presentation deliveries following spontaneous labor," said Dr. Zhang.

Based on the speed of overall labor progression and current cervical dilation, Dr. Zhang and his colleagues calculated the expected traverse time for the cervix to reach the next centimeter and the expected rate of cervical dilation at each phase of labor. "Our curve is very different," Dr. Zhang said, pointing out that on his curve the average was 5.5 hours for progression from 4 cm to 10 cm, compared with 2.5 hours on the Friedman curve.

"We also didn't see a deceleration phase," he said, noting that in 1978 Friedman modified his curve, but the distinctive sharp upturn remained, as did the deceleration phase. "Our data suggest that most women enter active labor at different times, mostly between 3 cm and 5 cm dilation, and even in the active phase the speed of progression varies from person to person," he further explained. The median time for cervical dilation to progress from 4 cm to 5 cm in the present study is 1.7 hours. And for fetal descent, it could take 3 hours to progress from station +1 to +2, and an additional half hour from station +2 to delivery, he added. "Therefore, the definition of protracted descent or arrested descent appears to be too stringent in current practice," according to Dr. Zhang.

Generally, when there is a plateau (stopping of progress) of two hours in Friedman's curve while in a non-medicated active labor, or of three hours in active labor with an epidural, then "failure to progress" is the diagnosis and C-section is indicated. Of course, evaluation of the "4 Ps" -- Power, Psyche, Passenger, and Passageway (basically this means the force of labor, mental preparedness of the mother, the size and position of the baby, and the size of the birth canal) must be made to see if there is a correctable measure.

A long plateau is when a typical hospital provider generally starts to freak out (about malpractice, perhaps?) and push for interventions like breaking water, giving pitocin, and suggesting that the mom have an epidural so she can rest since she's obviously exhausted -- whether or not the client says she's tired. I've had a lot of overnight labors. I've only ever attended one where the woman has said she's exhausted. (And it was a woman who had not followed my suggestion that if her labor began while she was sleeping and she wasn't have contractions yet, she should try to go back to sleep, or at least rest. That might have made a difference.)

In a different setting, with a different provider, nobody freaks out when the labor doesn't progress as it "should." In fact, there are no "shoulds." As long as everyone is healthy -- baby's heart rate is fine; mom is eating and drinking and peeing and resting when she can -- the labor simply continues. The provider might consider some alternatives that would gently move the labor along -- changing positions frequently, homeopathic remedies, eating and drinking, resting, discussing any psychological issues the mom may have surrounding the labor and birth and impending motherhood -- but she doesn't force.

Trusting the process is somewhat different from sitting on my hands, which I wrote about last month. Sitting on my hands was at a birth where everything was progressing as it "should," but I felt like something needed to be done. See, I'm inexperienced! Trusting the process is about stepping back and looking at the facts and making decisions based on this individual situation, while taking into account the midwife's experiences.

A quick note about midwives who work in hospitals, also known as Certified Nurse Midwives. I believe that many of them trust the process, but the physician who is supervising them does not, and they are at his or her mercy. At a hospital birth recently, a machine kept malfunctioning and recording incorrect information; the baby was fine but it said that the baby was in distress. The CNM would come in and say that they had to get it fixed because if the attending physician saw the records, he would "go through the roof." Did she trust the process? Well, yeah, she knew the baby was fine. But she was under the direction of the physician who clearly did NOT trust it -- or maybe because he was supervising multiple labors simultaneously (without ever seeing anyone face-to-face) so he was unwilling to look at the individual labor.

Saturday, August 22, 2009

In which I extol the virtues of the Cochrane Database and evidence-based practice

Of all the websites I use for wasting time, The Cochrane Collaboration is probably the one I should make my homepage. Rather than learning how to make a hula hoop out of pvc-piping and a vice grip, the Cochrane Database has systematic non-biased reviews of health care studies.

About The Cochrane Reviews:

"Based on the best available information about healthcare interventions, Cochrane reviews explore the evidence for and against the effectiveness and appropriateness of treatments (medications, surgery, education, etc) in specific circumstances. Designed to facilitate the choices that doctors, patients, policy makers and others face in health care, the complete reviews are published in The Cochrane Library four times a year. Each issue contains all existing reviews, plus an increasing range of new and updated reviews."

Some things I learned tonight from about 15 minutes spent on the Pregnancy and Childbirth Topics page:
  • They spell cesarean, "Caesarean" -- so if that's what you're looking for, there's how to spell it. Otherwise you might not get any hits.
  • In Amniotomy for Shortening Spontaneous Labour, the results were "The evidence showed no shortening of the length of first stage of labour and a possible increase in caesarean section. Routine amniotomy is not recommended for normally progressing labours or in labours which have become prolonged."
  • In Antibiotics for mastitis in breastfeeding women, "The review included two studies and approximately 125 women. One study compared two different antibiotics, and there were no differences between the two antibiotics for symptom relief. A second study comparing no treatment, breast emptying, and antibiotic therapy, with breast emptying suggested more rapid symptom relief with antibiotics. There is very little evidence on the effectiveness of antibiotic therapy, and more research is needed."
  • In Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection, "The review of five trials (including approximately 2190 term and preterm infants) showed that although chlorhexidine reduced the number of bacteria that passed to the babies, the studies were not large enough to say whether it reduced GBS infections or not."
I found the GBS study the most interesting, because you would assume that if the number of bacteria passed to the baby is reduced, the GBS infections would be reduced also, and it's not (as far as the review shows. Probably more research is needed. Isn't it always?)

I love being a doula, and helping women give birth, but sometimes being at a hospital can be so disheartening. Hospital protocol often has nothing to do with research. Withholding food and drink in labor to prevent aspiration "just in case" moms need an emergency c-section under general anesthesia is ridiculous -- in a study that included 78,000 laboring women who ate and drank, there was not one case of aspiration (source: The Thinking Woman's Guide to a Better Birth). Continuous fetal monitoring for low-risk pregnant women doesn't improve outcomes any more than intermittent monitoring, and may in fact raise rates of c-sections due to the high false-positive rate (same source). And yet, I see the former at every birth, and the latter pretty frequently. Women who are essentially told to run a marathon are told in the same breath to go the distance without food or water. An IV is not meal replacement -- in fact, they often overload the mom with too much fluid, causing her kidneys to work overtime -- and they are invasive and painful.

Glad the next two births I'm scheduled to attend are not at hospitals.

Friday, August 21, 2009

In which I did something that I honestly didn't remember that midwives do back when I signed up for this!

Guess what I did?

Leigh and I had briefly discussed that I would begin giving injections (using B12 as practice) but I haven't started that yet. Meanwhile, we were with an extremely easygoing client who needed an injection, and she graciously allowed me to shoot her up. Thanks!

Add this to the list of things that I had totally forgotten that midwives do on occasion. People think midwifery is about catching babies but that's just a small part of it. Most of it is about care during pregnancy and postpartum; childbirth is just one day. Although it all seems to come down to that one day!

I'm working on a routine for our days at home so that I can keep my house on the right side of CPS's version of clean, get some school work done (mine), get some school work done (kids), and allow all of us a chance to waste time on the computer enjoy free time. So far it's wake up, brush teeth and get dressed, clean up rooms a little, have breakfast, free time for kids (while I do some school), school time for kids, lunch, quiet time/nap, more learning, clean downstairs, plaaaaaaaaaaaaaay etc dinner husband home. I hope it will work out -- I absolutely need some time during the day for school work; I can't do it all at night. Some nights I have interviews with potential clients, or prenatal visits or postpartum visits.

Thursday, August 20, 2009

In which I attend a whole bunch of births

with evidence!

(Yes, I hold every baby in my left arm, and only wear solid-color shirts.)

Here's what I've learned lately: I can't predict anything. I can't assume anything. Even when the evidence is there after hours of labor and I'm thinking that I know -- I know! -- in which direction the labor is heading, I usually don't.

I have learned to turn off that aspect of my brain during labor and just focus on the task at hand, like holding an emesis basin while a mom throws up into it. Otherwise I start thinking, "Wow this really isn't going well, I hope she doesn't end up with a C---" (and baby is born vaginally 20 minutes later.) "Wow, this is going fantastic, this baby is going to be here in an hour--" (and 17 hours later, the baby is born.)

It seems antithetical to the idea of holistic midwifery to put my ideas and my experiences on someone else. Every birth is different. I learn something new at each birth. And what I've learned over the last few years is that I just can't predict anything. Women surprise me. Labors surprise me.

I've progressed a little in my school, I'm now in "Orientation" and have requested my curriculum. My mentor just graduated and took the NARM exam. Recently I talked to another student who told me that I'm making my assignments more difficult than I need to; I'm over-thinking them. Really? Me? The woman who can't order food without having an internal dialogue (complete with debate of the pros and cons) between a grass-fed hamburger that is cooked medium versus medium-well?

I guess it's really not that surprising.

Another example of how I have to be like Nike:

and Just Do It.

Thursday, August 13, 2009

In which I write about the first birth-related book I read

Copyright 2009. Please do not copy or repost.

The first book about pregnancy I read was “The Girlfriends Guide to Pregnancy.” As much as I want to denigrate the content of the book, especially from the perspective of a student midwife, I enjoyed it at the time. I recall fondly laughing out loud at some of Vicki Iovine’s descriptions of various complaints of pregnancy, because I could relate!

My first pregnancy was unplanned and unexpected, and initially I did not have the support of my family or my then-boyfriend, so laughter and lightness were hard to come by. Looking back, I cannot completely ignore that positive effect of reading it. I do remember specifically that she’d had two c-sections and two vaginal births, and she rated them about equally. At the time, I thought, “How is that possible? One is surgery!”

The first book about birth that I read was “The Thinking Woman’s Guide to a Better Birth,” by Henci Goer. I read it later in the same pregnancy – which turned out to be twins – while on bedrest for Twin-to-Twin Transfusion Syndrome. I was given the book by my doula, Gretchen Humphries, who is a VBACtivist and writer on VBAC-related topics, after she had twins by c-section and two HBACs. I had never read a birth-related book before. It was incredibly eye-opening.

Prior to reading it, I didn’t realize that I had a choice in anything relating to my pregnancy and birth. I just thought the doctor I was seeing – an obstetrician in a high-risk clinic; a maternal-fetal medicine specialist and a twins expert – had my best interest in mind. (In retrospect, I’m not saying he didn’t. But I assumed it because he was my doctor, not because of how he treated me.)

After reading The Thinking Woman’s Guide, I realized that I had to be my own advocate. I specifically remember asking about telemetry monitors, and my doctor gave me a funny look, which I later interpreted – after becoming a doula and seeing that same look exchanged between my clients and their providers – as his realization that I’d become one of “those” types of patients. The annoying type; the type who asks a lot of questions and want a lot of answers, and want to understand the research behind the protocols.

As my pregnancy with my twins progressed, I had a lot of NSTs and BPPs. Baby A, the donor twin, was smaller and seemed growth-restricted. One doctor in the clinic I attended recommended a c-section at 33 weeks, but I refused. I ended up consenting to an induction at 34 weeks due to possible IUGR in baby A. I had cervidil, and did not need pitocin; I had a vaginal birth eight hours after my induction, with a feet-first baby B who was 2lbs bigger than baby A.

I really credit reading “The Thinking Woman’s Guide” to helping empower me. In turn, I wanted to help empower others. Birth is so different when a woman can say, “I chose this,” versus “The doctor did this…” At first I thought that every woman wanted to be empowered during her pregnancy and birth. Later I realized that many don’t. However, those who do need the support of other empowered women, especially those who have had an empowered birth.

Saturday, August 8, 2009

In which I write about everything else I do

Today I went to a homeschool conference. I have four children -- monozygotic ("identical") twin boys who are 6 years old, a 4 year old girl who is very sneaky, and a 2 year old girl with ringlets -- and we're going to start homeschooling this year. Or we already are, I guess. Of course the day wouldn't be complete if upon parking at the conference location I hadn't immediately run in one of my sister student midwives and had a quick discussion about recent births we've attended. But mostly my morning focused on learning more about homeschooling.

My biggest concern used to be spending 24/7 with my children; but as I've been doing it all summer and we've all survived, now I'm mostly concerned about finding the time to homeschool, do my own school, attend prenatals and births and postpartums, and keep the house clean enough that CPS isn't called to our house based on reports of squallor. Did I mention we also have three dogs who all shed profusely? Oh, and also keep everyone fed at regular intervals.

I think in my heart, I'm an unschooler. I'm really not looking forward to sitting down with my kids for a specific amount of time and teaching a specific... thing. I'd really rather just kind of let them learn about laundry piles and how to maintain them, and why keeping the door shut to the least insulated room in the house keeps our upstairs somewhat cooler, and how to get dog hair out of the corners where it all seems to converge, daily. I'd rather just let them count their Cheerios and learn the left side of the sink from the right side of the sink for putting their bowls on the proper side, and learn to read by watching TV with Closed Captioning -- because I can't watch TV without using Closed Captioning. I like to see exactly what everyone is saying.

However, that all said, I would like them to read -- at least so they can stop bugging me about "what does this say? what does that say?" -- and write and learn a foreign language and maybe an instrument. Math, I don't really care about, and science is more of Dustin's thing. He's a chemist; I don't even know why the sky is blue.

So, I'm dutifully looking into "curriculum," and have decided that it will consist of Teach Your Child To Read in 100 Easy Lessons, Handwriting Without Tears, and Math-U-See. Also, Sing Song Latin -- one of the only useful lessons from high school was learning Latin and Greek root words and prefixes and suffixes; thank you, Mrs. Taft -- art supplies including Stockmar Crayons, some kids' music, and playing outside.

I'm tired just thinking about it. And this does not even account for time to do laundry!

Seriously, we might be living in squallor! I cannot procrastinate my own school work, I cannot skip prenatals or births or postpartums; something's gotta give. And it will probably be the house.

I'm wildly lucky to be married to Dustin, who is totally impervious to filth. Totally impervious. He has many good qualities, but that may be his best. Of course, when I'm actually ready to strap on my shoulder-length rubber gloves and tackle the bathrooms, he seems totally miffed, but I'd rather have someone who doesn't mind the mess than someone anal-retentive. Or COD, as my bff Emily calls it. That's OCD properly alphabetized, of course.

I have hobbies other than laundry and wasting time online. I love to read. I love to write. I want to show Maizey and get her titled so that she can be bred in a few years. I want to get back into running -- I ran two 5K races several years ago and I felt like a rockstar although at the time I looked more like a Clydesdale.
You know, those giant horses that clop-clop-clop really loudly? That's how people on the website describe overweight runners. There's even a group called Lady Clydes. Lovely. I have tons of extra skin since my surgery, and my sister swears that running will help. However, my broken toe still hurts, so the treadmill will probably maintain it's usefulness as a towel-holder for another month til I feel 100%.

Sleeping in my bed is another hobby. I miss sleeping late, and I miss my bed. I used to get into bed on Saturday nights and read People magazine; now I leave it in the bathroom and thanks to my weight-loss surgery and its effect on my intestines, I usually get it all read within a week.

Monday, August 3, 2009

In which my ideals conflict with reality

I have this thing. I'll call it a thing. It's like my achilles heel. It's a thing I see at births that drives me a little crazy, that I vow I will absolutely never do.

I know how silly that sounds. It actually sounds like I'm a total birth newbie -- if I weren't, I'd realize that nothing about birth is absolute, and it's stupid to take such a hard line, especially when I haven't seen that many births. Birth is not black and white, and midwives -- midwives! -- value autonomy and individual decision-making over generalizations like "I NEVER do XYZ to clients," or "I ALWAYS do ABC to clients."

In fact, when I was pregnant with my last child, and looking for a homebirth midwife, I interviewed someone over the phone who had a blanket policy for all clients -- when labor started, the client had to take an enema. This midwife insisted on it, in all circumstances. Immediately a giant red flag went up, and I did not hire that midwife.

So why do I feel so strongly about my thing?

In my idealized version of reality, I'm a midwife who sits on my hands and simply watches a woman birth her baby with no assistance from me. (See my post about knitting during births.) In my idealized version of reality, I'm Ina May Gaskin, with silver Princess Leia hair and no make-up and long patchwork denim skirts.

In reality, sitting on my hands is uncomfortable for me, and I can only assume I will continue feeling that way. I don't want to do every intervention, but I definitely have a hard time just watching and waiting.

I think my strong feelings come from my own experiences, and that of a close lovely friend who has had 5 babies. The truth is, I have always messed with my body during labor in some way. I've taken castor oil, an enema, I've had my membranes stripped, I've done the breast pump, I've had sex solely for the purpose of getting the baby out, I've taken black and blue cohosh. I've tried it all, everything you can do at home that toes the line of "natural" induction methods. And I regret it.

And so, as I become a midwife, I guess I want to save my clients -- from MY bad experiences.

But, the rub is, maybe those same things aren't bad experiences for others; maybe they will do them and not regret them; maybe they will do them and feel grateful. I always have to remember that these are not my births. I have to remind myself, my births are over, done. And I can't undo them, or redo them, no matter how many births I attend. Honestly I don't want to, not consciously. (All that pain... throwing up... no thanks.)

So, among all the things I'm learning -- Braxton hicks contractions start at six WEEKS! Engagement is the point when the widest diameter of the presenting part has passed through the inlet of the true pelvis! PROM occurs in 10% of all pregnancies, PPROM occurs in 2% of pregnancies! -- I'm learning about myself also, and how I can be the most effective midwife for my clients. For them. Not for me.

Saturday, July 25, 2009

In which I desire to learn

Being in school as an adult is completely different than when I was a teenager and in my early 20s. While my husband knew what he liked as a kid (science), studied it in college (chemistry and biochemistry), and started an illustrious career in it (he's a chemist), I followed the more "traditional" path of getting a B.A. in a vague liberal-arts type of concentration: psychology, and creative writing. The creative writing has served me -- and you, dear reader(s)! -- well over the years. I write, not as much as I want, but I am satisfied with my style that I hope mixes humorous anecdotes with serious topics. But I've never used the psychology, and a bachelor-level degree in psychology is sort of ambiguous anyway.

My parents paid for my school and I'm grateful. Thank you, parents. However, now that I'm paying for my own school, I feel more INSPIRED than grateful. (Because, honestly, it's hard to feel grateful to yourself, right?) I want to milk this for all its worth. I want to get my money's worth. I want to learn while I have the opportunity and the access to teachers and fellow students.

Yeah, learning never stops, blah blah blah. But I think this a specific time in my life when learning is the FOCUS. Reading, writing papers, attending births, learning. That's going to be it for the next few years. Leigh gets a chance to read for pleasure, to see movies, to watch "The Office" with her husband. I've always got an assignment to do, a birth/midwifery/breastfeeding-related book to read, something to google.

I keep a list of things that I want to learn. It's pretty short right now, but each topic is vast. I update it every few weeks. Here's what I've got:
  • Normal physiological birth
  • Placentas
  • Nutrition during pregnancy
  • Hormones during labor and birth and postpartum
  • Homeopathic/"Natural" cures for pregnancy-related complaints
  • Twins
  • Anemia
  • Common diagnostic tests during pregnancy, and interpreting their results
  • Meconium
  • Appropriate weight gain during pregnancy, and its effects.

Sunday, July 19, 2009

In which I learn why midwives knit

I go to Ancient Art Midwifery Institute, where the unofficial motto is, "An unassisted birth for every woman, unless she really really REALLY thinks she needs a midwife (although she probably doesn't; she has just been convinced by society that she cannot birth alone) in which case you must be the midwife who knows everything -- but does absolutely nothing!"

Seriously, Carla's mottos are "Trust Birth," and "Birth is Safe. Interference is Risky."

But sitting on your hands is difficult. At least for me. Even though I know that doing nothing is important, both for the sake of normal physiological birth and for the woman -- intervening can lead her to believe that her body failed by not doing that thing that we did for her, or that her body is incapable of doing that thing we did for her. My friend Angela, when she was pregnant with her 5th child (who was born unassisted at home), worried about her water breaking. With her first four births, it had always been broken by a doctor or CNM. She worried that her water wouldn't break. She worried that her body didn't know how, or when, would be the right way or time. That baffled me. This from a woman who had had four children without any drugs, and suddenly, with #5, she didn't trust her body to give birth!

So, at a birth recently I sat on my hands (not hard; I don't do much anyway) and I watched Leigh sit on hers, and it was difficult for me. I wanted to move along the labor. I wanted to "help" the mom. I just wanted to DO SOMETHING.

So, next birth I will bring some long-term knitting project. I've known how to knit for 20 years. I've never actually completed a project other than a scarf or two. But now, I'm inspired. I want to make these to help teach breastfeeding!

Saturday, July 18, 2009

HIPAA -- I salute you!

Yes, you! I'm talking about you!

Actually, I'm not talking about you. I can't. It would violate HIPAA to blog about you, and it would feel ethically wrong to discuss specifics about a client. I know I don't ever say anything bad about clients, but still, it's just a comfort thing. So I've gone back and edited my old blogs. From now on, I'm going to maintain privacy: change details, times, not use names, etc. I am upfront about working with Leigh, and she is an out-of-hospital midwife, but when the birth center opens she will be doing both homebirths and birth center births. And I'm going to be working with midwives other than Leigh in the future.

So there, HIPAA! Take that!