Birth attendants: worth more than burger-flippers at McD's, I hope.

I feel frustrated when birth work isn't valued, particularly by the women who claim they want it. Most of the time, women who want doulas realize the value of having a doula. But there are some who just don't get it. I think this is more with regards to doula work than midwifery. With midwifery, the care is more tangible. With doula work, it's a little more difficult to see on the surface; we're not always "doing" something.

(I could easily go off on a tangent right now how our entire society and our whole nation doesn't seem to value birth work, versus other countries who subsidize doulas. See "Sicko" and note the part in France with the postpartum doula, who the government provides for free for all women. And I don't want to debate France, since so many people in our country are anti-France; I'm just making the point that the French value birth work. And we don't. Le sigh.)

I'm also thinking about trusting my instincts with regards to the doula clients I take. I've gotten burned over that one. It's just so difficult for me to turn down doula clients. Here's why:

1. I do this because I want to help women have positive birth experiences, and most of the women who hire me choose to birth in a hospital, and they need all the help they can get!

2. There are eleventy-million doulas here, far more doulas than women who want a doula. So getting hired makes me feel good -- I feel validated. I realize that this is my ego talking, and I shouldn't look at it like it's about me, because it's not. When I was pregnant with Allegra, I met several doulas and none of them were the right one. It wasn't anything personal. And when someone I meet with chooses another doula, I feel okay about it because all of the local doulas I know are fantastic, and I usually feel confident that the woman will be in good hands. But it does feel good to get hired.

3. Money. Being a doula is a business, and I deserve compensation for my work.

I spend a lot of time and energy on my clients. Even if I'm not in constant communication with them, I'm thinking about them, I'm googling things and learning things that might help them with their birth, I'm emailing with them or talking on the phone. When I'm on call, my life is on hold. I'm usually sleeping with one ear open, as it were. Going through Helping Hands, my apprentice workbook, most midwives said the most difficult part of being a midwife is that your client owns you, and I'd agree. It can be sucky. Emily once had a client go into labor when we were at a party that was really far away. I've had a birth on Christmas eve and Christmas day. Tomorrow I'm going for an interview with a woman who lives an hour away.

I've attended a birth that started Sunday evening and she didn't give birth til Wednesday evening. Leigh once said that midwives need their faculties about them after the baby is born; but that isn't true for doulas! We work like mules. We can totally deplete ourselves, physically and emotionally, and we often do.

Serendipity: Coming soon to a computer near you!

So, in my last birth-related post I blogged about wanting some more experience breastfeeding, or at least wanting to learn more about breastfeeding, particularly about troubleshooting. I was even thinking about taking the Aviva Institute breastfeeding educator class. Today I was going through my AAMI emails and found that lo and behold, Christine, my AAMI mentor and real-life friend and fellow apprentice, is actually teaching a course on this very subject! Fantastic. It's free for AAMI students -- and only $10 for non-students. I love when life is serendipitous like this. It's an online class, and I think I can attend it, even with my crazy schedule. (Christine, btw, is an IBCLC and a RN, and she's thisclose to being a midwife. And she's also an amazing woman!)

I'm working my way through Helping Hands, the Apprentice Handbook, which was written by Carla, the director and founder of AAMI. It's pretty interesting. It's a workbook, and a chance for me to record my thoughts and experiences with midwifery. It's really good for helping me to answer the questions, Why am I in midwifery school? How am I going to complete midwifery school? What will I do when I complete midwifery school? What are my goals and hopes for being a midwife? How will this affect my life? How will this affect my family?

In between making a prenatal exam cheat sheet for the back of my clipboard

Here is your daily quiche recipe, "Breakfast Quiches to Go" --

But first, let me explain why I love quiche. Mostly it can be summed up in three words: Weight Loss Surgery. I had a biliopancreatic diversion with a duodenal switch (hereby known as a DS or a "switch") in November 2008, when I weighed 262lbs. I currently weight 172lbs, which means I've lost 90lbs in 5 months. It's been fairy easy (I can't drink milk or eat too many carbs, otherwise I feel gross) and although it was excruciatingly painful at first, I feel fantastic now. (But I can't ever forget, it was the most pain I've ever experienced in my life, and I will never have abdominal surgery again if I can help it.)

From allrecipes.com

INGREDIENTS

• 2 (8 ounce) cans Pillsbury® refrigerated garlic butter crescent dinner rolls
• 1 (8 ounce) package cream cheese, softened
• 3 Eggland's Best eggs
• 1 small onion, chopped
• 1 (9 ounce) box Green Giant® frozen chopped spinach, thawed, squeezed to drain
• 1/4 teaspoon salt
• 1/8 teaspoon pepper
• 1 cup shredded mozzarella cheese

DIRECTIONS

1. Heat oven to 350 degrees F. Spray 16 (2 3/4x1 1/4-inch) muffin cups with CRISCO® Original No-Stick Cooking Spray.
2. Separate each can of crescent dough into 8 triangles. Press 1 triangle on bottom and up side of each muffin cup.
3. In large bowl, beat cream cheese with electric mixer on medium speed until smooth. Add eggs, one at a time, beating well after each addition. Stir in onion, spinach, salt and pepper until well mixed. Fold in cheese. Fill each cup to the top with egg mixture (do not overfill).
4. Bake 15 to 20 minutes or until knife inserted in center comes out clean and edges of rolls are golden brown. Remove from pan. Serve warm.

Nutritional Information

Servings Per Recipe: 16

Amount Per Serving

Calories: 197

• Total Fat: 14g
• Cholesterol: 60mg
• Sodium: 429mg
• Total Carbs: 12.6g
• Dietary Fiber: 0.2g
• Protein: 6.3g

Because Boobs are the Best!

One aspect of midwifery education/experience in which I am sorely lacking is breastfeeding. Of my four children, I only breastfed one for longer than a month, and that was Sydney. (I will explain the whys later.) Sydney and I had not a single problem during our breastfeeding relationship, and while I'm really happy that our experience was so positive, I realize that I lack the ability to address problems based on my own experiences! She had num-nums for about a year and we both loved it.

I think that my best personal characteristic for being a childbirth educator and doula and midwife-to-be is my vast array of birth experiences. I've given birth in a hospital -- in an O.R. -- in a birth center and at home. I've given birth with an epidural, a shot of narcotic, and medication-free. I've experienced labor starting with contractions that got longer, stronger and closer together, and labor that started with my water breaking. I've experienced a labor that didn't start for nearly 2 days after my water had broken, which really tested my patience and my faith in my body! I've had one baby born with a cord around her neck. I've had to change my birth plans based on needed medical care. I've had a great birth experience and not-so-great birth experiences. I think those experiences are my greatest personal assets to a client.

But not so much with breastfeeding.

First, a confession: I had a breast reduction when I was 16, not thinking about ever breastfeeding in the future, or how having a reduction would affect it. Then, when I was around 20, I had a boyfriend who had a baby that was 100% formula fed in bottles. She was a sweet happy baby, and that was my first experience with seeing a baby eat. Later I had a friend who had a baby (my first doula client) and she breastfed for a year, but she experienced overwhelming feelings of sadness when she first breastfed -- there's a word for it, but I can't remember it.

So, when I was a single mom-to-be of twins, my focus was mainly on having a vaginal birth, and not so much on breastfeeding. I went to a La Leche League meeting, but I just didn't give breastfeeding a lot of thought. I had been told by my doc that my babies would likely be in the NICU, and they'd be tube-fed high-calorie formula if they were preemies. (This was all determined by the fact that they had Twin-to-Twin Transfusion Syndrome and would likely be born prematurely.) I could breastfeed if I wanted, and I could pump and store milk, but they would be tube-fed and then bottle-fed before they could go home from the NICU. And I just didn't really think about the transition and how difficult it would be, and whether or not I even believed I could get them 100% breastfed because of my reduction. So, I pumped and bottle-fed them for about three weeks, at which point my level of exhaustion was so great that I made the informed (or so I thought, but looking back I was woefully uneducated) decision to formula feed. Pumping and feeding IS exhausting; someone on motheringdotcommune once calculated that she spent an extra 40 hours per week on pumping and feeding -- 40 hours that she didn't spend with her baby or family.

With Allegra, I had much better intentions. I dutifully breastfed. It was painful and I didn't give my breasts much time to heal. I didn't give myself much time to bond with Allegra either -- I was hell-bent on not taking any time away from Rory and Tiger, and it was to my own detriment and to the detriment of my relationship with Allegra. (In retrospect, I wish I'd done a "babymoon" or a "laying-in" period with Allegra, which I did do with Sydney. It's basically a time just to focus on breastfeeding and bonding with your newborn. It's lovely.)

At three weeks after Allegra's birth, I developed this terrible pain in my stomach, and I went to the ER and had emergency gallbladder removal. I came home the next day and we went back to breastfeeding. But after that, I developed a post-op infection and spent the next week in the hospital, without Allegra. The hospital told me I couldn't have Allegra with me because hospitals are full of sick people (aside: if it's so full of sick people, why is it okay for babies to be BORN there?!?!?!) and my doctor suggested I dry up and stop breastfeeding her.

I was devastated, and I followed his advice, but I was so incredibly sad. Later I tried to re-lactate, but it was just too difficult. I really tremendously regret following that advice, and saying okay to Allegra not being with me in the hospital. It was such wrong advice on so many levels. I wish so much that I'd had some of the friends I have now -- friends who would have provided me with a pump and support in continuing to breastfeed, friends who might have even nursed Allegra themselves so she didn't forget how to breastfeed!

But Sydney was my baby where I really tried to do everything "right," and that included breastfeeding. I did a laying in with her for two weeks, during which we cuddled and breastfed and I caught up on "One Tree Hill," that terrible show on CW. By the time Dustin went back to work, I felt comfortable with my new baby and with breastfeeding her. I felt more than comfortable -- I felt bonded and attached. It was a fantastic feeling. I can't even really describe it. She looked at me, drunk on milk, and I look back at her, drunk on oxytocin. We were a pair.

I would have liked to breastfeed her longer than a year, but I desperately needed to have weight-loss surgery. I was morbidly obese and was starting to experience some common comorbidities with morbid obesity. I didn't want to put it off for another year.

So that's my story on my breastfeeding experiences: three kids for about three weeks, and one kid for a year with no problems. I never had any mastitis, let-down problems, engorgement, over-supply, infection, thrush or any other types of problems. I can spot and possibly correct a bad latch, but I don't have the personal experience with breastfeeding issues that other CBEs and doulas and midwives have. And I'd like that experience.

I know there are some doulas and CBEs and midwives who don't even have children, who have never been pregnant or breastfed. I also know that anecdotal experience is not the entire picture. There are tons of aspects of midwifery that I've never seen, things that are probably even considered common. I haven't had a c-section and I don't particularly want that experience! But this is something I can learn about.

Aviva Institute, where I took my CBE class, offers a three-week Breastfeeding Educator course, and I'd really like to take it.

A glimpse of the future

Starting in June I will be homeschooling and apprenticing and in midwifery school. This week the kids are all on spring break and I'm planning to enjoy it and catch a glimpse of what our life will be like when the kids are done with school this year. (So far, that glimpse involves going to the library, coming home and having quiet/nap time, and then the kids running off to their friends' houses, not to be seen since. Homeschooling is great!)

I feel very confident about the decision to homeschool. I have given school a fair shot -- I dutifully get the boys out the door at 8am every morning M-F and pick them up at 2:30pm. I have only pulled them out of school once for a midwife-related endeavor, and that was to play with the other midwives' kids at a monthly meeting. I've done homework and sent in snack and paid for all the extracurriculars and attended Spirit Nights. I'm still not sold on school. I'm not anti-school, I just hate the bureaucracy and the rules and the general institution-ness of school. I don't like a schedule. This is yet another reason midwifery appeals to me; it's not going to be a 9-5 thing. I know that prenatals will be during business hours, but I also enjoy Leigh's late night prenatals.

I'm trying to find someone I can pay to be on-call for me for babysitting. I have two friends, Leslie and Ana, who are willing to watch the kids, but I don't want to burn through the friendships with unreturned favors, and I want someone who has a real incentive to babysit anytime I need a sitter, even if it's early in the morning or late at night. I met one woman who lives very close to where the birth center will likely be located, but if the birth center ends up not being at that location, she's far out of the way. And I'm just not 100% certain about her. I'm supposed to meet another woman this week; she lives very close to me but her email address includes the phrase Jesus Loves You so I'm not sure that will work out either (aside: I've been studying Paganism, upon recommendation from an administrative person at AAMI who I told me sad plight of being currently religion-less. Paganism very interesting, but I'm also not sold on it because it's all about nature and earth, and I'm a bug-killer and always will be.)

Today I requested my AAMI prepak, which is... okay I'm a little confused about the way AAMI works, but everyone says just to do it and I'll catch on as I'm going... I think it's like my orientation paperwork and assignments. It should take a few months to do. When I've finished that, I can request my actual curriculum, but not until I've paid AAMI $750 toward my tuition, which means it will be several months, and I'll need to make an extra payment or two. But I'm progressing along on time. I had to complete 15 assignments before requesting my prepak, which I've done. They included things like getting CPR certified, writing a few papers on what kind of midwife I plan to be, writing a summary of a Midwifery Today article, interviewing my mom and Oma about their births, and starting lists of midwifery-related topics I want to learn about/learn more about.

I'm trying to get more and more into the midwife frame of mind. The other afternoon, when I was picking the boys up from school, we stopped at the park on the way home and stayed for an hour or so. Meanwhile, I missed a bunch of calls from a midwife who plans to work at the birth center, and also from Leigh (when the midwife couldn't get me, she called Leigh. Leigh in turn called Emily, my bff, and then Dustin). Finally I got home and straightened everything out but I told everyone, "I don't keep my cell phone on me when I'm not on call, and I don't have anyone due until mid-May." (And that's as a doula; currently Leigh doesn't have anyone due til early July.) But Leigh told me I was thinking like a doula; a midwife is always on call. A client can always call with prenatal support issues, and I have to answer. So now I'm going to get a holder to clip my cell phone to me so that I'm always near a phone!

From Carla, to the South Carolina Department of Health

in response to an email asking for confirmation of my enrollment as a student with AAMI (in order to license me as a South Carolina apprentice midwife)

Yes Erika is student #2012. We are quite excited to have another South
Carolina enrollee. I have quite a soft spot for South Carolinians. You may
not be aware, but Robert Lawyer was, that we offered the first comprehensive
academic program in the country for non-nurse midwives and have just
celebrated our 28th anniversary. Mr. Lawyer was the first state official to
give us approved status and wrote me a letter I still have to this day about
how thorough our program is.

I know that students there have many choices and I am all for that; I hope
you continue to allow students to choose their own education. However, I
want you to know that our students are not like any other midwifery
students. They know that there are far shorter and eaiser courses out
there, but those chose the most difficult and comprehensive, on purpose.
They will serve the women and families of South Carolina well long after
they have assisted with their births.

We not only offer the most advanced midwifery education but we place a
strong emphasize on parent education. Our approach helps parents realize
their own authority, which means that we help them accept their
responsibility for parenting and birth and health, which can only be a great
thing for your state's future.

You can expect Erika to be an asset to South Carolina and your birthing
families and we know that she will be an asset to our program. Please do
not ever hesitate to contact me with any issue relating to midwifery or our
students. We would love to be of service to you.

Thanks, Carla Hartley
Founder, Director
Ancient Art Midwifery Institute

Nice, right? I thought that was such a nice email. Carla bcc'ed me on it. And then I fwded it to Leigh.

It feels really good that someone I don't even know personally has such confidence in me. Okay, so it's probably really just confidence in her midwifery program, but still, the outcome is the same: I will be awesome in a few years. Even awesomer than I already am!

I'm very excited about AAMI. As I'm reading and printing and 3-hole-punching and filing, I'm very excited. I'm thinking about my future: I will have to pick two specialties of focus, one that is pregnancy and birth related and one that is related to holistic medicine. I'm thinking about twins for the pregnancy and birth related specialty. Obviously I know a little more about twins than the average lay person. I really have no idea about the holistic medicine one. I mean, everything sounds interesting, but nothing in particular sticks out. I would love to go to the Farm though, and do a workshop on herbs.

Off to eat dinner.