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!

Saturday, July 11, 2009

From the "Marsden Wagner is eating my brain and all I got was this lousy t-shirt" file

What is safe?

We -- I'm talking about doulas and CBEs and even midwives -- teach our clients that if they end up at the hospital, and a doctor or CNM suggests an intervention, to ask, "What are the benefits? What are the risks? Is it safe?"

My boyfriend Marsden writes:

Since every medical procedure or technology has side effects and risks, no technology is 100% "safe." In every case, it is necessary to balance the chance of a good result (efficacy) with the chance of a bad result (risk)... But the decision as to whether the good chance outweighs the bad chance should not be made by the doctor, who is taking no chances, but can only be made the person taking the chance -- the woman. Therefore the doctor can never say that any procedure is "safe" but only tell the woman the chances and let her decide.

I'm going to think about this the next time someone asks me if a particular intervention or procedure is safe. I tend to think of "safe" as interchangable with "risk," but they're completely different. For example, I usually cite the BMJ study and say that homebirth is safe, but the real result is that homebirth outcomes were similar or better than hospital birth outcomes for low-risk women. To me, that means that homebirth is as safe as hospital birth -- which I'm allowed, since it's my opinion -- but that isn't fact.

This really becomes an issue for VBACs, where there are risks for VBAC and risks for a repeat c-section. There are slightly more risks for single-layer incisions, and less risk for double-layer incisions. Is VBAC safe? I think so. In my opinion, the risk of uterine rupture is less than the risk of surgical complications. But many women disagree, and schedule a repeat c-section. I tend to blame the doctors or others for over-emphasizing the risk of uterine rupture, but nevertheless, safety comes down to opinion.

I've seen some homebirths where the baby or mom needed intervention -- actually I've seen more homebirths like that than nice normal easy homebirths -- but I still think that homebirth is safe.

Thursday, July 9, 2009

"Hey, aren't you a doula?"

This week I've gone on three interviews with potential doula clients, all first-time parents, all of whom are planning "natural" birth. (I put that in quotes because I do not believe a hospital environment is natural. What I would say is that these couples are planning "medication-free" births. However, they all referred to it as "natural." It is splitting hairs, perhaps, but I put a lot of stock into language -- one day I'll post about how breast isn't best, and my favorite list of condescending obstetric phrases, like "incompetent cervix." Siiiiigh.)

I'm not a huge fan of interviews, although the more I do it, the more used to it I become, and I start to feel more comfortable. There are many many many doulas in Charlotte, so it's rare that I meet a couple and we click and that's it. Usually the couple is interviewing at least one other doula. I start out with the usual, Hi, I'm Erika

and ask about the woman's experiences so far, how her pregnancy is going, how she's feeling, what she's planning for this birth, how I can help, and how I can help her partner. Sometimes it's just a natural flow of conversation, sometimes I sort of rely on the checklist in my head (birth plan, location of birth, ob group, newborn plan, postpartum concerns). Once I was genuinely interviewed like, "How are you different from all the other doulas in Charlotte? What do you do if your client wants an epidural?"

Honestly, I'm probably not that different from all the other doulas in Charlotte. I market two things about myself: one is that I've given birth in a hospital with an epidural, in a birth center with a shot of narcotic, and at home with nothing; two, I'm an apprentice midwife and midwifery student.

For the first point, I think it relaxes people to know that I'm just like them, that I traveled on a path to natural birth and didn't just start out knowing that I would do it that way. Because most of the women I meet -- especially first timers planning a hospital birth -- aren't ready for a homebirth with their first baby. And they say that too, "Not with my first baby!" Like the first one is a practice baby. I wish I could go back and have homebirthed all my kids, but with my first three I just wasn't there yet. And I respect their position and I understand where they are coming from, and I want them to know that.

As far as being an apprentice and AAMI student, my leg up is that I know more than the average doula about normal pregnancy and birth. I'm early in the game, but I've learned a lot, and I can't even imagine all the things I will learn in the next three years!

I usually try to work in my favorite doula story, which is that the doula I had for my first birth wasn't a licensed doula, she was just a woman interested in birth who had attended a few births and offered to help me. Her name is Gretchen Humphries and she's very active in ICAN. She was so wonderful, during my pregnancy and my birth. My twins had Twin-to-Twin Transfusion Syndrome; I was induced and I was a first-time mom; my baby B was a foot-first breech; in short, I was a fantastic candidate for a c-section. And yet I had a beautiful vaginal birth. I really credit Gretchen with helping me get there. My doula for my next birth was licensed by several doula organizations, and she was very well-known. I felt lucky to have her. Still, I don't feel we clicked, and for that reason, she wasn't very helpful for me.

The moral of the story is: forget all the labels and the initials behind the name (I am Erika Gebhardt, CD, CCBE, LAMW SC) and go with the person you feel comfortable pooping in front of. Because you will!

And yes, I'm also still a childbirth educator.

(See all my hats?) Tonight I'm teaching part of Leigh's class, on breastfeeding. I've posted before about my experiences with breastfeeding. Leigh and I agree that breastfeeding success is about 95% intention. At the Red Tent I met a woman who had breastfed while having MRSA infection in her breasts! That's pretty incredible. (Although Leigh points out, only HIV/AIDS and Hep B have contraindications for breastfeeding. But still. MRSA! Is there a scarier word? And how the hell did she get rid of it?)

Monday, July 6, 2009

Suturing! Anne Frye! Chickens! Oh My!

In which I pretend this chicken is a perineum

And then I cut an episiotomy on it

And then I put it back together and feed it to the dogs.

I pray that I never have to suture anyone -- at least, not for several years -- because I really had no idea what I was doing. I know I say that frequently on here, but really, this time I meant it! I did note that when we watched a video about repairing tears, Anne Frye (of Holistic Midwifery fame) pronounced ischial the proper way (is-kee-al) rather than the commonly accepted "ish-ee-al." I smirked at Leigh when we saw that, because when I first told her how ischial is supposed to be said, she didn't believe me. (Google it. You'll see.)

I've been out of town for the last week, at Outer Banks with my family and my extended family. It was a beautiful trip except that on the next-to-last day I fell down the stairs and broke two bones in my big toe. That sucks. It hurts, it's hard to walk, and it bled for a long time. I didn't go in the ocean after that happened. Oh, well. We plan to go back next year too, and I will not carry laundry downstairs again on narrow, creaky stairs. These stairs were really narrow and really creaky. I had a feeling someone would get hurt on them, I just didn't imagine it would be me.

While I was gone, one of Leigh's clients had her baby. I'm so bummed I missed it! Unfortunately her birth was not quite what she had planned. I'm still learning about complications, and I'm struck with the unfairness ofl ife. A not-particularly-healthy mom can have an easy birth, and a very healthy mom can end up with a medical condition. But, of course, like Forrest Gump says, "Life is like a box of chocolates. You never know what you're going to get."

This week I have three interviews with potential clients. Two are Wednesday, back-to-back, after a vet appointment for Maizey, and after a prenatal appointment with Leigh and one of her clients. Yeah, it's going to be one of those days. I just had another interview tonight. I can never tell how it goes, except when it goes exceptionally badly. Luckily there's a million women in Charlotte who want to hire doulas; unluckily there are a zillion doulas here who want to get hired. I hate competing against my friends, but at least I feel good knowing that if I don't get hired, it's usually because someone I know and like did get hired.

I did do some studying while I was on vacation; there's actually a picture of me, in a bikini, no less, diligently reading my boyfriend, Marsden Wagner. I will post it when I upload the pics from my computer (which I've been saying I will do since we got home on Saturday). Marsden and I spend a lot of time together lately. I'm reading his books and articles. After him, I'm moving on to a relationship with Jan Tritten, the editor of Midwifery Today. Then Henci Goer, whose book, The Thinking Woman's Guide to a Better Birth, set me on my path toward midwifery. I have three years of midwifery and I don't think I'm going to be monogamous with anyone during that time.