Not an Apprentice Midwife

In which I change my blog name, and move it to another site

2010-03-22T16:06:00.000-04:00

So please, if you have me bookmarked, change me to this

http://creamofmommysoup.wordpress.com

In which I consider changing my blog name

2010-03-19T13:15:00.000-04:00

Dear Three Blog Followers,

Thank you for reading my blog. I appreciate it. Even if you never leave comments, it's good to know that my writing amuses more than just my parents, who think a blog is the least I can do after they paid for my degree in creative writing from the University of Michigan.

That said, I am changing my blog name. (Those of you reading this on Facebook may be shocked to know that I have an blogger account. And that the internet does exist outside the parameters of FB.)

Here are some names I'm thinking about:

mommymarinade.com (Improving the flavor of motherhood!)
momandcheese.com (The perfect side dish!)
spilledrawmilk.com (Not crying over it since 2009!)
creamofmommysoup.com (Just add water!)
alfrescomom.com (Just like the commercial!)
mangiamama.com (Even though I'm not Italian)

What do you (four) think?

In which I make my own condiments

2010-03-13T13:37:00.000-05:00

Oh, how I love cooking!

Even though Mineral doesn't eat anything I make -- My Masterpiece does, and Animal and The Informant will nibble. My Chemical Romance likes my food. But forget about them; I love my cooking. Despite eating out a lot as a kid -- I had two working parents and who likes to come home from a hard day to the kitchen? -- at this point I'd rather stay home.

Introducing: Dressing!

(This was a picture that came up when I googled 'dressing')

RANCH DRESSING

1/2 cup mayonnaise
1/2 cup buttermilk = 1/2 tbsp white vinegar (or lemon juice) + milk to make 1/2 cup
1/2 cup sour cream
1/2 teaspoon dried chives
1/2 teaspoon dried parsley
1/2 teaspoon dried dill weed
1/2 teaspoon garlic powder
1/4 teaspoon onion powder
1/8 teaspoon salt
1/8 teaspoon ground black pepper
1/2 teaspoon vegetable oil

Whisk together all ingredients. Cover and refrigerate for 30 minutes before serving.

BLUE CHEESE DRESSING

2 1/2 ounces blue cheese
3 tablespoons buttermilk
3 tablespoons sour cream
2 tablespoons mayonnaise
2 teaspoons white wine vinegar
1/4 teaspoon sugar
1/8 teaspoon garlic powder
salt and freshly ground black pepper

In a small bowl, mash blue cheese and buttermilk together with a fork until mixture resembles large-curd cottage cheese. Stir in sour cream, mayonnaise, vinegar, sugar, and garlic powder until well blended. Season to taste with salt and pepper.

ITALIAN DRESSING

1 tablespoon garlic
1 tablespoon onion powder
1 tablespoon white sugar
2 tablespoons dried oregano
1 teaspoon ground black pepper
1/4 teaspoon dried thyme
1 teaspoon dried basil
1 tablespoon dried parsley
1/4 teaspoon celery salt

In a small bowl, mix together the garlic salt, onion powder, sugar, oregano, pepper, thyme, basil, parsley, celery salt and regular salt. Store in a tightly sealed container.

To prepare dressing, whisk together 1/4 white vinegar, 2/3 cup canola oil, 2 tablespoons water and 2 tablespoons of the dry mix.

Meanwhile, if I have one piece of advice about cooking, one thing that has revolutionized my life, it is this: always always ALWAYS marinade your chicken overnight before cooking it. Chicken has a tendency toward dryness, and marinading (I use Italian dressing) makes it so juicy!

This does require forethought. I usually have to plan chicken meals at least a day in advance. Still, it's worthwhile. I notice a difference in my Garlic Cheese Chicken Roll Ups (my favorite meal) when I don't marinade.

Meanwhile, I'm going to attempt over the next few weeks to introduce a few vegetarian meals into my repertoire. Vegetarian meals are healthier than meat-based meals; they are also better for the environment. I've found a few on allrecipes.com that are supposed to be very tasty.

Today I had an abdominal and pelvic CT scan at the hospital. I've been having some tummy troubles, and I'm hoping there is some explanation better than my GI doctor throwing up his hands and blaming my weight-loss surgery. Which is what he normally does. Yes, having my guts re-arranged has caused me some issues. So did weighing nearly 300lbs.

In which I describe my family

2010-03-11T17:05:00.001-05:00

First we have Animal and Mineral. They are twin boys. They have been fighting since they were in utero, when Animal was supposed to be born first. I was told by my doctor that they could not change places. Late in my pregnancy, two weeks before they were born, they did. (Thus began my skepticism of mainstream health care practices.) Mineral was born first. Here is a picture of them at about a month old.

Aren't they precious?-- Note Animal is eating Mineral's head. That picture was taken nearly 7 years ago. Not much has changed.

Next is The Informant. She will be 5 soon. She has never met a human being with whom she didn't long to share her entire life story. Along with anything else you've ever made the mistake of saying in her presence. She will happily describe my TTT in detail, along with information about Mineral's eczema, Animal's love of tomatoes, and the plot of The Sixth Sense. "Rosebud was his sled!" she gleefully exclaimed to a playmate. "I knew from the beginning that Kevin Spacey was Keyser Soze," she once whispered to me conspiratorially.

Keeping track of the world is often quite useful; she lets me know when the house is about to burn down or when My Materpiece is awake from a nap. On the other hand, another word for informant is tattletale.

Finally, we have My Masterpiece. It took me four tries to get a child who nursed for a year, loves to cuddle, sucks her thumb charmingly (meaning: when she's tired; not all the time) and has a sunny disposition. She's two-and-a-half and has never climbed out of her crib. She loves laying on her tummy and rolling a matchbox car along the carpet, doesn't complain when her routine changes, and recently started replacing Ts with Ns ("I want to go DOWNSNARES!")

She giggled when I posted that picture. My Masterpiece.

The other players in my house are my husband, also known as My Chemical Romance; the fish; and Maizey, also known as the Dog Without A Downside.

Upside only.

That's my family.

In which I explain why I now WILL take Opium!

2010-03-06T11:57:00.000-05:00

But first, let me explain why I was offered Opium. (Leigh pointed out to me that I had such an intriguing title yesterday, and didn't even bother to work it into the blog!)

Tincture of Opium -- which is much more potent than Paregoric -- can help with Toilet Time Trips. So, after trying many different medications to, um, stop the daily TTT my GI doc suggested it. With the following caveats:

Filling this RX at your pharmacy will get you red-flagged with the FDA; I will get flagged for prescribing it. You'll have to document appointments with me every two weeks. It is a potent narcotic and you will have to find the lowest dose that helps and then try to get off it as quickly as possible.

I left the appointment and threw the RX in the trash. It sounded too complicated. Plus, I just can't get on board with being on narcotics -- although it sounds like fun! -- while homeschooling four children every day.

I had began to think of my daily TTT is just another part of my life, like cooking or brushing my teeth or watching The Real Housewives of New York.

But, alas, daily TTT is becoming multi-daily TTT which is accompanied by pain and bloating, and I think it's time to do something about it. I saw the GI yesterday (GI Joe) and he said that I'm not a complainer about pain--

Dustin: BWHAHAHAHAHHAHAHAHAHAHA!

My mom: Boy, do you have him fooled!

Leigh: Did you send in a doppelganger or something?!?!?!?!?

--but I think he just said that because he went to Ohio State and therefore is clearly a moron (Go Blue!). Or a sadist in his spare time.

Really, daily TTT is somewhat a part of life post-BPD/DS, but that doesn't mean I shouldn't try medication to stop it. Right???

In which I will not take Opium -- sorry!

2010-03-05T14:59:00.000-05:00

But first let me talk about my surgery, a Biliopancreatic Diversion with a Duodenal Switch. ("You had gastric bypass surgery?" "NO. I had weight-loss surgery that involves a lot of malabsorption.")

What on earth is a Biliopancreatic Diversion with a Duodenal Switch?

from dsfacts.com

Approximately 70% of the stomach is removed along the greater curvature, also called a vertical sleeve gastrectomy (VSG). The remaining stomach is fully functioning, banana shaped and about 3 - 5 oz in size which restricts the amount you can consume. The pylorus continues to control the stomach emptying into the small intestine; as a result patients do not experience "dumping". The upper portion of the duodenum remains in use; food digests to an absorbable consistency in the stomach before moving into the small intestine.

A benefit of removing a portion of the stomach is that it also greatly reduces the amount of ghrelin producing tissue and amount of acid in the stomach. Ghrelin is the "hunger hormone" and by reducing the amount of the hormone produced the appetite is suppressed.

The intestines are switched so that food from the stomach and the digestive juices travel separate paths and don't mix until they meet up towards the end of the small intestine.

The alimentary limb carries the food.

The biliopancreatic limb carries the bile and digestive juices.

The common channel, also known as the common tract or common limb, is the point from where the alimentary and biliopancreatic limbs meet in the small intestine to where they move into the large intestine. The common channel is where a DS patient's food, bile and digestive juices mix and nutrients are absorbed. Since the common channel makes up such a small portion of the small intestine dietary starches, fats and complex carbohydrates are not fully absorbed.

So, why'd you choose a BPD/DS rather than a more common Roux-N-Y gastric bypass?

It came down to this: I could never willingly submit to surgery that might cause me to vomit after I eat sugar. A life without sugar isn't for me (see "The Health Project" and "MAJOR FAIL"). Also, I enjoy my pylorus. Because I have a functioning pylorus I do not have "dumping" syndrome; I can take NSAIDS; and my entire stomach can be scoped if need be. Plus, the long-term weight loss results of BPD/DS are simply the best of any bariatric surgery (see here, here, and here).

And you went to Miami to have it done, and paid for it out-of-pocket?

Yes and yes. It actually reminded me of paying for a homebirth rather than going to the hospital for a "free" birth. I could have had a RNY. My insurance would have covered it. (My insurance would not cover a BPD/DS because I wasn't morbidly obese "enough.") Instead, I paid for it, so I got to call the shots. I chose a surgeon in Miami who is one of the best; he's taught most of the BPD/DS surgeons in this country how to do it. I chose my date (election day 2008. When I came out of anesthesia, I kept asking, Did Obama win? Did he REALLY win? Really? Seriously?) I stayed at my parent's house after the surgery.

What was it like?

There aren't words to describe how sucktastic the first few [-]weeks[/-] months were. I was in so much pain. I cried. I missed my family, as I was away from them for almost two weeks. I could barely walk. My mom had to wipe my ass. She washed me in the shower. Every part of my body hurt. Food tasted weird. Drinking water gave me heartburn so bad I thought I would spit fire. It was the most physically painful experience of my life -- and I've been pregnant with twins, I've given birth without any painkillers, I've had my gallbladder out after an attack of gallstones, I've had dental surgery. My BPD/DS surgery knocked it all out of the ballpark.

But eventually, it got better. Yet it was over six months before I ever said, "I'm GLAD I did this." I lost a remarkable amount of weight, and for the most part, I can eat "whatever I want."

That said, there are downsides.

First and foremost, I spend a LOT of time in the bathroom. Lots.

I've read a LOT of books since this surgery. I've been hospitalized because I spent so much time on the toilet; nothing was staying inside my body.

Secondary to my Toilet Time was a problem with an external thrombosed hemorrhoid also known as "the second most physically painful experience of my life."

There's another downside that Dustin could talk about:

It has to do with not having enough good bacteria in my intestines and yada yada yada -- if I skip a dose of probiotics, or don't eat good whole-milk plain yogurt daily, do NOT stand behind me!

Right now I'm having some issues with bloating. There's nothing like weighing 135lbs at 5'6" and being asked REGULARLY if I'm pregnant. By strangers. To me, it means (1) people are RUDE (2) clearly, I look pregnant enough that strangers feel comfortable asking me when I'm due.

Anyway, over the last nearly-18 months, I've come to the realization that no weight-loss surgery is perfect; everything has it's downsides -- and I'm currently taking Cipro and waiting on a full-abdomenal/pelvic CT scan to rule out anything else.

Having this surgery was really another chapter in my life; I think about it the way I think about my kids. There was life before my BPD/DS. It was good, it was bad -- it was different. There's life after my BPD/DS. It's also good, sometimes bad, but mostly full of positives. I have no regrets about having this surgery. None. I'm so glad that I had it done. I'm so glad that I've lost weight, that I'm healthier than I was, that I extended my life expectancy. I would go back and do it a million times again -- despite the Toilet Time, despite the 'roid rage, despite the gas, despite the bloating.

In which I do not bake cookies for crazy neighbor

2010-03-04T14:59:00.000-05:00

I have a neighbor I hate. He's so annoying. I'm trying -- not as part of any project, just in general -- to feel neutral toward him, because it's a waste of emotion to hate, but really I just can't stand him.

He's also a total wackadoo, as the kids are calling it these days. Here's why:

1. The "hidden" cameras. Crazy neighbor has two: one in his front window, the other in his above-garage window. I can only assume it's to track the comings and goings of everyone in our neighborhood.

2. The incident with a former neighbor. He pulled a gun on a former neighbor during an argument. This was before my time on the street, and the former neighbor moved away -- actually lost his home in a foreclosure -- but the police were called and crazy neighbor was arrested.

3. The wife nobody sees. Really. I've lived here for two years and have seen her once, in her car. I waved. She gave me a dirty look. A nice neighbor once saw her in the cafeteria at her (nice neighbor's) work -- she (crazy neighbor's wife) was temping at nice neighbor's office. Nice neighbor waved. Crazy neighbor's wife dumped her food tray and left.

4. The dogs who aren't allowed on the grass. Crazy neighbor takes great pride in his grass. He has two dogs. They are not allowed on the grass. Naturally, whenever my former dogs would escape, they ran straight for his grass.

5. The Animal Control on speed-dial. Yes, my neighbor calls Animal Control every time my dog barks more than twice in a row. Unfortunately for me, my dog is a herding breed who uses her voice to move the (imaginary) sheep all over our backyard.

When Animal Control is called for a "noise nuisance" they sit in front of the house that has been complained about, and listen for 15 minutes. The first... three?... times this happened, I freaked out. However, each time the Animal Control officer has knocked on my door and said that he didn't actually hear anything -- because, I don't leave my dog outside to bark! -- but by law he has to give me a copy of the law -- which states that 15 minutes in a row or more of continuous barking is considered a nuisance. Sigh.

The good news is that crazy neighbor has actually helped me bond with less-than crazy neighbors; he calls Animal Control on his adjacent neighbors practically daily, and once when Maizey escaped during a torrential downpour, they grabbed her and brought her back to me. They are actually suing crazy neighbor for harassment.

What have I learned from this? Well, prior to this move, I've always enjoyed living in a neighborhood. You know, the kind with HOA and lots of neighbors and a pool. I've never longed for some huge piece of land that Dustin would spend all weekend mowing. Until now.

Since we average living someplace for 2-3 years, I sometimes think about our next stop. And I hope it will not be in a confined neighborhood; if it is, I want a lot of distance between houses. I bemoan the lack of a community pool -- that was the best thing about living in Arizona, we had a pool in our backyard! -- but I can deal if we join a Y or a Carowinds-type place or something.

In which I spend a week on the Health Project and mostly FAIL

2010-02-26T09:38:00.000-05:00

But at least I've learned. Let me begin.

SUCCESS:

1. Taking Lactase before I drink milk or eat milk-based foods. No-brainer, right? It helps. I take it every morning, before I eat the remainder of the kids' breakfast -- a little oatmeal, a bite of Cheerios, a banana. My own breakfast is usually yogurt with a banana and some dry oatmeal, all mixed together.

2. Going to bed at 9PM. Not as bad as I thought and the bonus is I spend time with My Chemical Romance who generally goes to bed pretty early.

3. Jumping on the tramp once a week. I would be a sucktastic mom if I couldn't find one day per week to spend bouncing around with my kids.

FAIL

1. No sugar-based foods.

Are you surprised? Not only that, I totally coveted sugar and actually made brownies from scratch last night -- and I'm a cook, not a baker. However, I will note that I felt better when I didn't eat sugar. I felt less bloated and my stomach felt better than usual. Sigh. Life is a series of trade-offs, no?

2. Walking 5x per week. I'm kind of bummed that I failed this, because it made me realize that I do enjoy moving, that I am woefully out of shape, and that I would like to firm up a bit.

3. If we're going to be technical, I did not go to bed at exactly 9:00PM every night. Tuesday night I went to bed at 11:00PM and this picture describes me on Wednesday

What I've learned from this:

1. With regards to eating, less is definitely more. Again, another no-brainer. Michael Pollan sums up his book Food Rules in six words: Eat food. Not too much. Mostly plants. I'm not sure how he feels about brownies. Calorie restriction has its benefits in the general population -- mostly that it is linked to reversing the aging process in primates and mice -- but for me, not over-eating reverses any stomach problems. And that makes life much more enjoyable!

2. I can make myself go to bed early, and the world will not stop spinning on its axis, and if I get that "important" email at 8am instead of 1am, that's okay too. And I'll get to sleep next to the non-snoring My Chemical Romance! (Not snoring is one of his best qualities.)

3. Walking is boring, but I do want to exercise. I want to join the Fort Mill YMCA, which has an awesome outdoor pool area for kids with tons of slides and water fun. It also has step aerobics on Tuesday evenings, a kids' fitness class on Wednesdays, homeschool PE on Thursdays -- basically, I think I can make it work with the kids where they wouldn't hate going.

I'm going to work on my Health Project for next week. I may change it to Weekly Health Goals.

In which I survive my first weekend on the Health Project

2010-02-22T16:06:00.000-05:00

By the way, did I mention for how long I intend to keep it up? Three weeks, as that's how long it takes to make or break a habit -- although that "fact" is probably just some kind of mythic conjecture.

I'm on day four. I've learned a few things already.

1. Going to bed at 9:00PM is not as bad as I thought.

I imagined I'd lay there for hours, tossing and turning, feeling anxious. Nope. I go to sleep. Extremely surprising.

2. Walking is more work than I thought!

I thought walking for 20 minutes, five times a week, would be nothing. And yet, after four days, I have shin/ankle pain. Just like when I was in college, I'd have pain for the first few weeks every September as I walked all over campus. Then it would go away as my legs got accustomed to Ann Arbor.

However, I am thinking about getting a pair of MBT shoes.

I am selling my Dansko clogs -- which were my Christmas gift from Dustin after pining for months. I even tried them on at a Nordstrom. Apparently 12 minutes in a Nordstrom wasn't enough to tell that my feet are too fat for them. Yeah, my feet are thinner than they were 130lbs ago, but still wider than average. Sigh. So now I'm thinking about MBT shoes, but I want to make sure they don't also run narrow.

BTW, I walk barefoot when I use the treadmill because barefoot exercise has health benefits!

3. I can't compensate for the lack of sugar. I've tried to compensate by eating every non-sugar item in my house that isn't nailed to the ground -- and it only gives me stomach pain.

For a minute I thought honey was the answer to my sugar-free prayers, but it's just not that good. We have a vat of honey from Costco that I'm working on, slowly; I'm sure fresh local honey would be a different story.

4. There was a trampoline debacle, and I'm staying off until I fix it.

The ground near the entrance was getting muddy from so many kids (and adults) climbing in, as well as a lot of rain in early February. I thought about how to fix it -- maybe straw? or hay? -- but Dustin thought that sand was the answer. Sand + mud = thicker, grittier, more hearty mud that covers not only the surface of the tramp, but also the soles of shoes and therefore the floor of my house. UGH. I'm safe for today, because it's raining outside (although this means even MORE mud), but tomorrow I'm getting some wood chips or cedar chips or straw -- or a combination -- to put down near the tramp entrance. Hopefully, problem solved. I'm not a huge fan of mud all over my house, and I also like to be barefoot on the tramp without jumping on nasty pieces of dirt.

In which I do a "Six Word Saturday" for Feb 20 2010

2010-02-20T07:40:00.000-05:00

Life without sugar hurts my brain.

In which I describe the Health Project

2010-02-19T10:22:00.001-05:00

I'm reading The Happiness Project, which was written by a woman who decided to take a year to improve her happiness. She wasn't depressed. Her life was good. But she wanted to be happier, so she thought about what would help her, and she read books and blogs and suggestions, and made a plan for herself. Then she wrote a book about it. She also keeps a blog.

I am not ready for a complete happiness project -- I haven't finished the book yet! -- but I'm ready for a Health Project. To that end, I thought last night about things relating to my health that would make me happier, healthier, and more pleasant to those I love. Here's what I've got

1. Take lactase enzyme before I drink milk. Seriously, I own it. It works. Why not take it before I drink milk?

2. Go to bed at 9. Yes, this means PM.

3. No sugar-based foods for 21 days. Supposedly it takes 21 days to break a habit. We'll see. I'm not cutting out carbs, or flour, but I need to stop eating things where 'sugar' or some variant of it is in the top three ingredients.

4. Walk for 20 minutes, five times per week. I actually dusted off the treadmill. Goodbye, towel hanger!

5. Jump on the trampoline once per week. Because I have as much fun as the kids when I do it!

In which I slack on the cooking posts!

2010-02-18T15:35:00.000-05:00

Foolish me, I thought when I stopped apprenticing -- and by the way, everyone, I did not quit; I am taking a break! -- I'd have more free time. According to my weeknight schedule, the joke is on me:

MONDAY: Cub scouts. Early dinner then my three scouts rush off (Dustin's a den leader).
TUESDAY: Erika's parenting class. Yes, even the most perfect parents need help sometimes with their litter of children.
WEDNESDAY: Maizey's Dog Class, then a late date with Leigh.
THURSDAY: I see Dustin and the kids for more than 4 minutes consecutively before bedtime. Hooray!
FRIDAY: Dustin's Nerd Night/Erika's night to put the kids to bed early and cuddle up in bed with People . (And, oh, when my People doesn't arrive in Friday's mail, there is hell to pay!)

This schedule does not take into account the postpartum work I'm doing for the next three weeks. Postpartum work involves going to someone's house and helping them adjust to life with a new baby. My twist is that I cook and bring them food, including some freezer meals.

I love cooking. (Phrase #2241515 I thought I'd never say, along with #131241, Please stop licking the dog and #42546 Stop trying to pee on your brother in the shower.) Specifically I love casserole-type meals. This is a real issue for my children, who do not want their food touching anything else, and want to scrape the cheese off the lasagna noodles -- or, alternately, want to scrape the noodles out of the meat/cheese sauce. But I love the idea that with a casserole you can get the perfect bite that includes protein, vegetables, starch, and carbs. Chicken pot pie. Spinach and beef lasagna. Enchiladas.

Sorry, kids, Cheerios with cut-up banana on top does not count. This does not count either, in case you were wondering. Because putting anything with Cheerios -- other than whole milk -- is sacrilege.

So, I'm at a new mom's house, cooking and cleaning -- I actually washed a few dishes by hand recently; like, hello, why have a dishwasher if you're not going to use it?!?!? -- and doing laundry and snuggling new babies. It's fun, but I wish I were home, sticking everything in my dishwasher and ignoring my own piles of laundry and snuggling my own children for the ten seconds they'll still let me snuggle.

Since my break from apprenticing, I've let go of a bit of the whole SuperMom thing. For a while, I felt like because I was doing so much, I should be SuperWife and SuperMom. Kept house immaculate. Cooked homemade every night. Even stayed on top of laundry and linens. Then, for a week or two, I was totally off the wagon and barely looked at the washing machine or fridge. Now I'm finding a balance.

I seem to have a lot invested in what others think of me. I was really worried that my decision to take a break from apprenticing would come at the expense of my reputation in the birth world. Turns out (1) nobody really cares -- and I mean that in a good way (2) everyone seems understanding (3) nobody ever figured out how or why I did it in the first place. It's not like I needed more things to do. Even without doing postpartum work, my life is full.

In which I have a new camera and a hope for a new teacher.

2010-02-17T23:57:00.003-05:00

I love my Maizer, but life with her has been nothing if not dramatic since I got her, on my 30th birthday last year.

First she got "strangles" which I put in quotes because there's some discrepancy over whether or not it was actually strangles, a very serious condition. Next came demodectic mange which a few of her brothers and sisters also got. There was also the incidence of the Evil Vet Who Doesn't Believe Dogs Should Be Raised With Children Or At Least Not My Particular Children -- but still wanted me to continue at the vet practice. Thank you, but no. I'll go to a vet that doesn't accuse me of benign neglect when I bring in my puppy for hundreds of dollars worth of care. I switched to another vet who was comfortable with raw-feeding -- which I had done with Deuce and Tex for years -- but that didn't last very long because I inadvertently got involved with some drama at the local kennel club over Maizey being skeleton-esque, and ended up seeing a vet an hour away who does performance with her dog (agility) and pronounced Maizey perfect and un-skeletal.

(Picture taken with my new camera! Thank you, Dustin! It was my Valentine's Day Gift.)

But now, I'm concerned about her obedience class. After I got her, I took her to Puppy School at PetSmart, which was mostly just a chance for her to be around other dogs. Then I took her to Puppy K at my local kennel club, and I had an awesome teacher. Her name is Tina and she was so enthusiastic about teaching, and so helpful. You know the type -- the teacher who loves what she's doing and inspires you to learn. She was very down-to-earth and personable, she always gave the students a chance to ask questions and discuss specific concerns, she had a great sense of humor. She was awesome -- okay she still is awesome, but she's not my teacher since Maizey graduated from Puppy K to Dog Beginner, in January.

And right away, I realized that my new teacher was Debby Downer and would not inspire much -- except a thorough evaluation of the class and her as a teacher, which I've been composing in my head since about week two, because I want to make sure it's free of vitriol and full of suggestions.

Dear Class Evaluator,

I have taken both Puppy Beginner and Pet Beginner at this club. I noticed several areas of concern. First, the discrepancy between what is taught in Puppy Beginner and what is expected in Pet Beginner is enormous. I feel both classes would benefit from some curriculum coordination. I felt at a huge disadvantage when I began Pet Beginner, after just finishing Puppy Beginner. Further, I believe Pet Beginner is too stringent, and much closer to an Advance Beginner class. Not all who take the class plan to do performance with their dog, and I feel it is geared toward that instead of the average dog owner who simply wants a better-behaved dog.

The instructor could use improvement in her teaching skills. Although her knowledge and experience with dogs is impressive, she seems ill-at-ease with their human companions.

Specifically, she does not answer questions until after class. She seems to believe that whatever issues one person is experiencing with his or her dog is not indicative of the rest of the class -- despite the fact that everyone in the class has dogs approximately one year old and came from the same Puppy K class. She does not offer real-world suggestions for dealing with dog behavior, except to say what she would NOT do.

She singles out the "best" two or three students in the class to use as examples, leaving everyone else ignored. She demands all attention on her for the entire class, getting angry if the students exchange pleasantries with each other. Again, this is a class full of adults who have been together weekly for four months. She does not inspire positive feelings about dog training or attending her class. She insists that everyone tell her we've practiced, even if we haven't, rather than address why those who aren't practicing are having problems finding the time. She again showed favoritism by announcing what students would pass CGC/TDI testing and who wouldn't, which was somewhat embarrassing for those whose dogs wouldn't pass.

She suggested that my dog would not pass CGC/TDI testing, and that I should repeat Pet Beginner. Although I take responsibility for my dog, I will not be repeating the class with her as an instructor.

Sincerely,

Definitely NOT One of the Best Three Students

In which I quote a midwife I know

2010-02-04T01:13:00.000-05:00

Lots of midwives follow Navelgazing Midwife's blog, which has a lot of information on it, and is extremely well-written. She has been a midwife for many years, and a writer for longer. I knew her when I lived on the Left Coast, and she has quite a presence in San Diego.

As you all know, recently I quit (although I hate calling it quitting; I'm not a quitter) apprenticing. I feel really good about the decision. Yes, I regret that I may not become a midwife until I'm 40 -- or older! -- but I'd rather spend the next ten years with my family, preparing for when I enter another apprenticeship or school, than drive us further apart by continuing.

My guilt mostly comes in that I chose to apprentice without really thinking about the details of how and when and WHY I was choosing to do it. It was a few months before I realized, Damn, I'm spending most of my time doing prenatals, and very little time on births. Also, when I did births, I realized, Damn, midwives have a LOT of responsibility.

Can you overestimate the responsibility in being a pregnant woman's care provider? Midwives value autonomy, and they have it, but the other side of that is a huge amount of responsibility.

At this point I could also veer into midwife's responsibilities versus client's responsibilities, and walking that line, but instead I'll delve further into the apprentice thing.

Many women want to do what I did; they want to become a midwife. They want to go to midwifery school and apprentice. Leigh will have no trouble finding another apprentice, if she wants one. However, most people don't get the reality of what midwives do -- and what apprentices do -- and so I want to copy this post from Navelgazing midwife because I think she really gets it. All credit goes to her. I just want to spread this message because I think if I'd really really REALLY thought about it before I started with Leigh, I might not have started and might have saved some stress on myself and my family.

Sweet women come to me, starry-eyed and their heads tilted sideways, looking at me with respect and (sometimes) awe. It's an honor to help women on their paths towards birthwork, but it is also a responsibility. I've listened to midwives wax poetic about being a midwife, pulling the potential apprentice along, muchly because the midwife needs some free help with her work. I think this is unfair and, as happens too often, the women end up leaving the "apprenticeship" once the realities of birthwork tarnish the dream. While I might be seen as a wet blanket with these dreamy women who come asking questions, I know it does no one any good if they begin and quit, one "apprentice" after another; it's just easier to get the whole picture out in the open from the get go.

"I want to hold babies" is a common refrain from the women who sit across from me. I smile and say, "Listen, we only hold babies from here (the vagina/vulva) to here (the abdomen)." Taken aback, I'm assuming they just hadn't thought of that since their faces goes blank. I then begin listing the things a midwife does hold: sweaty hair, the barf bowl as the woman throws up in it, the laboring woman as she dangles and the mother's hand as she squeezes it white and bloodless. We hold placentas as we demonstrate their amazing beauty. We hold scrub brushes as we wash blood off our instruments. We hold needle holders as we suture vulvas. It's important to me to make sure the woman knows the unglamorous parts of the "calling"/"job", just as much as she knows about the good parts.

She needs to know - the most important thing we hold is two lives in our hands.

If, after telling her all those realities, she is still drooling and her eyes light up more with every description, then it is obvious the woman is pretty darned birth-obsessed and a good candidate for apprenticeship.

But there's more. I let Donna (my apprentice) tell these parts of the apprentice story. She speaks about missing birthdays, telling them how many she missed in the first year along. She tells them about missing her kids' school awards... how we've had births on Thanksgiving, Christmas Eve (which requires us to make a home visit on Christmas Day) and wedding anniversaries. How we are called at all stages of the pregnancy, sitting with a woman with a UTI in the hospital at 30 weeks, going to a woman having a miscarriage at 13 weeks or driving 60 miles for a look-see if the woman's membranes have ruptured (nope!). She tells the woman how she can be gone sometimes for 3 days at a time, pumping her breasts so she can keep nursing her one-year old.

We both share the reality of putting 60,000 miles on your car a year, not having an income, paying for gas and child care, food outside the house, buying birth clothes or shoes, all kinds of incedentals that are easy to forget about.

As I said, this might sound all dramatic and tragic, but really, really, women need to know the realities of being a midwife's apprentice. And none of this includes the prenatals, the office work, the making of charts, the answering of emails, calling women back with lab results and all the other nuances in the life of a woman wanting to be a student midwife.

I imagine women's spirits sagging by this point, those sitting in front of me and those reading this, but there are AMAZING parts of being a midwife, too. But if you don't want... no, CRAVE... all that I said above, then reconsideration of this career is called for.

Being at a birth is glorious, but it is a blip in the life of a client's pregnancy. We become part of the family's life, we become part of the birth story forever, even if they can't remember our names 30 years later. We are invited in to see the wondrous joy a new baby can bring, but we also become counselors as the pregnancy brings out the warts and hoptoads lurking beneath the marriage's fascade or their relationship with the in-laws. As midwives (and students), we are privy to things most regular folks never hear from their neighbors, co-workers - and even closest friends. We become connections for women and their families to find food, help them see parts of themselves they'd hidden for decades and stand by them as their world is forever changed by the new soul coming to them.

Some clients become friends, but most slowly disappear over time, coming around again when the midwife holds an anniversary picnic or when they are again pregnant. It's important to keep a boundary between friend and care provider because care providers sometimes have to make serious decisions a friend would never even think of. It doesn't mean you can't empathize with your client... heck, if I don't cry with a client at least once during the pregnancy it's because she's changed care providers! Women become their own type of midwives, creating their style as they walk through their apprenticeship. A good mentor/preceptor doesn't want a clone, but fosters her apprentice's individuality. While I am a motherly type of midwife, other clients want a more business-like provider; there is a midwife for every type of client (in some areas like here in San Diego). Midwives are responsible for being perceptive as to how close or far her clients want to be. It can be a fine line and is crossed sometimes, but realizing it and correcting it quickly brings the relationship back into balance.

It's pretty clear, without even saying it, that a midwife musthave worked through a great deal of her own issues... fear, abuse history, pregnancy, family dynamics, child-rearing and more. It's crucial not to bring one's own issues into the prenatal, laboring, birthing and postpartum periods. We talk about that with new doulas, to see each birth as an individual experience, not thinking, "Oh! My last lady had pitocin and a cesarean, so this woman will, too." But allowing the birth the unfold in its own way. Sure, there are themes and generalizations, but when WITH a woman, BE with her, see her as herself and see her birth as her own. With midwifery, this admonition is even more important because there can be a tendency to think her clients' births will be/should be just like her own midwifery birth. Midwives, too, must allow the woman to have her own walk, even if that walk includes a cesarean. We have to BE with her, not drag her along, but to stand by her side (or even a tiny step behind) as she feels her way through her birth experience.

Birthing women are extremely vulnerable. They (often) take advice literally. They(often) are easily swayed. I am not saying that they don't have a mind of their own or that they can't feel very strongly about certain things, but I have seen women bend to the will of her midwife simply because the midwife is The Expert. Midwives canNOT exploit this. Can NOT. When offering options and giving informed consent, it is imperative to keep one's feelings about the coming choice out of the equation. It doesn't mean you can't share how you feel about a test or a procedure, but not being married to the outcome is vital. I really can't stress enough how important it is to not exploit a client's vulnerability. I believe it takes a great deal of self-discipline not to. Midwives, please don't. Please.

This has gone on longer than I expected, but I felt led this morning to write this out. These are thoughts that come out in small spurts when I speak about what being a midwife is about. Of course, midwifery is different for every woman; these are MY experiences and they seem pretty universal, but others certainly have their own story to tell. I am honored... that word seems so small... so honored to be called to be a midwife. I hold the honor close to my heart and work so hard to do the blessing justice. I always have room to grow (who doesn't?!) and I welcome the ways my midwifery practice will continue to change, evolve, as I learn more and more with every client (and inbetween).

I hope this resonates with some of you. I write this for those birth addicts who know in their very soul they are destined to be midwives. I'm waiting to bring you into the fold.

In which I manage to miss two births in a day

2010-02-01T16:51:00.000-05:00

... and am now embracing my new role as a postpartum doula.

Yes, you read that right. TWO births in ONE day. Quel Loser!

Here's how it went down: I was watching Food, Inc with my mom and Leigh, while our children were upstairs watching Lion King.

(By the way, if you haven't seen Food, Inc, I'd highly suggest it. What a movie! I will never look at food the same way. Specifically, I will never look at processed beef the same way. The way that ground beef ends up wrapped in plastic and at your local supermarket is really astounding. Also, what's put into the meat to keep it from getting contaminated with E. Coli will shock you -- AMMONIA. Yeah, the stuff to wash glass. That's in 70% of hamburgers, as of 2008. Forget never eating conventional meat again -- I'm not sure I can ever eat a hamburger in a restaurant again.)

So during the movie I got a call from one client -- and then a call from another. One was pretty close to her due date, but the other was pretty far. One client's water had broken but she wasn't having contractions; the other was having contractions but her water hadn't broken.

And also, a "winter storm" was brewing in Charlotte, which makes everyone here go insane. Granted, I'm from the Midwest, where I can only remember school closing due to a windchill of -40, but the infrastructure here is not prepared for more than a few flurries; scare-mongering runs rampant and people generally lose their minds.

Maybe it was the change in barometric pressure that caused them to go into labor, I don't know. But something happened. Both went to the hospital somewhat earlier than they'd planned because of the weather; both said they would call and update me when they got there and we'd make a plan for when I would go to the hospital for them. (Incidentally, neither knew the other was in labor. I'm not sure they even knew I had other clients. I was just so surprised that they were both in labor -- to contrast, in December I had clients due for four straight days and nobody had babies near each other!)

One called at 5am and said she was 5cm dilated. I started to get up to get ready to go in. Her husband called back 20 minutes later to say the baby was here!

The next one called several hours later and was getting augmented. At this point I have to say that I made a huge error in judgment. I did not immediately go to her. I could blame the awful weather, because I'm not sure that even if I'd left right away I would have made it. But really, it was my own stereotypes and judgments and my own comfort that kept me from rushing off to her. I thought I had plenty of time.

Dustin says it was incredibly unprofessional and I'm burned out. Leigh says I was in midwife mode and burned out. Either way, by the time the client called and said Yes, I really need you now, the baby was born an hour later and I wasn't there.

The first baby, I probably could not have made it. But the second, I definitely should have been there. There wasn't an excuse.

Note: I do have in my contract that I don't refund for a precipitous labor and birth which I miss.

I apologized to the first client, and told her that since I missed her second meeting -- because she had this baby so long before due date -- and her birth, I'd like to provide her with 12 hours of postpartum support. She said she would appreciate that.

I apologized to the second client, and told her that I would refund her half my fee since missing her birth was completely my fault -- and preventable. Alternatively, I told her, I'd provide her with 15 hours of postpartum support. She could choose, and either option was fine with me. She chose the postpartum support, which I'm starting on Tuesday.

I'm looking forward to being a postpartum doula. We all know I love to cook. I'm bringing food on Tuesday, Garlic Cheese Chicken Rollups to eat for dinner that night (along with herb rice and vegetables), and Chuck's Macaroni and Cheese with beef hotdogs and peas to freeze. And yes, I am probably burned out on labor and birth for a while. But I'm thrilled to go to a family's home and help them acclimate to being a new family. I'm excited to hold a newborn and give breastfeeding support.

I'm glad that my next doula client isn't until late April and she's a homebirth.

In which I am no longer an apprentice midwife

2010-01-27T22:31:00.001-05:00

Say WHAT?!?!?!?!?

It's true. I am an apprentice midwife no longer.

But WHY?!?!?!?

Because my life isn't working well right now, and something has to give.

Mainly, I don't have the resources -- the time, the energy, or the money -- to balance my family responsibilities with birthwork. I miss my family and my dog when I'm at a birth, I miss them when I'm doing prenatal appointments, I miss them when I'm home but I'm an absentee wife/mother/owner because I'm birth-hungover. (In theory, I would also miss them when I'm off studying, but I haven't been doing much of that for the last few months, sadly.)

We won't even talk about my personal (not family-related) interests, except to say that a few months ago, when Leigh suggested we start watching The Office from the beginning, I nearly cried at the thought. Because as much as I wanted to see it, I knew that would take even MORE time away from my family and my dog and my schooling, and I would prefer not to even watch it than to add more on to my already-full plate.

Seriously, the idea of watching The Office stressed me out. That was probably my sign.

(I did end up watching it, and I love it!)

But I have this bad habit of being hard on myself, and I couldn't see that I was doing too much. Honestly, it didn't seem like that much to me. I have another bad habit of comparing myself to others; there are tons of apprentices and midwives out there with more kids and more responsibilities than me, so why couldn't I do it? But now I look back and think, A husband and four kids. Three dogs (when I started my apprenticeship). Homeschooling. Not to mention the other things I started doing along the way: cooking, becoming a child passenger safety tech, dog training.

It was actually the Child Passenger Safety Technician thing that got me on this path. I took the class, I got my certification -- but then I found that I just didn't like it. I enjoy knowing about car seats, I enjoy putting thought into what my kids are riding in, but I have no interest in attending community events and installing seats.

It took me several months to get to that point, though. I got my CPST certification in September -- and spent the week after my class in the hospital with dehydration! -- and I just recently came to this conclusion.

It was a really radical thought, though, that I could stop being a CPST because it felt disingenuous. However, it was also totally not-radical because the world kept on spinning when I made my decision. That was when I started thinking that maybe I could stop apprenticing and I'd survive that too.

Also a contributing factor: the events that led to giving our dog Deuce back to Dustin's grandparents, and giving our dog Tex to my parents. I did not like having three dogs. I admit that. I didn't really want three dogs. But I thought that because I had at one time or another chosen to have all these dogs, I should keep them all forever, no matter what my feelings were. I felt utterly terrible when Deuce went to San Diego, and Tex to Florida. But now I don't. They're happy -- no kids! long walks on the beach! warm weather! -- and I'm happy with just having Maizey. I love her tremendously.

So, I've just discovered that you can realize you've made a mistake and cut your losses, rather than suffer with unhappiness because you feel you "should."

I've also discovered the value in taking time to make a decision. The value in contemplation and thoughtfulness rather than blindly going after whatever you want at that particular second, like a certain two-year-old I know.

Midwifery is supposedly a calling that won't be denied. But I can tell you that missing your family, not having any money (and the stress that causes in relationships), and sleeplessness can really dull those feelings. Right now I am nearly at the point where I resent pregnant women. !!!!

Of course, some of this has nothing to do with my apprenticeship; being a doula at hospital births burns me out. Being a doula felt like a Catch-22: I took lots of clients because I needed the money, because I was spending so much on my apprenticeship and school. But -- duh! -- if I'm not spending as much money on apprenticing, I can turn clients down if I see red flags during the interview. (Which, for the record, I've seen and ignored, only to kick myself later because I should have listened.)

Also, this practically goes without saying, but I'll say it anyway: none of this has to do with Leigh. I love my Lii. She's a wonderful friend who has always been there for me. Telling her that I wanted to stop apprenticing was incredibly difficult, even though I knew that as a friend she'd understand. I told her, truthfully, I'd turn down an apprenticeship with Ina May Gaskin right now. I can't do this right now. I don't want to do this right now.

She gave me a really beautiful compliment, probably without realizing it was a compliment: she said that my life is really full without midwifery.

It is. My life is really full. I love my husband and kids, I love homeschooling, I love cooking, I hate cleaning, I love my dog, I love training her. I can fill up 24 hours a day without even thinking about birth. Thank you for saying that Leigh.

I'm going to continue this blog because one of the other things I love to do is WRITE! But I'm changing the name. If anyone has any suggestions about a new name, let me know!

In which I have so much to say, but not much time to do it

2010-01-16T22:35:00.003-05:00

I'm realllllllllllllllllly tired due to all the births I've attended recently -- six in the last three weeks, but who's counting? I have several birth-related blogs half-written in Word that I want to share, but first I want to give a Maizey update.

Last Sunday she woke up and refused to leave her crate. When she finally came out, she started running into walls and furniture. Her pupils were dilated. I immediate took her to an emergency vet an hour away where she was diagnosed with acute blindness. I was shocked, although it was obvious that she couldn't see. The vet prescribed prednisone, a steroid that would hopefully reduce the swelling that was the underlying assumption for causing the blindness.

She responded beautifully to the steroids and regained her sight. I was so happy.

I took her to an ophthalmologist vet on Friday, who gave somewhat disappointing news: she has/had optic neuritis, which causes blindness. It is treated with steroids; unfortunately it tends to be recurring. The vet gave me a 75% chance it will come back. Each time it comes back, it is harder to treat. Eventually, he believes, she will be permanently blind.

I am somewhat devastated by this diagnosis. She's only 10 months. The vet thinks she will have about five years of sight before blindness.

However, I am grateful that she will have five years -- or will possibly be the 25% that doesn't have a recurrence! -- and the blindness is not life-threatening or painful. She will adapt -- probably faster and easier than I will! It sucks, but I'm still glad that I know a little more about it and how to deal with it if or when it recurs.

Jeannie, a local Cardi-person and dog trainer, is willing to work with me privately to ensure that she is well-trained and well-behaved before she loses her sight. And even if she keeps her sight, I want her well-trained and well-behaved! We're going to meet once a week. I'm also still in Beginner Obedience with her, and plan to start Rally in March. I joined a Yahoo group for owners of Blind Dogs, and someone sent this to me. I think it's wonderful:

How to work with a newly blind dog!! 
Jester, our 13 year old frisky boarder collie mix went blind in three days.  He has diabetes and at this point, he is not a candidate for surgery.  We had two other border collies, Maggie, 14, was blind in one eye since birth (didn’t know it till we did a check up) and  Cosmo, who died at 16 and was going blind for  awhile.

Anyway, when Jester went suddenly
blind, his eyes literally changed in front of us, we were blindsided, so to
speak.  We were trying to learn as quickly as we could how to deal with our “new Jester”.  I am not sure what Jester thinks is going on, if he thinks the world is just dark or if it’s him.  It doesn’t matter, really, it is what it is to him, and I help him make it work.
It may seem daunting at first, but the “rules” are simple, and pretty soon having a blind dog will be second nature.  Jester did sleep a lot a first, but I knew that wasn’t good, so we just went for it, fumbled along and he is now my protector.
First bit of advice, and is almost the most important, is to have a great attitude.  When we told people he was blind, and they sounded sad talking to him, his tail went down like he was a bad boy.  But if we and others said, “wow, he’s doing great”, his tail was up, and his body language changed.  It is really important that you are positive, and that your dog doesn’t think you feel sorry for him. 
I realized working with Jester was like working with my daughters when they were young.  If they fell, I just helped them back up and moved on.  If they got confused, I let them get a little confused and work their way through the problem.  You must let your dog be a dog, and let them find their way in their new darkened world.
 Don’t carry them up the stairs. 
Don’t put food under their noses.  Don’t lift them onto sofa or into car.  Let them feel their way.  Sure, they will get frustrated, but most dogs won’t give up.  They want to do it.  Jester bumped his nose many times trying to get into the car.  He slid down the stairs.  It was okay.  Pat the sofa and maybe guide them up, or help them half way.
Here are some simple tips and advice to get going.  The sooner you get back to “normal” the happier your dog will be and the more progress you will make.  Jester goes on leashed walks, unleashed walks and to off-leash dog parks.  We go to several places, but try and walk the same routes once there.
Tips:
Use very simple language.  Pick
one word, ie TREE, to warn dog if they are going to bump into something.  They actually need to bump into something for the word/warning to mean anything.  It needs to be one word, no matter the obstacle.  We use TREE, so I say TREE TREE TREE, and he knows to slow down and veer left or right.  When we were walking I had to let him walk into a bush or door slowly so I could give the warning.  It didn’t take long before Jester knew that when I said TREE he needed to slow down and veer to the side. If he still bumped into the object, I just said, oppsy, and moved on.  They will still bump into things, but by giving warning, they will slow down and little damage will be done.  
We also have lots of stairs in our home.  I put treats on the stairs and as Jester found the treats and tried to go up, I said STAIRS STAIRS STAIRS. Just the one word.  And that was for up or down.  I would sit on the stairs and coax him down with treats, saying stairs the whole time.  Pretty soon, at home he was going up and down no problem.  In the park, I just give him a warning, STAIRS when we get close and he lifts his little paw higher and finds the steps. 
Dogs have great physical memories and can do a lot more than we give them credit for.  Jester remembers the different textures of the ground and adjusts. He can sense if it’s a hill- up or down- he senses the change from sidewalk to street to gravel to dirt to grass.
Keep your home simple.  Remind people not to leave backpacks on the floor, items on the stairs, etc.  Keep water bowl in same place.  When feeding dog, put bowl on floor and call dog to dinner.  Tap the bowl or keep picking it up and putting it down.  Tell your dog dinner and encourage them to go to the bowl.  It gives them a sense of independence and pride.
In the house, chat to your dog, say hello, ask how they are, let them know when you are leaving room and when you are coming back.  You should do this a lot initially so your dog will connect the sounds to your movements. 
I use Jester’s name, but also say Dude to him.  If I say jester, he may feel he needs to come and respond, and if he is laying in the sun, or doing his “biznezz”, I don’t want to disturb or disrupt him.  By saying Dude, I am right here, he knows I am there but doesn’t have to come over right away.  This is important on off-leash walks, if Jester has gone to explore and  I sense he needs to know I am still there.  When we first started taking walks, I carried a radio so he would know where I was.  I would also just chatter away to myself, so he could hear my voice.  Now, I don’t have to so much as he follows me, and his other senses are more tuned in.
We had a dog that would sneak up on Jester, and when he went blind, it was an unfair fight.  So Maggie got a bell put on her collar.  And that bell was really helpful for walks.  If you don’t want to deal with a radio or chatter, carry a bell with you and jingle it. 
When we encounter a lot of dogs at the dog park or on the sidewalk, I say Puppies!!! Puppies!!! to give Jester some warning.  He does fine, he likes to smell other dogs and get smelled.   Sometimes, if a dog suddenly starts barking and then other dogs join in, Jester is unsure if it’s a fight or just playing, so I let him know it okay.  
Most people can’t tell he is blind until they look at his eyes or he walks into them.  I tell people he can’t see anything but that he loves getting petted, and to go ahead.  If I stop to talk to people, I remember to “include” Jester, so he knows I remember he is there.  Sometimes people will put there had out for him to sniff before they pet him, I let them know its okay and he loves the attention, so massage away.
 When its treat time, I toss dry little
treats on the kitchen floor and Jester smells his way around and finds the treats.  I don’t hand feed him.  He works to find the treats and feels good about it when he find them.
The best piece of advice I can give you is to be positive.  Don’t sound sad.  Imagine if you went blind and everyone sounded like you should be put down, or sounded like they wanted to cry or didn’t think you could do anything anymore. 
Jester always barked when the postman came by, I thank him now for letting me know the mail is there.  He loves car rides like he did before.  Sometimes, I can see a bit of frustration when he wants to sniff another dog and that dog moved away and Jester is trying to follow him by scent.  That frustration quickly passes. He loves to take walks, smell, say hello and still be Jester.  
We have a back yard with a doggy door.  Initially, he was unsure going through in once he couldn’t see, but after some coaxing, he uses it just fine.  I also made a point of taking him out at night down the sidewalk to pee.  It gave him a sense of adventure and a chance to relearn the neighborhood.  We go for walks three times a day, and he gets so excited.  He finds his way to the car, by following me, he feels his way along the car or listens to me open the door and finds his way in.  I pat the seat.  At first, he wouldn’t get in, but after a few attempts, he knows that it’s a safe place to op into and if he falls behind the seat, he can just feel his away to sit on the seat.
At the park, we walk the same routes and he recognizes the ground.  If we are on the path, he knows when he is going off the path to smell something, and then finds his way back.  I am talking to him or one of our other dogs, or just saying, “Right here Dude” “Hey, good job” just making that verbal connection.  I don’t use his name unless I want him to come closer, because I learned when I said Jester, he stopped smelling around and came to me.  I needed him to know I was just letting him know I was close, but he could keep sniffing away.
At home, we have a few dog beds around the house.  He can easily find one to lay down in.  This morning, he walked around feeling for the sunny spot on the floor.  

You don’t need to have baby gates up everywhere, its better to teach your dog how to navigate your house.  They can and people need to let them.  By putting up barriers, you are telling the dog they are no longer welcome in much of your home and treating them like they did something wrong, they didn’t.  Spend time now with your dog and soon they will get around just fine.
 Be upbeat.  If they bang their
noses, go Caboomy or something silly and move on.  If you say TREE and they successfully dodge the obstacle, say GOOD JOB, so they know they dodged something.  Warn them about steps and stairs.  When stepping off or up a sidewalk, I say step.  That’s it.  If he slips, so what?  Your job is to pay attention to your surroundings, be upbeat, give warnings, give praise, let others know and remind them your dog is amazing.   They will bump into things, they will get nervous, they may snap at a dog who is too pushy, that’s okay.  Just pay attention, and let your dog still be a dog.  They can do this and we need to let them.  Don’t do for them, re-teach them how.  Its like working with a toddler.  Find the right balance of protecting them and letting them be who they are.  They need that.

In which Tour de Birth 2010 starts

2010-01-08T20:34:00.008-05:00

I wrote this blog about 10 days ago but then things got crazy with more births, and Maizey's optic neurtis, so I am just now getting around to posting it.

The new decade is but 8 days old and I've attended two births. Two awesome births, to be exact. (And after that I missed one with Leigh because the labor started just after I got home from the second birth, which had been a 24-hour marathon. Thanks for letting me recover, Leigh!)

Both moms had beautiful natural births in comfortable environments and I was honored to be a part of their experiences.

Being a labor support person in any role can be challenging, whether it's as a doula or an apprentice. I try to make sure that before my doula clients go into labor, they know that they can say anything to me; they don't have to sugarcoat it if they need me to STFU during labor.

But first time moms are the most difficult because they've never labored before; they don't know how they'll feel or what they will need during labor. If they're having an intense experience, they might not be able to put their needs into words. And of course, I don't want to interrupt their rhythm by asking a bunch of questions. So it's a challenge.

Many labor support professionals have certain things that they have found that work with most clients. Leigh once grabbed a laboring mom's feet and she loved it. After that, the mom would say, "Feet! Feet!" as a contraction was starting.

A few days later, I attended a birth and grabbed the mom's feet during a contraction and she shrieked, "Stop touching me!"

It takes all kinds.

I used to take a lot of "stuff" with me to births. I'd have a Birth Ball, a rice sock, a tennis ball, a small massager, some positive affirmations or a birth book or two. However, after reading Spiritual Midwifery by Ina May Gaskin, I decided that the most important thing I can do is express love for the mom. Yes, that sounds really cheesy, and no, I don't love every client. But I can express my love for what the mom is doing, my belief in her and her body, my compassion and empathy for her, and my encouragement. And that's all I usually need. If she wants other stuff, she can get it for herself.

That leads me to something that someone said to me recently, which was that a doula can do too much for the laboring mom. Honestly, I'd never thought about that. I always want to make a laboring mom as comfortable and happy as possible. But, once in a while I see a mom whose labor takes a long time because she's just not willing to get to that uncomfortable place. Labor can be very uncomfortable. It doesn't have to be painful, but there's usually some amount of discomfort involved, and if the mom isn't feeling any discomfort, she's probably far from giving birth.

Achieving a medication-free birth is a feat; it takes hard work, it takes perseverance, and it takes a lot of support. But in the end, only the mom can do it. I can't take it away from her -- and I don't want to. I love this blog which compares preparing for a medication-free birth the way one would prepare for a marathon. I have never run in a marathon and I don't plan on it. But if I did, I wouldn't want to be carried across the finish line, even if I were uncomfortable and in pain and wishing I'd never signed up for this stupid marathon in the first place. Anybody can be carried across the finish line. Not everybody can actually step across it.

In which I share Sydney's home birth story

2010-01-01T09:25:00.010-05:00

This is a very brief version that I wrote out for my local mommies group. It's just the labor and birth/info. At some point, I hope to write the longer version.

My water broke with my fourth baby on October 12. Just like with my previous labor, I slept through it and woke up in a pool of water. I called my midwife, who had traveled from Louisiana to attend my birth. We did not have any homebirth midwives in my small town in Arizona, and the closest midwives were over three hours away, in Phoenix or San Diego. I have a history of short labors – a blessing and a curse! – and I didn’t feel comfortable with a midwife who was that far away. My midwife had arrived when I was 39 weeks pregnant. She was staying in a nearby hotel with her two children. I had done my own prenatal care. I was now 41 weeks pregnant.

So, my water broke… and nothing happened. For two days. Over the course of those days I drank castor oil, tried an enema, used the breast pump, and took blue and black cohosh. Still I felt nothing, not even a twinge of contractions. I was practicing good hygiene, taking vitamin C, and listening to the baby’s heart tones by Doppler. And waiting. Finally, after a day and a half, I talked to my midwife about my options.

I wasn’t worried about my water being broken for so long. I was more worried that she’d want me to go to the hospital. I’ve given birth in a hospital with an epidural, to my twin boys in 2003. I’ve given birth in a birth center with a shot of stadol, to my girl in 2005. For this birth, I wanted to be home.

I called her, and told her I needed 12 more hours. If, after 12 more hours, I still hadn’t gone into labor, I’d go to the hospital; I’d get the dreaded pitocin (and probably an epidural and a series of other interventions).

As soon as I hung up, the contractions began. It was like my body needed me to verbalize that I trusted myself before labor would start. The contractions started coming quickly and without much of a break. I remember thinking, “This is absolute misery.”

I asked my husband to fill up the birth tub. I got in, and I said, “Wow, this is so nice,” – until I had another contraction. At some point my midwife arrived, and my best friend who was acting as my doula.

I wanted absolute silence and darkness. It was around 1AM, and my three older children were asleep. Everyone tiptoed around, and I shushed them. At one point the midwife tried to get heart tones, but I shooed her away. She said something about it, like, “I am not taking the baby’s heart tones, are you alright with that?” I nodded. The baby was moving like crazy, and I knew she was fine.

After that I felt the urge to push, but my brain was telling me it was too soon. I started to get out of the tub so my midwife could check me, but I just couldn’t leave that warm water. Instead, I reached down and could feel the baby’s head. I pushed a few times, grunting loudly, and felt her head come out. I remember saying, “Her head is out. Now what do I do?” I really could not remember what would happen next.

My midwife said, “Push the rest of her out.” So I did. I pushed her out and brought her to my chest. She had a nuchal cord, and seemed to be around 8lbs. She was perfect, and I was exhausted! Sydney was born on October 14, 2007 at 1:32AM. She was 8lbs 8oz.

In which I make some resolutions for 2010

2009-12-31T15:33:00.015-05:00

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.

HAPPY NEW YEAR TO MY FIVE READERS!

In which I write an open letter

2009-12-28T10:16:00.008-05:00

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

In which I briefly discuss a very non-brief birth

2009-12-23T19:35:00.005-05:00

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.

In which I discuss my other hobbies

2009-12-19T14:35:00.008-05:00

(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, allrecipes.com

World's Best Lasagna it was SICK. (And I mean that in the way that all the teenagers use it. Apparently "SICK" is the new little black dress. Not that teenagers wear anything but jeans and hoodies, but I digress.)
Garlic Cheese Roll-ups actually out beat my favorite processed chicken food in taste. That is saying a lot.
Chicken Enchiladas putting Taco Bell out of business, one cheese-filled bite at a time.
Bacon-wrapped hamburgers What could possibly taste better than a burger? A burger wrapped in BACON!
Amish Breakfast Casserole almost makes me want to bust out a floor-length peasant dress and never have my picture taken again.

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.

In which I meet Ina May

2009-12-17T07:06:00.005-05:00

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.

In which I get back to the grind!

2009-11-18T08:35:00.006-05:00

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 amazon.com 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!

In which I share a video of Maizey Rockstar

2009-10-23T23:04:00.001-04:00

In which the Carolina Community Maternity Center gets its license!

2009-10-21T22:31:00.006-04:00

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.

In which I finish a somewhat large assignment

2009-10-19T09:08:00.004-04:00

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.

In which I try not to hinder myself

2009-10-15T09:13:00.008-04:00

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.

In which I step away from the toilet

2009-10-11T00:28:00.004-04:00

...to 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!

In which I receive the book

2009-09-25T01:01:00.003-04:00

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.

In which I am forced into hiatus by illness

2009-09-20T08:02:00.004-04:00

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.

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

2009-08-29T16:21:00.007-04:00

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 oldnavy.com 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.

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

2009-08-22T20:13:00.006-04:00

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.

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

2009-08-21T09:25:00.005-04:00

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.

In which I attend a whole bunch of births

2009-08-20T09:11:00.010-04:00

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.

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

2009-08-13T20:27:00.004-04:00

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.

In which I write about everything else I do

2009-08-08T22:36:00.007-04:00

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 coolrunning.com 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.

In which my ideals conflict with reality

2009-08-03T18:42:00.007-04:00

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.

In which I desire to learn

2009-07-25T11:24:00.006-04:00

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.

In which I learn why midwives knit

2009-07-19T21:36:00.005-04:00

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!

HIPAA -- I salute you!

2009-07-18T18:21:00.002-04:00

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!

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

2009-07-11T22:33:00.009-04:00

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.

"Hey, aren't you a doula?"

2009-07-09T17:56:00.006-04:00

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?)

Suturing! Anne Frye! Chickens! Oh My!

2009-07-06T22:26:00.013-04:00

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.

Along with "a housekeeper" "a laundress" and "a mansion on the beach with private surfing lessons given by Laird Hamilton,"...

2009-06-25T10:51:00.006-04:00

Recently I've been fantasizing about all the midwifery items I'd purchase if I won the lottery. Most of what I want is books, as midwifery texts cost a freaking fortune. Most of them are in the $50-ish range, which isn't too awful, but some, like "Midwifery: Community Based Healthcare During the Childbearing Year," is $135. Myles Textbook for Midwives is over $70. I'm just thinking about the NARM primary reference list, although I know I'll come across many more books and texts that I want as I progress through AAMI. In my dreams I own most -- if not all -- of them, and have extra copies of books that I think are helpful for clients, like The Nursing Mother's Companion, The Baby Book, The No-Cry Sleep Solution, Attachment Parenting, etc.

Other than books I'd love the following:

1. A one-handed bp cuff. Oh, to me, that is the height of luxury. Whenever I take blood pressure, I feel like I have two left arms, I'm craning my neck around to read the sphyg, and all the cords are in the way. This one would be so nice.

2. A Littmann stethoscope. My friend Amy works in a hospital and I'm always asking her to steal me one; it seems like they're everywhere. You can hear so clearly with them. I don't even know why I bought my $20 sphyg/stethoscope set, since it's so quiet that I usually use Leigh's (slightly more expensive) set anyway.

3. A Leff fetoscope. It looks like just a regular fetoscope, but it's actually $300. They have really incredible sound quality, and actually block out other noises. They are supposed to actually rival a doppler, which would be fantastic for clients who want to limit u/s exposure. I'd like to try one before purchasing it, but if I really won the lottery, what's $300?

4. A birth stool. This one just looks so comfy and perfect for giving birth. Much better than a toilet.

5. An iPhone. You're thinking, this has nothing to do with midwifery, right? But you're totally wrong! Just check out these applications for it: iPregnancy, OB Patient Tracker, Due Date Calc, Bishops Score Calculator, and Weight Converter. Not to mention the GPS, huge amount of storage space for all my clients' info, and internet. I WILL HAVE ONE!

6. That tree in our backyard. Except $100s on it, instead of $1s (lame!) Although I'd take a few branches of $1s. Beggars can't be choosers, right?

7. While I'm in fantasy mode, a day with more than 24 hours in it (in which I still need only 8 hours of sleep -- or less!) Sometimes it seems like there's more to do than there is time to do it and still see my family. I am definitely starting to see the push-pull of the working mom. On one hand, sometimes I miss my family. On the other hand, I feel that what I'm doing is so important -- for me, and for the women I help, and even for society -- that I need to do it and I need to do it NOW. I cannot wait or put it off til my children are adults.

La Carpa Roja

2009-06-21T21:38:00.009-04:00

I went to a BOLD Red Tent on Saturday, which included a raffle with all the benefits going toward the Birth Center. It was a good time, full of positive energy and healing and woman-empowerment. I think I can say that without sounding all New Age-y. The purpose of a BOLD Red Tent is to have a place where women can come together and celebrate ourselves, through birth or just anything woman-related in general. It was a little different for me this year -- although still just as hot as it was last year, and I don't care what happens next year, I absolutely insist that our next BOLD Red Tent either take place in February, or at another location where we're not on the second floor facing directly west, on a 100-degree afternoon. It was different because last year I hardly knew anyone there, as I was still fairly new to Charlotte and hadn't gotten involved with the local doula group. I had Sydney with me at the time, and I shared an unhappy birth story, and most of the women after me shared sad/angry/traumatic birth stories. It was a very intense night. This year, I know all the doulas, I knew many of the women who were attending, and I didn't feel like going as deep as I did last year. Yes, I've had three births (for four children) and they were not all perfect; in some ways the hospital birth was the best one, which is pretty screwed up. I shared about my twins' birth, and basically talked about the support I had at that birth. My point was that being supported during birth is important, and I appreciated being in a place where I could say that and other women got it and didn't say, "But at least you had a healthy baby!" Ugh, I hate that. I've had four healthy babies, who are now healthy children, but their births did and do matter.

There was a group of girls from a local home for pregnant young women who are at-risk in some way or another. Most of them didn't seem too interested in being there, but one of them shared. I hope the ones who stayed at least got something out of it. I'm really grateful to spend most of my time among women who believe, like I do, that birth matters. At first I thought I was a total weirdo -- and when I lived in Yuma, AZ, I was one of the only two, along with my BFF, Angela -- but here in Charlotte there are enough women who care about birth that I can actually pick and choose to be around them most of the time. It is really liberating to live in a place where I can do that. I can embrace my passion for pregnancy, birth, and postpartum -- as well as babies, of course -- and I actually have people to hang out with!

Today Leigh and I went to our most recent client's house and did the PKU on newborn. The PKU is not a fun test, because it's a heel-prick that will make the baby cry, and then we have to get 5 drops of blood on the card, which involves squeezing blood out. Not fun at all. I thought the client might get upset because the baby was crying during the test, but it's an important test. It detects metabolic disorders. I was glad not to do it, but I'll probably be doing one sooner or later.

I finally figured out what I mean when I refer to myself as a moron when it comes to midwifery; I'm not a moron, but I expected my doula training and experience to help me with midwifery in some way, and... no. Not really. Not very much. The fact that I've seen births prior to entering midwifery training is probably the only advantage I bring to the table. So that's what I mean. I'm not a moron; but neither are my years of experience as a doula all that helpful. I would imagine that I'm pretty much where most women start off.

In which my puppy attends her first homebirth

2009-06-17T06:58:00.006-04:00

... not counting her own, of course!

Yes, Maizey attended a homebirth yesterday. I was so focused on finding a sitter for the kids that I didn't even think about Maizey. My older dogs can handle being crated all day -- once in a while -- but Maizey is just barely 12 weeks. Also, I thought the birth would go quickly, so I just dropped the kids at Emily's neighbor's house and drove to the birth. The kids were at Emily's neighbor's house because their usual sitter was at the hospital with her daughter, who was also in labor! Oh life, you are so ironic. Anyway, a few hours after I got there, while the mom was laboring with her husband and I was trying to teach Leigh how to play some card games, I realized that Maizey might be on her own for approximately 8 hours, which is way too long for a puppy. So Maizey came to the birth. She was very good. However, I learned that I need to put a spare key somewhere near my house so a neighbor can let her out. I'm sure not every client will be as cool and dog-loving as this one.

Also, I learned that (1) I'm not much help to Leigh yet, however (2) that's in my job description, so (3) we need to practice. Suffice it to say the birth didn't go as easily as the last one we attended, and the mom needed some assistance. Leigh and I had touched briefly on some procedures, but we hadn't practiced anything. So when push came to shove, I didn't know how to help.

I was whining to my friend/midwife for Sydney's birth, Charlotte, who told me that it's okay that I'm not much help yet; that I'm not going to be much help for a while, til I have more experience. I am somewhat of a help because I have two hands and I can take bp, pulse, temp, and find fetal heart tones. And I can write! (And I think my writing is beautiful! Leigh totally disagrees!) I can chart. Leigh and I are going to do some drills on procedures so that if she ever comes across a situation like this, I can actually help.

I really look forward to the birth center opening. I think I'm going to get more experience on a regular basis -- before this, Leigh and I hadn't attended a birth together since late March, I think? -- so things will be more cohesive in my mind. Right now it's new AND it's infrequent. Fabulous!

Feeling slightly less totally incompetent

2009-06-15T14:18:00.005-04:00

The title is my roundabout way of saying I actually feel slightly MORE competent lately. Which is a relief. I can't point out anything concrete, but I just feel like some clinical things are starting to click in my mind. Maybe it's that checking fundal height is finally getting a little easier -- for some reason, I have a really hard time finding the exact spot on the pubic bone to start measuring. I used to be off by up to five centimeters. Now I'm getting a little more accurate.

I have also long proclaimed that I know nothing about midwifery, but as I'm delving deeper into AAMI, I can say that though I may be an idiot currently, I'm going to be a freaking genius by the time I graduate from AAMI. The coursework is all copyrighted so I can't say much, but suffice it to mention that the sheer volume of readingis enormous. And that's not to mention notes, papers, reviews, commentaries, and critiques.

For those (my three readers!) who are considering midwifery school, I recommend AAMI. Just looking at the small bit of curriculum I have now, I'm going to get a very thorough education. It takes a while to get used to AAMI-isms, but once you start drinking the Kool-Aid, it makes more sense. Plus the other students are very supportive and will share how they are balancing everything -- life, apprenticeship, education. The most difficult part is probably the money, which unfortunately is not something we have a lot of. Just this last week my oldest dog, Deuce, had an emergency vet appointment and treatment (she's fine now), and Dustin accidentally broke one side of the double-paned window next to our front door. Babysitting costs is what really kills me, although I appreciate the situation I have: a woman and her 5 daughters babysit the kids. The daughters were all homeschooled and are all (except one) married with kids and live close by. So I almost always have coverage, and I don't have to drive far, and next year when we're homeschooling, they will understand that and not think it's weird that 6yos are home during the day. It has really worked out nicely. The daughters are all into natural birth, so hopefully one of them will use the birth center in the future!

Last night I went to a Mother's Blessing ceremony for my friend and fellow doula and midwifery student, Brooke. This is her third pregnancy in four years; she is ridiculously fertile and has very fast labors. I didn't know her before her last Mother's Blessing, but apparently everyone gave her candles which she never even had time to light during the labor. It was less than two hours. We all joked that if she doesn't get a chance to use the candles with this labor, she can save it for the next one. HA. Soon she will be tandem nursing three children. Go Brooke!

The Ethics of Formula Companies

2009-06-03T23:59:00.005-04:00

In 1981, the

United States

became the only country to vote against the World Health Organization’s International Code of Marketing Breastmilk Substitutes. Although the United States eventually supported the Code, little has been done in nearly thirty years to enforce it and the

United States

lags behind many countries who call for more strict regulations on the sale and promotion of formula.

Formula companies market relentlessly without concern for health ramifications, as each pregnant and postpartum woman is a possible consumer who will bring in revenue. Once a mother’s breastmilk dries up, she is dependant upon that substance to nourish her baby for up to a year or longer. Although the Innocenti Declaration of 1990 encouraged all countries to maintain the Code by 1995, in practice, the Code is rarely enforced.

The Code’s main provisions include no free samples to mothers, no advertising, and no gifts or personal samples to health care workers. With regards to the last rule, formula companies circumvent it by donating samples to health care organizations – such as hospitals or medical offices – rather than specifically targeting health care workers. These gifts are not just the formula itself but also helpful parenting tips (including the “breast is best” adage), diaper coupons, and, more often than not, a free diaper bag. These tactics are particularly manipulative with regards to lower income families – especially non-Hispanic black women, who have the lowest breastfeeding rates in the United States – as the free gifts are an important aspect of their birth experience. However, the increased financial cost of uninsured mothers receiving formula from WIC burdens all taxpayers. The gifts may be free, but the long-term ramifications are costly.

Forced not to advertise directly, formula companies came up with a brilliant trick: “follow-up” formula for babies who have been weaned. As follow-up formula targets mothers of babies who have been weaned, its promoters claim freedom from following the Code’s guidelines. Unsurprisingly, manufacturers advertise this formula for babies as young as three months. This type of formula – which has the same name as the infant formula, making it nearly indistinguishable from the infant version – is marketed with pictures of cherubic, smiling babies drinking formula from bottles.

The next marketing ploy used by formula companies is promoting breastfeeding. Since formula companies cannot state that formula is superior to breastmilk, they must concede that breastmilk is best and advertise as such. However, these pamphlets, books, and videos often contain advertisements for the formula company. In addition, many depict breastfeeding mothers as exhausted, nursing in a dark room by themselves. This is a marked contrast to the smiling woman bottle-feeding her chubby baby, surrounded by family and friends.

When trying to market formula that is nearly as good as breastmilk, formula companies have again damaged babies and mothers. Specifically, formula companies have added laboratory-produced oils that contain DHA and ARA in order to compete with breastmilk, which naturally contains both fatty acids. However, the DHA and ARA found in formula are extracted from fermented algae and fungus, via hexane, a solvent known for being neurotoxic. Formulas marketed to contain DHA and ARA only contain 40-50% of each fatty acid, with the rest made of components not found in human breastmilk – resulting in diarrhea in babies who consume this formula.

The most conclusive evidence that formula companies place profit above health comes from the Philippines, where three large United States-based companies – Wyeth, Abbott, and Mead Johnson – attempted to block the introduction of formula marketing regulations similar to the WHO code. In fact, the three companies sued the Philippine Government in order to prevent ethical marketing guidelines for formula. The WHO estimates that 16,000 babies die in the Philippines each year because they are not adequately breastfed, and that 90% of babies under six months who die are bottle-fed and fed foods other than breastmilk.

Time flies when you're waiting on a baby

2009-06-01T22:22:00.008-04:00

I haven't posted since May 8, which was a client's due date. Today is June 1. I had a ton of stuff going on between then and now, much of which I tried to put off until after the client had her baby. For example, I planned to attend a homeschooling conference but didn't want to make formal plans to go until after my client had her baby. Same with contacting another client who is due in August. Same with planning a party for my birthday, which was May 23.

My client went to 42 weeks 4 days.

What I have learned from this experience is that I need to calm down and not avoid living my life because I'm on-call. They all have babies. I have babysitters set up. Everything works out just fine. (I have never missed a birth except for the sand-road situation with Leigh, which was not my fault.) But not sleeping and stressing out because I'm waiting is not good for me. Or my family. Or my friends, or Leigh, to whom I whined about my dilemma.

However, I did not skip my birthday trip to NY state, where I got a new puppy! Yes, my first puppy. Her name is Maizey and she is a Cardigan Welsh Corgi, with many many champions in her immediate family (in fact, nearly everyone for three generations back). I have always had older dogs from the Humane Society, so I was a little nervous about getting a puppy, but she's doing very well. Along with my AAMI books and literature, I'm reading Dr. Ian Dunbar's book "Before and After You Get a Puppy," and "The Art of Raising a Puppy," by the Monks of New Skete. I'm following all the rules, and in return, she's having very few accidents (none today!) and chewing only appropriate chewtoys, and sleeping in her crate when I can't keep my eye on her and at night. I plan to show her and try to finish her. The breeder, Kate Roberson of Hagaren Cardigans, was very kind and generous, and if I am able to title Maizey, and if she is breedable, I'd like Kate to breed her. If she wants to, of course.

(Aside: my birthday trip was when I was technically off-call, as I'm on-call til 42 weeks, and my birthday was at 42 weeks 1 day. I did set up a back-up doula, just in case.)

Leigh gave me my first bit of constructive criticism, which was a terrifying moment for me. She had said, "I need to talk to you about something," and my first thought was, "Aw fuck, what did I do?" LOL. We have been in the honeymoon phase, as Carla refers to it in "Helping Hands," where it's all sunshine and compliments and she's the best preceptor ever and I'm the best apprentice ever. (I am probably the funniest apprentice ever.) Leigh had some genuine concerns about maintaining my (slow, but steady) progress and not moving too fast in clinical practice before I get there in academic study. Totally valid stuff. The initials "CD" and "CBE" behind my name really mean very little when it comes to midwifery (perhaps I've mentioned this before?) and I am really starting from square one, just like everyone else. She was very kind and I felt like an idiot for being so worried. That's always how I feel when someone says, "I need to talk to you;" I always assume I've done something completely wrong and I rack my brain trying to come up with whatever it is, and then when it turns out that I haven't ruined the world, I think, Oh. Right. Just like stressing about being on-call, I need not to stress when it's time to receive constructive criticism. It's just information really, that can help me to improve. Leigh and I have the same goal, which is to prepare me for being a licensed midwife.

Here is another picture of Maizey. Her AKC registered name is Hagaren's Maizey Rockstar. My kids picked the middle name Rockstar.

"Just enough to hinder..."

2009-05-08T00:17:00.007-04:00

I'm one of the rare women who got an apprenticeship before starting midwifery school. I'm totally lucky. Religious folks might call it the hand of God; I call it incredible serendipity and/or fortuitousness. I don't even think there was a formal asking or accepting. Leigh was new to the area and through auditing her childbirth class (which I was doing to fulfill a requirement to become a CBE) I met a few of her clients, and, as she didn't have an apprentice, I offered (or maybe she asked me?) to attend the births with her, and that was that. We attended a birth together and we appeared to drive well together (or at least, we both survived the high-speed race to get there) and so I got my TB test, enrolled in midwifery school, and became licensed in South Carolina as an apprentice. At some point Leigh started referring to me as her apprentice, and I started referring to myself as her apprentice. Voila.

From what I understand, it typically doesn't work that easily. Many women who choose distance midwifery school are students for a long time first, and then have to apply to become an apprentice, and interview and compete against other potential apprentices. Reading on my AAMI group about other students who are doing that -- I'm thrilled that becoming an apprentice and enrolling in school has been so easy for me.

What has been difficult is turning my brain into a midwife brain when I've been a doula for years. Or, I should say, when I've been a non-midwife for my entire life up until now. Even though I saw a CNM for my second pregnancy, and a licensed midwife for my third, my default brain is still amazingly medical. It's insidious; I think it's just from living in this country and talking to pregnant women. I believe 98% of women have hospital births, and so 98% of women are talking about doctors, inductions, pain medication, and other interventions, and they're NOT talking about nutrition during pregnancy, comfort measures for normal pregnancy discomforts, and spontaneous labor and birth. Now, many of my friends and acquaintances are that 2%, but still. It's hard to replace approximately 22 years of mainstream-ness (I would say I've become more crunchy and natural-minded in the last 7 years).

Also, many of the pregnancy and birth related things that I "know" aren't really things that I "know" but are things that I've seen or heard, like anecdotal evidence. I now need to do the research and really learn. For example, the Cochrane Collaboration does not specifically say that Cytotec causes uterine rupture; one study does say, however, that it hyperstimulates the uterus, which can lead to uterine rupture.

There's so much to learn! And I thought that being a doula would be an advantage but if it is, it's a very small advantage. Tiny. I like to talk a lot and recently I've been trying to STFU during prenatals unless I'm either making small talk ("What are you planning to name the baby?") or something that I really really really KNOW for a fact. There are a few things that I know. But there's way more I don't. It's probably like that 98%/2% statistic.

However, AAMI is a long program, and by South Carolina law, I cannot take the NARM until after I graduate (which is different than most other states, where you can take the NARM anytime you have fulfilled the clinical requirement) which will be in 2012. So I have plenty of time to learn. I'm already feeling more comfortable taking vitals on mom and baby, and I'm starting to get better at measuring fundal height. I'll get there.

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

2009-04-22T19:46:00.005-04:00

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!

2009-04-16T18:16:00.004-04:00

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

2009-04-13T17:20:00.004-04:00

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

Heat oven to 350 degrees F. Spray 16 (2 3/4x1 1/4-inch) muffin cups with CRISCO® Original No-Stick Cooking Spray.
Separate each can of crescent dough into 8 triangles. Press 1 triangle on bottom and up side of each muffin cup.
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).
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!

2009-04-12T18:02:00.005-04:00

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

2009-04-06T17:53:00.003-04:00

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

2009-04-03T18:00:00.001-04:00

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.

Where are we going, and why am I in this handbasket?

2009-03-30T10:35:00.004-04:00

One of my AAMI assignments and suggestions for Phase 1 is starting a journal of my birth-related experiences (check) to chronicle my growth as a midwife (check). What brought me to this point (check) and where am I going (uncheck).

So, where am I going.

I sincerely hope that I'm going to a place where I can practice midwifery legally, and that the restrictions placed on my license are appropriate within the scope of the midwifery model of care, and not difficult for either me or my clients to follow. I would like practice somewhere where I can legally do VBACs, twins and breeches.

This location may not actually exist. (It might be Texas or Oregon.)

I realize that I'm answering the question very literally, like what specific place do I want to go and practice as a midwife. What I really want is to be able to follow the midwifery model of care. I'm not sure that a place where I can't handle breech (which is a normal variation) is really a place that supports the midwifery model of care. Same with VBAC. Twins, well, maybe. I realize that some twins can be more risky, like MZ mono/di twins. But DZ twins usually aren't very risky. I wonder what the Cochrane Database says about DZ twins and midwifery.

To answer where I want to go: I want to be a midwife. I want to understand normal physiological birth. I want to know enough about complications to be able to handle them calmly, or know when and how to transfer to the appropriate medical facility. I want to be able to help clients prevent complications to the best of their ability (whether they choose to do so or not) and treat pregnancy-related issues in a holistic way. I want to know. I want midwifery-related concepts and ideas and physiology to be second nature for me.

In order to do this I'm going to have study and learn learn learn. Despite being a doula, it really amazes me how little I know about midwifery. I (happily) turned off my brain when it came to midwifery (or obstetrics) because it was outside of my scope as a doula. Now my scope is changing and I feel like a total moron! I have absorbed practically nothing in years of being around pregnant women!

I feel like such a beginner that I kind of disbelieve that I'll be able to license as a midwife in three years. It doesn't seem like enough time to get me from here to there. (Seriously, did I mention I'm a moron?!?!) Maybe in some ways I know more than I think, but I don't ever want to be cocky about what I know anecdotally to be true, that might not be backed up by science.

Everybody was Kung Fu Fighting!

2009-03-26T22:45:00.007-04:00

Today I attended a birth and actually made it before the baby was born! I learned something, of course. Leigh (and everyone) says that you learn something at every birth. Even after you've attended a zillion, you learn something at each birth, and she suggested I write down the information before I forget. So here's what I learned: Even when a woman gives birth outside of a hospital, it can still take a while for her to get comfortable.

To wit, when Kung Fu Client arrived (I will explain this nickname later), I thought We are in for a long night. She was laughing, joking around with us, chatting. Her contractions were short, albeit painful. Leigh made some suggestions, and then when we checked her again, she was almost complete! I couldn't believe it. So, that's what I learned. She just needed some time to get comfortable in the space.

Of course a homebirth (even when it's not your home) is a more relaxed atmosphere than a hospital, and I'd imagine it's somewhat like the birth center will be when we open it. But if it's not the client's home, she may take awhile to feel comfortable and get into her groove. And that's exactly what happened. And then once she was in her groove, it was actually a pretty short labor.

Meanwhile, the Kung Fu nickname... She was just a total warrior. I'm always impressed when women don't whine about the pain like I always did during my labors ("Why does it hurt so much?" I cried, when I was in labor with Sydney. "Because you're in labor," my midwife answered. Oh. Right. That!)

On a totally unrelated note, I have my Enrollment Verification Pak from AAMI, and I have to complete 15 items (at least) on their list before I can request my curriculum. One of the items is write a journal entry explaining how you got here and where you want to go. So I'll start with how I got here.

I blame idiocy and Gretchen Humphries for getting me on this path. Idiocy in the form of having intercourse without using protection, and Gretchen Humphries in the form of my doula for my twins' birth.

Prior to my pregnancy with my twins, I was happily unaware of pregnancy related information -- not blissfully unaware; happily unaware. I wasn't really into babies or kids. I am an only child. I didn't babysit much. (I once babysat for a brother and sister who were less than two years apart and came home and asked my mom, "Why do they FIGHT so much?!?!?!") I wasn't particularly into holistic health care at the time, although I'd categorize myself as non-mainstream. But I still took tylenol when I had a headache and probably would have consented to a c-section if they were both breech or something. But being pregnant with twins, and twins who had Twin-to-Twin Transfusion Syndrome which resulted in 18 loooooooooooong boring weeks on bedrest, and I spent a lot of time reading and thinking about choices. God, there are a lot of choices when you're a parent! It's kind of cool and it's also kind of frightening; it's such a huge responsibility. And I didn't just want to just do what everyone else did without doing some research. Why? Why? Why? Why is this the norm? What are the alternatives? I also didn't want to do anything that couldn't be un-done. Vaccinating can never be undone. Either can circumcision. I wanted to do more research. (Still do! Always.)

So, around this time I met Gretchen, who had twin boys born by c-section and a girl born at home (HBAC). My family has actually copied Gretchen's exactly: she has twin boys followed by two girls, just like me. Anyway, I didn't know that Gretchen was very active in ICAN and writing essays about cesarean section birth and VBAC. Because of the twin boys' thing, and because she was just so darn nice, I gravitated toward Gretchen for advice and comfort. A twin pregnancy is just one giant bag of SUCK, in my experience. (Okay, so I also think that about a singleton pregnancy. But a twin pregnancy seems to kind of suck more. Maybe it's because you can't fit into anything, even maternity tents, at the end.) She offered to attend my birth as a support person, and I welcomed her. And then she did it. She gifted me with an item that changed my life forever.

The Thinking Woman's Guide to a Better Birth by Henci Goer. I sat on my bed, my ass-cheeks molding into the mattress more with each day of bedrest, and read it cover to cover.

And I was shocked -- shocked, I tell you! -- to learn that I had choices with regards to my birth. I could ask my provider questions and demand answers, and I could say NO. I said no to an unnecessary cesarean about a week before my boys were born. That was so powerful. I have forgotten many aspects of that pregnancy, but I haven't forgotten sitting in my hospital room (I was staying overnight because baby A had had a decel during a non-stress test) listening to the doctor suggest a c-section, and saying NO. I didn't think it was medically necessary. And clearly the doctor didn't think it was either, because if it was, he probably would have forced me to have one.

So blah blah blah Gretchen gave me the book, I read the book, and I claimed my power as a pregnant woman. I'd always felt powerful as a woman. But pregnant women are, as Leigh pointed out, a vulnerable population, and being an empowered pregnant woman felt... pretty fucking cool.

I felt great about the twins' vaginal hospital birth (with a foot-first baby B who was 2lbs bigger than baby A). I decided I wanted to help other women feel great about their births, so I became a doula. And then, when I moved here, and learned that Charlotte's motto is "A Doula For Every Man, Woman, Child and Dog in our Metropolitan Area," (chosen over the more traditional theme: "We Have More Doulas Than Pregnant Women") I decided to become a childbirth educator, so I could have another way to help women.

And then one of my requirements for my CBE class was to audit another childbirth class, so I audited Leigh's class, which is how I got to know her and her clients, and then became her apprentice. And here I am: doula, childbirth educator, apprentice and midwifery student.

Idiocy and Gretchen Humphries, I salute you!

The Medicaid Midwife's Apprentice

2009-03-14T13:08:00.005-04:00

Leigh, my preceptor, is beginning to get a reputation as the only local midwife who takes Medicaid. It's fine with me, since I don't get paid anyway. I don't mind not getting paid -- apprentices don't get paid, and some apprentices actually pay their preceptors, which seems like a conflict of interest to me. (The preceptor is supposed to teach the apprentice, and evaluate the apprentice's skills from an objective viewpoint. But how can she be objective about me if I'm paying her?) Aside from loving birth and birth-related stuff, I like the idea of midwifery from a feminist/empowerment point of view. Historically, midwifery has been taught from one woman to another. I like that. I like the idea of passing it down, and I like the idea of midwifery stemming from one original midwife who helped women give birth. Someday I'll have an apprentice and I'll teach her, and thus midwifery will continue.

So, "we're" trying to get the Carolina Community Maternity Center started. I say "we" because although I attend all the meetings for it, I'm not a midwife, and I don't really have a say about any decisions. But I still go to the meetings so I can learn. I figure that this is all part of my midwifery training. Someday I might move away from here, and maybe I'll want to start a birth center wherever I end up, and I can look back on this experience and draw from it. Basically, it's a lot of reading and paperwork, and making sure that we're within code for the health department. Once we get approval, it's going to be a lot of money and fundraising and finding volunteers and donations. Many many many many people in the Charlotte area have said they want to help; I'm really hoping that some of them actually do it. It's just like being a doula and getting lots of emails or phone calls -- usually only about 1/4 of those emails or phone calls actually translate into a client. But I hope I'll have help with the laundry and cleaning the floors and folding pamphlets. (Yes, I'm going to be doing my time as a grunt, just like every apprentice before me did, and every apprentice after me will do.)

Next week is the last week of my Childbirth Educator class. I'm taking it through Aviva Institute, and the program has been very comprehensive. I wasn't really sure what to expect, since it's an online course, and I didn't know how an entirely online course could really teach thoroughly, but it has. I feel ready. I think it also depends on how much time and effort each student puts into it, and I've put a lot of time and effort into it. Kathryn Berkowitz, the instructor, is so fabulous; I would take a class of anything she teaches.

Tomorrow I'm going to see her -- and all my former BIRTH women -- for dinner. I absolutely can't wait to see everyone! I was in BIRTH last September, and it was the most amazing experience: professionally, birth-wise, and personally. I got to perform on stage in front of 400 people; I got to learn even more about birth and pregnancy; and I got to spend my summer rehearsing with 10 really incredible women, my BIRTH sisters. That's how I really got to know Emily, who is my BFF. That's how I met Kathryn, who I consider one of my mentors professionally. Honestly, being part of BIRTH really changed my life. It was while doing BIRTH that I started researching weight-loss surgery and made that decision. It was while doing BIRTH that I really started to learn my way around Charlotte and feel comfortable (in spite of Lee, my GPS device).

Meanwhile, I've decided that I'm not going to do BIRTH this year. I'm apprenticing with Leigh, which hopefully will include lots of learning time, and I'm enrolled in Ancient Art Midwifery Institute, which definitely will take up a lot of my time. I've promised Dustin (and myself) that as far as "extracurriculars," midwifery is my priority, and I will let go of most other things. I still plan to keep up with Exploring Holistic Alternatives (since they're my people) and of course Charlotte Doulas, but being in BIRTH took up a lot of my time last summer, and I don't have as much time as I used to.

And now, since I don't blog as often as I'd like to (see, not as much time as I used to have, above) I'll include a picture of my youngest, laying on the floor in the computer room while I type this:

"And then we drove at 90 mph..."

2009-03-07T22:38:00.004-05:00

Client A lives pretty far away and we drove fast. Leigh asked me to call 911 to let them know that we were on our way to a homebirth and driving really fast, and please tell the cops not to pull us over. They didn't. I don't even think we saw any cops. And her car didn't blow a tire, despite some really awful sounds coming from the wheels when we driving.

I assisted Leigh in examining the placenta. She showed me the two arteries and one vein in the cord, and where it was attached to the placenta, and which side came out first, and the two parts of the amniotic sac. The placenta was actually more gross than I realized (placenta in general, not this particular client's placenta). It was really bloody and lumpy and squishy, like a Halloween trick where you put your hand into something gooey and someone tells you it's a bunch of ferret eyeballs or something like that.

The baby was perfect and adorable. I turned into a pile of mush when I held the baby, "Awwww wook at the wittle bitty baby waby you're such a cute baby aren't you!" Normally I attend hospital births, and when I get to hold the baby I'm always accutely aware that I'm IN A HOSPITAL. It's very generic and cold and sterile, and the baby always has a diaper on, and a hospital bracelet, and one of those security tags. But a homebirth is so much more intimate; I really felt like I was seeing a family welcoming its newest member.

I filled out a lot of paperwork. Damn, but there is a lot of paperwork. I'd say that's the only advantage a hospital has over a homebirth; someone else fills out all the paperwork. It was a bunch of paperwork. Mother's record, baby's record, birth certificate, postpartum evaluations for mom and baby.

I was really excited that I got to take blood from the placenta and examine it so closely, and also learn how to bake the meaty parts so that they can be ground and encapsulated.

Today we went back for a postpartum visit. I also did most of the newborn exam, which was very cool. Mostly measuring and checking skin and reflexes. The baby looks great, and mom does too except she is tired. We reminded her several times not to do anything except nurse and rest; no cooking or cleaning or taking care of anyone but the new baby. She has a lot of family around, so I think she will be fine.

To MEAC or not to MEAC

2009-02-28T19:11:00.007-05:00

The answer is probably not to MEAC.

MEAC is the Midwifery Education Accreditation Council, and if an apprentice midwife graduates from a MEAC school, she is automatically eligible to take the NARM exam, and upon passing is a
Certified Professional Midwife. (The NARM exam is the North American Registry of Midwives certifying exam. Midwifery is legislated by state, and most -- all? -- states require a midwife to pass the NARM in order to become licensed.) If I go to a non-MEAC school, I can still take the NARM, but as a PEP (portfolio entry process) which is a time-consuming pain in the ass, from what I understand. However, I'm still pretty confused about the entire process. Like, Christine, a local apprentice who attends a non-MEAC school, told me that if the state I want to license in recognizes the non-MEAC school I choose as a "path to education," I don't need to do the PEP process. And South Carolina, which is the state I want to license in, recognizes several non-MEAC schools as paths to midwifery.

Regardless, I'm keeping really careful records of everything I do. Apparently there can be a lot of red tape in becoming a midwife if you don't attend a MEAC school.

I would love to attend a MEAC school, but most of them are residential programs, and most of them are prohibitively expensive. (There's some more red tape about getting student loans for midwifery schools.) And then there's the fact that Dustin's company increased their employees' contribution to healthcare, which translates into us being down $200 per month. We do not have an extra $200 per month to compensate, much less an extra $200 per month plus $20,000 for midwifery school.

I've always wanted to be a licensed midwife. However, I didn't plan on starting midwifery education and training until my kids were older -- I didn't think I had the time or the money. But in January I started an online CBE training course, and I managed to strike a balance between learning and studying, and spending quality time with the kids. I also met Leigh in January. She talked to me about her experience, first in midwifery school with young kids, and now as a midwife with young kids. She asked me, if midwifery is my dream, how long am I willing to put it off? And if I do put it off, what will be the personal cost?

Around this time she told me she was looking for an apprentice, and since she didn't have one, I asked if I could sit in on a prenatal or two. From there, she asked if I would attend a birth with her as her assistant, and then she offered to train me, and here I am. A currently-unlicensed South Carolina apprentice midwife. (I'm just waiting on the results of my second TB test, and also I have to register with a midwifery school, and then I can get my apprentice license.)

So back to the school issue. I'm currently leaning toward Ancient Arts Midwifery Institute, which is not a MEAC accredited school, but it is a school that South Carolina recognizes as a path to education for midwifery. (Will have to do more research. Of course.) AAMI will accept a monthly payment plan for three years, interest-free. Everyone I know in the online world -- as well as several people in real life, including Christine -- say that AAMI is an excellent education, so thorough that most students pass the NARM before even graduating! Christine is a RN, and she has told me that AAMI is as difficult as nursing school. Also, the fact that it's recognized in South Carolina is a huge bonus. If I didn't have to do the PEP process, that would be fantastic. (But I'm doing the paperwork for it so far, just in case.)

The money thing will be difficult, as always. Dustin's salary going down $3000/year really scares me. I'm trying to look the money issue in the eye and figure it out. It's math. I shouldn't let it scare me. On the other hand, when I'm apprenticing and studying, I'm not going to be taking very many doula clients, so that might will some impact on our finances. Plus I'll need books and some supplies. Eeek.

But the program is only three years. In three years, I will be able to license and become a midwife. That's pretty exciting.

Last week was busy...

2009-02-21T16:12:00.006-05:00

Sunday: Attended the last day of a Birthing From Within mini-class. A three part class, approximately 10h in total, of BFW pain-coping strategies, mixed in with some EFT. This last meeting was called our "Warrior Ceremony," and involved using the pain-coping techniques we'd learned in very difficult situations that I honestly hope never to replicate. Overall, I'm not a huge fan of Birthing From Within -- it's too conceptual for me, and I don't think holding ice is anything like having a contraction -- but I do think there are some good parts. I like the "labor jobs" that BFW recommends, like pulling weeds while in early labor, or baking a birthday cake for the baby. But taming tigers? Foot baths? Not my scene.

Took my week three quiz for my childbirth educator class. Got 12/15. Called Kathryn, the instructor, in a slight panic, to ensure that I'm going to pass the class. I'm putting a lot of time and effort into my childbirth educator course, and I'm having a difficult time with the quizzes. I tend to overthink the answers. Kathryn assured me that I'm fine, and tried to encourage me to do midwifery school with Aviva Institute, but as great as Aviva probably is, I don't have the thousands of dollars to start at a "great" school. I'm planning to start with the Midwife-To-Be program, and if that doesn't go well, then I'll see if we can come up with the thousands of dollars to enter another program. Christine, who is a senior-level apprentice, practically a licensed midwife, told me that AAMI, which is what she and many other students I know take for midwifery school, is harder than nursing school was for her. Great.

Monday: Got the results of my first TB test in order to become a licensed apprentice midwife in South Carolina. (I'll do the second TB test next week.)

Went with my preceptor, Leigh, to visit Client A at her home. Client A is due in March -- we have spent a good amount of time trying to determine her estimated due date -- and is having her first homebirth. During the drive I read Client A's chart, which made me feel a little carsick, but I did not tell Leigh that! At the visit we answered questions from Client A's family, who are a little nervous about homebirth. Leigh was confident and straightforward. They seemed relieved to hear the answers to their questions, which included the ever-present "What if the cord is wrapped around the neck?" I swear, that question throws more people for a loop than anything I've ever seen. Even educated people get all up in arms about a nuchal cord. Please bear in mind that babies don't actually breathe until they're born.

Leigh had me take Client A's blood pressure, which I couldn't find, and then she told me that it takes forever to learn that particular skill. (I came home and found a sphygomanometer -- aka a blood pressure cuff thingy -- on craigslist so I can practice.) I took Client A's pulse, using the math skills that Leigh has suggested I work on, to calculate her rate. I also did the baby's rate. Leigh palpated the baby in order to find where to listen with a doppler, and tried to show me where to palpate, but I had a harder time. She measured the client and did a vaginal exam. When she asked if the clients had any questions, they asked about circumcision. Leigh actually deferred to me, since I have two boys, to answer that while she did some paperwork. A little nervously, I explained that the AAP does NOT recommend routine infant circumcision. I told them that most people seem concerned with cleanliness, but it's our job as parents to teach our children to clean themselves, and my boys have never had a problem. I also talked a little about the recent studies that have shown that uncircumcised men have higher rates of HIV and AIDS, but that the study doesn't mention using condoms. I talked a little about the high school locker room scenario (my theory: don't look, don't tell!) and about how the overall circumcision rate is going down.

Hopefully they will at least give it some more consideration and not just do it automatically. If they wait 2w past birth, the baby will not need an injection of Vitamin K.

Tuesday: Dropped my mom off at the airport (she had been visiting since last Thursday), went to a meeting with Leigh and several other midwives about getting a birth center started in South Carolina. We actually met with a local businesswoman whose name I don't recall because I spent most of the meeting chasing Sydney, my 16-month-old daughter, all over Demaris' house. Sydney has certainly transitioned from cute little baby into curious toddler, and since Demaris' kids are teenagers, it wasn't the safest house for her to explore. I probably only listened to about 25% of the meeting. After the businesswoman left, everyone assured me that Sydney was fine, but I still felt kind of bad.

Spent the afternoon cleaning for my mother-in-law, who, as luck would have it, actually arrived the evening after my mom left! I had just enough time to change the sheets in our guest room and vacuum the house before it was time to go to Leigh's house for her childbirth class.

Attended Leigh's class, which included Client A and her husband and kids, (potential) Client B, another apprentice/student midwife, and me. Leigh's classes are free. She does that to provide a service and get her name out in public, since she's new to South Carolina, but I wish the people who attended the classes actually respected the classes. One couple didn't show up, one couple quit after a week, and Client A has been late twice. I think maybe it's because the classes are free. Again, I know why Leigh is doing them for free, but I'm so busy right now, I wouldn't want to put in the effort to host a childbirth class unless I was getting something tangible in return. Maybe I'm a little jaded.

Wednesday: After the older kids went to school and preschool, took Sydney to the library with my mother-in-law for story time. Fun, as usual. Came home and Sydney and my mother-in-law napped (my mil is severely jet-lagged from her x-country flight) and I did a bunch of childbirth educator class homework. I actually intended to nap also, but I got too involved in my homework. It's an online class that involves a reading lecture, supplemental websites for information, online videos, a discussion forum with mandatory essay questions, research glossary, and weekly quizzes.

I was supposed to go to a meeting of Holistic Moms Network, but I just couldn't drag myself out of the house after three straight days of running around. I promised Dustin that when I started with midwifery, I'd drop my other extra-curricular activities and just focus on midwifery and him and the kids. And that's fine. I'm busy enough, and being social enough, that I don't feel like I'm missing anything right now. I do look forward to homeschooling the kids next year, because I'll see them more. I miss them.

Thursday: Best day of my childrens' lives. I let them play hooky from school and preschool, and we took the train to Discovery Place, where they played for hours. Came home, took a brief nap, then went to Plaza Fiesta to play. Hung out with my bff Emily and her kids, and my friend Leslie and her husband and kids, and watched the kids play. Ate pizza and Mexican and ice cream.

Friday: Took my Adult/Child/Infant CPR course. I'm now officially certified. Most of the other participants were midwives, doulas, and the like, so I met some new people, which I always enjoy. Not just from a professional level; I am a very social person. Especially when it comes to birth people -- we just have a lot in common, and knowing my fellow birth people in Charlotte is a bonus. After the certification, there was a delicious potluck (I brought homemade oatmeal cocoa cookies). Then Leigh and I, along with Demaris and Christine, went to look at a building for the Carolina Community Maternity Center, which we hope to have up and running by Labor Day. (Get it? Labor Day.) The building was fantastic. I was not expecting it to be such a perfect location for a birth center. It was beautiful, with tons of windows, and it's on the second floor, which is great for privacy. Really, it's perfect. This sparked discussion of how we need to file for 501c3 status, like NOW, and get some money rolling in.

Meanwhile, Dustin took the day off from work, since his mom was in town, and he forgot to pick the kids up from school. Nice, Dustin.

Saturday: Went to a long-overdue postpartum visit with my Christmas Client. She's wonderful, and so is her baby. Breastfeeding is going great. Client is feeling great. She's very supportive of our birth center idea. Christmas Client is someone I like on a personal level, and because of her career in the alternative health field, I know I'll be running into her again. She's in the Holistic Moms Network too.