In which I manage to miss two births in a day

... 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

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

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

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

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

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.

1.

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.

2.

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

3.

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.

4.

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.

5.

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

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

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

(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

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!

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

In which the Carolina Community Maternity Center gets its license!

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



Happy dance!

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

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


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

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

In which I finish a somewhat large assignment

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


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

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

In which I try not to hinder myself

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



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

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

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



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

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



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

Off to do errands.

In which I step away from the toilet

...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

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

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.

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.