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 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 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 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 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.

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

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

About The Cochrane Reviews:

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

Some things I learned tonight from about 15 minutes spent on the Pregnancy and Childbirth Topics page:

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

I found the GBS study the most interesting, because you would assume that if the number of bacteria passed to the baby is reduced, the GBS infections would be reduced also, and it's not (as far as the review shows. Probably more research is needed. Isn't it always?)

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

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

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

Guess what I did?

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

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

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

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

Copyright 2009. Please do not copy or repost.

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

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

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

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

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

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

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

In which I desire to learn

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

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

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



I keep a list of things that I want to learn. It's pretty short right now, but each topic is vast. I update it every few weeks. Here's what I've got:

• Normal physiological birth
• Placentas
• Nutrition during pregnancy
• Hormones during labor and birth and postpartum
• Homeopathic/"Natural" cures for pregnancy-related complaints
• Twins
• Anemia
• Common diagnostic tests during pregnancy, and interpreting their results
• Meconium
• Appropriate weight gain during pregnancy, and its effects.
  

In which I learn why midwives knit

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

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

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

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

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

"Hey, aren't you a doula?"

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

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



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

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

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

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

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

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

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

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

Suturing! Anne Frye! Chickens! Oh My!

In which I pretend this chicken is a perineum


And then I cut an episiotomy on it


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


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

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

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

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

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