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

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

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

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

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

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

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

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

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

Serendipity: Coming soon to a computer near you!

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

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

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

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

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

From allrecipes.com

INGREDIENTS

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

DIRECTIONS

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

Nutritional Information

Servings Per Recipe: 16

Amount Per Serving

Calories: 197

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

Because Boobs are the Best!

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

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

But not so much with breastfeeding.

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

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

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

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

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

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

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

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

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

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

A glimpse of the future

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

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

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

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

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

From Carla, to the South Carolina Department of Health

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

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

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

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

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

Thanks, Carla Hartley
Founder, Director
Ancient Art Midwifery Institute

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

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

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

Off to eat dinner.

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

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

So, where am I going.

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

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

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

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

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

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

Everybody was Kung Fu Fighting!

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

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

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

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

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

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

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

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

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

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

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

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

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

Idiocy and Gretchen Humphries, I salute you!

The Medicaid Midwife's Apprentice

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

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

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

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

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

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

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

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

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

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

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

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

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

To MEAC or not to MEAC

The answer is probably not to MEAC.

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

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

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

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

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

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

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

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

Last week was busy...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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