If I could give you a glimpse into our life- specifically, where we’ve been, what we’ve come from, and what our life is on a daily basis- I think you might be incredibly surprised. There are occasions when I think of it and the sheer craziness of it all leaves me in awe. It will never cease to amaze me the twists and turns of life and that in which we are capable of arising from…and, how when things are truly meant to be, they will be…even when it seems the world is rotating in another direction, trying to catapult you opposite of where you’re trying to go.
I look back on the past couple of years, perhaps more specifically this last year- not just in MY independent life, but rather OUR life as ‘Tara and Glen’- as the couple, as a family, as birth professionals and business owners- in every sense of ‘US,’ this has been an incredible year…filled with ups and downs, overwhelming highs and gut-wrenching lows. A marriage in September, not of just a man and a woman but the joining of five lives and the making of a blended, true “his, hers, and ours,” getting pregnant in October, miscarrying in November, and getting pregnant again in December. Whew! With January 2011 came a new calendar year and immediate trials in our professional life- a warped, blindsided, solitary confinement of sorts. A true testament of Glen either bowing his head just to make life easier, or standing up and hunkering down in what he believed in and the kind of care he wanted to provide, and in turn, wearing the Scarlet Letter as punishment. And so he wears it proudly.
Gain and loss, shunnment and perseverance, love and growth and lessons learned, and the underlying theme to our life- Birth- prevailed. The birth of change. The birth of new things. The birth of growth. Personally and professionally and all of it intertwined. We celebrated our first wedding anniversary together on September 4th 2011 , and the very next week (as I write this, just 5 days ago) we would welcome a new baby girl, Adria, into our family.
As is most things in life, my pregnancy with Adria was nothing like what I had already experienced or expected it would be. Her birth was fittingly true to this as well, and so I want to share it… It might just be another birth story to some, but it is our story, and HER story, and it means more than I could ever express with words…
On Tuesday, September 13th, I was attending a Childbirth Educator training. I had been cramping in the morning but went anyway. Over the course of an hour it got progressively more uncomfortable and I found myself not able to get comfortable in my seat or even concentrate on what the educator was saying. It might as well have been in Chinese…the words coming out of the lady’s mouth and topics being discussed were just blurbs of nothingingness floating into my ears. I texted Glen to see what he was doing and to tell him that I thought I should probably head home- that all of a sudden contractions had come out of nowhere and my back was THROBBING. He texted back and said he was just about to start a 90 minute surgery. Great.
I headed to the car. I was in there about a minute, got another contraction, and this time, vomited with it. As soon as I gained my composure, I called Tonya to ask her if she could meet me at the house. I didn’t want to be alone for the next couple of hours until Glen was able to get home. With each contraction I would vomit. “Why don’t you just pull over to the side of the road,” she asked? I had been vomiting in the console of the car, and did not want to stop. “No, I just want to get home.” Every contraction was a triple whammy- the actual contraction, the intense back pain, and the violent vomiting that accompanied.
I got home and immediately drew a bath and got in. The water helped, but only ever so slightly. Tonya got there within 5 minutes. I don’t remember the entire ordeal very crisply, but I do remember, in no chronological order I am sure, alternating between hands and knees, back and forth between the bath and the shower, attempting to find some relief. The hot water did feel so good, but would eventually cause more problems than it helped to alleviate. Lesson learned? Don’t let me run my own bath or shower. Or Doppler myself.
“WHERE is Glen? Is he almost here? Can’t he get someone to fill in for him and come home now?” These are questions I kept asking Tonya. She called Glen and no, he was right in the middle of the case and had to finish.
“Maybe we should call someone. Do you want me to call someone? Who should I call?” Tonya would ask.
“No, no, no, I’m fine.” Or, “I don’t think so.” Or, “I don’t know…what do you think?” I’m not sure which is worse- my stubbornness or my indecisiveness.
“Yes, we should call someone. Who would you like me to call?”
“I don’t know. Do you have a preference?” I asked her as if it were her birth. I didn’t want to be bothered with thinking.
I was half-oblivious, wishy-washy, and indecisive. Me in labor.
About this time I started to shake like a leaf, in addition to the puking which had continued. Likely a combination of a few things- the intensity of it all, dehydration from the vomiting and the toll it was taking on my body, and probably the biggest factor of all- my temperature rising from the hot bath and shower I had essentially been camped out in.
A midwife colleague got there and Glen got there not very long afterward. My temp was elevated and the baby’s heartrate was elevated as well. I got out of the bath, IV fluids were started, and I got into any position I could that would help the baby turn from the posterior position she was in.
To make a long story short, that day or night was not the labor or birth of Adria. Things would putz out. And then start again. And putz out. Perhaps slightly frustrating, but the good news was the rest and the position change that the baby would make…which made a world in difference in how and where I felt the discomfort. So we took what we were given and we were thankful.
True labor would come Thursday.
Around 5pm on Thursday I started contracting. Although they were strong enough to notice and fairly regular, they were certainly not anything to write home about. I very often tell the expectant moms who attend my childbirth class to ignore contractions…put them in the back of your mind and carry on with your business as usual…until you come to a place where you find that they have gotten so intense that it is simply impossible to ignore them any longer. They are DEMANDING your attention. I laugh at this, with hindsight being 20/20… At 7pm I yelled down to Glen, who had been watching TV with Candice, “Glen?!”
“Yeah?” he asked.
“Could you come here?” I was slightly irritated.
He gets up from the sofa and comes upstairs to our bedroom, where I was.
“WHAT have you been doing?” I asked him. I knew full-well where he had been and what he had been doing. He had been within my sight the entire time.
Innocently he says, “I’ve been on the couch watching TV with Candice.”
“Well, WHY haven’t you even checked on me?!,” I asked, as though it were completely normal for me to expect to be ‘checked on’ for no apparent reason. My eyes started to well up with tears. I looked away so he wouldn’t see. I was slightly irked and being emotional for no apparent reason, and I wanted him close.
I knew then that I was going to be having a baby soon.
Candice left to go home for the night and to do homework, and from that point on, Glen stayed with me. He quickly realized that I was contracting every 2-3 minutes. I was completely fine, completely normal, and very excited in between contractions. At this point though, the intenseness was now noticeable. With every contraction, I would rush back over to lean on the bed from wherever I had wandered to, and beckon Glen to caress my back. It would be over and I would go back to what I had been doing- in between contractions, putting on my make-up. I couldn’t fathom being unpresentable for meeting Adria and looking a mess in our birth pictures. So a little eyeshadow here, a contraction. Finish up that eye. A contraction. On to the next eye. A contraction. Ok, mascara. A contraction. I got it done in bits and pieces. The beauty of contractions is that each one goes away. I was actually enjoying this.
After a half hour of Glen watching me do this and have contractions every 2-3 minutes like clockwork, Glen started to say to me that he thought we should call someone ( one of the midwives), that the contractions were really close. I think he was getting nervous. I still felt fine. And further, I’m stubborn. I was fine and I didn’t need an audience.
“We can call someone when I’m in transition,” I told him.
“TRANSITION!?! No! If we wait that long, they’ll miss it!”
In my mind- I had everyone there that truly NEEDED to be there. Him and I. It was all I needed anyway- Me to birth this baby and him to support me in doing so and making sure things were safe. No place to go, no rushing about. Quite simple really.
Then, in the matter of this 5 minute conversation of him insisting we should call someone, I had a couple contractions and noticed the intensity had increased a bit and I now I felt the need to get some relief by doing something other than what I had been doing. I knew it would be a good time to get in the water. Knowing what I was feeling and that I was progressing, the next time Glen mentioned calling the midwife, I reluctantly said, “Fine. Alright. Ok. Go ahead and draw me a bath and call.”
At 7:45pm he called Jennifer, one of the midwives I work with, and I got into the tub. I still felt great. Just uncomfortable for the brief duration of the contraction, and great in between. I would end up only getting out of the water twice, briefly to pee, and would give birth to Adria 3 hours and 43 minutes later.
A few weeks prior to labor, I had told Glen that I did not want to be “checked” during labor. I didn’t want anyone asking me if I wanted my cervix to be checked or be bothered with it. Dilation meant nothing to me. I didn’t want to be working hard and then be told I was 3 cm. I didn’t want to have to think or worry or obsess about a number that really didn’t mean a whole lot and subject myself to having the intrusion.
And so, perhaps one of the best things about my labor and birth with Adria is that my cervix was never once checked. It didn’t need to be. I had said to Glen as I got in the tub, “I’m about 5cm.” Then later I would say to him and Jennifer, the midwife, “I’m about 6-7.” I had no TRUE knowledge of that. I was telling them what I thought, based on how I felt. What a concept!
And so I floated and swayed and rocked in the water through labor. Glen would hang alongside the tub and provide me his pinky…not his hand, but just his pinky. I didn’t like the firmness of holding his entire hand, but preferred just hanging on to his little finger while I floated through a contraction. One finger afforded me the ability to float and rock and sway through the currents however I wanted, maneuvering however I wanted, without the constraint of being tethered to his hand. I would begin to feel another one coming on and ask for his pinky. Even through labor, I could see the comedy in this.
And so I labored by candlelight, in the water, with him by my side, my Pandora station playing various favorite songs in the background. Candice and Tonya and Jennifer remained in the background- there as support in their presence but not intrusive. This scene rang very much true to my personality- my independence intact but yet appreciative of the optional support that surrounded me. Glen may have been barricaded from me by the bathtub, but in my mind I very much needed him there and just by his presence alongside me, he soothed me.
Labor for me was only intense for about 45 minutes. And even though it was intense for but a brief moment in time, I still looked to my support people for support.
“Say something nice to me,” or “Say something positive,” I would say.
“You’re getting so close.” “You’re almost done,” both Glen and Jennifer said at one point during a contraction.
I opened my eyes and glaringly looked at them and very adamantly said, “Don’t tell me I’m getting ‘so close’ or that I’m almost done. You have no idea. I could be 4cm for all you know!” And so they laughed at me. Glen muttered something about how between the two of them they had ONLY probably witnessed a few thousand births. What did they know anyway?
It was important to me to deliver and ‘catch’ the baby on my own, with minimal interference, so long as everything was well. I didn’t want anyone else’s hands down there, doing unnecessary things and distracting me. Glen and I had talked about it and I had told him that I wanted to deliver the baby’s head and then have him help me with her shoulders and body. Funny enough, it ended up being the opposite- he helped me with her head, and I brought her up from there. I remember feeling her head for the first time, as she started to crown. Glen felt as well. I looked at him and said, in an almost giving-him-permission sort of way, “You can do whatever you have to do.” So he reached down and supported my perineum and helped me ease her head out. Then with my hands guiding her, I pushed the rest of Adria out into my hands and brought her up from the water, straight to my chest.
In that instant, life seemed surreal. Not just from enduring labor and experiencing the birth of our baby, but the culmination of our life and the transformative rollercoaster of a year that we had lived through. WOW. Did we really just have a baby? YES! We just had a baby. We had wanted this baby from day one. Her birth meant so much- represents so much- in so many ways. Adria Kinley Elrod had arrived- brought into this world by our own hands, the way we wanted, and the way we believed to be the best and the safest.
Made at home, born at home. Beautifully and safely.
Monday, September 26, 2011
Tuesday, June 21, 2011
I Hardly Knew Her Name
Not very long ago, I was asked to provide doula support to a mom who was planning a VBAC. Perhaps not so very unusual of an event in my life, but what was most interesting about this situation was that the idea of receiving doula support seemed to be much an afterthought for this client. Most of my clients tend to hire me in the first or second trimester, or at least know they are considering a doula. This particular client was by sheer happenstance.
In our practice, women who have had a prior c-section and desire to deliver vaginally are required to take our childbirth class. Why? For a plethora of reasons. They might learn new information or honestly, they might not. Maybe they know it all already. Cliché or not, hindsight tends to be crisply and painfully 20/20. Most women, in my experience, who have had a ‘bad’ birth experience or a c-section they feel was unnecessary, tend to re-look at it in the aftermath and see the “shoulda’ coulda’ woulda’” of it all. In turn, they become even more educated, even more prepared, even stronger, and even more determined the next time around. So the REAL point to the required childbirth class is to get minds thinking and open the doors of communication and trust. WE learn what to expect from THEM and THEY learn what to expect from US…and sometimes, how to meet in the middle, how to work together so that the goal is reached…not just a “Healthy mom and healthy baby” (because Lord knows I despise that saying…), but a healthy mom, a healthy baby, AND a woman and family which feel that their needs were met, they were supported, listened to, and given the reigns in their own care.
But anyhow, I digress…
So there she was- 37 weeks pregnant and sitting in my childbirth class- our very first time meeting. She sat there quietly and didn’t say much. But at the end of class, after only having “known” me for 3 hours and hardly a handful of words exchanged between us, she asked if it was too late to hire me as her doula. And as I would find out, it would be just her and I. No husband, no family, no other support.
That was the last time I saw her before the day she gave birth, just about a week later. The difference between her and other clients is that I never really got to know her and she never really got to know me. We were essentially just mere strangers, who happened to cross paths, and (hopefully) share the same thoughts and beliefs about birth. I may not have known her from Eve, but I knew she wanted- more than anything- a healthy, normal, vaginal delivery, in which she felt supported. That was good enough for me. She may not have known me from Eve, but she had seen enough to know I was passionate in what I taught, that the words that came from my mouth were genuine, and that I believed she could do it. And so that was good enough for her.
On the day she went into labor, we corresponded back and forth, all throughout the day. As the natural progression usually goes, she increasingly sounded more and more uncomfortable, and more hesitant in carrying out my suggestions of warm showers, rest, tea- the array of positions and relaxation techniques that tend to be suggested in early labor. Exhausted I’m sure, and mentally worn, weary, and wondering if any of her work had made a damn bit of difference after working hard all day, she decided to head to the hospital. We got there and she was 8cm. : )
Many things about that birth stick out in my mind, but perhaps what is the most interesting aspect (and you might find this to be horrible and look badly upon me as a doula, but afterall, it is part of the point I am trying to make), is that I literally could not remember her name. Perhaps because of the intensity of the atmosphere, but more likely due to that I simply did not know much about her, her name would not come to me. I would open my mouth to give her words of encouragement and praise, and yet I had to catch myself from using her name because it simply was not there. I remember every time I wanted to address her, having to look over at the computer monitor so that I could see her name. An abstract piece of technology with patient details and irrelevant information displayed, and there I was relying on it to remind me of my client’s name. The first time in my career as a doula that I had ever found myself doing such a thing.
But it didn’t really matter. She was working hard and focused on everything that really mattered- working with her body, physically and mentally, and working to bring her baby into the world. I was there as support- verbally encouraging her, explaining what needed to be explained and how close she was getting, verbalizing how great she was doing and how strong she was, and how she was going to have her baby in her arms soon. It is always amazing to me how strong and captive one’s words are. She may not have truly known me outside the walls of a Dr.’s office or a labor and delivery room, but she believed in my words and trusted their meaning, and what I said held weight and made a difference.
“I can’t do it, I can’t do it, oh GOD, I can’t do it!” she said exasperated, discouraged, defeated. And I felt for her, as a woman who witnesses birth but also as a woman who has been there before and who has experienced it. I could feel that overwhelming emotion of encountering a 60 foot brick wall in front of you, when scaling it seems nothing short of impossible. Whether it’s you first baby or your third or tenth or your attempted VBAC, you get to that place of mental or physical exhaustion and you’re not entirely sure how it’s possible to carry on. There is no end in sight.
And so my response to her, ‘I can’t do it’?
“Yes, you can do it. You ARE doing it. This is it…You’re in the midst of it. It’s happening and you are doing great. You are making a conscious effort to have your baby the way that YOU wanted, and to give him the best birth that you can give him. You asked for this, and wanted it, and have worked so hard for this. You are DOING IT and you are giving him a beautiful birth.”
And so we danced that danced. She would start to doubt or start to fear and I would simply reinforce what she already knew. And 30 minutes into that, she gave birth to a healthy baby boy… Vaginally, unmedicated, fully-aware, fully-feeling, fully conscious, surrounded by nothing but positivity and support.
Part of why VBAC’s hold a special place in my heart has to do with the aftermath- those particular feelings of triumph and empowerment that happen afterward. It’s present with all births, but yet even more potently present with moms who have succeeded and triumphed in their vaginal birth after cesarean. And it was all over her face. I remember saying, “I can only imagine how gloriously victorious you must feel right now. You did it!”
And in the end I may hardly have known her name and really not have known her at all. But all she wanted, all she really NEEDED, was someone to listen to her and respect her desires, her body, and the process…to encourage her, and therefore give her a fighting chance at being successful. Isn’t that what we all want and need?
And so I think of her and it seems so simple. But yet it’s not. Just like so many other things.
In our practice, women who have had a prior c-section and desire to deliver vaginally are required to take our childbirth class. Why? For a plethora of reasons. They might learn new information or honestly, they might not. Maybe they know it all already. Cliché or not, hindsight tends to be crisply and painfully 20/20. Most women, in my experience, who have had a ‘bad’ birth experience or a c-section they feel was unnecessary, tend to re-look at it in the aftermath and see the “shoulda’ coulda’ woulda’” of it all. In turn, they become even more educated, even more prepared, even stronger, and even more determined the next time around. So the REAL point to the required childbirth class is to get minds thinking and open the doors of communication and trust. WE learn what to expect from THEM and THEY learn what to expect from US…and sometimes, how to meet in the middle, how to work together so that the goal is reached…not just a “Healthy mom and healthy baby” (because Lord knows I despise that saying…), but a healthy mom, a healthy baby, AND a woman and family which feel that their needs were met, they were supported, listened to, and given the reigns in their own care.
But anyhow, I digress…
So there she was- 37 weeks pregnant and sitting in my childbirth class- our very first time meeting. She sat there quietly and didn’t say much. But at the end of class, after only having “known” me for 3 hours and hardly a handful of words exchanged between us, she asked if it was too late to hire me as her doula. And as I would find out, it would be just her and I. No husband, no family, no other support.
That was the last time I saw her before the day she gave birth, just about a week later. The difference between her and other clients is that I never really got to know her and she never really got to know me. We were essentially just mere strangers, who happened to cross paths, and (hopefully) share the same thoughts and beliefs about birth. I may not have known her from Eve, but I knew she wanted- more than anything- a healthy, normal, vaginal delivery, in which she felt supported. That was good enough for me. She may not have known me from Eve, but she had seen enough to know I was passionate in what I taught, that the words that came from my mouth were genuine, and that I believed she could do it. And so that was good enough for her.
On the day she went into labor, we corresponded back and forth, all throughout the day. As the natural progression usually goes, she increasingly sounded more and more uncomfortable, and more hesitant in carrying out my suggestions of warm showers, rest, tea- the array of positions and relaxation techniques that tend to be suggested in early labor. Exhausted I’m sure, and mentally worn, weary, and wondering if any of her work had made a damn bit of difference after working hard all day, she decided to head to the hospital. We got there and she was 8cm. : )
Many things about that birth stick out in my mind, but perhaps what is the most interesting aspect (and you might find this to be horrible and look badly upon me as a doula, but afterall, it is part of the point I am trying to make), is that I literally could not remember her name. Perhaps because of the intensity of the atmosphere, but more likely due to that I simply did not know much about her, her name would not come to me. I would open my mouth to give her words of encouragement and praise, and yet I had to catch myself from using her name because it simply was not there. I remember every time I wanted to address her, having to look over at the computer monitor so that I could see her name. An abstract piece of technology with patient details and irrelevant information displayed, and there I was relying on it to remind me of my client’s name. The first time in my career as a doula that I had ever found myself doing such a thing.
But it didn’t really matter. She was working hard and focused on everything that really mattered- working with her body, physically and mentally, and working to bring her baby into the world. I was there as support- verbally encouraging her, explaining what needed to be explained and how close she was getting, verbalizing how great she was doing and how strong she was, and how she was going to have her baby in her arms soon. It is always amazing to me how strong and captive one’s words are. She may not have truly known me outside the walls of a Dr.’s office or a labor and delivery room, but she believed in my words and trusted their meaning, and what I said held weight and made a difference.
“I can’t do it, I can’t do it, oh GOD, I can’t do it!” she said exasperated, discouraged, defeated. And I felt for her, as a woman who witnesses birth but also as a woman who has been there before and who has experienced it. I could feel that overwhelming emotion of encountering a 60 foot brick wall in front of you, when scaling it seems nothing short of impossible. Whether it’s you first baby or your third or tenth or your attempted VBAC, you get to that place of mental or physical exhaustion and you’re not entirely sure how it’s possible to carry on. There is no end in sight.
And so my response to her, ‘I can’t do it’?
“Yes, you can do it. You ARE doing it. This is it…You’re in the midst of it. It’s happening and you are doing great. You are making a conscious effort to have your baby the way that YOU wanted, and to give him the best birth that you can give him. You asked for this, and wanted it, and have worked so hard for this. You are DOING IT and you are giving him a beautiful birth.”
And so we danced that danced. She would start to doubt or start to fear and I would simply reinforce what she already knew. And 30 minutes into that, she gave birth to a healthy baby boy… Vaginally, unmedicated, fully-aware, fully-feeling, fully conscious, surrounded by nothing but positivity and support.
Part of why VBAC’s hold a special place in my heart has to do with the aftermath- those particular feelings of triumph and empowerment that happen afterward. It’s present with all births, but yet even more potently present with moms who have succeeded and triumphed in their vaginal birth after cesarean. And it was all over her face. I remember saying, “I can only imagine how gloriously victorious you must feel right now. You did it!”
And in the end I may hardly have known her name and really not have known her at all. But all she wanted, all she really NEEDED, was someone to listen to her and respect her desires, her body, and the process…to encourage her, and therefore give her a fighting chance at being successful. Isn’t that what we all want and need?
And so I think of her and it seems so simple. But yet it’s not. Just like so many other things.
Sunday, April 10, 2011
What You Didn’t Know About Direct-Entry Midwives
I’ve decided that one of my favorite things is attending the Baby Fair and the Women’s Fair that Mat-Su Regional annually hosts. It gives us the opportunity to see the community, for them to see us, and most importantly, affords us the opportunity to share information about us, our practice, and our beliefs for birth and care. And believe me- I will talk to anyone who will listen! As I stood there this past Saturday, dolling out Sleeping Lady Women’s Health Care totes and water bottles, one of the other doctors (who I had yet to have the opportunity to meet) approached me and very nicely introduced themself. A very nice gesture, yes, but it would inevitably be a very interesting, if not slightly disappointing, conversation. This doctor knew me only as “Tara, Dr. Elrod’s wife.” Not, “Tara, the Childbirth Educator, Doula, and Apprentice Midwife.” They were seemingly completely unaware of the latter.
What was so interesting? We got to talking about the politics of the practice and the issues we have faced regarding call-coverage. It is no secret- Glen has now been on call steadily and alone since January 1st. The other Obstetricians of the valley sent him the now well-known, Facebook-publicized letter, which cited issues with malpractice insurance regarding sharing call with a physician who had a “relationship” with Direct-Entry Midwives. The doctor I was conversing with went on to express their disapproval that those “lay-midwives” could think they could actually have the knowledge to deliver babies- afterall, it took this doctor years of medical school and residency to be able to do this! How could these “lay-midwives” possibly have adequate training, know what they’re doing, and do it safely OUT-OF-HOSPITAL? It seemed to be almost incomprehensible, and nothing short of negligent.
As this conversation carried on, it was reaffirmed to me that the issue with the disapproval, distaste, and fear associated with midwives and Out-Of-Hospital birth is stemmed from the simple unknown, lack of knowledge, lack of understanding, and sheer misunderstanding…all of which lead to complete misperceptions. My mind drifted to Dr. Marsden Wagner in one of my favorite scenes of “The Business of Being Born”- Home birth is like the far-away land that most doctors know nothing about…they have never been and are too afraid to go!
So let’s ask the same question that this physician argued- How CAN a Direct-Entry Midwife provide the same care and carry the same responsibility as a doctor who had to go through years of formal education and training? It is a very valid thought process and question, afterall. How can they have the knowledge and skill and NOT be negligent? The answer is, as my answer was to this doctor- it is not the same.
It is not the same- not the same care, and not the same population being cared for. Perhaps it would benefit many people to know that the reality is, only a small population of women can be legitimately and safely cared for by a Direct-Entry Midwife. Most women risk-out of care before they even walk through the door! Here in Alaska, CDM’s/CPM’s are licensed and governed by the state and there are strict laws as to who a Direct-Entry Midwife can provide care to, along with a risk assessment that pretty much spells it out. These regulations also state what a Direct-Entry Midwife can and cannot do. So who CAN a Direct-Entry Midwife care for here in Alaska (notice I say Direct-Entry Midwife, not ‘Lay-Midwife?’ Ugh.)? Can they take care of someone with a prior C-section (or any uterine surgery for that matter)? No. Can they care for someone with Chronic Hypertension? No. Congenital Heart Defects? No. Seizure disorder? No. Platelets less than 90,000? No. Pregnancy Induced Hypertension? No. Preclampsia? No. Diabetes or Gestational Diabetes? No. What about multiple gestation? No. How about non-vertex (Breech) deliveries- are they permitted to do those? No. In case my point was lost- In the state of Alaska, per the CDM regulations, moms under the care of a Direct-Entry Midwife can have NO serious illnesses, NO serious psychiatric disorders, and NO serious complications. Simply said, they have to be completely ‘normal,’ completely healthy, with a singleton pregnancy, and deliver between 37 and 42 weeks of pregnancy (with baby in the vertex, head down position). If mom was otherwise ‘normal’ and healthy and went into labor at 36 weeks and 6 days pregnant, could she deliver Out-Of-Hospital with a CDM/CPM? Absolutely not. Even one day shy of 37 weeks makes all the difference.
My point to this doctor and my point to anyone who questions the safety of midwifery care and Out-Of-Hospital birth- care provided is so limited and to such a limited population SO THAT it is kept safe. If there was a better understanding of these regulations, rather than the assumption that care could be provided for anyone, I think the perception would be much different. Additionally- midwives are NRP trained, carry the same medicines that are available at the hospital to combat postpartum hemorrhage, and have oxygen on-hand. These so-called “lay-midwives” do not simply show up to a birth, hardly trained, unlicensed, and on the wings of a prayer to Lord Jesus that everything will just "be OK!”
At the end of the day, Out-Of-Hospital birth is safe. Very safe. BUT, in the right population and with licensed providers. It might also be argued that for a normal, healthy woman, with a normal, healthy pregnancy, the risk is greater IN the hospital- where she is susceptible to lack of support, restricted mobility, restricted nutrients, and the cascade of interventions. Which is more risky? Does a 32% c-section rate say something for normalcy and ‘safety?’
Just a thought.
What was so interesting? We got to talking about the politics of the practice and the issues we have faced regarding call-coverage. It is no secret- Glen has now been on call steadily and alone since January 1st. The other Obstetricians of the valley sent him the now well-known, Facebook-publicized letter, which cited issues with malpractice insurance regarding sharing call with a physician who had a “relationship” with Direct-Entry Midwives. The doctor I was conversing with went on to express their disapproval that those “lay-midwives” could think they could actually have the knowledge to deliver babies- afterall, it took this doctor years of medical school and residency to be able to do this! How could these “lay-midwives” possibly have adequate training, know what they’re doing, and do it safely OUT-OF-HOSPITAL? It seemed to be almost incomprehensible, and nothing short of negligent.
As this conversation carried on, it was reaffirmed to me that the issue with the disapproval, distaste, and fear associated with midwives and Out-Of-Hospital birth is stemmed from the simple unknown, lack of knowledge, lack of understanding, and sheer misunderstanding…all of which lead to complete misperceptions. My mind drifted to Dr. Marsden Wagner in one of my favorite scenes of “The Business of Being Born”- Home birth is like the far-away land that most doctors know nothing about…they have never been and are too afraid to go!
So let’s ask the same question that this physician argued- How CAN a Direct-Entry Midwife provide the same care and carry the same responsibility as a doctor who had to go through years of formal education and training? It is a very valid thought process and question, afterall. How can they have the knowledge and skill and NOT be negligent? The answer is, as my answer was to this doctor- it is not the same.
It is not the same- not the same care, and not the same population being cared for. Perhaps it would benefit many people to know that the reality is, only a small population of women can be legitimately and safely cared for by a Direct-Entry Midwife. Most women risk-out of care before they even walk through the door! Here in Alaska, CDM’s/CPM’s are licensed and governed by the state and there are strict laws as to who a Direct-Entry Midwife can provide care to, along with a risk assessment that pretty much spells it out. These regulations also state what a Direct-Entry Midwife can and cannot do. So who CAN a Direct-Entry Midwife care for here in Alaska (notice I say Direct-Entry Midwife, not ‘Lay-Midwife?’ Ugh.)? Can they take care of someone with a prior C-section (or any uterine surgery for that matter)? No. Can they care for someone with Chronic Hypertension? No. Congenital Heart Defects? No. Seizure disorder? No. Platelets less than 90,000? No. Pregnancy Induced Hypertension? No. Preclampsia? No. Diabetes or Gestational Diabetes? No. What about multiple gestation? No. How about non-vertex (Breech) deliveries- are they permitted to do those? No. In case my point was lost- In the state of Alaska, per the CDM regulations, moms under the care of a Direct-Entry Midwife can have NO serious illnesses, NO serious psychiatric disorders, and NO serious complications. Simply said, they have to be completely ‘normal,’ completely healthy, with a singleton pregnancy, and deliver between 37 and 42 weeks of pregnancy (with baby in the vertex, head down position). If mom was otherwise ‘normal’ and healthy and went into labor at 36 weeks and 6 days pregnant, could she deliver Out-Of-Hospital with a CDM/CPM? Absolutely not. Even one day shy of 37 weeks makes all the difference.
My point to this doctor and my point to anyone who questions the safety of midwifery care and Out-Of-Hospital birth- care provided is so limited and to such a limited population SO THAT it is kept safe. If there was a better understanding of these regulations, rather than the assumption that care could be provided for anyone, I think the perception would be much different. Additionally- midwives are NRP trained, carry the same medicines that are available at the hospital to combat postpartum hemorrhage, and have oxygen on-hand. These so-called “lay-midwives” do not simply show up to a birth, hardly trained, unlicensed, and on the wings of a prayer to Lord Jesus that everything will just "be OK!”
At the end of the day, Out-Of-Hospital birth is safe. Very safe. BUT, in the right population and with licensed providers. It might also be argued that for a normal, healthy woman, with a normal, healthy pregnancy, the risk is greater IN the hospital- where she is susceptible to lack of support, restricted mobility, restricted nutrients, and the cascade of interventions. Which is more risky? Does a 32% c-section rate say something for normalcy and ‘safety?’
Just a thought.
Sunday, March 20, 2011
Shadows in the Closet: Life and Birth Lessons of a 3-Year Old
There have been nights recently, particularly ones which Glen has been away and it has just been myself and the kids, that Ethan has cried out into the dark- afraid to close his eyes for sleep, and fearful for “the shadows in the closet.”
I’ve never been an entirely compassionate mother when it comes to these matters. Not to say I am not a compassionate person or mother in general, but in cases such as this, I am very much logical, and perhaps stern in not playing into figments of the imagination. “There are no shadows in the closet, Ethan. Close your eyes and go to sleep,” I have been guilty of saying from down the hall, from the comfort of my own bed. “Yes there ARE, Mom! The shadows in the closet are scaring me!” Only with my continued insistence, did he eventually let it go and go to sleep.
And when it happened again, the same scene would transpire. Ethan would cry out against the shadows which he was sure were lurking in the closet, and I would again assure him that there was no such existence- that there were no shadows hiding in the closet, nor would they or could they harm him. “Go to sleep Ethan, there are no shadows.” Logical to me. Simple for me to say.
What didn’t dawn on me at the time was that I wasn’t fixing it. I wasn’t acknowledging or even recognizing the problem. I was diminishing it to nothing, to hardly an existence and just merely sweeping it under the rug. But the problem with sweeping things under the rug is that even though they are hidden, they are still there- Still existing, still just beneath the surface, ready to rise up and be exposed at any given moment. It’s a temporary fix, if even that.
As if orchestrated, soon after I had a prenatal appointment with a mom who was on her second baby, due any day.
“How are you feeling,” I asked her?
Surprising to me, “Fearful,” was her response.
And in that instant, as my mouth opened to form my own response, I thought of Ethan’s shadows. I had so many thoughts go through my head in a fraction of a second, but yet it all came together and made sense to me. I thought of the beautiful birth this mom had had before and wondered why now she would be fearful? I wondered what exactly she was fearful of? I thought of how easy it would be to just give her generic reassurance and to say, “It’s alright. You can do it.” But I realized, in that fraction of a second, we are all like 3-year olds with shadows in our closets. Particularly women preparing for or experiencing birth.
Sometimes our fears may be completely illogical. Sometimes they may be silly. Sometimes they may be legitimate but exaggerated. But no matter what they are- how exaggerated, silly, or illogical, at the end of it all, they are REAL. If only to us and no one else. Those feelings elicited are genuine and something that can’t be discounted or ignored or swept under the rug.
Of course there really were no shadows in the closet for Ethan to see. But what Ethan was afraid of was the darkness. And what is to be feared about the darkness is that, because we cannot see what is right in front of us, it becomes unfamiliar. He wasn’t afraid of the shadows per se…he was afraid of the unknown. As was that mom.
So what did I do? I applied my new-found life lesson of my 3 year old. I took the time to hear her. I acknowledged her feelings. And I acknowledged that yes, the unknown is scary. Doesn’t matter if it’s your first or your tenth baby. Each is different, with a host of different experiences and emotions. I focused on the positive. I didn’t discount feelings. I didn’t sweep it under the rug.
And the next time Ethan brought up the shadows in the closet, I did the same. Yes, there very well might be shadows in the closet. How do I know anyway? But did he think maybe they could be nice shadows? Focused on the positive, listened to him, and acknowledged his feelings. In the end, as with that mom, it made a big difference to how the unknown came to be perceived. Either way, the unknown is the unknown. There are certain things in life that will remain that way, out of our control. We can only perceive it a bit differently.
So thank you to my energetic, imaginative, beautiful 3-year-old for the continued life lessons.
I’ve never been an entirely compassionate mother when it comes to these matters. Not to say I am not a compassionate person or mother in general, but in cases such as this, I am very much logical, and perhaps stern in not playing into figments of the imagination. “There are no shadows in the closet, Ethan. Close your eyes and go to sleep,” I have been guilty of saying from down the hall, from the comfort of my own bed. “Yes there ARE, Mom! The shadows in the closet are scaring me!” Only with my continued insistence, did he eventually let it go and go to sleep.
And when it happened again, the same scene would transpire. Ethan would cry out against the shadows which he was sure were lurking in the closet, and I would again assure him that there was no such existence- that there were no shadows hiding in the closet, nor would they or could they harm him. “Go to sleep Ethan, there are no shadows.” Logical to me. Simple for me to say.
What didn’t dawn on me at the time was that I wasn’t fixing it. I wasn’t acknowledging or even recognizing the problem. I was diminishing it to nothing, to hardly an existence and just merely sweeping it under the rug. But the problem with sweeping things under the rug is that even though they are hidden, they are still there- Still existing, still just beneath the surface, ready to rise up and be exposed at any given moment. It’s a temporary fix, if even that.
As if orchestrated, soon after I had a prenatal appointment with a mom who was on her second baby, due any day.
“How are you feeling,” I asked her?
Surprising to me, “Fearful,” was her response.
And in that instant, as my mouth opened to form my own response, I thought of Ethan’s shadows. I had so many thoughts go through my head in a fraction of a second, but yet it all came together and made sense to me. I thought of the beautiful birth this mom had had before and wondered why now she would be fearful? I wondered what exactly she was fearful of? I thought of how easy it would be to just give her generic reassurance and to say, “It’s alright. You can do it.” But I realized, in that fraction of a second, we are all like 3-year olds with shadows in our closets. Particularly women preparing for or experiencing birth.
Sometimes our fears may be completely illogical. Sometimes they may be silly. Sometimes they may be legitimate but exaggerated. But no matter what they are- how exaggerated, silly, or illogical, at the end of it all, they are REAL. If only to us and no one else. Those feelings elicited are genuine and something that can’t be discounted or ignored or swept under the rug.
Of course there really were no shadows in the closet for Ethan to see. But what Ethan was afraid of was the darkness. And what is to be feared about the darkness is that, because we cannot see what is right in front of us, it becomes unfamiliar. He wasn’t afraid of the shadows per se…he was afraid of the unknown. As was that mom.
So what did I do? I applied my new-found life lesson of my 3 year old. I took the time to hear her. I acknowledged her feelings. And I acknowledged that yes, the unknown is scary. Doesn’t matter if it’s your first or your tenth baby. Each is different, with a host of different experiences and emotions. I focused on the positive. I didn’t discount feelings. I didn’t sweep it under the rug.
And the next time Ethan brought up the shadows in the closet, I did the same. Yes, there very well might be shadows in the closet. How do I know anyway? But did he think maybe they could be nice shadows? Focused on the positive, listened to him, and acknowledged his feelings. In the end, as with that mom, it made a big difference to how the unknown came to be perceived. Either way, the unknown is the unknown. There are certain things in life that will remain that way, out of our control. We can only perceive it a bit differently.
So thank you to my energetic, imaginative, beautiful 3-year-old for the continued life lessons.
Sunday, February 27, 2011
Jude- A name synonymous with Hope
As Glen and I were lounging together watching the Oscar's, someone during an interview mentioned the actor Jude Law. Funny how the mind has the ability (and very often does so...) to connect seemingly irrelevant information and circumstances to other events in one's life, connecting miscellaneous information to personally relevant memories. It immediately brought back memories of my mother praying to her favorite saint- Saint Jude, the patron saint of lost causes and cases of despair. I see her before the Green candle with St. Jude's face emblazoned on it, glowing from the flicker of the lit candle, atop that antique dresser.Thinking of it now, perhaps I know why he was her favorite saint... it was the most applicable to her life. Though all of that is for another blog, which maybe I will write someday.
I have those memories, as a child, seeing and hearing her praying St. Jude's prayer...though I had to look it up-
"O most holy apostle, St. Jude, faithful servant and friend of Jesus- People honor and invoke you universally, as the patron of hopeless cases, of things almost despaired of. Pray for me, for I am so helpless and alone. Please help to bring me visible and speedy assistance. Come to my assistance in this great need that I may receive the consolation and help of heaven in all my necessities, tribulations, and sufferings, particularly (state your request) and that I may praise God with you always. I promise, O blessed St. Jude, to be ever mindful of this great favor, to always honor you as my special and powerful patron, and to gratefully encourage devotion to you by publishing this request. Amen."
Perhaps, if we have a little boy, we will name him Jude. It somehow seems appropriate.
I have those memories, as a child, seeing and hearing her praying St. Jude's prayer...though I had to look it up-
"O most holy apostle, St. Jude, faithful servant and friend of Jesus- People honor and invoke you universally, as the patron of hopeless cases, of things almost despaired of. Pray for me, for I am so helpless and alone. Please help to bring me visible and speedy assistance. Come to my assistance in this great need that I may receive the consolation and help of heaven in all my necessities, tribulations, and sufferings, particularly (state your request) and that I may praise God with you always. I promise, O blessed St. Jude, to be ever mindful of this great favor, to always honor you as my special and powerful patron, and to gratefully encourage devotion to you by publishing this request. Amen."
Perhaps, if we have a little boy, we will name him Jude. It somehow seems appropriate.
View From The Other Side
Thursday afternoon, as Glen and Aubrey were off grocery shopping, I awoke from a nap. Having felt nothing out of the ordinary, I got up to make my way downstairs and start thinking about dinner. But as I got up I felt a large gush. I thought I had urniated, but when I looked down, it was bright red that I saw, screaming out at me. My heart skipped a beat. It continued to trickle out. My heart started racing. I grabbed my phone and attempted to call Glen. But when I tried to grab the phone, I had so much adrenaline pumping and so much going through my mind, I could hardly grasp the phone. My hands had lost all coordination because of my racing mind. I was like a fumbling idiot. I tried to dial his number, yet my fingers weren't hitting the buttons I was trying to push...I was shaking so badly. Somehow in my near hysteria I managed to verbalize to Glen what was going on and needed him to come home. He left the grocery store and was home in minutes. I didn't move from the spot I was in. I envisioned passing out and him finding me on our bedroom floor. Probably my imagination running wild, but I was expecting the worst.
I knew some bleeding in pregnancy was relatively common, but this...I didn't need anyone to tell me or even a second thought, to know that THIS was not normal. I was expecting to find out I had miscarried and would need a D&C.
We got to the office and, being the emotional person that I am, I needed to have some kind of emotional primer- something to prepare me for what I was expecting we would see on the ultrasound. The ultrasound was too definitive- within seconds, if something was bad, we would know, no ifs ands or buts. So instead I had Glen put the doppler on. If we heard heart tones, I would know the baby was alive. If we didn't, I would know that I had probably miscarried, but yet there was still the chance that he just missed finding the heart tones. Does that make sense? Silly, but it was a mental preparation of sorts for me.
Of course he didn't find heart tones. He was a damn erratic, fumbling idiot. He would put the doppler on and move it two seconds later, not waiting long enough to move it slowly and precisely- never giving it the chance to pick anything up. He had it clear up to my belly button, which an 11-weeker would not be at yet, since my uterus was hardly out of my pelvis! A worried husband and father does NOT make a good doctor (Remind me to never let him operate on me...). It turns a good doctor into the said above erratic, fumbling idiot who moves about the doppler with no rhyme or reason! And so with that said, we moved on to the ultrasound...
We immediately saw the flicker of the heart beating and the wiggles and dance of the baby, displayed on the screen. The baby looked fine. What didn't look fine was the reason for my bleeding- a small subchorionic hemorrhage. In other words, a small area where there is a gathering of blood between the placenta and the uterus. Surprisngly, I was relieved. I had known something wasn't quite right, and I had been expecting the worst. While it wasn't the best news- it was still better than what I had been expecting.
So with that, we go forth...Though I'm not sure in which direction or which course of events will follow, nor how this story will play out. But for the time being we trudge forward, happy and grateful to still be pregnant.
I knew some bleeding in pregnancy was relatively common, but this...I didn't need anyone to tell me or even a second thought, to know that THIS was not normal. I was expecting to find out I had miscarried and would need a D&C.
We got to the office and, being the emotional person that I am, I needed to have some kind of emotional primer- something to prepare me for what I was expecting we would see on the ultrasound. The ultrasound was too definitive- within seconds, if something was bad, we would know, no ifs ands or buts. So instead I had Glen put the doppler on. If we heard heart tones, I would know the baby was alive. If we didn't, I would know that I had probably miscarried, but yet there was still the chance that he just missed finding the heart tones. Does that make sense? Silly, but it was a mental preparation of sorts for me.
Of course he didn't find heart tones. He was a damn erratic, fumbling idiot. He would put the doppler on and move it two seconds later, not waiting long enough to move it slowly and precisely- never giving it the chance to pick anything up. He had it clear up to my belly button, which an 11-weeker would not be at yet, since my uterus was hardly out of my pelvis! A worried husband and father does NOT make a good doctor (Remind me to never let him operate on me...). It turns a good doctor into the said above erratic, fumbling idiot who moves about the doppler with no rhyme or reason! And so with that said, we moved on to the ultrasound...
We immediately saw the flicker of the heart beating and the wiggles and dance of the baby, displayed on the screen. The baby looked fine. What didn't look fine was the reason for my bleeding- a small subchorionic hemorrhage. In other words, a small area where there is a gathering of blood between the placenta and the uterus. Surprisngly, I was relieved. I had known something wasn't quite right, and I had been expecting the worst. While it wasn't the best news- it was still better than what I had been expecting.
So with that, we go forth...Though I'm not sure in which direction or which course of events will follow, nor how this story will play out. But for the time being we trudge forward, happy and grateful to still be pregnant.
Tuesday, January 25, 2011
Learned, Learning, Applying
I called my Preceptor tonight and asked if there was a way to reschedule the postpartum class I was supposed to teach this evening. I had no urgent, tangible, see-able excuse. Childcare wasn’t an issue, my vehicle was functioning, I wasn’t ill. My only reason was how I felt emotionally. Overhelmed, frustrated, despaired, and sad.
As soon as I asked her, I felt a bolt of guilt charge through me and immediately regretted it. What kind of midwife would that be- To put my life, my schedule, my feelings first, and not be ready, willing, and able to serve a woman, regardless of my own circumstance? I’ve heard it before and I believe it- There will be times in my career, perhaps more often than not, when a woman’s labor and need for me will not perfectly align with my life and my circumstances. Part of being a good midwife, I have learned, is pushing this aside, putting yourself below the number one priority spot, as even sometimes you will do with your own family. I have seen midwives miss anniversaries, birthdays, Christmas parties, and countless other events without skipping a beat. All for the role of serving a woman.
So I struggle with that. I could have sucked it up, I could have held to my commitment and obligation to these women and their families. But yet, I thought about it and another thought dawned on me- even if I had composed myself and was there to teach this class, would it have really been ME? Would it be all of myself I was giving, 100%? Would it truly be the best of myself while I taught? Or would I be thinking about all of the events of the day in my own personal life, and wishing I was elsewhere? Because that in itself isn’t fair to them. That in itself seems like an incredible injustice.
In the end, the beautiful thing about being a group, about being a team, is that you have others who are there to pick up where you leave off, others who are there to fill in when you are unable, who will in general, support you in your work, as well as in your personal life.
I’ve been shown this and have learned this through my preceptor and the other midwives who I work with and learn from. With our own business, and in our own professional lives in general, I hope Glen and I can always foster this same belief. You put your own issues and conveniences aside until you possibly cannot anymore…until it reaches that point where to continue to try and serve them is actually short-changing them, as all of yourself is no longer there to give. When our staff encounters personal issues and life obstacles, it’s my hope that we apply this same concept- to continue to be good support, to pull together and get the job done when they are unable, to support them in being successful with work, as well as in their personal lives.
In the meantime, I am incredibly thankful for the night off and the chance to re-group.
As soon as I asked her, I felt a bolt of guilt charge through me and immediately regretted it. What kind of midwife would that be- To put my life, my schedule, my feelings first, and not be ready, willing, and able to serve a woman, regardless of my own circumstance? I’ve heard it before and I believe it- There will be times in my career, perhaps more often than not, when a woman’s labor and need for me will not perfectly align with my life and my circumstances. Part of being a good midwife, I have learned, is pushing this aside, putting yourself below the number one priority spot, as even sometimes you will do with your own family. I have seen midwives miss anniversaries, birthdays, Christmas parties, and countless other events without skipping a beat. All for the role of serving a woman.
So I struggle with that. I could have sucked it up, I could have held to my commitment and obligation to these women and their families. But yet, I thought about it and another thought dawned on me- even if I had composed myself and was there to teach this class, would it have really been ME? Would it be all of myself I was giving, 100%? Would it truly be the best of myself while I taught? Or would I be thinking about all of the events of the day in my own personal life, and wishing I was elsewhere? Because that in itself isn’t fair to them. That in itself seems like an incredible injustice.
In the end, the beautiful thing about being a group, about being a team, is that you have others who are there to pick up where you leave off, others who are there to fill in when you are unable, who will in general, support you in your work, as well as in your personal life.
I’ve been shown this and have learned this through my preceptor and the other midwives who I work with and learn from. With our own business, and in our own professional lives in general, I hope Glen and I can always foster this same belief. You put your own issues and conveniences aside until you possibly cannot anymore…until it reaches that point where to continue to try and serve them is actually short-changing them, as all of yourself is no longer there to give. When our staff encounters personal issues and life obstacles, it’s my hope that we apply this same concept- to continue to be good support, to pull together and get the job done when they are unable, to support them in being successful with work, as well as in their personal lives.
In the meantime, I am incredibly thankful for the night off and the chance to re-group.
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