Long time, no write

Hi Folks!

So much has happened since I last wrote. Nothing extraordinary, but enough to keep me hopping (and not sleeping too much). Two babies, a wedding, career decisions, nursing school stuff.

I'll start with the wedding: Had great fun wearing this red headed babe while her parents tied the knot. About the only time I didn't hold her was while her mom nursed her (she had a custom designed wedding dress that allowed her to unzip from the side to nurse-brilliant!) and when her mom carried her down the aisle as her "baby bouquet"! I danced a lot, and got a kick out of watching other folks dance. It was a half-Jewish wedding, and they did the chair dance (apperntly the official name is Hora), where the music builds to a crescendo, people dance in a frantic spiral, and eventually some drunk uncles and cousins hoist the couple onto wobbling chairs while they cling to each other via a white hanky. This was definitely the energetic high point of the whole weekend of wedding festivities. While I am not Jewish, nor am I planning a wedding, I think if I did get married I might be forgiven for the cultural appropriation if I stole this dance. After all, Alex's paternal Grandmother was Jewish.

As previously mentioned, I was on high alert for two term clients during the wedding festivities, one who was due Saturday, the other not due until today. The one due today was having a scheduled cesarean birth for a breech, but I had a feeling she wouldn't wait for the scheduled birthday. And she didn't! So I went to her birth on Sunday. A lovely 7#4oz baby girl.
Almost no one intentionally catches vaginal breech babies anymore, at least not in Washington. I've heard that in Oregon there are some home birth midwives who will, and at The Farm in TN they will (they do a lot of higher risk births at the Farm, but they are also set up with a basic NICU, private ambulances, a helicopter pad, and some very, very highly skilled midwives). For the most part, the kabosh was put on vaginal breeches by this international trial of vaginal versus cesarean outcomes for breech birth. The data was so apparently conclusive that they stopped the study early. Ever since, the standard of care is a cesarean for all known breeches. However, the study itself is quite controversial. Questions include: is a randomized trial really an appropriate methodology for this condition, where most practitioners would make decisions based on other findings such as parity, fetal weight estimates, overall health of the fetus, pelvimetry, etc? While the study claimed that experienced practitioners were managing all the vaginal breeches, in reality it was used as a teaching tool for inexperienced OB's, and only 2.8% of the practitioners were actually "experienced". Also, this was an international study but failed to take into account the fact that major abdominal surgery might be less safe than vaginal breech birth in area with limited access to things like epidurals, blood products, and antibiotics. I am absolutely all for evidence based care, but you really need to be careful about making sure your evidence is high quality before you dive in head first (or butt first in this case...). Unfortunately, one of the side-effects of this study has been that now, since no one is having breech babes vaginally, no one is getting experienced in catching them. So, vaginal breech birth is an endangered skill set, and that will make it all the harder to reverse the policy if we later realize that vaginal birth might be safer for some moms and babes.

At any rate, Sunday was a cesarean breech birth. Frank breech babies are funny when they come out, because their legs stick up next to their ears, just like they have been in the womb. Usually they relax on their own, some need treatment for hip problems. Anyway, that was Sunday.

My Wednesday birth was just as lovely and normal as apple pie. Both births were with one of my favorite nurse-midwives. Why is she one of my faves? She strikes a very difficult balance between faith and trust in normal birth, and a hawk's eye for abnormality that requires intervention. For me, she defines midwifery care: a focus on educating and empowering parents, providing guidance and information, and being positive, respectful, and encouraging but also scrupulously honest. Not to mention she's got mad skills, yo!

I am very grateful to all the providers (midwives, OB's and nurses) that I learn from at every birth. From some I learn great tricks and valuable lessons, others it's more of a cautionary tale.

In other news, I think I've told most of you who could (or could not) be reading this blog, that I am planning to stay home with the Bird this fall. People keep asking me why. Its because I want to be off call, sleep through the night, go out of cell phone range, and have lots of time for wrapping up nursing school apps. But, I can't say it's an easy decision. For one thing, I do love my job, as draining as it can be. Also, I have a little fear that people won't respect me as much as a stay at home auntie, as they did as a small business owning doula who dashes out at a moment's notice at three in the morning to help mothers birth. It's just not as cool. Alex says he wonders how this fits into my overall career plan, and the answer is that it really doesn't, except as it gives me time to work like mad on nursing school applications. I'll also have more time to volunteer as a doula at the UW Medical Center, and to volunteer as an advocate at New Beginnings Shelter, both of which I love and are valuable experience for my career. Like I said though, not an easy choice.

I'm going to wrap this up. Alex and I are going to the Torchlight Parade with his sister tonight, and then he leaves for a week long bike trip through the Columbia River Gorge tomorrow at 0-dark thirty.

LOVE!!!
Caren