Baby Wave!

There's something in the air, people! It must be spring time! The hospital I work at has been absolutely packed to the gills with new moms and babies, and in my personal friend circle there have been 4 babies in the last month! Two boys and two girls, all beautiful as only the newly born can be. The baby wave has called me back into rotation as a postpartum doula/lactation educator. I'm loving it. I had forgotten how much I savor having hours with one family to just talk to them about what's happening for them, what they need/want/hope/fear, and then getting to help them feel more confident and successful in their parenting and breastfeeding. It really is THE best job in the world. It kind of makes me wonder sometimes if I'm doing the right thing to go into nursing when I already love this role. I can see in my interactions with families that I have changed with nursing school, for better and for worse.

The better: I am generally more accurate with what I'm concerned about and what I can see for normal variations (not 'oh my god, call your doctor! just 'oh, that's interesting'). I am better at asking hard questions and directing conversations a little bit to get the information I need. For example, this morning I was on an inpatient psychiatric ward, talking to a man who tried to strangle himself over the weekend. THAT was a difficult conversation, in a different way than it's difficult to sit with a mom and hear her out as she processes her birth and transition to parenthood. But many of the same skills apply, and I'm better at them now, I think.

For worse: friends, it is so, so very easy to lose the wonder of birth when it happens all the time. It is just too easy to see a primip in room 512, instead of Lisa and Bob, who are having their first baby are very excited and nervous and eager to do their best at this first task of parenthood. It's easy to slip up and forget that everything we do in that sacred space really, really matters. It may be remembered and cherished as affirmation of this woman's worth and dignity, or it may be remembered and loathed as affirmation of her worthlessness and weakness. Women should not have to cry out for that kind of care-not only the families who come in with a doula and a birth plan should get it, the Somali mom having her 7th child should get it, and the 14 year old having her first baby should get it too. The mom having a planned cesarean and the mom having an unmedicated birth. Hospital culture, despite having wonderful people with the best of intentions, pushes us to reject birth as a sacred rite of passage and treat it only as a medical procedure. I'm not sure exactly why this happens, but I know it's not something I'm game to be part of. I plan to work at a high-risk hospital that serves many families who truly need a high level of medical intervention in their births. That doesn't mean that they don't also need a high level of love, dignity, respect, and compassion. I don't want anyone's birth to be forgotten in the haze of their medical care. Fortunately, this particular hospital is much better than most at providing "high tech, high touch" care, but it's still a hospital. I know I'm going to have to actually concentrate on being mindful, to stay true to my values and give each family the best care possible.

Being Born Is Important

Being Born Is Important
by Carl Sandberg

Being born is important
You who have stood at the bedposts
and seen a mother on her high harvest day,
the day of the most golden of harvest moons for her.

You who have seen the new wet child
dried behind the ears,
swaddled in soft fresh garments,
pursing its lips and sending a groping mouth
toward nipples where white milk is ready.

You who have seen this love’s payday
of wild toiling and sweet agonizing.

You know being born is important.
You know that nothing else was ever so important to you.
You understand that the payday of love is so old,
So involved, so traced with circles of the moon,
So cunning with the secrets of the salts of the blood.
It must be older than the moon, older than salt.



Thanks to Rebecca Shepherd for sharing this poem on Facebook.
Speaking of Facebook, I am considering abandoning my account except to have it automatically post a notice when I update this blog. But now that I've been on FB for so long, it feels sort of self-important to ask people to come all the way over to my blog or (GASP!) email or call me to catch up. And, I would miss out on notices of impending babies, preggy pictures, baby announcements, baby pictures, etc. Oi, what to do? Will decide and let you know.

Friedman's Curve is a Bunch of BS!

Read it and weep, one centimeter per hour devotees!! Muahahaha!!

This is an incredible piece of research. If read and implemented, I think it could save SO MANY women from the pitocin-epidural-cesarean cascade. There is also an excellent review of the article on Academic OBGYN. Check it out! If you want the full article, shoot me an email or comment and I will send you a PDF. The formatting gets messed up if I try to post it here.

Enjoy!

The Natural History of the Normal First Stage of Labor

Zhang, Jun PhD, MD; Troendle, James PhD; Mikolajczyk, Rafael MD, MSc; Sundaram,
Rajeshwari PhD; Beaver, Julie MS; Fraser, William MD, MS
Obstetrics & Gynecology
Issue: Volume 115(4), April 2010, pp 705-710
DOI: 10.1097/AOG.0b013e3181d55925

Abstract

OBJECTIVE: To examine labor patterns in a large population and to explore an
alternative approach for diagnosing abnormal labor progression.

METHODS: Data from the National Collaborative Perinatal Project were used. A
total of 26,838 parturients were selected who had a singleton term gestation,
spontaneous onset of labor, vertex presentation, and a normal perinatal outcome.
A repeated-measures analysis was used to construct average labor curves by
parity. An interval-censored regression was used to estimate duration of labor
stratified by cervical dilation at admission and centimeter by centimeter.

RESULTS: The median time needed to progress from one centimeter to the next
became shorter as labor advanced (eg, from 1.2 hours at 3-4 cm to 0.4 hours at
7-8 cm in nulliparas). Nulliparous women had the longest and most gradual labor
curve; multiparous women of different parities had very similar curves.
Nulliparas may start the active phase after 5 cm of cervical dilation and may
not necessarily have a clear active phase characterized by precipitous dilation.
The deceleration phase in the late active phase of labor may be an artifact in
many cases.

CONCLUSION: The active phase of labor may not start until 5 cm of cervical
dilation in multiparas and even later in nulliparas. A 2-hour threshold for
diagnosing labor arrest may be too short before 6 cm of dilation, whereas a
4-hour limit may be too long after 6 cm. Given that cervical dilation accelerates
as labor advances, a graduated approach based on levels of cervical dilation to
diagnose labor protraction and arrest is proposed.

Slightly drunk on a summer night

I must say: it is a really lovely feeling to ride my bike through the city slightly drunk on a warm summer night, after laughing a lot with good girl friends. This must be what youth is about.

Good Day, Sunshine

I don't have a lot to say today except that it was a good day. I woke up to sunshine streaming in through our bedroom window. Alex and I had a good snuggle while we listened to housemates making breakfast downstairs. When we figured it was about ready, we headed downstairs and were treated to yummy porridge in the breakfast nook with our homies.

I forced myself to do paperwork all morning, and studied, then in the afternoon I rode up to McPhereson's Produce Stand and splurged on summer fruit-two kinds of cherries, grapes, papaya...and ingredients for spring rolls. My giant new grocery delivery basket on my bike works like a champ-three bags of groceries, no problem! I spent the afternoon making spring rolls until my fingers got pruny from pulling the rice wraps out of the water. Alex and I had a backyard picnic, watched the clouds, and I started a new book (The Bicycle Diaries, by David Byrne).

When we got bored we headed down to Full Tilt Ice Cream for some delish cream and pinball. I got Thai Iced Tea vegan ice cream, and Alex got the classic Ube flavor. We detoured on our way home to watch a spectacular sunset over the sound, mountains, and city skyline from Jose P. Rizal park. We were among several other pairs of lovebirds, and one lonely looking Latino man watching the sunset from his tiny, old red car. As we were sitting there we saw three Airlift Northwest flights dropping folks off at the helipad behind Harborview. It was strange to be having such an incredibly peaceful and content moment with my lover, and know that at the very same moment there were nurses and doctors in Resus Rooms 1, 2, and 3 trying to save people's lives. I was grateful to be on my side of the moment.

Our little chicks are spending their first night outside tonight. Up to now they've either been in our dining room under a heating lamp or in the garage under a heating lamp. They've had brief adventures in the chicken tractor during the warm part of the days, but tonight is the first night that they're on their own out there for the duration. It reminds me of kids having their first "camp out" in a tent in the back yard. Alex and I have been simultaneously worrying over them and glad they're out there growing up. They're teenagers now, after all. Last we checked, they were in a chick cuddle puddle in their nesting box in the chicken tractor. They seemed quite content, but we brought them some extra food and bedding just in case. I hope they do OK out in the big world tonight!

Purple Scrub Safari

So....I woke up this morning with a clear idea of how my day would go. I had a study group in Madison Valley from 9-12, then a group photo for at my clinical site at 1pm, then miscellaneous finals week tasks to do until dinner time. I rolled out the door and got to Madison Valley just fine. We got all the new study guides for the final done! But then, things took a turn. I had an adventure. Well, a misadventure.

I used the new bike maps feature on Google Maps to plan my route from Madison Valley to Children's. It routed me through Broadmoore, which I thought was a little odd, but probably quiet and peaceful and safe, so away I rode (directly up hill-Madison Valley is not called a "valley" for no reason) towards Braodmoore. For non-Seattlites, Broadmoore is a gated, private neighborhood of mansions inhabited by the bougousie, plunked down in the middle of a major public park, the Arboretum. Only in Seattle, dudes, only in Seattle. I was admitted to Broadmoore once, to attend the board meeting of a non-profit I was involved in. I wasn't involved in that non-profit for long. It turns out Broadmoore does not allow bicyclists to roam it's golden streets, and so I had to continue past the guarded gates and take the main road, Lake Washington Blvd, through the arboretum. It's a nice route, flat and tree lined, except that it's also a major traffic route. Two lines of twisty, winding, narrow pavement, traversed by many an SUV-and me in front, holding up the show. There is no shoulder. But, to be honest I have no qualms about holding up traffic whatsoever. If they want bicyclists not to hold up traffic, maybe they should build some decent bike paths, eh?

Now we get to the misadventure part. Following Google's directions, I took Foster Island Rd out to the waterfront trail. It turned out not to be so much "water front" as "water covered." It was ok, if just slightly muddy for the first quarter mile or so. Then it got a little more muddy, but still passable if I walked my bike. Then suddenly, in a single step, I was knee deep in swamp mud. The kind of swamp mud that sucks your shoes off. Swamp mud also smells like shite, a familiar and comforting smell to a girl who spent many happy hours playing in the swamps of south Georgia, but definitely still a shite smell. Did I mention I was wearing my purple scrubs to pose for a group photo in a hospital? Last I checked, most hospitals do not welcome with open arms students covered to their knees in foul smelling mud, nor does it make for a lovely, professional photo. I was half laughing, and half cussing as I extracted myself-with both shoes, miraculously-from the mud. "Ha!" I thought to myself. "Nice try. I'm made of tougher stuff than that!" I decided to get through the rest of this god-forsaken trail, then pause at the sylvan water's edge and wash the shit off my scrubs and running shoes and hope they dried out a little bit on the rest of the ride to the hospital, which I now had about 20 minutes to make. A brilliant plan, no? I made it through the rest of the mud, and finally returned to the maintained, wood chipped part of the trail. Along the way, I noticed not one, but two pairs of abandoned running shoes on the trail! I was clearly not alone in my woes. Now that I was through the mud it was time to implement my wash-dry-look decent plan. I leaned my bike against the railing, stuck my left foot in the water, shook it around, and was relatively pleased with the mud removal accomplished. Next, I stuck in my right foot. Next, while balancing on my left foot, I fell into the water up to my thighs. Damn. It. It was a long, cold, wet ride home. I really turned heads, let me tell you.

So, here are the bummer things about that bike ride:

1) Google bike maps can kiss my patooty

2) I failed (FAILED!) to deliver the cards I had for students to sign for the nursing staff who have so kindly allowed us to breathe down their necks, step on their heels, and ask really dumb questions all quarter. I will get them to them somehow, but dadgumit!

3) Someone will have to photo shop my head onto Jennifer Anniston's body, and then make it look like Jennifer Anniston is wearing purple scrubs, and then insert that into the group photo.

Here, though, are the great things about that bike ride:

1) If you have to fall on your butt, it's really much nicer to do that in mud and water than going 30 MPH on pavement, which is what I was doing only a few minutes before I fell in the water. I think fate was looking out for me, in a dysfunctional kind of way.

2) I quite enjoy wallowing in mud. I think it's romantic. The most romantic thing I've ever done in my life was picking raspberries in a cold drizzle, ankle deep in muck, at the foot of the Cascades with Alex.

3) That was, sadly, the most adventure I've had since my 5k/Polar Bear Plunge in January! I really need to get out more!

The Midwife

I'm reading a really great book-in fact, since I checked it out yesterday I've read 160 pages of it, Care in Illness exam be damned! It's called The Midwife. You'll never guess what it's about...

OK, OK, you guessed! It's the autobiography of a young midwife, Jennifer Worth, working in the East End of London in the 1950's. In the first pages, the midwife nonchalantly describes getting a call out (at the convent where she was living while in training), rolling out the door at 2am, and...clipping her birth kit to the back of her bike! How cool is that!! I can't tell you how much this sparked my imagination, and actually reminded me of my first births with the midwives while I was a student at SMS. I was so excited to hear my cell phone ring in the quiet stillness of the night. I concientously changed my cell ringtone to something I thought would be a gentle awakening in the wee hours. This midwife (Jennifer's) description of what it was like to prepare for and attend a birth reminded me exactly of what I imagined it would be like before I knew what it was like. Reading her description of getting the call, checking her kit, and riding to the birth in the company of the other night workers. The quiet, quick, straightforward birth, everyone down to earth with their expectations for hard work and pain, but not fearful, and open to the inherent wonder of birth.

Reading from her perspective actually made me wonder why birth is so damn complicated. Is it the me? The women? The culture? Of course all of these births Jennifer is describing are at home, so that helps greatly. I have been to plenty of home births that mainly involved women standing around in the kitchen, eating, making food for the family, laughing, massaging and generally loving up the mom, entertaining other kids, and being glad that a new little one was on the way. Creating a good, relaxed, loving and normal vibe in other words. But, I've been to lots of births where people got really, really excited when the mom had a (as in one, single) contraction, lit candles, and turned on the yoga music seemingly expecting a wholly spiritual, mainly pleasant event, to take no longer than 6-12 hours (whether it's a first birth or not). I can't help but think that a return to a more realistic view of birth could be helpful: not sheer terror, agony and suffering. Not orgasmic and ethereal. Real, hard work, that takes time, patience, love and care. The spiritual element I think comes from the community of people that come together to support the mom, and her finding her inner resources to do this hard work. I just saw a nice film in fact, about the need to return to realistic images and expectations of birth. It's called Laboring Under an Illusion. But, I digress.

Jennifer describes some antiquated practices, like shaving and enemas, but she seems to giggle at herself and the rediculousness of the practices in hindsight. (Side note: sometimes I do wonder- if we still used enemas routinely in the hospital, might we use less pitocin? They do get things moving, and not just the poo. But of course, the best solution is neither enemas nor pit, but patience.) She describes testing for proteinuria by holding the top half of a vial of urine over a flame and watching for the protein to cook, thus turning white (like an egg), which is kind of ingenious. Glucosuria was tested for by adding something called Fehling's solution to the urine and comparing the color to a chart. So much more complicated than our fancy dipsticks these days! Fetal heart tones were assessed exclusively with a fetoscope (pinard horn), not with a handheld doppler and certainly not with one of the gawd awful continuous electronic fetal monitors.

Mothers were routinely kept in bed for 10-14 days after birth. This is now known to predispose women to deep vein thrombosis, a blood clot that can break off a vessel and become lodged in the lungs, or rarely, the brain. However, Jennifer also points out that in the days and places where women had 5-10 or more other children and extremely difficult living situations, 'lying in' did ensure that they got a little bit of much needed rest to recover, eat, and breastfeed. I, along with many, many other student midwives, have been taught the phrase, "A week in the bed, a week on the bed, and a week around the bed," as our advice (given with all of our full medical authority) to new moms. No electronic commuting, working from home, full schedule of childbirth and postpartum yoga classes. Certainly no going back to work that requires standing all day, lifting, etc. and provides little or no break time for pumping. Just a few weeks where the priority is to feed mom, feed baby, snuggle and get to know each other, and sleep when the baby sleeps. But by all means, get up to use the bathroom, take a walk, flex your legs and keep that blood pumping.

Jennifer talks about delivering a-gasp!-breech baby. The technique sounds exactly like what I was taught in 2006! Things don't change that much, except of course that the midwife in this book was experienced and adept at breech birth, and this is not so much the case for most practitioners today.

Another interesting aspect of the book is Jennifer's description of midwifery training, and nursing training in general-the two being then and now more closely linked in England than in the US. She mentions the Nightingale School of Nursing, and a book Nightingale wrote about birth at the time, "Introductory Notes On Lying-In Institutions, Together With A Proposal For Organising An Institution For Training Midwives And Midwifery Nurses." I must read this! I just finished reading her "Notes on Nursing: What it is, and what it is not." I learned a lot from it and look forward to reading her thoughts on birth practices and midwifery. At any rate, it's fascinating to read Jennifer's description of becoming a nurse, and the strict hierarchy and occasional cruelty of the matrons she learned from and worked under. It sounded familiar.

Most intriguing is the fact that to learn midwifery after being a nurse for some time, Jennifer was sent to a convent in an urban slum. She lived with the nuns, whose entire practice was exclusively midwifery. I am trying to picture moving into a convent. Having my own stone room, a cot, a desk, a wash basin, a bike, and that's it. And all I would do, from dawn to dusk six days a week-midwifery. Antenatal clinic once a week in the church basement, births zoomed off to by bike, and twice daily postpartum visits to moms in the first week after birth, then once a day for another 1-2 weeks. I have to admit, it actually sounds kind of great. I would miss Alex of course, but I think I could love living with other midwives, and having my own stone room for a few months. It would be pretty amazing to have the opportunity to focus so closely on developing my skills.

Well, I should go. I am at Children's tomorrow morning, and I want to get up at the crack of dawn, so I can finally put my big rack and basket on my bike! I want to put my kit on it and roll away!

The book is The Midwife, by Jennifer Worth.

Holy Births and Howling Babies

Holy Births and Howling Babies

In my backyard there are nuns who live in a shaded brick building

next to the St. Stanislaus church and elementary school.

Together we rise before the sun is in the sky.

Behind the kitchen curtain, in the damp haze of morning,

I watch them walk in shades of blue robe.

They glide in white sneakers across the parking lot.

They are cool, calm, brisk.

Some day, I’ll go see them

I’ll ask for some lesson on prayer.

Because the thing is…I pray now.

Not Dear God Almighty!

Just slow, easy, quiet thoughts.

I pray when my patience is worn.

When my shoulders ache.

When my own voice becomes tiring to my ears.

I pray when my heart sits heavy with stories and faces of women.

A prayer for the 32 week babe.

A prayer for the lady with the skinny, squawking twins.

A prayer for a mother without a mother, or a lover, or a friend.

I pray when my cold hands run across a pregnant belly

And I feel a kick from the inside.

I pray for all my babies, Be good to your mama.

I pray for all my mothers, Be strong, be good to this baby.

I pray secretly and I pray slowly.

I pray for us, the midwives and the almost midwives.

I pray that we make the right decisions.

And I pray for those of us who make bad decisions.

Decisions we regret with outcomes we can’t change.

I pray that we learn from our mistakes.

That with age comes wisdom.

I pray deeply and I pray completely.

For all the hands and all the bellies.

I pray for holy births and howling babies.

-Dana Quealy, CNM, MSN

You are Already Enough

At the end of a long 12 hours at the hospital. Strangely, after a full day of urine dipsticks, gowning and un-gowning, call lights, pumps, shots, meds, and more pee, all I want to write about is how much I've learned from my clinical instructor, F. She has a pretty amazing depth of hands on, nitty gritty 'how to give that drug' 'how to assess this kiddo' 'how to chart that crazy thing that just went down' knowledge to share, and she shares generously. She's nice, too. She build us up my confidence and passion, instead of making me feel like incompetent jerk, going home every night wondering why on Earth I thought this was what I wanted to do. But the two biggest things I've learned from her are nothing to do with drugs, pumps, lines, or machines that go ping. The two things are 1) Our patients are human and 2) We are human too, and that is a good thing.

You might be thinking "But Caren, you're a doula and a future midwife-you know you have to act in loving kindness, honoring the human experience." I do, it's true. I know it's important. I also have to tell you that it's a lot easier to do that when I have no real doubt that this will be a happy ending, an experience I will overall be glad I was present for and that I know is healthy and normal-not something that will break my heart and make me want to hide under a rock. Instead of being happy to engage in a joyful family process, I am scared to get pulled into the current of a terrifying, tragic, draining time in a family and child's life. Also, I was good at my job as a doula, and didn't have to think that hard about what I was doing at every moment. I was unlikely to kill anyone if I made a mistake. That made it easy to focus on the experience and the people. When I'm all thumbs and nervous as hell that I'll screw up bad enough to hurt someone, I get tunnel vision to what my hands are doing and which tasks need to be completed. So, although I have the values in place, F. has deepened my understanding of them and challenged me to live my values in more difficult times.

On the first point, that our patients are humans, you'll think "yeah, duh." But people in hospitals are dehumanized, for many reasons and in many ways. I think staff dehumanize patients in an effort to protect themselves from heartbreak and burnout (although I'm unconvinced that it's an effective strategy). For some professionals who do very high risk things (like surgery) it might take a certain amount of dehumanization to do their job without abject terror.

We are educated in a way that dehumanizes patients-we are shown gruesome pictures of terrible injuries and diseases, with only the diseased body part shown or the eyes blacked out. There is never a caption on these pictures that says, "This diabetic foot belongs to Mr. Jones, who is the proud grandfather of 3 boys and a girl, the husband of 65 years to Mrs. Jones, and an avid hobby train enthusiast." Mr. Jones is reduced to just a disembodied gangrenous foot. We memorize standard symptoms, pathologies, and treatments, and not how it feels to be a 17 year old girl who is incontinent, and has no hair on her head, but a full beard from her medicine.

Perhaps most importantly, we never see these patients-these people- in their "real" lives. When we see them they are afraid for their lives, surrounded by equipment, with lines and drains coming out of any or all orifices and out of unnatural holes we've made in their arms and chests. They are living under literal microscopes that tell us every detail of every body fluid and cavity, but also under figurative microscopes that are constantly observing how they parent, how they behave towards their parents, if they're 'compliant', if the parents' marriage is 'healthy', if they're 'in denial' or 'high needs.' For God's sake, do you know that your neighbor had an affair? Do you know how much they drink? Do you know they flipped out and yelled at their kid yesterday? No. You aren't given the opportunity. We have the opportunity to observe and pathologize and dehumanize at every moment of these kids' and families' existence. All of it adds up to make people into patients.

And yet, what we see in the hospital room is not them. It's not their real life. It's a little piece of something they're doing so that they can live their real life. For example, I was reading a blog today from Harvard's Center on Women's Mental Health that referred to pregnancy as a disruption to a woman's treatment for bipolar disorder. A year ago I wouldn't have thought twice about that statement. After this quarter with F. and the families on my unit I think, "No!" The treatment is a disruption of this woman's life course which includes pregnancy, not the other way around. The treatment is meant to enable her to have that life that she chooses, not to become her life. So, F. is teaching my to cut through the dehumanization and see a 2 month old and his parents for who they are, not for what the diagnosis is and what equipment he's hooked up to, and what the social work note says. She's teaching me to do the harder thing, to see my human patients, my fellow humans, our thus to see our shared human fallibility.

This brings us to the second point: we are humans, and that is a good thing. This is a hard one for me. Like most people, I pull back reflexively from things that hurt me to see or do. I do mean things to people sometimes. Shots, dressing changes, meds that make kids barf or cry. It's hard to be human when I'm doing sort of inhuman things, even when I know it's for the patient's health. F. pushes me to be uncomfortable and be in the moment with uncomfortable people. You may wonder what could be more uncomfortable than 40 hours of labor (which I happily and quite comfortably am present for), and I can tell you that acute illness of the kind seen at acute care hospitals is much, much more uncomfortable, undignified, and scary. Labor is normal, healthy pain with a joyful purpose, while diseases causes suffering with no purpose. But, just like women in labor, people in the hospital be they a kid with cancer or an adult with a broken pelvis need me to be human, be present, do everything possible to prevent suffering- but also not flee when I can't prevent it. F. said today, in response to a question about what we should know to say and do at the end of a patient's life, "It's ok. You are already enough. You are a human, just be human." So simple, so hard, and so true.

Rareified Air

I've never in my life used the term "rareified air" and I don't even know what it means. But all I could think as I rode my bike along Lake Washington this evening is that the air was rareified. Not only are all the houses on this route gorgeous, and have beautiful, overflowing cottage gardens, but the air itself actually smelled like honeysuckle and ocean. I got the lovely nostalgic feeling of being at my grandparents' house on the sound in Florida, the same feeling I get every time I smell Yardley of London Lavender soap (the only kind my grandmother uses, and what was always sitting on the stump next to the faucet where we soaped up and hosed off after playing in the sound all day, before we were allowed to come into the house). I also get this feeling whenever I see one of the extra-gigantic (2 gallon?) plastic buckets of ice cream at the grocery store. I always resist the urge to buy them because, hey, I don't need to eat 2 gallons of ice cream. But I long to see that big plastic bucket in my own freezer, and later to use it for compost. My garndparents always had the big bucket of ice cream (makes sense with 7 grand kids and their parents always at your house), and when it was empty, it became the compost bucket, which my grandfather would take out after cleaning the kitchen with a grandchild after dinner. When I was a teenager and still lived at home, but could drive, my grandparents no longer lived at that house, having been flooded out of it by every hurricane for the past 25 years or so. But I would still drive over to that house and park across the street from it, looking at it, when I was really upset or had a bad day.

Life Tasks vs. The Big Picture

Several conversations over the last few days have made me think about what life should be like, who I want to be, who Alex wants to be, who we want to be together. My mom was making a "bucket" list (I made one a while back, you can see it in my July post from last year). But as I was looking over it just now, and talking to Alex, I was realizing that what I want is not to neccessarily accomplish this certain list of tasks. What I'm going for is a lifestyle, which I can kind of get a picture of from looking at those tasks.

I want my life to be a little bit like a Nikki McLure print, I guess. I want my life to be oriented towards adventure, enjoying the small things, being together with Alex and growing our relationship over the decades, learning from life and other people and growing spiritually, appreciating the passage of the seasons, communing with friends, building community, giving service to others-loving life and sucking the marrow out of it. I've always told people that I am a very visual person. I have to be able to actually see myself doing something or being someone in order to make it happen or to feel that it's right. So when I look at my life list I see myself riding my bike to the farmer's market in Columbia City, having coffee on the porch with Alex, making dinner with a crowd of friends, picking raspberries and sweet peas in the garden, being an excellent and compassionate midwife, going stargazing with Alex and making out on the beach.

Having the life list is helpful because it helps me see what the vision is, and maybe it will help me check in with how I'm doing. Since there will no doubt be hard days in any life (how else would we learn, and deepen connections with our loved ones), knowing that I am generally on the right track will be good. Here is my somewhat updated life list. It's scary to let go of the old one, becuause I worry it means I'm never going to accomplish anything with this everchanging goal. Ain't that life, though?

Near Future:
1) Keep fresh flowers in my house
2) Shop at the farmer's market
3) Grow our own food, and preserve for the winter
4) Remember to send cards and little gifts on people's birthdays
5) Kill my TV for good!
6) Learn to play the cello and/or the fiddle
7) Host a Love Feast
8) Go ice skating every winter, pick berries and fruit every summer, bake cookies and press leaves in the fall, cut our own tree and decorate like crazy for Christmas, dress up and hand out candy at Halloween, go all out for Thanksgiving Dinner with lots of family and friends, make Valentines cards and cookies for friends and family...
9) Try rock climbing
10) Be a trail runner
11) Make a budget and stick to it for a year
12) Hike a National Scenic Trail with Alex
13) Do yoga at least once a week for a year
14) Use my bike for 90% of my transportation
15) Fulfill my wedding vows every day
16) Go on a date once a month
17) Bake our own bread
18) Make out with Alex at a drive in movie
19) Go on a weekend road trip with Alex
20) Maintain close friendships and let my friends know how much I value them
21) Go stargazing with Alex and make out under the stars
22) Camp on a beach in the Fall with friends

Long Term
1) Be a kind, loving and faithful wife
2) Be an excellent, compassionate, skilled midwife
3) Be a foster parent
4) See Alex hold our baby
5) Volunteer at a hospice
6) Have my babies and grow old in one single house

Standard Issue Nurse

I bought my UW purple scrubs a few weeks ago. And a white coat. Oh, the white coat. That symbol of authority and knowledge, of professional solidarity . I am at once proud that I will soon be wearing the uniform of a health care professional, and extremely cautious about it's meaning. I just want to be clear with myself about what kind of provider I'm going to be. I think I need to be pretty solid about my core beliefs and values before I start the standardizing process of nursing school.

There are advantages to standardization. It's nice to know that no matter where you get your care your privacy is protected by HIPPA, and your physician is somewhat bounded by standards of care. On the other hand, our health care system is not as uniform as one might think. There are huge variations in policy and treatment from one hospital to another, and even from one provider to another in the same institution. One week at Evergreen, moms with epidurals can use a squat bar and eat popsicles. The next week they're flat on their back for the duration, and it's ice chips only. One Group Health provider says 4cm and contracting every 5min is not even active labor. Another says if you do this for more than 12 hours you need a cesarean for failure to progress. So, standardization is at once a blessing, a curse, and an illusion.

Nursing school and medical school seem to be designed not only to teach providers the physical and mental skills, the facts, figures and flowcharts of their professions, but to teach them a certain belief system about their profession and about patients. It involves a little bit of de-humanization. Maybe you have to be a tad arrogant and a bit emotionally removed to take people's lives into your hands. I guess all I know is this, that I want to keep a few things about my beliefs and my humanity intact, regardless of what I learn in school. Even if I look like everyone else, in my purple scrubs and white coat, I want to hold onto what makes me human, and passionate about health care in the first place, and what grounds me. So I think I better write it down before I even start school.

1) We all, every one of us, deserve compassion, dignity and respect.
2) Just because I know some things about the human body does not mean I know more about my patient than they know about themselves, and does not make me superior in any way.
3) An ounce of prevention is worth a pound of cure.
4) People make good decisions for themselves, when provided with the information and resources they need to make those decisions. If it's not the choice I would make, that's Ok because it's not my choice to make and I'm not the one who lives with the consequences.
5) Most of the time, people need you to listen long and hard before you speak.
6) It's OK to say you're sorry.

Defensive Doula

You often hear about "defensive medicine." Providers who at the very least, chart every possible interaction and occurance with their patients so they are somewhat protected if the patient later sues for a bad outcome. At worst, providers use an intervention just to say they did something, which is thought to be better than doing nothing. Lately I feel like I've been practicing defensive doulaing.

I've begun to feel like, when I attend a hospital birth, the doctors and staff very much assume that my client will have an epidural, pitocin, and very possibly a cesarean. They are justified in the assumption: at one local hospital, 90% of women have an epidural, adn 36% have cesareans. When 90% of your patients have an extremely abnormal birth, abnormality becomes the new paradigm. The staff at the hospital with the highest epidural rate is clearly uncomfortable with normal birth. All the moaning, all the pesky position changes, the sheer duration of a normal birth. They are uncomfortable with women in pain, women who are tired, women who need emotional interaction and support. They are so used to an immobilized, chatty, TV watching laboring mom that when my sweaty, moaning, vomiting and shaking, hip rocking, crying, squatting, normal birthing mom is in the room they feel they must DO something. And what do they know how to do? For a while they might sit next to a bed (where many women assume they must stay during labor, or are stuck with a routine IV and fetal monitors) and tell a woman to "just relax, breath it out." But, they have other things to do, and I really get the feeling that many of them think the idea of unmedicated birth is just heinous, an unnecessary cruelty. And if you offer a woman in that much pain an epidural, they have an awfully hard time saying no.

Anyway, lately I've been feeling like I need to prepare my clients, really, really prepare them, to defend themselves from the new normal. Wait to go to the hospital until the last possible moment in labor. To say no (repeatedly, confidently, and assertively) to pretty much everything the staff tells them they 'have' to do. To close their ears to the innumerable discouraging comments, and to close their legs to the innumerable, discouraging, and pointless-unless-you're-in-a-hurry vaginal exams. I've even resorted to encouraging the use of very defensive, almost legal language in birth plans, to put the fear of god and litigation into the staff. "I DO NOT CONSENT to any cesarean that is not an emergency." Telling patients they might want to cross out the section of the admitting paperwork where they sign a general consent for a cesarean. This is not stuff that encourages the team spirit, mutual respect, and collegial vibe that I have always worked for in my relationships with staff.

Although I'm not happy about these ways in which I've changed my practice, I'm not ashamed of them. There are changes, however, that I am more worried about. These are where I am truly taking on a practice similar to defensive medicine: I'm doing something (something I don't even believe in) just to do something, to change my clients behavior because I can't change the providers' behavior. I'm ashamed to admit that I've used directed, purple pushing with unmedicated moms, because I know we have 3 hours to get the baby out before the staff start to move for a cesarean or if we're lucky, a vacuum. An unmedicated mom with a good urge to push may take 4-5 hours to push her baby out, both mom and babe are perfectly healthy, and she pushes when and how she feels she needs to. Lately I've told moms that they're better off to flat out lie to staff about their pain, frustration, or fatigue. Of course the mom is tired. That is NOT a valid reason for major abdominal surgery. Even worse, telling women you think they are too tired to push at all, before they even try, and before they have said boo about being tired. I feel terrible encouraging my women to change their normal birth to save them from an abnormal birth. Wait forever to go to the hospital so that you have to practically crawl down the hall in transition. Furitively sneak gulps of apple juice when the nurse is out of the room. Outright deny your perfectly normal feelings of fatigue, frustration, uncertainty. Lie when they ask you to put your (level unspeakable) pain on a 1-10 scale and say it's not too, too bad, maybe a 7. Lie and say you aren't at all tired when it's time to push, say you have all the energy in the world. Because the staff has 0 faith in women's ability to give birth, they latch onto the slightest indication that she too is doubtful, and exploit it to push intervention.

All of this bugs me on the obvious level that it is unjust for the laboring woman. But it bugs me in a more insideous way too. Because I am not a rule breaker. I am a rule maker, a rule follower, a research and science and fact junkie. I'm the kid who cried when I was even mildly scolded for breaking a rule. I'm not one of those fanatical, radical, 'use nothing but your intuition to make decisions about your birth' people. I believe firmly that there is a time and a place for everything, including epidurals, pitocin, and cesarean birth. I believe that we should base medical recommendations on good research, and that clients should base their decisions on solid, honest information about the recommendation, the alternatives, and the risks and benefits of each. It bothers me that sometimes I hear myself talk about birth, and I hear the voice of a frustrated fanatic, not the logical, down to earth, pragmatic person I am. Of course it bothers me that believing a woman in labor has the right to full informed decision making makes me sound radical.

Moreover, I have to walk a very fine ethical line between my scope of practice and standards of care as a doula, and doing what the situation demands to defend my clients from ridiculous hospital policies and bad provider attitudes. It's hard on my self image; it's hard on me emotionally to go to births where I feel like the woman is truly treated unjustly, and it's hard on me to feel like I'm constantly toeing a line between actually helping my clients get good, healthy outcomes, and stepping outside of my very restricted scope as a doula. Technically as a doula I am supposed to "protect the woman's memory of her birth, recognizing that birth is a peak life experience." But I am quite sick of trying to protect women's memory of their unneccessary cesarean. And it's hard to qualify an afternoon spent napping, doing cross-words, and watching TV as a peak life experience, even though it does end in a new human being.

I'm doing my best, and I'm not sure I'm doing enough. That sucks, because I care. A lot. About birth as a peak life experience. About the health of moms and babies. About the way a woman remembers her birth and perceives her strength in birthing, and takes that memory and knowledge of how strong she is, and uses it to get through sleepless nights, teething, smarty pants eight year olds, snotty teenagers, sending her baby to college, supporting her daughter when she has a baby of her own. It really, really matters.

Obit Reader

Reading the obituary page is definitely my favorite part of the whole paper. The rest of the paper is all passing news, the scandal of the hour, and no matter how horrifying that particular hour is-well, as someone once said (the Bible?), "This too shall pass." But not the Obits. The Obits will stay the same way forever, and the lives of the people they memorialize are now static. How much easier it is to get a handle on something when you're pretty sure that no new information will be dropped on you at the last minute. Of course that isn't uniformly true. God bless the family that finds out years after a death about some unsavory aspect of the deceased (Grandma's S&M buddy memorializes her as such in his obit), and also those who find out about a heretofore unknown aspect of their loved one's good character (the janitor who saved millions to donate to charity). However, these are probably the exception to the rule. For the most folks, the obit is the final summary of what you did or did not do.

When I scan the obits, I look first for the tragedy. The birth and death dates that aren't far enough apart, the "died suddenly and unexpectedly," the ones that mention the memorial service being held at a high school. Tragedy wakes you up like no cup of coffee ever could, readying you for a day of making sure you get a few things taken care of, telling some folks how much you love (or despise) them, and doing something worth noting for chris'sake! It seems like a mistake to me to think that because I am 23 I have plenty of time to make my death noteworthy and my obit interesting. I've seen many 17-25 year olds in the paper, whose families were obviously struggling to come up with something notable about them without resorting to their remarkable ability to be an ass to their parents, their outrageous acne, their record breaking SAT scores, etc. They end up with something like, "Jessica/Kevin was a friend to everyone she/he met." No, they weren't. Why would they want to be? I much prefer the families who choose to acknowledge what may have been truly remarkable about their kid, but maybe they're the only ones who knew or appreciated it. "Epiphany Asteroid Jones once told her 2nd grade teacher to kiss off, and maintained that attitude ever since, applying it especially vigorously to her cancer." The lucky ones are those whose kids actually did do something that they would have wanted written about. "Mary volunteered as a Ski-for-All guide, helping people who were blind or had no legs to ski." It seems almost more tragic than a premature death when the parents can't think of anything to say about their kid. I don't want to be mean. The last place anyone hopes or plans to spend their creative writing energy is on their child's obit, and unlike the elderly, few teenagers pre-write the obit or mention what they want said. I guess I just hope that if I died right now, no one would censor themselves. Just pour out all the grief and humor you can find in my life and death, and publish it for posterity to dig up in a geneology library some day.

The next set of folks I look for are those who were married for 50+ years. Remarkable. That's something that, if I am hardworking, lucky, and dogged enough to accomplish, I damn sure want noted in my obit. If the spouse is surviving, I am forced to think about them. I have shared a bed with Alex for seven years, and I don't sleep well without his twitches and snorts, and the occasional, precious half-awake declaration of love. It's unimaginable how one would feel after 65 years, whether they were spectacular years or not. I guess for some it could be a sense of relief, but I have to think that for most it's more like losing three of your limbs, all at a go. "John leaves behind his wife of 67 years," is going to be a rarer and rarer sighting on the obit page. Those I read about who reached the 50 year mark were married when they were around 20, sometime in the 1940's. I know very few people now who are married before they're 30, if they marry at all. Those that do eventually marry proceed to get divorced in fairly short order. It seems like 20-25 years is the longest one can hope to be married these days. I certainly hope it's a trend that turns around, that some miracle of good communication skills and loving respect will present itself out of the depths of a nation immersed in bad examples on reality TV. In the meantime, I pay my respects to these hardworking and loyal spouses.

After premature deaths and long-time spouses, I read everyone else. A few minutes spent in meditation on people with no obit, just death notices. A few admiring thoughts for folks who did quirky things they must have caught flack for (collecting 150 antique vacuum cleaners comes to mind), and people who suffered the extraordinary and lived on (a child abducted and never heard from again, a holocaust survivor, any combat vets). I know there are lots of things not said in the obits that might be lovable or despicable, and I spend a minute contemplating what those things might be.

Then I close the paper, and having been reminded of the important stuff, live my life.

Not Much Cookin'

Not much to report at all today. I rode the bus to the shelter, which was great. Buses are fantastic when you have all the time in the world to get where you're going, and a good book to entertain you and keep the weirdos away. It was a perfect fall day here: cool, crisp, blue skies, and a breeze.

The shelter was quiet, and all I did was update obselete forms in an obselete word processing program. I worked with T., my favorite advocate. She is hardworking, up front, and knowledgeable. What more could anyone ask for.

I just finished a pretty good book, called The Beautiful Things that Heaven Bears. And, after spending a few minutes thinking about it, I decided to add a reading list to this blog. I always appreciate a lead on a good book, and my mom has always (really, always-like since 2nd grade) encouraged me to start a reading list. Like many things my mom has encouraged me to do over the years, I regret not having done this sooner. Just trying to remember what I've read over the last few weeks was hard, let alone 2nd grade. I'll always remember Ramona, Nancy Drew, Zel, and unfortuantely and embarrassingly, the Babysitters Club series. Beyond that it's a long, mostly happy blur. The public library doesn't keep a list of what you check out, which is quaint, since I'm sure Homeland Security does.

Maybe I'll have more exciting things to say soon. If anyone actually reads this blog, post comments now or forever hold your peace when I start posting gory details of my cat's life because I think no one else is reading this....

Workaholics, relax-o-matics

I've been thinking a lot about work lately. Some would say I have time to think about it because I haven't been doing that much of it. I think it's part of my lifelong process of self-acceptance. Also, living with and loving the people I do, work is like a 7th house mate, a family member, the juicy friend that's great to gossip about around the dinner table.

Some people work a lot because they must in order to make ends meet. Other people genuinely love what they do for a living. Some feel obligated to work because their work is important to the world. But I've found that the people I know, regardless of their motivation for working or whether they take pride in the work itself, take pride in working a lot.

I'm not so sure working more than necessary is a good thing. Everyone seems to have a rebellious viewpoint on at least one generally excepted socio-cultural norm. My friend Ben thinks that lard is good for you, and damn the surgeon general. Several friends think that monogamy is a terrible and oppressive practice. A few disbelieve in the existence of most mental illness. I take issue with the moral value of work, specifically working a lot.

These work-a-lot types aren't the people I'd think they would be. It's not like they're stock brokers, day traders, ER residents, miners. They're union organizers, teachers, bar tenders, students, retail clerks. Alex, as some of you might know, is definitely a work-a-lot type, and he has so far come up with the best (and most damning) explanation of work-a-lots for me. "If everyone else would just work more, just do their share, I wouldn't have to work so hard." He told me this a few years ago, and I was overcome with guilt. I, through my relaxation, was working him to death. I immediately started a student group, joined a board, started volunteering at a shelter and a hospital. By God, I was going to do my part to save the hard working work-a-lot types from perishing for my relaxation sins. Of course, that is the vastly oversimplified version of events. I really did and still do care about the organizations and projects I am involved in.

Nothing changed except for my level of anxiety and self-loathing. I'm bad at being overworked, and for a long time that has been a source of shame for me. I have an irresistable urge to slack when I am overwhelmed, and it's not as pleasant as it sounds. At my breaking point, it happens like this: I lay down to sleep, at last, around 1am. I have nightmares all night, that make me cry out, thrash, and generally disrupt my own and Alex's sleep (recently, my spine was torn out by an alligator). After weeks of sleep that is basically more exhausting than it is restful, I wake up one morning, crack my eyes, and can't get out of bed. My heart is beating so fast I fear that I will have a heart attack. I know, from various failed attempts at athletic training, what my maximum heart rate is, and I know that I must me approaching it as I lay there sweating and panting, exhausted and unable to do the 8 bazillion things I have promised various committees, the homeless, the abused, my family, my friends, myself, that I will do. It goes on like this, until I close my eyes and wait, submit to the panic, and eventually it passes. If I have any sense, I go climb into the guest bed and go back to sleep. If not, I go get started on the 8 bazillion things, but the truth, I've learned from so many repeats of this episode, is that it's all over at this point. My relax-o-matic kicks in. I can't focus enough to get anything done. In my shame, I don't call or email or text anyone to let them know that I'll be dropping out of society for a few days or weeks. I just stop. Recently, I stopped as I have before, but this time I tried something different. I tried not to hate myself for stopping. The nightmares and the heart attacks continued for a while, but over the last few weeks they've been on the decline.

It's hard not to think of my inability to handle overwork as one of my greatest moral failings. There are all kinds of derogatory labels for people like me, but I know they're others out there. Partly because Alex is not one of them, and he complains frequently about people who all of a sudden, after a period of good work, stop returning his calls and emails, miss deadlines without warning, blow off important meetings. He is mystified, but I know. They're me. It doesn't help a lot on my mission of self-love that these people drive Alex crazy, but whether out of unconditional love or out of ignorance of my true relaxing nature, he loves me. I prefer to think it's the latter that gets us through.

One option that I've considered in the past is that other people only pretend to work harder than I find possible, unkindly fibbing me into attempting the unreasonable. Sadly, that theory has been disproved my my current acquaintances. In the interest of their privacy, I won't go into specifics of their schedules, but suffice to say that no one works merely 40 hours a week. Relaxation is a priority for no one. Reading the paper leisurely while drinking a hot cup of coffee, contemplatively staring out the window for a few minutes, browsing dusty corners of the local public library-none of this is penciled into their schedules. Some of them try, sometimes subtly, sometimes cuttingly, to make me feel like a bit of a loser for partaking in these activities. Lately, I refuse. I refuse to feel guilty. Not that I have reached Buddha-like peace with myself on this issue. I'm still just a little jealous of other people's capacity for work, but lately I've been hoping that they are a tad jealous of my capacity for doing nothing.

Oi! The guilt!

Song o' the day: http://www.xtreak.com/go/carenott/130533/Trinity_Roots_-_Little_Things.m

I just called in sick to my postpartum job today, because I am so overwhelmed with other things I need to get done. In the longterm, it's a good decision because I'm working on my longterm, big picture plan today, but in the short term...Oh the guilt! I just need to be organized enough to work full time AND get nursing school stuff knocked out. But we all know that's not how I am, at least not at this stage of my self-improvement.

Things I'll be doing today:
1) Writing three birth stories and emailing them to clients
2) Calling to check in on postpartum mamas
3) Calling to check in on pregnant mamas
4) Emailing out birth plan forms/examples and homebirth supply lists to two clients
5) Rough drafting two essays and finishing the form part of the common application
6) Volunteering at the DV shelter
7) Mailing off some care packages
8) Deciding who to ask for letters of rec
9) Catching up on SMS board stuff....ugh
10) Updating my appointment book

Things I need to do tomorrow:
1) Take a float test for rowing (yep, I can tread water for 10 minutes!)
2) Study for GRE
3) Pick out some cologne for Alex (cause it's really for me...)

Alex is being incredibly wonderful helping me stay motivated and enthusiastic about nursing school applications. We daydreamed last night about how great it'll be to get acceptance letters (please, please, please!) and actually get to go somewhere new and do something new. The world is so wide! Staying focused on the outcome is definitely important, when it's so easy to get dragged down in the annoying details of applications.

I'm trying to think about any updates I haven't included since I last posted. Went to a great volunteer birth at the UWMC last week. Early in the labor I really didn't feel like I was connecting with the mama. The differences between us were so huge: she was African, already a mother, much older than me, probably not someone who would've chosen me had we interviewed. But I was the only volunteer available when she got to the hospital, and she was stuck with me-or at least I felt like she felt stuck with my cheerful, young, white, childless, English-speaking self. But as usual, when hard labor really set in, the walls came down, we connected, and afterward we felt like sisters for the 45 minutes or so I could stick around. It is wonderful and amazing what labor does to social boundaries and divisions.

I also got a kick in the pants from watching the new resident, and (I know this is totally prideful and arrogant) realizing that I know a bit more about normal labor and birth than he did, and possibly am even more familiar with the common drugs and interventions. To cut the guy some slack, all the newbies just started July 1st, so he hasn't had a whole lot of time yet, and maybe he doesn't even want to work in OB. But still-it made me realize how much I really have learned from going to all these births over the last couple of years. The interrupted sleep has paid off!

My twins moms had their babies yesterday-they are HUGE for twins, and so healthy! Yea!

Alex has a stress fracture and tendonitis in his wrist, probably from his bike trip. Poor guy can't ride his bike now, but he is quitting his job effective late September. That's soothing the wound of being bike-less.

As you can see from the To-Do list above, I need to go actually get things done.

Love ya's!

Caren

Holiness Issues in Blasts

What a lovely morning. 59 degrees, drizzling. The Bird is squaking away in her crib, and I'm sure her mom is trying to squeeze in a few more minutes of precious sleep. Here's the perfect song for the morning.

Alex, Ben and Jason left for their bike trip through the Columbia River Gorge this morning at 6:30am. I hauled myself out of bed to wave them off with a white rag, like a good Adkison-Ott girl would. Then back to bed with a hot cup of coffee and a good book. Annie Dillard is my favorite essayist. She writes about the details of things, and I think I move through the world more appreciatively after I read her writing.

"This hospital, like every other, is a hole in the universe through which holiness issues in blasts. It blows both ways, in and out of time. In wards above and below me men and women are dying. Their hearts seize, give out or clatter, their kidneys fail, their lungs harden or drown, their brains clog or jam, or die for blood. Their awarenesses lower like lamp wicks. Off they go, these many great and beloved people, as death subtracts them one by one from the living-about 164,000 of them a day worldwide, 6,000 a day in the United States-and the hospital shunts their bodies away. Simultaneously, here they come, these many new people, for now absurdly alike-about 10,000 of them a day in this country-as apparently shabby replacements."


Last night's Torchlight Parade was awesome. My favorite, of the at least 12 drill teams, was the Baby Dangerettes. All between 6 and 12 years old, these little girls rocked the tasseled cowgirl boots and sequined uniforms with attitude. "Bang, bang, choo choo train, come on girls and shake that thang!" Indeed! The high school marching bands were poignant-all arms and legs and tubas, faces temporarily ravaged by acne, playing for all they're worth. At the end of the parade the Seafair pirates come through, blasting realistically loud cannons, terrifying small children, and running off with pretty bystanders.


I've been working on my Must-Do List. Here is a start on it.

1) Be a foster parent
2) Ride the Duck
3) Complete a triathalon (Next August, Danskin Women's Triathalon)
4) Catch 10,000 babies in my lifetime (9,998 to go!)
5) Catch babies somewhere else in the world, too
6) Live in NYC (With Alex in Philly, I should be able to at least visit NYC sometime this year!)
7) Kill my TV for good
8) Learn to play the fiddle
9) Hike a National Scenic Trail (or all of them...)
10) Host a Love Feast
11) Go ice skating each winter
12) Try rock climbing
13) Rent a canoe on Lake Washington
14) Become a nurse-practitioner (nurse-midwife/FNP) (On my way to a BSN from UW!)
15) Make a budget and stick to it for 6 months (2 months down!)
16) Consistently balance my checkbook on the first day of the month (REMOVE FROM LIST: HUBBY IN CHARGE OF THIS NOW!!!! MUAHAHAHA!!!)
17) Go to yoga at least once a week
18) Develop my spiritual practice in some way-need to think about how
19) Learn to play cello
20) Volunteer at a hospice
21) Earn my board certification as a lactation consultant


More to come!

I'm off to church, then to see Mama Mia with Alex's sister Jennifer and her kids, who are visiting from El Paso, TX this week.

All my best!
Caren

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

Duck, Duck, BIRD!

Well, nothing too exciting happened yesterday. Except....BIRD SAID HER FIRST WORD!!!! I've been waiting practically since she was born to see what this brilliant little person was thinking about. Turns out she's got ducks on the brain! Mama Bird gave her a little stuffed terry cloth duck, which the Bird absolutely adores. She loves to hug, chew on, and whack this duck. When I go to pick her up from a nap I often find her chillin' in her crib with Duck. So Papa Bird and I were holding it up for her and saying 'Duck' over and over and over, ad nauseum. Bird must have gotten sick of us idiots babbling on about her duck and not playing with it, so she put a stop to it by holding up her hands in a gesture of surrender and saying "DUCK"! Wow. It's somehow made me feel like I know what her voice is, even though she's been babbling away loudly for months now. That she articulated an actual word that we both know the meaning of just made her into such a kid. Supposedly she's only supposed to know 3 words or so by 12 months (she's 10 months now), but this Bird is smarter than the average Bird, so I wouldn't be surprised if she starts work on her first novel next week. Something perhaps entitled: Boobs, Ducks, and Pureed Carrots: The Three Great Loves of Baby Bird's Life.

In other news yesterday, I got to go on an Argosy cruise! What scenery! The couple I'm babysitting for had a great rehearsal dinner party while we cruised the Puget Sound for three hours. Their little red-headed 5 week old slept right through it, despite being the subject of the Auntie & Granny Paparazzi. I wore her in the Moby all night to avoid a massive game of pass the baby. Hopefully I'll post some pics soon.

The minute we got back to the dock I got a page from a second time mom who thought for sure she was in early labor. Fortunately for me, I've found that second time moms often labor at night for days or even weeks, and then stop completely during the day. My old midwife pointed this trend out to me, and attributed it to a brilliant evolutionary development: labor at night, take care of the other young during the day, and then eventually have your babe under the cover of darkness. It was also a full moon last night. Anyway, I did get a full night of sleep, and dreamed that this mom had a precipitous unplanned homebirth. I caught her baby, covered in thick mec (I don't carry any birth equipment with me, because I never intend to catch babies, but in my dream I tried to suction this kiddo with my mouth over his nose and mouth-not super effective). He was pink and toned, and all kinds of supernatural weather events (lightning filling the sky, flying rainbows, water spouts on Lake Washington) were happening outside. I told the dad to call 911, but they never came, and I did the whole birth myself (intact perineum and a lovely placenta, but a slow trickle hemorrhage that I gave her Shepherd's Purse and lots of fundal massage for, BTW). This dream was perhaps partly due to being almost done reading the last Harry Potter book, partly because I did accidentally catch a baby the other day (but in the hospital), and partly because I love this mama and I really want her to have a calm, spiritual, and healthy birth-but not an unplanned homebirth!

I rode my bike down to the pier and back last night, which was fun. Everyone was out in the International District and Pioneer Square, celebrating summer, Friday night, and a full moon. Some fella hung out the side of his souped up blue caddy with gold rims, and asked for a high five! Sorry man, too slow for me!

Gotta go! I'm off to yoga at the Y, and then maybe Goodwill for a dress to wear to the wedding tonight. I also had a dream last night about a dress I tried on years ago at a thrift store and loved, but it was too small. In my dream I went back to the store and the dress was 75% off, so I thought, 'Why not, I'll just try it again.' It fit like a charm.

Love,
Caren