Archive for March, 2009
One of my AAMI assignments and suggestions for Phase 1 is starting a journal of my birth-related experiences (check) to chronicle my growth as a midwife (check). What brought me to this point (check) and where am I going (uncheck).
So, where am I going.
I sincerely hope that I’m going to a place where I can practice midwifery legally, and that the restrictions placed on my license are appropriate within the scope of the midwifery model of care, and not difficult for either me or my clients to follow. I would like practice somewhere where I can legally do VBACs, twins and breeches.
This location may not actually exist. (It might be Texas or Oregon.)
I realize that I’m answering the question very literally, like what specific place do I want to go and practice as a midwife. What I really want is to be able to follow the midwifery model of care. I’m not sure that a place where I can’t handle breech (which is a normal variation) is really a place that supports the midwifery model of care. Same with VBAC. Twins, well, maybe. I realize that some twins can be more risky, like MZ mono/di twins. But DZ twins usually aren’t very risky. I wonder what the Cochrane Database says about DZ twins and midwifery.
To answer where I want to go: I want to be a midwife. I want to understand normal physiological birth. I want to know enough about complications to be able to handle them calmly, or know when and how to transfer to the appropriate medical facility. I want to be able to help clients prevent complications to the best of their ability (whether they choose to do so or not) and treat pregnancy-related issues in a holistic way. I want to know. I want midwifery-related concepts and ideas and physiology to be second nature for me.
In order to do this I’m going to have study and learn learn learn. Despite being a doula, it really amazes me how little I know about midwifery. I (happily) turned off my brain when it came to midwifery (or obstetrics) because it was outside of my scope as a doula. Now my scope is changing and I feel like a total moron! I have absorbed practically nothing in years of being around pregnant women!
I feel like such a beginner that I kind of disbelieve that I’ll be able to license as a midwife in three years. It doesn’t seem like enough time to get me from here to there. (Seriously, did I mention I’m a moron?!?!) Maybe in some ways I know more than I think, but I don’t ever want to be cocky about what I know anecdotally to be true, that might not be backed up by science.
Today I attended a birth and actually made it before the baby was born! I learned something, of course. Leigh (and everyone) says that you learn something at every birth. Even after you’ve attended a zillion, you learn something at each birth, and she suggested I write down the information before I forget. So here’s what I learned: Even when a woman gives birth outside of a hospital, it can still take a while for her to get comfortable.
To wit, when Kung Fu Client arrived (I will explain this nickname later), I thought We are in for a long night. She was laughing, joking around with us, chatting. Her contractions were short, albeit painful. Leigh made some suggestions, and then when we checked her again, she was almost complete! I couldn’t believe it. So, that’s what I learned. She just needed some time to get comfortable in the space.
Of course a homebirth (even when it’s not your home) is a more relaxed atmosphere than a hospital, and I’d imagine it’s somewhat like the birth center will be when we open it. But if it’s not the client’s home, she may take awhile to feel comfortable and get into her groove. And that’s exactly what happened. And then once she was in her groove, it was actually a pretty short labor.
Meanwhile, the Kung Fu nickname… She was just a total warrior. I’m always impressed when women don’t whine about the pain like I always did during my labors (“Why does it hurt so much?” I cried, when I was in labor with Sydney. “Because you’re in labor,” my midwife answered. Oh. Right. That!)
On a totally unrelated note, I have my Enrollment Verification Pak from AAMI, and I have to complete 15 items (at least) on their list before I can request my curriculum. One of the items is write a journal entry explaining how you got here and where you want to go. So I’ll start with how I got here.
I blame idiocy and Gretchen Humphries for getting me on this path. Idiocy in the form of having intercourse without using protection, and Gretchen Humphries in the form of my doula for my twins’ birth.
Prior to my pregnancy with my twins, I was happily unaware of pregnancy related information — not blissfully unaware; happily unaware. I wasn’t really into babies or kids. I am an only child. I didn’t babysit much. (I once babysat for a brother and sister who were less than two years apart and came home and asked my mom, “Why do they FIGHT so much?!?!?!”) I wasn’t particularly into holistic health care at the time, although I’d categorize myself as non-mainstream. But I still took tylenol when I had a headache and probably would have consented to a c-section if they were both breech or something. But being pregnant with twins, and twins who had Twin-to-Twin Transfusion Syndrome which resulted in 18 loooooooooooong boring weeks on bedrest, and I spent a lot of time reading and thinking about choices. God, there are a lot of choices when you’re a parent! It’s kind of cool and it’s also kind of frightening; it’s such a huge responsibility. And I didn’t just want to just do what everyone else did without doing some research. Why? Why? Why? Why is this the norm? What are the alternatives? I also didn’t want to do anything that couldn’t be un-done. Vaccinating can never be undone. Either can circumcision. I wanted to do more research. (Still do! Always.)
So, around this time I met Gretchen, who had twin boys born by c-section and a girl born at home (HBAC). My family has actually copied Gretchen’s exactly: she has twin boys followed by two girls, just like me. Anyway, I didn’t know that Gretchen was very active in ICAN and writing essays about cesarean section birth and VBAC. Because of the twin boys’ thing, and because she was just so darn nice, I gravitated toward Gretchen for advice and comfort. A twin pregnancy is just one giant bag of SUCK, in my experience. (Okay, so I also think that about a singleton pregnancy. But a twin pregnancy seems to kind of suck more. Maybe it’s because you can’t fit into anything, even maternity tents, at the end.) She offered to attend my birth as a support person, and I welcomed her. And then she did it. She gifted me with an item that changed my life forever.
The Thinking Woman’s Guide to a Better Birth by Henci Goer. I sat on my bed, my ass-cheeks molding into the mattress more with each day of bedrest, and read it cover to cover.
And I was shocked — shocked, I tell you! — to learn that I had choices with regards to my birth. I could ask my provider questions and demand answers, and I could say NO. I said no to an unnecessary cesarean about a week before my boys were born. That was so powerful. I have forgotten many aspects of that pregnancy, but I haven’t forgotten sitting in my hospital room (I was staying overnight because baby A had had a decel during a non-stress test) listening to the doctor suggest a c-section, and saying NO. I didn’t think it was medically necessary. And clearly the doctor didn’t think it was either, because if it was, he probably would have forced me to have one.
So blah blah blah Gretchen gave me the book, I read the book, and I claimed my power as a pregnant woman. I’d always felt powerful as a woman. But pregnant women are, as Leigh pointed out, a vulnerable population, and being an empowered pregnant woman felt… pretty fucking cool.
I felt great about the twins’ vaginal hospital birth (with a foot-first baby B who was 2lbs bigger than baby A). I decided I wanted to help other women feel great about their births, so I became a doula. And then, when I moved here, and learned that Charlotte’s motto is “A Doula For Every Man, Woman, Child and Dog in our Metropolitan Area,” (chosen over the more traditional theme: “We Have More Doulas Than Pregnant Women”) I decided to become a childbirth educator, so I could have another way to help women.
And then one of my requirements for my CBE class was to audit another childbirth class, so I audited Leigh’s class, which is how I got to know her and her clients, and then became her apprentice. And here I am: doula, childbirth educator, apprentice and midwifery student.
Idiocy and Gretchen Humphries, I salute you!
Leigh, my preceptor, is beginning to get a reputation as the only local midwife who takes Medicaid. It’s fine with me, since I don’t get paid anyway. I don’t mind not getting paid — apprentices don’t get paid, and some apprentices actually pay their preceptors, which seems like a conflict of interest to me. (The preceptor is supposed to teach the apprentice, and evaluate the apprentice’s skills from an objective viewpoint. But how can she be objective about me if I’m paying her?) Aside from loving birth and birth-related stuff, I like the idea of midwifery from a feminist/empowerment point of view. Historically, midwifery has been taught from one woman to another. I like that. I like the idea of passing it down, and I like the idea of midwifery stemming from one original midwife who helped women give birth. Someday I’ll have an apprentice and I’ll teach her, and thus midwifery will continue.
So, “we’re” trying to get the Carolina Community Maternity Center started. I say “we” because although I attend all the meetings for it, I’m not a midwife, and I don’t really have a say about any decisions. But I still go to the meetings so I can learn. I figure that this is all part of my midwifery training. Someday I might move away from here, and maybe I’ll want to start a birth center wherever I end up, and I can look back on this experience and draw from it. Basically, it’s a lot of reading and paperwork, and making sure that we’re within code for the health department. Once we get approval, it’s going to be a lot of money and fundraising and finding volunteers and donations. Many many many many people in the Charlotte area have said they want to help; I’m really hoping that some of them actually do it. It’s just like being a doula and getting lots of emails or phone calls — usually only about 1/4 of those emails or phone calls actually translate into a client. But I hope I’ll have help with the laundry and cleaning the floors and folding pamphlets. (Yes, I’m going to be doing my time as a grunt, just like every apprentice before me did, and every apprentice after me will do.)
Next week is the last week of my Childbirth Educator class. I’m taking it through Aviva Institute, and the program has been very comprehensive. I wasn’t really sure what to expect, since it’s an online course, and I didn’t know how an entirely online course could really teach thoroughly, but it has. I feel ready. I think it also depends on how much time and effort each student puts into it, and I’ve put a lot of time and effort into it. Kathryn Berkowitz, the instructor, is so fabulous; I would take a class of anything she teaches.
Tomorrow I’m going to see her — and all my former BIRTH women — for dinner. I absolutely can’t wait to see everyone! I was in BIRTH last September, and it was the most amazing experience: professionally, birth-wise, and personally. I got to perform on stage in front of 400 people; I got to learn even more about birth and pregnancy; and I got to spend my summer rehearsing with 10 really incredible women, my BIRTH sisters. That’s how I really got to know Emily, who is my BFF. That’s how I met Kathryn, who I consider one of my mentors professionally. Honestly, being part of BIRTH really changed my life. It was while doing BIRTH that I started researching weight-loss surgery and made that decision. It was while doing BIRTH that I really started to learn my way around Charlotte and feel comfortable (in spite of Lee, my GPS device).
Meanwhile, I’ve decided that I’m not going to do BIRTH this year. I’m apprenticing with Leigh, which hopefully will include lots of learning time, and I’m enrolled in Ancient Art Midwifery Institute, which definitely will take up a lot of my time. I’ve promised Dustin (and myself) that as far as “extracurriculars,” midwifery is my priority, and I will let go of most other things. I still plan to keep up with Exploring Holistic Alternatives (since they’re my people) and of course Charlotte Doulas, but being in BIRTH took up a lot of my time last summer, and I don’t have as much time as I used to.
And now, since I don’t blog as often as I’d like to (see, not as much time as I used to have, above) I’ll include a picture of my youngest, laying on the floor in the computer room while I type this:
Client A lives pretty far away and we drove fast. Leigh asked me to call 911 to let them know that we were on our way to a homebirth and driving really fast, and please tell the cops not to pull us over. They didn’t. I don’t even think we saw any cops. And her car didn’t blow a tire, despite some really awful sounds coming from the wheels when we driving.
I assisted Leigh in examining the placenta. She showed me the two arteries and one vein in the cord, and where it was attached to the placenta, and which side came out first, and the two parts of the amniotic sac. The placenta was actually more gross than I realized (placenta in general, not this particular client’s placenta). It was really bloody and lumpy and squishy, like a Halloween trick where you put your hand into something gooey and someone tells you it’s a bunch of ferret eyeballs or something like that.
The baby was perfect and adorable. I turned into a pile of mush when I held the baby, “Awwww wook at the wittle bitty baby waby you’re such a cute baby aren’t you!” Normally I attend hospital births, and when I get to hold the baby I’m always accutely aware that I’m IN A HOSPITAL. It’s very generic and cold and sterile, and the baby always has a diaper on, and a hospital bracelet, and one of those security tags. But a homebirth is so much more intimate; I really felt like I was seeing a family welcoming its newest member.
I filled out a lot of paperwork. Damn, but there is a lot of paperwork. I’d say that’s the only advantage a hospital has over a homebirth; someone else fills out all the paperwork. It was a bunch of paperwork. Mother’s record, baby’s record, birth certificate, postpartum evaluations for mom and baby.
I was really excited that I got to take blood from the placenta and examine it so closely, and also learn how to bake the meaty parts so that they can be ground and encapsulated.
Today we went back for a postpartum visit. I also did most of the newborn exam, which was very cool. Mostly measuring and checking skin and reflexes. The baby looks great, and mom does too except she is tired. We reminded her several times not to do anything except nurse and rest; no cooking or cleaning or taking care of anyone but the new baby. She has a lot of family around, so I think she will be fine.