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Thursday
Oct182007

“The Business of Being Born”: The Impact on Me

When I went to El Paso in 1993, I began doing PKU tests. We had to do them on the babies on day 1 and day 3 postpartum… a heel stick that tested the babies for 5 metabolic disorders. I did about 250 in 3 months’ time. After that, I went to Orlando and continued doing them on those babies, but we only had to do them on day 3 postpartum, so I only did about 250 in a little over a year. In 2000-2001, I was once again in El Paso and easily did about 400 PKUs (by that time, I was not only doing my own, but also instructing students in the proper way to do them).

We don’t call them PKUs anymore, but Newborn Screens (NBS) because it screens for a multitude of metabolic and other disorders (over 40 here in California). I was doing the NBS from 2001 as a homebirth apprentice until I gave the reigns over recently to my apprentice Donna – and even still will take over if she is having a hard time getting the blood; don’t want to distress the baby or family too much, of course.

I’ve gone years without doing a NBS and have picked up a lancet and been able to poke a baby without sweating, with getting the exact area needing to be poked, getting more than adequate blood quickly and easily and doing it while loving the baby and the family. It is a body memory skill I know and suspect I will always know and own.

I want that with other skills, too.

I suture a couple of times a year. I’ve done an IV twice in the last 4 years. When I have to check a woman’s vagina, I am nervous that I am going to have to pick up a suture needle and cut through her skin – worried that my skills are going to suck and her vagina isn’t going to go back the way it should. I’ve watched hundreds of vaginas be sutured, but it isn’t the same as doing it yourself. I want to do it myself. Not so much that I am going to cut anyone or let anyone tear, but I need more practice.

You see, I had a birth a couple of weeks ago and my mama tore pretty badly. She pushed mightily to get her baby out despite my wholehearted attempts to slow her down; she needed her baby out to feel safe and I don’t blame her at all for that – I would have done the same thing. When I looked at her bottom, my first impression was, “This isn’t something I should do,” and I called a CNM in to come and suture for me. Looking again while waiting for the CNM, I thought, “I could do this here on the side, but I better let her look first. It looks kind of deep over here.” I had everything set up for the repair when the other midwife arrived and she gave mom a hefty dose of Lidocaine before going in to look around. It didn’t take too long before she was down around her sphincter muscle and said she could see the whole thing and would need some special instruments to hold things together to suture her and neither of us had those instruments, so mom was going to need to go into the hospital for the repair. It was a bummer, but it was going to be okay because the hospital was cool about it when I called and we headed off half an hour later.

Once at the hospital, two docs came in and opened mom’s vagina up but good and looked hard. They were talking about her as if she wasn’t there (and I’d asked mom already if I could learn and she said yes) and they began pointing to what was her exposed sphincter muscle. I could have just as well been looking at the starry sky and trying to see a constellation for all I didn’t recognize what a sphincter muscle looked like. One of the docs, the resident, didn’t know what the muscle looked like either and had to be shown, so I didn’t feel so bad. The resident put her finger in mom’s rectum to see if the tear was through the muscle – it was not – yet the decision was made to do the repair in the operating room with a spinal anesthesia. The final classification was a 3rd degree tear over the sphincter muscle, no other tears anywhere in the vagina or labia. The repair went great, mom stayed the night and everything is great now. The sutures will stay for about 4-6 months deep inside.

I want to be able to see a tear and know exactly what I am seeing and exactly how to fix it. I want to own those instruments and be able to repair a third degree tear.

I can practice suturing on a pillow until I am blue in the face, but until I see dozens/hundreds of torn vaginas, I am just not going to have that (what I call) Helen Keller moment (that moment when spelling w-a-t-e-r in the hand a thousand times suddenly MEANS “water” in all its forms). Until I feel that needle and thread going through the flesh myself, it isn’t going to connect completely and I won’t be the as wonderful a midwife as I want to be.

Same with IV’s. I can do them when I have to. I can start one in an emergency if I have to, but I shudder when I think about having to and I don’t want to be afraid of any skill I want to be able to do with aplomb. I want to be strong and sure-footed and jab the arm with the same body memory I have for poking a baby’s foot. And I can never get enough practice in a homebirth practice, even when practicing on family and friends. I need volume. And sitting here as a homebirth midwife, doula, monitrice and natural birth advocate, I hear how absurd it is to say I want to practice putting in IVs when IVs aren’t a part of natural birth! But, there are other places to learn how to put in IVs. I’m going to find them.

So, I ended up seeing “The Business of Being Born” about 12 times and I scrutinized it from my own inner perspective: Why am I watching this movie? What message is it giving to me?

The movie implores us to DO something, to make a difference in maternity care in our society. How anyone can sit still after watching this movie is beyond me because the messages from Michel Odent (especially) were so powerful, so moving that it would take someone completely heartless to not be touched.

Reading Sagefemme‘s “the proof is in the puddin’” speaks so well of why women should be staying home to have their babies – how much more sense it makes – how we should work as a society to get that change to happen. I love her post today (please go read and respond to it!), but there is the other side.

Women (most likely) aren’t going to change overnight. Or in a year. Or in a decade. And those women need care that is transformed from what it is to what it can be.

I want to be a part of what it can be.

I want to be a Certified Midwife. Not a Certified Nurse-Midwife, but a CM – like a CNM, but without the nursing component. CMs aren’t even legal here in California (only in New Yorn, New Jersey and Rhode Island) and there is only one school that teaches them right now (SUNY Downstate in New York City), but I want to go anyway and my Sarah has given her blessing. Of course, I have three years of school to go before I can get there, but what’s three years, right?

So, in January, I am going to take that algebra class I keep dreading. Then I will take the statistics class, then Anatomy & Physiology I & II, then microbiology and Chemistry and all the other pre-requisites to get into the CM program. All these courses will also lead me to a Bachelor of Science in Community Health (you have to have a Bachelor’s in anything to get into the midwifery program). My thyroid and depression meds are perfectly level, I have a brain, I am not stupid – I can do it.

I can make a difference.

I might never work in a hospital. I might get my CM, come home to California and be a homebirth midwife forever, but I will have wonderful skills I could never have gotten as a homebirth midwife. I want to know more!

I’m reading Mainstreaming Midwives by Robbie Davis-Floyd and it is an interesting treatise on the splitting of midwifery into CNMs and direct-entry midwives and one of the major bones of contention is that DEMs don’t have enough education. Well, I didn’t go to a school, but went through an apprenticeship only. Perhaps if I went through a school, I would feel better, but these are hands-on skills you learn from doing, not reading about.

I don’t feel my lack of some skills endangers my women or babies at all because I know what I don’t know and don’t hesitate to ask for help. I would know if the bowel was perforated (have seen that before) and now have seen this sphincter-type of tear so know what that looks like. I can start an IV – whenever I practice, I get the IVs in right away – but I just don’t like the thought of having to do them and I don’t want to think that way. Life and death skills I practice continually and do not hesitate with at all – those are all body memories already.

I thanked my sphincter-torn mama for helping direct me into a new path – she was so gracious in her gift to my future. I’ve got to thank Barranca Productions (the staff of “The Business of Being Born”) for their kick in the butt, too. I’ve felt kind of lost since quitting school when I decided psychology wasn’t for me anymore. Now, I have a path again. And I am excited as all get out!

And, I am not waiting until I am at SUNY to learn about tears and suture and IVs and such, either. I grabbed my Williams Obstetrics and my Anne Frye's Healing Passages today to start reading again. And I will find a sad pillow and start suturing it – over and over and over again.

Ariel (& I) say:

I want more!

... And ready to know what the people know
Ask 'em my questions
And get some answers
What's a fire and why does it
(What's the word?) burn?

When's it my turn?
Wouldn't I love
Love to explore that shore above?
Out of the sea
Wish I could be
Part of that world

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Reader Comments (13)

A few thoughts....What about workshops at The Farm? Their advanced workshop is supposed to be AMAZING. Docs who have attended say they learn more in it then in med school. Also, recommended to me was Maternidad La Luz? I am hoping to do both as part of my training. After my week at the Farm, I felt the same way (though I am not yet a midwife). I thought, WOW, I have SO much that I want to learn!

October 18, 2007 | Unregistered CommenterKat

Volume is a valid source of learning. I know in my work I see thousands of patients a year compared to some of my colleagues who see the same volume of patients I see in one day, over a 2 month period.

Not denying the advantages of fewer patients and the benefit of the level of personal care you can offer to fewer patients...but from a learning perspective, there is something to be said for having access to large volumes for your learning curve.

October 18, 2007 | Unregistered CommenterAnonymous

I hope you're not in NY when it's time for my homebirth!

October 18, 2007 | Unregistered CommenterLynnSofia

Wonderful for you! And this whole time I was thinking that you were a CPM and not a LM. As a doula I am struggling to find the best way to bridge that gap between what obstetric care is and what I think it ought to be, and how I can help.

AmericanMum

October 18, 2007 | Unregistered Commenterkristina

I just wanted to tell you that I think you are so awesome and I LOVE that you are continually trying to educate yourself and learn and move forward. YOU are awesome. I love you.

October 19, 2007 | Unregistered CommenterCurlyCue

I'm working towards the Downstate program too! I went to an info session a few months ago and the midwife who led the group was really wonderful.

I'm a little daunted by everything I have to do before I can even apply to the program but I'm also really excited.

I've been listening to med school class podcasts from iTunes as an extra assist in my anatomy etc. studies. Don't know if you might find that helpful too.

Good luck with Algebra!

HSP

October 19, 2007 | Unregistered CommenterAnonymous

I'm an LM *and* a CPM. I couldn't/wouldn't practice here without my License.

But, I want more! (You know how that is, don't you, Kristina!)

October 19, 2007 | Unregistered CommenterNavelgazing Midwife

Workshops on the Farm are a great idea until I get to school... and I went to Casa - that's where I've spent over a year and a half total before (also in El Paso, where La Luz is) and there really isn't a lot of suturing and no IVs going on at all there.

I know there will *always* be more to learn... and I will keep learning... but I want to fill the gaps asap. Know what I mean?

October 19, 2007 | Unregistered CommenterNavelgazing Midwife

Good for you Barb! You'' do brilliantly!

I wanted to let you know that I witnessed my 1st birth on wednesday - normal, hands off birth, no pain relief, not even entonox. It was wonderful!

Also - if you want to practise IV's & suturing, you cannot beat Limbs & Things, i'm sure you'll have some of their stuff already... http://www.golimbs.com/

October 19, 2007 | Unregistered CommenterAgatha

Congratulations on your new life path (extension of your life path). But...I'm a little confused. You say you want higher volume in the types of things homebirth midwives see little of. But a CM program is not likely, during school, to give you that. It's actual practice in a hospital setting that would, yet a CM does nothing for you in CA. So are you thinking of practicing in NY? Or why not do CNM school in CA? Just wondering.

October 19, 2007 | Unregistered CommenterAnonymous

Knowledge really is power and if you think you need to experience and knowledge, then more power too you!!

P.S. Algebra is not so bad. I just returned to school last fall after a 10 year hiatus and I've taken 3 algebra classes. So far none have made me want to pull my hair out.
GOOD LUCK!!!

October 20, 2007 | Unregistered CommenterJenifer

Just so you go in eyes wide open: I'm in a CNM program and we don't spend a lot of time learning IV stuff (in fact, none at all yet) and I'm not sure that you will get tons of practice with suturing either, even in your clinical rotation because you will probably only have 1 class (two at the most) that deals with birth! (ie: Intrapartum, which is only a semester long) But you may get more at the end of the program if you do an integration into the real world...

But of course you will learn tons of stuff...I wish CNM students could spend a considerable amount of time with homebirth midwives learning, especially learning herbs because we don't really get that. But the only midwife who did homebirths with our school left last year. *sigh*

Just want to give you the heads up!

Good Luck!

LP

October 20, 2007 | Unregistered CommenterLoving Pecola

I thought that BayState Medical Center had a CNM program. They are in Springfield MA.

October 26, 2007 | Unregistered CommenterLabor Nurse

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