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