Log onto Squarespace

From My Doula List

A doula said she was considering leaving doula-hood and invited people to read her blog regarding her desire.


I comment:

Regarding making any difference at all and the difficulty being a doula in the environment out there at the moment, sometimes the ONLY thing I *can* do at a birth is love the woman.When every intervention is foisted upon her, her fear is showering her, no one else believes in her and she is incredibly disappointed in her choices (or her choice to be where there *are* no choices), the only thing I can offer is love.

I believe that my greatest role as a doula is to Be with the woman. Witness to her experience. Storyteller to her years later about the experience (or writing-storyteller if it's a transient relationship). A filter of experience that translates what happened when mom begins asking questions regarding her birth experience.

Many times, my role as doula is the most miniscule during birth; it tends to be much, much greater during the first year postpartum (and I do not mean as a postpartum doula, either).

Another part of the prism of my continuing to do occasional doula work even as a midwife is that I am able to speak confidently and truly about experiences that happen in the hospital and effectively communicate them to my childbirth classes and even my clients who find themselves, for a variety of reasons, within The System. It is painfully obvious which midwives have on-going hospital "training"and which don't. I suspect the same could be said for childbirth educators. Without continuous re-education or re-exposure, their words fall flat with inconsistencies and inaccuracies. Midwives who don't re-experience the hospital experience every so often seem clumsy and stilted when they lumber around the hospital room during a client's transfer.

I find my doula experiences over the last 22 years invaluable as I progressed towards being a midwife. So important, in fact, that I revive my belief in doula work periodically by taking a hospital client on as a reminder. I mean, 99% of the women in the US have their kids in the hospital, right?

Even if the 4 other (or 8 other) people in the room are ho hum about the bringing forth of a life, I know that I can BE with the woman and her partner and SEE the preciousness, witness that child's only time to take a first breath, witness the birth of a family and the addition of one more soul to the earth. While I no longer weep at birth (most births, anyway), even after over 800+ births, I remain humbled and honored to be invited in to such a sacred event.

I just wanted to share these thoughts with you as you consider leaving doula-hood.

A blog spot that concerned me was the one that discusses a woman who chooses not to take childbirth classes ("5 Dumb Excuses for Not Taking a Childbirth Class") and, particularly, clients who don't practice what they learn in classes... even going to the point of saying: On the other hand, if you are not dedicated to practicing and preparing, you just might not have a clue how to deal with contractions. But is that the fault of the childbirth education class?

I find this statement, and the entire piece, incredibly offensive.

Women inherently know "how to deal with contractions." True, birth provider (or lack of provider), birth location, and inner beliefs all play into the birthing experience, but blaming a woman for her potential (or experienced) difficulties in birth on her not practicing breathing exercises (or relaxation) is vulgar and cruel.

As a woman who has taught a variety of "classes" from Preparation for Parenthood classes for the Red Cross, through Bradley, and now a combination of Hypnobirthing and Birthing From Within gatherings... and a doula/midwife who has worked with thousands of women who have never had a class of any sort - women birth just fine without someone giving them a certificate for passing a class. For MANY women (not to mention their partners), class is boring, expensive, and a waste of time. And a huge bone of contention in the marriage at a time when harmony is better suited to preparing for a child.

Depending on the brand of classes I have taught, reasons for arguments with the spouse have varied from not practicing breathing exercises, not practicing perineal massage, and not practicing relaxation. I have seen that as my own "teaching" (guiding) style has changed, the arguments revert back to the basics of a marriage, mainly money. And the loud discussions are far, far less frequent when not about assignments from the childbirth teacher.

Women merely need to be reminded that they know what to do. If they lived in a jungle, they would know what to do. Even without a tribe of birthing women to witness her whole female life, she would find her way through labor and birth. Our culture that slams women into a bed and uses medications at the slightest whim of a doc or midwife has a whole lot to learn in childbirth classes, but breathing and birthing are the least of it. If she is left alone to find her way, she will rock and sing and moan and squat and kneel and sway and breathe and gasp and holler and grab and twist her baby out into the world.

One thing that is a constant in my birth walk over these last two decades plus is change. I learn from my women, their partners, my doula-sisters, my childbirth educator-sisters, the women who speak to me frankly and bluntly about their painful and fabulous experiences, the docs, midwives, and women who birth unassisted... and my words reflect that change. Not one gathering goes by that I don't alter my words or learn something, even from first time mamas.

What I know is They Know.

I honor their knowledge.


Fever & Babies (mine and not mine)

- I have had a continuous fever since day before yesterday. I get to feeling some better and then my eyeballs feel like someone has a campfire in my skull. My nose has that just blown out match shoved up the nostril feeling and my scalp has blisters and burns so that only ice-cold aloe gel relieves it for half a minute. I got a Jamba Juice today and considered dunking my head in the cup... or pouring it over my head, but dunking sounded better.

- A convoluted situation has given me the opportunity to do the postpartum doula gig for 5 nights a week for a few weeks until the other doula they want for 5 nights a week is available. It won't last but about 3-4 weeks at the most, but that would be perfect timing - right before the conference. I will also back up the doula for when she has births and she will do the same for me. I might use the money to go home sometime this summer. We'll see what happens... if Sarah needs surgery or not on her rotator cuff.

My job for this family is still to make my job (or any pp doula's job) obsolete. The mom needs major injections of Belief in Herself. I hope I can help her to find it.


good day/harder night

I taught the new midwifery students today - 5 hours of discussing informed consent, protocols, standards, and role playing different aspects of interviewing a client, working through eating disordered clients, and more. I was energized and had a grand time with the three of them (the fourth is at the MANA Conference in Portland). I took them to lunch and we had a 2 hour working lunch and I asked questions that encouraged them to think, feel, and imagine their future as a midwife and their present as a doula.

Once the women were gone, I began to feel. My body aches incredibly, I have a fever (first one in quite awhile), diarrhea, and my neck is getting stiff. I am now in pajamas sitting on the couch watching/listening to Legally Blonde (about the 30th time I've seen it).

The sign at the dealership advertising coffee was misspelled: Complementary Coffee. I shook my head.

I got a B12 and a B shot the other day. I think it helped a little. Gotta figure out what the deal is with my iron. I should have lab results back Mon or Tues.

It's nice not being on call, but I can feel the "need" growing. How strange I am.

Four of the people we are having financial issues with (the ONLY people we are having issues with) have the same last name, some spelled differently, but pronounced the same. Isn't that weird?

No license.

No agent.

No publisher.

Eleven days until I turn 44.



At the hospital where I have to go, parking is horrid. I go at least 30 minutes ahead because I know it will take at least that long to find a space. I have gotten savvy and sit to the side at the back of the parking lot, stalking those that are leaving their appointments to snatch their parking spaces as they edge out; I slide in. A sort of anonymous car sharing experience.

It can get vicious out there.

Today, an overabundance of cars were circling, circling... I sat stationary as I usually do. After 20 minutes of waiting, a woman walking to her car headed down my direction and another car turned the corner and started to follow her. I began cussing loudly. I saw them exchange words, the woman pointed to her car – 2 cars in front of me. I was squealing obscenities as the woman got in her car and the driver, a woman, grinned as the car pulled out of the space so that that other car was able to pull in before I could get there. I sat there staring. And cussing.

The woman got out of the car and then, without looking at me at all, she got back in her car. I thought, is she parked funny? She pulled out backwards and looked right at me and with the kindest face, mouthed, “you take it.” I just looked at her and she nodded, so I pulled in.

By the time I got out of the car, she was gone, off on her circling like birds of prey searching for the next meal. My head was flooded with thoughts, uppermost of which was shame. She couldn’t have seen me cussing at her. She sure couldn’t hear it. What in the world made her get back in her car and pull out for me? She had her own appointment to get to, why did she risk being late? I peeked over cars looking for her to ask her why she did that, but didn’t see her anywhere.

I thought about her and her grace during my entire appointment. I kicked myself for many things, but most of all for not taking down her license plate so I could find her car and put a thank you card on it. As I write this 2 days later, I am still filled with shame at my anger towards this woman who ended up giving me an extremely kind and graceful gift. I thanked her in my prayers.

The appointment itself was okay. My titers are up again; remission is non-existent. The Diflucan stays at 800 mg a day for at least another 6-12 months. So, no hair still for a long time. My eyebrows are diminishing. Can the armpit hair be far behind? The doc also increased my Acyclovir to 800 mg a day without a headache and then with the first sign of meningitis, up it to 800 mg three times a day. Between that and the Vicodin, perhaps we can avoid any more of what I had in November/December.

I wasn’t too disturbed about the results, surprisingly. I just shrugged and said, “well, more mental/spiritual work to do.” I am reveling in feeling really good right now.

With the postpartum doula gig, my days and nights are all mixed up. I just got up from a nap and it’s 5:15pm. I head back to their house at 9pm.

No license.

No agent.

No publisher.


Hamburger Hootie

* The saddest thing I have seen lately is Darius Rucker (lead singer of Hootie and the Blowfish) singing in a stupid cowboy costume for Burger King. Makes me want to weep.

* I still have no fever. Thank God.

* My postpartum gig was interesting. It took some time to get used to the really noisy baby. She just grutzed a lot... 2.5 - 3 minutes at a time, but would fall right back to sleep. I only had to go get mom once during the night and she was ecstatic over that. I slept fitfully, but think I can work with my psyche to sleep through those grutzing periods. The house is amazing. I rarely have seen so much. And it is their rental while their "real" house is being built. The bed I slept in had a Chinese silk comforter cover. The client's bathroom is as big as my living room, dining room, and kitchen put together. I need to sell a lot of books. A whole lot.

* I taught one part of the midwifery classes yesterday - on breeches. I had to study since I know basically what to do, but there was a lot of playing with the baby and pelvis involved. We moved a lot back and forth between shoulder dystocia and breeches; many similarities. Interesting how one of the students brought up putting hands inside the vagina and trying to rotate a lodged head as one of the last ditch efforts at extracting a stuck breech. The other midwife (their instructor) and I hadn't ever heard of that maneuver, but thought it sounded like a dandy idea. Scary as shit, but dandier than a dead baby.

* We talked a lot about Anne Frye's new Holistic Midwifery (Vol. 2) book. I don't have it yet, but need to get it soon. Anne is the Minutae Midwife... detailing the most amazing teeny tiny possibilities anyone ever heard of and then explaining it until nary a noun, verb, or adjective is left on earth to explain it. In our talking about shoulder dystocias, apparently HM discusses if a baby's hands are behind his back... something I never ever heard of ever in all of these years. There were details of how to put your hands inside the mother and find the elbow, for crying out loud, and pulling it in front of the chest. If there was enough room for a hand inside there to maneuver an elbow, there would be enough room for the damn shoulder! There was a line... something along the lines of... "If there is a shoulder dystocia, analyzing why the dystocia is occuring helps determine how to proceed"... something like that. I'll tell you what, unless it is bed dystocia, I don't give a flying fuck why it is happening, I am going to work until one of us dies to get the baby free.

I told the students that HM had too much information to assimilate. That if they wanted to process it all, I suggest some hypnosis or subliminal learning during their sleep cycles. I don't know how anyone would retain that amount of information. Goddess forbid should any midwifery board choose those books to use as study guides for their exams. No one would pass. Maybe not even Anne Frye.

*I'm heading out to buy new scrubs. I keep loaning mine out during inbetween birth times and never getting them back. I miss my Tinker Bell scrubs most of all. I get to shop with the money I got from sleeping and teaching. Woo hoo!


Tokophobia - Fear of Childbirth

Forgive me, my Empowered friends. I felt this post was important to share here lest someone search "tokophobia" and actually stumble upon a different view than the medical belief... that I believe it is a wholesale cultural brainwashing.

And, for the women with tokophobia... TURN THE TV OFF! Birth shows on tv are part and parcel of the tokophobia phenomenon! It isn't making up for the lack of tribal birthing we once experienced, it is edited and dramatized and is the epitome of the worst that birth can be in this culture.

A woman writes of her fear of birth (she actually called it BIRTH PHOBIA) and her joining a list I am on. She says, after a brief time on the list, that she is more afraid than ever... and that surprises her. This is my response:

What is it about birth that scares you? Pain? Possible death? A disabled/deformed child? The cost in raising them? That you will be a wimp? That you won't be able to make any decisions about what happens to you? That you will be touched in ways you don't want to be touched?
And let's move now to... what is it in particular about this group's posts that are making those fears worse?

I encourage seeing things in context. If you were sitting on a regular old pregnancy board, THEN I would see why you might be terrified - women having vaginal exams at the whim of the doctor or midwife, the morphine at 2 cm dilated, the 8 inch needle in the spine that numbs mom from nipples down, cuts to the vagina as a regular course of events, pulling the baby out with a vacuum or forceps... or the ever-gory, but popular cesarean descriptions.

Women here speak of what happened to them and how they intend to not allow that to happen to them again. THAT is empowerment. You, I suspect, are here like many not-yet-pregnant or newly-pregnant-for-the-first-time women who don't want the Birth Story From Hell to tell at baby showers, but a birth that makes your knees weak with pride and tears spring to your eyeballs as you remember your strength, your toughness, your amazing ability to allow your body to work its miracle - with or without your conscious help.

This group is not therapy, but it is therapeutic. Listening in is good and many, especially pregnant and nursing mamas (the majority here, by far) do not or cannot listen to horror stories over and over, but if you have specifics, by all means, name them and let's shine the light on them so we can dispell them or nod and say, "ayup, that one's for real." We just ask that you put something in the subject line that denotes, for example: "SPOILER - newborn fears" or "SPOILER - my vagina" so women can make a choice to read or skip.

Listening behind the words is important, too. A woman writing about the 23 hour labor that was exhausting and how she pushed for 4 hours and how her veins popped out of her neck and the baby mooshed out of her and it was SUCH a humongous sensation she couldn't believe a baby could come out of her ass, but that the baby smells amazing! that her life as it is now is better than she ever imagined! that her love for her partner, her child, and her Self is beyond belief in its enormity. She isn't telling a horror story. She is telling HER love story. She speaks her Truth and how wonderful she is that she watched the wall of fire and walked through it, even though it was hard and painful and long. She did it!

And that doesn't include, of course, the stories you haven't read yet of women who have delicious, yummy, juicy births that include lovemaking, orgasms, slow-gentle sliding out of babies from vaginas and the transformation those births inspire.

Or the women who make the decision (or the baby that makes the decision) to transfer to the hospital and who might end up with medications, an epidural, an episiotomy, forceps or a cesarean... and how beautiful that birth was, too... because she *knew*... she knew what to do because of these women around us who have shared what they would do differently if they had a chance to do it all again.

For a woman with tokophobia, I hope you stay around. Name your fears and remind yourself to remain open to the *tone* of the birth stories, the rememberence that many women ONLY type on the Net when they have difficulties or pain and need help, and that you will find a place of healing in your heart. Enough to someday have a baby if you want to.

If we all lived in tribes. No one would be afraid of birth. Afraid of lions and bears, sure, but birth? It would be as natural as going to the river for water. Did they see mothers and babies die and mourn over it? Sure they did, but, they also knew more acutely than we tend to that death is as sure as birth; by being conceived, we all agree to die.

I look forward to this dialogue. And one last note. You are sooooooooo not alone in your fears. It isn't *so* common here (or at least the fears are named differently [or named at all]), but I learned the word "tokophobia" recently and how whole studies are being done on it. Very, very hard for me, a midwife, to grasp that the cultural indoctrination of the horrors of how birth is in today's society and how it is accepted and now, studies and doctors are deciding that the cure for tokophobia is a scheduled cesarean instead of the humanization of birth.

So much work to do... so very much.


Coffee Shop Thoughts

My partner shaved my head again today. She made the observation that I always seem so sad when she does it. I have sores on my scalp and it hurts. I try not to cry, but invariably the wet mixes with the falling teeny hairs and clumps on my cheek. I have a receding hairline now. I shaved my pits today – the first time in a month and it looked like it had been 2 days. When we went to Costco the other day, I bought shaving cream and when she asked what in the world for, I said, “wishful thinking.” I promise to never complain about shaving ever again. I miss my hair.


Happiness & Resistance

The midwife I work with most... she and I had a real live HBAC yesterday! We needed it as much as the woman herself needed it. It was a delicious water birth and the family was so happy, mom kept saying how surreal it was. I loved it. I was only there 2 hours before the birth, too. Yay, hurrah!

I need my blood drawn... titers and Coumadin levels. Still haven't done that yet.

I have several business things I keep letting slide past me. I don't know why I think that ignoring them is going to make them easier to tend to when I eventually do get to them.

I am an ass. All the complaining I do/have done about the midwives in my area, apparently it is only my perception that I am being ignored or considered persona non grata. I honestly don't think I am making it up and have my own "evidence," but trying to explain that, well, I sound stupid and paranoid. Maybe I am. I think that that is the bulk of my personal disturbance. That I have so many people angry with me and I have to keep functioning. I want to hide deep inside. I am embarrassed and want to make it all go away.

Why don't people pray for the Pope to die peacefully? They keep praying for him to heal. He's 84 years old, for goodness sake.

I could just live with having diarrhea 4 times a day instead of 8.

I wish I wasn't so angry all the time.

I hate that I take it out on my partner most of all. She is so kind and loving. Always.

I'm almost 44 years old. When did that happen?

Kids are good. I miss them so, so much.

I miss too much too often.

I want to see light again.


Catching up, as usual

Birth Day Live yesterday was most interesting. Several parts were very cool, some was weird and much of it was incredibly sad and horrible.

(I'm watching Phoebe have her triplets on Friends as I write this.)

Parts I liked:
* They showed cesareans really, really close up, opening the layers one by one, breaking the water, suctioning the blood and amniotic fluid... it was just all so cool seeing it so close.
* That labors were really long. I watched for almost the whole 12 hours (except for a nap) and some women that were on the show in the beginning were still in labor on the end of the show. Well, most of those women were then wheeled into the OR for cesareans, but the aspect of how long labor can be (is) was important. Baby Story shows the entire process in less than 12 minutes. 12 hour labors are short as far as I am concerned, so it was good to show that part.

Parts I hated:
* 1 in 3 births were cesareans. It seemed that every other moment was a woman in the OR for stupid reasons... mostly "long labors" or the baby not coming down. Gee, wonder why, what with the woman lying down and all.
* Every vaginal birth had the woman on her back with her knees shoved back, nurses laying on the woman's knees.
* One scene that had my partner screaming at the tv was the reporter leaning on a woman's leg as she was pushing! Holding the microphone, elbow on the woman's calf, the doc and reporter yacked it up until the woman had a contraction. I had to change the channel because I was worried she was going to blow a gasket.
* A reporter asking two nurses about epidurals and look how many women are having them... doesn't anyone come in wanting natural birth? The one nurse snortylaughed and said, "yes," that women did come in saying they wanted natural birth. The reporter asked, "and how many of those, once labor gets painful, end up with epidurals?" and the nurses laughed and said, "all of them!" They all thought that was so hilarious.
* A doctor, while a woman was nearly crowning, said to her, "if it hurts too much, we can give you something for the pain."
* The umbilical cords, every single one, was clamped and cut immediately.
* That they brought in so many nurses that each woman had her own personal nurse. That sucks for all the women who believe that is what they will get.
* That they applauded the nurses a thousand times. Most of the nurses were smug and snotty about natural birth.
* That they kept calling a vaginal birth "natural." Annoying.

I loved, LOVED that the whole show was one giant commercial about why to not have a baby in the hospital. The impersonal parts, the hands in the vagina, the gawking at the vagina by complete strangers, all compiled together to show how disgusting hospital births are. I wish I would have taped it so I could use it in childbirth classes. It was the most real birth movies ever. They didn't show the epidural ever going in, but they did show a shoulder dystocia, a couple of near-crash sections, episiotomies, vacuum attempts, and more.

Phoebe had vaginal triplets. Would that really ever happen?


Write First

Each day I promise myself I will write here first and then I blink and the entire day has slipped by. So, this morning, I am writing first.

I've had fevers for 2 days now... didn't yesterday which was nice. I hate that illness is such a focus of my life, but I also hate feeling like crap. I had some really great days and I want an infinite number of those!

I am one big knee-jerk reaction and hate it.

Knee-jerking includes women who try to make me out to look like an ass as a midwife. One list I am on, there are two women in particular who continue egging me on and I am not playing anymore. I answered the questions about my limitations and I will not apologize for having limitations about what I will not take as a midwife. I mentioned that perhaps they would change their tune if they were the one standing there responsible for two other lives, but they seemed to think they would not... that they would support women and be there for them, no matter what.

Well, I won't witness something that I know could be made different by help or assistance. I will not watch a baby die if resuscitation can help him live. I will not allow a woman to bleed to death because she wants to wait and see if God will take care of it. God gave us pitocin, for crying out loud!

Now, if the baby is going to die, I would absolutely Be with the woman and her family. I would be honored to share in the birth/death of their child in a peaceful and loving manner. That is different.

A midwife here recently had a client check out AMA because her baby died (38 weeks) and she went home in labor and called her midwife who came and assisted her having her baby. That is different. I would be honored to be at such a birth.

But, placenta previa? myelomeningicele? triplets? placental abruption? drug addict? active alcoholic? symptomatic pre-eclampsia?


I am sure there are more and should maybe write them down. Is that making my own protocols? Perhaps.

I watched the DVD of Psalm and Zoya's Unassisted Birth (twins, the second is a footling breech) and loved it. I was flabbergasted that the most she said was "fuck" as she felt the baby was feet first. The dad asks, "what should I do?" and she calmly... more calm than I could imagine being... says, "nothing." It was a distinct lesson for me to continue believing that just because they tell us something... that we have to call 911 for a footling breech doesn't make it so. I worry: what if the baby gets stuck? what if the cord is between the legs? Am I fear-based? Brainwashed? Could I do it? I don't know, but the DVD gave me a lot of food for thought.

Okay, I have to answer a woman's post that I forgot to answer yesterday. She is processing her cesarean and I am trying to help her as she does. I am glad she is looking at it.


Salman Rushdie and More

Here I sit, on my partner's laptop (she just got home from Vegas), with 2 heating pads on my right leg trying to dissolve the three blood clots that are crippling me with pain and immobilization. I had a baby on Sunday morning (1:32am) after a day of running back and forth to her house, the university hospital, and then doing the birth... dang hooties, did I pay for it all day yesterday. I took Vicodin and slept a lot. I am still taking the massive NSAIDS they gave me, plus the baby aspirin, but the pain is unreal! It feels like someone is hitting me with a baseball bat, but without any rhythm... just a constant pain. I am SOOOO sick of pain. So tired of hurting. I will call my own GP tomorrow and see what to do next. Should have today, but took Vicodin instead.

So, Salman Rushdie. How did he join my Hero List? (Do I have a Hero List?) I knew, peripherally, about Mr. Rushdie... how he was condemned by the Ayatollah Khomeni in Iran and an edict... a fatwa... was issued for his life. I didn't pay too much attention except to think how stupid it was that a whole religion/culture would expend that much energy on someone else's book.

Now, after having a mere 3 midwives speak/write about my writing about how other midwives are perceived and how I should just be quiet about it... I have the most minute fraction of a sense of what is to come once I really begin busting up the "profession" with the words I am writing and thinking.

And then, multiplied a billion-fold would be Salman Rushdie. To find that words are that powerful, that words can incite so many others, can cause such a ruckus, so much fear and anger... I am beyond awed with respect for his continuing to write even when he had to have been terrified to do so. The interview I saw of him the other day spoke about how, after the fatwa was issued, how he considered never writing another word, but that he could not. He had to write. He had to speak. And the interesting/not-so-funny part of all of that is that he thought Satanic Verses was a positive book about Islam!

When I get scared or angered by what other midwives say to me, I will remember Mr. Rushdie. I will find a picture and put his name up in my writing room. I will be brave.

I am worried that I keep getting sick. I don’t know what God or the Universe is trying to tell me except sit on my ass and write, but sometimes I feel so poorly, it is difficult to even write. I don’t want to die before saying what I want/need to say.

I will work on the birth story tomorrow. Know that it was a homebirth (hurrah!), 92 minutes from beginning to end, that I was there (I was spending the night at their house because I hurt so badly… otherwise, I wouldn’t have made it), my assistant and my co-childbirth educator made it… the baby came out screaming his head off after scaring the poop out of us all day long… and that he is PERFECT and gorgeous. Zachary Alfred.

And that birth ends my 5 birth run of transfers and cesareans.

heavy sigh


Forced Cesarean

We drove 90 miles at 80 mph to get to the hospital that was supposed to treat us nicely... kindly. We passed at least 8 other hospitals along the way and left two, much closer, behind us. We had been led to believe that the university hospital, a hospital that also had a birth center on a separate floor run by over a dozen CNMs, would be a safe space for us midwives who had to transfer a client in the midst of labor and birth. Absolute emergencies, of course, went to the closest hospitals, but this wasn’t an emergency. Yet.

We drove in a caravan, me behind the laboring client whose husband was driving, the other midwife right behind me and then family members behind them. Thankfully, most of the evening traffic had abated, so the gang stayed pretty much together until we got a lot closer to the hospital downtown.

I kept begging God to let the baby come in the van. Please, please, please just let the baby come now.

When we left the house, mom was 7-8 cm and the baby was a –2 station. A huge difference from complete and 0 station before the hugely bulging membranes ruptured. Sometimes membranes not rupturing make me angry! They aren’t always misleading, but this time, those membranes told a whole different story than when they were gone and the head got to tell the story. At least the fluid was clear. I was so worried the fluids wouldn’t be clear once the membranes broke, but that was a pleasant surprise. It is one reason we don’t like breaking them; what we don’t know won’t scare us.The other midwife and I paved the way for the client who was waiting for a wheelchair to bring her up. Does she want to try for a vaginal birth? Well, we doubt that will happen at this point, but, of course, if possible! The charge nurse tsk tsking in the background as she was assigned a bed.

Into the room the entourage goes and mom is hooked, hollering, up to the monitor and asked a dozen questions. Everything is going too fast! It isn’t an absolute emergency. A female resident comes in and says she wants to check my client and she submits to only the 4th exam of the labor. She has a cervical lip and the baby is +2. What?!? She is fractions of inches from having this baby vaginally! The doctor wants to see if she can lift the lip and has my client push with all her might as another nurse is prepping her for an IV and others are bustling about the room. She pushes as best as she can after not pushing for the entire 2 hour journey down to the hospital and into that bed and the doctor takes her hand out and says, “sorry, don’t think it’s going to happen.”

And that’s it.

And that’s it?!

My mind races as I think of alternatives to a cesarean for a cervical lip with a baby at a +2 station (+4 is the baby’s head visible at the entroitus). I mention to the doc that some midwives will use ice in a sterile glove on a swollen lip... might we try that? She said she wasn't comfortable with that, but interesting concept.

I discuss with the client... quietly... but quickly... that an epidural might do the trick. An hour or two without pushing/pressure might relieve the lip’s pressure and the baby could come sliding out. Positive, loving words of encouragement, her perfection, how great she worked all the way down from another county. I nurse starts the IV angrily in the back of her hand causing my client to holler and wince. The anesthesiologist is going to come in now, another nurse says, to discuss her spinal for the cesarean.

Somewhere in all of this is the absence of the CNM who was supposed to meet us in the room. She had an emergency transport from upstairs to L&D, so couldn't meet us. Had that happened, we might never had experienced the story below.

Later, another CNM told me that the new slew of residents and attendings hadn't been sufficiently brainwashed by the CNMs yet to leave things alone. They were eager to cut and learn. Why on my client?

I note a waif of a woman at the bottom of the bed staring, but say nothing to her as I discuss strategy with my client; there are so many people in the room already. The nurse walks out the door and I let her know that my client would really like to discuss an epidural so she might have her vaginal birth after cesarean and the curtain drops in a huff.

Waif woman, it turns out, has been eavesdropping and also happens to be the Attending Physician; the Queen of All Decision Making. The attending says she just doesn’t see how a vaginal birth is going to happen... mom has been through SO much already, isn’t it time to just have the baby in her arms now?

The anesthesiologist comes in and does his Spinal Spiel... checking for dentures, size of the mouth and throat, going over allergies, discussing previous surgeries... and the other midwife, gently, touches his shoulder to explain that mom had to be poked three times for her epidural last time. He shrugs her hand off as if she were a poisonous spider without any other acknowledgement of our presence.

Mom, in so much pain, enduring the indignities of these people’s questions, being poked, prodded, having the monitors adjusted over and over during contractions (they always forget that not everyone has epidurals and adjust them during contractions)... all she wants is a moment of relief.

She says to the anesthesiologist, a male doc, that she wants an epidural because she wants to try and have a vaginal birth. The attending butts her head in there and says she doesn’t think that is going to happen... and look! the baby is starting to show signs of stress now. Look at those late decels. What?! I go to the machine and see no late decels, but plenty of head compression decels and find hope in them... wanting to scream at the attending for her hate and venom of disbelief in my client and her ability to birth vaginally.

I write this in a linear fashion. This was not linear. This was layer over layer of fear and anger and waves of loud and huge contractions and disbelief and shock and noise and undermining and lying and people talking all at once and hurry! hurry! hurry!

My client asked for a few minutes with her family, leaving the other midwife and I with her husband as she said she really wanted to stop the pain and to try for a vaginal birth. I asked her if she wanted to see the strip because I didn’t believe they were late decels at all and she said she couldn’t look as yet another contraction pulled at her body.

The docs came back in... three now... the original resident, the attending and the anesthesiologist... and the CNM, too... and as my client asked for an epidural, the attending lowered the client’s bed some... pointing to the monitor showing what a hard time the baby was having now. There wasn’t time to see anymore. It was time to go back now!

The anesthesiologist began discussing the epidural and that it wouldn’t last long... maybe two hours... and it wouldn’t be able to be used for the actual surgery. She didn’t care! The attending had to have given him a glaring, evil look or kicked him under the bed or something because then he started this whole other voice.

A grapeseed of evil surrounded by a honeycomb.

Now, if you have an epidural in here, if we have to go back, I just might not be able to re-dose it. Sometimes it’s hard to do that.

Remember, there is a lot of commotion still going on... still so much noise and activity. But he created this tiny pocket of silence where only the client, the husband, the midwife, and I could hear.

So, if you can’t be re-dosed, then, gee, I guess you’ll just have to have general anesthesia for your surgery.

My head swirled. I thought I was going to vomit as his threat washed over me. I wanted to take the IV pole next to me and smash his arrogant head with it, letting him feel the agony he was causing other women at his hands.

There were no options. They evaporated with his remark. This man, no matter what, was going to have needles next to my client’s spinal cord and he had the power to make that experience hell or tolerable. My only regret is not begging my client, just one more time, to try without medication. It was ludicrous since she’d been in good active labor for about 50 hours at that point; it wouldn’t have been fair to do so, but since it is human nature to replay things a thousand times, that is my only major regret.

I wasn’t sure if my client “heard” what he said, but I leaned over and whispered to her, through tears, “you have to go back now” and she said, “okay.”

Promises were made about keeping mother and baby together, Duramorph being used so mom could be pain-free long, but still mobile, and mom was wheeled out of the room with the chaos, leaving dad, the other midwife, and me.

Dad was in the OR for the birth and remarked that someone had to go to the end of the table to dislodge the baby’s head from the pelvis before she could be born abdominally. Another wave of nausea swept over me.

Mom was taken across the hospital to the “overflow” recovery room... the PACU... where no babies are allowed, where moms are not allowed any visitors at all... where the recovery period is 4 hours as opposed to the 2 hour max in standard OB Recovery Rooms. The baby was taken to NICU and found, quickly, to have low glucose. (All this happened within the first hour postpartum.) The nurses wanted to give her a bottle of formula and when dad refused, they readied an IV solution of dextrose! An IV!! Through careful and kind negotiation, dad convinced an NICU nurse to take the baby to the PACU to nurse on mom and, blessedly, they did (after much arguing about policies). The baby’s glucose never went down again.

Mom was left alone in recovery despite my trying to get in. When we sent the baby, the mother-in-law (MIL), an NICU nurse herself, tried to stay, but the client said she wanted to sleep. The PACU nurse made snotty comments about mom sleeping so well until the family interrupted. I asked dad if he told the nurse to shove it and that mom would MUCH rather lose some sleep to nursing than sleep through the first 4 hours postpartum without nursing. He said he said something to that effect.

Mom's belly incision was made above the old incision... and in a drunken fashion. The resident's first incision on a belly? We are waiting for the records to see what the uterine incision will be... hopefully, the same incision, but, considering the surgical and emotional punishment foisted on her throughout her short L&D experience, I wouldn't doubt if they gave her a vertical incision on her uterus.

After the baby nursed, I gathered myself together, said my good-byes to the troups and went home. I’d gone to the mom’s home 23.5 hours earlier, fully anticipating a wondrous and amazing birth. And here I was going home, defeated. Feeling so useless as a midwife. Feeling powerless as a doula. Feeling useless even as a friend.

I sobbed the entire way home.



* I took a family member who has never been on meds or in therapy before to the triage therapist yesterday, but got an "in" with my own Psychiatrist for her (even a note to give to the triager) so she wouldn't have to go through the usual stupid long hoops. The therapist, in questioning whether this family member needed meds or not went through the usual questions:

- On a scale of one to ten, how depressed do you feel?

Family member says to me afterwards: It is right there on the sheet of paper that took me 35 min to fill out. Don't they read?

- Why did you get divorced?

Family member says: The first was unhappiness. The second was he had an unhealthy desire for my children.
Therapist replies: It is not uncommon for the abused person to bring an abuser in to the household.
I, upon being told he said this scream: ASSHOLE! What possesses a person to say something like this to someone reaching out for help?!

- If you would just change your lifestyle, get some exercise, lose some weight... that will help your mental state tremendously.

Family member: no duh

Thank god I had that note from my doc for her. I told family member she never has to see that person again. If therapy is recommended, a mature female can be hand-picked for her. Sheesh.

* In the waiting room, a black woman says to me: Chemo? I looked up and asked, "huh?" and she pointed to my growing-out hair and asked again, "chemo?" I said no, that I was on a different medication that made my hair fall out... that I'd gotten sick in the fires last year. "Oh," she says, "stress." I replied, not caring if she heard or not, "uh... no, not stress." I ignored her comments.

Another woman in the waiting room was reading a book as I was. The chemo-lady kept talking and talking. At one point she said she shoulda brought her Bible in to read... that she could really use her Bible about now... that there were dark spirits right around her right that minute (us?) and her Bible would help keep her safe.

I wanted to tell her they had medication for that.

But, I didn't.

* A baby shower for one of our midwives who delivered awhile ago is this morning. Peer Review with that, too. I got her some goodies at the local Jewish book and gift store. I also bought two books on having a baby in the Jewish way (Jewish laws regarding fasting during pregnancy, etc.).

* A client is trying to decide whom she wants at her birth. Completion with the other midwife (whom I won't work with) since the last birth ended in cesarean? Or a new start with me? I won't hard sell, but shared who I am and let it go at that. She asked if I would come as her doula and I said that I would have to work some issues out, but that I thought I could. In thinking later, I think no only because I couldn't watch that midwife do the things I so adamantly believe to be harmful anymore.

Is it abuse if the woman doesn't know it is and thinks it is normal? Is it only in the enlightenment of depression that reality is seen? Is it abuse if someone watching calls it so, but the person being acted upon thinks it is fine?

I remember this discussion in incest support groups. What if I liked it? Asked for it? Is it still abuse? The answer: If power was used to begin "the game" then yes, it is abuse. If it was mutual, the line is more blurry. If age or ranking was involved, it was abuse. Sex is supposed to feel good. Just because a woman feels pleasure or even orgasm during her rape or abuse doesn't make it okay. (They long ago threw that question out of rape cases in court.)

So, if the midwife uses her power to coerce an exam, manipulate the energy... but the woman doesn't know any better... is that wrong?

I believe it is and I will not watch.

Is it my duty to say something? Or present my own walk and allow her hers?

This part is hard. So very hard.


I Dreamt...

... that it was the end time. (I never dream; two nights in a row I have dreamt vividly!)

The moon exploded and we all watched. It made thumping noises as we watched it fall apart like a ball of ice hit by a hammer. It was horrifying and beautiful all at once as we watched the particles fall to the earth around us.

I went around to the different organizational meetings and quietly introduced myself to the one pregnant woman I could find and the meeting inevitebly stopped as the pregnant women met me and I gave out cards so they could remember whom to ask for (no phones at the time, of course)... they were the same cards I have now.

I woke up with amnesia and then remembered and thought I should write.

I wonder how often I dream such odd and vivid dreams?

Last night was about one woman who is due and that she was totally in labor. We were at her home and filling the pool and talking softly to her and spending time all together... and she was laboring so beautifully! I, in that other part of my brain, wondered if she would call to awaken me to come to her. When she didn't and it was 10am, I called her and she was not in labor, but was gardening (!!). Maybe tonight, she asked? (that would have been last night)

Is the time without Provigil allowing dreams? So many meds in my life that have squashed the dreams and now, two nights in a row... dreams! That I can recall! Very, very strange.


Low-Profile Midwifery

The editor of Compleat Mother told me that on page 123 of Michel Odent's The Farmer and the Obstetrician (out of print) the term "low-profile midwife" is used to describe what she saw in me in the Hands-Off Birth Story. (I need to send it to her, as a matter of fact. She wants it in the next issue.) She also gave me an assignment that is finished about GDM. I asked for feedback from 15 people. Two have answered. sigh Oh well, I am learning who to and not to send to, right?

Low-Profile Midwife.

I like that lots. Those I have shared the term with also like it lots. It seems to fit. There if I need to be or the mother needs me to be and not there if she doesn't. I like it lots. I should put it on my business cards. On the website. Somewhere.

And I want to share the information.

Oh, and I am!

I have a lot of the birthrape article written. I sent out 4 surveys to various lists and am getting replies from places I didn't even send them to! And the lists that I thought for sure I would hear from: two people. That is it. Interesting. I have gotten about 25 responses, however... and none from midwives at all. A couple of doulas, but no midwives. It just speaks to me that midwives just don't really see a problem at all with the status quo. And that bugs the crap out of me.

I read a lot of the piece to my partner the other night. I was alone at Cheesecake Factory for about 3 hours and wrote lots. I read some of it to her and she was as angry as I am at the invisibility of the pain and the issues that come up over and over in our birth stories. I didn't remember until a day or so ago that even my partner... even a STRONG and powerful woman like her... was abused during her birth. Told to shut up, not cuss, to roll over, to spread her legs, and then the doctor (a female) tried to cut her even though she pushed her son out in two contractions. The doctor had two other women delivering at the same time as my partner and she was "in a hurry." My love yelled at her to NOT cut her, so the doctor did something called a Ritgen Maneuver, usually reserved to tuck a head more deeply so it can be born with the smallest diameter, but she exaggerated the maneuver and she tore up and into her urethra. As this happened, the doctor said, "I hope you tear."

Afterwards, a stupid nurse put the same catheter inside her now-stitched up urethra 5 times before getting it into her bladder to drain the pee that couldn't come because of the rip. Not surprisingly, she had the UTI from hell afterwards with fever, antibiotics, and feeling like crap. Not the best situation for a new mama. All for a hurried doctor since there was zero medical issue with pushing out a 36 week, 6 pound baby in 2 pushes. And she did tear, asshole doctor. And you did it to her.

We had another birth this week... my other Low-Profile Midwife friend (LPM is the term I shall use forevermore) and I. It was a homebirth, but the baby transported an hour postpartum for odd unilateral twitching and then the mom transported about an hour after that for hypoglycemia/shock/rule out pulmonary embolism... you take your diagnosis. Both are well and home now (baby got home last night... at 5 days postpartum).

The transfer of care was gentle, respectful, and coordinated. We did not run into each other. We were balanced and comfortable with our respective roles. We remembered to watch both mom and baby even when both were being worked on. We'd left mom and dad together most of the labor and faced those demons of: the more I am in the room with them, the more I want to DO. So we stayed out of the room. Staring at someone never helps. I got an article written. And some stuff read. And my calendar up-to-date.

LPM allows me to Be what the mother wants and needs me to Be. Even if it is just Be-ing.

I need to finish the other birth story I began nearly two weeks ago (the baby is 2 weeks old on Tuesday). Maybe today.

I met a woman yesterday (and we had lunch together) who had UC twins (unplanned) with one vertex and the other a footling breech. She videotaped it and is selling it everywhere. I told her my UC friends were gonna be J that I got to spend time with her. She told me her friends would be J she got to spend time with me!

More, as always, but enough for now.




My precip-ing lady still hasn't had her baby. I did a home visit this morning and she wants the baby OUT. I did a vag exam and she is a tad more open, but I wouldn't strip her. The great news is the head is so much harder than last week... that made me happy.

She is incredibly emotional and called me yesterday telling me how she was making her kids cry and that she hated her husband, but couldn't remember why. She does this before each child, so we are probably close(r). I spent some time talking with her about her needs and they are for solitude more than anything since she is living with in-laws and they party every night (Mariachi Band and all, last night). We strategized about how to find some peace and even offered to have her come to my clean and quiet house or do home visits with me... whatever she needed, we could find a way.

Her fundal height is low and getting lower. It concerns me, but after discussing her history, it seems this isn't uncommon. Her kids are tiny even now and she isn't having eating issues or vomiting or anything and there feels like there is plenty of fluid (that baby bounces around easily), so I am just mildly concerned. I spoke with the CNM backing up for my regular LM since she is off seeing fall colors in the northeast and I think I want the client to come in Monday for someone else's evaluation and to consider an ultrasound. Mom said she would be fine with an ultrasound, too, so we'll see what happens. Maybe there won't be a baby inside to ultrasound by Monday.

I got into the circumcision discussion with a Jewish lesbian couple I met initially 18 months ago or so when one was pregnant and they were interviewing doulas. They didn't choose me. So, now they are at our Temple (actually, we are in theirs) and are much more kind and I love their baby. One of the women was a Rabbinic student and I mentioned my heated discussion with the Rabbi and she had the same arguments he did, especially about it being THE covenent of the Jews and how it is so sacred, blah blah blah. I asked her what women do to show God that they are Jewish and she said women don't have to do anything, that in times past, they needed to be protected and that circumcision would show who would really protect them. I blinked looking at her, disbelieving what I was hearing. I said to her, "you know, we are not even welcome in an Orthodox Shul," and she continued with how Orthodoxy is relatively new and that women can demand sex, not the man... how women don't have to do this or that, but the man does... and she totally missed the "Honey, Jews hate dykes" that I was trying to say.

I was exhausted and my partner tried to pick up where I left off, but I realize just how ingrained, culturally and religiously, these folks are and how I would never change anything with them. And the funny thing is, I don't think they need to change the religion to totally banning it (although that would be nice), but to acknowledge the holiness and purity and PERFECTION of God's children and allowing the parents - and the child - a choice in whether they have body modifications or not. I mean, if you believe that some rules should have been tossed out as others brought in, why isn't this one of those out-dated rules? I see it as archaic.

It's how my grandparents and great-grandparents looked when they talked stupid crap about blacks and Jews. They SO believed it and looked SO convincing. I could see the polished speeches in their eyes.

I considered, after the talk with the Rabbi, not going back. I was that angry and hurt that he couldn't understand what I was saying. Sarah said at least there was discussion at all and I told her there was zero discussion... it was his thoughts and opinions and my thoughts and opinions; there was no considering the other's side (I admit that, even for me). And then I reminded myself, again, of his humanity and his brainwashing and that just because he was wrong on this issue didn't mean he wasn't a good teacher on other issues I agreed with. So I sucked it up and went last night and held my head up high as I looked at him. I'm glad I did. I certainly don't want a man to get in the way of me and my relationship with my God (and the definition is open for interpretation, btw... it isn't some man sitting in the clouds) or my own inner work towards a deeper spirituality. It is easier for me, though, I acknowledge that, since it isn't me with a new baby boy wanting inside the Temple and not being welcomed. It would be a different story if we had a son we were wanting to raise as a Jew.

I created a title in my head: Rabble Rousing With the Rabbi

I think it's catchy.

Estrillas = stretch marks (I always got them confused with stars when working in migrant locations)


Circumcision and the Rabbi

I finally had 2 seconds to speak with the Rabbi last night after our first adult education class and I was less than pleased about the outcome. In fact, I cried the moment he turned away and continued all the way home.

My consolation comments to myself: He's just a man. And he's wrong.

The situation: Clients who are Jewish or who want to be Jewish, yet won't circumcise their boys on ethical reasons and how they cannot find Temples to join or even feel welcomed at. (dangling preposisition, I know) So, this new Rabbi, so progressive! so wonderful about how so many laws are outdated and should have been tossed out long ago! I thought, for sure, he would be on my side on this issue. I was more sadly mistaken than I could have imagined.

His arguments: It is the most important covenant with God along with Shabbat in the home. It doesn't hurt the baby. There are no dangers in it. Moms don't have to watch. It's worse in the thinking about it than in the doing it. Babies cry when their blankets are removed... the same as crying with circumcision. The babies that continue crying are rare and probably have colic or something. It isn't the same as female circumcision. Why would someone let the child make the decision since parents sometimes have to make the decisions like not touching a hot stove?

My retorts: Just because a culture accepts something doesn't mean it is morally correct... as in the case of female circumcision. If moms don't want to watch, why make the baby go through it themselves? Babies cry much more with circumcision than with jostling of blankets. Babies that keep crying hurt; they are not colicky. Body modification is a whole 'nother animal than a hot stove. Babies penises have been cut off by the process... and there is infection.

I couldn't believe how sad I was talking about this with him. I had to shove my tears back (why?) during the whole talk.

When I spoke about penises falling off he made comments about not finding butchers to do the ceremony and then proceeded to tell me about a mohel here in San Diego that was so bad the Rabbis gathered together and ordered him to stop or they were taking him to court. I was so stunned I couldn't eek out the WHAT ABOUT THOSE POOR BABIES HE MUTILATED BEFORE YOU TOLD HIM TO STOP?!?! And he spoke about butchers more than once. I look forward to speaking up in the future about it; I doubt this is the last we will speak about the issue.

I told him my partner and I would not circumcise a boy if we had another... that one of our son's was circumcised and one was not.

He said he would be glad to speak with those that hadn't circumcised their boys... telling them how horrible it is to be raised Jewish only to be ready for their marriage in the Temple and to not be allowed because they really truly were not Jewish by having an intact penis. I told him that none of these people I know have anything to say to him.

I told him we would have to agree to disagree. He said he hoped this issue wouldn't remove us from the membership.

And it is then that I reminded myself of his humanity and his fallability and that my reality is just as valid (if not more so) than his on this issue. That I, too, am a Rabbi in my life.

It just makes me so very sad.

wiping tears still

And this on my first son's 22nd birthday. How I wish I had never had him cut. I learned so much from him.


Not Everyone Invited Will Be Coming Back From Lunch

I'm on a Lion King kick right now (the Broadway edition)... I can't sing it enough.

* I have talked about vaginas more this week than in ages! And done more vag(inal) exams than in the last year.

I have a woman who precip'd last time (had her baby damn fast) and is 36 weeks + and is way dilating and effaced and we are going to have a baby next weekend. There are major dilemmas at play. Balancing prompting the baby to come along with her history of precip-ing and hemorrhaging, she is extremely afraid to deliver alone. She was laughing and talking last time with tiny crampies... stood up... and the baby was there. Silent labors can be scary and the subsequent hemorrhages are worse. If the uterus doesn't have to stand at attention to get the baby out, it isn't as attentive at keeping the uterus tight after the baby comes.

We are going to put in a heparin (actually, saline) lock, have pit and meth in a small bag of fluids, and then strip her and see what happens. She was stripped twice last time and still she nearly delivered alone.

I asked my partner (who has assisted me before) if she would at least go and be with her (parnter is a cop) and she said she would... until one of the 4 midwives around the county we have at the ready for her. I was so touched she would do that! Surprised, too. She said she would call the fire department, too, because she won't just let her bleed, but I told her to just let them take care of her until we got there. I reminded her of this client's intense modesty, too, and she understands. I asked the client if she minded and she said, "No!!" that she would be a friendly face and I had to remind her that she looks imposing in her uniform with her vest on... she is huge! and she said she would remember that.

I am hoping that, with all this preparation, we have a 4 hour labor when everyone can get there and the birth be gentle and wonderful and no bleeding at all.

We want to do the IV pit and meth because it takes effect immediately as opposed to IM pit which can take 3-5 minutes to kick in. Just in case.

The mom wanted us to strip her this week. She was very convincing, but that head was a tad softer than I would have liked (she swears she is 37+ weeks), so we bargained for another week.

* Another client, a VBAC, continues having some pretty darn good contractions. She needs to stop it. She isn't due until Thanksgiving.

* Another client is screwing her head off with her man in South America and emailed to tell me she is having the most fun and sex of her life. Her vagina, too, is seeing some action! Her man lives down there and can't get up here... they are trying, but if he can't, they are working on getting a webcam set up so he can at least "be" at the birth in a cyber sort of way.

* I helped a doula client with nursing yesterday. The baby was clicking his jaw and was gnawing on mom... I am hoping that positioning will tend to it. He feels like he has a short palate, too, which will be better with age. He was also way small and yellow at 2 weeks postpartum. I weighed him and he was 2 ounces heavier than 3 days earlier (still 10 ounces from his birth weight, though); if he'd been the same, I would have sent her to the ped. The baby was some awake at one time, but kinda tired. The yellow this late is a tad disconcerting, too. She said he was better, then he was worse again with the nursing probs. I hope I helped. She goes to the ped on Monday for a weight and bili check.

She had me wear gloves to touch her baby. She whispered that others don't hold him right. She won't let anyone else drive the baby but her husband. She knows she is neurotic (her word) and I casually mentioned that it should go away, especially with another child someday. That no one wanted to break the kid's neck or crash the car with him in it. When she talked about supplementing with organic formula, I suggested another nursing mom (my co-teacher that she knows) and she was horrified. Inside, I wondered how she could justify a foreign animal's milk that she has zero knowledge of (or even if one can bet 100% on it being organic) vs. a mother she knows and likes loads and doesn't drink or do drugs. I would take my friend's milk over formula without batting an eye.

* So, we had dinner the other night with a friend and I was the odd woman out. All the others were major athletes from pro golfers to active surfers (who, for all I know, just sit on their boards in the water). Partner and I were the only parents in the small group, so I made sure to bring up placentas in the freezer and vaginas. Doubt I'll be invited back. I probably embarrassed my partner, but she was kind enough not to say anything. She didn't embarrass me even though she had some fine, fine wine we brought (Jarvis cab). I wasn't bored or anything, but it was just weird not having anything in common with a group of lesbians. Oh, except for liking vaginas... we do have that in common.

* Hired another doula.

* Met a midwife from New Zealand who is moving to our area in about a year. I am going to help her get her license to practice. There is a mechanism for foreign-trained midwives, we just have to figure out what that is. Liked the midwife LOTS and told her whenever she wanted to commiserate about homesickness, I was her gal.

Thanks for reading!


Nobody Ill Can Scream Like That

(one of my favorite lines ever in a book/movie)

Secret Garden

2am on Saturday morning.

It feels like forever since I have last written! I miss it. I dream about blogging, but so haven't had the time. My clients are having a harder time than we would have expected at this time.

* I missed a doula client's birth because Baby 3 took my phone and pager and put them in the office (here at home) and closed the door. I was sick and went to bed and forgot them on my purse. He told his mom he moved them because they "kept going off." I wanted to explode. Everyone else finds it amusing. I was infuriated and feel he should pay me back for some of the money the client is sure to ask for back.

* That same client had a velamentous insertion of an umbilical cord, an anterior placenta, a breech baby with a nuchal cord x2. They went from wanting a homebirth to "let's see how a scheduled cesarean can be made better." I spent loads of hours on the phone and in the office with them (they were also in our childbirth class) and then about an hour before she went to bed the night before scheduling her cesarean with her doctor. Her water broke and that is when they called and called me and went to the hospital and had surgery 20 minutes later. A beautiful boy! I have no idea about the cord yet, though. I'll need to see the Op Report. Dad got to cut the cord, though, which was great! And her sister was also in the OR with dad; very unusual. I am SO disturbed I missed it. I offered to do the PKU for them free-of-charge, but they didn't take me up on that. No mention from them of wanting money back yet.

* Another client is just barely 36 weeks and is 3cm dilated with head engaged and ready to GO. She had a 30 min labor last time with hemorrhage (the only IV I have ever gotten; got it when it was important!) and there are 4 midwives on alert for her... we hope at least one gets to her. She is about 12 min from my house, but about an hour from the office. The other closest midwife (my Licensed Midwife with this birth) lives about 25 min away, but is leaving on vacation on the 14th for 2 weeks. The CNM is backing me up (overseeing), but it would be better if it were the LM, simply for familiarity's sake. The CNM, however, delights in IVs and we want to have a Hep Lock in this mama the second she feels contractions going... and a pit and meth in a 250 ml bag of fluid just in case something goes on.

An aside about pitocin: It takes 3-5 minutes for intra-muscular (IM) pitocin to kick in/take effect in a body. It takes effect immediately when done intra-venously (IV); hence, the IV being ready.

We hope that if we have everything ready, we won't have to use a thing.

* Another mama, due mid-November hadn't felt her baby move for far too long. I had her drink a couple of cups of coffee and some ice water (when babes won't/don't move and makes mom nervous, we have them drink their favorite caffeine... either soda, juice, or coffee... works very well), but the baby still didn't perk up. She lives an hour away (at 85mph with no traffic... I know for a fact), so I sent her to the local hospital (if she'd have been closer, I would have gone there to check; next time, I will drive there anyway... probably best to find out if there is a fetal demise at home than have the experience you are about to read). I called her midwife at the local teaching hospital and she said it was the right thing to do, that if she were closer, she could have come down here, but if the baby was dying, sooner than later was good.

She got to the hospital about the time I was in 25 minutes away and dad called to tell me the baby sounded good and I wept with relief after hanging up.

I got there and mom tells me she told them she was having an HBAC and they were having cows over it. She also told them her midwife was coming up. (!) She was nervous, for sure, but I attempted a save later... dunno if it worked.

The baby's heart rate was a perky 150-170 (120-160 is normal), which was not unusual considering the coffee intake. She was reactive and doing well, but also having some mild contractions. When I was still driving, they said they might want to keep her overnight, but when I talked to the CNM down at the other hospital, she said we could come down there if overnight was necessary (and to deliver the baby if it was gone). When I got there, the dad said they talked about the AMA (against medical advice) thing and how insurance wouldn't pay for the visit if that were they did that. I didn't have time to explain it would have been a transfer of care, not AMA, but it became irrelevant.

The nurse made comments every time she came in the room about the risks of a homebirth and a homebirth after cesarean... acting as if my client chose to HBAC on a gambling bet or something. She is a nurse, for crying out loud! And well-read. And she and her husband have discussed all the pros and cons for years before this pregnancy. The discharge papers said it all: Patient educated (EDUCATED?!?) on risks of home birth and vaginal birth after cesarean. Gee, if y'all hadn't said anything, we never would have known!

Besides the odd comments in general (why wouldn't you want to deliver in the hospital naturally?), two stand out:

Nurse - You know, we had one of our nurses try for a homebirth after her cesarean and, well, it just was a disaster. *tsk tsk-ing* And her baby... *trailing off for effect* (None of us three picked up the trail, either... we let it lie.)

Doctor - Now, you know the risks, right? I mean, the baby could die. You're okay with your baby dying? *looking right at dad* You're perfectly fine with your baby dying at home?

Dad - Uh, no, I am not okay with the baby dying, but I do know the risks. (YESSSSSSSSSS!!! Can't get much more graceful than that, can ya?)


When the nurse was in the room, I mentioned calling the other hospital and asking the midwife for her records, but they were still at the office since she was so early. The nurse looked at me oddly and then the client and said something about delivering with midwives in the hospital... we didn't pursue that either. But, at one point, I did say I was her doula. That sucked. I don't even remember the context.

I didn't feel especially scared, but it was a taste of what I will feel/get in a transport situation and needed to feel/experience that to remind myself I am not within the law and to make sure my fear doesn't push me to the ground.

* I know, in many ways, my pregnant/birthing women are keeping me alive and mostly well.

* The 2 new midwives do not want to work with one of the older midwives. Originally, it was going to be a job sharing situation, but neither is comfortable with her style. That midwife is doing major power crap at the office as she feels more and more threatened. A midwifery chart takes about an hour to put together and she needed 2 papers in one and didn't want to wait for the receptionist to get them from the file, so she tore apart a chart for them and threw the rest of the out-of-order chart into the re-file box. I was sooooo mad. I will email and speak about it when I see her next. She also keeps telling the new midwives that they will get all the clients now and she won't have any. I told the one midwife who felt badly about that that the issue was the midwife's ego and to not let that affect her at all! The midwife has clients jump ship with subsequent pregnancies because of her "style" and attitude. Her skills are fine, if not great; her attitude sucks.

* The 2 new midwives and I went through my birth kit and talked about why things went where and how I'd labeled everything and why. We played with gauze to show how each of us packs (or doesn't pack) for suturing. I shared my strengths and weaknesses so they would know and not be surprised at a birth.

Strengths: shoulder dystocias, calmness in emergencies, neonatal resuscitation (I practice all the time), labor support

Weaknesses: IVs, suturing (2 things I have rarely, thank god, had the opportunity to experience)

They shared their strengths which included IVs and suturing. smile

I let go of the worry about suturing, however, when I heard an older midwife say: if you put two pieces of a vaginal cells together in a room, they will find each other. I figure suturing them together will help that process even more.

* Besides the fevers and stuff, my heart is lighter. I love birth and this life. I am tired, but happy. I want more... time, money, and leisure... but, who doesn't?

"Nobody ill can scream like that."

That's how I feel with my writing.


Naming That Dark Place