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Saturday
Apr232005

is mental illness that prevalent?

Why are so many women so sick with postpartum depression? My theories include the disassociation of women's minds and spirits from their bodies during a hospital birth. (Abuse, but not yet recognized as such.) That our bodies are meant to till the fields, hike miles to get water, make our own clothes, grow our own food, and run from the predators. For goodness' sake, when we were doing all of those things we didn't have time to worry about a booger inside the baby's nose. And I do mean worry.

The family I am tending to hired a live-in nanny-type and then fired her the next day because her daughter stole her zoloft and she was manic without it. Apparently, she wouldn't shut up and stay out of the house.

I was there again last night.

I wanted to take a picture of the baby this morning. I mean, I am pretty good at it and all, but I wanted to ask permission. Tentatively, the mom said, okay, maybe one. I just looked at her. As I focused, she turned away, covering him and asking if I had already done it and I said I had not. She said she didn't think she wanted any pictures of him yet. Before I could think, I blurted out, "You'll regret that, too, in about 15 years. These weeks are the most speedy of the changes and someday you won't even remember him being this small." And I packed up the camera and waved. "See you tonight!"

She is a germiphobe. After these pp doula jobs, I wonder who isn't anymore. She was concerned that I was carrying the bottle and nipples outside to the cottage (where the baby and I sleep) without their being covered. I said to her that it wasn't like I was dredging them in the Ganges River where people poop and drink and pee in the same water. I said it lovingly. And she let me go without covering the bottles.

I didn't tell her about the midwifery meeting where we just had a child drop his pacifier under a midwife and when she picked it up, it had a slug on it. She flicked it off and set the pacifier behind her. Sure enough, the kid walked right up and popped it into his mouth before any of us could at least wipe it off on our pants. We laughed hysterically and did comment on the amount of women who would be horrified at that situation. We shrugged and said, "well, he's building slug immunities now!"

Sunday
Apr172005

First Babies

I think we should all have our 4th kid first. It would make things so much easier.

I was called last night about a woman, 7 days postpartum, who seemed to be in an emotional crisis and they were looking for a PP doula. They lived about 70 miles away. After talking to the woman's mom (forevermore known as grandma/gma), I felt it would be good to go and see her because the gma seemed to be in some denial about how serious it was, the things she was saying.

I got there and sat with the new mom for about an hour, talking to her, and she had been having feelings of dying, feelings of the baby dying (but not by her), anxiety to beat the band, and major insomnia.

Clinical postpartum depression doesn't usually hit for at least 4-6 weeks postpartum, so if this woman was this sick at one week out, she REALLY needs help. With talking, she admits to having anxiety for years, never treated. Time to be treated, I told her.

The family is very holistic. Their pantry and fridge was like being in Whole Foods or Trader Joe's. The gma was distraught about her daughter taking meds, helping herself feel better that it might not be forever. I encouraged the gma to stay in the here and now and to Let's Get Through Today sort of thing.

The mom was making plans for the baby should she be hospitalized. She wants gma to take the baby and spoke a lot about how she did not want the dad to have the child. Dad, apparently, is struggling himself, by being an insensitive oaf. On purpose? Hard to tell.

I spoke in-depth about this "going away" feeling and it seemed to help.

PPD is so painful.

Friday
Apr152005

What I Learned from Oprah Today

That Mean Girls are insecure and they meaner they are, the more insecure they feel. The more people gossip and say mean things, the less good they feel about themselves.

I could say this in about 40 hundred different ways. It lays on the surface of my brain as an oil slick on the lake.

I knew this, but hearing it in different ways, in the context of my life, with Mean Girls all around me sometimes... weirdo clients, bizarre midwives, neighbors who throw eggs or puncture tires... it helps to be reminded.

I feel stronger.

Friday
Apr152005

Queen's Anger

Note to Doulas:

Don't take credit cards.

While this happened awhile ago, I had a surge of fury about it last night while I was at the hospital tending to a UTI I have (Macrobid - bid x 7 days).

Client hired me, spent HOURS with me prenatally. Issues arose that guided them to a cesarean. I helped them choreograph the cesarean and the day before she had the baby, spent 3 hours with her and her husband. She was going to schedule her cesarean, but the night after we met, she went into labor.

I'd gone to bed exhausted that night.

I awoke at 3:30am and found my phone and pager in the closed office as opposed to on the dining room table where I'd left it. The pager was beeping. The phone had several messages on it. When I listened, I heard she'd gone into labor and I immediately called the client. I'd missed the birth (a cesarean), but got dressed and went to the hospital right away. I was there by 4:10am (the birth was at 1am).

I spent hours with the client that night, and 2 other postpartum hospital visits. I also went to the home for a long visit, helping with nursing and guiding the mom to more comfort with her new baby. Dad called me on several occasions, worried about his wife's mental health. We spent a lot of time talking.

And then, the parents got mad that I'd missed the actual birth. We offered $200 back even though I would not have been permitted into the OR. Even though I was there 3 hours pp and had spent LOTS of time with them pre- and post-partally. Even though, with counting, I'd spent about 30 hours with them. We sent them a check.

Then we get a statement from American Express that the client wanted all their money back. (Now, it gets complicated and includes back and forth with paperwork, he said/she said, and accusations on all sides.) Blessedly, I keep meticulous records in my Red DayTimer and I faxed all of those dates (with other personal notes from my daily life) to AmEx. Who, in turn, sent them TO THE CLIENT!!!!!!!!!!!!

My head nearly spun off its spindle.

Weeks passed with discussions back and forth between my partner and AmEx and then a lull. A letter came in the mail about 3 weeks ago that said that AmEx gave the clients their money back.

All of it.

We wanted to scream. So my partner did. Right in AmEx's ear. She made them re-open the "case," but it is remote anything else will be done. She cancelled our AmEx acceptance at the office and our account with them because of their inept-ness in understanding what a doula does. Their "reasoning" (and I use that term loosely) was that I missed the birth. No amount of explanation of doula work seemed to sink into their heads.

The client also has our $200 check still. So they made money off the deal.

I don't know why I felt the fury of this while at the doctor last night. But, even now, it is there. So, I thought the most productive way to deal was to offer doulas (and midwives) the verbage to add to their contracts regarding doula/birth care.

We added something to the effect: In the odd case of the doula missing the birth due to circumstances out of her control and her inability to obtain a back-up, the client will receive a $200 refund (or whatever is appropriate for your practice - $200 is a quarter of what a contract is). Doula will assist the client for an additional post-partum visit either in the hospital or at home, wherever the client deems necessary.

What happened to my pager and phone that night? My step-child moved it into the office and closed the door "because it wouldn't shut up." It was the first - and last - time I ever slept without my phone next to my head.

Thursday
Apr072005

A Story

A woman 20 weeks pregnant feels she is going into labor. She'd already lost twins at 23 weeks and another baby at 20 weeks, so she has a pretty good idea of what she is talking about.

In the hospital, they explain she really needs to consider cerclage... where the cervix is sewn shut until the end of pregnancy. She agrees. She is 2cm dilated already.

During the stitching, her membranes are accidently ruptured.

She is now hospitalized, ass end up (Trendelenberg position) with monitors on as she waits another 20 weeks for her baby's birth. She doesn't move except slightly side to side. No bathroom privileges. No trips to Babies R Us for receiving blankets. No La Leche League meetings or childbirth classes. Just lying, ass end up in a hospital bed, waiting.

The hospital doesn't have an exquisite NICU, so through consultation, it was decided to wait until the woman was 24 weeks along and send her to the Big University Hospital (BUH) where they could take better care of the baby should he be born early.

During the weeks, a guess is made that the membranes have re-sealed, however her amniotic fluid volume remains terribly low... between 2 and 4. Normal would be 18.

The extremely difficult 4 weeks go by and the woman, via ambulance, ass end up, is shipped to the BUH.

At the BUH, the doctor admits her and says she doesn't need to remain ass end up anymore. That there is no research showing that Trendelenburg does anything for women trying to keep a baby inside... that there is pressure anyway, so she might as well get up and do something. She refuses. She asks to see another doc who says the same as the first. She asks for another. Same answer. She goes through this 6 times, including with perinatologists, who tell her it is fine to get up.

She doesn't believe so, but she guesses they must know what they are talking about.

The nurse gives her a sleeping pill for her agitation and sends the woman to the bathroom to pee before bed. It is the woman's first upright in over 4 weeks.

She climbs back into the bed and the nurse attaches the monitors back on and wishes the mom a good night.

About 30 minutes later, the nurse wanders in and says the baby must have moved because they haven't heard the baby in about 20 minutes.

She can't find the baby, so they bring in an ultrasound machine. The baby's heart has stopped.

A vaginal exam shows an occult cord prolapse through the 2.5 cm open cervix.

This happened here, to one of my midwife's clients, last week.

The mom that lost her baby is a lawyer.

Tuesday
Apr052005

Doula Post

On-going discussions about women's choices, how doulas hate them, how much should doulas tolerate/accept... has moved into our own ignorance even in education.

My comments:

This another part of my own walk that I see as women birth in ways I personally find aborrhant. I was that lemming! I was that woman who walked blindly down the induction, medication, episiotomy, etc. path and who, through sheer luck of the draw, found herself surrounded by Bradley, LLL women who gently illuminated the other path around the lake.

And I took that path.

I believe that if I, the ignorant of the decades, can find it, so can other women. I believe that we who do birth work share our experiences. The ripples begin and end in places we never have an awareness of.

Be the example you want others to follow.

This is my personal motto and I strive to work those words.

A voracious reader, my first birth mimicked the birth books. Hospitalized with all the inherent accoutrements.

When I learned there was another viewpoint, I took that to its extreme and UC'd.

With my third, I found (some) balance and had a U-Labor and a (somewhat) assisted car birth.

This was an earlier time (my car baby is now 19 years old), but back then, each time I thought I had completed my evolution. What else was there to learn? How many different ways can a baby be born? When #3, I'd attended maybe 30 other births. I am now 800 + above that number and while there are two *routes* for babies to be born, there are infinite WAYS for them to be born.

Because I have watched myself, and DOZENS of others, walk this path from Medical Model to Belief in Women & Birth Model, I remind those who cringe at women and their choices that, in 20 years, she might be a magnificent doula/midwife *because* of this part of her walk.

Even if YOU believe the woman doesn't have her baby's best interest at heart, even if YOU don't see her thinking of things, I believe SHE thinks she does. And isn't her perception as valid as yours? In fact, her perception is her reality. Your perception of her is YOUR illusion.

with regards to stripping membranes "hurting" the baby and a midwife saying that no, it doesn't hurt the baby

As a midwife, I would answer that question the same way. No, it doesn't hurt the baby. It might move things in YOU to another level... might rupture the membranes... might blah blah blah, but hurt the baby? Physically? No.

That is the question that people usually mean when they ask: Will it hurt the baby? (Can I have sex? Will it hurt the baby? If I ride the ferris wheel, will it hurt the baby?)

with regards to an epidural hurting the baby

But, this is the interesting part. Even midwives... even homebirth midwives... don't believe that what you asked hurts babies. In the way things are asked, I hear (again) "physically" and no, epidurals don't physically hurt the baby. It can cause issues in mom that have an effect on the baby so I don't even see the midwife answering evasively. She was answering clearly as to how she heard the question.

And many Many MANY medical and midwifery people don't believe either of the situations you asked about have ANY consequences at all. Even epidurals are seen as benign in many midwifery circles.

with regards to one's "ignorance" at a previous time and the doctor's belief that they are acting in the best interest of the mother and baby

But, see, they ARE acting in the absolute most wonderful interest of your baby. They still are and do. They believe 1000% that their care is optimal, correct, safe, and validated via studies and experiences. It is rare that I hear whispers of economics, lawsuits, or time contraints as reasons for what they do, although those of us here know better. They really, really REALLY believe they are doing the right and best thing. They think that those of us asking for individualized care, occasional monitoring, etc. are nuts and that we are asking for a dead baby by our "selfishness." I've heard that several times. "If I didn't have to go to court to defend my actions, I'd say 'leave her off the monitor - let her see what happens when she does.'"

I love my evolution. I love that I had a highly mechanized birth 22 years ago. It has helped shape me into the birth worker I am. Just as every birth, vaginal, cesarean, home, hospital, birth center, birthrape, hands-off, gentle, frantic, death-shrouded, life affirming birth I have attended has helped shape me into the birth worker I am.

And my evolution continues.

Saturday
Apr022005

Why...

... don't Catholics let people die in peace?

I am so lost as to the reasoning for the fighting for Terry Schiavo's death/life and now all the praying for the Pope's healing. I don't understand why they don't pray for them to just die sweetly and quickly. Very weird. And all in one week.

The most bizarre irony of all of this death talk is that Terry Schiavo found herself in that vegetative state because of anorexia - she was killing herself through starvation. And then, she actually dies that way via the courts, her husband, and ultimately, her own choice. Isn't that the most odd thing? None of the reporters say anything about this part of the story. I would highlight the crap out of it for all those anorexics out there.

Do YOU want to be a vegetable? No? THEN EAT ONE!

(probably not so funny to anyone else but me)

I taught some midwifery students today and had a good time. We talked about situations surrounding transports. I like asking, "what makes you squirm?" Helping the women to find their outer limits of comfort for different scenarios... high blood pressure, hemoglobin, transient tachypnea of the newborn, etc. It was great... and I learn a lot about the women and their strengths and how they learn and think. I remind them that one of the best things about these classes... with midwives and with each other... is that they see that each of us has different strengths and comfort levels and if they have a woman with creeping BP and are getting out of their comfort level, they can call in another midwife who isn't so uncomfortable and work together... or refer, whichever they want to do (even if that referral is to the other midwife).

The midwife I work with a lot sat in on some of it and we play off each other well, so it was really nice.

It seems a cult-ish "positive thought" workshop has spread over some of the midwifery community. It has gotten difficult dealing with some of the women who have gone through this because they seriously drop work, money, and friends and family for this "training." One of my own practitioners is driving us bonkers as she removes herself from her duties and, instead of these "trainings" improving her attitude, her drive for success, and her work, it is making her not be available to anything BUT the trainings.

It's hard watching because I keep seeing the women who are not anchored in themselves latch onto these trainings. The seminars are ego-raising! If you go back to the very very beginning of my blog, when I talked about PSI, it is the exact same thing, but in a different dress. A Break You Down to Build You Up thing. In these seminars, people find community where they had none. Family where they thought/felt/really had none. They are infectious! I agree, but they are supposed to assist in a person's success, not downfall. And I am watching women around me fall a lot.

Monday
Mar212005

Slinging Your Baby (published article)

Babies have been carried since babies have been born, yet, in our culture, babies are carried in their car seats (what some call “plastic buckets”). Wouldn’t it be nice to bring our babies close again? To remove the foot-wide space of plastic and embrace the tenderness that is our child? All too soon, those babies grow up and are gone; hold them tight while you can.

The way most of the world carries their children is with a sling. From rebozos in Latin America to the kangas of the Maasai, baby wearing is very much the norm. Our own culture and even our local community is seeing an increase in baby wearing. Where does someone start who has never worn a baby before?

Many different types of slings exist. Some are simple cloth, others silk (the choice of materials are endless!), some with padded shoulders, some that go on the front of mom or dad with the baby facing in, and others facing outward. Style and comfort can be combined as you find a sling that is tailored just for you. An experienced mom or a specialty store that offers natural supplies for baby can certainly help you out. in has been a resource for many families as they embark on their journey towards slinging. Women of all shapes and sizes can find the sling that is right for them; the one that doesn’t pinch, cut, or sit unused in the closet.

It can take some time to get used to wearing the sling and even some time for the baby to get used to being in the sling. Practice makes for easy-going days and accomplishing things that you might not otherwise have been able to do. Laundry, shopping, and daily walks become a reality once you hit your stride with the sling. The more you wear the sling, the more you will enjoy it.

Nursing in the sling is a cinch and for those that find modesty very important. They afford mom plenty of freedom and time out in the world.

Dads love slings, too, and are able to offer mom some time alone if she is needing that. When colicky evenings traumatize new parents, a sling can offer the baby some tender swaying and some semblance of the memory of being in the womb. Either parent is able to head to the beach or walk around the block, allowing mom or dad some exercise and head-clearing time.
Many wonder if carrying a baby on one hip or the other is tiring, but most who regularly carry their children find it surprisingly easy; not quite the same as when carrying a baby when they are on the inside, which can be more uncomfortable. The extra weight of the baby is evenly distributed as the sling curls around your back and sides.

Slinging a baby is merely one part of what has become known as Attachment Parenting… a belief that the child’s needs are at least as important (if not more so for a time) than the parent’s needs. AP families are also known to co-sleep, have extended nursing of their babies, child-led toilet learning, and even a concept known as un-schooling (allowing your child to live and learn in life, not in a structured school environment). But others who don’t necessarily ascribe to the complete AP picture can benefit from slinging their babies and might consider a trip to the local sling shop for a fitting.

After all, don’t we all love to be held?

Sunday
Mar202005

Hibiclens & Precip Births (separate topics)

A question arose regarding Hibiclens being on a list of supplies from the midwife. I reply:

Hibiclens (that is the proper spelling) is used in lieu of antibiotics in labor for a woman who is GBS positive. That is the only thing I can imagine using it for in birth.

You can read about it at:

http://www.gentlebirth.org/archives/gbs.html

Many women do not want antibiotics, but want to do something and the Hibiclens, while controversial, seems to do a pretty decent job in helping babies avoid GBS infection as they pass through mama's vagina. It is not standard treatment at all in North America, but in countries where antibiotics are unavailable or scarce, the Hibiclens seems a great alternative.

My personal take... NOT speaking as a midwife, but as a mama - if I was GBS positive, I would choose to do nothing and watch the baby closely afterwards. If I were negative, I would absolutely not let someone near me with Hibiclens. If I was forced to choose between antibiotics and Hibiclens, I would choose the wash.

If a woman chooses the wash, it should be done ONCE, diluted, and not until birth is imminent.

Another question regarding precipitous babies and their inability to breathe because of the speed of the birth was brought up... truth or fiction?

I answer:

It can be both. Most of the time, precipitous births, just like most births, do fine. However, there can be complications, just like in slower births. You ask about the baby's breathing, so I will address that first.

Babies who fly through the vagina in a fast and intense labor have two issues at play. Babies, for all intents and purposes, hold their breath during contractions. The umbilical cord provides their oxygen, but if contractions are so hard the baby and the cord are mooshed, the baby can have a harder time. If contraction follows contraction with nary a moment to breathe, the baby can show their stress when we listen with a doppler.

I encourage women having precip births to BREATHE and breathe deeply as much as possible even through the contractions. Making noise/singing is fabulous! It takes oxygen to make moaning or singing noises and babies benefit greatly.

So, if a baby comes out after having this intensity as their labor, they can be rather surprised to find themselves out and needing to breathe on their own. The other look I see (and it is called this in most medical circles I have been in) is "stunned." Babies have their eyes open and might even blink, but you can see in their eyes they are momentarily freaked out at being on the earth. They didn't have the hours and hours to get ready for their transition; instead, they find themselves needing to breathe on their own and it can take a few moments for their complete spirit/soul to follow... and then they take their first breath.

Most precip births are perfectly fine and even with a stunned baby, just touching them and looking in their eyes to let them know they are fine and safe and perfect is usually enough to bring them "home" into your life. At the most, a "kiss" of a puff or two of air from your mouth is enough.

Someone mentioned tearing, which you didn't ask about, but babies who fly from uterus to your arms can tear the vagina since it can take some time to stretch the vagina gently to allow the baby's entrance. I have come to believe the adage, if it hurts, don't do it! If you feel burning, wait and let the burning feeling go away. Let the uterus do the work for you. And yes, precip labors' uteri can push those babies out in one giant whoosh! so any extra help from mom probably isn't necessary.

(I've been writing a lot about this for my book, so forgive me if I go on a tiny bit more.)

The only real concern is bleeding after a precipitous birth because the uterus is just as stunned as the baby to be empty. Nursing right away or at least nipple stimulation and (I cannot stress this enough) TELLING YOUR UTERUS TO CLAMP DOWN! Some women choose to use herbs and others obtain pitocin just in case, but unless a real issue is unfolding, allowing the body to catch up just takes a few moments (maybe 2 minutes).

Women, too, find themselves surprised or even shocked that the birth has happened and it is very important to stay in touch with the body at this time. Getting totally high after the birth of the placenta and making sure bleeding isn't an issue is great.

end post

I just thought these were good points to share.

Sunday
Mar202005

If It's So Bad, Why Do They Do It?

Also from my Doula list. The question above is regarding physicians and hospitals.

I answer:

Three major reasons:

Liability - doctors are sued for NOT doing cesareans, not do-ing them. Their liability insurance guides much of what they can and cannot do; the current atmosphere for VBACs as an example. Vaginal twins? Vaginal breeches? Not if insurance has anything to say about it. If there is the *slightest* chance that something might be going wrong, do EVERYTHING to document that you tried everything.

Time - scheduling inductions and cesareans and even doing epidurals with augmentations of pitocin dramatically shorten doctor's days and nights and limit the call time away from their families and other parts of their practice, including doing other GYN surgeries. Scheduling options has lightened the burden for OBs so dramatically in the last 10 years, I have heard docs quietly congratulating each other for not having been called out at all during a week-long night call schedule. Most of us know the not-so-subtle brainwashing that begins in early, early pregnancy to attend to "due dates" and "large babies" (and small babies and low fluid or too much fluid, or Or OR...) so that when scheduling becomes the "requirement" later on, the groundwork has already been firmly laid.

Money - No one likes talking about this part, but its reality must be addressed. Docs *do* make buckets more money for a LOT LOT LOT less time with cesareans. The average vaginal birth hospital cost, without prenatal care, without an epidural, is $10,000. A cesarean, without paying the anesthesiologist, is $25,000. Medi-Cal here in CA pays $800 for a vaginal birth. Around $3000 for a cesarean. Now, of course that is still peanuts compared to insurance payments, but you can see the dramatic difference and with FAR less time invested.

Wrapping all three of these reasons into one ugly package, it's incredible any woman gets an unmedicated vaginal birth out of a hospital doctor. I am always amazed and my mouth hanging open when I hear stories of patient docs and long labors allowed to continue. I send prayers of thanks to those docs that are actively bucking a system designed to bring them to their greedy knees asking for more and more money.

And I hate the insurance companies that schmooze the docs and bribe them with trips, things, and incentives to cut women. It disgusts me, the underbelly of the OB World. Not that I wouldn't be seriously tempted if I were in their shoes, believe me. It feels much easier and safer for me sitting here, as a homebirth midwife, to say these things to my clients and my childbirth classes. And of course, their picture (the doc's) is very different than my own, though liability is most often cited as THE reason for the cesarean rate, induction rate, etc. Not safety.

Long and convoluted.

Thanks for the patience as I ranted.

end post

I add:

Another poster brought up a wonderful point about fear and how people in this culture go to docs all the time to be fixed and cured and that many see birth as something to be fixed, too. That women are subtly promised that all will be well if they see docs and that fear continues to drive them to the hospital and docs in droves. I must remember to keep "fear" in the equation when asked this question. This will be a great point at ICAN meetings.

Made me think, that's for sure.

Sunday
Mar202005

From My Doula List

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

http://pattinewton.proudpregnancies.com/blog

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.

Sunday
Mar202005

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.

Friday
Mar182005

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.

Tuesday
Mar152005

Parking

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.

Saturday
Mar122005

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!

Sunday
Mar062005

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.

Sunday
Mar062005

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.

Friday
Feb252005

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.

Tuesday
Feb222005

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?

Wednesday
Jan192005

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?

Nope.

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.