"You hear in the person you’re destined to love the sound of those yet to be born." - Alyson Richman
1998. As the plane lands in Detroit, an image flashes across my mind of my boyfriend waiting for me at the gates, as it usually does when I land on the cross-country trip. This one is different: his arms encircle three children who are also waiting for me. I laugh at myself for the schoolgirl imagining. Then, I think, I wasn't imagining on purpose - this image came to me unbidden. I call it back and look more closely. There are two girls and a boy, somewhere between the ages of maybe 5 and 11. Two of them have light hair, but I can't see their faces. I laugh again; my boyfriend is dark-complected and I can't imagine him ever having a child with light hair. I pull my carry-on out from the overhead bins and walk off the plane quite amused with my subconscious. I am 19, and I have hardly considered life after college graduation. The image is gone before I reach the airport shuttle. The fantasy was so great, my boyfriend is not even able to meet me at the airport today.
Tonight, 2011. I read the lines above in Richman's book "The Lost Wife," and the image returns to me, equally unbidden. The father of my children with two daughters and a son. The dark-complected first born so like him in many ways, the younger two more like me, growing into people I never could have imagined yet somehow I've always known.
For a moment, time feels simultaneous.
Monday, December 26, 2011
Thursday, September 29, 2011
Donovan!
My baby boy turns three tomorrow! Incredible! Here's some recent cuteness from him.
"Moly holy!"
"Elilala" has turned into "Elilana"
"Happy Rosh Hashalah!"
"Kiki, me onwy Donowan. Me not Baby Donowan anymore."
Walking down the stairs first thing in the morning: "Mommy! Dere a boy comin!"
"Me need help. Me onwy a lidda boy."/"Me do it aself. Me a big boy."
D: "Me want to go back a my fwend's house. Me want more Shabbat."
Me: "We're going home now, but when we wake up, it'll be your birthday."
D: "WHAAAT?"
Me: "Yep, and we'll go to a park and see friends."
D: "Donowan birfday! Donowan birfday! Donowan birfday!"
"Moly holy!"
"Elilala" has turned into "Elilana"
"Happy Rosh Hashalah!"
"Kiki, me onwy Donowan. Me not Baby Donowan anymore."
Walking down the stairs first thing in the morning: "Mommy! Dere a boy comin!"
"Me need help. Me onwy a lidda boy."/"Me do it aself. Me a big boy."
D: "Me want to go back a my fwend's house. Me want more Shabbat."
Me: "We're going home now, but when we wake up, it'll be your birthday."
D: "WHAAAT?"
Me: "Yep, and we'll go to a park and see friends."
D: "Donowan birfday! Donowan birfday! Donowan birfday!"
Sunday, September 25, 2011
Food, stress, self-care, oh my!
Food:
January-June, I ate pretty well, though always on the run. I wasn't cooking. I was eating freezer meals, take-out, prepared foods from Whole Foods, and food from the fridge at Starbucks.
July, I was in Utah and was eating worse. Sometimes the same types of foods as before. Sometimes less - plain greek yogurt and a green smoothie was a pretty common meal. I was making an effort to eat nutritious foods, but finding little time to eat.
From the end of July to the middle of August, I ate terribly. I was packing up my house, getting ready to leave, and I gave up completely and ate at a restaurant or ate take-out most of my meals. I gained 4 lbs in 3 weeks, which is the first time that has ever happened outside of pregnancy.
Right around the time we moved out of our house and into our temporary apartment, my body let me know that it was done with this. The high-fat diet of outside meals gave me a gallbladder attack - the first one since I was a teenager - right about the same time that I started wanting to eat a whole bunch of salad, fruit, and tofu/veggie stirfry. I didn't even want dessert - and for someone with a sweet tooth like mine, that's saying a lot.
Stress:
I got home from Utah running on empty emotionally, not only because my stay there was so intense, but because of the six months that preceded it. Then I dove right in to moving, and not just moving but moving into a small and temporary place in a bad neighborhood, with a long commute to my girls' school and to my work. My husband and I don't quite know how to interact, since we are both so stressed and are having a hard time supporting each other because we are both so bogged down in our own stress. I'm also gearing up for submitting my application for the NARM exam (aka licensing boards), putting all my ducks in a row and studying.
Self-care:
I'm getting what should be adequate sleep. I am exercising, although this is pretty clearly the one facet of self-care which has plenty of room for improvement. I am spending time with friends and laughing. I'm having fun with the kids when they're off school. I even managed to get a massage last week.
I've been in a pretty horrific mood - very self-critical, primarily. I've been trying to figure out where it's coming from, because it feels disproportionate to the actual amount of stress that I am under. I finally figured out that it's just a cumulative effect of the several months of stress, the month of eating absolute junk, and the fact that right now, I am losing weight. Looking back over my life, I definitely get more self-critical and "down" when I am losing weight, for any reason. Since I am not losing weight on purpose, and I am eating nutritious foods when I am hungry, I don't really know what to do about that. I am hoping it will even out over time as I adjust back to a healthy and low-fat diet, and that I will just naturally stop losing weight as I reach a body composition that my body actually likes, or that my body will be okay with adding in more healthy fats as time passes since having overdone it on the fats.
I apologize for being MIA on the blog. If you know me in person, I apologize for being crabby at you if I have been. I think I have mostly been crabby at myself, though, and the good news is that I am able to keep all my responsibilities fulfilled, and am enjoying my time with my kids, friends, colleagues, and clients quite a bit. This tells me that I'm okay (and gives me a reprieve from being hard on myself). But I am definitely looking forward to the self-doubt monster getting the boot, when this funk passes or I find a solution.
I hesitated about posting this. Do former and potential future clients who are reading this really want to know when I feel weak? I finally decided just to be real. Midwifery is hard. It's physically, intellectually, and emotionally challenging. Midwives burn out at a high rate. Most midwifery students don't complete their training. Other midwifery students reading this deserve to know it's not always rainbows and roses for me and only challenging for them. So here you have it, a bump in my road. It'll smooth out. I've had bumps before. I've got a full tool box, a heart full of resolve (*cough* stubbornness), and all the support I need.
Ah - acupuncture. That's the one tool left in my toolbox. I think it's time for a trip to Berkeley to see my favorite acupuncturist.
January-June, I ate pretty well, though always on the run. I wasn't cooking. I was eating freezer meals, take-out, prepared foods from Whole Foods, and food from the fridge at Starbucks.
July, I was in Utah and was eating worse. Sometimes the same types of foods as before. Sometimes less - plain greek yogurt and a green smoothie was a pretty common meal. I was making an effort to eat nutritious foods, but finding little time to eat.
From the end of July to the middle of August, I ate terribly. I was packing up my house, getting ready to leave, and I gave up completely and ate at a restaurant or ate take-out most of my meals. I gained 4 lbs in 3 weeks, which is the first time that has ever happened outside of pregnancy.
Right around the time we moved out of our house and into our temporary apartment, my body let me know that it was done with this. The high-fat diet of outside meals gave me a gallbladder attack - the first one since I was a teenager - right about the same time that I started wanting to eat a whole bunch of salad, fruit, and tofu/veggie stirfry. I didn't even want dessert - and for someone with a sweet tooth like mine, that's saying a lot.
Stress:
I got home from Utah running on empty emotionally, not only because my stay there was so intense, but because of the six months that preceded it. Then I dove right in to moving, and not just moving but moving into a small and temporary place in a bad neighborhood, with a long commute to my girls' school and to my work. My husband and I don't quite know how to interact, since we are both so stressed and are having a hard time supporting each other because we are both so bogged down in our own stress. I'm also gearing up for submitting my application for the NARM exam (aka licensing boards), putting all my ducks in a row and studying.
Self-care:
I'm getting what should be adequate sleep. I am exercising, although this is pretty clearly the one facet of self-care which has plenty of room for improvement. I am spending time with friends and laughing. I'm having fun with the kids when they're off school. I even managed to get a massage last week.
I've been in a pretty horrific mood - very self-critical, primarily. I've been trying to figure out where it's coming from, because it feels disproportionate to the actual amount of stress that I am under. I finally figured out that it's just a cumulative effect of the several months of stress, the month of eating absolute junk, and the fact that right now, I am losing weight. Looking back over my life, I definitely get more self-critical and "down" when I am losing weight, for any reason. Since I am not losing weight on purpose, and I am eating nutritious foods when I am hungry, I don't really know what to do about that. I am hoping it will even out over time as I adjust back to a healthy and low-fat diet, and that I will just naturally stop losing weight as I reach a body composition that my body actually likes, or that my body will be okay with adding in more healthy fats as time passes since having overdone it on the fats.
I apologize for being MIA on the blog. If you know me in person, I apologize for being crabby at you if I have been. I think I have mostly been crabby at myself, though, and the good news is that I am able to keep all my responsibilities fulfilled, and am enjoying my time with my kids, friends, colleagues, and clients quite a bit. This tells me that I'm okay (and gives me a reprieve from being hard on myself). But I am definitely looking forward to the self-doubt monster getting the boot, when this funk passes or I find a solution.
I hesitated about posting this. Do former and potential future clients who are reading this really want to know when I feel weak? I finally decided just to be real. Midwifery is hard. It's physically, intellectually, and emotionally challenging. Midwives burn out at a high rate. Most midwifery students don't complete their training. Other midwifery students reading this deserve to know it's not always rainbows and roses for me and only challenging for them. So here you have it, a bump in my road. It'll smooth out. I've had bumps before. I've got a full tool box, a heart full of resolve (*cough* stubbornness), and all the support I need.
Ah - acupuncture. That's the one tool left in my toolbox. I think it's time for a trip to Berkeley to see my favorite acupuncturist.
Sunday, September 4, 2011
Absence makes the heart...
The kids were at my parents' for the past two days and got home right at bedtime tonight. I gave the girls a cuddle, and Eliana said, "Mom, I missed you."
"I missed you, too, honey!" I replied.
And then she finished her sentence: "...for the first time."
I guffawed.
"Why are you laughing?"
"Oh, I love you, Eliana."
"I missed you, too, honey!" I replied.
And then she finished her sentence: "...for the first time."
I guffawed.
"Why are you laughing?"
"Oh, I love you, Eliana."
Sunday, August 28, 2011
Random happenings
D: "Mommy? An me hab peany butta like Olly?" (Eliana has just had her bedtime snack: Barney's almond butter on a spoon.)
Me: "You want it on a spoon like Elly?"
D: "Yeah, yeah, me hab it on a poon! Pleadz?"
Me: "Okay, let's go to the kitchen, I'll get it for you."
He leads the way. By the time I get to the kitchen, he's holding the tub of Barney butter, which he hands to me. I notice that he's also licking his teeth.
Me: "Did you already eat some peanut butter?"
D: "No."
I look inside. There's clearly scrape marks along the side. Elly's spoon, or D's fingers?
Me: "Did you use your fingers?"
D: "No, me not."
I smell almond butter on his breath.
Me: "You clearly ate some, my son. Tell me, what did you use to eat the peanut butter?"
D: "Me tongue." Sticks it out. "Me need a poon, Mommy."
I do love that he pronounces Elly "Olly" - my niece Meriden did the same at his age.
Also, he's combined "Yee-haw!" and "Wheee!" into a delightful exclamation - "Whee-haw!" That might be the best word ever.
The girls started at a new school last week - two days of school then the weekend. It's a small school - only one class per grade. Today she got invited to a birthday party, happening today, because they had invited all the girls in the class a month ago and the mom just figured out this morning that there were new kids to invite. I thought it was pretty cool that she went to the effort to get ahold of me and make sure that Kes didn't feel left out. After the party, Kesenia was describing to me who she was making friends with and what she likes about them, and then she said: "I think I'm going to make a good lot of pals this year, Mom." I couldn't be happier for her. Last year, in our homeschooling group, there were a ton of kids Eliana's age and one boy Kesenia's age. I am hopeful that this school is exactly what my kids need both academically and socially.
I overheard Eliana explaining to Kes the other day that there were two kinds of twins: "In one kind, like Rowan and Meriden, there are two eggs and two sperms and each egg gets a sperm. In the other kind, there's only one egg and it gets two sperms." (I stifled a laugh, then straightened that out really fast. )
Me: "You want it on a spoon like Elly?"
D: "Yeah, yeah, me hab it on a poon! Pleadz?"
Me: "Okay, let's go to the kitchen, I'll get it for you."
He leads the way. By the time I get to the kitchen, he's holding the tub of Barney butter, which he hands to me. I notice that he's also licking his teeth.
Me: "Did you already eat some peanut butter?"
D: "No."
I look inside. There's clearly scrape marks along the side. Elly's spoon, or D's fingers?
Me: "Did you use your fingers?"
D: "No, me not."
I smell almond butter on his breath.
Me: "You clearly ate some, my son. Tell me, what did you use to eat the peanut butter?"
D: "Me tongue." Sticks it out. "Me need a poon, Mommy."
I do love that he pronounces Elly "Olly" - my niece Meriden did the same at his age.
Also, he's combined "Yee-haw!" and "Wheee!" into a delightful exclamation - "Whee-haw!" That might be the best word ever.
The girls started at a new school last week - two days of school then the weekend. It's a small school - only one class per grade. Today she got invited to a birthday party, happening today, because they had invited all the girls in the class a month ago and the mom just figured out this morning that there were new kids to invite. I thought it was pretty cool that she went to the effort to get ahold of me and make sure that Kes didn't feel left out. After the party, Kesenia was describing to me who she was making friends with and what she likes about them, and then she said: "I think I'm going to make a good lot of pals this year, Mom." I couldn't be happier for her. Last year, in our homeschooling group, there were a ton of kids Eliana's age and one boy Kesenia's age. I am hopeful that this school is exactly what my kids need both academically and socially.
I overheard Eliana explaining to Kes the other day that there were two kinds of twins: "In one kind, like Rowan and Meriden, there are two eggs and two sperms and each egg gets a sperm. In the other kind, there's only one egg and it gets two sperms." (I stifled a laugh, then straightened that out really fast. )
Friday, August 5, 2011
Happy 6th birthday Kesenia!
Six years ago today, my second baby was born!
Don't all mothers reminisce about meeting their baby on their child's birthday, no matter what their plans for birth or what actually happened during their birth? It's why I wish my friends a happy momiversary, or a happy birthgivinday, or a happy birthiversary instead of or in addition to wishing them a happy birthday for their child.
It was such a healing process for me. Eliana was born in a planned hospital birth with unplanned and unnecessary interventions. Making peace with her birth was a long process that spanned many years, and Kesenia's birth was a leap forward in that for me.
As I reminisce and reread her birth story as I wrote it back then, I can't help but notice again what I've always felt about my kids - their births suit them so well. Kesenia's life has been as full of love, surprise, and joy as her birth.
Don't all mothers reminisce about meeting their baby on their child's birthday, no matter what their plans for birth or what actually happened during their birth? It's why I wish my friends a happy momiversary, or a happy birthgivinday, or a happy birthiversary instead of or in addition to wishing them a happy birthday for their child.
It was such a healing process for me. Eliana was born in a planned hospital birth with unplanned and unnecessary interventions. Making peace with her birth was a long process that spanned many years, and Kesenia's birth was a leap forward in that for me.
As I reminisce and reread her birth story as I wrote it back then, I can't help but notice again what I've always felt about my kids - their births suit them so well. Kesenia's life has been as full of love, surprise, and joy as her birth.
Wednesday, August 3, 2011
Rounded out
We're packing up the house for the move, and today I came across a journal I started as a private adjunct to the journaling I was doing on this blog, about 5 years ago. It only has 3 entries in it; apparently privacy wasn't all that necessary. (?) To set the scene, I had only the two girls at the time and they were about three and one. I had recently taken my Lamaze teacher training course and was observing a Lamaze series taught by an excellent childbirth educator, but had still not attended any of the 3 births I was required to attend to complete my Lamaze certification, and I was nervous about them. I knew birth was extraordinary and powerful. I thought I was too small to hold the space for birthing women.
The entry 5 years ago today states, "I recognize that I need to carve out some time for myself and some space for me to be more than Elly and Kes's mom. That will always be the most important part, but I need to define myself as my own person separate from them, just as they will - and are - defining themselves as separate from me as they grow. Heck, it may even make me better at being their mom. I don't know what this will look like... it's going to take a lot of exploration."
Heh. I wouldn't call it exploration. More like "Hook, line, and sinker" with that very first birth. I went home and signed up for doula training. Then during birth five, I knew I had to be a midwife. I remember the exact moment the switch flipped in my brain. It didn't feel like a choice.
Looking back on this journal entry, I'm proud to have defined myself so strongly as my own person. My kids still come first and I would do anything for them, even give up midwifery, if that were what they needed. It's also a little sad to remember what I had in mind as the time and space that would be mine alone, and compare it to the dedication it takes to become, and be, a midwife. I would not have chosen something that encroaches on my life and parenting this much if it hadn't chosen me.
I've often thought about whether I would do it all the same again, knowing what I know now. It has been incredibly hard to be away from them as much as I have, especially in the past 6-7 months. I know I am a midwife, and I am so fulfilled by the work, even when it is hard, and these experiences have also made evident the benefit in waiting a few years, til one's kids are school aged. I've had moments of doubt and have begged Scott to tell me, "Am I doing the right thing? Are the kids really okay? Can I keep doing this, or do they need more consistency from me?" Every time, he says, "I've never seen you this happy. You need to do this for you. The kids are fine, and they need you to be happy." He's right - I am a happier, more complete person. I have more to give to them, even though I have less time for giving it. The time that is taken away is made up for in the laughter and connection that I've added to our lives by rounding out the person I am, and being myself. I won't deny that there have been days that I have been so sleep deprived that they've watched too much TV or I haven't had the patience with them that I would have had on a full night's sleep, but in general, I am indeed a much better mother than I was when I wrote this entry five years ago.
I feel not only proud, but grateful to have happened upon birth work, and grateful at how smooth my path has been. I've had excellent midwives as teachers, and I've had the opportunity to not only witness the beauty of birth at countless "butter" births, but to learn from many challenging births. I can see myself not only as strong enough to support women in the portal, but steady enough to have clarity in times of crisis, and act. As I near the end of my official training period (one never stops learning), it's affirming to stand back and see that I am stepping into a part of myself that was waiting, to see that I am who I thought I could be. This journal entry from five years ago was more evidence of all the work I've done. I feel fortunate.
The entry 5 years ago today states, "I recognize that I need to carve out some time for myself and some space for me to be more than Elly and Kes's mom. That will always be the most important part, but I need to define myself as my own person separate from them, just as they will - and are - defining themselves as separate from me as they grow. Heck, it may even make me better at being their mom. I don't know what this will look like... it's going to take a lot of exploration."
Heh. I wouldn't call it exploration. More like "Hook, line, and sinker" with that very first birth. I went home and signed up for doula training. Then during birth five, I knew I had to be a midwife. I remember the exact moment the switch flipped in my brain. It didn't feel like a choice.
Looking back on this journal entry, I'm proud to have defined myself so strongly as my own person. My kids still come first and I would do anything for them, even give up midwifery, if that were what they needed. It's also a little sad to remember what I had in mind as the time and space that would be mine alone, and compare it to the dedication it takes to become, and be, a midwife. I would not have chosen something that encroaches on my life and parenting this much if it hadn't chosen me.
I've often thought about whether I would do it all the same again, knowing what I know now. It has been incredibly hard to be away from them as much as I have, especially in the past 6-7 months. I know I am a midwife, and I am so fulfilled by the work, even when it is hard, and these experiences have also made evident the benefit in waiting a few years, til one's kids are school aged. I've had moments of doubt and have begged Scott to tell me, "Am I doing the right thing? Are the kids really okay? Can I keep doing this, or do they need more consistency from me?" Every time, he says, "I've never seen you this happy. You need to do this for you. The kids are fine, and they need you to be happy." He's right - I am a happier, more complete person. I have more to give to them, even though I have less time for giving it. The time that is taken away is made up for in the laughter and connection that I've added to our lives by rounding out the person I am, and being myself. I won't deny that there have been days that I have been so sleep deprived that they've watched too much TV or I haven't had the patience with them that I would have had on a full night's sleep, but in general, I am indeed a much better mother than I was when I wrote this entry five years ago.
I feel not only proud, but grateful to have happened upon birth work, and grateful at how smooth my path has been. I've had excellent midwives as teachers, and I've had the opportunity to not only witness the beauty of birth at countless "butter" births, but to learn from many challenging births. I can see myself not only as strong enough to support women in the portal, but steady enough to have clarity in times of crisis, and act. As I near the end of my official training period (one never stops learning), it's affirming to stand back and see that I am stepping into a part of myself that was waiting, to see that I am who I thought I could be. This journal entry from five years ago was more evidence of all the work I've done. I feel fortunate.
Thursday, July 21, 2011
Coming up for air
Sorry for lack of posts, I'm at a very busy and thankfully short-term internship. I miss my kids incredibly. 4 days to go...
Thursday, June 30, 2011
A house, a home
We've lived in our house about 6 years, and throughout our time here I have always claimed that it never felt like our home. A few weeks after we moved in, cracks started appearing in the walls. Long story short, the previous owners, who had lived here for over 30 years, had chosen not to disclose to us that the house had significant settlement issues, going so far as to cover up all evidence of it. We had put a good chunk of money into purchasing the house (this was 2005, after all), and Scott was very worried that there were structural issues. Fortunately, the only effects of the settlement were cosmetic, but the stress of the situation prevented us from emotionally attaching to the house at the time, and for some reason our detachment persisted. It is relatively barren in terms of furniture and decoration. We have only six pictures hung in the house, in total.
Recently, a constellation of factors have converged to make a move the reasonable choice. We're not going far, only 15-20 miles away. Still, it will bring a host of benefits to ourselves and our children, and both Scott and I have come to the conclusion separately and together, pragmatically and intuitively, that this is the right choice for us at this time.
So, here I find myself, packing boxes, shocked to be nostalgic. I've been looking forward to moving since about 8 weeks after we moved in, yet in packing up rooms, I see Kesenia's first steps. Eliana's first written word scrawled on a magnadoodle. Birthday candles lit, anniversary gifts given. The last time Kesenia nursed, turning away the breast for my newly short hair. Wine and friends. Forgiving myself for being an imperfect mother, and again, and again. Learning my niece-or-nephew was a niece and a nephew. Our decision-making process about midwifery school. Donovan's birth. The first time he nursed, newborn-crawling across my belly, minutes old, naked and sticky. Butterfly kisses, group snuggles, piggyback rides. Laughter.
I'm surprised that I've linked these sweet and salty memories to this place. The truth of the matter is that the memories are of limitless love which follows us wherever we go. Still, I am committed to making our next house a real home. It has a different sense now. I will embrace it from the get-go as the backdrop of where love happens.
Recently, a constellation of factors have converged to make a move the reasonable choice. We're not going far, only 15-20 miles away. Still, it will bring a host of benefits to ourselves and our children, and both Scott and I have come to the conclusion separately and together, pragmatically and intuitively, that this is the right choice for us at this time.
So, here I find myself, packing boxes, shocked to be nostalgic. I've been looking forward to moving since about 8 weeks after we moved in, yet in packing up rooms, I see Kesenia's first steps. Eliana's first written word scrawled on a magnadoodle. Birthday candles lit, anniversary gifts given. The last time Kesenia nursed, turning away the breast for my newly short hair. Wine and friends. Forgiving myself for being an imperfect mother, and again, and again. Learning my niece-or-nephew was a niece and a nephew. Our decision-making process about midwifery school. Donovan's birth. The first time he nursed, newborn-crawling across my belly, minutes old, naked and sticky. Butterfly kisses, group snuggles, piggyback rides. Laughter.
I'm surprised that I've linked these sweet and salty memories to this place. The truth of the matter is that the memories are of limitless love which follows us wherever we go. Still, I am committed to making our next house a real home. It has a different sense now. I will embrace it from the get-go as the backdrop of where love happens.
Monday, June 27, 2011
Happy buttday to you!
Eliana managed to sit on a cactus at day camp on her birthday. Not just any cactus... one of the furry kind with teeeny tiny spines very close together. So hard to see and grab with tweezers, and she had about 10 left by the time I got to her (not sure how many the camp counselor got out). She held very still and didn't complain too much (typical).
I suggested I could call her "Cactus Butt" ala The Lion King, but she said, "Mom, it's my birthday, you can't joke with me in embarrassing ways." So I started singing "Happy buttday to you, happy buttday to you!" and she laughed. So I got to sing that to her for the rest of the day.
I was so above bathroom humor as a kid. I'm sure making up for it as a mom...
I suggested I could call her "Cactus Butt" ala The Lion King, but she said, "Mom, it's my birthday, you can't joke with me in embarrassing ways." So I started singing "Happy buttday to you, happy buttday to you!" and she laughed. So I got to sing that to her for the rest of the day.
I was so above bathroom humor as a kid. I'm sure making up for it as a mom...
Friday, June 24, 2011
I've been a mommy...
...for eight years.
Cheers to the kid who changed every preconceived notion I had of my parenting style - and abilities. Keep challenging me, love. You are remarkable. Happy birthday, Eliana Rose.
Cheers to the kid who changed every preconceived notion I had of my parenting style - and abilities. Keep challenging me, love. You are remarkable. Happy birthday, Eliana Rose.
Thursday, June 16, 2011
Donovan language
Donowan - Donovan
fwimmin - swimming
fwing - swing
donitoe - dinosaur
namilla = vanilla
-er words end in -y
helicoppy - helicopter
couny - counter
beddy - better
tinggy - finger
pliddy - computer
dinny - dinner
Atemby - September
"Me Donowan like a fwog." "Me Donowan like a donitoe." "Me Donowan like a alligady."
"Me need a kitt you on da moup." "Me need you neck." (He puts a hand on my neck as a cuddle spot.)
"No tange me dipee! No wipe I penit! Me no ha poopies on a butt." (I heard on the radio that kids start lying at 3.5 years old. No way, man. Kids start lying as soon as they can talk.)
"Yeah do!" "No me not."
"A cake it yummy. A you lite it, Tudin?" (Do you like it, Susan? to my mom)
fwimmin - swimming
fwing - swing
donitoe - dinosaur
namilla = vanilla
-er words end in -y
helicoppy - helicopter
couny - counter
beddy - better
tinggy - finger
pliddy - computer
dinny - dinner
Atemby - September
"Me Donowan like a fwog." "Me Donowan like a donitoe." "Me Donowan like a alligady."
"Me need a kitt you on da moup." "Me need you neck." (He puts a hand on my neck as a cuddle spot.)
"No tange me dipee! No wipe I penit! Me no ha poopies on a butt." (I heard on the radio that kids start lying at 3.5 years old. No way, man. Kids start lying as soon as they can talk.)
"Yeah do!" "No me not."
"A cake it yummy. A you lite it, Tudin?" (Do you like it, Susan? to my mom)
Sunday, June 12, 2011
Routine ultrasound for presentation at term
A reader left a comment on my Surprise Breech post suggesting that we might have used ultrasound prenatally in order to prevent the surprise. It's a bit snarky for my taste, but here it is, followed by my response (which I didn't include in comments on that piece):
"lisa said... Ahem: an ultrasound or two might have been a good idea? Just sayin'....this isn't the Dark Ages. We have modern medicine now."
We love modern medicine! We're so thankful that it exists when we need it. And in fact, if we'd had the slightest question in our minds about this baby being head down or not, we would have referred her to an ultrasonographer. We use ultrasound as necessary, just like we access every other medical intervention as necessary.
Actually, standard of care in modern medicine includes an ultrasound at around 20 weeks, so early that babies are still swimming around in utero, and their position is inconsequential. Most obstetricians still use their hands to assess fetal presentation at term. (Most do a vaginal exam to feel for baby's head.) So, even current medical standards don't include your suggestion.
That said, the tides are turning. More and more obstetric practices are not touching women at all, using ultrasound at every visit to assess fetal growth, and to assess fetal presentation at term. Some hospitals are indeed doing an ultrasound on each woman in labor to check that the baby is vertex. Serial ultrasounds, in fact routine ultrasounds of any type, are not recommended in pregnancy even by the professional organizations that you might think would recommend them. Feel free to google for guidelines, and you will see that each notes that ultrasound is to be used as medically indicated. The FDA advocates for the "prudent use" of ultrasound. Unfortunately, many practitioners misconstrue the vague guidelines about what constitutes necessity; for example, the guideline to use ultrasound to assess fetal growth has been perverted to mean it should be used at every visit rather than in the instance that a concern about fetal growth has arisen in other medical assessments. (Just because I love metaphors: I don't need my children to get an MRI at every well-baby visit; measuring head circumference will do.)
Is this safe? What untoward effects might serial ultrasound have? We really don't know. We know babies aren't being born with missing fingers or with severe mental retardation. But, we haven't studied it well enough to know what less obvious effects might be occurring. We do know that ultrasound changes cells - and I am going to go out on a limb here and say that since fetal cells are generally normal, to say that ultrasound changes them is to say that ultrasound damages them. Several studies have shown an increase in left-handedness in children who were exposed to ultrasound in utero. Who cares about left-handedness, you might say... but what this study tells us is that ultrasound changes the fetal brain. Anecdotally - and I'm not a fan of anecdotal evidence, but in this instance it's pretty striking - over half of the children I know personally who had serial ultrasounds in utero have significant issues that affect their lives, including hearing loss, behavioral issues, and learning disabilities.
So, should our practice adopt a policy of routine ultrasounds at the end of pregnancy to catch breeches? Let's apply some math. (Yes, I'm a geek, it should be well established.) This was my preceptor's first surprise breech in her career of over 450 births. According to the flawed study that all but ended vaginal breech birth in the United States, which I will quote here since it is the standard quoted study despite its flaws, planned vaginal breech birth carries a 5% incidence of perinatal mortality or serious neonatal morbidity, or an incidence of 1 in 20 of any undesirable outcome including those that can be overcome with time. 20 x 450 = 9000, so there is a 1 in 9000 chance of anything at all bad happening, even something temporarily bad as opposed to death or permanent disability, because we don't diagnose fetal presentation with ultrasound. A 2009 study found that there was a 0.2% incidence of perinatal death for breeches, so 1 in 450 x 500 = a 1 in 225,000 chance of a baby dying because we didn't do an ultrasound for presentation at term. Compare that to asking every one of those 225,000 women and babies to expose themselves to the unknown risks of ultrasound, the known evidence around ultrasound radiation, and the costs - well, let's not even discuss money here - the answer is no. No, I don't see us recommending an ultrasound or two at term for all our mamas and babies.
I haven't even touched upon the most important issue. The hallmark of midwifery care is client-centered care. We offer our clients information and they make their own decisions. The potential for an unanticipated malpresentation is in our informed consent to home birth. If a client desired an ultrasound at term for presentation, we'd discuss all of the above and then respect their decision.
"lisa said... Ahem: an ultrasound or two might have been a good idea? Just sayin'....this isn't the Dark Ages. We have modern medicine now."
We love modern medicine! We're so thankful that it exists when we need it. And in fact, if we'd had the slightest question in our minds about this baby being head down or not, we would have referred her to an ultrasonographer. We use ultrasound as necessary, just like we access every other medical intervention as necessary.
Actually, standard of care in modern medicine includes an ultrasound at around 20 weeks, so early that babies are still swimming around in utero, and their position is inconsequential. Most obstetricians still use their hands to assess fetal presentation at term. (Most do a vaginal exam to feel for baby's head.) So, even current medical standards don't include your suggestion.
That said, the tides are turning. More and more obstetric practices are not touching women at all, using ultrasound at every visit to assess fetal growth, and to assess fetal presentation at term. Some hospitals are indeed doing an ultrasound on each woman in labor to check that the baby is vertex. Serial ultrasounds, in fact routine ultrasounds of any type, are not recommended in pregnancy even by the professional organizations that you might think would recommend them. Feel free to google for guidelines, and you will see that each notes that ultrasound is to be used as medically indicated. The FDA advocates for the "prudent use" of ultrasound. Unfortunately, many practitioners misconstrue the vague guidelines about what constitutes necessity; for example, the guideline to use ultrasound to assess fetal growth has been perverted to mean it should be used at every visit rather than in the instance that a concern about fetal growth has arisen in other medical assessments. (Just because I love metaphors: I don't need my children to get an MRI at every well-baby visit; measuring head circumference will do.)
Is this safe? What untoward effects might serial ultrasound have? We really don't know. We know babies aren't being born with missing fingers or with severe mental retardation. But, we haven't studied it well enough to know what less obvious effects might be occurring. We do know that ultrasound changes cells - and I am going to go out on a limb here and say that since fetal cells are generally normal, to say that ultrasound changes them is to say that ultrasound damages them. Several studies have shown an increase in left-handedness in children who were exposed to ultrasound in utero. Who cares about left-handedness, you might say... but what this study tells us is that ultrasound changes the fetal brain. Anecdotally - and I'm not a fan of anecdotal evidence, but in this instance it's pretty striking - over half of the children I know personally who had serial ultrasounds in utero have significant issues that affect their lives, including hearing loss, behavioral issues, and learning disabilities.
So, should our practice adopt a policy of routine ultrasounds at the end of pregnancy to catch breeches? Let's apply some math. (Yes, I'm a geek, it should be well established.) This was my preceptor's first surprise breech in her career of over 450 births. According to the flawed study that all but ended vaginal breech birth in the United States, which I will quote here since it is the standard quoted study despite its flaws, planned vaginal breech birth carries a 5% incidence of perinatal mortality or serious neonatal morbidity, or an incidence of 1 in 20 of any undesirable outcome including those that can be overcome with time. 20 x 450 = 9000, so there is a 1 in 9000 chance of anything at all bad happening, even something temporarily bad as opposed to death or permanent disability, because we don't diagnose fetal presentation with ultrasound. A 2009 study found that there was a 0.2% incidence of perinatal death for breeches, so 1 in 450 x 500 = a 1 in 225,000 chance of a baby dying because we didn't do an ultrasound for presentation at term. Compare that to asking every one of those 225,000 women and babies to expose themselves to the unknown risks of ultrasound, the known evidence around ultrasound radiation, and the costs - well, let's not even discuss money here - the answer is no. No, I don't see us recommending an ultrasound or two at term for all our mamas and babies.
I haven't even touched upon the most important issue. The hallmark of midwifery care is client-centered care. We offer our clients information and they make their own decisions. The potential for an unanticipated malpresentation is in our informed consent to home birth. If a client desired an ultrasound at term for presentation, we'd discuss all of the above and then respect their decision.
Wednesday, June 8, 2011
Surprise breech
Recently, we had a surprise breech at home. I've been rolling around in my head the value of sharing this story publicly, both to share a positive breech story and to show to student midwives and midwives the variation of breech that fooled us, and so a few days ago I got up the nerve to ask the mama for permission to post about it here. She agreed, and has previewed and approved sharing these words and photos.
Prenatally, there was no suspicion that the baby was breech at any time in the third trimester by any one of the two midwives or two apprentices. When we palpated the baby at term, s/he felt like a vertex baby whose head had descended into the pelvis so far as to be unballottable. During the vaginal exam during labor, the presenting part was at +3 and felt round and slightly edematous, like a head descending with caput.
We suspected nothing until, while mom was pushing, when Mollie checked for descent and positioning, her glove got covered in what can only be described as breech meconium. (Vertex baby meconium is mixed with amniotic fluid before it can show itself and is more accurately named as meconium-stained fluid. Breech meconium doesn’t have much opportunity to mix and looks like newly born baby meconium.) Within a push after that, we were seeing the baby’s skin... the baby’s very very bald skin. Yet still, this was nothing like what a breech “should” look or feel like. Mollie and I both extensively checked all around in a circle as deep as we could, looking for a butt crack, an anus, or any sign of something that felt like buttocks, and neither of us found anything except this big round baby part, still feeling like a head with caput. Still, we prepared ourselves mentally for a breech birth given the completely undiluted meconium. Baby was descending quickly, and we knew we did not have time to transport.
Soon, we saw a small quarter-sphere baby part at the edge of the presenting part. It looked like the baby’s shoulder was presenting next to its head, but that being impossible, we now had absolutely no idea what we were seeing. A few minutes later everything became clear as that small round part grew in length and popped out - with toes. Breech!
We brought mom to the edge of the bed, so that the baby could be born hanging downward off the edge of the bed. (This is the classic way for breeches to be born, because it facilitates flexion of the baby’s head to navigate under the pubic bone; then the baby is lifted by a care provider to facilitate extension.) The round presenting part was the left hip, with the left knee pulled up and the left foot tucked up next to the bum. As the hip was born, the knee released and the leg was born. Only then did the asynclitism right itself, showing us first labia, then her right buttock and right foot. (Unlike most pictures of complete breech babies, her legs were not crossed. Tuck position rather than cannonball.) Then her right leg was born and her right hip, emerging to just below the waist. Mom’s pushes with the next contraction brought her out to her chest. I gently held a warm blanket over her, hands at her hips waiting to safely help lift her when needed. When the next contraction did not bring her arms, Mollie reached up inside for them and brought them out one at a time. A minute or so later, she flexed all her limbs; I’ll never forget the sensation of feeling this baby, not quite born, move like that in my hands as I held that blanket on her. With the next contraction, we could see the lower part of her skull, and Mollie asked me to raise her body as she helped deliver her head, but it wasn’t ready, so we moved her back into the hanging position. Before the next contraction, I could feel her body lose its tone, starting to become limp. She was still pink but I was now more than ready for her to be born. I’m not sure whether Mollie saw how limp she was getting but I know Mollie was more than ready for her head to be out as well! With the next contraction, her ear started showing, which revealed that her head was transverse. Mollie told me to lift her toward the side, and Mollie directed her head at that angle, and she was born.
She breathed immediately, and as I quickly got the stethoscope on her, I counted her heartrate at 140 bpm. She started rooting by the time she was a couple of minutes old, and latched and nursed vigorously at eight minutes old. The only sequelae we noted from her mode of arrival were the bruises on her left buttock and hip, left labia, and left foot, and her breech baby posture which confirmed for us that we’d missed her position prenatally.
Bruise and "caput" on left buttock from hip to labia, none on right side.
Bruised left foot.
Posture and head shape. This cutie was never vertex.
Many, many thanks to the parents for allowing me to share this.
Prenatally, there was no suspicion that the baby was breech at any time in the third trimester by any one of the two midwives or two apprentices. When we palpated the baby at term, s/he felt like a vertex baby whose head had descended into the pelvis so far as to be unballottable. During the vaginal exam during labor, the presenting part was at +3 and felt round and slightly edematous, like a head descending with caput.
We suspected nothing until, while mom was pushing, when Mollie checked for descent and positioning, her glove got covered in what can only be described as breech meconium. (Vertex baby meconium is mixed with amniotic fluid before it can show itself and is more accurately named as meconium-stained fluid. Breech meconium doesn’t have much opportunity to mix and looks like newly born baby meconium.) Within a push after that, we were seeing the baby’s skin... the baby’s very very bald skin. Yet still, this was nothing like what a breech “should” look or feel like. Mollie and I both extensively checked all around in a circle as deep as we could, looking for a butt crack, an anus, or any sign of something that felt like buttocks, and neither of us found anything except this big round baby part, still feeling like a head with caput. Still, we prepared ourselves mentally for a breech birth given the completely undiluted meconium. Baby was descending quickly, and we knew we did not have time to transport.
Soon, we saw a small quarter-sphere baby part at the edge of the presenting part. It looked like the baby’s shoulder was presenting next to its head, but that being impossible, we now had absolutely no idea what we were seeing. A few minutes later everything became clear as that small round part grew in length and popped out - with toes. Breech!
We brought mom to the edge of the bed, so that the baby could be born hanging downward off the edge of the bed. (This is the classic way for breeches to be born, because it facilitates flexion of the baby’s head to navigate under the pubic bone; then the baby is lifted by a care provider to facilitate extension.) The round presenting part was the left hip, with the left knee pulled up and the left foot tucked up next to the bum. As the hip was born, the knee released and the leg was born. Only then did the asynclitism right itself, showing us first labia, then her right buttock and right foot. (Unlike most pictures of complete breech babies, her legs were not crossed. Tuck position rather than cannonball.) Then her right leg was born and her right hip, emerging to just below the waist. Mom’s pushes with the next contraction brought her out to her chest. I gently held a warm blanket over her, hands at her hips waiting to safely help lift her when needed. When the next contraction did not bring her arms, Mollie reached up inside for them and brought them out one at a time. A minute or so later, she flexed all her limbs; I’ll never forget the sensation of feeling this baby, not quite born, move like that in my hands as I held that blanket on her. With the next contraction, we could see the lower part of her skull, and Mollie asked me to raise her body as she helped deliver her head, but it wasn’t ready, so we moved her back into the hanging position. Before the next contraction, I could feel her body lose its tone, starting to become limp. She was still pink but I was now more than ready for her to be born. I’m not sure whether Mollie saw how limp she was getting but I know Mollie was more than ready for her head to be out as well! With the next contraction, her ear started showing, which revealed that her head was transverse. Mollie told me to lift her toward the side, and Mollie directed her head at that angle, and she was born.
She breathed immediately, and as I quickly got the stethoscope on her, I counted her heartrate at 140 bpm. She started rooting by the time she was a couple of minutes old, and latched and nursed vigorously at eight minutes old. The only sequelae we noted from her mode of arrival were the bruises on her left buttock and hip, left labia, and left foot, and her breech baby posture which confirmed for us that we’d missed her position prenatally.
Bruise and "caput" on left buttock from hip to labia, none on right side.
Bruised left foot.
Posture and head shape. This cutie was never vertex.
Many, many thanks to the parents for allowing me to share this.
Friday, June 3, 2011
Childhood for sale
Marion has been my best friend since junior high, and her dad's house is for sale. It's proving more emotional for me than if my own parents were selling their house. I can only imagine how she feels.
In this house, all our friends gathered...
We played Darn, chugged more soda and ate more pizza than I care to remember, watched silly movies and horror flicks.
Marion and I watched Schindler's list for the first time, together, knowing we'd need the support. I haven't seen it since.
We complained about our teachers and school work.
We were awoken in the morning after sleepovers by Marion's dad announcing one of our parents had arrived to end our togetherness.
We videotaped a Valentine's Day music video - my two best friends and I competing for the affections of the camera to The Cardigans' "Lovefool" - and sent it off to Scott, away at college.
We planned and brought to fruition countless school projects - as many as possible in the form of plays and movies.
We held party after party. One Halloween, we haunted several rooms of the house - open to the public.
We played video games. We played truth or dare. We played games of our own creation.
I drank my first alcohol, a gin and tonic.
We spent every Independence Day lighting fireworks in the front driveway.
We tended the fireplace, pet cats on our laps, and stayed up all night talking about our fears, our dreams, our futures.
And then our dreams and futures started to happen. We now ranted and raved about our professors and strategized how to earn a living on our own. Marion hosted my bridal shower and Eliana's baby shower in the living room and backyard. Her dad - a towering Marine colonel I had met when I was twelve - told me I should call him Philip. (I still can't.) My own children ran through the parklike backyard with abandon. We talked about Marion's acting career instead of her acting aspirations, about PhD programs, about entrepreuneurship. We drank fine wine at the behest of the colonel at night, and made and finished breakfast before he awoke in the morning.
The house is officially on the market now. The saddest part is that every other home that has sold in the area recently has been torn down and the large lot used to create a mega-mansion estate. This is a truly beautiful, Old World style home; our hope is that its charm will make someone fall in love with it and maintain its original design. Otherwise, the setting of our memories will become only a memory.
In this house, all our friends gathered...
We played Darn, chugged more soda and ate more pizza than I care to remember, watched silly movies and horror flicks.
Marion and I watched Schindler's list for the first time, together, knowing we'd need the support. I haven't seen it since.
We complained about our teachers and school work.
We were awoken in the morning after sleepovers by Marion's dad announcing one of our parents had arrived to end our togetherness.
We videotaped a Valentine's Day music video - my two best friends and I competing for the affections of the camera to The Cardigans' "Lovefool" - and sent it off to Scott, away at college.
We planned and brought to fruition countless school projects - as many as possible in the form of plays and movies.
We held party after party. One Halloween, we haunted several rooms of the house - open to the public.
We played video games. We played truth or dare. We played games of our own creation.
I drank my first alcohol, a gin and tonic.
We spent every Independence Day lighting fireworks in the front driveway.
We tended the fireplace, pet cats on our laps, and stayed up all night talking about our fears, our dreams, our futures.
And then our dreams and futures started to happen. We now ranted and raved about our professors and strategized how to earn a living on our own. Marion hosted my bridal shower and Eliana's baby shower in the living room and backyard. Her dad - a towering Marine colonel I had met when I was twelve - told me I should call him Philip. (I still can't.) My own children ran through the parklike backyard with abandon. We talked about Marion's acting career instead of her acting aspirations, about PhD programs, about entrepreuneurship. We drank fine wine at the behest of the colonel at night, and made and finished breakfast before he awoke in the morning.
The house is officially on the market now. The saddest part is that every other home that has sold in the area recently has been torn down and the large lot used to create a mega-mansion estate. This is a truly beautiful, Old World style home; our hope is that its charm will make someone fall in love with it and maintain its original design. Otherwise, the setting of our memories will become only a memory.
Friday, May 20, 2011
Sweet boy
I walk in the door, sit down on the couch, and my sweet boy crawls up on my lap, puts his hand around my neck, and kisses me.
"Ah meet you, mama."
"I missed you too, honey!"
"Me happy to tee you, mama."
"I'm happy to see you too, boyzer!"
"You home! You home now."
"I love you, Donovan."
"Ah wuh loo too, Mama."
It would have been enough to hear these words from him once, but this scene has repeated more times than I can remember. My sweet boy has such sweet words for me.
"Ah meet you, mama."
"I missed you too, honey!"
"Me happy to tee you, mama."
"I'm happy to see you too, boyzer!"
"You home! You home now."
"I love you, Donovan."
"Ah wuh loo too, Mama."
It would have been enough to hear these words from him once, but this scene has repeated more times than I can remember. My sweet boy has such sweet words for me.
Saturday, May 14, 2011
"Clearing up my perspective"
A while back, I posted a link on Facebook to http://www.cesareanscar.com as a request for people to think about how deeply cesarean affects women. Cesareanscar includes a whole range of emotional reactions to cesarean, but some people did not seem to visit the site and instead assumed what it might say. One comment on my Facebook page was a woman who had needed a hysterectomy as a young woman and who had not had any children reminding all those who have borne children to be thankful. I responded that women who have had cesareans are acutely aware and grateful for the existence and health of their child, and that this does not negate any other feelings they may have. Others added to the discussion enough for me to feel that perhaps I had not made my feelings on birth experience clear. These feelings are too lengthy for a Facebook comment. I wrote the following piece in response to this experience; because this was spurred by the link to cesareanscar.com, it focuses on cesarean experience but holds true for any birth experience.
Clearing up my perspective
In 1904, a woman gave birth to her first child. In 1906, her next child was born. Two girls. They would have had two brothers after them, but each time, the doctor came out of the birth room to ask the father whether he should save the mother or the child. Each time he opted to save the mother. (In order to do so, the doctor killed the baby and extracted it in pieces. If he had saved the baby, he would have performed a cesarean, assuming an outcome of maternal death due to the high mortality rate associated with it in those days.)
The first child was my grandmother. In 1939, she gave birth to her only child. She was told she should not have any more children should she wish to survive to raise my father.
Clearly, I understand the value of cesarean. Two dead babies and some never-conceived aunts and uncles would have been around if cesarean had been an option in those days. Today, many lives are saved by cesarean, sometimes mothers, sometimes babies. Many cesareans are performed just in case, when a question arises about the safety of continuing with the birthing process. Most of these babies would have been fine, but since we don't know which ones, it makes sense to do a cesarean when the risks of cesarean become better than the risks of continuing with the birthing process. Unfortunately, in our country, at least half of cesareans are done either before the risk ratio tilts in this direction, or after it does so due to previous unnecessary interventions. But let's pretend that every cesarean was life-saving, and heck, let's even pretend that cesarean carries no greater physical risk than vaginal birth.
I still would understand, support, and defend women who are upset by the experience. Why? Because humans are emotional beings that deserve to grieve when they need to, and to be supported in healing. And honestly, it is a reasonable thing to be disturbed by the experience of having the happiest day of your life also be a medical event. Many people are disturbed by medical experiences alone; I know many people who hate going to the dentist or having blood drawn. When something as emotional as having a baby involves invasive procedures, some people will be fine with that and some will be traumatized. When you add in the lack of respect that happens in some medicalized births for the incredible experience of your baby's entrance into the world, the number of traumatized women increases. It is possible to honor the miracle even in the context of surgery, and I wonder if the women who emerge from cesarean emotionally well were honored better. In fact, it's usually women feeling disregarded or disrespected that causes them the most trauma (whether birth is cesarean or vaginal).
The idea that the birth experience doesn't matter is the predominant idea in this country and it bothers me quite a lot. It is not the most important thing, this is true. The vast majority (99.99%?) of mothers would submit to any kind of birth experience for the sake of their baby. But we get into a slippery slope if we start to think that only outcome matters. If your house is broken into by a man who is going to kill you anyway, is it OK for him to rape you first? If you come home from a war, should you not be "allowed" to have PTSD from what you saw there, and just be grateful that you are alive? If you walk away from a car accident, is it ridiculous to have nightmares?
I believe that people should feel what they feel, and if you happen to think it would be better for them that they stop having those feelings, perhaps the best way to help them stop is to support them on a path through and out of their pain, rather than telling them it's inappropriate.
When resistance to the idea of birth trauma comes from women who have had similar experiences to those who do feel trauma, I wonder if they feel as though they are being judged. I certainly hope I do not do or say anything that feels like judgment to anyone. I find birthing women strong, capable, and brave regardless of how their babies get here, regardless of the choices they make around birth. I respect each and every one of you for who you are. I respect what you think and feel. I am blessed to know you. I enjoy seeing my friends feel strong. I dislike seeing strong, amazing women feel guilt, regret, disempowerment. I post information here not because I am judging anyone's experience but because I see two ways to help more women feel their strength - one by changing the birth culture to support more women finding their strength in birth rather than being knocked down, and two by listening to women talk through any negative feelings that have come up for them and being alongside them as they navigate the path to healing. All my posts about birth are meant to build up a healthy birth culture, not to knock down anyone who had a different experience than what I am posting.
I hope you all feel the strength I see in you.
Clearing up my perspective
In 1904, a woman gave birth to her first child. In 1906, her next child was born. Two girls. They would have had two brothers after them, but each time, the doctor came out of the birth room to ask the father whether he should save the mother or the child. Each time he opted to save the mother. (In order to do so, the doctor killed the baby and extracted it in pieces. If he had saved the baby, he would have performed a cesarean, assuming an outcome of maternal death due to the high mortality rate associated with it in those days.)
The first child was my grandmother. In 1939, she gave birth to her only child. She was told she should not have any more children should she wish to survive to raise my father.
Clearly, I understand the value of cesarean. Two dead babies and some never-conceived aunts and uncles would have been around if cesarean had been an option in those days. Today, many lives are saved by cesarean, sometimes mothers, sometimes babies. Many cesareans are performed just in case, when a question arises about the safety of continuing with the birthing process. Most of these babies would have been fine, but since we don't know which ones, it makes sense to do a cesarean when the risks of cesarean become better than the risks of continuing with the birthing process. Unfortunately, in our country, at least half of cesareans are done either before the risk ratio tilts in this direction, or after it does so due to previous unnecessary interventions. But let's pretend that every cesarean was life-saving, and heck, let's even pretend that cesarean carries no greater physical risk than vaginal birth.
I still would understand, support, and defend women who are upset by the experience. Why? Because humans are emotional beings that deserve to grieve when they need to, and to be supported in healing. And honestly, it is a reasonable thing to be disturbed by the experience of having the happiest day of your life also be a medical event. Many people are disturbed by medical experiences alone; I know many people who hate going to the dentist or having blood drawn. When something as emotional as having a baby involves invasive procedures, some people will be fine with that and some will be traumatized. When you add in the lack of respect that happens in some medicalized births for the incredible experience of your baby's entrance into the world, the number of traumatized women increases. It is possible to honor the miracle even in the context of surgery, and I wonder if the women who emerge from cesarean emotionally well were honored better. In fact, it's usually women feeling disregarded or disrespected that causes them the most trauma (whether birth is cesarean or vaginal).
The idea that the birth experience doesn't matter is the predominant idea in this country and it bothers me quite a lot. It is not the most important thing, this is true. The vast majority (99.99%?) of mothers would submit to any kind of birth experience for the sake of their baby. But we get into a slippery slope if we start to think that only outcome matters. If your house is broken into by a man who is going to kill you anyway, is it OK for him to rape you first? If you come home from a war, should you not be "allowed" to have PTSD from what you saw there, and just be grateful that you are alive? If you walk away from a car accident, is it ridiculous to have nightmares?
I believe that people should feel what they feel, and if you happen to think it would be better for them that they stop having those feelings, perhaps the best way to help them stop is to support them on a path through and out of their pain, rather than telling them it's inappropriate.
When resistance to the idea of birth trauma comes from women who have had similar experiences to those who do feel trauma, I wonder if they feel as though they are being judged. I certainly hope I do not do or say anything that feels like judgment to anyone. I find birthing women strong, capable, and brave regardless of how their babies get here, regardless of the choices they make around birth. I respect each and every one of you for who you are. I respect what you think and feel. I am blessed to know you. I enjoy seeing my friends feel strong. I dislike seeing strong, amazing women feel guilt, regret, disempowerment. I post information here not because I am judging anyone's experience but because I see two ways to help more women feel their strength - one by changing the birth culture to support more women finding their strength in birth rather than being knocked down, and two by listening to women talk through any negative feelings that have come up for them and being alongside them as they navigate the path to healing. All my posts about birth are meant to build up a healthy birth culture, not to knock down anyone who had a different experience than what I am posting.
I hope you all feel the strength I see in you.
Thursday, May 12, 2011
Shrug, crushed.
"What an expansive year, and yet, it all felt normal. It all just happened. It was simply the life I was living. Other people would remark on it, and I'd be speechless, feeling an internal shrug. It was what it was."
It's been less than five months since I posted this. That shrug? Gone.
A few births blew open subconscious preconceptions I held about the realm of possibility in this world. They proved to me again (and again) that I am able to remain steady and get the job done in tense moments, but for the first time I felt truly shaken after all was secured. For the first time, the ground felt uncertain under me for not only a day but weeks, and I questioned what I knew and what I wanted. Now, I know more. I remember and confirm what I want.
My kids have stretched me, too. I suppose I shouldn't put it that way, because it's more that I'm doing the hard work of examining what I expect from myself as their mother. Really, it comes down to that I'm working harder than I ever have before, , and I miss them. It was planned, and planned to be temporary, and it will resolve on its own. There are practical decisions to make, such as their schooling for next year (home or private? If home, which charter?) and where and when to move houses.
Being a midwife is mindblowing, heart and soul work. Being a parent is heart-wrenching, expansive work. Doing both is, perhaps, as everyone told me, crazy. I love both. But no more shrugs, I admit it, this is huge.
It's been less than five months since I posted this. That shrug? Gone.
A few births blew open subconscious preconceptions I held about the realm of possibility in this world. They proved to me again (and again) that I am able to remain steady and get the job done in tense moments, but for the first time I felt truly shaken after all was secured. For the first time, the ground felt uncertain under me for not only a day but weeks, and I questioned what I knew and what I wanted. Now, I know more. I remember and confirm what I want.
My kids have stretched me, too. I suppose I shouldn't put it that way, because it's more that I'm doing the hard work of examining what I expect from myself as their mother. Really, it comes down to that I'm working harder than I ever have before, , and I miss them. It was planned, and planned to be temporary, and it will resolve on its own. There are practical decisions to make, such as their schooling for next year (home or private? If home, which charter?) and where and when to move houses.
Being a midwife is mindblowing, heart and soul work. Being a parent is heart-wrenching, expansive work. Doing both is, perhaps, as everyone told me, crazy. I love both. But no more shrugs, I admit it, this is huge.
Monday, May 2, 2011
The Moldau
It's easy to describe events, real or imaginary, but emotion... emotion is a bigger challenge to put into words. Thank God for music, which describes what words can not. Lately I've been thinking of how to describe the interplay between some of the deepest emotions in my life and the most profound piece of music in my history. It's time to try.
History: I was raised by musicians in a house filled with music in the physical, auditory, and spiritual senses. History: I played violin from the age of five, with a love-hate relationship for the first six years and a passionate love affair for the next six. History: The Moldau was one of the last pieces of music I played.
Through the unraveling of my self as musician, The Moldau became inextricably linked to everything I know about myself as a vulnerable and triumphant human being.
It was our chairing audition piece in the youth symphony that year. I flailed through it so badly that I left the audition in tears, sure that I was going to not only lose my chair of 9th out of the 16 1st violins but that I was going to end up in the back of the 2nd violins. I got out of my car at home and took out my frustration on a 4 mile round trip walk to my best friend's house. (She wasn't home. Life before cell phones.) Calling to receive the news of my placement was nerve wracking, and when the woman on the line told me I was 8th chair I had to ask her "1sts or 2nds?" Firsts. Firsts! I'd actually gained a chair. And I thought I had learned a lesson in believing in myself and feeling my own strength.
No signs of trouble throughout the year. I was in pain, but I had been in pain for years. Taking 800 mg of ibuprofen every 4 waking hours was a routine part of my day, with breakthrough pain from my neck to my midback and all the way down both arms. I never questioned it. My childhood best friend was a ballerina who also lived with chronic pain. My arms, her ankles. We paid the price for our art.
Then in spring, I was preparing for a solo competition, two recitals, and the youth symphony's spring concert. The Moldau. I knew it was written about a river that runs through Prague, but I always felt it as my heart beating, my life's energy coursing through me. It's the closest understanding I have of the concept of chi. The Moldau.
By mid-May, I'd completed three of the four performances. Just before the fourth, my hands rebelled. Seized up completely. I don't remember the pain, only the inaction. My hands and wrists were frozen in claws. I would use the back of one hand to open the other and place it on an object I wanted to grasp, but that was as far as I could get. I did not have the strength to turn a doorknob or lift a glass of water to my lips.
I saw a physical medicine specialist, who told me I could expect permanent damage if I did not quit violin immediately. He preferred that I stop permanently, but said I could try playing again after six months of complete cessation and physical therapy, provided I made enough progress. I also had to immediately and permanently stop taking the ibuprofen, so that I would be completely aware of my pain and prevent myself from harming my body any further in my daily activities.
The physical and emotional pain over the next several months eclipsed the rest of my life. I have few memories from this time frame. I do remember that at one point it occurred to me that I was mourning the greatest loss of my life. Fifteen years later I would still agree with that viewpoint. While I would have given up violin to save the lives of any of the people I have lost (and I do note that I have not lost any children or either of my parents), the mourning that came with the end of what I had regarded as my very being was immense. After close to a year had passed, I attempted to practice the music to audition for UCLA's symphony. I forcefully relapsed. And I acknowledged that it was over.
Nothing could replace violin in my life. Slowly, though, I found other, smaller ways of fulfillment. I became physically active in a way I had never anticipated, loving hiking outdoors and indoor rock climbing. I graduated from college and married my high school sweetheart. I finally fully rested my hands, in ending school and finding a job with no computer work involved. After three specialists and three physical therapists, I found the cure for my repetitive strain injuries: massage therapy. Money, time, and an extraordinary body worker finally ended my chronic pain four years after I had quit violin. And somewhere in that four years I had become whole again, so subtly that I can't point to a moment of transformation into a complete self that wasn't a violinist.
I couldn't listen to any music at all that first summer. Even rock music - guitar is a stringed instrument, after all. After several months I could listen to rock. After a few years I reintroduced classical music. In fact, I played so much of The Four Seasons (one of those last recital pieces!) when I was pregnant with my first child that it was the only thing that could calm her on car rides in her infancy.
As I gave birth to my children and then found birth work, I recognized that birth was the first thing since violin that had fulfilled me as wholly, though differently, as violin had. And one day, as I drove to my first midwifery skills class, The Moldau came on the radio. For the first time in twelve years, I listened. I let it wash all over me, feeling acutely the loss of the violinist and the triumph of my soul.
Since that day, I turn to the Moldau when I need to find peace with my vulnerability or feel my ability to prevail. In becoming a midwife, these needs have been great! When I listen to The Moldau, my emotions are raw. Every muscle in my body sings with proprioceptive memory of playing violin. My heart joins in the song. I can smell the rosin and the wood, feel the vibrations of the symphony around me in my chest and in my feet on the wood planks of the stage. I can believe I'm there again. I remember what I've lost, and I remember what I achieved in gaining myself back, finding my impenetrable core. Then I recognize again what I am working for and who I am. I recognize that I can exist outside of a named identity but as deeply as I was a violinist, I will be a midwife; as deeply as music will always continue to stir my body and soul, I have always been a midwife.
History: I was raised by musicians in a house filled with music in the physical, auditory, and spiritual senses. History: I played violin from the age of five, with a love-hate relationship for the first six years and a passionate love affair for the next six. History: The Moldau was one of the last pieces of music I played.
Through the unraveling of my self as musician, The Moldau became inextricably linked to everything I know about myself as a vulnerable and triumphant human being.
It was our chairing audition piece in the youth symphony that year. I flailed through it so badly that I left the audition in tears, sure that I was going to not only lose my chair of 9th out of the 16 1st violins but that I was going to end up in the back of the 2nd violins. I got out of my car at home and took out my frustration on a 4 mile round trip walk to my best friend's house. (She wasn't home. Life before cell phones.) Calling to receive the news of my placement was nerve wracking, and when the woman on the line told me I was 8th chair I had to ask her "1sts or 2nds?" Firsts. Firsts! I'd actually gained a chair. And I thought I had learned a lesson in believing in myself and feeling my own strength.
No signs of trouble throughout the year. I was in pain, but I had been in pain for years. Taking 800 mg of ibuprofen every 4 waking hours was a routine part of my day, with breakthrough pain from my neck to my midback and all the way down both arms. I never questioned it. My childhood best friend was a ballerina who also lived with chronic pain. My arms, her ankles. We paid the price for our art.
Then in spring, I was preparing for a solo competition, two recitals, and the youth symphony's spring concert. The Moldau. I knew it was written about a river that runs through Prague, but I always felt it as my heart beating, my life's energy coursing through me. It's the closest understanding I have of the concept of chi. The Moldau.
By mid-May, I'd completed three of the four performances. Just before the fourth, my hands rebelled. Seized up completely. I don't remember the pain, only the inaction. My hands and wrists were frozen in claws. I would use the back of one hand to open the other and place it on an object I wanted to grasp, but that was as far as I could get. I did not have the strength to turn a doorknob or lift a glass of water to my lips.
I saw a physical medicine specialist, who told me I could expect permanent damage if I did not quit violin immediately. He preferred that I stop permanently, but said I could try playing again after six months of complete cessation and physical therapy, provided I made enough progress. I also had to immediately and permanently stop taking the ibuprofen, so that I would be completely aware of my pain and prevent myself from harming my body any further in my daily activities.
The physical and emotional pain over the next several months eclipsed the rest of my life. I have few memories from this time frame. I do remember that at one point it occurred to me that I was mourning the greatest loss of my life. Fifteen years later I would still agree with that viewpoint. While I would have given up violin to save the lives of any of the people I have lost (and I do note that I have not lost any children or either of my parents), the mourning that came with the end of what I had regarded as my very being was immense. After close to a year had passed, I attempted to practice the music to audition for UCLA's symphony. I forcefully relapsed. And I acknowledged that it was over.
Nothing could replace violin in my life. Slowly, though, I found other, smaller ways of fulfillment. I became physically active in a way I had never anticipated, loving hiking outdoors and indoor rock climbing. I graduated from college and married my high school sweetheart. I finally fully rested my hands, in ending school and finding a job with no computer work involved. After three specialists and three physical therapists, I found the cure for my repetitive strain injuries: massage therapy. Money, time, and an extraordinary body worker finally ended my chronic pain four years after I had quit violin. And somewhere in that four years I had become whole again, so subtly that I can't point to a moment of transformation into a complete self that wasn't a violinist.
I couldn't listen to any music at all that first summer. Even rock music - guitar is a stringed instrument, after all. After several months I could listen to rock. After a few years I reintroduced classical music. In fact, I played so much of The Four Seasons (one of those last recital pieces!) when I was pregnant with my first child that it was the only thing that could calm her on car rides in her infancy.
As I gave birth to my children and then found birth work, I recognized that birth was the first thing since violin that had fulfilled me as wholly, though differently, as violin had. And one day, as I drove to my first midwifery skills class, The Moldau came on the radio. For the first time in twelve years, I listened. I let it wash all over me, feeling acutely the loss of the violinist and the triumph of my soul.
Since that day, I turn to the Moldau when I need to find peace with my vulnerability or feel my ability to prevail. In becoming a midwife, these needs have been great! When I listen to The Moldau, my emotions are raw. Every muscle in my body sings with proprioceptive memory of playing violin. My heart joins in the song. I can smell the rosin and the wood, feel the vibrations of the symphony around me in my chest and in my feet on the wood planks of the stage. I can believe I'm there again. I remember what I've lost, and I remember what I achieved in gaining myself back, finding my impenetrable core. Then I recognize again what I am working for and who I am. I recognize that I can exist outside of a named identity but as deeply as I was a violinist, I will be a midwife; as deeply as music will always continue to stir my body and soul, I have always been a midwife.
Saturday, February 19, 2011
Elly's 2005 hospitalization
Per a specific request from a friend and in honor of the several friends whose kids have been hospitalized for various reasons this year, I dug up the emails I wrote back in Feb/Mar 2005 to friends and family when Eliana was hospitalized.
---------------------------------
Eliana woke up screaming 3 times Monday night/Tues morn so I took her to the dr (my FIL who is a dr asked his colleagues who the best ped in town was and that's how we got hooked up with Dr. Van Schenck) and he sent us to the hospital to get Xrays and an u/s done to look for a kidney infection or an intusseception (prolapsed intestine). All that came back normal so he sent us to get labs drawn to make sure she didn't have a problem with absorption. Weds morning the Dr. said that her blood test results were allfine except she was a little low on iron so I needed
to start iron supplements. So he said that since all
her other levels were fine, that means that her diet
is fine except for she is not getting enough calories
for her needs, so he called a nutritionist for us to
see. He also ordered some stool samples to rule out
parasites and some other things that can cause poor
weight gain. We went home. Elly acted pretty much
herself but tired and was really not eating much over
the next couple days.
Friday at 2:45 Eliana woke up from her nap throwing
up. A lot. I called the dr who had left for the day
but left a message which the answering service lady
said he'd be checking at 5. Elly continued to throw
up every half hour, the first 2 times it was lunch,
then it was bile. Then she would just dry heave and
dry heave and finally get up about a tablespoon of
bile. It was when her breath started to smell not
just like bile but like poop too that I really started
to worry.
The dr called back at 5:30 and told us he'd meet us at
his office at 6:30. We got there, he basically looked
at her and saw the greenish color of the puke on her
outfit (she'd thrown up in the car on the way over)
and told us to head over to the hospital and he'd call
over to have them admit her and meet us there. I
called Scott, who was at work which is over two hours
away from Sac *not* on a Friday night, and told him to
come over, and called my parents and his parents. We
got to the hospital, got registered, and then my ILs
showed up. Then the dr came and took us back to
x-ray. Again I had to wait in the hall and listen to
Elly crying for mama, this time with my MIL holding
her. They finished the x-ray and my FIL came out and
said it didn't show anything, but that x-rays aren't
100% so they needed to do two tests - one to look for
the inteseception where the intestine telescopes on
itself, and then if that didn't show anything they'd
need to do an upper GI test to look for a twist in her
duodenum, just below the stomach. And she needed an
IV to get her rehydrated b/c she was really
dehydrated.
Then we got taken upstairs to check into the pediatric
ward. We met our nurse who was awesome and waited for
the pediatric radiologist to get done with his shift
at another hospital so he could do those tests. The
ped ward was totally busy - 7 admits basically all at
once - so it was really slow going to get Elly that
IV. Meanwhile she was totally going downhill. She
was sleeping (and that's putting it mildly) on me and
waking up every half hour to dry heave and get up
maybe a teaspoon or two of bile. She wouldn't even
hold up her head to puke, she would turn it to the
side on my hand which I'd covered with a towel and
just puke into my hand. Soon after we settled in the
room my mom got there.
Scott arrived around 10:15, and soon after they were
ready to give her the IV. I held her while they put
it in... there was no sign that she even registered
the needle stick. She stayed totally limp and didn't
make a peep. This from the kid who screams at the
sight of a dr's office. Right after we got back to
the room she threw up again and I think that was the
last one. The rehydration really helped her body get
itself back into whack.
Then we got called back down to the next tests. Again
I was stuck out in the hallway, but at least now Scott
was there to take care of her. She pretty much didn't
make a peep except for when they did the really
painful stuff. The test for the inteseception they
had to pump air up into her intestines through her
anus, so she screamed a little over that, and then the
other test they usually make you swallow barium but
since she was throwing up so much they had to put it
into her with one of those naso-esophageal tubes, so
she screamed a bit over that too. Not crying, more
like crying out in pain.
Both tests came back negative, so no surgery for my
girl, thank G-d. They said it was probably just a flu
bug, but they were going to do more blood tests and
get the stool tests to rule out other things. We got
back up to our room at about midnight, and finally
settled into bed.
Too bad that didn't mean rest. They needed to get a
urinalysis which meant this bag that they literally
stick around their privates to collect it. So every
couple hours the nurse checked it to see whether she'd
peed yet. We absolutely had to get it this way, there
was no option for catheterization b/c of her labial
adhesion - no access to her urethra. Then the first
time the nurse checked her vitals she had spiked a
fever to 101.9 (from 98.1 when we got to the
hospital). The nurse wanted to call the dr to get her
some tylenol but the head nurse wouldn't let her til
after they'd gotten the urine... which didn't happen
til 5:30 am.
She ran a fever basically all of Saturday until late
that night. But Saturday she was definitely doing
better than she'd been Friday night. She even asked
to go on a walk and walked the floor 4 times that day.
I think she was just trying to figure out an escape
route though - she kept trying to hang out in front of
the elevators. I don't think she laughed all day
Saturday but we got a few smiles. Every time someone
left the room, she'd cry and say bye-bye, and we said,
"yeah she went bye-bye" but she'd cry and say,
"Nonna!" meaning, "no, I mean I want to go bye-bye
too!"
The pediatric gastroenterologist came to see us
Saturday and said she really thinks it's just a virus.
She also said she was really concerned about her
weight, moreover the consistent jumping down curves.
She said she's in the 4th percentile for weight to
height ratio. And that when you bottom out on the
weight curves after jumping down like that, the next
thing will be height and head circumference and brain
development. So she wants to see us regularly until
she's comfortable with Elly's weight. She also
approved a clear liquid diet for Eliana to see if she
could keep it down. She did, but didn't drink much.
A few sips of water and apple juice. But her "output"
was acceptable so the nurses weren't worried about her
getting dehydrated again.
Sunday she got put on a normal diet again, but she
didn't eat much. Rice, cheerios, some banana, some
granola bar. Her tummy was still bothering her. Her
temp dropped to normal and stayed there. We went on
more walks and she even ran a little. But she always
came back to the room exhausted. At night she started
really crying and telling me her belly hurt way down
low.
This morning she woke up asking to eat. She had an
egg and some cheerios and applesauce. Big
improvement. She also chugged about 6 oz of water.
We talked briefly to a nutritionist who said basically
what the ped gastroenterologist had already said, and
the gastroenterologist and the pediatrician saw her
and both said she could go home.
So we're home. But she still doesn't feel like
herself, and in fact she just puked once. My mom's
got her right now but I'm going to go cuddle her as
soon right after I talk to the dr's office, which
opens up again in 2 minutes. So I'm off. That's the
story.
--------
OK so I think the last thing I sent out was about how
we had just gotten home from the hospital and then
Elly threw up again. She slept on me from 1:30 to
4:00, threw up again at 6, and slept from 8pm to 9am
with a brief awakening at about 3:30 to puke. When I
woke her up in the morning, I carried her out to the
couch to watch a video with her, and she was simply
not there. She couldn't make eye contact, couldn't
focus on anything, and was only half conscious. When
I said "Eliana, look at mama," or asked her to do
something simple like touch her nose, her eyes would
open a little further but that was it, they wouldn't
even move in my direction. I called the doc who was
in with a patient and five minutes later when he
hadn't called back I just threw us in the car and
drove to his office.
He examined her and said right away she needed to be
readmitted to the hospital. I said, "when do we start
worrying about her brain?" and he said, "well
certainly at this point we have to consider something
neurological" and said they'd do a spinal tap and
possibly an MRI. I don't know if I told you guys this
but she had been having these weird symptoms for a
couple weeks like not liking her toys that make noise
and not wanting to go on the swings at the park. Plus
on Monday when we got her home she was wobbly when she
tried to walk.
So we got to the hospital and got checked into her
room and waited for the intensivist to come see us and
do her spinal tap. I have never been so scared in my
life. Friday night she'd been out of it b/c she'd
been puking her guts out for hours, and we knew she
either had a stomach flu which the IV would fix or one
of two problems that are fixed with a routine surgery,
so I was worried but felt like everything would
eventually be alright. Tuesday, we were facing
meningitis, encephalitis, and even a brain tumor, and
I was absolutely terrified. I couldn't stop telling
her that I loved her even though I don't think she was
listening to me.
They did the spinal tap and wouldn't let me in the
room, which was horrible, the worst scream I heard out
of all the procedures she's gone through. They got a
new IV in. The intensivist gave us the good news that
the fluid had been clear (a good sign) and then later
we heard that it had no cells in it, meaning there
wasn't even anything in there to culture to find out
whether it was meningitis or encephalitis or not.
Then he said he was sending us for a CT to rule out
anything else that would be a neurological emergency.
My FIL (who was a total wreck) called the pediatric
radiologist and he got us down there pretty quick.
Again I had to wait outside (radiation/pg) but quickly
they came back with the results that it was clear.
Thank G-d.
Eliana was still really out of it by this time. The
IV had perked her up the last time but by now she'd
been on it hours and was still only semi-conscious.
She said "home" once and "Dada" once so I think she
knew where she was and who was with her, but she still
wouldn't make eye contact.
After all these negative tests the general concensus
was that the GI flu had just knocked too much out of
her and her body was shutting down b/c it couldn't
cope and hadn't had enough calories. Basically she
had gone from very skinny but still healthy into not
eating for a week and throwing up quite a bit and just
shoved herself right into a state of malnutrition.
So they decided to start her on a feeding tube, the
kind that goes up through the nose and down into the
stomach. They started that at 11pm Tuesday and did a
drip of 50 ml per hour for 8 hours. By Wednesday
morning, she was looking at me again. Still very
fatigued but making eye contact and talking.
Wednesday at 3:30 they did a bolus of 8oz/250ml in an
hour. That went fine, so she was scheduled for
another bolus at 7:30. 166ml of it went in and then
she threw up pretty much all of that. So they stopped
the feed and called the ped GI dr and she said to put
it back down to 50ml/hr and just do it continuously
all the time. It's 1 calorie per ml so that was 1200
cal per day, whereas the bolus every 4 hours would've
been 1500 cal per day. Then she threw up a little bit
when she woke up the next morning, but just a little.
She was starting to get perky that morning, being
silly, smiling a lot.
Then she napped for about 2 hours and woke up not
there again. No eye contact, not responding to me
talking to her. But this time instead of being
totally lethargic she was obviously in some sort of
pain and she was also having trouble breathing. I
looked at her belly and it was huge. I called the
nurse in and she felt her belly and turned off the
food pump. Within 5 minutes she was making eye
contact again and responding to me, and within 15
minutes she had perked right back up.
So what was happening was that her tummy wasn't
emptying the food as fast as it was being put in,
because when you hit malnutrition your digestive
system starts to shut down, and it hurt and was
pushing on her diaphragm keeping her from breathing
deep enough. We kept it stopped for a couple hours
and then turned it back on at only 30ml/hr. This
morning they put it on 35 and then this afternoon they
put it on 40. She's also been put on Reglan which is
supposed to help the digestive system work things
along.
She's doing really well today. She's giggling and
playing, and really really bored. She's having
trouble walking b/c she is atrophied and tired. But,
assuming she doesn't throw up or have any more scary
episodes, we should go home tomorrow. We will be
getting the pump and formula for the feeding tube
delivered to our house and I will be in charge of that
until she gets to a weight that is not only healthy
but has a good amount of safety net so that an illness
won't bump her from the healthy range to the unhealthy
range again. The GI dr says she wants her at the
25th% in weight-for-height, or above. She was at the
4th% a week ago and I bet she's lower now.
Wish us a steady if slow forward-moving healing
process. I'm so tired of thinking she's getting
better just to have her throw up again or get
half-comatose on me. I'm trying not to get my hopes
up about going home tomorrow, but I know I'm going to
be upset if we don't - b/c that would mean she
would've taken another step backward.
I'm going back to the hospital now - my mom is there
with her but I don't want to leave them too long.
This was my first time stepping out of it since we
took her back, the first time I was relaxed enough to
put her in someone else's hands for an hour.
Hope everyone's been having a marvelously boring life
while I've been off...
Love,
Meg
-------------------
Eliana saw the pediatric gastroenterologist today.
She has gained nearly 1.5 lbs in the 6 days since her
discharge from the hospital. The difference is
visible, and so nice. She's back to looking like a
skinny kid rather than a morbidly underweight baby.
We still have a ways to go to hit the 25th%ile though,
where the ped GI wants her - we're at about the
10th%ile now.
We're going to be reducing the amount of tube feeding
and no longer doing continuous but bolus instead - a
lot in a short amount of time - which is just great
for my active toddler. We've been given very calorie
dense supplements to add to any drinks or smooshy/wet
foods - for example one of them is 1.5 ounces and 330
calories. It sounds like this will be a long term
addition to her diet, continuing after the tube is
taken out, since the doctors all seem to agree that
her tummy just can't take in enough calories for her
metabolism, and that's why she wasn't gaining
adequately. We'll also have to continue to focus on
calorie rich foods, like dried fruits instead of
regular.
We have another appt with the ped GI dr on Wednesday,
at which point she hopes to be able to reduce the tube
feedings even more. Then the next appointment the
week after that, it sounds like she is hoping we will
be able to take the tube out. Needless to say, we're
hoping to have the tube out sooner rather than later
as well. Given her weight gain so far I'm feeling
optimistic about it.
I am still just so happy that the illness was "just" a
GI flu, even though it resulted in some complications
and brought to light these calorie issues... the other
possibilities were too scary. And moreover, I'm
thrilled to have my girl back to normal - happy,
silly, and 100% toddler.
Take care all,
Meg
--------------
We had another GI appointment today, and Elly has
gained another 10 oz, in just 5 days. The dr is very
happy with how she is looking. We are keeping the NG
tube in for now, though. She will get it out at her
next appointment which is in 2 weeks.
Originally we had hoped that she could get it out next
week, but we got thrown another curveball - Eliana has
her first ear infection. So, since she's sick, she's
really not eating much. The dr decided to give it an
extra week to make sure she gets through with this
infection first. In the meantime she is back to
mostly getting her calories through the tube and I am
supposed to inject the BeneCalorie (the 330 cal in 1.5
oz) straight into the tube until she feels well enough
to drink her yogurt drinks (where I usually put the
BeneCalorie). I guess I should look on the bright
side of the tube - I can put the antibiotics straight
into the tube instead of coaxing her into taking them
orally!
So, that's where we are...
Oh, and as for me, since so many of you have asked if
I am taking care of myself... at my midwife
appointment on Monday they told me to eat more and
rest more. OK... eat more, that I can do, now that
Eliana is out of the hospital. Rest more, not in my
near future. But overall, I think I'm doing a very
good job of taking care of myself physically.
Emotionally is another story, but I plan to have some
serious me time to make up for it after Elly is
better. For now, there just aren't enough hours in
the day. As for the bun, s/he's got a nice steady
heartbeat and seems to be growing appropriately.
Occasionally turns or kicks or stretches to remind me
that I have to think about someone besides Eliana.
Our ultrasound is on March 14.
Take care all,
Megan
----------------------------
Ever since she got the tube out, I ask Eliana, "What's
on your nose?" and she says, "No tube!!!" Then
yesterday she saw the general ped about her labial
adhesion (which is gone and looks perfect now) and the
only thing that would keep her from crying the whole
time was me saying over and over, "Just the doctor.
No tube. No hospital." So we got home and had lunch
with my parents and she spent the whole time telling
Grandma and Grandpa, "Noooooo tube. Noooooo popple."
On the phone with Daddy, the same thing. It's sooo
cute.
------------------------------
Final installment went on the blog: http://oncallmama.blogspot.com/2005/06/bustin-out.html
---------------------------------
Eliana woke up screaming 3 times Monday night/Tues morn so I took her to the dr (my FIL who is a dr asked his colleagues who the best ped in town was and that's how we got hooked up with Dr. Van Schenck) and he sent us to the hospital to get Xrays and an u/s done to look for a kidney infection or an intusseception (prolapsed intestine). All that came back normal so he sent us to get labs drawn to make sure she didn't have a problem with absorption. Weds morning the Dr. said that her blood test results were allfine except she was a little low on iron so I needed
to start iron supplements. So he said that since all
her other levels were fine, that means that her diet
is fine except for she is not getting enough calories
for her needs, so he called a nutritionist for us to
see. He also ordered some stool samples to rule out
parasites and some other things that can cause poor
weight gain. We went home. Elly acted pretty much
herself but tired and was really not eating much over
the next couple days.
Friday at 2:45 Eliana woke up from her nap throwing
up. A lot. I called the dr who had left for the day
but left a message which the answering service lady
said he'd be checking at 5. Elly continued to throw
up every half hour, the first 2 times it was lunch,
then it was bile. Then she would just dry heave and
dry heave and finally get up about a tablespoon of
bile. It was when her breath started to smell not
just like bile but like poop too that I really started
to worry.
The dr called back at 5:30 and told us he'd meet us at
his office at 6:30. We got there, he basically looked
at her and saw the greenish color of the puke on her
outfit (she'd thrown up in the car on the way over)
and told us to head over to the hospital and he'd call
over to have them admit her and meet us there. I
called Scott, who was at work which is over two hours
away from Sac *not* on a Friday night, and told him to
come over, and called my parents and his parents. We
got to the hospital, got registered, and then my ILs
showed up. Then the dr came and took us back to
x-ray. Again I had to wait in the hall and listen to
Elly crying for mama, this time with my MIL holding
her. They finished the x-ray and my FIL came out and
said it didn't show anything, but that x-rays aren't
100% so they needed to do two tests - one to look for
the inteseception where the intestine telescopes on
itself, and then if that didn't show anything they'd
need to do an upper GI test to look for a twist in her
duodenum, just below the stomach. And she needed an
IV to get her rehydrated b/c she was really
dehydrated.
Then we got taken upstairs to check into the pediatric
ward. We met our nurse who was awesome and waited for
the pediatric radiologist to get done with his shift
at another hospital so he could do those tests. The
ped ward was totally busy - 7 admits basically all at
once - so it was really slow going to get Elly that
IV. Meanwhile she was totally going downhill. She
was sleeping (and that's putting it mildly) on me and
waking up every half hour to dry heave and get up
maybe a teaspoon or two of bile. She wouldn't even
hold up her head to puke, she would turn it to the
side on my hand which I'd covered with a towel and
just puke into my hand. Soon after we settled in the
room my mom got there.
Scott arrived around 10:15, and soon after they were
ready to give her the IV. I held her while they put
it in... there was no sign that she even registered
the needle stick. She stayed totally limp and didn't
make a peep. This from the kid who screams at the
sight of a dr's office. Right after we got back to
the room she threw up again and I think that was the
last one. The rehydration really helped her body get
itself back into whack.
Then we got called back down to the next tests. Again
I was stuck out in the hallway, but at least now Scott
was there to take care of her. She pretty much didn't
make a peep except for when they did the really
painful stuff. The test for the inteseception they
had to pump air up into her intestines through her
anus, so she screamed a little over that, and then the
other test they usually make you swallow barium but
since she was throwing up so much they had to put it
into her with one of those naso-esophageal tubes, so
she screamed a bit over that too. Not crying, more
like crying out in pain.
Both tests came back negative, so no surgery for my
girl, thank G-d. They said it was probably just a flu
bug, but they were going to do more blood tests and
get the stool tests to rule out other things. We got
back up to our room at about midnight, and finally
settled into bed.
Too bad that didn't mean rest. They needed to get a
urinalysis which meant this bag that they literally
stick around their privates to collect it. So every
couple hours the nurse checked it to see whether she'd
peed yet. We absolutely had to get it this way, there
was no option for catheterization b/c of her labial
adhesion - no access to her urethra. Then the first
time the nurse checked her vitals she had spiked a
fever to 101.9 (from 98.1 when we got to the
hospital). The nurse wanted to call the dr to get her
some tylenol but the head nurse wouldn't let her til
after they'd gotten the urine... which didn't happen
til 5:30 am.
She ran a fever basically all of Saturday until late
that night. But Saturday she was definitely doing
better than she'd been Friday night. She even asked
to go on a walk and walked the floor 4 times that day.
I think she was just trying to figure out an escape
route though - she kept trying to hang out in front of
the elevators. I don't think she laughed all day
Saturday but we got a few smiles. Every time someone
left the room, she'd cry and say bye-bye, and we said,
"yeah she went bye-bye" but she'd cry and say,
"Nonna!" meaning, "no, I mean I want to go bye-bye
too!"
The pediatric gastroenterologist came to see us
Saturday and said she really thinks it's just a virus.
She also said she was really concerned about her
weight, moreover the consistent jumping down curves.
She said she's in the 4th percentile for weight to
height ratio. And that when you bottom out on the
weight curves after jumping down like that, the next
thing will be height and head circumference and brain
development. So she wants to see us regularly until
she's comfortable with Elly's weight. She also
approved a clear liquid diet for Eliana to see if she
could keep it down. She did, but didn't drink much.
A few sips of water and apple juice. But her "output"
was acceptable so the nurses weren't worried about her
getting dehydrated again.
Sunday she got put on a normal diet again, but she
didn't eat much. Rice, cheerios, some banana, some
granola bar. Her tummy was still bothering her. Her
temp dropped to normal and stayed there. We went on
more walks and she even ran a little. But she always
came back to the room exhausted. At night she started
really crying and telling me her belly hurt way down
low.
This morning she woke up asking to eat. She had an
egg and some cheerios and applesauce. Big
improvement. She also chugged about 6 oz of water.
We talked briefly to a nutritionist who said basically
what the ped gastroenterologist had already said, and
the gastroenterologist and the pediatrician saw her
and both said she could go home.
So we're home. But she still doesn't feel like
herself, and in fact she just puked once. My mom's
got her right now but I'm going to go cuddle her as
soon right after I talk to the dr's office, which
opens up again in 2 minutes. So I'm off. That's the
story.
--------
OK so I think the last thing I sent out was about how
we had just gotten home from the hospital and then
Elly threw up again. She slept on me from 1:30 to
4:00, threw up again at 6, and slept from 8pm to 9am
with a brief awakening at about 3:30 to puke. When I
woke her up in the morning, I carried her out to the
couch to watch a video with her, and she was simply
not there. She couldn't make eye contact, couldn't
focus on anything, and was only half conscious. When
I said "Eliana, look at mama," or asked her to do
something simple like touch her nose, her eyes would
open a little further but that was it, they wouldn't
even move in my direction. I called the doc who was
in with a patient and five minutes later when he
hadn't called back I just threw us in the car and
drove to his office.
He examined her and said right away she needed to be
readmitted to the hospital. I said, "when do we start
worrying about her brain?" and he said, "well
certainly at this point we have to consider something
neurological" and said they'd do a spinal tap and
possibly an MRI. I don't know if I told you guys this
but she had been having these weird symptoms for a
couple weeks like not liking her toys that make noise
and not wanting to go on the swings at the park. Plus
on Monday when we got her home she was wobbly when she
tried to walk.
So we got to the hospital and got checked into her
room and waited for the intensivist to come see us and
do her spinal tap. I have never been so scared in my
life. Friday night she'd been out of it b/c she'd
been puking her guts out for hours, and we knew she
either had a stomach flu which the IV would fix or one
of two problems that are fixed with a routine surgery,
so I was worried but felt like everything would
eventually be alright. Tuesday, we were facing
meningitis, encephalitis, and even a brain tumor, and
I was absolutely terrified. I couldn't stop telling
her that I loved her even though I don't think she was
listening to me.
They did the spinal tap and wouldn't let me in the
room, which was horrible, the worst scream I heard out
of all the procedures she's gone through. They got a
new IV in. The intensivist gave us the good news that
the fluid had been clear (a good sign) and then later
we heard that it had no cells in it, meaning there
wasn't even anything in there to culture to find out
whether it was meningitis or encephalitis or not.
Then he said he was sending us for a CT to rule out
anything else that would be a neurological emergency.
My FIL (who was a total wreck) called the pediatric
radiologist and he got us down there pretty quick.
Again I had to wait outside (radiation/pg) but quickly
they came back with the results that it was clear.
Thank G-d.
Eliana was still really out of it by this time. The
IV had perked her up the last time but by now she'd
been on it hours and was still only semi-conscious.
She said "home" once and "Dada" once so I think she
knew where she was and who was with her, but she still
wouldn't make eye contact.
After all these negative tests the general concensus
was that the GI flu had just knocked too much out of
her and her body was shutting down b/c it couldn't
cope and hadn't had enough calories. Basically she
had gone from very skinny but still healthy into not
eating for a week and throwing up quite a bit and just
shoved herself right into a state of malnutrition.
So they decided to start her on a feeding tube, the
kind that goes up through the nose and down into the
stomach. They started that at 11pm Tuesday and did a
drip of 50 ml per hour for 8 hours. By Wednesday
morning, she was looking at me again. Still very
fatigued but making eye contact and talking.
Wednesday at 3:30 they did a bolus of 8oz/250ml in an
hour. That went fine, so she was scheduled for
another bolus at 7:30. 166ml of it went in and then
she threw up pretty much all of that. So they stopped
the feed and called the ped GI dr and she said to put
it back down to 50ml/hr and just do it continuously
all the time. It's 1 calorie per ml so that was 1200
cal per day, whereas the bolus every 4 hours would've
been 1500 cal per day. Then she threw up a little bit
when she woke up the next morning, but just a little.
She was starting to get perky that morning, being
silly, smiling a lot.
Then she napped for about 2 hours and woke up not
there again. No eye contact, not responding to me
talking to her. But this time instead of being
totally lethargic she was obviously in some sort of
pain and she was also having trouble breathing. I
looked at her belly and it was huge. I called the
nurse in and she felt her belly and turned off the
food pump. Within 5 minutes she was making eye
contact again and responding to me, and within 15
minutes she had perked right back up.
So what was happening was that her tummy wasn't
emptying the food as fast as it was being put in,
because when you hit malnutrition your digestive
system starts to shut down, and it hurt and was
pushing on her diaphragm keeping her from breathing
deep enough. We kept it stopped for a couple hours
and then turned it back on at only 30ml/hr. This
morning they put it on 35 and then this afternoon they
put it on 40. She's also been put on Reglan which is
supposed to help the digestive system work things
along.
She's doing really well today. She's giggling and
playing, and really really bored. She's having
trouble walking b/c she is atrophied and tired. But,
assuming she doesn't throw up or have any more scary
episodes, we should go home tomorrow. We will be
getting the pump and formula for the feeding tube
delivered to our house and I will be in charge of that
until she gets to a weight that is not only healthy
but has a good amount of safety net so that an illness
won't bump her from the healthy range to the unhealthy
range again. The GI dr says she wants her at the
25th% in weight-for-height, or above. She was at the
4th% a week ago and I bet she's lower now.
Wish us a steady if slow forward-moving healing
process. I'm so tired of thinking she's getting
better just to have her throw up again or get
half-comatose on me. I'm trying not to get my hopes
up about going home tomorrow, but I know I'm going to
be upset if we don't - b/c that would mean she
would've taken another step backward.
I'm going back to the hospital now - my mom is there
with her but I don't want to leave them too long.
This was my first time stepping out of it since we
took her back, the first time I was relaxed enough to
put her in someone else's hands for an hour.
Hope everyone's been having a marvelously boring life
while I've been off...
Love,
Meg
-------------------
Eliana saw the pediatric gastroenterologist today.
She has gained nearly 1.5 lbs in the 6 days since her
discharge from the hospital. The difference is
visible, and so nice. She's back to looking like a
skinny kid rather than a morbidly underweight baby.
We still have a ways to go to hit the 25th%ile though,
where the ped GI wants her - we're at about the
10th%ile now.
We're going to be reducing the amount of tube feeding
and no longer doing continuous but bolus instead - a
lot in a short amount of time - which is just great
for my active toddler. We've been given very calorie
dense supplements to add to any drinks or smooshy/wet
foods - for example one of them is 1.5 ounces and 330
calories. It sounds like this will be a long term
addition to her diet, continuing after the tube is
taken out, since the doctors all seem to agree that
her tummy just can't take in enough calories for her
metabolism, and that's why she wasn't gaining
adequately. We'll also have to continue to focus on
calorie rich foods, like dried fruits instead of
regular.
We have another appt with the ped GI dr on Wednesday,
at which point she hopes to be able to reduce the tube
feedings even more. Then the next appointment the
week after that, it sounds like she is hoping we will
be able to take the tube out. Needless to say, we're
hoping to have the tube out sooner rather than later
as well. Given her weight gain so far I'm feeling
optimistic about it.
I am still just so happy that the illness was "just" a
GI flu, even though it resulted in some complications
and brought to light these calorie issues... the other
possibilities were too scary. And moreover, I'm
thrilled to have my girl back to normal - happy,
silly, and 100% toddler.
Take care all,
Meg
--------------
We had another GI appointment today, and Elly has
gained another 10 oz, in just 5 days. The dr is very
happy with how she is looking. We are keeping the NG
tube in for now, though. She will get it out at her
next appointment which is in 2 weeks.
Originally we had hoped that she could get it out next
week, but we got thrown another curveball - Eliana has
her first ear infection. So, since she's sick, she's
really not eating much. The dr decided to give it an
extra week to make sure she gets through with this
infection first. In the meantime she is back to
mostly getting her calories through the tube and I am
supposed to inject the BeneCalorie (the 330 cal in 1.5
oz) straight into the tube until she feels well enough
to drink her yogurt drinks (where I usually put the
BeneCalorie). I guess I should look on the bright
side of the tube - I can put the antibiotics straight
into the tube instead of coaxing her into taking them
orally!
So, that's where we are...
Oh, and as for me, since so many of you have asked if
I am taking care of myself... at my midwife
appointment on Monday they told me to eat more and
rest more. OK... eat more, that I can do, now that
Eliana is out of the hospital. Rest more, not in my
near future. But overall, I think I'm doing a very
good job of taking care of myself physically.
Emotionally is another story, but I plan to have some
serious me time to make up for it after Elly is
better. For now, there just aren't enough hours in
the day. As for the bun, s/he's got a nice steady
heartbeat and seems to be growing appropriately.
Occasionally turns or kicks or stretches to remind me
that I have to think about someone besides Eliana.
Our ultrasound is on March 14.
Take care all,
Megan
----------------------------
Ever since she got the tube out, I ask Eliana, "What's
on your nose?" and she says, "No tube!!!" Then
yesterday she saw the general ped about her labial
adhesion (which is gone and looks perfect now) and the
only thing that would keep her from crying the whole
time was me saying over and over, "Just the doctor.
No tube. No hospital." So we got home and had lunch
with my parents and she spent the whole time telling
Grandma and Grandpa, "Noooooo tube. Noooooo popple."
On the phone with Daddy, the same thing. It's sooo
cute.
------------------------------
Final installment went on the blog: http://oncallmama.blogspot.com/2005/06/bustin-out.html
Thursday, February 10, 2011
School. (Mine.)
I appear not to have chosen a midwifery school that is structured in a way that fits my learning style. Fortunately for me, I will be able to seek information in addition to my school program to round out my knowledge. Even more fortunately for me, I've got a preceptor who is taking it on herself to provide me with guideposts for this learning process and who organizes these guideposts in a fashion that is much better suited to my learning style and my goals for myself.
Wonderful preceptors are priceless; wonderful preceptors who are a good match with their apprentices are even a notch above that. (Hopefully apprentices who are a good match with their preceptors provide a fair trade of benefits... I can't imagine that I do as much for them as they do for me, but I suppose I will figure that out when I'm experienced enough to have my own apprentices...)
Wonderful preceptors are priceless; wonderful preceptors who are a good match with their apprentices are even a notch above that. (Hopefully apprentices who are a good match with their preceptors provide a fair trade of benefits... I can't imagine that I do as much for them as they do for me, but I suppose I will figure that out when I'm experienced enough to have my own apprentices...)
Nemo
Why is Finding Nemo one of the easiest Disney movies to quote? We sing "Just keep swimming" for tough moments, squawk "Mine!" to break up the tension when the kids get possessive, and speak whale regularly in this household. Today I'm reminded of a different moment that comes shortly after "just keep swimming"...
This is what it's like to come home at the end of a wonderful day of work, or to have a fantastic day hanging out with my kids, and then in the 15 minutes before bedtime Eliana completely loses all composure or semblance of cooperation and becomes a defiant, screaming mess. And yes, that is exactly what happened tonight.
It's like eating a delicious meal and then in your very last bite of dessert biting into something unrecognizable.
I get that having to do something you don't want to (go to bed) and being really tired (because it's. your. bedtime.) is a bad combination. But it can still leave both of us feeling completely disconnected and frustrated right as we are saying goodnight. When we have both calmed down, I'll go in to talk with her, and sometimes this is exactly what she needs. Other times it just starts the whole cycle over again.
Thankfully this isn't too common of a scenario; in fact, tonight's episode reminded me just how much less frequently this is happening now than it used to. I also help myself wind down from it by reminding myself that she knows she is truly loved, even in the rough moments.
It also helps to remind myself of how awesome she is:
E, to male family friend: "So, when are you going to have another baby?"
MFF: "Oh, we're not having any other babies. When are your parents going to have another baby?"
E: "They're not either... my daddy already had the surgery for that."
This is what it's like to come home at the end of a wonderful day of work, or to have a fantastic day hanging out with my kids, and then in the 15 minutes before bedtime Eliana completely loses all composure or semblance of cooperation and becomes a defiant, screaming mess. And yes, that is exactly what happened tonight.
It's like eating a delicious meal and then in your very last bite of dessert biting into something unrecognizable.
I get that having to do something you don't want to (go to bed) and being really tired (because it's. your. bedtime.) is a bad combination. But it can still leave both of us feeling completely disconnected and frustrated right as we are saying goodnight. When we have both calmed down, I'll go in to talk with her, and sometimes this is exactly what she needs. Other times it just starts the whole cycle over again.
Thankfully this isn't too common of a scenario; in fact, tonight's episode reminded me just how much less frequently this is happening now than it used to. I also help myself wind down from it by reminding myself that she knows she is truly loved, even in the rough moments.
It also helps to remind myself of how awesome she is:
E, to male family friend: "So, when are you going to have another baby?"
MFF: "Oh, we're not having any other babies. When are your parents going to have another baby?"
E: "They're not either... my daddy already had the surgery for that."
Thursday, January 27, 2011
I fall!
Driving in the car, I hear D: "Hep! Hep! I fall! I fall!"
Now, I'm pretty darn sure I buckled him in correctly, but any mother is going to look back and make sure that the kid hasn't suddenly figured out how to get himself out of his carseat. What I see cracks me up.
D is, in fact, fully buckled in his car seat. His arms and legs are pointing at the ceiling and waving in all directions. My adorable little two year old is playing pretend that he is falling and needs me to save him.
I touch his hand. He says, "Oh, tatyu, Mama. I okay. Dat fwawy, now I okay."
Speaking of "fwawy", here are some of my favorite cute D words at the moment:
fwawy = scary
flallow = flower
bleebie = blankie
ahmeeoh = oatmeal
way, way, uhpie, new play = put it away up high and get down a new toy
tseeoh = cheerios
folly = sorry
Now, I'm pretty darn sure I buckled him in correctly, but any mother is going to look back and make sure that the kid hasn't suddenly figured out how to get himself out of his carseat. What I see cracks me up.
D is, in fact, fully buckled in his car seat. His arms and legs are pointing at the ceiling and waving in all directions. My adorable little two year old is playing pretend that he is falling and needs me to save him.
I touch his hand. He says, "Oh, tatyu, Mama. I okay. Dat fwawy, now I okay."
Speaking of "fwawy", here are some of my favorite cute D words at the moment:
fwawy = scary
flallow = flower
bleebie = blankie
ahmeeoh = oatmeal
way, way, uhpie, new play = put it away up high and get down a new toy
tseeoh = cheerios
folly = sorry
Monday, January 17, 2011
Un/limited
Today pretty much all I did was cuddle my sweet baby, nursing for most of the day. He's coughing like crazy on what I hope is the tail end of a flu. I also have it, not the cough but man my throat is painful. It took 800mg of Advil and nonstop Throat Comfort tea to make me stop wincing every time I swallow.
Anyway, my body hurts, no longer from the flu, but from sitting all the time to cuddle D. I'm bored. I can't wait to get back to the usual.
And yet, what a precious day it was. It hurt my heart to see the boyzer so sick again, but I felt lucky to be able to provide him the comfort he sought, and I soaked up the blessing of it. To be a mother, to soothe, to love, to have exactly what your child needs, is a gift I relished today, just as I treasured his small hand around my neck, his arms around my waist while nursing, his head leaned against my shoulder, his "Pleeee," "Huk," "Bleebie," and all the other special smallness of him that is so fleeting.
The beautiful ache of it all is how love is limitless, but time is not.
Anyway, my body hurts, no longer from the flu, but from sitting all the time to cuddle D. I'm bored. I can't wait to get back to the usual.
And yet, what a precious day it was. It hurt my heart to see the boyzer so sick again, but I felt lucky to be able to provide him the comfort he sought, and I soaked up the blessing of it. To be a mother, to soothe, to love, to have exactly what your child needs, is a gift I relished today, just as I treasured his small hand around my neck, his arms around my waist while nursing, his head leaned against my shoulder, his "Pleeee," "Huk," "Bleebie," and all the other special smallness of him that is so fleeting.
The beautiful ache of it all is how love is limitless, but time is not.
Thursday, January 6, 2011
Love sponge
Have a nice little x-rated inner monologue joke about that one for a minute, and once you've got it out of your system, come back to me.
Ready? K.
I've described Eliana as a cup emptier. Most children are cup emptiers. It's their job. They drink up our energy, our knowledge, our love, and use it to grow and learn. Parents should expect to give, to be drained, and to expect to need to refill their cups outside of parenthood. Yes, kids put some drops back in, but it's a rare child who refills the cup. Eliana is also a less-than-common child: she makes me feel like she has drunk from my cup, licked every last drop clean from it, and then thrown it across the room because she's upset that it's empty.
Really, she's a love sponge. She thirsts for verbal and physical affection and soaks it up. She runs dry fast and needs it poured over her to stay vital.
When I say this aloud it sounds as though I must have either coddled her or starved her of affection, but I've had 7 (oops - andahalf, can't forget that part) years of reflection on this child's personality, and I've gotta say, I did neither. My kid was born a love sponge.
It's exhausting. Yet it also challenges me in beautiful ways. She pushes me to find new ways to verbalize love, ways to make it real in a child's eyes. To give it a flavor, a smell, a color, a size, a light.
Tonight I found these words for her and I wish to hold them tight for myself to get me through the times that she throws my cup against the wall and cracks it. Moments like these are the glue that puts my cup back together so I can even begin to refill.
Me: "I love you. I love you."
Eliana: "I already heard you."
Me: "I know your ears heard me the first time, but did your heart hear me?"
Eliana: (big smile) "Yes, Mom, my heart heard you both times."
Me: "What about your nose?"
Eliana: "No, it didn't."
(lifts her face for a kiss, I kiss her nose)
Me: "But do your bones know how much I love you? And your toes?"
Eliana: "All of me understands, Mom, except my bones. You have to kiss them."
Me: "How will I kiss them through all your muscle and skin?"
Eliana: "Just do it hard right here on my arm."
(smoooch)
Eliana: "See, now my bones feel love."
Me: "And now I have to get up and you have to go to sleep."
Eliana: (fights tears)
Me: "But first I have a question... do I love you more when I'm cuddling you than when I'm asleep or doing dishes or at work?"
Eliana: "No, you love me the same, always more than is possible."
Me: (tearing up, so thankful for this amazing child) "That's the truth. Now, when you grow up you can make choices for yourself. When you grow up if you don't want to have children that's OK and if you do that's OK, too. But can I tell you that there is one reason I hope you will be a mother? And that is because I know how much you love your parents, and your brother and sister, and your grandparents,"
Eliana: "-but my grandparents most of all-"
Me: "but the only way you will ever know how much I love you is if you become a mother, because the way a mother loves her children is more than any other love there is in the world."
Eliana: (bursts into tears) "I don't know how I started crying, but I am crying such a happy cry."
Ready? K.
I've described Eliana as a cup emptier. Most children are cup emptiers. It's their job. They drink up our energy, our knowledge, our love, and use it to grow and learn. Parents should expect to give, to be drained, and to expect to need to refill their cups outside of parenthood. Yes, kids put some drops back in, but it's a rare child who refills the cup. Eliana is also a less-than-common child: she makes me feel like she has drunk from my cup, licked every last drop clean from it, and then thrown it across the room because she's upset that it's empty.
Really, she's a love sponge. She thirsts for verbal and physical affection and soaks it up. She runs dry fast and needs it poured over her to stay vital.
When I say this aloud it sounds as though I must have either coddled her or starved her of affection, but I've had 7 (oops - andahalf, can't forget that part) years of reflection on this child's personality, and I've gotta say, I did neither. My kid was born a love sponge.
It's exhausting. Yet it also challenges me in beautiful ways. She pushes me to find new ways to verbalize love, ways to make it real in a child's eyes. To give it a flavor, a smell, a color, a size, a light.
Tonight I found these words for her and I wish to hold them tight for myself to get me through the times that she throws my cup against the wall and cracks it. Moments like these are the glue that puts my cup back together so I can even begin to refill.
Me: "I love you. I love you."
Eliana: "I already heard you."
Me: "I know your ears heard me the first time, but did your heart hear me?"
Eliana: (big smile) "Yes, Mom, my heart heard you both times."
Me: "What about your nose?"
Eliana: "No, it didn't."
(lifts her face for a kiss, I kiss her nose)
Me: "But do your bones know how much I love you? And your toes?"
Eliana: "All of me understands, Mom, except my bones. You have to kiss them."
Me: "How will I kiss them through all your muscle and skin?"
Eliana: "Just do it hard right here on my arm."
(smoooch)
Eliana: "See, now my bones feel love."
Me: "And now I have to get up and you have to go to sleep."
Eliana: (fights tears)
Me: "But first I have a question... do I love you more when I'm cuddling you than when I'm asleep or doing dishes or at work?"
Eliana: "No, you love me the same, always more than is possible."
Me: (tearing up, so thankful for this amazing child) "That's the truth. Now, when you grow up you can make choices for yourself. When you grow up if you don't want to have children that's OK and if you do that's OK, too. But can I tell you that there is one reason I hope you will be a mother? And that is because I know how much you love your parents, and your brother and sister, and your grandparents,"
Eliana: "-but my grandparents most of all-"
Me: "but the only way you will ever know how much I love you is if you become a mother, because the way a mother loves her children is more than any other love there is in the world."
Eliana: (bursts into tears) "I don't know how I started crying, but I am crying such a happy cry."
Sunday, January 2, 2011
Funny, I was only born with two of them...
D: "Mama, nehneh."
Me: "I just nursed you, my nays need a break."
D: "Unna tide?"
Me: "We already had the other side, we had both sides."
D: "Fwee tide, peeeeeese?"
Me: "You need three sides?"
D: "Yeah! Fwee nehneh, yay!"
Me: "I just nursed you, my nays need a break."
D: "Unna tide?"
Me: "We already had the other side, we had both sides."
D: "Fwee tide, peeeeeese?"
Me: "You need three sides?"
D: "Yeah! Fwee nehneh, yay!"
Frequently Asked Questions
Lately I've gotten a TON of interest from all walks of life about what I'm up to - midwifery in general, licensed/direct-entry midwifery in particular, and even more particularly where I am on my path. Some of the same questions keep coming up over and over again, so I thought I'd write an FAQ... sorry if some of these answers sound curt or leave out some of the subtle beauty of midwifery. If you want waxing poetic, look at my last entry!
What's the difference between a midwife and a doula?
A birth doula offers physical, emotional, and informational support to the birthing mother, providing a presence that adds comfort to the woman's experience. A midwife is the care provider who is responsible for monitoring the mother's and baby's well-being to ensure that the birth is as safe as possible. In this way she takes the same role that an OB or a family care physician would take at a birth, though midwives are very different care providers than OB's. Midwives at home generally do also provide physical and emotional support for the mother, and providing information is part and parcel of midwifery care, but this is a doula's entire scope, whereas a midwife's primary job is monitoring the health and safety of the mother and baby.
OK, so what's the difference between an OB and a midwife?
OB's are physicians who have chosen a surgical specialty which enables them to diagnose and treat issues related to the female reproductive system, including pregnancy and birth. Obstetrics generally addresses pregnancy and birth as an abnormal state for a woman's body which often requires intervention to keep it safe. Midwives specialize in healthy pregnancy, birth, and postpartum, and view it as a physiological variation that is normal though not the default state of being for a woman. They are experts in facilitating birth without resorting to medical intervention, and in recognizing when a complication may be arising, in which case the client is referred out to the specialists in medical intervention (OB's, perinatologists, pediatricians, and neonatologists) for a consultation or to transfer care completely. Midwives believe that the process of birth usually works best when left to itself, that women labor easiest when they feel safe, that the judicious use of medical technology is life-saving but that routine use is risky. OB's are ideal care providers for women with medical conditions or complications that increase their risk in pregnancy or birth; midwives are ideal care providers for healthy women having healthy pregnancies. OB's work within an authoritarian system, in which they are to diagnose and lay out a treatment protocol for their patients. Midwives in hospital also have to work within this system. Midwives at home work as partners with their clients, giving them information about their health and the options available to them, including the risks, benefits, and alternatives of their choices. Perhaps the starkest difference comes in looking at rates of intervention. In our country, for healthy women carrying a single baby, head-down, full-term, planning a vaginal birth, in the most recent study done in North America, the cesarean rate for OB's in hospital was approximately 20%, and for homebirth midwives it was 3.7%, with equal outcomes of mortality across the two groups. (Note that midwives do not perform cesareans, they transfer care of their client to hospital and OB care.) In other words, a healthy woman having a healthy pregnancy beginning her labor in hospital with an OB has 5 times the chance of ending her labor with major abdominal surgery compared with beginning her labor planning a homebirth with a midwife, but does not increase her chance of having a live, healthy baby by choosing OB care.
"Knowledge of ovarian cancer staging, or the ability to perform a laparoscopic hysterectomy does not make me a better caregiver for the patient in labor, and yet the midwife’s focus on facilitating the normal birthing process in healthy women does lessen their chance of adverse events, and this mode of care should at the very least be an option for women." - Henry Dorn, M.D.
I thought you had to be a nurse to be a midwife.
There are different ways to become a midwife. Nurse-midwives are RN's first and then have two additional years of training in midwifery. They are trained in all types of nursing and retain their ability to work as a nurse in any department. They are able to work in hospitals under the supervision of doctors, and in some places and instances may be able to attend home births. The route I am taking doesn't require a nursing degree, it's called direct-entry midwifery. Direct-entry midwives take a three-year didactic and clinical program. The didactic program can be at a brick-and-mortar school or a distance school, and their clinical learning is generally an apprenticeship with a midwifery practice providing home birth care or at a midwife-staffed freestanding birth center. Hospitals do not generally grant privileges to direct-entry midwives, so it is an educational process appropriate for aspiring midwives who want to work outside of the hospital system. There is a national certification, the CPM (Certified Professional Midwife) which is recognized in some states and allows the CPM to legally provide services there. In other states, midwives have to pass state licensing requirements which are usually roughly equivalent to the CPM; for example, in California, one has to be licensed by the state medical board and is a LM (Licensed Midwife), and a licensed midwife in Utah is designated a DEM (Direct Entry Midwife). In a few states, licensure/certification is not required at all; for example, in Utah one may choose to become a DEM or to be a lay midwife. A lay midwife is one who has obtained her own education through self-study and apprenticeship and who has chosen not to become a CPM/LM/DEM etc. In most states, lay midwifery is illegal or alegal, and in several states, no licensure is available and the CPM is not acknowledged, making direct-entry midwifery alegal in total. I am seeking my CPM and my state license.
Do you have to get a certain number of hours?
Similar to that, but instead the program ensures a minimum experience level by what's lovingly referred to in the student midwifery community as "getting numbers" - counting numbers of different types of experiences. Number of births as primary midwife under supervision is the holy grail that everyone latches on to, but there are several categories, which apparently vary by school (all meeting requirements for the CPM). My school counts the following: number of initial prenatal visits, number of subsequent prenatal visits, number of births as assist, number of births as primary midwife under supervision, number of newborn exams, number of postpartum visits in the first 5 days, and number of subsequent postpartum visits or well-woman exams. All of the required visits/exams are as primary under supervision.
How much longer do you have to go?
Ack! What a question!
Timeline-wise, I hope to take the licensing exam in February 2012, which means I have to have the application submitted by December 1st of this year, which means I have to have all my school requirements completed including my numbers before then. I actually hope to have all my numbers done by September 1st. It usually takes a few to several months after sitting the exam to receive one's license, just waiting for the red tape.
Numbers-wise,
I have 11 and need 9 more initial prenatals
I have more than I need of the 75 follow-up prenatals
I have more than I need of the 20 assist births
I have 7 and need 13 primary births
I have 19 and need 1 newborn exam
I have 20 and need 20 more postpartum visits in the first 5 days
I have 22 and need 18 more 6+ day postpartum visits and/or well-woman exams
It's a humbling and inspiring process. Thank heavens I have incredibly skilled and compassionate midwives to learn from.
What's the difference between a midwife and a doula?
A birth doula offers physical, emotional, and informational support to the birthing mother, providing a presence that adds comfort to the woman's experience. A midwife is the care provider who is responsible for monitoring the mother's and baby's well-being to ensure that the birth is as safe as possible. In this way she takes the same role that an OB or a family care physician would take at a birth, though midwives are very different care providers than OB's. Midwives at home generally do also provide physical and emotional support for the mother, and providing information is part and parcel of midwifery care, but this is a doula's entire scope, whereas a midwife's primary job is monitoring the health and safety of the mother and baby.
OK, so what's the difference between an OB and a midwife?
OB's are physicians who have chosen a surgical specialty which enables them to diagnose and treat issues related to the female reproductive system, including pregnancy and birth. Obstetrics generally addresses pregnancy and birth as an abnormal state for a woman's body which often requires intervention to keep it safe. Midwives specialize in healthy pregnancy, birth, and postpartum, and view it as a physiological variation that is normal though not the default state of being for a woman. They are experts in facilitating birth without resorting to medical intervention, and in recognizing when a complication may be arising, in which case the client is referred out to the specialists in medical intervention (OB's, perinatologists, pediatricians, and neonatologists) for a consultation or to transfer care completely. Midwives believe that the process of birth usually works best when left to itself, that women labor easiest when they feel safe, that the judicious use of medical technology is life-saving but that routine use is risky. OB's are ideal care providers for women with medical conditions or complications that increase their risk in pregnancy or birth; midwives are ideal care providers for healthy women having healthy pregnancies. OB's work within an authoritarian system, in which they are to diagnose and lay out a treatment protocol for their patients. Midwives in hospital also have to work within this system. Midwives at home work as partners with their clients, giving them information about their health and the options available to them, including the risks, benefits, and alternatives of their choices. Perhaps the starkest difference comes in looking at rates of intervention. In our country, for healthy women carrying a single baby, head-down, full-term, planning a vaginal birth, in the most recent study done in North America, the cesarean rate for OB's in hospital was approximately 20%, and for homebirth midwives it was 3.7%, with equal outcomes of mortality across the two groups. (Note that midwives do not perform cesareans, they transfer care of their client to hospital and OB care.) In other words, a healthy woman having a healthy pregnancy beginning her labor in hospital with an OB has 5 times the chance of ending her labor with major abdominal surgery compared with beginning her labor planning a homebirth with a midwife, but does not increase her chance of having a live, healthy baby by choosing OB care.
"Knowledge of ovarian cancer staging, or the ability to perform a laparoscopic hysterectomy does not make me a better caregiver for the patient in labor, and yet the midwife’s focus on facilitating the normal birthing process in healthy women does lessen their chance of adverse events, and this mode of care should at the very least be an option for women." - Henry Dorn, M.D.
I thought you had to be a nurse to be a midwife.
There are different ways to become a midwife. Nurse-midwives are RN's first and then have two additional years of training in midwifery. They are trained in all types of nursing and retain their ability to work as a nurse in any department. They are able to work in hospitals under the supervision of doctors, and in some places and instances may be able to attend home births. The route I am taking doesn't require a nursing degree, it's called direct-entry midwifery. Direct-entry midwives take a three-year didactic and clinical program. The didactic program can be at a brick-and-mortar school or a distance school, and their clinical learning is generally an apprenticeship with a midwifery practice providing home birth care or at a midwife-staffed freestanding birth center. Hospitals do not generally grant privileges to direct-entry midwives, so it is an educational process appropriate for aspiring midwives who want to work outside of the hospital system. There is a national certification, the CPM (Certified Professional Midwife) which is recognized in some states and allows the CPM to legally provide services there. In other states, midwives have to pass state licensing requirements which are usually roughly equivalent to the CPM; for example, in California, one has to be licensed by the state medical board and is a LM (Licensed Midwife), and a licensed midwife in Utah is designated a DEM (Direct Entry Midwife). In a few states, licensure/certification is not required at all; for example, in Utah one may choose to become a DEM or to be a lay midwife. A lay midwife is one who has obtained her own education through self-study and apprenticeship and who has chosen not to become a CPM/LM/DEM etc. In most states, lay midwifery is illegal or alegal, and in several states, no licensure is available and the CPM is not acknowledged, making direct-entry midwifery alegal in total. I am seeking my CPM and my state license.
Do you have to get a certain number of hours?
Similar to that, but instead the program ensures a minimum experience level by what's lovingly referred to in the student midwifery community as "getting numbers" - counting numbers of different types of experiences. Number of births as primary midwife under supervision is the holy grail that everyone latches on to, but there are several categories, which apparently vary by school (all meeting requirements for the CPM). My school counts the following: number of initial prenatal visits, number of subsequent prenatal visits, number of births as assist, number of births as primary midwife under supervision, number of newborn exams, number of postpartum visits in the first 5 days, and number of subsequent postpartum visits or well-woman exams. All of the required visits/exams are as primary under supervision.
How much longer do you have to go?
Ack! What a question!
Timeline-wise, I hope to take the licensing exam in February 2012, which means I have to have the application submitted by December 1st of this year, which means I have to have all my school requirements completed including my numbers before then. I actually hope to have all my numbers done by September 1st. It usually takes a few to several months after sitting the exam to receive one's license, just waiting for the red tape.
Numbers-wise,
I have 11 and need 9 more initial prenatals
I have more than I need of the 75 follow-up prenatals
I have more than I need of the 20 assist births
I have 7 and need 13 primary births
I have 19 and need 1 newborn exam
I have 20 and need 20 more postpartum visits in the first 5 days
I have 22 and need 18 more 6+ day postpartum visits and/or well-woman exams
It's a humbling and inspiring process. Thank heavens I have incredibly skilled and compassionate midwives to learn from.
Saturday, January 1, 2011
Looking back, looking forward...
Happy New Year!
It's been a huge year for me.
It's a year that found my motherhood in a new set of struggles I've never had before - trying to balance work and parenting, recognizing some of the specific challenges that my children face, finding new ways to meet them where they are and accept them for who they are while trying to give them tools to enrich their lives.
It's been a year that saw my marriage stretched thin and bounce back, in which I found myself a place of independence within the context of this family of five, while forging new connections with each of its members.
It took me from beginning midwifery student to primary under supervision. It took me from knowing I had the inner strength to proceed through urgent situations to witnessing myself being strong in them. It changed me deeply and irreversibly.
Each opportunity to be with a woman finding new places of strength inside herself made me more honored to be a woman.
Each moment of wonder at a baby's emergence made me more reverent of this process through which we begin our lives.
Each birth which required intervention that the hands of an ancient midwife would not have been able to access made me more thankful to live in a time and place where we can access life-saving technology both at home and in hospital.
It's all managed to increase my ability to live in the grey area, to let integrity, tenacity, and vulnerability lay side by side inside of me, to honor the uncertainties of life and birth alongside the expected and the joy.
What an expansive year, and yet, it all felt normal. It all just happened. It was simply the life I was living. Other people would remark on it, and I'd be speechless, feeling an internal shrug. It was what it was.
Looking into 2011 I see a busy year ahead of me, a time to finish checking off all the boxes toward becoming a licensed midwife, not only in paperwork, but more importantly in skills and capabilities. I have a deadline of finishing all my required experiences by December 1 if I am to sit my exams in February 2012 as I aim to do. (Don't tell my kids, but I hope to celebrate the completion of my requirements with a family trip to Disneyland.) I have another Utah internship scheduled, which I am 90% sure I will proceed with. I have homeschooling children. I have preceptors I remain dedicated to helping as much as I can, which will never equal the amount that they have helped me. I have my 10th wedding anniversary, the 4th anniversary of the first birth I attended, and a few milestone birthdays in the family. And I have a feeling it's going to be even bigger than the past year, and that the year will go by just like this one - charging through it til the end, until I look back on it in amazement of how full and life-changing it was.
It's been a huge year for me.
It's a year that found my motherhood in a new set of struggles I've never had before - trying to balance work and parenting, recognizing some of the specific challenges that my children face, finding new ways to meet them where they are and accept them for who they are while trying to give them tools to enrich their lives.
It's been a year that saw my marriage stretched thin and bounce back, in which I found myself a place of independence within the context of this family of five, while forging new connections with each of its members.
It took me from beginning midwifery student to primary under supervision. It took me from knowing I had the inner strength to proceed through urgent situations to witnessing myself being strong in them. It changed me deeply and irreversibly.
Each opportunity to be with a woman finding new places of strength inside herself made me more honored to be a woman.
Each moment of wonder at a baby's emergence made me more reverent of this process through which we begin our lives.
Each birth which required intervention that the hands of an ancient midwife would not have been able to access made me more thankful to live in a time and place where we can access life-saving technology both at home and in hospital.
It's all managed to increase my ability to live in the grey area, to let integrity, tenacity, and vulnerability lay side by side inside of me, to honor the uncertainties of life and birth alongside the expected and the joy.
What an expansive year, and yet, it all felt normal. It all just happened. It was simply the life I was living. Other people would remark on it, and I'd be speechless, feeling an internal shrug. It was what it was.
Looking into 2011 I see a busy year ahead of me, a time to finish checking off all the boxes toward becoming a licensed midwife, not only in paperwork, but more importantly in skills and capabilities. I have a deadline of finishing all my required experiences by December 1 if I am to sit my exams in February 2012 as I aim to do. (Don't tell my kids, but I hope to celebrate the completion of my requirements with a family trip to Disneyland.) I have another Utah internship scheduled, which I am 90% sure I will proceed with. I have homeschooling children. I have preceptors I remain dedicated to helping as much as I can, which will never equal the amount that they have helped me. I have my 10th wedding anniversary, the 4th anniversary of the first birth I attended, and a few milestone birthdays in the family. And I have a feeling it's going to be even bigger than the past year, and that the year will go by just like this one - charging through it til the end, until I look back on it in amazement of how full and life-changing it was.
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