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

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.

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."

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!"

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.

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.