Birth Spirit

I'm back...

2007-09-30T16:13:00.000-04:00

So, I have been seriously neglecting my little blog for months, but I'm back. I really need to start writing this stuff down so I don't forget everything. A lot has happened since I wrote last. I graduated nursing school and started working in a L&D department of a hospital I said I would never work in (never say never). Anyhow, I am through my orientation and I have seen so many absolutely crazy things that I could never possibly list them all here. But, I will start to write more. One thing I know for sure-- I cannot stay in this job long. I just need to get some experience and get the hell out. I don't want any of this to sink in and I don't want to pick up lots of bad habits and I'm sure that I am already acquiring a few.

Whose birth is it anyway?

2006-12-26T14:46:00.000-05:00

Everyone has their limit. Each person will feel differently about pushing themselves to their absolute extreme-- it depends on their motivations, their past, and their beliefs. For example, I would do anything to avoid a c-section. And the only reason I would have an epidural is for a c-section. Some do not feel so strongly and pushing for 5 hours is more traumatic than a natural birth is worth. I think midwives should figure this out long before the birth to really understand their client goals.

I attended a birth last night that was a train wreck and ended in a transfer (finally). It started so well, mom coped great with dilating and made it to "complete" pretty fast. But, this is where things started going down-hill. Having an out-of-hospital birth for this mom was stepping pretty far outside of her mainstream life and I could sense that she was not very sure of her strength or very trusting of her body. She questioned everything that was happening. "What should I do... I'm not doing this right... Should I push..." etc. The last time the midwife checked her she was about 6 cm. I would guess by her reactions that she was now about 8 or 9 cm. The midwife says "follow your body," and "you can try pushing with the contractions." Do those two statements belong in the same sentence? I don't think so.

If someone is questioning whether or not to push, I feel that generally they are too much in their head. I would tell them to follow their body and not to worry because there may be a point when they will know without a doubt that they have to push and if they never feel that way that is OK too because your strong uterus will be pushing with or without your conscious effort. Every time I have heard a midwife throw out "you can push if you want" when the mom is not really in-tune with their body the mom begins to push because she thinks that is what she is supposed to be doing. And then it seems like I see a lot of swollen anterior lips or babies that don't come down after hours and hours of pushing-- like this mom. 5 hours of pushing for this poor mom and then a trip to the hospital in a state of pure exhaustion. In cases like this I think an earlier transfer would be called for. It would be good to ride in the car, be admitted, wait for the OB, be examined, get an epidural, etc. before a woman hits the point of exhaustion and apathy. Being in labor for hours, with no sleep, then pushing forever, and then ending up with a c-section... That would be awful. It would be hard to welcome that baby at that point.

And the worst part of the entire night happened at the very end. The midwife tried one last ditch effort to turn this now OP baby. It was torture for the mother who eventually was crying and saying "no, no, no, no, I can't do this, stop, I want to go to the hospital..." Why do this? That is just flat out abusive. What was this midwife trying to do-- cover her own ass by avoiding the hospital at this point more for her own reputation than for the sake of the client? Whose birth is this? Who gets to decide when enough is enough! Is a natural, out-of-hospital birth always the die-hard goal regardless of feelings or client wishes?

Compassion...

2006-11-03T11:24:00.000-05:00

In clinical recently I had an experience that made me question (again) if I could ever work in the hospital as a L&D nurse. My preceptor and I started our day with a couple in very early labor. In fact, they probably wouldn't even be at the hospital, but the mother had SROM early that morning and was GBS positive. Per the hospital protocol, a GBS+ mother has IV antibiotics every 4 hours in labor. It’s unfortunate that primips are told to come in right away because usually with a primip you have plenty of time to get in a round of antibiotics before the birth even if they stay home until they are in active labor. Any time you come in early to the hospital your labor will be fucked with-- that you can count on. If you decide you want a hospital birth, my advice to you is to go to the hospital when you are cookin' with gas, check your own cervix before you go in. It blows my mind that people go in, scared they will be sent home (which they pretty much never do so don't worry about that) when they could check their own cervix-- its your cervix dammit!!!!

I spoke with the couple while working on their admission paperwork and they told me they were interested in having a natural birth. The mother stated she was having some back pain, so I asked my preceptor if we could take off the monitor for awhile so the mother could move around. Of course this is never something a nurse would offer, someone would have to insist on it and they only way the will take it off is if everything is going perfect so far and there are no interventions yet.

These parents seemed unable to cope with contractions and did not seem prepared with any coping strategies. I am not suprised as I sat through the birth class offered at the hospital and its absolutely ridiculous. I made some suggestions about positions, but it seemed to me that they were not confident in there abilities, nor did the mother seem able to follow her body through the contractions. The nurse suggested getting out of bed and put a chux on the chair and said "you can sit there." Well, you may as well be strapped to the monitor because sitting up in a chair is not going to do any good! This is where a good child birth class can be very helpful, so parents have tools they feel confident in to deal with pain. This poor woman was fighting every contraction, hyperventilating, curling her toes and trying to stay in control. Its so sad, I feel there is nothing I can do at this point.

Eventually the mother took some Stadol and slept for awhile. The husband thought this would be a good time to run home to take care of their dogs. He probably did not understand the importance of his presence as my nurse and I did not spend much time doing labor support. Why that is, I don't know. We only had one patient! We could have sat in the room doing charting or been a little more encouraging, but basically nurses stay in the nurses station until 2nd stage.

The Stadol began wearing off and the doctor told us to start Pitocin at 2 by 4 every 30 minutes. I overheard the medical resident state that this order was “obnoxious.” I was glad somebody thought that was ridiculous. It makes me laugh when I see these fat, old OBs; give me a break, why are you doing this work?! You don't give a shit about women or birth or babies! This doc is the same one that nurses can tell when he checks someone when they are in the hall because women scream. Really nice... why isn't he confronted about that? That's assualt if you ask me. The whole thing is just disgusting.

This protocol was very intense for the mother and it was obvious that no one could have a natural birth with that level of Pitocin. She appeared to be in a great deal of pain and will probably not remember that day fondly even though its supposed to be one of the happiest days of a woman’s life. I have seen many natural births, but I have rarely seen anyone in this much pain especially so early in the dilation phase of labor (2-3 cm). I mean, this woman was suffering. This wasn't "pain with a purpose" this was inflicting an unnatural level of pain that the body would not be able to create on its own. The contractions were every 2-3 min. lasting 60-90 seconds and they were beyond intense, they were torture. She was grabbing the bed, holding her breath, trying to escape the pain. She was sobbing. It was horrible. And then we left the room. We went to the nurses station and paged the anesthesiologist as there is no other option at that point. I could here her sobbing and screaming from the nurses station and she was all alone. I should have stood up to my nurse and said I'm going to stay in there with her until her husband comes back, but it just didn't feel like an option. When I have stepped up and done that in the past nurses get offended like I am overstepping my bounds as a student.

My nurse and I switched to postpartum and last I had heard our patient had not progressed much past 3 centimeters dilation and the baby was beginning to have decels. Some of the nurses were calling her a c-section early in the day and that prophecy looked to be self-fulfilling. It is so unfortunate that she would probably be an “emergency” c-section for fetal distress that the doctor most likely caused by his aggressive labor management. And then they will say "thank you, thank you doctor for saving our baby."

I find the level of compassion in the physicians, nurses, and residents to be disheartening. My preceptor and I sat in the nurses’ station and paged the anesthesiologist to get an epidural right away as this seems to be the only option at this point. I don’t know if turning the Pitocin down is an option. The resident sitting in the nurses’ station seemed concerned about our patient and I said to her “it’s pretty intense and her husband isn’t here right now, he had to run home.” She turned to me and said “so,” in a way that made me think that she had never experienced pain like that, nor did she have any empathy. Compassion and empathy are very valuable qualities to have in health care providers and these skills seems undervalued in comparison to technical skills or getting a patient “delivered” as fast as possible. What happened to the nurse being the patient advocate!

I could not agree to such a high dosage of Pitocin causing more pain for the patient and more risk. If a patient has some negative consequences from the oxytocin management who is to blame, the doctor that ordered it or the nurse that carried the order out? In school it seems that we have learned we always have to double check what a doctor orders because if we give what they order and its incorrect then our license is on the line. As a nurse I wonder if you are able to question or disagree with a doctor. These are all questions I would have to answer before becoming a labor and delivery nurse.

Patient Abuse...

2006-10-17T11:55:00.000-04:00

There was an incidence at my clinical the other day that just made me want to quit and get out of this clinical rotation stat! Here's a little synopsis of what happened:

My preceptor and I had a patient, I will call Jane, that the nurses had labeled “a pain.” She is 19 years old and a first time mother. She was married to an older man, which was also pointed out by many of the nurses, and this new family was in a lower socioeconomic status. I wouldn’t normally point out the socioeconomic status except for the fact that it seems to make a difference in the care received and the rights a patient may have.

My preceptor and I were walking down the hall to the postpartum area when this women, whom I perceived to be a nurse (from her demeanor and attire), came walking past us talking very loudly and was obviously upset. “I can’t believe this girl! I can’t believe she is going to refuse these blood tests; it’s ridiculous that she would do this to her baby! I swear if she doesn’t let us take her blood, I’m calling child protection services because this is crazy!” The patient that she was upset about was our patient for the day, Jane. Then we heard the story from the other nurses on the floor. Jane did not have much prenatal care and refused many of the standard blood draws done in pregnancy including blood typing, most likely because of her self-stated fear of needles and I think because of her being young and not understanding the implications of testing. As a result, her health care team did not know her Rh status. Blood typing will alert staff if a mother is Rh negative. If the baby is Rh positive then there are risks for future pregnancies and infants as the mothers’ body can produce antibodies against the baby.

My preceptor and I entered Jane’s room to discuss the testing with her. The nurse stood at the end of the bed to address the patient lying in bed and I sat down next to Jane. My preceptor proceeded to use scare tactics and to threaten the patient to submitting to the test. The nurse spoke in an authoritative and condescending tone as she explained the consequences to the patient. “I have to make sure you understand what you are doing. You are avoiding one poke so your baby can have at least six, do you understand? You have a choice, but you baby doesn’t—you can refuse this test, but we have a legal right to draw blood from your baby and there is nothing that you can do about that and it will take at least six pokes to complete all the tests your baby will need because we don’t have your blood type information. If you are Rh negative and your baby is Rh positive, than we to treat you or your future babies can die. If you are Rh negative and your baby is Rh positive than we can give you a shot to protect your future children. Do you understand that if do not allow us to take your blood than you will not have anymore babies!? Do you understand that?! They will die; you will not have any more children!” (I was not able to write down this exchange immediately, but this is very close to the exact exchange). I was pretty amazed as I sat there listening to this transgression as I knew that the nurse was lying about some of the information and I found the treatment of this patient to be unethical. Patients have the right to refuse. I believe that if this patient was older, more affluent, educated, or understood her rights as a patient this may not be the case. I also have a feeling that this kind of treatment is not necessarily a one time incident.

Jane didn’t say anything; she just lay in the bed with a defiant look on her face. My preceptor than left the room and I sat and tried to talk with Jane on more of a friend-to-friend level. She was very afraid of needles, so afraid in fact, that she had a natural childbirth the night before. As far as I can tell, that was the only reason she didn’t have an epidural—not because she was striving for natural childbirth, but because she was that afraid of needles. I also got the impression that Jane did not deal well with authority figures and was very, very immature for her age. I tried to understand Jane and treat her like an adult and be her friend and ally. After talking with her about the test and how we could use the smallest needle, she could squeeze my hand, and it would be over before she knew it, she was beginning to change her mind (I had realized at this point the informed refusal would not be a viable option unfortunatly). Then, in walked the irate women from the halls earlier. She introduced herself as a Pediatrician and began pretty much the same drill as my preceptor. I made a mental note to find out if this woman really was a doctor, I just couldn’t believe it. She also proceeded to try to coerce the patient with out offering the facts of the test or risks versus benefits. After her talk I followed her out of the room as she again vented about what a pain this patient was and how she couldn’t believe her and what a “psycho” she was.

In the end, with about 20 minutes to spare, Jane did decide to go through with the blood draw. I stayed in the room with the phlebotomist as she did the draw and reassured Jane that she was doing great and the worst part was over. It turns out that woman is a Pediatrician; I just could not believe how unprofessional a doctor could be. The fact is that patient had a right to refuse that test, but she also had the right to fair and unbiased information. I feel that the correct way to address this situation would have been to present the facts about Rh factor. The facts are that 15% of the population are Rh negative and that 17% of Rh negative women who are exposed to Rh positive blood ever make antibodies. In those instances, fetal autoimmune hemoloysis can develop. Results can range anywhere from mild anemia to life-threatening conditions such as hydrops fetalis. These facts are a lot different then stating “you will never have anymore children, they will die.”

The next morning in shift report Jane’s name came up again. One of the nurses asked if she would be going home today. A nurse responded that the Pediatrician would call and find out if the babies temp was stable today and if so, then the baby could go home with its mother, if not the baby would stay and the mother would go home. Another nurse asked “why? They don’t usually do that, how unstable is the temp?” The nurse responded that the Pediatrician had to spend a bunch of time convincing the mom to have a blood draw and this was probably pay-back.

It scare the hell out of me to know that health care professionals will hold personal grudges against patients and give them different treatment as a result. Unfortunately I am sure that this kind of treatment is not that uncommon. I feel that it is very important for me as a nurse to set an example by being fair and professional in my practice. There will be times when I will not necessarily agree with decisions my patients may make regarding their care, but it is not my responsibility to force people to make decisions I think they should make. My job is to provide the facts as we know them in a fair and unbiased way so that my patients can make informed choices on their own care.

2006-10-13T18:08:00.000-04:00

Go Red!

The God Complex...

2006-09-29T17:29:00.000-04:00

What is it with midwives/nurses/doctors that think they know everything and you know nothing? What is it with all the egotistical health care workers out there?

I am having such a difficult time working with a midwife that takes everything personally. From a great birth, to a suggestion-- everything is a reflection of her. I get pushed down if I even bring up something new that I learned. Now I have learned that I have to keep my mouth shut. Belittling someone does not help you to be a better doctor or midwife or nurse.

I have to remember that when I am a nurse and a midwife I can still learn from the people "under" me, I can learn from everyone. I can be open to new ideas and knowledge and it doesn't necessarily mean that I am doing anything wrong. I will respect everyone, even the pee-on birth assistant.

I won't give any examples of the midwife I work with now, because I don't want to jeopardize my job yet. But, to illustrate my point I will give an example from the nurse I work with. She was demonstrating to these new parents how to take their babies temp. She explained that a rectal temp is the most accurate and this is how you do it... Later I casually mentioned that in my class at school we actually learned that axillary was the recommended way to take a child's temp until they are at least 3 years old (I didn't even explain how its actually less accurate because new babies usually have stool in their rectum, so it reads lower than it is. Nor did I mention that its actually more dangerous because you can perforate their bowel or how invasive it is or that in my conservative text book it says "axillary temps are the preferred method to rectal temps...). I didn't belittle her in front of anyone or push my idea, but her reply was "really? I didn't know that... Well, I don't even believe that because rectal is much more accurate and thats how we were taught..." and then I got the cold shoulder for awhile. Now, this is this nurses first job out of nursing school and she has been at this hospital for 10 years (in fact, I found this to be a common thread-- first job, closed minded, not evidenced-based etc...). She has no children and I bet you she has never read one book on birth or taking any childbirth classes. But, she's the expert telling new parents what to do? And she won't even open her mind to consider using axillary temps vs. rectal temps or even look it up to see the research? Wow...

Nursing School...

2006-09-25T17:14:00.000-04:00

I am so overwhelmed right now that I haven't had time to write. In fact, I should be studying right now for a test on Wednesday, oh well... I have been to clinical two more times-- one day in the nursery and one day in postpartum. Yeah, they are all separate there. Its so funny because in their information booklet they say they practice mother-baby nursing, yeah right. Anyway, I have to come up with a project to do and it can be a scholarly paper or a project to implement a new practice at your clinical site. So, now I'm working on what I want to do, I will post my ideas when I have them and we can take a vote.

I'm Now Entering the Dark Ages...

2006-09-05T20:34:00.000-04:00

My first day at my new clinical... Absolutely horrible, horrific I would even say. I should have taken notes, I was trying to remember all of the ridiculous things I saw done. I knew this hospital would be bad, but I had no idea it would be this bad. While its fresh on my mind I will list some of the things I can remember below and I am sure I will add more later.

The dreaded cascade: continuous EFM, epidural, labor slows down, pitocin to speed it up, baby's heart rate drops to the 70s, uncomfortable positions and oxygen, internal monitor placed by screwing electrode into baby's head, finally she's complete(even though its only been 8 hours and she is a primip), pushing semi-fowlers using stirrups (I can't believe they still use those!) for 3+ hours
Stern male OB stands in front of women... Contractions space out. Coincidence? I think not.
OB can't keep his hands out of her yoni, he pulls down so hard on her perineum that she is bleeding a little. His encouragement is "drive that baby! Get mad! Get mad!"
Forceps or Cesarean?
They decide on forceps first (at this point I was actually hoping for a c-section, it seemed less traumatic, can you believe it?) Big scary looking blades are inserted into her and with the next contraction the OB pulls and shimmies and pulls and cuts a episiotomy without any warning, mom screams, the baby's head is out. Finally this poor little soul is brought into this world.
Mom sees baby for a minute, doesn't really hold him, then placed in warmer.
Mom is being stitched while baby is poked and prodded. Ointment to eyes before even being able to gaze at mom, Vit K, and rectal temps (what the fuck!)
Mom finally gets to feed baby (breastfeeding, yeah ;-) Then he is whisked off to the nursery to be monitored, bathed, and get temp stabilized (how about with mom instead). Baby will be spending most his time in the nursery, mom moved to recovery (yeah, not in the same room).

I'm so pissed right now that I need to take a break and write more later.

Cesarean Birth or Cesarean Surgical Procedure?

2006-08-28T18:42:00.000-04:00

At work the other day one of the birth assistants corrected a midwife when she said "c-section," she said we should call it a cesarean birth. I have in the past accepted this terminology, but now that I have contemplated it further I feel that calling it a "birth" does not express the seriousness of it. In school I attended this surgery and it did not look, or "feel" (in an energetic way), at all like a "birth" in the sense that I have felt births in the past. It was surgery and that's it.

Maybe down-playing the seriousness of a cesarean is not helping anyone. If women accept these too easily, even ask for it, and then call it a birth it is equating a cesarean to a vaginal birth, and they shouldn't at all be equated. They are not similar for mother or child. Risk of death with a c-section is 1 in 2,500; risk for death with a vaginal birth is 1 in 10,000. Those odds are not at all similar and should not be taken lightly.

As I shadowed the nurse assisting in the c-section I witnessed, she was explaining the procedure to the woman on the way to the OR room. It was very matter-of-fact and she explained that "the doctors and nurses would be chit-chatting and even if it feels like we forget that your there, don't worry we don't. We know that you are lying there and your welcome to talk and ask questions." They put up a barrier and strapped down her hands as she lay there shivering. And then the surgery began and a baby was removed. That was that, it was nothing even remotely like a birth. And everyone in the room did pretty much ignore the mother and the baby.

Circumcision...

2006-08-18T09:16:00.000-04:00

The biggest suggestion out of the 2006 AIDS conference is circumcision, you can check out a clip on the news here. There have been some studies done in Africa that showed circumcised men were %60 less likely to contract the HIV virus. I don't know what else to really say about this except this is not going to help people that are on the fence about circing. Who knows, this may even change the AAPs recommendations.

On a side note, a friend of mine had her son circed last week. I was over visiting her and her mom and I watched as my friend changed the babies diaper. Her mom said "look, it looks like a real little penis now." I wanted to say 'NO, it was a real penis before you modified it!' God, people are stupid.

My Day Off...

2006-08-13T21:42:00.000-04:00

Well, sorta. I volunteered to go in and help out because two multips were coming in and the midwife thought they may have their babies at the same time. She wanted some extra help and me being the nice person (sucker) that I am, I volunteered. So much for a day off.

This was a rough birth. I don't know exactly why, but it was just rough on this mama. I felt bad for her, she looked shell-shocked afterwards. I think it was really a combo of things-- a lip that came down with a posterior, big, baby. That makes for a really hard pushing stage. We tried quite a few different positions in the tub, in the bed, squatting on the floor while holding the lip back finally did the trick. Luckily this worked as this mom was talking of giving up, of going to the hospital regardless of how much support and encouragement we were giving her.

Immediately after the baby was born mom said "I am never doing this again." I've heard other moms say this, but this time I actually believed it.

On a side note, I am absolutely dying to have a baby. Even if my birth was just as difficult or long or whatever. I am so tired of watching others experience what I am longing to experience. I feel like I have no idea when this will happen for me-- I feel like I have no idea how I'm going to ever get my boyfriend to agree.

2006-08-11T11:57:00.000-04:00

I went to visit the midwife I used to apprentice with the other day. She is taking a break right now so she can garden (her real passion) and write. Being a midwife for years can take its toll, in fact, almost everytime I see her she tries to talk me out of this career, but I'm stubborn.

Now that I have worked with about five midwives I can really appreciate differences. I am trying my best to hold onto what I believe is right, picking and choosing the techniques I agree with, and I'm hoping that I don't pick up bad habits. I told my past preceptor that the new midwives I work with have more hemorrhages (of course my whole conversation with her took place in her garden while she weeded). She asked me if I had an idea why and I told her they mess with stuff too much. They are in too much of a hurry to get the placenta out. I remember attending births with my first preceptor and she always waited until the mother felt the cramping of the placenta detaching itself, even if the amount of time that elapsed was quite long. She told me that whenever she questions what to do she thinks about how birth would have been thousands of years ago. "Thousands of years ago, a mother would have pushed out the placenta on her own once she felt cramping. You can't mess with perfection." I couldn't agree more.

Update and Rant...

2006-08-09T09:04:00.000-04:00

I talked with my friend S. this morning. She had her baby boy yesterday around 8:30 pm. He has been in the nursery all night because he is having a hard time breathing. I would venture to guess its because they induced her and the baby is early! It makes me so angry to think that this baby would have been able to stay with his mother and breastfeed (he has only had formula so far) if the asshole O.B. hadn't insisted on inducing my friend for no reason whatsoever! He was only 6 lb. 10 oz. and I think letting S. go until she was ready to have this baby would have made at least a pound difference in his weight and a lot more maturation of his lungs. It is just so sad, the bonding she is missing out on and the effect that may have on her breastfeeding. They didn't even have her pump throughout the night! I just feel like writing a string of profanity... Instead I will update after I go see her today.

The State of Birth Today...

2006-08-05T14:02:00.000-04:00

Where to begin with this topic... I guess I am surrounded by pretty progressive people for the most part, but I do still have a few "mainstream" friends. A friend of mine from high school is due to have a baby August 9th. Even though I love this friend, S., she doesn't ever question the status quo. She chose an O.B. at a community hospital and basically goes to her appointments and that's the extent of her involvement. She eats O.K., definitely not stellar, and drinks too much soda (with caffeine I might add). This is really not much different than many others. She has had a completely uneventful pregnancy, but she is being induced Tuesday.

So, my friend S. is being induced the day before her due date. I thought it was bad enough when people were induced on their due date. What is the world coming too? When she told me this, I had to really control myself. Here is just one example of the absolute cluelessness: A mutual friend of ours had a 9 lb. second baby right around her due date and I said "did you hear that Sue had her baby? It was a 9 pounder (proudly)! S. says "I can't believe they let her walk around like that!" And I said "like what? Like why didn't they induce her?" And S. said "yeah!" See, I don't even know where to begin with that. Anyway, I digress... When I spoke with S. today and she told me of the planned induction, I asked her why they were inducing her and she said she didn't know why, the O.B. didn't give her any reason. S. believes it may be because she is 3 cm. and 80% effaced (that is some messed up logic!).

I find it very interesting that people believe there are no risks to these interventions, but even more disgusting is that their doctors are not informing them of the risks versus benefits or I bet most would not agree to an induction. So, I want to list the risks for my own sanity:

ACOG's own statement: The side effects of oxytocin use are principally dose related; uterine hyperstimulation and subsequent fetal heart rate deceleration are the most common side effects. Hyperstimulation may result in abruptio placentae or uterine rupture (a rare complication). Water intoxication can occur with high concentrations of oxytocin infused with large quantities of hypotonic solutions. The antidiuretic effect usually is observed only after prolonged administration with at least 40 mU of oxytocin per minute. A rapid intravenous injection of oxytocin may cause hypotension.
Labor is more painful
An IV is required
Continuous fetal monitoring is the norm
Uterine hyperstimulation is possible
Baby may be born in poor condition (doubles risk)
Increased PP blood loss
Increased newborn jaundice
Increase ceserean birth rate
All of above have their own additional risks

Breasts!

2006-08-04T13:08:00.000-04:00

Even though I'm at work right now, I had to post a comment on this news story Breast Isn't Best?

This absolutely makes me irate! Are people just fucking crazy or what?! I don't see anything offensive about this picture, you can't even see any nipple, give me a break! I can't believe someone in the article said they ripped off the cover so as to not scar their children.

I find it very sad that in our country breasts are only seen as sexual objects, even when nursing a baby. I have seen way more skin on the cover of most magazines (like Glamour, Rolling Stone, whatever) and these photos are demeaning to women! A mother should be more concerned with her daughter seeing women displayed like objects in magazines than breastfeeding!

Birth philosophy...

2006-07-20T11:17:00.000-04:00

I hope that Sage Femme doesn't mind me posting this (if you do let me know and I will pull it). But, I felt like her feelings are spoken very well and are my thoughts almost exactly:

"I'm still not where I want to be in terms of how I practice (I think I'm leaning more towards eventually wanting to be a resource for couples planning unassisted births vs really attending births), but the awareness is there and that's what spurs me on.
you know, during my apprenticeship I was all about using midwifery as a way to fill my needs - mainly those fears of feeling unimportant and not valuable. this was not good - it led to a multitude of actions that took part in "saving" women and babies and wanting to be the one that they were indebted to for their good birth.I realized, a couple years after being in my own practice, that this was not serving me or my clients well. I had to get those things I needed from within, not from anyone else. I was acting in a very codependent and passive-aggressive way.I have to admit that sometimes I feel like I'm alone and it's very isolating. When I attend peer review, I hear some stories that just sound really horrific to me - and I feel for the people who are doing this work with so much anxiety. When I hear scary stories of dramatic emergencies with birth, I remind myself that I am not inviting that into my life. I don't need those situations to humble myself to birth. I also don't kid myself that I'm open to whatever God/universe brings to me. I feel very divinely protected at births.(It also helps a great deal that I've had two incredible apprentices whose belief system is close to my own. While they may believe some things differently, the fundamentals are there - and that is very important to me! They've taught me a great deal about really examining why we do what we do.)I've had a midwife in my community once tell me that the reason I am the way I am is because I haven't had anything "scary" happen yet. I don't know what she means - maybe a baby dying? I've certainly had my share of emergencies...she tells me that once I get "that", I will be more conservative.In other words, being the youngest midwife in the community means I'm a bit naive. I question everything I do that is different from my peers. I question it alot - I start to feel like maybe I'm not doing it right and I should re-evaluate why I'm doing it. Then, I look at it again and realize that I'm practicing the way I want to and my clients want me to.I've had a couple clients admit after their birth, almost disappointed, that they didn't know I was going to be that hands-off. But, both those couples hired me again for subsequent births. I think it helped me see that I need to be really clear about clients asking for what they need - that I'm not going to try and second guess everyone's needs and if they want more, they can ask for it and I will gladly be there and do it. I talk more about my philosophy and what I usually do at births (sit in the other room, etc) so clients aren't surprised - and they know that I'm there at their service, but I'm not going to take over.I've had my share of things I've done for clients that are not too hands-off. I've released membranes to start labor, I've done numerous vaginal exams during labor, etc. I think the difference is that these actions are not part of my standard of care - they are talked about and have a purpose. Many times, the interventions are something that are desired by the mother. "

These are all thoughts that I have struggled with, for example, why midwives are even really needed at all. But, I think I have come to the conclusion that many women feel they need the assurance of someone available in case a situation were to arrise-- not everyone is ready for the leap into unassisted birth. I can try to make it as unassited as possible.

It absolutely drives me crazy when ego is involved in anything, especially birth. And its so common, probably the number one reason people get involved in midwivery, obstetrics, or healthcare in general. I remember having a session with a very wise and intuitive woman about my goals in life and that I just couldn't find my path and it was so hard for me. I told her that I want to help people which at the time I thought was a very noble cause. She didn't agree and she warned me against getting involved in anything with that in mind. Its not my job to help anyone, if I respect people then I know that they can help themselves. She reminded to choose a career for myself, that I would enjoy and not for anyone else. Getting ego out of the way is a continual process and something that I'm sure I will be working on throughout my life.

I almost decided to not be a CNM for this exact reason. The first hospital birth I attended (after quite a few beautiful homebirths with a amazing midwife) shook me to my core. I noticed the OB and nurses walked around with an energy about them like they thought they were Gods. I could tell that they thought this young woman wouldn't have had a baby without them, they had such looks of pride-- they were beaming, but not in the right way-- not for the mother, but for themselves...

I explored the CPM route. I talked with a few midwives that had taken different paths, but I still felt that underlying ego and competitiveness. Thats when I decided it really doesn't matter what path you take, but who you are and what your intentions are.

I know that I will talk about this again and I could contemplate it forever. The wise CNM that I first worked with never accepted a Thank You after a birth, she always said "don't thank me, I didn't do anything, you birthed your baby beautifully..." and thats basically my feelings exactly.

Diet...

2006-07-13T17:29:00.000-04:00

I'm really amazed at how some women can't set aside their own issues for 40 weeks and concentrate on the health of their baby. At the birth center clients do a diet recall at some point during pregnancy and it gets put in their chart. Sometimes I flip through them and can't believe what I see-- Lean Cuisine! What the f***?! I mean come on, your eating diet food that has about 200 calories a meal and absolutely no nutritional value. I guess I shouldn't be that surprised when 1 out of 4 women in this country have an eating disorder and 4 out of 5 have disordered eating. But, I really wish women could stop focusing on just themselves during pregnancy.

I really believe that what you eat during your pregnancy will have the biggest effect on how your pregnancy, birth, and baby turn out (that you have control over anyway). People even try to follow the Atkins diet while pregnant which is crazy when you are trying to grow a baby with a healthy brain-- neurons need a constant supply of glucose to function!

I would start with organic food, as unprocessed as possible, and lots of filtered water. It isn't rocket science. I would also avoid chemicals of any kind (even in personal care products). One study found 180 chemicals within the amniotic fluid-- so please try to do as much as possible to lighten that load. Welcome every pound that you gain, it is making your baby healthy and happy. Weight gained in pregnancy is one of the biggest predictors of health.

Breastfeeding...

2006-05-13T15:07:00.000-04:00

I recently took care of a baby that was being formula fed from birth; my first experience as of yet. All the mothers and babies that I have cared for are breastfeeding, at least so far. It’s very strange to me. The more I am around mothers and babies, the more I do not understand formula feeding at all. The difference between a formula fed baby and breast fed baby is just obvious and sad in my opinion. It is a very small percentage of people that are not physically able to breastfeed (less than 0.5%). But, many women in this country choose not to breastfeed, not even to try it. Don't you want to try them out and see what they are for? It blows my mind. This mother has chosen to formula feed all of her children thus far; this was her third little girl. All of her children have had terrible colic and reflux (this is just a no-brainer). I can't believe the mother wouldn't just try it for her children’s sake. Of course, I never actually voice my feelings on this, but my feelings have become very strong because I have seen the difference in health, and in motherbaby bonding. When I come into the room of a formula fed baby they are usually lying in their cradle, breastfed babies are usually being held. Formula fed babies are often sent to the nursery for the night (and many nurses enjoy the formula fed babies because they can feed them and mother them-- that’s a whole 'nother post for another time).

Its funny too that it feels like you can't talk about breastfeeding versus formula feeding. It’s off limits like religion, sex, and politics. Doctors will use scare tactics if you choose not to vaccinate, but often nothing is said if a mother chooses not to breastfeed and the health consequences are just as serious. Formula fed babies are more likely to die before their 3rd birthday; shouldn't we be able to talk about this?

Anyway, I worked up the nerve to ask this mother if she had breastfed any of her children (in a very nice, unassuming way). She said "no. I've never felt comfortable with 'that." She added that her sister breastfed her children, but that she was 'different' and they did things that she didn't agree with. She said her sister loved it, but it just wasn't for her. I asked her if she got very sore when her milk came in and she said yes. She said that on that third day she always second guessed her choice when the baby is crying and her breasts are full...

I can't imagine completely denying your own instincts. I feel like these formula fed babies are cheated for many reasons and they don't have a choice. I feel like these mothers are cheated because they don't have the confidence or support or education to choose to do what’s best for their own health and their baby's health.

One Year Down...

2006-05-12T14:41:00.000-04:00

And only one to go! I am officially done with my 3rd year of nursing school... I can't even explain how ecstatic I am about that. It seems impossible that I only have one year left. People warned me that it would be really hard-- terrible in fact, but I made it through the worst of it. Next year is supposed to be easier, we'll see. I will also be the first person in my immediate family to have a Baccalaureate, which is also pretty awesome.

News: U.S. Newborn Survival Rate Ranks Low

2006-05-09T15:50:00.000-04:00

Just saw this on yahoo news this morning-- we rank really low in infant mortality and nobody can understand why with all our technology. I propose it is because of our technology. In countries where midwives are the main providers for perinatal care there is better outcomes, I mean, this isn't rocket science! Columbia and Vietnam and Sweden are at the top of the list, why is that? The U.S. is at the bottom of the list second to Latvia! Midwives are the primary providers in these countries and breastfeeding is the norm. Check out the new report for yourself: Report2006

What it's all about...

2006-05-09T15:26:00.000-04:00

I had the priviledge to attend one of the most beautiful births I have seen so far last night. I don't remember ever seeing a couple so loving and supportive of each other. And the really surprising thing is that it was their fourth baby! This was also their first out-of-hospital birth and it was perfect! Mom caught the baby herself and I have never seen a baby breastfeed like such a champ! And no hospital food afterwards...

Birth of a blog...

2006-05-07T18:26:00.000-04:00

Much less painful than a baby I presume. I know that I don't have time for this, but I feel the need anyway. I am not a writer, nor am I good at spelling or grammar. On this blog I will share what I know, or more like, what I think I know and what I learn. Feel free to comment or yell- whatever the case may be. I hope that this will at least be amusing to someone, even if its only me.