Milk Chocolate Midwife

Update: I'm BAAAAAAAACCCKKKKK!!!

2011-11-02T00:29:00.000-07:00

So, I'm 29 weeks and 3 days pregnant now. Here's what's been going on in my life since my last post:

*I thought I was nauseaous during that last post, but honey, I didn't know what nausea was! Right around week 12, when I thought that the mild nausea I was having would be passing, my body kicked into high, vomit-y gear. I was barely keeping down water on some days. It was lovely, really. Who knew vomit came in so many fabulous colors? My last barf session occurred at 17 weeks and it ceased quite suddenly thereafter. Thank the good Lord!

*Been getting increasingly annoyed w/ one of the midwives I attend birth with. Don't get me wrong. The nurse-midwives I assist are wonderful folks, bless them dearly, but one of them often tries my patience with some of the things she says and does in and out of a labor/birth setting. And her labor management skills sometimes border on...hmmm. Let's just say she could use some good, strong support in the form of a second (knowledgeable) midwife in most situations. That, and a course on interpersonal communication. Maybe some sensitivity training, too. She's not a bad person by far, but, sheesh. She sure can rub people the wrong way at times. Of course, I'm too diplomatic (or is it chicken-shit?) to say much about this to her. Actually, I've tried to have conversations about cultural differences that some clients might have and how we need to be sensitive to these things. Well, that's never gone in the direction I thought it might. She either claims people are just so ignorant and that's why their beliefs differ or that others are displaying "reverse racism" by not simply accepting her views or her care as is. *sigh* Uh, yeah. Okay.

*Went down to see my sister who is also pregnant. For the love of Christmas, that was one stressful trip. I love seeing my family and my sisters in particular, but after dealing w/ one pregzilla, she and her husband constantly bickering, family blood pressure issues, a first grade terrorist in the making (and her mother who believes that yelling = discipline)??? I was ready to come home ASAP. I was only there for 4 days and it felt like 4 weeks. I was so stressed out that on the plane trip back home, I began having contractions. Oh, yeah. More to this story below...

*I thought the contractions I was having were due to the change in air pressure or whatever on the plane. After we landed, those suckers continued. And they got stronger. And more organized. Well, after I downed a liter of coconut water and laid myself down, I expected things to stop. I was only 25 weeks, for crying out loud. They didn't stop. In fact, they were every 4 minutes. I texted my midwife and got hubby to take me to the nearest hospital. By this time, I had been contracting for several hours. The intern (who as it turns out lives in the building next to mine) ran a fetal fibronectin which came back positive. Yay. VE revealed I was fingertipping but not very soft or showing change over several hours. Contractions finally stopped after I got 2000mL of Lactated Ringer's solution. Until I got up to walk out of L&D. I didn't even bother to tell the nurses. I was tired and assured that my cervix wasn't dilating. I just took my ass home and put myself on temporary bedrest. Apparently, I have an excitable uterus. Yay, me.

*I FINALLY got my midwifery license to practice in the state that we're planning to move to next year! I'm so excited. *does a twirl*

*What else? Hmm. I think that's it for now. Especially since it's past 4am right now. *Yawn* Oh, wait! Did I mention that I'm having a baby boy? If not, I'm mentioning it now. I so love him already. I know what you're thinking. Yep, I now walk around with a vagina AND a penis. How cool am I? Don't be jealous. :o)

Peace.

I Haven't Been Abducted By Aliens...Well, kinda.

2011-07-08T00:52:00.000-07:00

Hey, folks. I've been a total slacker when it comes to this blog and for this I apologize. What I haven't been slacking on, apparently, is baby-making. It's true. Two pink lines. SQEEEEEEEE!!!! Just over 12 weeks now and the nausea is really starting to kick it up a notch at this point. It's generally supposed to be easing up around now (or soon, prayerfully), but as usual, my body must be the exception to all rules, right? *sigh* Barf.

Overall, though, I'm doing well (other than the N/V and crushing exhaustion) and the little alien/sprout is growing nicely. Even taught childbirth class and attended a lovely birth the day before yesterday, so I'm not slowing down much. Holy fark, I'm growing a person! My mind is officially blown. I seriously hope I'm better at this than I am at growing plants. Cuz I totally suck rat balls at that. Sheesh. Taking my tired butt to bed. But I promise to not be a total blog slacker from here on out. Or I'll at least try.

Peace and chicken grease. :o)

VBAC

2010-12-23T17:13:00.000-08:00

I've had the opportunity to attend several very interesting and eye-opening births during the course of the past year. A few were with moms who had c-sections previously. Two, in particular, stand out in my memory because they happened within a few days of each other but had very different patterns. One mother had a successful VBAC and the other had an emergency repeat section. Both moms and their babies are doing well. I hadn't attended a VBAC or even a TOLAC in a while so it was interesting to see how things can go and how I applied my midwifery skills in each situation. Granted, I was their doula and not their midwife, I couldn't help but to apply my midwifery training to give these women the best care I know how to give. And I'm glad I did.

When the mom who experienced the repeat c-section complained that she "felt a pop or pulling sensation" in her lower abdomen I knew to watch her baby's heart rate and her contraction pattern closely. Sure enough, within 20 min, her contractions became in-coordinate and her baby's heart rate began taking disturbing dips. Her midwife and I agreed that this wasn't going in a positive direction and the attending OB was called in to perform the c-section. After being rushed into surgery, it was discovered that this mom's uterus had indeed begun to rupture and her baby was in certain distress. He was fine, thankfully.

A few weeks later, the other VBAC mom went into labor spontaneously on a clear, cold morning and I met her at her house to monitor her progress. after a while, she began to feel some slight rectal pressure and we decided that it was time to move to the hospital where her midwife was awaiting us. This mother went on to birth her baby serenely and without incident. I felt confident at this birth because I knew what to look for. I knew what a uterine rupture could potentially look like and how it should be handled. Seeing that rupture in the previous birth, made me more aware of the fact that a rupture is certainly possible for every laboring woman regardless of their birth history. It also made me aware of the realities of a rupture. Its not exploding uteri or sudden death. It's often silent and relatively painless. Therefore, VBAC requires more vigilance, care, and respect.

The issue of VBAC, when discussed among professionals and lay-people alike, is often polarized. Many people, mostly health professionals, feel that attempting to give birth vaginally after having a surgical birth is inherently dangerous and they often spread that sentiment to the patients they come into contact with. There is also a contingent of people who feel that VBAC holds no increased risk at all. And then, there are folks like myself who feel that VBAC does potentially hold increased risk, especially if mom's medical/birth history is not a great one.

I think it's important to promote VBAC as a viable choice for moms who would like to attempt it. I also think it's important for everyone involved to be on the same page. That means midwife, mother, partner, back-up or co-managing OB, etc. Until that and malpractice reform happens, the issue of VBAC will remain polarized and access will be limited. And that isn't the healthiest scenario for moms and babies.

Musings of a Doula/Midwife and a Birth Story

2010-10-13T10:18:00.000-07:00

Sorry for the lack of posts. It's been a bit hectic around here. Between weddings, births, home visits, childbirth classes, etc. I miscarried what I believe was a blighted ovum. Holding that little, Oreo cookie-sized placenta in my hands was, and still is, heart-breaking and somehow awe-inspiring at the same time. Despite all the running around, I have had time to do a few things such as grieving the loss (mercifully), bathing (thankfully) and checking up on my family on FB (this is what the world has come to, people). Recently, I also had the opportunity to be the doula for a woman who was having a planned hospital birth. This isn't normally the kind of doula work I do. Most of my clients are planned home births. Being a doula (or a midwife) in a hospital setting can be difficult. Being both can be very, very uncomfortable. So here's the story...

This mother was in great health and having an uncomplicated pregnancy. However, she was going to an OB practice that specialized in high-risk pregnancies because she had developed a good rapport with one of the OBs there after suffering a traumatic loss a year ago. The OB and parents decided to undergo a medical induction at 41 weeks. We had already discussed the pros and cons of medical induction and all the likely scenarios. The mother decided that she was okay with receiving Cervadil but did not want Pitocin. I was feeling like the champion of informed consent before we went into the hospital. Then things began to change.

First, they couldn't give her the Cervadil because of an allergy issue. After much debate and confusion on the part of the parents as well as the medical staff, she was sent home to "wait it out" for the night with instructions to return in the morning. This left the mother feeling frustrated because she was ready to be in labor and tired of being pregnant. However, she decided to go home and wait. Two days later, on the morning that she was to return for another shot at medical induction, her water broke. When she called to tell me this, I asked how she felt about forgoing the induction since it seemed like she was beginning labor on her own. She informed me that she was just at a point where she was "over it" and just wanted the baby out. So, we went to the hospital.

I'm sure you know how things progressed from that point but for those who may not have guessed, let me re-cap: Pitocin started and doubled every 20 min --> Mom in unbearable pain --> Vaginal Exams every 2 - 3 hrs --> Epidural --> More Pitocin --> Failure to wait and fear of "big" baby --> C-section --> Mom distraught over how everything played out.

So...I left that birth feeling like I had done all I could do barring locking the doors or throwing myself prostrate over this woman's burgeoning belly. I gave her the information and allowed her to make her decisions free of judgement on my part. But when her choices led to the unwanted scenarios that we had repeatedly discussed for months, I felt like she was upset with me for not protecting her from those choices. I felt I had let her down. Maybe my mistake was in assuming that informed consent meant informed responsibility. Maybe it was that, in an effort to not make it seem as if her trusted provider was setting her up, I wasn't blunt enough with her about the writing I had already seen on the wall. How does one balance tactfulness and brazen defiance? After her doctor did the final vaginal exam and declared that she had made NEGATIVE progress (even after making positive progress all along) and gave her the c-section talk, I could've opted to check her with the mother's consent. But what would I have done if I had discovered that the doctor's exam was "inaccurate" and the mother was actually further along? At best, it would've seriously broken the trust this woman had in her doctor. At worst, it would've done that and possibly seen me arrested for practicing medicine without a license.

What would you have done?

Ramblings

2010-05-16T20:53:00.000-07:00

So...it's been a while since my last post. After the catastrophic earthquake in Haiti (and the many other world tragedies since then), I decided to take a break to breathe, to think, and to get really, really fat. Okay, that last one may not be 100% true, but let's just say that the treadmill is calling my name and I'd better answer that bad boy soon because I cannot afford to court the whole host of obesity-related diseases that plague my family. So, Operation Healthy Weight is in full effect as of yesterday.

In other news, it looks as though the hubby and I are moving toward the possibility of having a baby sooner rather than later. Or at least trying to. For those who don't know, (TMI alert!!!) my ovaries seem to hold onto their eggs like a two year old holds onto his "blankie". Those little gonads of mine just don't want to ovulate in any kind of regular pattern that I can discern. I'm talking period once or twice a year kind of irregular. And before anybody even THINKS, "Oh, you're so lucky to not have a period every month", just consider how hard it would be to try to concieve when your window of opportunity is reduced from a couple of days every 30 - 40 days to MAYBE a couple of days a year. Yeah... So, I'm basically trying to "regulate" my cycle through natural means such as acupuncture, herbs, and homeopathics. And I'm sure losing 15-20 lbs wouldn't hurt, either. We'll see.

To be honest, I'm not in a great hurry to storm the gates of Babyland because it's all kind of intimidating, isn't it? I mean, not the pregnancy and birth part of it all. I'll happily tackle pregnancy and birth because as challenging those aspects of the journey can be, for me, parenting is the monster under my bed. I know I'll do my best like most folks out there and, chances are, the wee ones would probably be no more screwed up than the rest of us. The thing about parenting that worries me the most at this point is the fact that there is no "right" way but there are a helluva lot of "wrong" ways to parent. Or so it seems. The amount of judgement that parents encounter from other parents, well-meaning relatives, and know-it-all strangers is crazy. It's hard enough trying to make the decisions that parents must make: breast or bottle, cloth or disposable, child care, sleeping arrangements, vaccinations, etc. Who needs flack from an outsider looking in? And, unfortunatley, when the choices one makes for their family are unconventional, judgement rains down from every direction and support can be hard to find. Especially for parents of color.

I see myself as someday being a home-birthing, exclusively breastfeeding, co-sleeping, cloth diapering, baby-wearing, organic garden growing, semi-crunchy, midwife mama. And I'd be a minority within a minority within a minority.

Poem for Haiti (by Milk Chocolate Midwife)

2010-01-14T00:14:00.000-08:00

Mother of my mother
Who taught me to love
Upon your visage is an ache
For babies lost before their first gurgled cry
Memories of your fruitful seasons woven into the fabric of time
How you once wore the dewy, green bloom of youth
I remember
How you conjured up colors that hushed me
Blue-green blades of grass on hillsides
So beautiful the sun would beg for a peek
Streaking auburn fires and golden lightning bolts
Splashed upon cliff faces
Your beauty is forever
Though a cloak of fragility and desperation
Is what adorns you now
The memory of your warrior's spirit
Carried with you from Guinea
Is not forgotten
I remember
The strength of a mother
Too mighty to be overcome
Though man and beast
And forces of Nature have tried
You were born of the ashes of genocide and slavery
Baptized in the fires of dictatorship and terror
Nursed on the bitter teat of corruption and racism
You strike fear in the hearts of men
For secrets held close to your granite bosom
Secrets of your strength
And joy
Your hour of need, mother, is upon us
And as your need is my need
My hand is your hand to lift you
I am yours
You are Haiti
Mother of my mother
Who taught me to love

A Birth Story

2009-12-26T22:06:00.000-08:00

I've been on hiatus. Isn't that what what folks say when they don't wanna say that they've been too lazy to keep up with their blog? Well, it's what I'm saying. I apologize. Please accept my gift of a birth story as a token of my.... Ah, hell. Let me just tell you this story.

About a week ago, I had the privilege to be an attendant at a beautiful, if mildly frustrating, birth. My frustration didn't stem from the mother or her labor pattern. It stemmed from the fact that, even though she was choosing to birth in a hospital, she was being cared for by a group of nurse midwives, and I had rather high expectations. My bad. So the story goes...

I received a phone call at about 8:25pm while sitting on the couch with the hubby. Turns out, this mama who I'd been expecting to go into labor soon had broken her water but wasn't having regular contractions yet. After having a brief conversation with her, I instructed her to call her midwives and see if they would like her to go to the hospital right away. Being that she was GBS positive, I suspected that they would tell her to come in, so I got dressed and waited for her to call me back. I was right. Off to her house I went. Because this mom and her partner had decided that the partner would stay with their young daughter if labor began at night, I would be the one to pick the mama up and drive her to the hospital.

We get to the hospital around 10pm and wait in the waiting room for about an hour while the maternity unit staff tried to find this mom a bed in the triage unit. Her contractions at this point are becoming regular and are about 4-6min apart lasting 30-45 seconds. Mom is hooked up to monitors when we finally get into the triage room and the monitors are showing decent contractions and good fetal reactivity. So, she's admitted and we're both told to go to sleep and she'll receive her first vaginal exam at 2am. She's been told my the midwife on that if she's not in good labor by then, they probably start her on pitocin. "All you'd probably need is just a whiff of pit to get things cranking.", she says. At this point, I'm thinking, "Oh, boy. The p-word already? From a midwife? Hmm." So this mama and I go into the labor room and attempt to sleep.

Instead of sleeping, I lay down in a chair and watch this mama (who is lying on her left side) for a while. Every so often, I notice that she reaches around and rubs her hand on her lower back. I ask if she wants me to rub her back, but she says she's okay and doesn't need it at that moment. She does ask me to check the monitor to see if it's registering her contractions. (Oh, did I mention this mom was on continuous fetal monitoring through most of her labor even though she was told that she'd be monitored intermittently?) I looked at the strip coming out of the monitor and noted that her contractions were not being accurately recorded even as I stood there with my hand on her belly during a contraction. I mentioned this to the nurses on several occasions and the monitor was readjusted several times.

At 2pm, the vaginal exam revealed that the mama was about 3-4cm, 50% effaced, and +1 station. She was also told that her contractions were insufficiently strong and that they could start pitocin or wait a couple of hours more. She opted to wait. As the midwife walked out of the room, the mom asked me why they were pushing pitocin on her when she'd created and given the midwives a birth plan that indicated a preference for no drugs including pit. I told her that I really didn't know, but could speculate that maybe that's what they're used to seeing and doing. I told her that whether she decided to take the pitocin or not would be up to her and her partner and they should discuss it.

A few hours later, the midwife returned and asked what mom'd decision was regarding the pitocin. The mother stated that she like to hold off on the pit for a while longer. Again, she was told that her contractions, at 6 min apart, were insufficient and pitocin would help to move things along. The mother declined the pitocin again. That midwife went off shift and another came on. The new midwife removed mom off the monitor (after readjusting it for the millionth time and getting the monitor to actually read the contractions which were quite strong) and sent us into the hallways to walk. The contractions weren't much closer together but were building in intensity. Mom's partner got to the hospital around 8am while we were walking. We went back into the room and the midwife came in to tell the couple that the contractions were still not very strong and pitocin would be their best bet. "...With your GBS status, CDC guidelines recommend delivery as soon as possible. Yes, we've given you antibiotics but the literature tells us that even if we do that, babies can still get the GBS infection...", the midwife stated. When the mom nodded that she understood and began saying that she and I had discussed the pros and cons of receiving the pitocin, the midwife cut her off by say, "Well, she's the doula. I'm the midwife. And I'm telling you that you need this pitocin." I didn't even bother to inform her that I was also a midwife. I don't think it would've helped.

At this point, the mom started having a contraction and went into the bathroom. Her partner followed and the midwife turned to me and said, "Why's she so resistant to the pitocin? I mean, I don't think she gets it. I haven't heard her say that this GBS infection could be deadly!" Umm, okay. So I replied, "I think she gets it. She's had this conversation with me, with her partner, and with the midwives she's seen during her prenatal care." Exasperated, the midwife walks out of the room shaking her head. 10 minutes later, the couple call me into the bathroom and mom has the look of a woman getting ready to push etched on her face. I step outside to call the midwife who was sitting 10 feet away. I called her name, said the mom looked like she was getting ready to push and was not acknowledged. Another nurse told me she'd send the midwife in. 5 min passed and I poked my head out the door again to call the midwife and was not acknowledged. A third time 5 min later and I was told by yet another nurse (not the midwife) that mom had to be out of the bathroom in order to be checked. 5 min later, the midwife walks in to check the mom who is completely dilated and pushing. After pushing for less than an hour, a beautiful 6lb 9oz baby boy emerged.

After the birth, we had a few more hurdles to jump in order to get baby to room with his amazing mother but we did it. I was exhausted and frustrated at how my expectations of the midwives at this hospital were not fully met. This mother delivered a healthy, beautiful baby a little over 12 hours after breaking her water. She DID NOT need pitocin. And none of the midwives sat with her long enough to monitor her contraction pattern themselves. I take the meaning of midwife, "with woman", to heart and I expected the midwives to be with this woman. All in all, I know that things could've been worse and I appreciated the midwives' willingness to let the mother and her partner have time to discuss things. I thanked both midwives for their patience. However, I also know that while things could have been worse, they could've been a little better, too. And I know that's not strictly due to the midwives, but our entire system of maternity care.

When Doctors Give Birth

2009-11-10T18:53:00.000-08:00

This weekend, my husband and I attended a get-together to celebrate the birthday of one of our dearest friends and his mentor. Because the hubby is a medical resident and his mentor is an attending at our local hospital, most of the party guests were either doctors, residents, or involved in the medical field in some respect. It was all good food, good conversation, laughing and sipping wine...Until the topic of birth came up!

You see, one of the doctors was expecting her first child and another had recently given birth. Was it fate that I would end up in the same room with both of these women and their partners? As I've said before, folks (including myself) have some really strong opinions regarding birth, breastfeeding, and parenting. So, of course the new mom proceed to give the mom-to-be an earful about what she should and should not do before, during, and after birth. Dr. New Mom's breathless advice: "Regardless of what your OB tells you, go to the hospital early because I waited at home an walked and changed positions and stuff to ease my discomfort (which was stupid because that's what helps you have stronger contractions, so don't do that) and by the time I got to the hospital I was 8 cm and they refused to give me the epidural. - Go early and get the epidural! Oh, and after the baby is born, don't ever let the baby sleep in your bed. EVER. Not even for a minute. Otherwise, you'll never get them out of your bed." *sigh* Dr. Mom-to-Be's response: Silence (wide-eyed, terrified expression plastered on her now ashen face).

Oh, what's a midwife to do, feel, or say in this situation? Here were two very intelligent women who are trained doctors and neither has clue number one when it comes to birth. I was frustrated. Yes, Dr. New Mom's comments irritated me because I don't appreciate misinformation. But misinformation coming from a medical professional, no less? It made me upset to realize how little doctors are taught about the natural process of childbirth. It made me furious to realize that highly educated women are no better protected than anyone else from the misinformation that all too often robs them of their power in childbirth and subsequent parenting. Of course, I already had some frustration simmering beneath the surface after recently speaking with a client (also a physician) who was in tears after being told that her 31 week fetus is too small (at 3lbs 5oz and within NORMAL range) following an ultrasound.

Growing up, I was taught that education is the key to not being taken advantage of. Granted, none of these women are in the field of obstetrics and I don't expect them to know what OBs know (and don't even get me started on what OBs "know" about natural childbirth). However, I did expect them to have an advantage over moms who lack education. They don't. In fact, studies show that women with post-graduate education are at higher risk for things like domestic violence and c-sections - things that many of us would like to avoid, to say the least. I left the party this weekend thinking, If education is the key to escaping marginalisation, these highly trained physicians should have nothing to worry about. Yet, they trust the medical system blindly because of their education. What a reality check.

Giving Birth to Judgement

2009-09-24T09:25:00.000-07:00

As I've been reading various blogs about birth and women's health, I'm finding myself face to face (or face to computer screen) with people who have very passionate views on birth, epidurals, c-sections, and so on. Sometimes it feels like every chatroom or blog with birth as a subject has at one time or another become one of those vitriolic town hall meetings on I've seen CNN. Birth and the circumstances surrounding it can be a sensitive issue for many people regardless of their experience with it. Women who are proponents of natural childbirth are called selfish birth Nazis. Women who have had planned, elective c-sections are being verbally attacked for their choices. And who is attacking these women, you might ask. OTHER WOMEN!!! Women belittling, degrading, and passing judgement on other women. What has that ever solved? Ummm, let me think... Oh, yeah. NOTHING!!! *Deep breaths* Sorry, I just get so steamed when I see this stuff. I'm calm now. I promise. Back to what I was saying.

Birth is a very personal event and there is no one right way of giving birth. And I don't believe every woman on the planet can or should give birth vaginally or without intervention. Anyone who knows me knows that I am a staunch supporter of natural birth and *true* informed consent. I have no problem with a woman choosing to have an epidural or a c-section as long as she knows the risks and those risks aren't down-played to influence her decision. What I do have a problem with is a system which perpetuates the idea that women's bodies are flawed, that at least half of us don't have the capacity to birth our babies the way our foremothers have done for ages, that we are emotionally and physically unable to cope with the rigors of childbirth, that we need to be rescued. I don't feel that a woman who undergoes a c-section or has an epidural has failed. If anything, it may be she who has been failed. Perhaps if more women were supported within their communities, by their health care providers, and, dare I say it, by other women, our (non-medically indicated) c-section rates might not be as high as they are. That being said, it is time we stopped hurling insults at each other and started turing our passionate feelings and our energy toward fixing the system.

2009-08-30T17:50:00.000-07:00

Last week, I discovered ACOG's disturbing survey, "Complications Related to Home Birth". Apparently, ACOG is concerned that the rising rate of elective home births will somehow lead to an increased rate of maternal and fetal complications. The list of complications that they provide for selection on the survey range from multiple gestation to shoulder dystocia to postpartum hemorrhage. My question was this: What does home birth have to do with these complications? Common sense tells me that the location of a birth does not dictate whether or not a complication arises. More relevant would be the awareness, knowledge, and preparedness of the birth attendant(s), perhaps. But even with the most skilled and perceptive attendant, hairy complications can happen, right? What ACOG seems to be suggesting, however, is that hospital births are free from complications until midwives or "untrained" birth attendants bring their so-called "train wrecks" from home to be rescued by doctors and hospital staff. It is precisely this type of thinking, perpetuated by many in the medical community, that leads people to expect perfect results every single time from doctors. And when perfect results are not achieved, lawsuits arise because folks need to blame someone. Who better to blame than the person or persons who assured you that if you followed all their often uncomfortable and counter-intuitive rules you'd have a perfect outcome? Anyway, that's my two cents.

I also found a great response to ACOG's survey. It's created by a doula, Tabare Depaep, J.D., and re-posted on the EnjoyBirth blog. Very cleverly written. Here's the link:

http://enjoybirth.wordpress.com/2009/08/28/response-to-acog-homebirth-survey/

2009-08-03T21:20:00.001-07:00

Lately, I've had boobies on the brain. That's right. I've been pondering breastfeeding. A lot. More specifically, I've been annoyed and outraged by those who claim that breastfeeding is obscene or disgusting and should only be done behind the closed doors of a public bathroom stall. And I've been vocal about it. One friend commented, "Wow, you sure are passionate about your breasts!" Well, I am. They're great. And someday, they'll hopefully nourish the next generation of the Milk Chocolate Midwife family. I'll be damned if I'm doing that important task behind closed doors unless it's strictly by choice!
So, in honor of International Breasfeeding Week, here's Blacktating's August Carnival of Breastfeeding. Love it, live it.

August Carnival of Breastfeeding: Prepared for Life

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Playing Doctor

2009-07-31T10:39:00.000-07:00

Sometimes, I get the feeling that many, if not most, of us in the health care field went into our lines of work because we simply don't like being the patient in a health care situation. We'd rather be the people who are in charge, the ones who know what's going on. Maybe I'm projecting, but as kids how many of us wanted to be the patient when we played doctor? I sure didn't. I wanted to be the doctor because being the patient held little appeal. The doctor got to use equipment and DO stuff. The patient just got to lay there and be sick. At no time during these play sessions did the patient question the doctor or get to participate in deducing what was wrong or deciding what to do about it. How did I (and so many others, I'm betting) learn these classic and faulty elements in the roles of doctor and patient at such a young age?

It must start when we are babies or very young children, for most of us. I remember my terrified little brother thrashing around on the table and eventually having to be restrained by four adults (he was 2 or 3 at the time) while the doctor looked into his infected ear with an otoscope. No one spoke to him or asked him what was wrong or why he was so afraid. Poor kid hasn't been to the doctor willingly since then. He's now 21. My own personal experiences with doctors as a child were often less than pleasant. One of my earliest memories is peeing in a doctor's lap as he gave me a shot in the buttocks. Hey, I told him to wait and he refused to listen to me! Note to pediatricians, when a 2 year old says, "Wait, I've gotta pee.", she may be stalling but maybe you shouldn't lay her across your lap in your newly carpeted office (instead of an exam room) and proceed to give her a shot! My dad was standing there unable to keep a straight face while I watched my urine soak the doc's pant leg. Even the doc laughed. I was mortified. Daddy apologized and dried my tears.

As an adult, the experiences don't get much better but by this time I made it a point to visit the doctor only if I was practically at death's door. When you have no insurance, that's an easy resolution to stick to. In 2007, I did have insurance. I also had a UTI that was morphing into some lovely kidney pain. After visiting the ER, I made an appointment with a nephrologist in my area. I was sitting in the exam room when the doctor came in to greet me. He glanced at my chart and said, "History of UTI, eh?". I nodded and he asked me to stand up. At this point, the doctor grabbed my crotch. Let me repeat. HE GRABBED MY CROTCH!!!!!! To add insult to injury, he said, with his hand still at my crotch, "Well, that's your problem right there. It's too hot in there." What the fucking hell??? I was stunned. My mouth simply hung open and no words came out. I did not punch him, though I should have. Nor did I push his hand away or yell any of the million things flying through my brain at that moment. I did nothing. I said nothing. Because he was the doctor. He was the DO-er and KNOW-er. He had the power. I was the patient. All I got to do was be sick. And after that, I was sick.

I don't hate doctors. Far from it. My dislike is for the unequal and counter-productive power dynamic that exists between many doctors and their patients. The existance of this dynamic isn't soley the fault of doctors or the medical community. I think that patients shoulder an equal share of responsibility here. But here's the problem. Most of us were patients before we were ever health care professionals and we've been socialized to be "good patients". A "good patient" doesn't ask too many questions, is compliant, and understands the patients' place in the medical hierarchy is below the doctor/nurse/midwife, etc. Today, we need less "good patients" and more people actively involved in their own health care. We need patient education and respect. We need to stop asking doctors to shoulder the burden of making health care choices for us because when things go wrong (as they sometimes do), whoever made the decision also carries the blame. We need doctors to stop practicing health care that's based on fear of litigation. We need to be the kind of patients who don't just lay there and be sick.

Religious Right? Or Wrong? Are We to Judge?

2009-07-14T18:59:00.000-07:00

One night not that long ago, I happened to find myself involved in a familiar and uncomfortable conversation about religion and spirituality. Now, I don't usually delve into these conversations with perfect strangers due to the sensitive nature of the subjects. However, that night proved to be an exception. Funny, enough, the conversation did not begin in this vein. It was actually about childbirth, at first. See, I love to talk about birth and women's bodies and the political dynamics of both. I don't know how this conversation which was initially centered on the anatomy and physiology of the birth process ended up "in God's hands" literally and figuratively (mostly figuratively).

Before I continue, I feel I should clarify a few things about myself for anyone who is reading this. 1. I do believe in a power that is above and beyond my intellectual reach and physical understanding. 2. I do not generally identify with any particular religion even though I try to live my life according to values that some might argue are inherently Christian (though I've also been called a heathen and I'm totally fine with that). 3. I try my best to respect the views and beliefs of others, even when it's so much easier to write someone off as a fanatic.

So, back to the strange and uncomfortable conversation. The woman with whom I was talking had very stong opinions and wasn't afraid to share them with me. Several times during the course of the evening, she made references to "healings", "revivals", and "casting out evil spirits". This didn't bother me. I understood that she was Christian as were the 6 or 7 other women in the room. I continued my lecture on the stages of labor and birth. After my lecture had ended, she sought me out to talk and I was open at that point to discussion. I thought the discussion would remain in the realm of birth. Silly me. I should have anticipated otherwise. The conversation was fine until I was told that Catholicism, Traditional Chinese Medicine, Buddhism, etc. all contained elements of paganism and satan in their workings. This is when I started to get that sinking feeling in the pit of my stomach.

Seeing as how I'm neither Catholic, Buddhist, or a follower of Traditional Chinese Medicine, I fought to understand why I was feeling offended by her comments. Then it hit me. I don't like hypocrisy. I don't like when people stand behind the shield of Christianity (or any other religion that espouses love as a beacon to live by) and hurl rocks of judgement and condemnation at anyone who doesn't share their brand of faith. While I admire those who posses an unflappable faith in whatever it is that they believe, I admire humility and honesty more. I'd much rather discuss religion and spirituality with someone who says "This is what I believe with all my heart and I pray that it pleases God.", as opposed to someone who says, "This is what I believe with all my heart and I know that I'm absolutely right and anyone who doesn't believe as I do is wrong." Now, don't get me wrong. This woman seemed quite nice and I'm sure she never meant to offend me. She was simply stating her beliefs as she has a right to do and I didn't argue with her. After all, I was there in a purely professional capacity. However, I got the distinct feeling that even if I had chosen to share my view, at best, she would not have been open to hearing them. At worst, I might have been marked as a harbinger of evil, possibly satan's concubine, and condemned to the depths of hell. Oh, well. Maybe next time.

Wise Latina Woman

2009-07-13T14:35:00.000-07:00

I've been watching the confirmation hearings of Judge Sonia Sotomayor and I'm frustrated and disgusted by the display of White, male privilege and fear that I'm seeing. It blows my mind that we've made such strides in this country with regard to overt racism, but at the same time, those gains seem to mean nothing when the reality of racism pervades our government so thouroughly. Much of the controversy surrounds a statement that she made in 2001 saying "I would hope that a wise, Latina woman with the richness of her experiences would more often than not reach a better conclusion than a White male who hasn't lived that life." Due to this statement, there is much talk of "reverse discrimination" and "reverse racism". Every time I hear these phrases coming out of the mouths of supposedly intelligent people, I want to scream. What the hell is reverse discrimination/racism???? As far as I know, racism is racism and discrimination is discrimination regardless of who is being discriminated against. No one race, gender, religion, etc. owns racism or discrimination. The belief that racism can only be perpetrated against people of color, for example, only serves to make racism okay (as long as its not publicly, and blatantly exhibited) because its something that only hurts "those people". The reality is that racism and discrimination hurts society as a whole.

What I don't understand is why this woman is being taken to task for asserting that her ethnic background and gender have an influence on the way she views the world and (gasp!) the way she may rule on cases. Is the same not true for the hundreds of White male law-makers? Am I to believe that White males' policies and judgements are not influenced by their upbringings, their race, and their gender? It's as if they would have the world believe that only people who are not White and male are suceptible to influences such as race, ethnicity, gender, and social class. Seriously????

I certainly understand Senator Lindsey Graham's assertion that if he had made a similar comment being that he is a Whilte male that he would have been condemned as a racist. However, I would argue that in the country in which we currently live, a White, male law-maker doesn't have to discuss or defend the influences that his gender or race have on his ability to make wise choices. He may discuss being a farmer or coming from "common" roots, but he doesn't dare publicly reflect on how White privilege has shaped his view of the world.
In American politics, White and male is the yard stick that is accepted as the norm. Everyone else is, well, everyone else. It's hard for me to hear law-makers claim that it's important to have diversity on the bench, but only as an effort to prove that racism, classism, and sexism have been eradicated from American politics. Not that we need diversity because different people bring different viewpoints that may add to the richness of dialogue and communication. Come on, folks. I think the American public is tired of the posturing, eloquent language, and "code words" (such as empathy) that serve to promote the kind of fear that only propagates racism, sexism, classism, and all the other -isms that we desparately need to overcome.

A Midwife's Transition

2009-07-09T17:15:00.000-07:00

During labor, transition is often the most challenging period of time for many women. This is a time when a woman generally has to dig deep to find strength for herself physically and emotionally. I've seen many women begin to doubt themselves during transition. That's when they start to cry out things like, "Come on, baby. Mommy can't do this for much longer." or "Time out. I wanna stop now and try again tomorrow." The urge to quit can be strong, but women usually come through it and birth their babies (often within minutes of calling for a time-out). It's a beautiful journey to watch and I always feel blessed to be a witness to it. Although I've never physically birthed a baby, I feel like I can relate to this type of struggle on an emotional level. Actually, I feel like I've been in transition for months now.

My transition has been manifesting on many levels and in various aspects of my life. It began when I graduated from midwifery school last year. A dear friend and midwifery classmate was battling cancer. My determination to get through my schooling was fuelled by the fact that she had become so ill that she couldn't continue her midwifery education. What right did I have to complain of being tired when she was dying? Watching my friend, the woman who was supposed to be my future business partner, gracefully slip out of this life...that was a tough and valuable lesson. Every time I look at her picture where she's smiling at a mother and her newborn, my heart aches to talk to her again.

The next phase of my transition came a few weeks after my friend's passing when I got married. I love my partner and I love being married. Like many couples transitioning from being single to being committed and living together, there have been challenges for us. It's been hard for me. Especially since I moved to another state a thousand miles away (literally) from my family and childhood home the day after the wedding to be with my partner while he finishes his education. If someone had told me a few years ago that I'd be living in a state where it's warm only 3 - 4 months of the year I would have laughed them out of the room. Leaving my home just wasn't part of my grand plan. But here I sit.

The latest part of my transition actually has to do with this move. Unfortunately, I have found myself in a place that is not very mother-friendly, baby-friendly, or midwifery-friendly. After talking to several midwives here, I'm beginning to realize that I may never be able to practice midwifery the way my heart and mind see fit if I stay here. The midwives here are too often bound to hospital policies and medical practices that are not evidence-based or even common-sense based. And this is, in part, due to their hospital-based training. However, there is the issue of the midwifery laws in this state. In short, they leave much to be desired. I'm becoming discouraged. A part of me is ready to call a time out. All I want to do is serve women and families. Why does that have to be so hard?

Educational Diversity in the Midwifery World

2009-07-05T13:57:00.000-07:00

The other day, I received some disturbing news in the mail. The letter was from the midwifery licensing board (of the state where I now live). It basically stated that my application for licensure was denied because I had not received "the right type" of midwifery training. I wasn't surprised. I did not receive the type of training nurse-midwives might get in this country. Nor did I attend a school that is accredited by the American College of Nurse Midwives. So, the midwifery board in my state says I cannot get licensed until I fulfill those two requirements.

It's not that I'm under-educated. I have a Bachelor's degree and underwent 3 years of a rigorous direct-entry midwifery program that prepared me quite well to attend to the needs of women and babies during pregnancy, labor, birth, and postpartum. I then passed the North American Registry of Midwives examination without much difficulty. My training was, in some ways, formal. We met for class at designated times, attended lectures, completed assignments, and had mandatory clinical hours to fulfill. But, in some ways, it was far from conventional. We were required to take on an overnight shift once a week for the entire three years. We had on-call days (and nights) 3 times a week our first year and 7 days a week by our senior year. If you were called to a birth, it didn't matter if you were at work or at a family function or across town, you were required to hustle your butt to the side of that laboring mama. There was no "clocking out" according to your shift. You left when the work was done. Period. Doing these things readied us for the realities of midwifery. Women don't go into labor when you want them to and babies aren't born according to our schedules or timetables. Continuity of care is important because the more familiar you are with a mom's (or baby's) norms, the sooner you can be alerted to a deviation from that norm and take the appropriate measures.

I don't regret taking the route I did to become a midwife. I had several options and purposefully chose this one. However, there are some who feel that there is only one "right" or "best" path into this profession. That is a very limited view. For many years, education was done on a one on one basis - knowledge passed from master to apprentice. This practice still goes on today all over the world. For many years, this was the only way to become a midwife and, for some, it still is. There are many routes one might take to enter this great profession and all of these routes should be respected. Just because someone does not receive knowledge in the traditional euro-centric fashion, doesn't mean that knowledge isn't just as powerful. As an educator (remember my Bachelor's degree?), I understand the need to verify learning according to a certain standard. As midwives, we are charged with the responsibility of caring for mothers and babies. There are certain standards that we should follow to ensure the safety of both. However, let those standards be measured by a non-biased exam of some sort. What we should not do is declare our chosen path to midwifery as the yardstick by which all other midwives are measured. We need to respect the many kinds of knowledge that exist and the various packages in comes in.

As for me, I'm most likely going to appeal the board's decision. If I wasn't a fighter, I wouldn't be a midwife.

Your Child-lessness Is Showing...

2009-07-03T17:17:00.000-07:00

As a birth professional, I get asked one question repeatedly whenever I talk to expected parents. It never fails. We're discussing pregnancy, birth, and/or newborn care and mom, her partner, or maybe even a grandparent will undoubtedly ask me, "Do you have kids?" It's a question that always makes me inwardly cringe just a little. My answer thus far has always been an honest "No, I don't have any kids, yet." Then, I get the look. What's the look? Well, it generally involves a slight widening of the eyes or raising of eyebrows (sometimes, both) accompanied by an upward tilt of the chin and the dreaded "Oh". *sigh* It's a look that seems to say, "Oh, so you don't really know what you're talking about. You've never been there." Actually, one mom said exactly that to me. I suspect others (but not all) may have thought it, but didn't say it out loud. And I don't blame them.

When I was looking for my first ob/gyn (at the age of 17), I insisted on having a female practitioner. My rationale was basically that a man couldn't ever truly understand certain female things such as menstrual cramps, PMS, or breast tenderness. Now, that I'm finding myself on the recieving end of this same kind of rationalization, it kinda sucks. Don't get me wrong. I totally understand the feeling of wanting a provider who you feel can relate to what you're going through. But sometimes, I can't help but think that this kind of judgement is a bit unfair. After all, most people don't insist on going to a cardiologist who has had a few heart attacks of their own, right? As a midwife, I am experienced and educated in a way many people (even experienced parents) may not be. And, to be fair, most people I encounter don't seem to base their entire opinion of me or the care I give based on whether or not I have given birth. In truth, the discomfort I feel at being asked the question and recieving the look, can probably be largely attributed to my own perceptions.

It's just that sometimes it doesn't seem like its all in my head. The world of birth and parenting is a world full of judgement. Whether it's medicated or unmedicated, organic or non-organic, formula or breastmilk; judgement creeps up in many, often well-meaning, ways. And it sucks to feel like I have to explain myself to every well-meaning parent who asks, because a simple "no" often doesn't seem like enough. I've been asked, "So, when are you gonna have kids?" by parents who I've know for no more than an hour. What does one say to that? Saying, "Well, we've tried and tried, but we're dealing with some infertility issues at the moment.", seems to put a damper on the convo pretty quickly but that leads to a whole other kind of look. And that look is more cringe-worthy than the first one.