The Nipple Natzi and the Prayer Warrior

I stopped by my son's place yesterday afternoon to drop off a copy of The Womanly Art of Breastfeeding to my daughter-in-law. She was in tears when I arrived. They both complained that the baby wasn't having bowel movements and that when they took him to the pediatrician earlier that morning for a weigh-in, he had lost 14% of his body weight. I encouraged her to read the book for some practical info and that I would take her to an LLL meeting next week. Meanwhile my mother comes by to bless the baby with her holy oil. She lays hands on my daughter-in-law as well and prays for peace and healing. It was really quite lovely. (My mother is a holy woman and a prayer warrior) I suggested two things. First, (a technique I actually learned from my mother, which she learned from hers), an ivory soap suppository to stimulate him to move his bowels. They gave me a little bar of soap which I cut off and carved a small chunk into a little fingernail sized bullet. I coated it in olive oil and inserted in his rectum. I then held him upright and massaged his back in downward strokes, soothing and talking to him. About 5-10 minutes later, out comes the soap suppository followed by a huge meconium stool. Next, I evaluated his suck to see why he has so much trouble latching on and staying on. I don't expect to find anything amiss since they've seen the lactation consultant twice at the hospital. But I find he has a short tongue, tongue-tied, and may need his frenulum clipped. I've seen shorter, but I do think its impeding his ability to maintain a good latch and suck. I tell them my findings and suggest they discuss it with the LC and pediatrician on Monday when they return. In the meantime, I tell her to attempt the breast at every feeding, followed by pumping and if needed finger feeding (which is what they've been doing). I tell her how important it is for her to empty the breast and make sure he gets that hind milk to overcome a possible calorie deficiency. I make an extra suppository for him in case they need it. I also encourage her to use lanolin on her one sore nipple and expose it to air to hasten healing. (She said the breast shield she was given at the hospital had cut her nipple- I had never heard of that happening.) When I leave, she has gotten him on the breast in a football hold and they are happily nursing away. It was nice leaving them smiling.

Breast is still Best

My Toastmaster's group ended its meeting yesterday with a baby shower for one of our members who is expecting twins. Everyone was encouraged to bring a children's book for the new mother-to-be. I gave her Henci Goer's, The Thinking Woman's Guide to Childbirth, a book that somehow stood out amongst the Dr. Suesses and Richard Scarrys. Each gifter had to explain their book selection, so I had an opportunity to talk about my work with birth. It felt good to have an audience for my ideas, and get their feedback and answer their questions. On another note, I also met with my Breastfeeding Committee yesterday. (My secondary passion after birth) We are a committee of the Maternal & Child Health Coalition (www.mchc.net), a health advocacy group. The BF committee is devoted to increasing breastfeeding initiation and duration rates in our metropolitan area through professional education and support. I'm so excited about our latest project for this year's World Breastfeeding Week. (August 1-7) (www.waba.org) We are bringing Kathi Barber to town, founder of the African-American Breastfeeding Alliance, and author of the book, The African-American Woman's Guide to Breastfeeding (www.aabaonline.com). I hope it's different where you live, dear reader, but our breastfeeding rates here are in the toilet, and worst of all for African-American mothers who nurse at the lowest rates of anyone. I always thought this a great irony since African-Americans tend to suffer most from the disease processes that are impacted the most by breastfeeding (think diabetes, obesity, etc.). Surely I can't be the first one to figure this out. Why hasn't there been an outcry within and without the African-American community or the healthcare community to promote breastfeeding? Why is it the folks who stand to benefit the most have the lowest rates? Still the silence continues. Our entire group is excited to bring Kathi to town to talk to healthcare professionals that work with at-risk populations. We are also sending all the hospitals in town that do deliveries, (all 19 of them) samples of our breastfeeding crib cards that we developed and the "eat at moms" onsie that we developed and trademarked, and are encouraging them to have some event at their facility to mark World Breastfeeding Week. This is truly our big event of the year and I like making the most of it. Meanwhile, sadly, my daughter-in-law is struggling with getting her breastfeeding established. They came home from the hospital yesterday, and I got one call in the middle of the night, and another early this morning. I hope she hangs in there with it. I'll visit later today to see how I can help. I plan to take her to an La Leche League meeting next week. Keep your fingers crossed for them.

Going My Way

I've been pondering why I feel as strongly as I do about birth issues, and why I have chosen to devote my life to this particular cause. Its not like tackling world hunger, or environmental causes like the ozone layer. Its not trendy or sexy, or even on the radar screen of common causes, at the moment. But for whatever its worth, it's my cause. I visited my friend, Dotty's church yesterday, and she showed me one of her Bill Gothard wisdom books. (These are christian homeschooling "manuals") It had an entire chapter devoted to myths about birth and breastfeeding. I heartily agreed with everything I read. I also realized others have said what I am saying and have said it better. It was a terrific reminder that birth is God's plan, not ours. The supreme designer of birth made our bodies to accommodate the rigars of birth. How did we get to this place? A place where epidural rates exceed 80% and cesareans are inching upwards of 33%. This is such madness. Everything within me screams that this is wrong. It reminds me of that scene from The Posiedon Adventure (the original, I haven't seen the remake yet). Our heroes encounter a group of ragtag survivors, slowly trudging toward what they think is certain safety, but what actually is certain death. However they cannot be convinced, and continue on to thier ill-fated destiny. The harrowing voice of a one our heroes calls out behind them, "You're going the wrong way, they're going the wrong way!" The sound of her distressed call fades as they disappear from sight. I suppose this is my job, a sentinel posted by the way, calling out to all that will hear me, "we are going the wrong way."

Why Women Can't Give Birth

Well, I just spent the last 24 hours with my son and his wife as she delivered her first child, (my son's third). Gabrielle Gregory was born yesterday at 5:32pm and weighed 8 lbs, 13 oz. He is beautiful and healthy. I am joyful and grateful at his being here, and yet feel a deep sense of loss. Gabrielle, like my son's other two children was born by cesarean. Here's how it happened. I got a call from them early Friday morning at about 3 am. I had just been dreaming that they were about to call me, so when I heard the phone ring, I woke right up and answered it. My son told me they were still at home and asked me to come over. When I arrived a little while later, the doula was already there. My daughter-in-law was having good ctx about 5 minutes apart and sitting on the birth ball. I thought this doula was fabulous. I had known her for a long time, but had never been at a birth with her. She is also a massage therapist so has a fine understanding of anatomy and physiology that she uses as she helps the mother adapt to the changes and sensory experiences of labor. Throughout the long day, I saw her use movement, repositioning, aromatheraphy, music therapy, verbal encouragement, counter pressure techniques, hydrotherapy, massage, homeopathy, and other tools in her arsenal of care. We were at their house about an hour before my daughter-in-law stated that she wanted to go to the hospital. Her ctx were so good and steady that I was hoping she would be dilated to 5 or 6. Her ctx had started about 8pm the previous evening, but I didn't want to be overly ambitious about a first time mom. I had reminded them repeatedly to pace themselves because first babies take a lot longer. The doula at one point pulled me aside and asked if I were willing to check her [cervical dilation]. I had thought of this just the other day, and decided that it was not something I was comfortable with. It was important to me to maintain my mothering role and not put on any other hats if I could help it. I told the doula this, but would do a check if they insisted. They never asked me to. So, an hour later, we headed to the hospital, about a 20 minute drive away. When we arrived and she was checked, she was dilated to 3. My heart dropped. My number one rule for a good birth experience had been violated. Don't arrive at the hospital too early. Getting there at 5-6 would have been better. But we were there now, so they immediately got back to the process of laboring. After a few minutes of monitoring (baby looked good) they went back to the birth ball and my son and the doula took turns giving counter pressure and massage. I hung back and observed giving encouragements here and there. It was strange for me to be in this setting in this role. It was important to me to hold my boundaries. This was not my birth. The doula told me later that she thought my son needed me there for him, more than for his wife. I think she was right. Several times throughout the day, I was asked for my opinions. I think he thought that my being a nurse would offer them some protection or special insight. It was an honor to be asked to be present at this sacred occassion. I offered opinions only when asked, and had to tread more carefully as the day went on. After two hours, my daughter-in-law was dilated to 4, and asked for an epidural. We had discussed the slippery slope of interventions, previously, but she said she felt as if she couldn't continue laboring the way she was. Her request caught me by surpise. We had used practically all the therapies mentioned above in those two hours. We were all working together as a team so well. Hearing her ask for the epidural was like hearing that it wasn't enough. Her midwife immediately granted her request. The midwife was a lovely and supportive person, several times during the day she came in and simply sat with us. However, I never saw her say or do anything that a physician wouldn't say or do (except for the sitting of the labor) throughout that long day. I could not pinpoint any difference in practice. Before the epidural could be placed, she need an IV placed (of course). She would now be confined to the bed, place on the fetal monitor continuously, and have her vital signs monitored every 15-20 minutes. After the epidural was in, a bladder catheter was placed to measure urine output, (and because she could no longer go to the bathroom). Her labor stalled. (Surprise, sursprise.) After another two hours, she was still dilated to 4. The midwife offered to break her water (the gravest error yet in my opinion) "to speed things up." The baby was OP (sunnyside up) and the head asynclitic (sideways) (we found this out later) so to my way of thinking, removing the cushion of fluid would only inhibit the ability of the baby to reposition itself. But this all occurred while I was out getting breakfast and when I returned, it had already been done. I sighed and sat back down. Time passes and she is dilated to 5. More hours pass and she's still dilated to 5. The midwife does sit her upright in the bed, and later positions her from side to side in an effort to reposition the baby. The midwife and nurse won't try the in-bed positions the doula and I suggest because her legs are too numb to hold her up. They have a point, our positions do require some use of her legs- hers are completely numb. More hours pass without change and her cervix has begun to swell. The midwife tells them they can try a pit augmentation, but my son says no. She already has a good ctx pattern every 2-3 minutes and he doesn't want to risk taxing the baby. (We knew this because the midwife had earlier put in an internal monitor.) Her other option was of course a cesarean. After the midwife and nurse left the room for us to powwow, I told them they had a third option of doing nothing and giving themselves more time. The midwife agreed to give them another hour. It was evening by this time. I had to leave again to pick up my three girls from a birthday party. I was glad to have to go (a cowardly thing to say, I know). I knew when I got back the cesarean would be over and done. It was a foregone conclusion from the time they broke the water, maybe even from when they did the epidural. I had seen this whole scenario played out 1,000 different times as a L&D nurse. My daughter-in-law fell right into a typical delivery. I really thought that teaching them childbirth ed myself, getting them a doula, and encouraging them to select a midwife would make a difference in their birth. It made no difference at all in how things played out. I realized then, as I returned to the hospital and they were rolling her back to her room from the OR, that birthing women themselves have to want a change, and are in the best position to make the change. My wanting things for her, made no difference at all. She had to want it for herself. My daughter-in-law knew she didn't want a cesarean (they told me she cried when the midwife came back and told her time was up and they were out of choices) but she didn't know what she wanted instead. How could I explain to her that she would have had an entirely different labor if she hadn't had the epidural that began the cascade of interventions and robbed her of her ability to reposition and be mobile in ways that could have made a real difference in the baby's positioning. I don't think she failed. I think the system has failed her. As they wheeled her back to her room, I thought of a whole generation of women who would not know the experience of vaginal birth and the impact it would have on the next generation of women. I felt almost doomed. I only perked up after a private conversation with the doula in which I could see my role more clearly. I have to write this book and make my documentary on birth. I stopped being a doula, and an OB nurse, and a childbirth educator and I stopped pursuing midwifery as a vocation. None of those was ever a good fit for me, but I am beginning to see my place in the grand scheme of things. My role is in advocacy and policy change. I feel powerless at the bedside. I'll never be an insider. I've been inept at causing change from within. Perhaps my book and film can help women internalize the need for change. At this point I feel it's all I have to offer to the cause.

Writer's Boot Camp

I've spent the last 48 hours putting a plan into place to finish my book. Here is what I've come up with. My two precious hours will be spent thus: 30 minutes of walking, 30 minutes of some combination of the following: blog writing/poetry writing/journaling/prayer/meditation and one blessed hour per day for working on my book. (Before I spent the two hours doing whatever struck my fancy the most- which was usually blogging and journaling.) Its not much, but I intend to jealously guard my time. I've also put a support system into place. I've asked my friend Drew, a published poet, (drewdorsey.com) to resume our little writing exercise. He sends me several titles a week, and I make them into poems. I've also asked my friend Barbara, also a published writer, to be my accountability partner and inquire weekly as to how my book is coming along. I'm compiling a list of women's magazines to query about a book exerpt and my story on homebirthing. I've also gathered some preliminary info on the Mexican retreats. I was watching Oprah's show on Monday about her weight loss boot camp. She said something that struck me. She said it doesn't take will power, but simply making a decision and then taking action to support that decision. Thats what I have done this week. I hope it works as well with writing as it does with weight loss.

Planning my Work and Working my Plan

My, oh my. Life has such limitless possibilities. I'm sitting on the balcony of my room of a local waterpark resort. My husband and I brought the children here for a few days of R&R. The kids have been staying up late, enjoying the cartoon network that we don't get at home (because we refuse to do cable). Everyone is still asleep, just like at home, because I like to have at least 2 hours of quiet time to myself every morning. I just spent my early morning hours catching up on my friend's blog. She's a NewYork author and speaker (just like I want to be when I grow up, except for the New York part- I'm happy where I am). Victoria and I met years ago when we were both homeschooling moms here in KC. I remember when she was writing her first book, now she's about to publish something like her 14th or 15th. I try to get a front row seat whenever she is in town for a presentation. I feel so priviledged to have witnessed her journey. She now travels nationally and internationally promoting her books and giving her talks. (check out her website for yourself at www.victoriamoran.com ) My, my, my, and here I sit, trying to wrangle out my first book. Her blog is so full of her now glamerous lifestyle hobnobbing with the rich and famous. I'm not envious, so much as impatient to see my own dreams come to fruition. I was reading an email this morning from another friend, Michele, who lives in San Miguel de Allende, Mexico. San Miguel is where I have gone two years in a row now, to participate in a three day pilgrimage through the mountains (a life altering event). Michele sent pictures of her retreat center and it just got my mind ticking. I've been trying to think of ways to link my business to San Miguel. I'd love it if it became a second home, in fact. It suddenly occurred to me that I could set up week long retreats that involve both education and vacationing. One of those learning vacations I heard about when I attended my travellers group meeting last week. I just have to figure out, a) what I have to teach, that folks would pay big bucks to learn, and b) the logistics. A will be the harder of the two. Should I teach to other healthcare professionals and offer continuing education credits? Could I offer a retreat on a more fun or frivolous topic? Could I set up a medical missions project and combine it with safety training or language learning? I have a lot of thinking to do. Of course, I always have to ask, how does the new baby fit into all this. One of my life goals is to travel. One of the reasons both my husband and I were looking forward to all the kids being gone is so that we could finally, at long last, do the travelling that we really have wanted to do. I know everything is falling into place. The quickest way to become a recognized "expert" in anything, is to write a book. I'm working on that one. I also want to become a presenter. I'm continuing to hone my presentation skills through involvment with my Toastmasters group. (I even took private lessons last year.) I've spoken at several conferences now (not for money, but for experience. I do have some connections and trusted friends of whom I can ask advice, and ones who have been where I want to go. I know how to create and or take advantage of opportunities. I'm still sharpening my niche, which I think is really important. What do I lack? Courage and belief. One cannot do the work I seek to do without a deep and abiding faith in his or herself and a willingness to step out in faith and conquer their own fears. My mind is so full of doubt. (Will people listen to what I have to say, why should they, who made me an authority on the topic, what validates my knowledge and experience?) Even at 43, I still feel like that little girl in pigtails sitting alone in the grass making flower wreaths. I don't take that as a bad thing. All my alone time cultivated my creativity and taught me how to entertain and motivate myself. But my desire is helping me to overcome my fear. I want what I want and I want it bad. Now I have opportunity like I have never had it before. I own my own time. That in itself is an amazing gift. Twenty-four hours everyday to make my life count for something. I can't let having a baby throw me back into chaos and the tyranny of the urgent. I may never have the opportunity of time, the way I do now. I must make it count. I have to take a step of faith and bring my goals to fruition. I have to complete what I have started. But how? Thats the working part of making and implementing a plan.

The Courage to Embrace Change

I think I'm ready to tell our families about the pregnancy now. I've been so conflicted about it and so afraid of what our parents will say. (I know I sound like a wuss, we are after all 43 and 47 and married) I know that some of them will still give us a hard time, but I know I can handle that, that together we can handle any negative feedback. I asked my husband what he'll say if his mom says something negative. He said, she'll say what she'll say, it won't change anything. He's right of course. We love one another and we're having a baby. So what. We didn't plan it. So what. We're still having a baby. We'll still love him or her and one another. This baby will be embraced by our whole family- eventually. I know I just need to bear the initial reactions of others. They'll need time to get used it, just like I did. Heck, I needed 3 months to get used to the idea! I need to allow others time to process this as well. I understand that part of other's reactions is concern for our family. We are stressed and overloaded. We did just recently downsize our lifestyle by moving to a smaller home, and will have to do so again to adjust to the loss of my income from my second job. Hey, I don't even know where we'll fit a crib in this new house, we certainly won't have a nursery! But we will have a home with a sane wife and mother and plenty of love to go around. I keep telling myself, this a blessing. As time goes on, it starts to feel more and more like one. I sat in a board meeting today, feeling my belly and smiling to myself. I completely spaced out during the financial reports. I'm beginning to have moments of terror where I think, "what will I do about _____ after the baby comes." Then I think, I'll just adapt how I do this, or I'll take the baby with me, or I'll have to modify my lifestyle, or even, I won't be able to keep doing this. Whatever needs to happen, I'll make it happen. I won't pretend anymore that my life won't change. A baby changes everything. I want to open my arms wide and welcome the change. After all, it's the next phase of my life- and I do fully expect my life to get better and better. I expect me to get better and better. I'm ready to embrace this phase of my journey.

Selected Glimpses of Childhood

Selected poems I've written about my childhood.

13th & Brooklyn

I must have crossed this street a hundred times

not as I do now

riding in my minivan

children in tow

crinkling their noses

to be in this part of town.

Back then

I crossed over to reach the liquor store

-long since gone,

replaced with tax-payer finery

in the form of a tidy senior community.

A ghost to my memory,

but tangible still,

its dirty concrete floors

stained with the footprints

of the forgotten many.

Adorning its dingy walls-

faded posters of foxy brown priestesses

with afros as commanding as any crucifix-

seductively offering the penitent a glass of forbidden fruit.

The smell of piss stings my nostrils still

as I remember winos and whores

exchanging trade in the doorways.

As a child I learned to move around them

-quietly

so as not to disturb the wreckage of their lives.

Still I was eager to enter

the array of offerings at the candy counter

calling me as fervently as the bottle calls a drunk.

The cellaphane crinlked sweetly

as I unwrapped my sugar-laden prize-

a momentary respite of pleasure

a mighty conquest for a few loose coins.

It was here that I first fell prey.

Two boys came toward me

from the other side of the street

blocked my right-of-way

in broad daylight no less

right there on the yellow line.

One rummaged through the bag of liquor store groceries

taking my sour apple now/laters,

the other forced open my hand

stealing the change

mamma had said was mine to keep.

-Practicing as I suppose they were

for future 7-Elevens

while I practiced being a victim.

The Little Princess

Once upon a time
there lived a little girl
with two pigtails
that flapped in the wind
when she would run
but she did not run often
preferring to sit quietly
in the grass
making flower crowns
to place upon her head

as she ruled benevolently

over cockroach infested lands

inhabited by

ungrateful subjects

who neglected to invite her

to join their games.

Learning to be Me

Last night was a blast. I had the best time. I couldn't believe I could have so much fun, so far out of my element. What was I doing? Attending a board retreat. That's right, a board retreat. I was elected to a local foundation board on June 1st and we went to a fancy hotel in town to haggle out our strategic planning for the upcoming year. I sat there, my second official gathering with about 20 other professional souls thinking, what am I doing here? How the hell did I get on this board? I'm surrounded by doctors, lawyers, and bankers, (me, the former welfare mother!) talking about how to disburse approximately 6 million dollars a year to impact the health of the medically indigent in our community. To my credit, I may be the only one on that board who's ever BEEN medically indigent- so I know what I have to bring to the table. It was still a little intimidating though. Until- we broke down into smaller groups to examine our mission, vision, and guiding principles. My group contained the board chairman, a handsome smart professional attorney who owns a string of nursing homes, currently running for political office. Our first job was to select a leader and a scribe. I was selected as leader. I then had to guide my group into discussion and was asked what's the difference between a vision and a mission. One of the other ladies in my group and I explained it, then we were off. I disagreed with the board chairman on practically EVERYTHING. Our group began to have this rousing animated discussion full of laughter and creativity. I was up at the easel writing our notes on the pad, waving my arms, in my bare feet, making my case, conceding points where I couldn't, and generally having a great time. I couldn't believe how quickly I came out of my shell. In the end, our group did not get all the way through the assignment, but what we did get done was noteworthy. (The facilitator said so, and cited several examples from our group.) What a lesson in being myself.

The Parable of Indiana Jones

Something is happening to me. Something I'm only now beginning to get a dim glance of, something huge. No, I don't mean the pregnancy- though that is certainly part of it. I think I'm beginning to become myself. After 43 years, I can sense the real me starting to emerge- like a butterfly slowly leaving its coccoon. Why should it have taken so long? Is it like this for everyone? I was emailing my friend Kevin last night. I've known him for 25 years. We went to art school together back in the early 80s and have attended the same church for these past 25 years. For the past 6 years, he has also been one of my pastors. I had confided some of my struggles to him a while back and he had suggested a particular counselor for me to see. I saw her for the first time this week, and the time with her was phenomenal. I was emailing him to thank him for the referral, and to ask how he was doing after a recent trauma in his life. His email back was stunningly frank and revealing. He communicated that his experience had shaken him to the core making him rethink his life, his priorities, everything. It all sounded so familiar to me. I had no idea, that quitting my job, as a result of the pregnancy, would change my life and be the start of my metamorphasis. I thought I was just depriving my family of necessary income and being a weak and pathetic quitter. Those were lies. I was really gathering my courage and stepping out in faith and taking a chance on my own abilities and talents. At times like these, I am reminded of a scene from one of the Indiana Jones movies. It is one of my favorite images, that I encourage myself with often. In the scene, Indiana Jones must step off a cliff in order to save the life of his father. It of course looks like certain death, it's sheer folly, but he can find no other way, his father's life is dependent on it. Finally, with a look of total resignation, he closes his eyes and takes a step of total faith, certain that he will fail and fall to his own death. The next moment shows a look of complete shock when his foot lands on something solid. There is a land bridge across the divide- he was unable to see it before. It was camouflaged and therefore invisible to the eye, yet it was there all along. This is how God so often works in our lives. When I quit my job, I thought I was doing it from a place of great weakness. I felt defeated. Now I see God's Word manifested in my day to day life- that His stregnth is perfected in our weakness. My, what a great work of effort it is only to become whom I was truly meant to be. I emailed Kevin back to tell him to go ahead, close his eyes and jump.

The Constancy of Change

I saw my friend Marianne yesterday, in fact I sought her out. I was dropping off my two youngest girls at Vacation Bible School (VBS) at Marianne's church. My kids have been attending VBS there every summer for years. They put on a really elaborate week long event. Anyway, I was looking for Marianne because a little over a year ago, she was in my same predicament. Her youngest girl was 10 and she found herself pregnant. She had told me what a struggle it was for her. I had visited Marianne a few weeks ago, under the guise of seeing her new house and new baby, but really to tell her about my pregnancy and my fears. It was a great comfort to talk to her about it, now I wanted to see how she was faring. I came around a corner and spied her at the bottom of the stairs. She had her baby boy, Tucker in a front pack and was talking with a small group of constantly changing women as they stopped to look at the baby or ask how she was doing or join the conversation. In fact, as I descended the stairs to where she was, I caught bits and pieces of several conversations that she was having with others. She stopped briefly to say hello to me and introduce me to several of the changing stream of women. I have to say, listening to her give her update reminded me of all her challenges this last year. Soon after Tucker was born, her Dad died after a very long illness and she had been by his side during both his illness and dying process. Financial challenges caused them to sell their house late in her pregnancy so they are still settling into their new home, which she dubbed, "the money pit." I watched Marianne as she told her story. The past year must have been hell for her, she looked a little tired, perhaps even a little older, but she was still her bright and chipper self- and she has a beautiful little baby boy. She spoke of her blessings and God's faithfulness in the face of change. Life does have a way of carrying on. I imagined myself with an infant strapped to my chest and was comforted by the image. Comforted too, by Marianne's courage in the face of change, in the face of life and death.

Counting My Blessings

Yesterday, I told more people about the pregnancy. I announced it to my Toastmaster group (its a public speakers group, I attend twice a month and we practice our public speaking skills by taking turns giving speeches and evaluating them). Later in the evening, I went blueberry picking with the kids and told my long time friend, LaDonna. The responses from both the group and LaDonna brought me to tears. All the ladies from my speaking group gathered around and gave me hugs and wished me well and promised me a group shower. I was so touched, not that I didn't think the response would be positive. Even so, being bathed in love and good wishes just feels so good, especially after a period of feeling so bad. The best part about telling people about this pregnancy, (I'm always forthright about it not being a planned pregnancy and that I'm 43 and that our youngest is almost 8) is that people tell me the most wonderful stories. I've heard the best stories about late in life pregnancies. After the meeting, one of the women told me about her baby brother, born when she was 16 during the early summer, and how she spent the entire summer helping care for him. She spoke of the time with such tenderness and delight that it moved me to tears. She must have been in her early 50s and I could tell it was a cherished memory for her. Another woman told me about her 8 year struggle with infertility and how she envied me (now thats a perspective I would have never thought of). I had to laugh out loud when she said it, I couldn't imagine anyone thinking my position was enviable- until I thought about it from her perspective. I asked her if she is continuing to try and wished her well. Infertility is such an invisible form of suffering and loss. The look in her eyes and the sound of her voice made me stop and count my blessings. Later, when I told LaDonna, who has 7 children of her own, and for whom mothering is her primary occupation, she smothered me in hugs right in the middle of the blueberry patch. We laughed and cried and hugged some more. She told me how she had gone earlier that day for her mammogram, but had to postpone it because she couldn't say with any certainty that she was pregnant or not. They asked her to simply return for the test during the time in her cycle when nonpregnancy was a certainty. I admired with what ease LaDonna and her husband accept pregnancy and new children as just a part of the life they have chosen for themselves. The love that radiated from her about the pregnancy was so pure that it was cleansing for me. Of course I should be pregnant, what better thing to be? And as LaDonna reminded me, so what if I'm pregnant and 43 and my youngest is 8? I'm married! We had a great laugh over that. It was more therapeutic than a trip to the shrink.

Childbirth Education 101

Teaching the childbirth ed to my son and his wife worked out really well. They got to ask all their questions, and start to formulate ideas. I found that they were like most couples. They make assumptions that whatever their caregiver decides to do will be fine with them, or that whatever they don't know, their caregiver will tell them what to do. This is, of course, exactly the kind of thinking I'm out to eradicate. They did read the books I gave them and we watched Barbara Harper's video, Gentle Birth Choices, together. The main issue I had to address was pain. Like most women, esp. those having their first baby, my daughter-in-law said, when asked what were her plans for pain management, that she would "try not to have an epidural." I quickly reminded her that trying not to do something does not constitute a plan. I encouraged her to formulate a real plan for managing pain based on her past experience with pain, and knowing and understanding her own response to pain. I told her she should NOT dismiss an epidural as an option if it actually fit with her pain management style. She selected the William Sears book and wanted to read more about what her options for pain management were. I encouraged her to communicate her plan to her doula, once she figured out what it was. They both had a good response to the video and asked many questions as we viewed it. They said that they had toured both hospitals and selected the one most open to their ideas about birthing. It sounded as though they did ask the right questions on the hospital tour. I think they selected a good one (or as good as it gets around here). They asked about circs and I gave them a video to watch. We talked a little bit about the mechanics of labor and what is taking place in the body. I encouraged them, once they get their birth plan formulated, to gather everyone who would be present at the birth and inform them of their plans and desires. Give everyone a role, so that they would know what is expected of them. Try to give folks something to do. For example instead of saying, your role is to support me, say, your role is to give me sips of juice, and wipe my foreheadwith a cool cloth, and hold my hand during ctx, or your role is to pray for me throughout the labor. Hopefully these suggestions help them and give them a place to start to make tangible well-thought out plans. I'd really like to see them have a good birth experience in the hospital setting.

The Next Generation of Birth

Today I have offered to teach a private childbirth class for my son and daughter-in-law. They are expecting a baby in a few weeks. I am a certified childbirth educator, but I haven't taught in years. I have so much I want to communicate to them, but my message is difficult to deliver and even harder to recieve. I've already given them a few books to read. I'll probably start by assessing what they already know and ask them about the issues that are most important to them. We'll then go over the mechanics of labor and birth and talk about birthplans. They are seeing a midwife (a good start) and I gave them a Doula as a gift. I don't know much about the hospital where they'll be delivering. In my years as a Doula myself, I never attended a birth there. They invited me and my daughter-in-laws' mother to be at the birth. (I don't usually recommend the presence of mothers at deliveries, but I'm not going to refuse when I'm the mother being asked!) All in all, I'm hopeful but a tad nervous. I don't want to go and watch another bad birth. On the other hand, if my presence or input can make a difference, I'd like to offer it. I'm trying really hard not to have expectations, after all its her birth not mine. Her birth values and expectations may be totally different from mine. She's entitled to have the birth she wants, not the one I want. I just want to be supportive of them and at the same time be true to my own beliefs.

With Freedom Comes Responsibility

I saw a commercial on TV last night that made me stop short. It aired about 3 times during the course of evening programming. Each showed 3 brief cameos of educated, well dressed women stating what they wanted in birthcare, and then at the end the logo of a local hospital where they can find such stellar care. Dare I suggest, that women have been taught to ask for care options only within very defined boundaries. Sure its okay to ask for midwifery care, good nurses, or qualified doctors, but who would aire a commercial with women asking for water birth, a massage therapist, or intermittent monitoring? I'm afraid so-called childbirth education has become a tool for manipulating women with precise and limited knowledge. I've been amazed by how tightly regulated it is by doctors. They now own most of what is known as childbirth ed. It should be called "Childbirth Indoctrination." What is needed is a new way to educate women about birth- but of course they have to want to know more than what they are currently being spoon-fed. Which brings me to my next rant.
Did anyone happen to read the latest issue of US News and World Report (June 12, 2006)? If so you might have caught Dr. Bernadine Healy's, On Health column, titled, "Birthing by Appointment" that starts out "Cesareans are in; pushing is out." Dr.Healy goes on to outlay the National Institute of Health's report on rising c/s rates caused by maternal choice, not medical necessity. She doesn't quote a percentage but states that "close to a third" of babies are born this way. She gives a nice quick overview of the past century and ends with an acknowledgement of the baby-boomer led natural birth movement that has ended with our daughters seeking the most medicalized births of all. Reading this made me recall a comment from my midwife friend Sandy who bemoaned to me last year that "All the midwives daughters are having cesareans." Dr. Healy attributes a lot of this, oddly enough, to consumer-directed healthcare. (What was I just saying about choice and control and how we can be free to make bad choices?) Of course my theory is that healthcare has created its own Frankenstein when it comes to women opting for nonmedically necessary cesareans. The same fear laden messages women are given about birth, have made them not only subsurvient to the healthcare system, but have pushed them beyond mere complience to requesting a procedure they think gets them out of "doing" the birth. There is also the issue of convenience which benefits both care providers and consumers.
So what was the NIH's take on all this? They don't know. Thats right, that bastion of learned medical wisdom, that flagship of research authority that others look to, couldn't figure it out. They could not conclusively say which was safer for a low risk pregnancy, an elective cesarean or a vaginal birth. But they could conclude this; more research needs to be done.
Dr. Healy ends the article with a quote from a physician willing to go on record as saying that vaginal birth is better, and even that providing elective cesareans presents an ethical conflict. (Wow, what is this guy, some kind of heretic?) However, he also admits that a woman's autonomy must be respected, as well as her informed and thought out decision making process. (Okay, this one leaves me scratching my head, but I knew yesterday when I was writing that a woman could take my same argument for homebirth on the basis of control and power and use it for elective cesarean. It's here that my logic gets stuck, I admit.)
The article on the whole was balanced and appealing except for the last sentence. She writes, "Welcome to the world of consumer-directed healthcare." She seems to be indicting that very freedom of choice as the crux of the problem. But again I state, women did not get to this place on their own. The culture of fear that surrounds birth and that is passed on in doctors offices and childbirth classes, at the office water cooler and around the dinner table has brought women to this place. I've gone round and round about this in my head and the conclusion is always the same; with the freedom of making choices comes the responsibility to be well-informed.

Slave or Free?

It occurred to me, yesterday, as I sat listening to (my senior pastor) Harry's sermon that the things he spoke of applied aptly to women's experience of birth. The sermon was on the topic of boundaries. When I noticed the correlation, I began to jot down notes. Harry asked, via his powerpoint, what was the difference between slave and free? His simple text outlined a few key differences.

Free Individual
has choices
has rights
has ownership
controlled by self


Slave
has few or no choices
has few or no rights
can claim no ownership
controlled by others or outside circumstances

Of course Harry was speaking of the condition of our mortal souls and was referencing enslavement to sin, but I immediately saw another context. Harry made the point, if I remember correctly, that we are free to the extent that we have control of ourselves and don't have to be controlled by others. He used the illustration of raising children. If I do my job correctly, my children should be slowly moving from parental control (control by others) to self-control (control by self) . Power and control (and who gets to have them) seem to me just as key in birth as they are in spiritual homeostatis. Women who give birth in authoritative settings are often subject to treatment that is, if not slave-like is certainly child-like. Consider these observations from my labor and delivery nurse perspective. A woman comes to the hospital to give birth. Usually the first thing she needs to do is fill out paperwork, and lots of it, divulging lots and lots of personal information. But okay, its only fair that her healthcare provider know her history. Unfortunately, way more people than her immediate provider has access to that information. Yes, the rest of us are on our honor not to access it unless we have to, but nontheless, its there for the viewing. She is then placed in a room, usually not of her choosing, and assigned a nurse to care for her, also not of her choosing. Lets contrast this so far with the homebirth mother who remains in her own home, and has hand selected most if not all of her attendants. Her personal information is available to a much smaller audience. (Though of course, the same rules of privacy apply in both settings.) Here in the medically conservative midwest, the out-of-home mother must submit to an IV or saline lock, be placed on a fetal monitor, attached to a vital sign monitor, deprived of food and drink, and possibly limited in who can be present with her in the room. She is also stripped of her clothing and given a hospital uniform to wear which immediately marks her as "patient." The staff, even down to the housekeeping staff wear uniforms that mark them as "authoritative others." Back at home,the mother wears her own clothing, and is monitored by less high tech and more intermittent systems of data tracking. The attendants may also be wearing their own clothing, which for me symbolizes a more equitable relationship. She moves about freely making her own choices about how to respond to the sensory experience of labor. She can go to the bathroom without asking anyone's permission, or needing someone to unentangle her from her various tethers. She can walk to her fridge and get a drink or a bite to eat without being told it is not allowed.
These are just a few of my observations. Of course many may argue that no one is really ever "in control" of birth and that these limitations and restrictions are for the mother and baby's protection. So it is when I tell my kids to wear their helmets when they ride their bikes, or put on their seat belt when we ride in the car, after all, life isn't safe, we need to take precautions. By contrast, noone is standing there to tell ME to put on my seat belt. I understand the danger and the protection offered by the seat belt and I make a choice to use it. But I can use it or not use it, noone can make me- though the law might compel me. This seems to beg the question that should a free person be free to make unsafe or even dangerous choice ? My answer is a loud and resounding yes, after all, people do that everyday, when they choose to drink too much or submit to addictive behaviors or not wear their seat belt. Some would quickly say that choosing a homebirth is just that- making an unsafe choice. But I would always, always rather err on the side of making my own choices, owning my own life. I cannot deny my own experience and my experience as a nurse tells me that what goes on in hospitals should not be construed as innately safe. My own knowledge and experience tell me that the body is made for birth and that most times it is best untampered with. What most women don't understand, and that I cannot get away from, is that the paternalistic attitudes that prevail in authoritative settings, can cause as many problems, as they solve.

The Wedding

Two days ago, I attended the wedding of Johnny and Stephanie. Johnny is the son of my dear friend Dotti. It was truly one of the most outstanding weddings I had ever seen. What struck me the most about this wedding was not the beautiful church, pretty decorations, lovely music, lavish flowers, the pagentry of the wedding party or the stunning bride-though all these elements were present. What struck me most was the message presented- yes the little mini sermon that the preacher does before the vows. The ceremony was officiated by Dotti's husband John. Now I've known John almost 20 years and I am quite fond of him and have listened to him preach as long as I've known him- but even so- I think he outdid himself this time. He has a very dry, high brow wit, that I have always enjoyed (nothing at all like my raunchy sense of humor- note the pimp and ho reference earlier!) I have to befriend people like John and Dotti to show that I have any class at all. Anyway, he used his humor to its best benefit (I can't recall ever hearing so much laughter during a wedding ceremony) even while the solemnity of the occassion was preserved.
What John talked about was the true Biblical definition of marraige. As defined in the Bible, human marraige is merely a temporal picture of the true marraige of Christ and the church. The lesser marraige (as we experience it) is meant to depict the greater marraige (the relationship between Christ and His bride, the church. So marraige is meant to teach us about our relationship to Christ and our obligations and engagement with Christ. (John said it much better.)
I was spellbound by this simple message. For me it was a simple and elegant reminder of what my life focus should be. I'm so caught up in my present circumstances, that I have often of late forgotten about the bigger picture. I forget that my life has a meaning greater than my current challenges, and that the challenges are placed before me for a greater purpose than just my consternation. Tears began to stream down my face as this reminder began to wash over me (good thing I was at a wedding). Everything that has happened in the past few months is meant to prepare me for my marraige to Christ, my life as His bride, my life beyond this life. There are moments when that life seems more real than this one. I was experiencing one of those moments. What would it be like to be my true self, in right relationship with myself, my world, my creator, living the way that was intended for me from the beginning of creation, called by my true name? I was having a transcendent moment that my human mind could not wrap itself around and just as quickly, it was gone. In its place, I felt a kick. Not a flutter, but a strong and decisive kick. A tangible reminder that this life is the one I have now, this life though training ground for the next, has tremendous value of its own. I jumped, startled by the baby's kick, and my hand went to my instantly to my belly. I smiled and wanted to tell someone, but there was a solemn ceremony going on, so I simply shared the moment with my creator, who seemed to me more real in that moment than any person I happened to be sitting next to.
I thought a moment later of my husband. He is such a priceless gift. I began to percieve a new perspective on our relationship. When my mind had settled and the wedding was over, I wrote this poem for him.

The Act of Marraige

It is for you my love,
that I engage the battle
for we have an accord,
that must be upheld
the children must be fed and clothed,
the debts paid and retired,
the dreams sought
-whether won or lost
for we have pledged our trust
to encounter life
inextricably bound
as savior one to the other.

Getting My Life Back

I had a very good visit with my midwife a couple of days ago. She recognized right away that I had been depressed during our first meeting a month ago. As I discussed it with her, I realized how depressed I had been. I had even been having suicidal ideations. Its hard to believe now that I was that far gone. I stuggled with depression in my early 20s but had not experienced it for over 20 years. The combination of the unexpected pregnancy, the stresses of a new job, financial concerns, and a general feeling that I was out of control of my life, all contributed. The best thing I did was to quit that second job. Money will be tight, but I'm so glad I did it. I'm so glad I didn't wait. I immediately felt a sense of control once more over my own destiny. Most of my depression was centered around that job, a job I didn't want. It was on my way to work that I would start to think, "If I just drove my car off the road, I wouldn't have to work this shift tonight." I felt as if I would do anything to get out of going. Two months into the job after a brutal night of being understaffed and overworked, I simply told myself, I would not go back. I immediately felt free. I immediately felt control over my life again. I literally felt the depression lifting like a fog evaporating. It was then I realized how bad things had been. Once the stress of that job was removed, I could even begin to feel some joy about the pregnancy. Of course now comes the real work. I have to produce an income from my business. I have to really push to boost sales and market more effectively. But it seems so do-able now. Many things seem more do-able now. I'm so glad I listened to that still small inner voice, that beckoned me to make the right choice for myself. My rational mind kept telling me that I had to be responsible, do the right thing for my family, make sacrifices. All the while I sank deeper, thinking my very soul had been sacrificed. Now I have time to write! (That alone has saved my sanity.) Now my mornings are filled with journaling, blogging, and working on my book. I've even written a poem a day since I've been back in my right mind! Now my schedule is my own to pursue with my time what I think is best. My next step is to add back in my exercise regimen, walking 30 minutes a day with the dog. I'll have to look into how much weight training I can add back in now that I'm pregnant. Or perhaps I'll do a prenatal yoga class instead. At any rate, my life seems my own again. The impossible seems once more possible.

If You Don't Know Your Options, You Don't Have Any

Today, I will visit my midwife for the second time. While I look forward to our visits, I know I'm going to have insurance issues. I called my insurance company to see what our coverage would be for a home delivery, and found out that they will only pay for prenatal and postpartum visits, not the delivery itself. I think this is an outrage, especially considering how much money I'm saving using midwifery care, and an out of hospital alternative. Of course I'm going to have to contest this. I'll have to get started already on my letter writing campaign. Why does it seem that everything is a struggle when you step outside the lines?
I attended a meeting yesterday, and one of the ladies there is pregnant and due about the same time as me, with her first child. We had spoken previously about our pregnancies, and I had mentioned that I was doing a homebirth. She seemed genuinely intrigued and said she wanted to know more about it. I told her yesterday that I will bring her a couple of my books to read when I see her again. I'd like to start her off with some easily digestible ones, like "A Good Birth, A Safe Birth" or one of Barbara Harper's books. I explained to her that the books I offer her won't be found in the local library or even on a bookstore shelf. They offer a holistic perspective on birth that is routinely denied to women in traditional prenatal settings. If she reads these books and wants more, I'll give her the more hard hitting stuff like Ina Mae's book or "Whose Having this Baby?" I'm eager to see how she responds. Yes, I know I'm approaching this with all the relish of a pimp plotting to turn out his next ho. I can't help myself. As Oprah says, "when you know better you do better" and as I always say "if you don't know your options, you don't have any." I simply want every woman to know all her options.