Controversial

I talked with my husband tonight about my volunteering at Planned Parenthood to be a support person to women having abortions. He was fully supportive and it was green lights down the line. I got excited and went on their site and entered my information into their resume tool, and while in the middle of that had to stop and run down to the store. It hit me that this whole plan might have after effects I'm not even seeing yet. I had a moment's pause when I thought about talking with a potential preceptor and in an effort to share about my experience, discovering that she was fiercely pro-life and could not abide considering me as an apprentice because of my time working in an abortion clinic. I thought about how I wouldn't probably post about my experiences (of course fully honoring HIPAA) because I have friends who are pro-life and I just wouldn't want the weird discomfort of that. I see how this can have some interesting consequences that are likely to be quite uncomfortable, at least momentarily. I don't know if that's what will happen but I can't deny that I at least gave a thought to the possibility of it.

I don't know what it will be like to do this work but I feel strongly that I must do it- and I think that if the timing is right (which it feels like it is, thus far) that it will happen and I will figure out these things as I go.

Blank canvas

Whispering to me in a language I can't yet understand, taunting me.

Oh blank page.

You can go to hell. ;)

I'm out.

Well, I'm not attending the MSL. It's been building and building and I'm glad to be released from it, but really sad that I will miss the experience of learning with women I know and care a lot about. That was one of the biggest things I was looking forward to, but I know there will be other opportunities to be with them.

I am grateful that I was able to sign up for the MSL because it was the excitement about attending which led to my epiphany about being a midwife in the first place. That was a really precious moment in my life and I feel warm every time I think about that 24 hours when it was revealed to me what I will do. It all unfolded in Divine perfection. :) It's okay with me that I am not going now, that is also in perfection.

I'm on to thinking about how I will gain these skills on my own and I have some options which I'm looking into. When you don't have what you need, create it if you can! I am excited about the possibilities and looking forward to the next steps toward midwifery.

So now what? Now I am talking to a midwife friend who has offered to teach me what I would have learned at the MSL and I am talking to her about doing a 'mini' session with a couple of friends who also want to learn. Nothing huge, just a few women getting together to learn together. I can't be derailed because of the shift in course on this MSL training and I won't be, I just have to create something that will meet my needs.

I also plan to contact the local Planned Parenthood and talk to them about volunteering there on Thursdays for the women who are terminating their pregnancies to offer a supportive presence. I know this is done at other clinics but not here (that I'm aware of). I realize that I haven't been exposed to this scenario much (beyond one abortion I attended a few years ago). I know that attending with women I don't know, and what I imagine to be a pretty wide cross-section of society. The majority of my practice is of paying clients- they know their options, generally, they have a good idea of what they want. I am not contacted by women in lower income brackets very often, for example and I don't think I've ever had a client of color, or a woman for whom English was a second language, etc. I've liaised with the public health nurses to offer free services to their clients since I started working as a doula in 2002, but we (the local doulas) don't get called very often. I don't know logistically how I can make this work but I'll talk to the hubs about it and see what ideas we can come up with. I can't see asking a friend (who might be pro-life, it's not like I interview my friends about things like that) to watch my kids so I can go sit with women who are having abortions, that seems weird.

I was thinking about it and I'm not attached to attending homebirths as a midwife. I don't have visions of what it will be like as women birth their babies at home. When I think about being a midwife what I think about is bearing witness to women stepping into their fullness, where ever that is. I love homebirth, but I don't have negative feelings about hospital births. When I think about being a midwife I think about meeting with a family, not just a woman, and standing vigil while they go through their own internal and external shifts into parenthood. Being there if needed and hoping not to be. Home vs. hospital is just not a part of my vision, but what I do see is being With Family, not just With Women.

I thought about why not going into nurse midwifery because I could do both, and I just don't think I'd be able to be present for families in the way I want and feel compelled to be if I was a nurse midwife. Maybe I lack information and I probably do- I never really looked into nurse midwifery because I just have a major aversion to being a nurse, being put in a position where I had to do things I had fundamental opposition to doing. Gah. I don't know. I'd love to hear from nurses/nurse midwives on this.

Time to get back to Daphne Singingtree! It was well worth the money I paid for it (and then some), it was definitely what I was looking for in a midwifery workbook for someone like me who is just getting started. I also downloaded some anatomy apps for my iPhone which I think is pretty funny. I don't know that I'll learn much but hey, every little bit helps. I know that I need to make a serious book list! I wish there were more apps besides Contraction Master for birth folk!

Birth, Baby or Woman? (Or more than one?)

I had an epiphany today which actually helped me gain some insight into why I seem to struggle in getting my point across to some folks of late. When reading threads on Facebook what I see is a constant struggle for the preservation of the birth experience. Not necessarily that it has to go down a certain way, but in some ways, *exactly that*.

When I did my doula training (DONA) one of the exercises we did was to identify our 'priority'. We answered several questions to identify whether we were primarily invested in the baby, in the woman, or in the birth itself. For example, there is a couple right now planning to have their birth televised live on the internet. There is a really fantastic discussion (which is actually what led me to my epiphany) about what this couple is giving up and/or gaining by having their birth filmed live. Is the birth experience the most important thing? Is it the baby's experience of the birth? Or the mother's experience? (The reason we don't include Fathers in this discussion eludes me but that's a post for another time.)

Reading some of the comments I admit to feeling a little frustrated that the couple's right to choose what they wanted to do with ther own birth experience seemed to be secondary to whatever the priorities were of the people commenting- but then BING! the light went on! I come in with the perspective that the woman comes first, her rights, her wishes, come first, because as I identified almost 8 years ago when I did my training, I am pro-woman. I realized that some of these folks might have had a different result on that test, maybe they are pro-baby, or pro-birth, or maybe their pro-woman just shows up a different way than mine. Duh!

I actually wish I'd had that realization a few months ago! Oh well, it is what it is- I'm grateful to have it now, I definitely feel like I need to bring this concept more into my awareness as I continue to explore, discuss and debate with folks online about some of these seemingly simple, but more often, complex issues.

My feeling is ultimately that the couple have the right to choose for themselves what they want to experience. Would I watch the birth? No. I don't want to be a voyeur, plus, while all births are individually magical and unique, I am honestly just not terribly interested.

It's not a job, it's a calling

I hope the Trust Birth folk don't feel like I'm picking on them. It's not my intention, really, it's not. I just never felt like I could pursue these topics on Facebook without resistance and well, that just doesn't sit well with me. :)

Okay, so I've seen this said a few times and whooooooa Nellie do I have some major disagreements with it. I don't think it's a TB philosophy (altho I don't know if it is or not, but I'm guessing not) that midwifery is a calling and NOT a job.

Wow, this lands for me in a really um... holier-than-thou kind of way. Now I'm not attacking, just saying how I experience this statement. Bear with me!

Why is making money doing something we are called to do a bad thing? What if a midwife is called to be a midwife and is so successful that heck, she makes a LOT of money doing it?

I want to understand this statement better and that won't happen without some dialogue so I hope someone will jump in and give me some background about what is behind this statement and what it really means, because I'm positive that I don't fully understand it.

Doula Vs. Midwife (my hypocrisy)

I find it really funny (and I'm claiming it here, publicly) that I have two ways of thinking about birth workers. They're very oppositional too, which I haven't delved into but I'm sure it will come up over the next few years!

I am not certified as a doula and have no intention to do so. I don't like the idea of paying out money every year so someone else can tell me what to do. I really think the certification process for doulas is generally misleading to clients and not valuable for the doula herself. Why do we need to be certified to sit with a woman in birth and tell her she's strong and amazing?

Now, as a midwife, I fully intend to license. I honestly can not imagine going to medical school and then not making that last leap that allows me to practice as a physician. I do understand why midwives don't license (see my discussion above lol), but I just personally can't imagine not doing it.

Having plucked at this just a tiny bit, I think one point for me is that doulas aren't responsible in any way, shape or form for the health and welfare of a mother and baby. I think that's the huge difference for me.

So does this mean I'm 'pro-licensing'? NO! I'm not anti-licensing, either. Am I anti-certification? Hmm... yeah I guess I am, in a way, but only for myself. I'm pro-choice too, but pro-life when it comes to my own body.

I think we spend a lot of time in the birth community assessing what other professionals are doing and whether it's 'right or wrong' and less, FAR less time finding the table where we do agree. We do not give each other the grace and trust and support to find our own way to becoming the best we can be. I'm not even a midwife and I already feel defensive (because of conversations I've had) about how I will practice -- and *I* don't even know what that looks like yet!

If women and babies are getting safe, exemplary care, then what do the details matter? Women hire professionals that reflect for them the vision of the birth they want and the things they most value. If we all did things the same, there would be no options for women.

What is 'interference'?

I'm having a nice discussion with some Trust Birth folk on my blog which is much easier here in my own territory, where I'm not misunderstood and have a chance to clarify. Facebook is too frustrating which is why I gave up trying there. Too much 'cheerleading'.

I AM questioning interference, but at this point I'm trying to understand how Trust Birth defines it, and it is also causing me to explore it for myself. I was reading about the Matrona and they share a lot of the interference messages which I thought was interesting. I'm looking at this concept from two perspectives:

1. Who defines interference? Can you know you're interfering until after the fact? What does intention matter, really?

2. What do I personally feel is 'interference' - I'd say unnecessary distraction of the parents (because I do not believe it is just about the mother), whether medical or social or whatever. If there isn't a good medical reason to be fussing with the parents, then don't. If there isn't a benefit to the parents for the social interference (guests, phones ringing, excessive conversation, etc.), then don't. Seems pretty simple to me.

What I get stuck on in this conversation (and I am thoroughly enjoying it!) is that I experience a black and white view of what 'should' and 'should not'. I see comments around what the TB person views as interference but that maybe the client wouldn't at all. Maybe the withdrawal of the support person (if it is unexpected) is an interference, too. I know that generally, women hire people with an idea in mind of what they're going to get. Sometimes they are surprised. If you are high risk and can only deliver with an obstetrician in a hospital setting and require intervention to make that happen- is that interference?

I am struggling to understand where the line is drawn. I love the idea of assessing newborn health without fussing with the mama and baby, which the Matrona promotes. I won't even pretend to say it doesn't scare ME, the idea of something going south and having to take records to a hospital where there is no charting of anything at all.

I don't think it's as simple as surrendering to a philosophy, not in this culture. We're very into records and defensibility. I think that each provider has to design this way of functioning for themselves. I have seen beautiful midwife Pamela Hines-Powell delve into her beliefs time and again and come out changed, with a new shift, with a new way of practicing. I've seen her pull back more and more and have been excited about what seems like a shifting faith and belief and trust, something we desperately lack in our culture. I have learned a lot from the journey's she's shared about simple things like hats, and major things like the birth bubble.

I want to end by saying that I feel very strongly that one message I take away from the TB discussions I've seen (and I've seen MANY) is that there seems to be only one *right* way to be present at a birth. This goes against my fundamental beliefs and it's probably one of the reasons why I just don't connect, despite the many areas we are in agreement. I am concerned about the idea of ANY organization telling ANY group of people that there is one way to be 'correct'. I have met many women and attended many births and each client wanted something a little different. She needed something specific to her to feel safe and feel connected. Let's not forget the fathers who are equally important and have their own set of needs- there's just no way we can ask midwives to subscribe to one set of beliefs and then serve such a wide population.

Let me explain:

One client might want a more hands on midwife because while she is excited about birthing at home, she needs the reassurance of the heart tones checking/vitals, verbal encouragement, etc. Another client might not want any of this. Both clients might not know this until they're in labor and this is often the case.

I suppose this means that the provider needs to discern for themselves in every moment what is 'interfering' and what is not. What worries me is that people might come out of their training thinking that they "will" or "won't" do things (which is fine and great), but until the mother in labor meets this boundary, there's no way to know whether it's interference or not. Maybe that sounds abstract, I don't know. I'm very obviously still plucking at this and working through it.

What is the 'right' way to midwife?

I don't have any idea. I don't know who I will be as a midwife, I don't know what I will value. I don't know what my learning experiences will teach me. I'm questioning NOW, I'm opening my heart NOW to things I do feel pretty resistant to, but I'm doing it anyway. How will I know what fits if I am not willing to really try it on?

What do we know about the OP baby?

Penny Simkin gave us a great talk yesterday at the MAWS conference about what the research says about OP (posterior) babies. I was chasing my toddler around so didn't get to write any of the statistics but a few things she said stuck out:

* There's no reliable way to know the position of a baby except for ultrasound (at this time). She didn't love saying this to a group of midwives and I doubt anyone was happy to hear that. ;)

* Palpation, back pain, digital examination, etc. - none of it was really reliable in determining the babe's position

* Lots of women have malpositioned babies and no back pain! It's just not a good indicator of whether a baby is malpositioned.

A question I have is whether in these studies it was one type of provider being studied or a cross of several. If we're asking doctors (who aren't necessarily invested in finding out fetal positioned by palpation/digital exam) to stand up against midwives who are, and who are therefore going to (likely) be more successful at it, is it skewing results? Could it be that midwives are better in some ways at determining fetal position than say, labor and delivery nurses?

I've been to many births where I suspected malposition (I have 'OP-dar) and during a vaginal exam would ask the nurse or doc if they could tell, and most often the answer is now. They say that there's a caput in the way, too much swelling. That's the only tool they have and they don't know what to do with information when the baby's head is swelling in the way. Somewhere along the way I learned (and I may be wrong but so far it's been right on) that if there's swelling in the way to feel the sutures, baby's head is in a wonky position, it's not OA. Now I'm not putting my hands in women, I can only go off of what is happening with the labor, what is happening in the woman's body and how she wants to move/doesn't want to move, where she's feeling sensation, and what the provider can say about the position- but so far I've been pretty consistently on about baby's position.

When I'm working with a client and I hear these things, it tells me there's something up with a baby:

* Water broke first
* Water broke and no contractions follow for many hours or even days
* Contractions are coming regularly but are short in duration
* Contractions are coming consistently (not going away) but are irregular in time between or in duration
* Mom has back pain, hip pain
* Belly button area is flat when she lays down or standing straight up
* Mom has a feeling about the baby in a funny position

I don't have to touch a client to see these things (and I don't, because I have no clue how to palpate). I don't have to inquire or interrupt her for the most part, it just is a matter of watching for it.

One thing Penny said was that just because a baby starts out the labor OP doesn't mean it will be born OP, and same goes for OA. Babies move in labor! We don't have to stress mothers out in their last weeks about fetal positioning and avoiding sleeping in certain positions, etc. I think this is a great starting point for dialogue about this. I definitely talk about fetal positioning because I want my clients to understand why it's important, but I don't tell my clients that they 'can' do something. I say they can 'encourage', but that the baby is a part of the deal too and they won't put themselves into danger or a stinky situation. Trust your body, trust your baby - it will be what it's supposed to be and we'll work with it. I have not seen it lead to a stress in my clients about their positions or the baby's positions.

Sometimes I wish I kept detailed information on every birth so I could go back and see how often babies are starting labor OP or asynclitic and then come out just fine, or otherwise - I just don't have that data in my own practice.

Trust Birth and Doulas

I was at the MAWS conference yesterday listening to Penny Simkin speak about what the research is saying about malpositioned babies (which was fascinating, I'll post about that, too). She made a comment about supporting her clients in labor and how sometimes she has to ask the mothers to do something they don't want to do for just a few contractions. I thought about times where I've been with clients and whether I've asked women to do things they didn't really want to do and while nothing specific comes to mind, I'm sure that it's happened.

I thought about things I've learned about interference, at least the Trust Birth philosophy (as I understand it, which I admit, I don't understand it well). I questioned whether doulas are 'interference' or help, and I wondered what the Trust Birth folk think. I'm sure the conversation has been had somewhere? I'm hoping someone will see this and post.

Political

Sometimes I think I can't really say what I think, feel, discern without pissing someone off. Historically it just seems like this is true. It usually doesn't' matter what I'm saying, how clearly or how objectively I write, someones gonna get pissed. A friend of mine said to me yesterday, "Kristina, how can you avoid being political? *YOU* are political, your very presence is political. Get over it." Oh, well... I hadn't considered that.

I keep feeling that I should just close my mouth and open my eyes and heart. Don't 'get in the way' with what I think. Let my inner silence be my outer silence, and let the thoughts and knowledge and doubts and wishes of others wash over me.

I definitely think that is a wise thing to do, generally. Talk less, listen a whole lot more.

In other cases, I feel like I'm dishonoring myself by not speaking what is true for me. I used to write on my blog prolifically until Dr. HasBeen picked me up and I went through the ringer. Then I went through a couple of things locally, too. Not ever because I was rude, mean, disparaging, slanderous, but because I said *too much*. Interesting. How does one know when one is saying too much until one does it??

My writing has suffered. It used to be a catharsis for me, a place that I could learn and reflect. I would start writing and by the time I was done with a post I had deep clarity, better questions, and usually some direction. Now when I try to write I feel that I must be so careful so as not to rock the boat. I must not write about my experiences with organizations or individuals, no matter how fairly, or to share the amazing gifts I get out of these exchanges, because when ya poke the bees nest you had better be prepared to be stung. I don't like being stung, but let me tell ya, silencing myself hurts a hell of a lot more.

Telling the truth, even if it is only your own truth comes at a cost. Sometimes it shakes the trees of other folks and generally speaking we don't like our trees shaken! I just feel that I was given this voice, this passion, this ability to communicate effectively, to listen and hear all sides - this is all within me for a purpose. I feel that by not sharing what I truly think and feel in the ways that resonate for me and feel good and healthy, that I am almost.. dishonoring these blessings.

I think change is in the wind. I am just tired of worrying all the time about who I'm going to piss off. I'm not co-dependent, I don't know why I'm acting like I am. It doesn't mean I'm on any hunt to target anyone, I'm not. I'm just refusing to filter every single thing I want to write about. Writing used to be a marriage for me, and lately it feels like a hooker I visit now and again, and feel bad about afterward. No more.

Career doula

I need a career doula. I need a little hand-holding right now, a little reassurance. Not the pats on the back that Facebook provides (which I do appreciate), but someone who can look me in the eye and ask me the hard questions and push me. That's what I need.

My husband is really good at that but I think what I want is someone objective of the situation. Someone who isn't attached.

I'm trying to figure out what I need to do and it's interesting that I'm actually farther away from midwifery school than I thought/knew I was. I figured it was taking a few classes and GO! Alas, because their program changed (woo hooooo!!!!), the pre-reqs are more involved. I basically should just finish my AAS.

I'm feeling somewhat overwhelmed by that prospect, but excited too. I can take courses here and there as I can afford it, thus getting time behind me where my kids can get a little older (namely my sweet tot) before I head to midwifery school. It all works out, but.. it kinda takes my breath away a little bit.

I'm in the midst of setting up a potluck get-together with the local doulas/birth folk to celebrate International Doula Month. I'm stoked to see everyone who can hopefully make it! It's been quite a long time since we've had a networking opportunity on the peninsula. I hope lots of people show up.

Okay, so back to the school thing. I need to make lists or something, I feel like I need a map of what's up ahead. 1. talk to admissions at midwifery school. 1. talk to advisor at the local community college to see what I have and what I need. 3. Figure out a plan to get some classes happening soon. 4. Dream up some fancy way of making the money to pay for said classes.

Easy enough, right? Ugh. Right.

Tree-Limb-Bee-Birth

One of my very favorite subjects - dads! A request for information on how to prepare dads/what to cover with them came up on a list I'm on so I wrote a bunch of stuff and then realized I might want to say something here, too. Disclaim: I don't want this to appear that I spend all my time talking to dads and am not invested with the mother, I'm simply emphasizing the conversations I have with dads for the sake of bringing this to light a bit.

Early on I realized that dads are important (duh, right?). They're not cheerleaders, they're integral to the birth process, and the birth process is integral to them going on to be fathers. I was hearing a lot of unintentional condescension around dads and being the mother of sons I feel rather sensitive around the messages we give boys and men. Words like 'clueless' get tossed around a lot.

I started talking to my own husband about what men want from the birth experience and he gave me a really great insight that has held true through every client over these last many years. Dads aren't invested in the process, usually. They want to know their wife is going to come home alive and safe. Second to that is that the baby will come home alive and safe. It's a hard thing to admit but it's usually true- dads don't want to be left alone to raise a child by themselves, they'd rather have another child with their wife if it comes to that. I totally hear that, I totally understand it.

What I see a lot is couples trying to meet in the middle but dad often doesn't get a chance to say what he thinks and feels without the mom kind of overriding it. I'm not saying this happens all the time, but generally, it's very common. Dads are attached to *survival*, not experience. If birthing the baby while hanging from a tree limb upside down while bees attack is going to be the very best assurance that his wife and babe will come out alive, he's a fan of tree-limb-bee-birth.

Moms want to know that as she goes into the mystery of her birth that he will protect her space, stand up for what she wants. Dads aren't as attached to the experience as they are knowing she'll be safe. This means that when a provider says, "We recommend we make this change in course for your safety," they're speaking to this man's deepest fears. This is going to trump his partner's wish for an experience, and understandably so!

When I meet with clients and ask moms about their desires for their birth, a lot of the time they have a pretty clear idea of what they do and don't want. Most are flexible to what surprises might arise and how willing they are to go with the flow, but generally they know they want no pain meds, or a waterbirth, or an epidural at 7cm, etc.

When I ask dads what they want, I have yet to meet a dad with a detailed vision beyond making sure his loved ones are safe. They often just don't know what exists beyond that. I think that this is hard for moms because we do know what we want and we want our husbands to know, too. We want them to be equally invested (in what we want). We want to know that if someone walks in threatening to break our water that he can speak up for us if we can't.

That's a tall order. It's certainly not impossible, but asking a father to be knowledgeable enough about birth to question the provider in a situation where he is oftentimes entrained to what the provider is saying is a tough spot to put a dad in. I've seen several scenarios:

* Mom wants dad to stand up for her. Dad tries, but it creates a conflict energy and mom shuts him down in front of the staff.
* Mom wants to avoid a certain intervention that is now being offered/suggested by a provider who seems to have a good argument. Dad feels stuck between the provider who is telling him that this needs to happen, and his wife's wishes. He ends up bending to what the provider is saying and helping to talk his wife into it.
* Mom and dad are prepared and ask for a few minutes alone to formulate their questions before deciding.

When I sit with clients at consultations I look at the father and say, "She really wants you to understand that this is a life changing experience for her. She will never be the same after this. You are about to see your wife turn into a bona fide warrior and you will never look at her the same way again. This is huge for her."

Then I say to moms, "He isn't as attached to the experience (and I invite dad to correct me if I have it wrong) as he is attached to bringing you home alive. He will happily chuck the whole scene if it means he gets to bring you home. This is a scary event for him, the closest he's ever probably walked with Death and it's not him, it's his 'heart', his wife, who has to do it." I see the light bulb go on over dads every single time I say this. They've been hesitant to say it for fear of upsetting her, or they haven't been heard, or it's been challenged by the mom's desire for a good experience, so a lot of time dads just keep their feelings to themselves around this. When I come in, objective, a 'professional' (whatever that means!), claiming what I know without judgment and asking the mom to meet him there, it has 100% of the time stimulated some powerful conversation between the couple.

As a doula what I then try to do is talk about how to fill the gaps between what they need. What does the mother need? What does the father need? Now that he's been witnessed in his journey, we talk about what they individually want out of the birth in an open way.

I tell my couples that if we treat men like fathers and not like birth coaches or assistants (or worse), that they will rise and feel like fathers. In a culture where a dad who sticks around for his family is viewed as a 'surprise' or a 'good man', the expectations around men being fathers is very low. I personally believe that if we set people up for success they will rise. If we enter into birth treating men like they must be told where to stand, where to look, what to say, how to say it, they will have pretty low confidence in parenting that babe after it arrives. It can set up a funky dynamic where the mother becomes the 'expert' and the father becomes (again) the assistant. Rather than parenting his child, he's supporting the mother in parenting the child for the both of them.

I argue that men should be heard equally with the mothers. Their own journey should be witnessed. I talked to dads about guarding the space, keeping it safe, and how to do that in a way that makes sense. It's not about standing outside of the birth hut to keep the tigers away. Now the tigers are a little different and the trick is getting dads to see them. For example, making sure the lights are low and voices are kept low so mom can focus. Make sure no one is talking to her during a contraction (unless there is some major necessity). Helping to keep distractions like the phone and visitors to a minimum. Telling her how strong, powerful, beautiful and amazing she is. Being the 'muscle' to hold her up, lift her, support her hips, etc. as she needs.

It's about teaching men a new language for being the protectors of the birth space so they can show up for the mother in the way they do best, and not just shuffling them to the head of the bed so they won't be 'traumatized' by what they see.

If men believed they were, and and were supported in being integral to the birth experience, how might this change how they show up as fathers?