Belly Tales

We’ve spent the past two days palpating each other’s breasts. Which hasn’t been nearly as uncomfortable as you might imagine. In fact, everyone seems quite professional so far, and comfortable with their bodies: eager to learn and very willing to let other’s have a feel if something interesting turns up (for example, one woman in our class has a fibroadenoma, and graciously offered herself up to anyone who wanted to try to palpate it.) It bodes well for the pelvic portion of our class, which will begin next week, and will ultimately involve performing peer pelvics on each other. Along with breast exams, we’ve been going over all the different kinds of breast diseases out there, and how to treat them. SO MUCH TO LEARN. Gah! Our first exam is next week, as well, so this weekend will be devoted to mucho studying, along with Miles for Midwives.

I must admit, though, this all feels a bit surreal right now. It’s hard to imagine that I will ever really will be a midwife. I don’t feel like a midwife at the moment. I feel like a kid, clueless and young and tripping through school. The idea of taking care of real women, delivering real babies…seems very far removed from where I am right now. How do I get from point A to point B, not just academically, but emotionally, in terms of confidence, and identity? I have no idea. I was reading my latest copy of The Quickening (the ACNM’s newsletter), and was suddenly filled with despair. I want so badly to contribute to the profession as a whole, and to do good work, and fight this fight, both politically and locally, to bring better birth choices and options to women everywhere, and to be their advocate, as well as an advocate for the profession….and meawhile, I still don’t even know how to do a pap smear. I know I’ll get there someday, but at the moment, I can’t see the path, at all, and even “getting there” seems like it will never arrive.

But then, maybe I’m overtired at the moment, and need to take a study break. A few of us went to a local Jamaican restaurant after class this afternoon and ate jerk chicken and quizzed each other over the material that’s going to be on our first exam. I’ve been organizing my flashcards, taking notes on the various chapters, and getting my work load under control. I guess I know how to be a student at the moment, even if I don’t know how to be a midwife, yet, so I’ll just carry on and assume that this transformation will just magically occur at some point in the future. Will it???

On the very first page of our Varney’s Midwifery (4th edition), before you even get to the table of contents, is the following poem, by Dana Quealy, CNM, MSN:

Holy Births and Howling Babies

In my backyard there are nuns who live in a shaded brick building
next to the St. Stanislaus church and elementary school.
Together we rise before the sun is in the sky.
Behind the kitchen curtain, in the damp haze of morning,
I watch them walk in shades of blue robe.
They glide in white sneakers across the parking lot.
They are cool, calm, brisk.

Some day, I’ll go see them
I’ll ask for some lesson on prayer.
Because the thing is…I pray now.
Not Dear God Almighty!
Just low, easy, quiet thoughts.

I pray when my patience is worn.
Why my shoulders ache.
When my own voice becomes tiring to my ears.

I pray when my heart sits heavy with stories and faces of women.
A prayer for the 32 week babe.
A prayer for the lady with the skinny, squawking twins.
A prayer for the woman without a mother, or a lover, or a friend.
I pray when my cold hands run across a pregnant belly
and I feel a kick from inside.

I pray for all my babies, Be good to your mama.
I pray for all my mothers, Be strong, be good to this baby.
I pray secretly and I pray slowly.

I pray for us, the midwives and almost-midwives.
I pray that we make the right decisions.
And I pray for those of us who make bad decisions.
Decicions we regret with outcomes we can’t change.

I pray that we learn from our mistakes.
That with ages comes wisdom.
I pray deeply and I pray completely.
For all of the hands and all of the bellies.
I pray for holy births and howling babies.

Now, my question is this: what do all of you think of this poem? Do you like it? Do you think it’s the right poem for the very beginning of a midwifery text book? Does it fill you with hope? Does it start things off on the right foot? Does it give you a visceral sense of what it may be like to be a midwife? I am just curious about other’s responses to it. I’ll share my own thoughts in a bit, but I’d like to hear other’s reactions first. I am just curious. (And don’t by shy! Analyzing poetry is fun! …says my inner English Major.)

In preparation for the pelvic portion of our class, I just bought me a copy of Anne Frye’s Healing Passage, which, I have been told, is THE bible on suturing, and is required reading. Looks very interesting, I can’t wait for it to arrive. I also had a moment to peruse all of the other offerings on Midwifery Today’s storefront. I had no idea they had so many cool things available! I don’t subscribe to their magazine, but now I’m beginning to wonder….should I??

In other happy book news, my copy of Henci Goer’s Obstetric Myths Versus Research Realities arrived yesterday, and I was able to start to dig into it last night. What fun! I love buying books (although I wish my bank account loved it too.)

Last night at work was the night of six minute bradycardias. Scary scary night. (Read on …)

We had a quick consultation yesterday with the professor who will be teaching us the pelvic part of our physical assessment class, which will begin in October. She had a three ring binder with her that was 4″ thick, filled to the brim with paper, and all of this was our pelvic unit. It was massive. You could kill someone with it if you accidentally dropped it on their heads. We were all a bit hushed and flabbergasted.

However, as she quickly (and correctly) pointed out, the pelvis is the foundation of our practice. We’re learning how to examine the heart and lungs, but truth be told, if we run into something seriously abnormal, we’re probably going to refer it out to another practitioner. Hearts and lungs will not be our specialty. The pelvis, on the other hand…we’ve got to know it inside out, all of its muscles, structures, ligaments, bones, how it works, how it feels, how it stretches, what a normal finding is, what an abnormal finding is, how to do a pap, wet mount and liquid slide, how to diagnose all the different variations of vaginal itch, and all sorts of amazing stuff that I don’t even know about yet.

To say that I’m excited is a bit of an understatement. I can’t wait! We’re finally getting to the good stuff. Although, looking out that 4″ binder…the good stuff is going to be a ton of work. But good work. Work I’ve been looking forward to for years and years.

In other news:

The Senate Judiciary committee has endorsed John G. Roberts as future Chief Justice, and the vote will go to the entire Senate next week. I’m still of a mixed opinion about this. On the one hand, he does seem like a very intelligent and judicious man, which is more than can be said about a lot of people, and he has repeated, on several occassions, that he doesn’t want to tamper with precedent, which you could possibly read as his way of saying that he doesn’t want to open the Roe v. Wade powder-keg without having to say it directly and piss off all of his right wing conservative supporters. Or maybe that’s just his way of skirting the issue and not answering directly, so that he can unload a bazooka gun at privacy rights just as soon as he’s nominated. He has been so ambiguous throughout this entire process, and infuriatingly indirect, and the uncoorperativeness of the White House has just been staggering. Honestly, you really don’t know what to think, because the entire thing has been so abstract and obfuscated. I can’t take the measure of the man. No one can. That’s been the problem. I have a sneaky suspicion we’re all going to have to find out the hard way on this.

A quick reminder: Miles for Midwives, the 5K run/walk that will jointly benefit the NYC Chapter of the ACNM and Friends of the Birth Center is next weekend. I’ve already signed my beloved boy and I up to run, and I know several of my fellow midwifery students and friends will also be going. If you live in the NYC area and are interested in attending, the registration form is here.

Finally, some adoreable shirts have been designed with the logo “Midwives Deliver” on them. Proceeds from the sales will also go to benefit Friends of the Birth Center, so if you’re at all interested in owning one, check them out here.

We spent the morning playing with opthalmoscopes and otoscopes and working on the Eyes and Ears portions of our physical exams. First you inspect the eyes and eyebrows for symmetry, lack of bumps, lumps, swelling, lesions, nodules, conjunctivitis etc. etc., then you have the patient follow your finger while you lead them through a series of movements to check their extra-occular muscles, then their pupils’ ability to constrict, etc. etc., and then, finally, you whip out your handy-dandy opthalmoscope and examine their retinas (and maculas, and foveas, and optic discs), which is not quite as straightforward as it sounds. I was lucky to get a red reflex most of the time, and in a few rare attempts I was able to see the blood vessels in the back of my partner’s eye, but I won’t be differentiating between diabetic retinopathy and deep retinal hemorrhages any time soon. The ear exam was much easier, and the tympanic membrane of my partner was very easy to find: pearly grey, translucent, with a shiny cone of light in the four O’clock position, no bulging, redness, exudate or perforations noted. In other words, a fabulously cool and perfectly normal tympanic membrane! And wheeeee, I spent the morning looking at retinas and tympanic membranes! How cool is that??

The afternoon was devoted to Primary Care, which is a neat class for no other reason than you get to listen to your professors relate all kinds of hilarious stories about the unexpected answers given by patients to very simple (but ambiguous) questions. For example, never start off an interview with the question “why are you here?” because the answer you get might very well be: “because I had an appointment.” Today’s lesson focused on screening tools, which involved going over the midwifery management process (again), and history taking (again), but hey, I’m not going to complain. I’m sure it’s a very good thing to have this stuff drilled into us again and again. And again.

This evening, I attended the ACNM Region II Chapter 1 meeting, which is only the second ACNM meeting I’ve ever attended before. As a student, I didn’t have a vote, and very little to add to the proceedings (although I did pipe up at one point and add a comment, to which I am somewhat proud of myself), but it was neat to watch, nonetheless. The important issue on the table was funding for a new PR committee designed to handle midwifery responses to political issues as they arise (such as the EC Bill debacle), as well as more vocally and professionally promoting midwifery. There was also a report from NYSALM regarding the lobbying work they’re doing on various bills in the NY State Assembly, all aimed expanding midwives’ practice, rights or reimbursement in some way. Overall, I thought the meeting went very well, and was run pretty smoothly and efficiently (as efficient as can be expected, I guess, with 50 or so vocal, opinionated midwives in the same room). I liked all of the moving and seconding, just like in a real board meeting, and I felt energized and excited and eager to help out.

That lasted until I got home, and looked at the pile of school books on my desk. Getting more actively involved in the Chapter is probably going to have to wait until I’m no longer a student. But again, it’s neat to get a glimpse of what the future may hold for me, and it’s always neat to see so many midwives in one place at one time.

There’s nothing like illustrated pictures of skin lesions to wake you up in the morning! After getting up, pouring my cereal and stumbling blearily over to my desk, there they were: last night’s homework spread all over the place, the page open to primary and secondary skin lesions. Yum yum. Syphillitic chancres, Actinic keratosis, squamos cell carcinoma, full color examples of stage IV pressure ulcers with tissue necrosis, spider angiomas, examples of hands and feet covered in pustular psoriasis, erosions, crusts, lichenification, herpes simplex vesicles, nodules with telangiectasia…all this crazy stuff I’m supposed to know! Eeeegads, how do dermatologists do it? Word to the wise: illustrated examples of skin lesions can really put you off your cereal.

I’ve stumbled upon some gorgeous birth art, and the artist, Misty Benson, has been kind enough to share. Here are my three absolute favorites:

“Secret of the Butterfly”
24″x32″ Acrylic on Unstretched Cotton Canvas Sheet.

Misty writes:

There is a Native American legend that says, “If you have a secret wish, capture a butterfly and whisper your wish to it. Since butterflies cannot speak, your secret is ever safe in their keeping. Release the butterfly, and it will carry your wish to the Great Spirit, who alone knows the thoughts of butterflies.” In Celtic beliefs, a woman wishing to get pregnant would swallow a butterfly soul. Whether you are wishing for a pregnancy or you have already swallowed the butterfly, it is no secret that a new life in the belly often feels like the fluttering of wings. Along with the butterflies, there are several symbols present in the painting. The gem suspended from the mother’s neck is the moonstone. Radiant with the light of the moon, it symbolizes rebirth, new beginnings, and wishing. Believed to benefit pregnancy, it is a feeling stone that helps aid in the changing cycles of our lives, bringing balance to our emotions and aiding us in calm reflection. The yellow of the mother’s blouse represents joy (as do butterflies), happiness, hope, and the dawn of a new day.

“Born of Water”
8″x10″ Acrylic on Unstretched Cotton Canvas Sheet.

“As Above, So Below”
12″x16″ Acrylic on Unstretched Cotton Canvas Sheet.

Misty lives and works in Boulder, CO, where she coaxes faery essence into this realm through her work with acrylic paint and canvas. She draws her inspiration from a deep well of faery lore, fantasy art, and cultural celebration. Misty has never followed the traditional path of an artist. She never drew as a child nor pursued art courses in high school. Although she attended college to become a veterinarian, she switched majors and went on to earn degrees in the Fine Arts and Cultural Anthropology. She writes about pregnancy and birth: My sister was born when I was 12, and I spent a lot of time helping to raise her. I honestly feel like I have already had a child! I love the pregnant form. I always encourage my friends on LJ to take lots of pictures while they are pregnant because they are so beautiful. I tell them not to simply take a sideview of their belly and call it a day. I encourage them to take full body shots and ham it up a bit. I tell them they won’t ever regret documenting this part of their lives! I just find pregnant women to be so beautiful and inspiring. The wondrous looks on their faces are looks that you don’t see on anyone but a pregnant woman. They are challenging to capture, but I enjoy it.

If you’re interested in seeing more of her work, you can visit her website, Gossamerfaery’s Attic, or buy prints through her ebay offerings. Enjoy, and thank you, Misty!

I realized yesterday, while attending my first research class, that I have done my first homework assignment for that class completely wrong. I thought we were supposed to come up with a topic that we wanted to research, i.e. do a literature review of all of the relevant articles out there, and see what’s currently being investigated about said topic. So, I blithely picked a topic that interested me, and thought I was good to go. Wrong. What we’re really supposed to do is come up with an idea for original research, and begin to draft a research proposal for said idea. This semester involves picking the problem we want to tackle, and doing the background research necessary to see what’s out there. Next semester will involve designing the study itself, and then writing it up into a proposal. Since we’re at the Master’s level and not the doctorate level, we won’t actually have to carry out the research, but by the time we’re finished, we should have a nice fat proposal that we could potentially send out for grants and sponsorship. It all sounds a bit daunting.

The topic I wanted to research was the 24 hour deadline held over women’s heads like a guillotine once their membranes have ruptured: deliver or else. The reason given for this 24 hour rule is that supposedly the inicidence of chorioamnionitis (an infection of the placenta and membranes) increases drastically after 24 hours, especially if the woman is Group Beta strep positive, and this infection can be dangerous for both the mother and baby. I have never looked at the hard numbers on this, though. I wonder what the rate of infection is, and if it really merits such a sharp deadline. I have seen many deliveries where the woman is still asymptomatic at 24 hours, afebrile and not showing any signs of infection, but her doctor urges a c-section on her anyway instead of allowing her to continue to labor. I wonder if the research really backs up such decision making. My instinct is that the clock ticks much more impatiently on women with ruptured membranes, and that this urgency and impatience, which is then used to justify inductions, augmentations and cesareans, is not actually necessary. I have no idea if this suspician is true, though. That’s what I wanted to investigate.

However, investigating this is just a simple matter of doing a literature review. It’s not a research design or proposal, and I can’t for the life of me think of a research study I could perform that could measure this, or contribute in a meaningful way to the literature. Doing a randomized control trial is not really an option. This doesn’t have much to do with midwifery, anyway. It’s more of a hard science, obstetrical connundrum, and I would rather do something more midwifery related.

So, back to the drawing board. Any suggestions on research proposals? It will require a lot more thinking.

I’ll grant you a terse congratulations, but that’s it. Britney Spears had a healthy baby boy today, via primary cesarean section. To quote the Reuters article: “Spears…had been previously reported as saying she planned to have the baby by Caesarean section to avoid the pain of a natural birth.” In other words, too posh to push.

Now, I have two conflicting thoughts here. On the one hand, it’s her body, her choice, she’s a woman, and I have to respect her decision, even if I would have counselled her otherwise, or made a different decision myself. On the other hand, she’s an icon with a huge following and therefore an untold amount of influence and power, and therefore an extraordinary opportunity to create positive change and lead by example. Some celebrities use this power to its utmost (just look at Sean Penn in New Orleans in his own boat, doing what he personally could to save lives and ease suffering); others fritter it away and could care less, and still others abuse their power and influence to terrible ends.

Britney had an opportunity to educate herself about birth. Britney’s family had an opportunity to edcuate themselves about birth. Britney’s health care providers had an opportunity to educate her about birth. Her fans were watching her pregnancy and the decisions she made very closely. She could have created far-reaching positive change in the way young women in this country view birth. Instead, she upheld the status quo, and embraced the idea that childbirth is painful, not something a woman can or should go through, if she can afford not to, and cesarean birth is an easier and safer ideal. Why did she have to go to the far extreme of technological intervention? Why not show instead that women’s bodies are strong, capable of birth, and that babies don’t need an exit through the abdomen when one has already been so perfectly designed for them? I mean, c’mon…if she really wanted to avoid the pain of natural childbirth, why didn’t she just have an epidural? Then she could have still delivered vaginally, at least.

Golden opporunity pissed down the drain.

I guess while we’re at it, we can always encourage Britney to breastfeed.