Tag Archives: Breast

After the sky falls…

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Sooo, after returning to work early-ish following the exchange from skin expanders to implants, I’ve had quite the eventful run of complications. That means I’m sitting here at home again, recovering. Not really feeling inspired to write, but bored to death with feeling bad.

I felt so nearly normal so soon after the implants were placed that I thought I was home free. But one night, I noticed the left breast seemed to be sitting a lot lower than the right. No discomfort, but weird. I got an appointment with the plastic surgeon for the next day, and in the meantime amused myself by writing about Henny Penny and the sky falling, absolutely never suspecting there was a real problem.

OK, so the sky did fall.

While driving myself to Dr. N’s office, the left implant’s pocket started filling with blood & didn’t stop. I could tell something was happening because I felt like I couldn’t breathe on that side. In the rearview mirror I could see a really big bulge over the top of my shirt, near my clavicle. Thank heavens for this fancy hands-free car phone stuff–it let me call home and leave a message for my husband: “Keep your cell phone on–I may need you!”

It’s a blur, but I did get to the office. Dr. N inserted a drain to relieve the pressure and hopefully save the reconstruction on that side. A friend who wasn’t supposed to be at work that day (but heeded the little bird who told her to show up) was available to drive me to the hospital faster than if we’d waited for an ambulance.

After the requisite 8 minutes of chaos, the ER figured out who I was and what to do with me. I was just grateful my friend was willing to stay & hold my hand while I writhed and cursed in and out of consciousness. I cannot adequately describe how it feels when over a liter of blood tries to burst through your skin, so I’ll leave it at that.

I remember thinking they’re just going to let me lay here and die and I’ll never see Brian again. But he’d been called, and soon after the thought, he was there with me, scared to death, too.

All was resolved with a timely return to surgery. Dr. N was suitably impressed by how much blood I’d lost (about 1.5 liters), and happy to have seen the cause of it–one of the little blood vessels that forms during reconstruction was torn & could be seen merrily pumping away. So, that got fixed, a new implant was placed, and I went home the next day with–yes–yet another drain. Not to mention tearful, weak, and pitiful from sudden blood loss.

So relieved to have a husband willing to help with the care and feeding of a PICC line.

So relieved to have a husband willing to help with the care and feeding of a PICC line.

A week goes by uneventfully, tho’ I’m secretly terrified of a repeat. It happened once– who’s to say getting in the shower and washing my hair (as I’d done the morning of my appointment), won’t spring another leak? I’m Catholic. It’s gotta be my fault, right?

So it’s back to Dr. N’s for inspection and to have the drain removed. All seems well until about 5 hours later, when I start feeling achy and warm. That progresses to joints screaming and hot. My temp goes from 101 to 104 within about an hour, and Brian’s making frantic calls to the on-call doc, then Dr. N, then I’m in the car and being carried back to the hospital where I stay for the next few days getting IV antibiotics.

Thank heavens for modern medicine & modern antibiotics. Infection after trauma–surgical or not–is the kind of stuff that killed people when we didn’t have what we’ve got today.

I’m home now getting the antibiotics here, as there’s no oral equivalent of what they need to give me to be sure there won’t be a recurrence. I’ve got what’s called a PICC line–an intravenous catheter that starts in my upper arm and dumps into one of the really big veins near the heart.

So far, each day is a bit better, and I’ve woven for myself an explanatory fiction that makes me less afraid I’ll have another bleed. I can think of the infection as old-fashioned sclerotherapy (therapy that scars) inside that pocket, sealing off any potential little bleeders that might lurk there.

And there’s Dr. N’s assurance that “this never happens.”

Except in one case he had where a woman’s stove electrocuted her.

And me 😉

I’m gonna live, so why am I crying…again?

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So I’ve had this marvelous breast reconstruction thanks to a very skilled plastic surgeon (which means despite bruising and surgical tape and drain holes, I’m fine with what I see in the mirror), I don’t have to do chemo or radiation, I’m walking around alive, and yet here I sit in the bathtub, in the grips of yet another crying jag.

Either I’m one ungrateful sod or it’s something else.

A good friend, who also happens to be a psychiatric nurse practitioner with lots of experience in wimmen’s stuff, tells me it’s something else. A panic attack, actually.

How embarrassing.

Which means we’re not just talking about one panic attack. I’ve been having them every time I turn around. Friends have assured me all this crying is normal. I’ve had my breasts cut out, for Pete’s sake. Which sounded right at the beginning of it all–back when illness and survival and a decent reconstruction were still uppermost in my mind.

Well, I’ve admittedly won the lottery as far as all the the above is concerned, but here I sit in my lavender bubble bath, crying my eyes out. Again. For hours. Yes, really, hours. Thank heavens I have a sensible husband who isn’t prone to panic. He just holds me and understands there’s nothing he can fix. At least not this minute.

Given to us by a dear friend and worth reading daily.

Given to us by a dear friend and worth reading daily.

The latest crying jag happened when I got convinced we’d all be homeless because of a $3,500 vet bill–payable right now, before we left the surgeon’s office or it was just a matter of hours before our doggie would be permanently disabled.

On top of a bazillion dollars not covered by own medical insurance. On top of me being off work long enough to run my disability down to zero and put an end to FMLA “protection.” Not to mention the taxes that would be due if we took money out of retirement.

And did I mention the IRS audit? The one that’s turned into two audits? Yeah, I think I mentioned the first one in a previous post.

I’m usually pretty good at ignoring unpleasantness. Even where the IRS is concerned. A trait that drove my mother crazy. She was into unpleasantness in a big way. So another thing fueling the crying jag was my certainty I was morphing into Mom.

Apparently not. My nurse practitioner friend said I needed an antidepressant. Like now. Been there, done that, but never for this particular symptom. And never had it work as quickly as it did it this time. Thanks to whatever powers that be, I haven’t had another crying jag (panic attack?) since.

What upsets me now is the realization that my mom, famous for the aforementioned unpleasantness, never had access to (and would never have accepted), the kind of help available today. It’s unfortunate the term “mental illness” was ever coined. Perhaps just unfortunate it’s used so freely for the kind of help many of us need when life becomes suffering.

Certainly some entities need to be thought of as true illness of the mind. If only so their sufferers can access state aid, have livable housing, and their medical needs met.

But should those of us fortunate enough to recover normal life with therapy and medication be thrown into a pot so discriminatory as to create fear about getting some help? I think not. To do so is irresponsible. And sad.

So I am sad for my poor mother. I think she could have been helped just as I have been. And I am sad for the women I see in clinic who are afraid to accept drugs or therapy when emotions get so awfully out of control.

I can be sad, but even so am feeling daily more able to enjoy the miracle that is life. Come to that, I’m downright happy about having a chest my husband’s not afraid to look at. And I’m not planning more crying jags any time soon, thank you very much.

At least not until the IRS checks in again.

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Treat your children well…

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I don’t know what I was expecting going into this Angelina Jolie-breast-preservation-mastectomy thing. Or maybe I do, if I get honest. I think I was expecting to look and feel pretty much like I did before the two, Two, TWO surgeries in one. Yeah, the Wrigley’s gum commercial dates me. I’m speaking of mastectomy followed immediately by “reconstruction.”

I’m feeling stupid because I let myself believe reconstruction meant restoration. They’re not the same. I’ve got what pass for breasts (very nicely, under clothes), but are really nothing but foobs (fake boobs, previously discussed). Kinda awful to look at without the clothes. They’re shaped by triangular-ish plastic inserts with a port for sequential infusions of saline. They could be made really, really big if I was into that sort of thing and wanted to lose the use of my right arm. More on that in another post.

And you know how they find the port to do the infusions? (Boy, what an education this has been.) With a stud-finder. Now that got my husband’s attention. He has mostly averted his eyes from the foobs, but pull out that stud-finder and he’s Johnny on the spot. It is kind of interesting. The expanders can shift, and they do, so the ports have metal in them to help with detection. Out comes the stud finder, for every infusion. First to “X” the spot, and again to check right before they stick the needle in. My doctor’s stud-finder is blue.  Hmmm.

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Does she, or doesn’t she?

Weird as it is, the process works, even if the result doesn’t look quite right and the “foreign body sensation” means they’re always on my mind. Always. It’s like having something in my eye. I feel them moving against my chest wall, and I can’t keep my hands off them. I’ve had to tell my husband to poke me if he sees me holding my chest in public. The edges of the expanders wrinkle and flex just like an IV bag. Or a flattened beach ball. The ports feel exactly like the squeaker in a dog toy, only harder, and the right one hurts from the inside when I lift something and my pecs flex. You wouldn’t believe all the little things we do without thinking that require pectoral muscles. Opening a mayonnaise jar, for one.

In the mirror (and I’m always looking in the mirror), I’ve got mounds. And that’s what they’re called in surgical parlance. “Breast mounds”. Don’t know how I feel about that. I get the mental image of a bunch of men in lab coats thoughtfully considering the desirability (in one way or another) of various breast shapes and how to achieve them. I joke with the nurses that in terms of shape, my left one is Mt. Ranier and the right one, the one that gives me trouble pain-wise, is Sugarloaf. I actually like Sugarloaf better when I look down and compare the two, but they’re certainly not the breasts I’d grown to know over time. The ones the surgeon frowned at for their degree of ptosis (read sagging).

I was never taught to appreciate what I had while I had it, as I imagine many of us find, plodding through life. In the words of that gawdawful song, “you don’t know what you got ’til it’s gone.” I’ve got old photos that catch half of me sitting naked on our porch in California (because that’s what we did in California), and wonder why the hell I ever hated my little booblets. Or my not-quite-flat stomach. Or my skin that wouldn’t tan. They were fine. They were lovely. But nobody told me so because that’s not what’s done in our world.

In our world–the world of women anyhow–there’s always room for a lot of improvement. And when I was  kid, I was one of the many victims of the depression-era hangover that said children shouldn’t be encouraged. Certainly not about body-related stuff. The closest I ever got to a compliment from my mother was, “there’s nothing wrong with you–you’re not deformed.” This in response to my teenaged despair about never finding pants long enough outside the boys’ section of the store.

My dad was better, always ready with a “don’t you look nice” at odd times and when I got dressed up. Much of his life was spent around female models, and he did them the favor of always being professional, never making comparisons, and as I mentioned in another post, never “improving” on them in paint or bronze. He also didn’t make the mistake of being afraid to include me in his life or touch me once I reached puberty.

I’m glad I took photos of myself before surgery, because even at 53, even with “ptosis,” my breasts were still lovely. Not because they met media criteria, but because they were mine, they were intact, and I was used to them. And for most of my life they weren’t diseased.

These new things, these foobs, aren’t mine yet. I’m reminded every time I lift something that they aren’t breasts, they’re pectoral muscles. They clench. They spasm. They can be seen doing so under the skin. My skin is stuck to them. But only just. Skin without fat under it is thin. Transparent, really. Foobs are a constant reminder that man cannot improve on divine intent, evolution, or whatever it was that got us here.

But I’m going to have to develop some affection for these poor, benighted things, as they’re being asked to do what muscles were never meant to do–masquerade as fat. And I’m going to have to do all the exercises the physical therapist prescribed if I hope to get strong enough to stay up all night and catch babies.

The plastic surgeon tells me I’m not a “high needs” patient–the kind we health care providers all know and dread because they can’t be helped–yet I certainly feel like one. I’d kind of like to be one. I have no reason to keep going to his office,  but the support from the nurses there makes me miss having an appointment every week. What a catch-22. Something helps, yet availing myself of it feels wrong, or weak, or…well, just weak.

Foobs aren’t exactly trouble-free. I still have pain when I first wake up and the continental plates shift across my chest. Then there’s the end of the day when I just can’t stand myself any more. Fatigue hits like a ton of bricks when I’ve simply pushed a cart around the grocery store. My brain functions like Swiss cheese. Honestly, NOBODY would want me delivering their baby right now. But I feel like I should be better than this. I just know my friends would be stronger–they’d be done with it all and probably back at work again, ignoring the fatigue. Like midwives always do. Like women always do.

It scares the hell out of me, but I’m going to do the polar opposite of what my work ethic wants. I’m staying home until all this is over with. You’re all invited to join me.

The Heartbreak of Phantom Bra Pain

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One of the more irritating features of this breast-building business is the tissue expander stage. Folks who have augmentation without mastectomy will have smaller implants placed either behind the existing breast tissue (fat & glands we associate with breast shape), or behind both breast tissue and pectorals (the large chest muscles so popularized by Jack LaLane). It’s a choice they make with the help of their plastic surgeon.

Folks like me, who have breast and underarm tissue removed in any of the various mastectomy surgeries, have a couple of reasons for needing to go the tissue expander route. If their own skin is spared, there’s no support for the implant within that empty pocket, so space must be created behind the pectorals to both support and hold it in place. It needs to be a larger space, for a larger implant, as there’s no more breast tissue to help shape it. Those who have a complete mastectomy that includes removal of skin and nipple will also need tissue expanders to stretch not only muscle, but the overlying skin as well.

I’ve said it before, and I’ll say it again: this is NOT a comfortable process. Aside from the requisite stretching and burning, I have this sense of something foreign–something large and foreign–strapped to my chest wall. All the time. It’s uncannily like wearing a too-tight bra every waking moment. And every other one, too. I’m constantly reaching up to tug on the elastic, pull at the underwire, or actually unhook the back. But nothing’s there.

Oh boo hoo. There are waaay worse things that could be happening right now.

But it is really strange. It’s exactly the sort of deja vu experience I’ve had ever since my parents died. Where I think before my brain stops itself: “Dad’s gotta see this…” or “let me just call Mom…”

I suppose in addition to grooves in my brain that track to the Mom and Dad thoughts, I’ve got another groove that tracks to the “gotta get this bra off” thought. And not just the thought, but the actual motor impulse that has me reaching up to find the thing. They’re the kind of impulse pathways that plague amputees with phantom sensations they’d swear were coming from the missing limb. Or the missing breast.

So if I’d gone with my health ed teacher’s advice and worn better fitting bras all my life–bras that didn’t create the need to reach up and yank down–would I still be doing this? Maybe some PhD-type will do a study. And give us a new ICD-9 code: phantom bra pain. I want my name on it.

“They’re heeere…”

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Foobs.

Fake boobs.

Rising out of nothingness…Suddenly. In Biblical fashion.

The surgeons very kindly took me seriously when I said the prospect of traditional dual mastectomy horrified me. They inflated temporary tissue expanders to about half capacity before I left the operating room. So when I explored my chest in the recovery room there were these little convexities–booblets–complete with my very own nipples, right where I’d expect to find them. Mightily encouraged (this is all hearsay, mind you–I’ve no memory of it), I am said to have gleefully exposed them to anyone who’d look–the spouse, my dear friend Peggy, and whatever nurses & techs were trying to keep me breathing instead of flashing the entire floor.

So I’ve discovered an inner extrovert. If it only emerges after anesthesia, I’m good.

I was apparently good that day, as the spouse was heard to say, “Gee–it looks like you’re nineteen again!” Bless him. We won’t talk about how he knew what I looked like at 19, except to say that it involved a communal swimming pool and some self-conscious skinny dipping. There are those who will remember the ’70s & how that used to be OK. Nowadays, if I’d been much younger, there’d have been arrests.

But, nobody gets to stay 19 forever, even a second time ’round. I left the hospital with the medical equivalent of saran wrap holding my chest together. This would stay on an additional two weeks, providing increased heat within really thin skin that needed to establish new circulation, and a way to peer at the nipples–which until the surgeon told me, I didn’t realize might dry up and blow away.

So now, three weeks out from the original surgery and with regular infusions of saline, foobs have emerged from the primordial booblets. Given my profession and the profound effect words have on women’s sense of self, I’ve always been careful to give body parts their correct names–at least with patients of a certain age  and comfort level. But special circumstances create the need for new vocabulary. An email friend who’s been through the same process tells me this stage is the “foob” stage. From the Latin, of course: fake boob.

Seems entirely appropriate to me, as these have certainly passed up my 19 year old booblet moment. Booblets are cute and unassuming. Foobs, well, foobs make their own way in the world. Anyone who accidentally runs into me won’t hurt me, but might come away with some serious bruises right about foob height. Which means we’re not talking “real” breasts yet.

I’ve got another one or two infusions to go before the tissue expanders reach their limit. Or I reach mine (this is not a comfortable process). A couple months after that, once things have stretched and settled to the extent they will, the expanders are exchanged for implants that feel much more like “real” breasts. And with any luck, I’ll start feeling real again, too.

It’s my party and I’ll cry if I want to…

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So I spent the last two days trying to take a friend’s advice. “Quit feeling sorry for yourself and write something interesting.” He was a little more tactful than that, but I got the message.

I did try, honest. He even gave me a good jumping-off point: my original mission statement for the Situational Midwifery blog–a soapbox about things encountered as a midwife. The things that piss me off about women’s health care. About how nothing has changed much under the sun. How women and their problems are often blamed for, well, women and their problems.

I’ve got half a lifetime’s worth of subject matter, but right now that’s not not exactly what’s rising to the top. Go ahead and look forward to future harangues, but for now they’ll be about my own stuff.

Participation is optional. Nobody is required to read a blog. I haven’t been a professional writer for more than half a lifetime now, so for all I know, it’s crap. Or it’s crap to men, or it’s crap to folks who haven’t faced something similar. I’m ashamed to say I’m one of those. I got so tired of my mother’s crying jags and worries and photos of grotesque surgeries that I was nowhere near as sympathetic as I might have been. At 15 years old. So I understand that point of view, too.

So read on, or not. Part of what I’m learning these days is to stand up for myself. My friend has given me yet another opportunity to do so, even though I’m afraid he’ll take this the wrong way. If I never hear from him again my husband (who loves this guy), will be really pissed. Then I’ve got two problems.

Sh*t.

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I hate having meltdowns. So I had two on Sunday. Sort of because my neck was killing me and Tylenol doesn’t cut it. And the chiropractor wasn’t in (lazy sod).  Retaliated by eating three ice cream bars. That helped. Then I got proactive and watched “Mastectomy and You”–the DVD my surgeon assigned. Like I get brownie points for  writing a book report. Or returning it on time. Like the stupid thing’s gonna help.

Should have been more protective of my mushy mind. Choose one source of information and stick to it, I say to my patients. Do I take my own advice? Noooo. The DVD pics bear little resemblance to the ones the plastic surgeon showed me. Not that they’re so bad, they’re just not so good, either. Hence the meltdown.

I swore I wouldn’t cry. Years ago Mom cried enough for both of us, wasting months wailing about which lifesaving procedure would, in fact, save her life. That she had months to waste should have been a clue. Her diagnosis was DCIS–now considered a high-risk precursor, but not cancer itself. Eligible for lumpectomy. In the 70s they didn’t know that and didn’t seriously offer anything other than modified or radical mastectomy. Didn’t offer reconstruction, much, either. If they did, it wasn’t until years after treatment, once survival was pretty much guaranteed. The fear was that reconstructed tissue and thick scarring might make a deep recurrence nearly impossible to see. Misogyny and concern rolled into a tight little bundle. And utterly believable as far as my mom was concerned. Lop off her breasts and replace them with something that could moot the whole point? No thanks.

Lord knows things have changed, and I’m grateful for it. Scoop out the offending bits and deal with the rest later. Unseen recurrence? Not likely. Leave the hospital with something that hurts, but pokes out instead of in? Priceless.

Mom and I were different in lots of ways. I guess every one of us is. After seeing those godawful mastectomy scars every day after my 15th year, the decision was made loooong before I was ever diagnosed. My best friend got leukemia. Possibly an infinitely worse diagnosis than mine. Ended up with stem cells, a stroke and a bald head. She rocked that look. Mom and her concave chest? Not so much. My aunt (her younger sister) didn’t even want to try it. Diagnosed two different times, she was stuck with two different reconstructions because silicone wasn’t on offer the first time. Her words to me? “Just do it.” No matter what the technique, just do it.

And her advice, I’ll take.

Hot diggity!

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Wow. I didn’t expect to be giddy with relief after the surgeon’s appointment today. Like Cinderella at the ball. Or Dorothy home in Kansas.

The three page birth plan is back in force. There will likely be no chemo. And probably no radiation. My hair won’t fall out and my skin won’t peel off. I won’t feel like I’m dying in the midst of “treatment.” Nobody batted an eye at my request for skin-sparing bilateral simple mastectomies and immediate reconstruction (the first steps of it, anyhow). The incisions are small, and the procedures will be done by folks I trust. All my externals will be left as they are–maybe even with some sensation. My friend Michelle just messaged me about the “awesome new rack” I’ll get for my troubles. LOL. I’ll be happy with just short of normal.

All the arcane testing done on my cells says they haven’t gone nearly as awry as “invasive” breast cancer implies. Chemo won’t work on “non-HER-2 expressors.” Or those with a “low Ki-67 proliferative rate.” Am I the only living woman with an urge to thank an under-acheiving cancer mutation? Mom viewed my decision to become a nurse as evidence of mediocrity. Well, hoo-yah!

We shall see. The above changes if it turns out some pesky cancer snuck into my lymph nodes. That will be determined with surgery and could require radiation. But by then I’ll have the expanders-soon-to-be-implants (yay silicone), and there’ll be no going back.

…I got to reading that last sentence, and realize there are friends and patients I know who’ve had a terrible time with aggressive cancers and all the misery chemo implies, as well as postoperative complications that require going back to the beginning and starting all over again. In the face of all that, my giddiness may well feel selfish and downright insensitive. I apologize. I’m enjoying the moment, though, and trust you don’t begrudge me that.

Not what I thought it would be…

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So I thought I’d be posting about midwife stuff.

Instead, I’m bawling into a wad of Kleenex after the second of what’s going to be a whole series of breast biopsies. Not that this is anything new. I’ve had cysts aspirated and densities sampled, and ultrasounds and mammograms–all in excess of the usual surveillance undertaken by good girls. Hey, I’m in the business. I don’t believe in the talismanic properties of medical tests, but I do them anyway.

This time seems different. Had the mammogram and got called back for more. Nothing unusual about that; it happens every time. I don’t even bring my husband these days. Then I was told I needed a fine needle aspiration. Still not alarming. But it must not be too fine a needle, as the radiologist left behind a titanium marker shaped like the stupid pink breast cancer bow. I didn’t get a vote, he just showed me the pictures and there it was: bow marks the spot.

Sitting with a cold pack on biopsy site. You can see how upset my dog, Buddy, is. There are angels among us, I tell you.

Sitting with a cold pack on biopsy site. You can see how upset my dog, Buddy, is. There are angels among us, I tell you.

Only it didn’t. Missed it by an inch. The Area Of Interest is deep, so I get invited to do a stereotactic biopsy. This one’s like being in a weird sex film–I’m face down, utterly helpless, boob dangling though a hole with people I can’t see sticking needles in it. And my husband’s in the next room (ok, I chickened out and brought him this time). There’s nobody to hold my hand. The technologist presses on my back, but I get the feeling it’s more about keeping me still than for comfort. It’s embarrassing because because I can’t breathe when I’m on my stomach. I’m snuffling and snorting, trying to keep the table dry, and they think I’m losing it–which I mostly only do in private.

So this time the marker’s in the right place. I don’t notice if it’s shaped like a bow or a bunny or what, because I’m riveted to the screen. Dunno why we bother with mammograms when there’s this kind of imaging. It clearly shows a mass. Not the “density” they’ve been whispering about, but a real mass. The radiologist calls it “very concerning.” It has spiky edges. The crablike kind that gives cancer its name.

Nobody says cancer yet (and if they keep not saying cancer I’m gonna be really embarrassed about this meltdown), but they want me back for another stereotactic hoo-haw the day after tomorrow. This time to sample smaller bright spots around the big spot. Everybody’s being very kind, very attentive, very professional. And I’d sooner stick my head in a toilet than step through their doors again. But guess what? I’ll be there Thursday morning, bright and early. Leaving the bells at home.

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I’m a midwife who’s been up all night for most of the last 30 years. Before that, I was editor of a small town newspaper. I left that job swearing I’d never face another 3 am deadline. Now I’m thinking what I really needed was a good night’s sleep. (And they say the definition of insanity is doing the same thing over and over, expecting a different result.)

But I miss writing, so I’ve decided to launch a blog to record some of the brain activity that occurs between naps. I’m a little worried about exposing my tender underbelly to the pointy public, but have decided to dive in and see how we all get along.

This page will be where I get on my soapbox about things I encounter as a midwife and women’s health nurse practitioner.

Some ideas:

  • HPV vaccine & parents who disapprove
  • Waterbirth. I do it, but it ain’t natural.
  • Birth plans. And staying flexible.