Tag Archives: Midwifery

The new normal? Maybe.

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OK, Colin (you know who you are). I’m back on the midwifery soapbox. Sort of. I got asked to write a blog about water birth for a hospital site. I kept the property rights, so it’s posted below in all its restrained glory.

Yes, I looked for a picture of lemmings leaping to their deaths, but never once mentioned that women in their thousands do not jump into the Bering Sea in the throes of active labor.

Except for those really staunch Russian women who do so in their threes (they were featured on a website years ago). They can probably be  seen across the Bering Strait by that gal who knows how to field dress a moose. She has a bunch of kids–wonder if she’s got “giving birth in the Bering Sea” on her resume.

I’ve been known to remind people (especially people with a medical reason for not being able to have one) that water birth ain’t natural. We haven’t done it for thousands of years and we’re not going back to our roots when we do them. An epidural can be more natural than water birth. (Especially those where they let the baby float around under water for minutes and minutes and hours. Forgive me. I’m just not that groovy.)

But boy oh boy, a tub full of warm water is a great thing for relieving pain if you’re not having an epidural, and when a baby comes out without much fuss (either way) there’s nothing better. Housekeeping thinks so too, as they wash the evidence down the drain. Epidural births happen on the bed, so housekeeping hopes the midwife’s good at mopping up all that stuff.

I’ll never forget the first days of trying to provide a “birth pool” in any of the hospital rooms where women wanted them. A doula (bless her long-suffering heart) would bring in this huge, inflatable tub and start it filling. Hopefully before the baby came or the water heater gave up.

There were plenty of times the water wasn’t ready, or the woman wasn’t ready, or the fitted top didn’t fit and the water got cold. And I’ll never forget the time a woman had a death grip on my hands, her feet braced against the tub, and super-human strength that was going to pull me head-first to my death. Yep, just like a lemming.

To save myself, I sat my butt on the floor, braced my feet against hers through the side of that squishy, ridiculous tub, and congratulated myself on cheating death. Next thing I knew, my pull exceeded her pull, and she and all those hundreds of gallons of water landed in my lap. Nobody drowned, and we were laughing SO hard that the baby flew out. Also into my lap.

I don’t have any kids, but am considered a mother many times over in the Biblical sense because of events like these. If you don’t believe me, just see Genesis 30:3. In the Tanakh Translation the barren Rachel says: “…that she may bear on my knees and that through her I too may have children.” Lovely.

And neither Rachel, her maidservant Bilhah, nor the benighted Leah were concerned with whether or not their babies were born in water. They just wanted them. And wanted them safe. Which is what my blog for the hospital tries to get across in “Waterbirth and Plan C“:

https://www.dropbox.com/s/htjui7t4ue1zkv7/Waterbirthand….pdf

If the stoopid link doesn’t work, go down to the Blogroll at the bottom. It does. Sometimes.

In the manner of my people…

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OK. So I said I wasn’t angry. I’ll take that back now. But being pissed off has got nothing to do with breast cancer. At least nothing wherein I can prove causation and sue people, anyhow.

Those of you close enough to hear me whine have heard about my second (yes, second) IRS audit. The Word came down just about the time I learned the breasts were history, so aside from falling apart that day, I didn’t pay much attention. Kinda like with a second pregnancy. You know what’s coming, that it’s gonna hurt like hell, cost a lot of money, and not necessarily turn out well.

The first time, being rank amateurs, we hired a tax attorney. Ended up paying him $4,000 to prove we didn’t owe the gov $8,000. The thing dragged on forever, and the attorney drove me f*ing nuts. I drove my husband likewise, I’m sure.

After dis- and reassembling the entire tax return (my work, not the $4,000 attorney’s), the man had a 5 inch thick binder stuffed with every bit of documentation I could find. He was very proud. And we ended up proving we hadn’t shorted the government a dime, though the woman reviewing us made noises about attaching a penalty for “messiness.”

Yeah. I’m a midwife, not an accountant, and I’m the daughter of both an artist and a mathematician. That’s a messy combination right there, so maybe the woman had a point. But she couldn’t make it stick.

Since then, I quit using “tax professionals” for the annual sacrifice. I knew it would come to another audit, someday, since the stuff we claim hasn’t had a reason to change. I also knew it wouldn’t make any difference to involve a third party in the deal. Instead, I bought the “audit defense” service that’s optional with most of the computerized tax programs. These guarantee you won’t get fined for messiness because they type things nicely and their math is perfect. And the poor sod being audited never has to come face to face with the nasty IRS. That’s the REAL deal. Especially when you’re post-mastectomy with a funny looking chest nobody can stop trying not to look at.

So far, so good, except when I couldn’t answer the phone & talk to the audit defender right after surgery, he got feeling sorry for me. Which means he didn’t call again. Which means that a couple days ago he did call, in a panic because his manager noticed there’d been no activity on my account. So now, suddenly, there’s a five day deadline. Not an IRS deadline, but a third party deadline (as they’d surely love it if I default and they can keep our $79.00, avoid the work, and say they’ve discontinued service for noncompliance).

What to do, what to do?

The gov’ment says they want $10,000 this time. Roughly $6,000 of that is what they say I underpaid. The rest is interest and penalties. Some of which are for–you guessed it–messiness.

Yanno, I think I’m just gonna pay the so-and-so’s. Via a payment plan. Over two or three or four years. I’d be nuts to ruin my recovery (some people go to ANY lengths for time off, doncha know). And nuttier still to go through the next surgery with this Great Matter unresolved. Or miss the impromptu family reunion my Canadian cousins have put together in the next little while.

If I get feeling better, and feistier, I can always re-submit the whole damn return. Which is basically what I did during the first audit.

Maybe Zoro will come to my rescue.

Maybe the letter I wrote President Obama (like he’ll ever see it) will bear fruit.

Nah. I don’t need to prove anything. I can pay yet another bill. Or not. Think they’d try to extradite me over $10,000? I’m just not going to worry my poor little head about it. The spouse will get on the phone tomorrow morning & use his best spouse voice to snag the best pay-the-IRS-$10,000-over-time deal.

My dad, looking on from above, will approve. And that’s what’s really important.

P.S. My parents were audited 7 times. And my dad, being an artist, had a messy room.

P.P.S. My mother, my dad’s sister, and my mom’s sister (twice), had breast cancer.

These things I do in the manner of my people.

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.

Late night thoughts…

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Lewis Thomas had his, prompted by Mahler’s 9th Symphony. And I’ve got mine, though none so lofty. Mine are like: Geez–nobody looked up Amazon (previous post). Everybody’s so freaked by the damned disease that they’re going to go through life thinking Amazon mostly means

  • an online bookstore
  • a river in South America
  • a big green parrot in South America
  • mythical female warriors who lopped off a breast the better to draw a bow

Actually, if you remembered the last one from 8th grade history, you’re close to being right. Amazon translates “without breasts” from the Greek. I only know this because I’m freaked by the damned disease too, and that piece of trivia came up early in my internet wanderings. I have no idea why it seems important tonight.

My dear friend took me to lunch yesterday. She’s so emotionally intelligent, anyone lucky enough to be her patient is really lucky. She asks things like, “what do you want to have happen?” and “what scares you?” Like she’s not afraid to hear the answers. Like if I don’t know, maybe she’s got some ideas. Or maybe not. But that’s ok, because at least she thought to ask the questions.

On the other hand, I already told folks at the office that I’m not into the whole “cancer journey” thing.

“So how’s YOUR journey going?”

My darling dad, a very private man, was mortified when an enthusiastic greeter at a center for alternative medicine grasped his hands and insisted on defining this “journey” for him. He was supposed to emerge changed: “different, yet somehow better” than before cancer. Actually, he was dying. He knew it, and he hated it. As was his right. As is mine, should it come to that.

And nobody’s shaving any heads. I’ve been put on notice by my friend Pam that she’s sure as hell not gonna be bald just because I get that way. I still have a niggling hope that I won’t be. My dad used a cold cap during chemo infusions, though his oncologist scoffed. But he kept his hair. A friend who was a cancer nurse introduced the idea, said she’d seen great success with it among patients at Cedars Sinai. Well, I’m wildly enthusiastic about the possibility of keeping some hair, even if the evidence-based-medicine Grinch won’t support it.

Oh.

Please.

There will be no talk of making plaster casts. None whatsoever. Pregnant bellies are fine in this medium. Old boobs are not.

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.

Empowered Blogger  

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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.