Thursday, October 30, 2008

love and sugar

The highlight of last Friday's Normal Labour and Birth class was the pelvimetry practice session in the afternoon, in which H and I learned the curves and projections and ligaments and musculature of each other's pelvises (technically, pelves), screeching with laughter all the way as she manipulated my coccyx with her gloved finger and all I could feel was a bizarre, enormously ticklish jiggling around in my bottom...

I am pleased to say that I have a "beautiful pelvis for childbirth", according to H's thorough evaluations, even though we all know that the best pelvimeter is actually the baby's head. In other words, there is
no way of knowing how 'roomy' a woman's 'outlet' is until she actually gives birth (mostly because of the influence of relaxin, a delightful hormone that softens ligaments in pregnancy and renders the pelvic bones considerably more moveable than they would otherwise be). That is why you will probably never hear a midwife tell a pregnant woman that she looks 'too small' to give birth naturally. A travesty!

On Saturday, I watched
W., an Oliver Stone film (peppered with Stone's extraordinary trademark dream sequences) about the life and presidency of George junior, and then headed out at night with some friends to dance and hang out at the White Heart in Portland. On Sunday, I ate otherworldly fries, cooked in duck fat, at the appropriately named Duck Fat restaurant on Middle Street. They were beyond words; defied description. In the evening, I tried to concentrate on my A&P homework (on the immune system). Eventually, I prevailed, and with schoolwork tidily completed, it was time to go home to make tomato-mozzarella pasta and chickpea salad.

Monday brought an interminably long day of A&P class, which had us yawning, dozing, and silently begging for mercy by 4pm. We'd much rather have been in Prenatal class, or Labour and Birth, where things are far juicier and closer to the bone. Having said that, I did make an impassioned speech to the class during tea break on Monday, that we could all perhaps enjoy A&P more if we approached it from the perspective of total awe for the incredible human body that we are studying, whose workings are unfathomable even when they are patently described for us on the page. Of course, they rolled their eyes at me...
bloody nerd!

On Tuesday morning, I hung out at a coffee shop with H and C, researching hypothyroidism in pregnancy on the 'net while they did their readings for the next installment of Labour and Birth. We figured we'd motivate each other by studying 'together' (i.e. pursuing our own individual ends, but at the same table). It worked.

By Tuesday evening, the soreness
from a heavy session of lifting weights on Monday night had set in, and I had to wuss out of a planned 5-mile run around the Back Cove. Instead? Indiana Jones on DVD. (Don't look at me like that.)

Three of my 'sisters' and I practised pelvic exams on each other yesterday morning at C's place, simply because we need as much practice as we can get, and because we feel so at ease with each other that the whole experience is actually enjoyable, rather than just something that needs to get done. In the afternoon, I was introduced to an amazing little deli by my friend B, who bought me a cappuccino and gave me a tour of the store's remarkable organic chocolate section. We had a much-needed, sweet and intimate catch-up talk, in the true spirit of holding the space for each other through difficult times (hers rather than mine, yesterday at least).


This morning I faced Skills Practice Day with buckwheat-maple pancakes in my belly. We went over counting foetal heart tones, Leopold's manoeuvres, assessing oedema, taking vitals, charting, and the like. Tomorrow heralds a Normal Labour and Birth class.

I went for a scenic run to the lake with K and proceeded to polish off more than a handful of homemade muesli cookies when we returned home (for I am not made of stone...), so with a brain made entirely fuzzy by sugar, I must now attempt to read a couple of chapters of Anne Frye's legendary purple tome,
Holistic Midwifery Volume II. Sweet life, no?

Thursday, October 23, 2008

meat and taters

Last Friday, I wrote another A&P exam in the morning (which went smoothly) and then spent my lunch-hour writing a short book report on Janet Balaskas' Active Birth manifesto (which has been in print for a quarter-century now) for book club that afternoon. After class, I hitched a pleasant ride with J and her dog to Portland. On Saturday morning, I hit the Back Cove for a hard run (only 4 miles, but a chest-wheezingly fast 4 miles). In the afternoon, I saw Brunswick for the first time, and hung out at a cute coffee shop called The Little Dog. I enlisted the help of a friend who is an expert at seeking out good used-car deals, and she helped me dig through Uncle Henry's guide in search of a decent Subaru. We eventually pulled out the notebook PC and surfed Craigslist to broaden our search, and came up with a few good leads. I still haven't actually bought a car, but I am much wiser for having had that brief-but-thorough education on the perils and pitfalls of used-car buying in the United States.

Later that afternoon, I slipped an enormous batch of lasagne into the oven. I'd been scheming to cook something hearty for C and W's potluck dinner that evening. The six blocks to their place were traversed that evening with a dish of steaming lasagne in one hand and a large bottle of Californian organic shiraz in the other. My various student-midwife friends brought their 'bits of fluff' (C's word for 'boyfriends', which she employed when urging us to bring our menfolk along on her potluck invite), and we all had a cracking good time.

On Sunday, I was on the far outskirts of Brunswick, walking through a friend's vine-tangled orchard surrounded by woods. I was mesmerised by the golden-yellow splotches clinging to the trees in the dappled sunlight, and the crunch of drying Fall leaves and pine needles underfoot. I spent the afternoon in Litchfield with a friend's family. They have a simple life in the country with a menagerie of animals and a glistening vegetable garden. I was shown how to wield an axe properly and to split a few logs, and then fed the horses while a heart-achingly cute miniature goat called Easter looked on. We all feasted on Maine lobster, melted butter, wholegrain bread from the Black Crow Bakery down the lane, and Shipyard Pumpkin Ale.

On Monday, it was time for our Physical Assessment class to get started. We discussed breast exams and pelvic exams in the morning, then practised them on each other in the afternoon. I and my friend H paired up for the pelvic exam, which we conducted respectfully and sweetly on each other. That evening, she drove me back to Portland so I could spend Tuesday and Wednesday hanging out in the 'big city' and trying to get some studying done for our Normal Prenatal exam this morning (i.e. Thursday). H and C and I spent time together at C's place early on Tuesday morning, creating a womb-like space of womanliness in which we could continue to practise Pap smears and bimanual examinations of the uterus and ovaries on each other at our own pace, with plenty of feedback and also room for making 'mistakes' and then correcting them in partnership with each other. I came away from that morning's session feeling enormously better about my practical skills, and about my capacity to interact with women in a sensitive way as a midwife, while honouring their autonomy and their right to know things (and be curious about) their own bodies and what healthcare providers are doing to them. I was supposed to finish two assignments on Wednesday, which only got done during the lunch break
today because I was too preoccupied with wondering around Portland, hanging out in its wonderful bookstores, eating a leisurely lunch at an organic café, talking to my darling friend N on the phone for an hour and a half in the afternoon (which was glorious, and ridiculously overdue), and surfing midwifery sites on the internet afterward. I got my best work done in the evening, when I earnestly stuck my nose in my books for an extended period before bedtime.

Today, we learnt the art of palpating a bellyful of baby (Leopold's Manoeuvres of abdominal palpation, for those who care to know), and measuring fundal height. In two weeks' time, we shall have
real (yes, real!) bellies to feel and learn from.

Tomorrow heralds the start of Normal Labour and Birth, yet another juicy course on offer at Birthwise, with the irresistible promise -- to all those participating -- of challenging homework, accompanied by a rapidly growing practical-skills base, and a long-awaited chance to chew on the meat-and-potatoes of midwifery work. Not long now before I'm a-catching babies, y'all...

Thursday, October 16, 2008

old orchard beach

wingspread

Last Thursday, I had a day of Normal Prenatal (including an exam), and the following is a rough outline of what we covered: informed choice for midwifery care and home birth; confidentiality and legal issues; charting/documentation; medical abbreviations used in midwifery; creating prenatal testing checklists for our own practices; medical/surgical/gynaecological history-taking; and how to conduct the first visit with a midwifery client (a.k.a. the consult visit). Of course, we cover all these topics in various other contexts, i.e. other classes, or in general discussion, or just in the business of practising our skills or doing our homework assignments, so it's not as though we spend just one class during our entire midwifery education discussing 'legal issues', or 'charting', and never grapple with those topics again. This is, after all, what we do -- we are becoming midwives, and if there's something a midwife needs to know, she needs to know it all the time (in other words, she needs to have that knowledge accessible all of time), not just for the purposes of passing an exam (only to lose her hold on that knowledge shortly thereafter). And in that respect alone, never mind all the others, this process of acquiring the skills and knowledge of a midwife is already completely distinct from any other formal education I've had in my life.

My hands are learning what it means to be a midwife; my toes are beginning to tap to the rhythm of foetal heart tones; my brain is making neural networks that will help me make solid clinical decisions when I need to; my heart is opening to the nature of the relationship between midwife and motherbaby.

On Friday, I had an A&P class in the morning, during which I delivered my research presentation on the physiology of blood clotting (how it works and why it fails sometimes). It went smoothly; and we spent the rest of the morning reviewing meiosis, spermatogenesis, haematopoiesis, and other things ending in "sis", as it would appear...

Three hours of Normal Prenatal stretched before me on Friday afternoon, which passed quickly and painlessly (indeed, happily) in discussion about routine initial prenatal testing, performing urinalysis, antibody screening, and various other aspects of diagnostic testing during pregnancy. All the while, I feel my grasp on things becoming more secure, my ease with the jargon (and better still -- my ease with that jargon's
real application to real situations) growing slowly and steadily. It's a wonderful feeling, and keeps back whatever doubts fleetingly appear about how I'm ever going to cope as an actual, bona fide midwife.

Later on Friday afternoon, we practised venipuncture on each other for a half-hour and I was hurt by a sister-student with admirable determination but hands made shaky by adrenaline. I shrugged it off, because that's part of the dance, and we're learning the steps. Nonetheless, the structural integrity of my median vein was compromised, and I tenderly nursed a blue-black puncture wound for the weekend that followed.

Shortly after the Needle Incident, I grabbed my weekend bag and my guitar and hitched an hour-long ride to Portland, made far shorter by sweet chatting and hearty guffawing with my friend C. In the evening, I had a delightful walk through the city in the crisp air (who needs a car, anyway?) and, having worked up an appetite, I ate pork confit and Tuscan beans with kale and pancetta for dinner. The only thing that could conceivably accompany such a fantastic meal was a woody, violet Sicilian merlot. Yikes, so damn
bourgeois...

Saturday - finally, Indian Summer! There was a rare and breathtaking wave of warmth over chilly southern Maine. Breakfast was buckwheat pancakes with raspberries and maple syrup, after which I rustily strummed my guitar for a bit. In the afternoon, a trip to Bradbury Mountain State Park, near Freeport, was in order. Once there, I ascended the incline at a leisurely pace through damp and mushroomy woods to a flattened rock balcony, from which I could see all the way back to Portland through an almost uninterrupted forest of extraordinary Fall foliage.

Sunday brought more exquisite, short-sleeved weather and a glorious breakfast at Portland's legendary Good Egg café, and yes -- they do make good eggs. And good oatmeal-molasses toast. In the afternoon, all I wanted to do was run and make merry and pet other people's dogs and smile at babies and walk and play along the shore at Old Orchard Beach. On Monday morning, the sea smell lingered on my skin.


On Monday, our classes for Physical Assessment began, and we launched right into taking blood pressure readings, and listening to heart/lung sounds, and palpating each other's abdomens, and asking our teacher (a naturopathic physician) a million questions about why we couldn't get the opthalmoscope to light up properly, or whether this 'lump' we felt on a friend's back was normal, or why the thyroid gland took the shape of a butterfly under our fingers. Can you tell how thrilled I am to be doing
hands-on stuff at last?! I'm grinning.

Tuesday and yesterday were spent getting through my rather ridiculously overwhelming load of homework. I took a long run through the Back Cove yesterday evening (although the irrational but crime-hardened South African girl in me was shrieking inwardly,
"How can I be outside, in the dark, running through thick trees, at this hour?"). Dinner (Thai red curry) was cooked on a runner's high. Sweet.

Today brought more Normal Prenatal, with a lesson on how to find and count foetal heart tones, among many other wonderful things. It's a quiet evening in Bridgton, and I'm about to settle down to study for an A&P exam tomorrow morning. Feeling good.

Wednesday, October 8, 2008

chrysalis

To keep things fairly simple, since I have an exam coming up for Normal Postnatal tomorrow -- behold the neat brevity (or rather, the failed attempt at brevity) that is my numbered list below.

The Week (in Brief) Since Last Thursday's Post:

1) Friday: I had Group Process with my sister-students in the morning. This time together is intended to help us explore our inter-personal and group dynamics outside of the normal, structured class hours. In the afternoon, I took an elective course on how to write reviews of midwifery-related literature for the purposes of publication.

2) Friday early evening: I settled down for two hours to study haemotology (= blood) and finish up the relevant pages of my A&P workbook so that I wouldn't have to worry about that over the weekend.

3) Friday late evening: Ah, the cacophony of 6 chuckling student midwives, all crammed into a tiny kitchen scented with the steam of cinnamon-spice tea and turkey chili on the stovetop.

4) Saturday: Hung out in Portland, finally getting a chance to explore the city (having only been through there twice before, either coming out of the airport or travelling via Portland into New Hampshire with K). Brunch was an omelette and blueberry pancakes at the water's edge, and then a walk along part of Casco Bay in the afternoon. It was worth stopping to watch the boats on the water from the Eastern Promenade, its hilltop punctuated with majestic old sea-captains' homes. That evening, friends kept my glass topped up with organic merlot and my belly full of Thai red curry and vanilla/dark chocolate brownies. We spent a toe-chilling hour outside at a bar after dinner, discussing politics and film and my friend A's job (she is an elementary-school teacher who works with developmentally delayed children).

5) Sunday: I woke up ridiculously early to be chauffeured back to Bridgton (an hour away from Portland) by 7am since the kind person giving me a ride needed to make it to a family outing to climb Mt Washington (the highest peak in the northeastern United States). I immediately went to bed and slept for two more hours. After I woke up, it was time to launch myself into researching the mechanism of blood clotting, which is way more complicated than I thought it'd be, to prepare for a class presentation this week. I finished an informed choice document for my future clients about Hepatitis C screening during pregnancy, and also took care of a large section of my A&P workbook on the reproductive system. I was more than exhausted by day's end.

6) Monday: Spent the day in an A&P class, which concluded with an exam on the nervous system, and all the muscles and bones of the body (particularly those of the pelvis, for obvious reasons). I felt very comfortable throughout the test, although my grade will be the final telling of how comfortable that really was...

7) Tuesday: On the one hand, I needed a mental rest; on the other, I needed physical activity. So -- I headed to B's apartment for our usual tea-date on Tuesday mornings, and she guided us both through some energising yoga postures. In the afternoon, I organised my room (needed to get to grips with a heap of school papers and a growing pile of 'homeless' clothes on the floor) and cooked myself a nourishing lunch before heading out to the gym to face a loaded Olympic bar for my half-hour series of squats and deadlifts. The so-called runner's high doesn't even come close to a powerlifter's elation -- apologies to my tarmac-pounding friends.

8) Wednesday: I discovered early this morning, via a note from P, that my beautiful friend N had given birth to her son in Johannesburg on October 6th (at around the same time as I was finishing off my anatomy exam, I later calculated). I'd last heard from N on Monday via another of her characteristically wonderful emails, in which she'd said she thought her boy would be making his way into our earthly dimension fairly soon. But in the frenzy of my week, I'd been lax about checking Facebook for updates, and understandably hadn't heard anything else by phone or email while she'd been labouring, so I figure I was one of the last in her circle to hear the incredible news that E had been born. I, of course, am ecstatic for her.

It does make me feel all the more disconnected from everything back home, knowing how far away I am in terms of actual distance but also that I've unintentionally isolated myself from some of my best friends in Jo'burg over the past two weeks, particularly. It's nobody's fault, it just is. I have thrown myself with fire and energy and abandon into my life here in New England -- and the connections I made in South Africa have hardly been severed, of course, but they are stretched more than usual and it's a struggle for me to pick up the slack sometimes.

But that is all blah, blah, blah -- because there is something more important to say! There is a new person in the world! A delicious, demanding, tiny human, a dewy young changeling who is opening his eyes on a loving family every time he wakes up. This is another victory for woman-centric childbirth, for the precious institution of the family, for the profession of midwifery, and no doubt a personal triumph for the magnificent birthing mama, whom I love with all my heart. Congratulations to you!

Thursday, October 2, 2008

days of awe*

All is well here in Bridgton, the land of falling leaves. I performed a phlebotomy (otherwise known as venipuncture) for the first time in my life this afternoon, and it went remarkably well. We had a full day of class, Normal Prenatal, concentrating on embryology, and then spent a couple of hours in the afternoon learning how to draw blood. We practised on dummy arms (complete with plastic veins) using vacutainer tubes and ridiculously scary-looking needles -- and keep in mind that I am most defiantly NOT afraid of needles or anything of the sort -- before we had built up sufficient courage to practise on each other. A delightful friend and classmate, to whom I am humbly grateful, offered up her antecubital fossa (the somewhat vulnerable part of the inner arm opposite to the elbow) for the betterment of my education. I explained to her what I was going to do, as though she were a pregnant client of mine, then told her she'd feel a "pinch" but that I'd try not to break her heart. And indeed, I got the vein, first time, and when I clicked the vacutainer tube into place, I watched in astonishment as blood quickly began to flow into it. Deep crimson vein-blood... and the flushed cheeks of success!

I spent Monday evening laughing and feasting with my girlfriends in celebration of Rosh Hashanah (and only one of us is actually Jewish). We ate veggie soup and stoneground bread and kale salad and apple cake, with yet more apples afterward (dipped in honey), as we passed a bowl around and each took a moment to share with our friends the highlights from the past year, and our intentions and wishes for the year to come. As I dipped my toothsome apple slice into the bowl of runny orange-blossom honey, I expressed gratitude for the amazing women I call my friends here, for all my friends back home, and for the friends I've yet to meet. For me, many things have happened over the past year that first seemed like disasters, like things I wasn't fully prepared for, or happenings that -- in my view -- really
shouldn't have happened. But as I ate my sweet tidbit (for a sweet new year), I shared out loud that so many 'disasters' have turned out to be extraordinary chances for growth, for getting real, for finding new ways to open up to honesty -- in the sense of living an honest life, in an open-hearted relationship with oneself and other people too. And by that, I also mean, not pretending my way into creating a totally different reality than the one that exists. And so -- my intention for the year is to remember this sweet realisation when I'm going about my daily activities and interactions.

My life really is full of these juicy moments of human connection. And so far, those moments have revolved almost exclusively around women! Lately, there's been a dearth of in-person interactions with the Masculine, although I get plenty of exposure to healthy male energy in my communications with P and with other friends (like I and S) back home. I am coming to terms with the fact that what I have with P, painfully, is a friendship; a treasured, precious, crystalline thing that we tend gently and tentatively, and dust off occasionally, and leave out in the sun to catch the light from time to time.

These days, I'm just in total awe of the quirkiness and bounty of the universe. The days of folding inward are morphing, like the New England trees bursting into fire-streaked Fall colours outside my window, into days of unfurling and leaping and living.

Days of awe indeed.


* Rosh Hashanah is the first of the High Holidays or Yamim Noraim ("Days of Awe"), which are days specifically set aside to focus on repentance that conclude with the holiday of Yom Kippur. Rosh Hashanah is the start of the civil year in the Hebrew calendar. It is the new year for people, animals, and legal contracts. Rosh Hashanah commemorates the creation of man whereas five days earlier, on 25 of Elul, marks the first day of creation.