Home Sick

Well, so much for my second call shift. Last night I got a wicked case of food poisoning (no, I didn’t eat any Sabra hummus, thank goodness!), so I’m home today recuperating…which, honestly, is kind of a relief. I’ve been up at 5:30 every morning since last Saturday, and people, no matter how excited I am about the thought of maybe catching a baby, I am not a morning person.

Anyway. Being home for the day gives me a chance to catch up on other things, like napping…and working on a case study for my intrapartum seminar where I’ll present my first birth. I took out some yarn this morning to practice my one-handed knots and instrument ties. I’ve also been reading various articles I’ve been tagging from our intrapartum reading list (transfusion protocols! laceration repair! intermitten auscultation! prolonged second stage!). I’ve also been enjoying Feminist Midwife’s newest blog series on Famous Midwives. 

Sadly, this morning I had time to catch up on the news, which left me fuming about the injustices faced by African-Americans in our country every day. When will I stop reading about another black man shot and killed by the police for no good reason?

I also took the time to call my senators, asking one and thanking the other for their support of an amendment to the Child Citizenship Act of 2000. The amendment would close a loophole that prevents some adult adoptees from receiving US citizenship because their adoptive parents failed to secure it for them, and would also eliminate their risk of deportation back to a country that they do not know.

Adam Crasper’s case has been on my mind and heart lately…he just had a hearing with the ICE to review his case, and I am crossing all my fingers that is not deported and separted from his wife and children.  Consider taking five minutes to call your senators, it could change people’s lives. As an adoptee myself, I can’t imagine living with the knowledge that every day, I could face deportation simply because my parents’ and/or the adoption agency they used failed to ensure my legal right to be here. 

Catch!

This past week has been a flurry of firsts: first time practicing knot-tying and suturing, first time doing postpartum rounds, and first catch! Yes, that’s right, I had the incredible honor of catching my first baby as a student nurse-midwife this past week.

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I was processing the experience with a friend of mine who’s also a midwife and all I could really say was how struck I was by the simultaneous extraordinariness and ordinariness of the experience at the same time. It was a smooth, uncomplicated delivery, perfect for a first catch. As always, I caught my breath at that moment when the baby crowned and we got to see her face for the first time…and yet…there was no feeling of overwhelm for me afterwards. There was just a feeling of inner stillness and calm.

For a brief moment, I wondered if I had become immune to the magic of birth already: was I already getting bored? But no, what I realized was that I have been to enough births that I can sit in that space of calmness about it…and that I can rest 100% assured that I am called to this work. Even though my hands felt a bit awkward, and I wasn’t really sure how much cord traction was necessary, and I struggled to come up with a wild guess on the EBL, there was no doubt in my mind that I was supposed to be there in that moment, catching that baby.

This is what I am meant to do with my life, and the feeling of “ordinariness” was feeling that sense of alignment that I have been waiting for my entire life.

I know that there are more complicated, challenging experiences for me coming down the pike, experiences that will make me question my skill, my clinical judgment, whether I am called to this work. I hope that I can remember the feeling from that first catch, and from my week of doing postpartum rounds. It’s a feeling of deep satisfaction. I love that I get to talk about birth and families and contraception and transitions and transformation and healing…all in a day’s work.

Can’t wait to get back on the unit tomorrow for another 12 hour call shift. Who knows that tomorrow will bring?

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Unexpected

Each twelve-week term of school that rolls by offers its gifts of unexpected moments, slowly shaping the midwife I am becoming. Sure, they don’t always feel like gifts at the time. I have been pushed, pulled, and stretched in a million different directions during this wild journey.

Sometimes these moments are surprisingly delightful—that thrill of witnessing a family see their baby on an ultrasound for the first time comes to mind. Of course,  I knew it was a special moment. But to be in the room wearing a “student midwife” badge while a family “meets” their little one for the first time…it sent an unexpected flood of warmth and joy through my whole being that nothing else in the world could possibly have matched.

Other times, the moments are accompanied by dismay or frustration…or just exhaustion. This is a clinical program, after all. The demands are high, and sometimes my patience wears thin.

I thought, having completed five terms of nursing school and one term of midwifery school, that I had developed a good sense of What To Expect. I knew the general workload, the types of readings, how to prep for different types of classes, how to make the most of those first shifts with a new clinical preceptor.

I don’t believe in Fate, per se… but sometimes I have to wonder if the Universe isn’t having a good laugh at us in those moments when we think we’ve got a handle on expectations.

I only say this because this term, right during midterms in week five of the term, I discovered I was five weeks pregnant.

“Discovered” makes it sound like I stumbled across a novel new molecule in the lab previously never before identified, which isn’t quite accurate, since I’m very familiar with the clinical signs and symptoms of pregnancy.  Clearly, I recognized those symptoms early in myself, and in fact was 90% sure I was pregnant even before I peed on the stick. But I certainly wasn’t expecting to be pregnant. Since 2012, I have assumed I was the quite happy owner of a Paragard IUD. Apparently not.

The details of what happened with the IUD aren’t really pertinent here, except to say that the pregnancy was confirmed to be a singleton and intrauterine, not ectopic, and fortunately, I do not have an IUD floating around somewhere in my peritoneum.

Regardless of what happened to my delinquent IUD (I feel compelled to say: rest assured, dear reader, losing one is very rare and despite everything, I still consider it a highly effective form of contraception), here I was, five weeks pregnant in week five of the term. It was very, very early. I had lots of time to sit with this news and consider my options. Despite four years of service as a pregnancy options peer-counselor for Backline, I never expected that I might need options counseling for myself. I expected that any pregnancy I might experience would be meticulously planned. After all, I do live with a software engineer. And I’m an INFJ. And a Capricorn. Did I mention he’s an INTJ and a Taurus? Yeah, we’re methodical, plodding planners over here. Spreadsheets with formulas, the whole nine yards.

This? Well, this was most unexpected.

I still don’t have words to express the flood of emotions from those next two weeks. It felt like time had stopped. Suddenly, I existed in an in-between space where I had to choose between two very different visions of my future. I was vaguely aware that Real Life, with its due dates, quizzes, clinical shifts, etc. continued to flow by…but I wasn’t fully present for any of that during those weeks (HUGE thank you to my cohort for helping me survive those first few weeks!!!).

I thought about my birth mother daily, wondering when she “discovered” she was pregnant and how she sat with that newfound knowledge, how she carried it—and me—in her body in the weeks before she told anybody else. What were her daily thoughts, her worries, her hopes? Did she know right away? Did she know what she was going to do right away? At five weeks pregnant, I strangely felt more connected to her than I ever have in my entire life. I know next to nothing about her story…but now, well, at least now we share the singular experience of an unexpected pregnancy, even if it is more than 30 years apart and with an ocean between us.

I did all the things I offered to Backline callers: I considered the pros and cons, where I saw myself and my husband in five years. I parsed out where my head was versus where my heart. I sat with each of my options, trying them on “like sweaters,” as my friend R. would say.  One day, I would plan to continue the pregnancy and parent. Another, I planned to terminate. The one sweater I didn’t need to try on was the adoption sweater. I didn’t need a day, nor even an hour, to know that wouldn’t be an option for me.

But otherwise, we took our time. We talked a lot and listened deeply. We sat in silence. We vented, we shared our fears and our hopes. I went to work at the abortion clinic on Saturdays like usual and I felt more fiercely than ever before that abortion must remain legal and safe (really, the experience of working in an abortion clinic while pregnant is a post for another day).

In the end, we decided to continue the pregnancy. Even so, it was not a straight-forward decision.

While I love babies, I’ve also spent the better part of 15 years working in some capacity with children from birth through age 12, as either a classroom assistant or teacher. I don’t claim the title of child expert, but I can say with a fair level of confidence that I have a pretty intimate understanding of what we’re about to get into. Parenthood is messy. It’s not always fun. It’s definitely not always cute. I don’t automatically squeal with delight when other people tell me they’re pregnant. Instead I ask them how they’re feeling. I want them to know it’s ok not to feel 100% excited and ready to join the baby-crazed mania of our culture. I want them to feel like they can truly talk about their hopes and their fears, and that it’s ok to have some ambivalence about being pregnant, even after you’ve made the decision.

I am grateful that I have the kind of friends that offer this same safe space for me to explore my own hesitations and ambivalence. It has made all the difference for me this term. I can’t imagine parenting without the kind of community that we have already built for ourselves. I don’t think there’s anything else as crucial to helping you get through the Unexpected Moments of life than a strong community.

So…here’s to the unexpected. Here’s to a wild ride that’s about to get more wild. Here’s to my midwifery education, about to become enriched with a kind of learning I never could have anticipated. And here’s to transformation, with all its potential. Not sure I can say I’m ready, but my seatbelt is fastened.

Full Throttle…into the Fog

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The walk to class each morning from the parking lot down the hill…

We’ve been having some weird weather here lately…lots of dense, heavy fog in the mornings, grey, grey, and more grey…and then in the afternoons, it burns off into blindingly brilliant sunny blue skies. It’s a bit of whiplash, really, to go back and forth between the two, but as someone who thrives on every drop of sun possible in these dark winters, I don’t feel like I should complain too much.

Mostly, I find the current weather a fitting metaphor for my outlook on life in general these days. I vacillate between feeling confident and excited about what I’m learning, to feeling slightly terrified and (almost always) overwhelmed with the sheer amount of content we’re taking in. I knew what I was getting into with nurse-midwifery education…but on the long days, I wonder how effectively I’m actually learning all of this…and am I really becoming the midwife I want to be? The reality of 20 minute prenatal appointments is startling. I have yet to see through the fog of my self-doubt that I will ever be able to run an efficient 20 minute prenatal.

Perhaps even more unsettling to me is the question of whether I want 20 minute prenatals to be what my practice looks like. I know that I’m not really called to homebirth midwifery…but 20 minute prenatals feel impossibly short. I just don’t know. In an overburdened system, maybe this is the best we can hope for? Group prenatal care is a wonderful alternative, but it’s often an inaccessible alternative to many of the patients in the clinic where I’m working this term, as we expect participants to come without their older children, and for many, it’s impossible to find affordable child care for the 2+ hour group appointment.

Most evenings I come home unable to really engage in meaningful conversation with my partner or housemates, because I’m either too tired or too busy with homework, or both. I know eventually this will change…but in the meantime, it’s hard to trust that eventually the fog will lift and things will feel easier.  I know so many wonderful midwives who make the most of those precious 20 minute appointments, and I just have to trust that I will be able to do the same. More than ever now, I find myself reaching back for the reasons that propelled me here to midwifery school in the first place–they’re the things that will keep me going, one step at a time.

Scheming and Dreaming (and trying to keep up)

I just want to say thank you to all of the many readers who shared my recent blog post on being an abortion nurse. I have been blown away by all the responses, from other fellow nurses, fellow students, and folks who have been cared for by nurses. It’s been a reaffirming past few weeks.

As an update, I want to let you all know that I’m in the process of exploring creative ways that I can collaborate with others on creating and sustaining this community that we so deeply desire. If you are interested in getting involved or have specific ideas of what you’d like to see, please let me know.

In other news…this term is wild, friends! Patho and pharm are all-consuming, which would be fine, except I have two other classes in antepartum and postpartum care. I’m still trying to sort out how I want to keep all my notes organized, especially for my clinical days. Lab values, common STI’s and treatment protocols, week-by-week reminders on things to discuss in prenatals, new intake forms…there’s so much and it’s all so fascinating.

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I think the hard part right now is pacing. Every week feels like another deluge of information. I know it’s not realistically feasible to integrate it all at once…but when I’m in clinical, I find myself making tons of mental notes: look up that test, read up on this genetic condition, review those STI symptoms…a lifetime is not enough, really. I imagine (desperately hope!) at some point down the road I’ll look back fondly on this stage and how new everything feels.

What were some of the things you found most helpful when you were starting your first clinical rotations? Any and all tips are welcomed, in the comments below or on Facebook!

Bumper Stickers, anyone?

Playing around with some fun design ideas for radical nursing bumper stickers…inspired by a Facebook comment earlier that ACNM has a Midwives for Life group, but no Midwives for Choice group. I’m not a graphic designer…but I love the idea of bumper stickers, pins, shirts, bags, etc. Anyone with design skills want to help make this a reality?

IHeartAbortionNurses Midwives for Choice RH Nurses Rock

On Being an Abortion Nurse

Today I was asked by a patient whether I found this work hard. By “this work,” she was referring to the fact that I work as a nurse in an abortion clinic. She’s not the first patient that’s asked this question since I started working in the clinic this past September. I still struggle sometimes with how to answer. I’ve been writing and re-writing this post in my head for the past four months, trying to sort through the various emotions I’ve been processing as I settled into this new job.

For background: I mostly work in the recovery room, caring for people as they wake up from general anesthesia after their abortion. I’d say most of our patients are coming in between 6 and 16 weeks for their procedures…but not infrequently, we also care for patients coming in later in their pregnancies, up to 23 weeks. Many of these cases are for fetal anomalies. I also care for patients after local procedures—that is, for patients who opted to not use general anesthesia. Most of these patients are earlier gestation—between 6 and 10 weeks.

So…to answer the question:

In many ways, no, I don’t find it hard at all. In terms of the nursing care itself, it’s not super complicated. My patients are, for the most part, healthy people coming in for a normal out-patient procedure. While some folks have reactions to anesthesia, most people wake up fairly quickly…a bit groggy and often forgetful, but the point is, they wake up, often within 15 minutes of first falling asleep. This is not ICU or trauma or emergency nursing. I monitor their breathing and other vital signs, check for bleeding, assess their ability to safely get home. When they’re awake, I go over pain management and how to take their antibiotics and talk them through what to expect physically over the next few weeks.…most days, I get into a good rhythm and there are few, if any complications.

In other ways, yes, it’s a challenge. I struggle with how to balance the needs of the clinic flow with my own ethics and priorities as a nurse. I want to spend time with my patients, to offer space for them to share their stories and feel heard. I want them to not feel rushed in the recovery process…I want them to feel like they can take an hour, or more, if they need it, gathering the strength they need to walk out of the clinic and back to the rest of their lives. The reality is, I don’t have much time with my patients—maybe a half hour or 40 minutes for general anesthesia patients, 20 minutes for locals. Sometimes that’s enough, but sometimes, it’s not. I feel good knowing that I refer every patient to great organizations like Backline…but I became a nurse to be able to connect with the whole person in front of me, not just offer referrals and take blood pressures.

Is it hard? Is it heavy?

The days in which I care for women who are terminating a deeply desired pregnancy due to a fetal anomaly, yes, it feels hard. What could I possibly do for or say to a woman ending a pregnancy due to a fetal anomaly after rounds and rounds of IVF that might ease her pain?

The days in which I care for a patient who would be thrilled to parent another child but can’t afford the expense, yes, it’s heartbreaking. There are so many systemic issues of inequity at play in the lives of the patients who come to us…to see these same systemic issues play out over and over again feels frustrating.

When I care for someone who for their entire life never thought they’d have an abortion, but whose nausea and vomiting are so horrifically awful that they can’t stand another day of pregnancy…yes, those days feel heavy.

However, contrary to what some people might imagine an abortion clinic to feel like…I find myself laughing and smiling quite a bit at work. My patients are funny…and often draw on their sense of humor to help them through what can be a difficult and uncomfortable experience. We joke about weird family members, lame boyfriends, the crazy protesters outside, how cold the OR is, what they’re going to eat first when they get home, what ridonkulus TV show on Netflix they’re going to curl up and watch. We talk about the mundane as much as the profound, finding moments of warmth and connection in between the fog of anesthesia and the sinking in that this pregnancy—desired or not—is over. For every patient I see with tears of sadness and loss, there are also women who cry and laugh at the same time, sighing an incredible sigh of relief as they smile and reply “Thank God!” when I tell them they’re no longer pregnant.

The heaviness I might feel on any given day is often mitigated by the support of my co-workers, who are wonderful. But here is a truth, one that I don’t share with my patients: while it’s not always heavy work, being an abortion nurse is lonely work.

It’s not something you can generally talk about at a dinner party, or at that family reunion, or on the bus to the person who sits next to you and asks what you do when they notice your scrubs…at least not easily, for most of us. Not many people want to hear about the challenges of being a nurse in an abortion clinic. Add to that the fact that there’s no American Association of Abortion Nurses out there. There’s no network—either within other nursing organizations, or in a professional group designed just for us—for those of us doing this work around the country to come together and share our experiences. I know that there are abortion nurses in private clinics large and small, in hospitals, and in Planned Parenthoods across the country doing the same thing I am…and yet, because no professional nursing organization exists specifically for us, we are scattered like stars across the galaxy…able to glimpse each other from light years away, but generally unable to connect.

This past year has been notable for an increase in public storytelling around experiences of abortion. But that publicity is relegated mostly to those who had abortions, or, sometimes, those who provide the actual abortion. For the nurses, nursing assistants, and medical assistants who also provide much-needed and vital care, our experiences are still largely missing from this conversation. The only organizations that come close are Clinicians for Choice, geared for advanced practice clinicians who perform abortion care (which, as a nurse, I am not), or Nursing Students for Choice (which does fantastic work, but is still more geared towards students).

I’m reminded of Michelle’s great post last September in which she reflects on reading Susan Wicklund’s memoir This Common Secret

Abortion providers are, by and large ostracized from the medical world just as much as abortion has become isolated from the rest of women’s reproductive health care, and this is where abortion and providers are vulnerable…This book left me with a feeling that cannot be squashed. That we are in this together. That we must rebuild a community of all those working in reproductive health and abortion care, not just for our own sakes, but to make this whole community safer and stronger.”

Now that I’m feeling more settled in my role, I find myself wanting to reach out to other nurses doing this work. I know, realistically, that many will make the decision to remain anonymous, heeding very real threats to their safety. I understand and respect that decision. But if you are a nurse willing to reach out, to connect, to share your story, and to potentially find yourself connected other fellow abortion nurses…well…I extend a warm and hearty invitation for you to be in touch. Let’s help take care of each other as we follow our calling to this vital work. The people we serve need us to take care of each other as much as they need us to take care of them.

Midwifery School: Week 9

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I think the last time I posted a weekly post was back in week 3 or 4 of the term…I definitely did not go into this term thinking I’d realistically be able to blog about each week…but somehow weeks 4-8 disappeared into some Black Hole.

In any case…last night I had my last reproductive health lab (wet mounts), and today had our last real health assessment lab (a bit of a repeat on sexual health histories and exams). There’s only one more week of class and then finals…and then a much needed three-week break.

In all honesty, this term didn’t really feel much like midwifery school, which sometimes was really frustrating. Only one of our classes directly addressed reproductive health in any meaningful way. A friend and I were talking about it yesterday, and we realized that somehow between now and June of 2016, somehow we’re going to become midwives. It’s a bit disconcerting how quickly this term went by…ten less weeks that I have available to me to learn the basics of what I need to be a safe and competent clinician. Eek!

I think if there’s anything I’ve learned over the past year of nursing school, though, it’s that patience has its virtues. I know that my experience would be really, really different if I were in a direct-entry program right now. I would have been doing prenatal and intrapartum clinicals already, etc. I have to remind myself that I knew all this when I started this particular path to midwifery…and I do feel I’ve learned some useful assessment skills as part of my nursing education.

That said…I’m already looking ahead to winter term. I’m registered for four classes: Advanced Patho II, Pharm I, and Antepartum and Postpartum Management, which has both a lecture component and a seminar component, in addition to a full clinical day. I’m also helping coordinate a reproductive health elective with folks from the medical school.

Some second years have told us that in the beginning of the winter it will feel like we’re just getting in the way, but by the end of the term, we’ll be able to hold our own pretty well in clinical, mostly running a prenatal visit ourselves. Finally! I’m ready to start feeling more like a midwifery student. There’s only so much of putting speculums in plastic vaginas that feels useful…at some point, we just have to dive in. Just have to wait till January…

Monthly Chai 7: November 2014

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Oh, November. It always creeps up so fast. Somehow, September and October just fly by, with their gorgeous colors and crisp air…and then it’s November, which feels like the Month That Lasts Forever. I must be honest, my friends, this past month has been a challenging one…and while I love Thanksgiving, November is not on my List of Favorite Months. School itself is fine, and work (work! have I even had time to write about that yet?!) is also fine, I just can’t avoid the November Doldrums that come around when the sun slips behind the grey.

So in the spirit of openness and vulnerability, I’ll invite you in to my new office to catch up on the past month, yours and mine. I’ll crank up the heat and put my indoor Uggs on. Tea kettle bubbling, I’ll pour us each a Good Earth Sweet and Spicy tea, brewing it extra dark. I’ll pull up my Miles Davis Pandora station and let you get settled in the new comfy chair.

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After asking you about your month and hearing all the latest news from your corner, I’ll share that it’s hard sometimes, knowing how honest to be about the ups and downs of life. Each person’s journey is so different. I don’t want to make anyone feel like there’s a right or wrong way to go through midwifery school. I will say, though, everyone warned me that being in midwifery school can be challenging not just for us as students, but also for our partners.

Between being super busy with assignments and clinical, never having time to cook dinner or do laundry, and always talking about vaginas at every opportunity, being the partner of a midwifery student is not for the faint of heart. I like to think that B and I figured some things out while I was in nursing school (ie, take-out is a perfectly reasonable dinner option and not just during finals week)…but the truth is, it’s hard work for both of us to make sure that we’re making enough time for each other. Midwifery school demands a lot of energy, and not always just academic. It can be hard to summon the energy to be fully present to the other aspects of our lives and relationships.

I share this not to scare people, but because I think strong relationships, of all kinds, are vital to surviving midwifery school. In that vein, I’m always reminding myself that nurturing those relationships is just as important as the papers and labs and loads of reading…the trick is learning how to balance work and home with awareness and sensitivity. Let’s just say some weeks are better than others. Just when I think I have some kind of routine down, the quarter ends and then we’re back to the beginning again.

Taking another sip of chai and casting a dubious look out the rain-covered window, I’d ask you how you find motivation on the days when it feels easier just to snuggle down under the covers. My regular care routine includes a sun lamp (essential in Oregon!), lots of Vitamin D and adrenal support herbs. I’m also much more gentle with myself in terms of the number of social engagements I commit to attending. November is my month for holing up with a book and some tea most nights per week. Or, let’s be real: just going to bed really early.

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I’d also share how grateful I am to have this new office of mine. After nine years of sharing office space with B, I decided it was time for a room of my own. B works from home and is on the computer/phone all the time, which makes studying at home a challenge. So, with the bit of extra income from my new job, I’m renting a little 8×8 room near work. Most of November has been spent slowly making it my own space. I didn’t realize how much I needed this space until I had it…but now I can’t imagine my life without it. I know it’s such a luxury, especially as a student…but it has been such a gift during this dark, cold weeks. Having such a warm cozy space outside my house makes it a little easier to drum up motivation to get going on the days I’d rather hide under the blankets. 

Pausing to refill with some fresh hot water, I’d share that despite moving a bit more slowly these days, I’ve still got some exciting projects on the burners…between planning our annual Roe v. Wade anniversary event on campus with local medical and law students, stepping into a board position with Nursing Students for Choice, and settling into my own with my job (more soon, I promise!), life is feeling full. It will be interesting to see how this all flows next term when I add prenatal clinic to my schedule (can’t. wait!!!).

Before we wrap up, I’ll share the start of my winter break fun list…and invite you to share what’s on yours!

  1. Christmas Snowshoeing at Mt. Adams
  2. Knitting!!!
  3. Making lots of soups and dishes with potatoes…
  4. Reading, of course! This, and this, and this…to start.

Wishing you a nourishing November, that flows at just the right speed for you. See you in December, post-finals!