Prepping for Call Shifts: Part II

Welcome back for Part II of Prepping for Call Shifts. My first post explored the nuts and bolts of how I prepare externally—sleep, stuff I bring, pre-call routines etc. This post is more about how I get ready emotionally and mentally for 12 hours of being a midwifery student on call. It’s also a window into how I communicate my learning needs and goals to the preceptor I’ll be working with. My experience so far is that this communication piece is critical for a successful call shift.

This is not a cut and dry “routine” with concrete steps, per se…but I have found over the past term and a half that there is a bit of a process that seems to be evolving and I’d love to both share and also hear from other students and practicing midwives about what they do to prepare emotionally and mentally for being on call.

Making Peace with the Trepidation

Let’s be perfectly frank. I often find myself at some point in the few hours before my next shift feeling both excited and nervous/jittery at the same time. “Maybe another birth today!” is the first thought. But there’s no getting around it…the responsibility of stepping into the midwife role feels daunting. I never really feel prepared enough, even though I’m constantly reviewing protocols for the high-stakes complications.

That’s just an element of midwifery that is inherently part of the work: labor and birth are unpredictable, often flowing without complication, but that can quickly change. I would add that triage calls are a whole other category of unpredictable. You just never know what’s on the other line. I have yet to experience a true shoulder dystocia or postpartum hemorrhage or severe preeclamptic patient…but I know it’s only a matter of time. So, before each shift, I try to take some time to sit for a few minutes quietly and just breathe. This is after the bags and food are packed, coffee is made, scrubs are on. Just a minute or two to be still and breathe in some calm energy.

Clarifying and Articulating Clinical Goals

After that initial sinking feeling of “Oh, gosh, am I ever going to feel competent?” has had a chance to bubble up, make itself known, and then settle again, I try to spend a little bit of time before the shift thinking about my clinical goals. I have a running list of things I want to be working on, informed partly by our course objectives and partly by my own level of confidence in certain skills or aspects of clinical judgment. Of course, I never know what’s going to come in, but I review the things I’ve highlighted as priorities and then think about how I want to present those priorities to the midwife on call for that shift.

The midwife will often ask, “So, where are you and what do you want to focus on today?” That’s an invitation for me to be as clear and honest as possible about what I feel comfortable with and what I still find slightly terrifying. I find that just naming it helps.

Key current example: For whatever reason, I’ve mostly attended multip births so far, so I haven’t had the opportunity yet to do a lot of laceration repairs. Of course, I’m thrilled for those folks—easier recovery for them! But it means that I still sweat bullets at the thought of getting started with a repair and often feel like even figuring out how to approximate tissue is a challenge. I will just come right out and say so, letting my preceptor know what I think I might need to feel supported in the event that I need to do a repair. I also quickly review with her what I’ve been doing on my own in the meantime to try to keep my hand-skills fresh.

I also try to give a quick run down of the things I feel pretty comfortable with now—getting a good history, doing an initial assessment, management of an uncomplicated early labor, giving SBAR to an OB if we need to consult on a patient’s care or possibly co-manage, informed consent conversations for various scenarios, for example. This helps my preceptor know how involved she should be and how much space she should give me in doing these things on my own. Knowing that we’ve set this foundation up in the beginning of a shift helps the whole shift run more smoothly.

Chart Review in Advance

One of the nice things about having EHR access from home is I can keep tabs on how many midwifery patients are on the unit throughout the preceding shift. Especially if it looks like things are going to be busy, I try to prep as much as possible before I go in, knowing I may not provide direct care for all of them. However, having quick notes jotted down on my brain before I go makes report go a little faster, often saving precious time if there’s an imminent birth or change of plan at shift change.

I personally like to do this prep regardless—sometimes we’re short on time and I don’t get as much time as I would like to review the course of prenatal care…but there are often lots of pearls to be found if I take the time to read through that history. In addition to all the usual labs and other medical things, I try to make note of at least a few small personal detail that will help me make a connection with each person I work with, particularly when I haven’t met them in clinic before. It takes some time at home, usually no more than a half hour or 45 minutes, but I generally find it’s worth the peace of mind of coming in feeling a little more prepared. Perhaps as a practicing midwife, this need will feel less pressing…but for now, it’s become a part of my routine.

Cultivating Flexibility

The way our call shifts work this term, we’re not assigned to one single preceptor for the entire term. The benefit of this model is that we get to see lots of different approaches among our clinical faculty practice. The downside is there is less consistency and it can be frustrating to be told one thing by one preceptor only to have another preceptor tell you something different on your next shift! This is a more ongoing thing, but I find that before each call shift I have to consciously remind myself to not go in with expectations if I’m working with someone less familiar and to just ask her what her preferences are around certain things (pushing comes to mind: hands on or hands off? Or placenta delivery…to twist or not to twist—I’ve seen lots of variation!). Being open to new perspectives, even when working with a familiar preceptor, is important—no two labors are the same!

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These are the core things I find helpful before a shift…some days feel more organized than others. But I’m trying to establish the habits I want to have as a practicing midwife now, as a student, weaving in threads of practice that I observe from my preceptors as well. What are the things you find most helpful in the mental and emotional preparation as either a student or practicing midwife on call? Share them here or on Facebook, I’d love to hear from you!

Prepping for Call Shifts: Part I

I’ve been wanting to write more about my experience with call shifts so far but finding it difficult to know where to start. Then, I had this idea that maybe a good place would be to explore how I prepare, both externally and internally. So, Part I today focuses on external prep (which, in my opinion, is a lot easier, although it still takes a while to find your groove, I think. At least it did for me).

I’ve been taking call now since April, and according to Typhon (ah, Typhon!), have logged about 230 hours of intrapartum call. I mention this, because 230 hours seems like a lot…and most days I still feel like I’m just barely keeping up. Just in the past week, though, I feel like I’ve turned a little corner…it’s amazing how having a routine really does seem to help.

So, without further ado, here some of the concrete things I do to get ready for call.

1. Get sleep! As much as possible. I don’t take 24hr call yet. In theory, I could choose to if I want, but for my own learning, I’ve found that 12hr shifts are plenty. Yes, sometimes it means I miss those near shift change births…but I would rather those mamas have a fresh team, ready to jump in, than be worried that my fatigue might contribute to an error. Those babies are going to be born no matter who is there–it’s really not about me at all.

If I’m on for a night shift, I sleep in as late as I can and try to take it easy during the day. If I can’t sleep in, I’ll try to get a nap in from 3-5ish. It’s a tough balance, because sometimes it’s slow and then if I slept a lot during the day, I can’t nap well in the call room. But, I always err on the side of more napping rather than less. For day shifts, I’m in bed the night before by 10 at the latest. I have to be up, showered, dressed, coffeed and walking out my door by 6:20 on a weekday, 6:30 on the weekend to arrive in time for report.

2. Pack food! Easier said than done at the end of the term when I’m pooped and just heading down to the cafeteria sounds so easy…but especially as a pregnant midwifery student, I need more than cafeteria BLT’s to keep my energy up. I try at minimum to bring a sandwich, some fruit, yogurt, and whatever leftovers might be lying around in the fridge, so that’s two meals I don’t have to buy. Also, my call bag is always loaded up with Lara bars. I try to keep a stash of crackers in my bag, and bring cheese and apples as a quick snack while charting. We SNM’s also do a pretty good job of keeping our own stash of chocolate in the SNM cubby above our desk.

IMG_21913. Speaking of call bag…I don’t know how other people do this, but after a term and half of trying different things, I’ve found it easiest to have two. The one on the left (my beloved Linus bike bag, which hasn’t actually been on a bike in a while now…), is always packed with a spare set of clothes, toiletries, my stethoscope and a few sets of sterile gloves, along with my food and water. The other bag (a conference bag that’s actually useful!) is the one I’ve been using to shlep school stuff in: books, laptop/iPad, my planner, papers…

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So what all is here?

  • After trying it both ways, I’ve found it easier for me (read: more time to sleep in) to bring a clean set of scrubs home with me so that I can come to my call shift already in scrubs. Door to door, I’m 20 minutes from the hospital without traffic…so not having to get there early enough to change into scrubs means an extra 10 minutes of sleep! Unless my scrubs get messy on a shift, I come home in scrubs, shower right away at home, and return the dirty ones on the next shift.
  • The little black moleskine notebook is where I jot down lab values I need to work on memorizing, protocols and/or questions I have–basically things I want to look up later. It does not contain any identifying patient info (that’s kept on my brain, and tossed at the end of each shift–see below).
  • Pager and stethoscope, of course. Also, Lara Bar. Always.
  • Toiletries. Never underestimate how a quick toothbrushing and some deodorant can perk you right up after a night call nap!
  • Fetal position wheel…this was a gift to all the first year SNM’s from the Oregon ACNM affiliate and it’s come in handy for both myself and for patient teaching. Basically, the little fetal head rotates on the card, so as I’m palpating sutures, I can adjust the head on the card to reflect what I’m feeling, and then use it to help explain to laboring patients what their baby’s position is. It’s always in my pocket!
  • Suture kit. I always throw it in my bag for the slow days, so I can practice knots. I’ve got a stash of sutures and felt in there, too, and in the call room, the SNM’s keep extra yarn and one of those Ethicon practice boards. I haven’t actually used it a ton…but I like being prepared.
  • Reference books. The two I always bring are Lisa Miller’s Fetal Monitoring book and Lauren Dutton’s Clinical Midwifery Pocket Guide. I used to bring my Oxorn and Foote, but there’s a copy in the call room, and it’s a bit bigger, so I don’t bring that one with me anymore. Feminist Midwife posted a photo a while back on Facebook of her copy of Dutton’s Pocket Guide…mine is rapidly approaching a similar “full of post-it’s and written-in notes” appearance. I’ll often go directly from jotting questions in my moleskine to looking up quick answers in Dutton, and then make a list of follow up things/articles I want to look up back in the moleskine.
  • Water and coffee thermos. ‘Nuff said.

Other things not photographed:

  • Laptop/iPad for getting schoolwork done on slow shifts (sometimes, especially at night, I’ll stay home because I’m so close…but often there are 2-3 hr lulls when it’s nice to have my own computer to work on stuff).
  • Copies of my CNM Brain (Lena’s IP Brain_Summer2015).
  • My clipboard with other reference docs I’ve created for both antepartum and intrapartum (again, on a slow day, I like to review algorithms, etc. More on that in Part II!).

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What do you all bring to call with you? What’s your pre-call routine? I’d love to hear it, either here in the comments or on Facebook!

Catching Up

Whew! Not sure how it’s already the middle of July…anyone else feel like June just kinda disappeared?

There are still, oh, about five posts in my head about my experience at the ACNM meeting in DC at the end of June…suffice to say, it was an amazing experience and I promise, I’ll be writing more soon.

For now, a few photos and little tidbits of my summer term (only 7 credits, my friends, I feel so…FREEEEEEEE!!!!)

Açai bowl summer yumminess...

Açai bowl summer yumminess…

 

Hey Green Journal, what up? I actually had to tab all the articles I wanted to read!

Hey Green Journal, what up? I actually had to tab all the articles I wanted to read!

 

Squish babies. That's what I get to do all summer! For credit!

Squish babies. That’s what I get to do all summer! For credit!

 

Knots. There is yarn. Everywhere. In. My House. And. Car.

Knots. There is yarn. Everywhere. In. My House. And. Car.

 

Hey, you again! My brain! It continues to evolve...there's now a phone triage cheat sheet on back!

Hey, you again! My brain! It continues to evolve…there’s now a phone triage cheat sheet on back!

 

For those who have been following the thread about my note-taking sheet that I use on the unit…I’ve made a few changes, including moving the birth details so that the full front half of each page can be used for one patient, rather than having to flip back and forth. The back side now has space for two triage call notes. You can download a .pdf here: Lena’s IP Brain_Summer2015.

What are you all up to this summer? Do share, either here in the comments or on Facebook!

ACNM60: Sunday June 28

  

Gearing up for the official first day of the ACNM annual meeting tomorrow…today was a day to get registered, get organized (notice the color-coded highlights and tabs for each day?) and help Nursing Students for Choice set their booth up. I’m looking forward to an awesome day tomorrow…here’s what’s on my docket:

8am-Noon: Clinical Management of Early Pregnancy Loss

10:30-11:30: TableTalk Discussions: Modernizing Oral Histories: Midwifery Presence in New Media

(Yup, this overlaps with the first session….but I’ll be leaving that a bit early, because the second item is the presentation I’m doing with Stephanie and Robin!! Come on down and join us for lively discussion on how new media is changing the way we tell stories and create community as midwives and students!)

  
11:45-12:45pm: Pregnancy After Transitioning: The Male Gendered Experience with Fertility, Pregnancy, nad Birth Outcomes

2pm-3:45pm: Opening Session

4-6pm: Nursing Students for Choice Booth in the Exhibit Hall (come over and say hi, get cool buttons, and enter the raffle to win awesome posters and other prizes!!)

6-8pm: Midwives for Sexual and Reproductive Health and Abortion Caucus Meet and Greet

Events I’ve highlighted in orange that I want to go to, but can’t…but hope to find the slides for or catch up on later:

10:30-11:30am: ES110 Infusing Diversity into Clinical Teaching: Moving from Health Disparity to Health Equity

5:30-6:30pm: ES122 The Unmet Need for Family Planning–What Midwives Can Do to Help

6:30-7:30pm: Region VII meeting

***

So looking forward to a great first day tomorrow and hope to meet up with those of you who are here! I’ve already met a few of you and have so loved getting to put faces to names! What are you fired up to attend tomorrow? Do share! 

Be sure to check out updates on Facebook, Twitter and Instagram throughout the meeting!

 

At a Loss for Words

My friend JaeRan and I noted yesterday that we both seem to be at a loss for words these days when it comes to the relentless onslaught of racially motivated violence that we have seen in just the past year…let alone, oh, the past several hundred years of our country’s history. 

As a transracial adoptee (and, no, Rachel Dolezal, you don’t get to use that word), I find myself in a unique position of both privilege and loss when it comes to my own racial identity: I am Korean by birth, but taken from my family and culture without my consent to be adopted into a white family who did their best but were given no resources to support their journey as parents of an Asian child. By a series of economic exchanges between disparately privileged countries,  I am now as bound to this country’s history of slavery and segregation as anyone else, even though I exist outside the white/black binary that continues to drive the racial politics and narrative of the United States.

In Korean culture there is this concept that really has no analagous counterpart in western culture, called han. Wikipedia (yeah, I know, but when you’re an adoptee, you generally don’t have first person access to authentic sources) describes it like this:

“Han or Haan is a concept in Korean culture attributed as a unique Korean cultural trait which has resulted from Korea’s more frequent exposure to invasions by overwhelming foreign powers. Han denotes a collective feeling of oppression and isolation in the face of insurmountable odds (the overcoming of which is beyond the nation’s capabilities on its own). It connotes aspects of lament and unavenged injustice.

The minjung theologian Suh Nam-dong describes han as a “feeling of unresolved resentment against injustices suffered, a sense of helplessness because of the overwhelming odds against one, a feeling of acute pain in one’s guts and bowels, making the whole body writhe and squirm, and an obstinate urge to take revenge and to right the wrong—all these combined.”

Another article quotes the West Wing episode of the same name:
“In the TV series “The West Wing,” U.S. President Josiah Bartlet (played by Martin Sheen) voiced his own understanding of the notion. “There is no literal English translation,” he says. “It’s a state of mind. Of soul, really. A sadness. A sadness so deep no tears will come. And yet still there’s hope.” 

I remember the first time I read about han, it was like someone finally understood my soul. A counselor once asked me where she thought my resilience came from. At the time, I had no answer. Now, I can see that resilience, too, in the face of all odds–personal, cultural, historical, economic–is a part of han. Also from the Wikipedia article:

“The Korean poet Ko Eun describes the trait as universal to the Korean experience: “We Koreans were born from the womb of Han and brought up in the womb of Han.”

It is inescapably a part of me, even though my cultural connection to Korea can only generously be called tenuous. For years, I’d harbored inexplicable anger and resentment, a condition I still grapple with. I couldn’t explain why the weight of the world sometimes felt so, impossible heavy. I mean, I’m not a descendant of slaves. I’m not oppressed on a daily level in the same way. I don’t worry about walking down the street and getting shot, nor will I have to worry more than the average white middle-class parent in the United States that my son will be a target of racial violence. 

But still. 

There is an anger, barely contained in the confines of the tidy English word, that seethes, raging up every time yet another black person is killed in this country. Anger doesn’t capture the all-consuming sorrow, the ache in my body, the barely controlled desire to speak hurtful words to those in my life who I feel aren’t doing enough. 

And let’s be honest…this includes myself. 

I have no eloquent words to offer from my so-called unique perspective as a bridge between cultures. Nothing I have to say can offer adequate comfort to those in Charleston who lost family to a racist killer last week. Where could I even possibly begin? Nothing short of a revolution feels like enough.

I imagine that more than any other group in this country, that black mothers would recognize han:

“I asked another friend what it’s like being the mother of a black son. “The condition of black life is one of mourning,” she said bluntly. For her, mourning lived in real time inside her and her son’s reality: At any moment she might lose her reason for living. Though the white liberal imagination likes to feel temporarily bad about black suffering, there really is no mode of empathy that can replicate the daily strain of knowing that as a black person you can be killed for simply being black: no hands in your pockets, no playing music, no sudden movements, no driving your car, no walking at night, no walking in the day, no turning onto this street, no entering this building, no standing your ground, no standing here, no standing there, no talking back, no playing with toy guns, no living while black.”

I only have questions. Lots of questions, which continue to form and manifest as I launch into a week of activities at the ACNM Annual Meeting, held in Washington DC. I am struck by how close the meeting is to important historical monuments of African-American history and struggle, and yet, how segregated we are from the day to day reality of the black community in the DC area. The black people here in National Harbor work in the restaurants in bars, serve me drinks and cater to my needs as a tourist. They don’t live here. 

And so I continue to wrestle with the han inside me, allow it to shape me, and try to shape it into something that can fuel action and change, even if I can’t box my anger into words.

What does it mean to be an ally? How can my voice and actions be of service for meaningful change?


What does justice mean in an age when it is still possible to be black and go to church and be killed?


Where do I place my efforts at community-building when groups called Birthworkers of Color make assumptions about what skin color qualifies as colored? Does it matter? Am I brown enough? Is it offensive that I’m asking?


What is my obligation when I am a part of a group deemed “too small to count”? Am I obliged to speak on behalf of our practically non-existent group? Can I even pretend I have a choice?


How am I complicit, every day, in perpetuating the silences that breed inaction, which in turn feed the machine of oppression?

I want to do more than just listen. I agree. Listening is too often used as an excuse for inaction, a conveniently comfortable position from which to perch in relative safety.
As John Raible, a fellow transracial adoptee writes in a recent blog post about white privilege:

“We need far more than symbolic gestures. We need effective leadership and anti-racist education. Allies must step up to lead real discussions to help heal these divisive issues.
We want to believe that love will win over hate. But we must make it so. We say we believe in interracial families and multicultural communities. For those particularly who declare their love for and allegiance to children and youth of color: How are you using your privilege to deflect the coming backlash?”

I don’t know yet, John. What I do know, as a future midwife, is that I have an obligation to use my privilege, my voice and words, and my clinical skill to do everything I can to protect the lives of black children and their families. Black lives matter. 

I don’t yet know the most effective way for me to do that. But I am about to renew my lifelong engagement in that fight, recruiting the han that is my legacy, along with the seemingly inadequate words that I hope will inspire others to do the same. 

Monthly Chai: June 2015

  
I have to laugh at Feminist Midwife’s hot off the press Monthly Chai Date post...I totally feel you, Stephanie, on the sentiment of “screw the month of May.” I haven’t been doing monthly posts for a while, in part because, well, school and clinic have just been so consuming. It’s been great learning, but I have limited brain capacity at the end of the day to write a truly meaningful reflection on it all.

Then there’s the whole growing a human thing… that takes some energy, too. I’ve been wanting to write more about this whole wild experience of being a pregnant midwifery student and the words just haven’t been coming. I finally took it as a sign that this is the universe’s way of telling me to take some of my own medicine, the very encouragement that I often share with laboring patients: stop being in my head so much and just let the experience unfold, noting sensations, but not feeling the need to obsessively catalogue and analyze each one. What a novel concept!

I will say this: baby kicks are the weirdest/coolest freaking thing ever. I can’t imagine ceasing to be amazed and delighted by the feeling of this little one wiggling around…inside my body! It’s wild and magical, and yes, also increasingly annoying when it’s at 3am and I’m trying to sleep…but mostly just magical. I can’t quite tell position yet (in a few more weeks I think I’ll be able to get a better sense of that), except that it changes often, exactly as it should be at this stage. 

Now that I’m a week+ past spring finals and officially on vacation, it feels like I can finally let loose a little bit. B and I are in the process of tearing down our garage and building an accessory dwelling unit for our housemates…which means last week we cleared out our garage in anticipation of demolition, giving away and/or selling boxes and boxes of books (so liberating!!), and being ruthless when it comes to getting rid of stuff we’re never going to use: 

Old cans of half-used paint? Goodbye!

That pile of wood scraps that maybe was going to be a cool project? Adios!

That stash of craft supplies that looked so pretty and colorful and not opened and gathering dust on the shelf? Passed along to a friend.

Old photos that I literally haven’t looked at or remembered exisiting in the past ten years? Tossed.

All those carefully organized notes from nursing school that I haven’t looked at since? Gleefully recycled.

And on, and on, and on. I made five trips to Goodwill, along with several others to the local FreeGeek to get rid of old computer stuff (B’s), and to our storage unit to store the things we actually will use again (B’s Lego collection, my culled-to-the-essentials collection of poetry and books on adoption, the stroller/carseat we’ve already purchased…).

As exhausting as it was, the week ended with the whole house feeling lighter. Books I’d been holding onto for years because I felt they were a part of my identity have finally been released back to the world…and the best part? I don’t miss them, not one bit. I will admit, I’m making more use of my Kindle these days…which feels like a perfectly acceptable solution to being a voracious reader but not wanting to be burdened with the space needs of physical books.

 If you’re looking for a place to start in paring down, I highly recommend The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing, by Marie Kondo. It’s a fantastic, short sweet read that will have you itching to get going. Read till the end, then start tidying. I promise, it will be super helpful! 

In other news…I’m in Boston for a few days visiting friends, and it is so lovely to get out of Portland. I like Portland alright, but I get antsy being in one place too long and I find Portland’s pretentious hipster culture grating after a while, so getting my every 4-6 month travel fix is always required for me to survive there long-term.  

On Thursday I head down to DC for my very first ACNM annual meeting and I am SO EXCITED! I’m attending as many of the diversity and inclusion events as I can (more thoughts on the recent ACNM report “Shifting the Frame: a report on diversity and inclusion in ACNM” soon). On Sunday I’ll be attending a workshop on Early Miscarriage Management led by two of my favorite midwives, Tara Cardinal and Amy Levi. I’ll also be co-presenting a little roundtable with Robin from The Mindful Midwife, and Stephanie over at Feminist Midwife called Modernizing Oral Histories. We’ll be talking about the role of new media, or social media, in midwifery storytelling and community-building! I’m also excited to participate in my first report-writing process as my campus liaison to the Student and New Midwives (SANMS) committee…and of course, Lobby Day on Tuesday…and, on Saturday and Sunday I’ll be tabling with Nursing Students for Choice! Com stop by and say hi and buy some great NSfC swag!

As I wind this post down (no chai today, had ice cream at the BEST ice cream place in the world, JP Licks!), I’ll share some of my latest reads. What have you been reading/listening to lately? I’ve been pulled in by:
Breaking Chains: Slavery on Trial in the Oregon Territory….a fascinating read on a little-known period in Oregon’s history in which we basically came thisclose to being a slave state…and the de facto effects of racism and exclusionary laws that made it feel like we might as well have been one for the next hundred years.

Citizen: An American Lyric, by Claudia Rankine. Read her searing, spot-on piece in the NYTimes today, too. More thoughts to come on this. 

Half of a Yellow Sun, by Chimamanda Ngozi Adichie

This amazing Tumblr, Pregnant, Parenting, and Pro-Choice (I submitted my own entry here.) 

The Book of Unknown Americans, by Christina Henriquez

Here’s to a great start to summer! Stop by and say hi in the comments, Facebook, or in person at ACNM! Looking forward to connecting with some of you soon!

Note to Self

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I am reading all these articles that quibble over definitions of and differences in

early term and full term and late term and postterm and

number needed to treat and

odds ratios of this or that with 95% confidence intervals of this or that and

adequately powered studies and

appropriate comparison groups and

relative risk and odds ratios and values

so that I can be as fully informed as possible when a pregnant person I’m serving as midwife asks me what the risks and benefits are of choosing one path over another.

so that I can, to the best of my ability, paint a picture of what we know and what we don’t know about what might happen.

so that I can help the folks I serve feel confident that they have as much information as they want and need to make their own decisions.

The end goal is not the paper. It’s not to be an expert on a particular topic. It’s not to be able to say I’ve read it all.

It’s to help each person I serve be able to make decisions about their pregnancy and feel a sense of empowerment in their health and well-being.

[Deep breath]

That helps a little, to remember the women I have served so far in clinic, to picture their faces, their families, and to imagine distilling these 30+ studies into a conversation with them:

“Here is what we know about what happens when pregnancies extend beyond 40 weeks…it is complex, and I trust you to make the decision that is best for you and your family. What questions can I answer for you?”

On Baltimore

Over the past year, each time another story emerges of police violence leading to the death of yet another black man, I’ve found myself at a loss for words. What can I possibly say that hasn’t already been said?

Partly out sheer anger, frustration, and overwhelm, I sat back quietly on this blog and social media, listening carefully and appreciating the voices of others who somehow seem to be able to give words to the outrage that I know many of us are feeling as a new name rolls across the ticker on the bottom of the news screen: Garner, Brown, Scott, Gray...

Watching the media coverage of the recent protests in Baltimore has once again brought back this feeling…and the questions I keep asking myself are, “What is it going to take to create a cultural change in this country? When will there be enough outrage over the unnecessary, violent deaths of black men and women in this country that it boils over not just into protests, but into policy, into research agendas, and into a universal understanding that it is unacceptable? When will people stop dying at the hands of the very people who are supposedly working to ‘keep us safe’?

This morning I happened across this incredible call to action within the medical community by pediatrician Rhea Boyd:

In the wake of Sandy Hook, the response from physicians, and pediatricians in particular, was astounding. The tragic deaths moved doctors to address gun violence and its health consequences.

But week after week, as black boys who could be my sons and black men who could be my father, are shot and killed by police, doctors remain silent. As a pediatrician, I’m appalled.

We are watching a public health problem unfold in front of us and we aren’t doing anything to stop it.

These words stopped me in my tracks.

We are watching a public health problem unfold in front of us and we aren’t doing anything to stop it.

Yes.

As a future midwife, I place my work in the context of reproductive justice: my role is to serve my community, to help ensure that women and their families are healthy, as individuals and as members of their community. My role is to help reduce the institutional barriers that prevent equitable access to healthy outcomes. Yet we know that rates of preterm birth are higher among African Americans, and that there have been links made between chronic stress and preterm birth.

As Boyd writes, “Like the trauma experienced by war veterans, living under the threat of unprovoked police violence triggers intense emotional and physical stress, even in moments of relative safety. The chronic stress that fear generates may place African-Americans at increased risk for health problems like heart and lung disease, and depression.”

I simply cannot fathom what it must be like right now, or ever in US history, to be an African American mother. I think about my own unborn child, who will come into this world with privileges they did not ask for. My child, for simple virtue of the appearance of their skin, will not have to fear driving in Portland, among the whitest of white cities in America, and being pulled over by the cops for no reason at all.

My child, by virtue of appearing “Asian” in heritage, will be assumed to be intelligent, well-spoken, “safe.” My child will not be unduly punished for minor infractions in school, nor will they face increased risk of being suspended or expelled simply because they cannot sit still and learn quietly.

My heart will only have to bear the average amount of anxiety as a parent when my child starts wandering around the city independently…but I will not have to fear that my child might “accidentally” be shot by police. Such an occurrence would be an outrage, it would be unthinkable.

And this only scratches the surface of privilege that my child will experience.

Yet it’s not what many parents in this country live with every day. As a future parent and a future midwife, I find myself unable to breathe sometimes, I am so angry at the injustice of it all.

What keeps me going is knowing that as a midwife, I will have an opportunity to connect with people during pivotal moments in their lives, especially during the child-bearing year. I hope that I can be a supportive presence for all the pregnant people I serve, no matter what stresses and injustices they are facing during their pregnancies. And beyond the level of individual care, I want to use my voice and skills as a midwife, researcher, teacher, and activist to help shape policy that improves the health of families and communities.

I believe that the midwifery profession can and should be doing more to speak out the public health consequences of race-based violence. I intend to do everything I can to ensure that my professional organization, the American College of Nurse-Midwives, plays a role in moving our country in a direction in which all families can raise their children in safe communities.

 

Fast & Furious: Catch #2

No, it’s not about cars.

It’s about a labor, and the magnificent mama overrun with the power of her uterus, on the edge of her ability to cope.

Contractions started with a bang. Her partner called soon after, asking whether they should come in.

We hemmed and hawed, concerned about the dwindling number of beds, asked to her wait a little while longer at home.

Not long after, partner calls back: Things are hot and heavy over here, she really wants to come in.

We manage to find a room, not the largest on the unit, but it will do.

They arrive, we check her, our fingers barely making it in before reaching a baby’s head.

Baby’s coming, just breathe, you can do this, you’re almost done, stay with us, mama, you’re so strong!

She glistens with sweat and power and the primal smell of birth. Uncontrollable, unstoppable, unbelievably strong. My breath catches in my throat with awe.

Hands poised, trembling, ready for the moment when inside meets outside.

My heart is racing, but then, hands steady as I breathe again and remember what I’m here to do.

Catch.

Baby’s here, beautiful, healthy baby’s here, up to mama, right where they belong.

From start to finish, two hours.

I can’t stop grinning all day long. Really. Really?! Really?!! I can’t believe I get to do this.

Let’s Start from the Very Beginning

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If you don’t know me well, here’s something you’d learn pretty quick in getting to know me: I actually really like school, and more broadly, learning new things in general. Back before nursing school started, B would snicker lovingly at the stacks of library books I’d bring home…literally a stack of books, on whatever topic had recently struck my fancy: Italian cooking, pottery, Korean history, permaculture, woodworking…the list goes on and on.

There’s just something addictive about being in that beginner’s mindset. While I love the fact that I’m delving deeper into midwifery (although, I wouldn’t go anywhere near the label “expert” yet!), I find myself wanting to turn to something new, something completely different, something that feels fresh.

Enter adult swimming lessons.

I didn’t grow up in a family that could afford swimming lessons or pool passes, so I learned the poor folks’ swim, which is to say, I can kinda sorta tread water. I can float, I’m not terrified of putting my face in the water…but I really can’t swim at all. After a certain age, it just becomes embarrassing that you don’t know how, especially when half your friends are on the high school swim team. So, yeah, the water and I, we haven’t been especially close.

But, I want Tahini (our nickname for the little bean in utero) to know how to swim…and honestly, the thought of being 7+ months pregnant in the summer and NOT really being able to enjoy a pool were both enough to push me over the edge and into the water. I had my first real swim lesson this afternoon, and people, it was so much fun!

It was refreshing to be taught by a couple of gangly teenage girls who know way more about something than I do. It was refreshing to have to relearn how to do something as basic as breathing (it’s harder than you think to overcome 30+ years of instinctual “in through the nose, out through the mouth”). It was refreshing to think about the possibilities of developing an entirely new skill set and new way of interacting with my environment. And, seriously? Who thought goggles might be such a life-changer? I think, after all these years, that I might actually like swimming!

So that’s what’s new here. Oh, and I went to the Thorn’s Game last night, my first time at a soccer game here in town. That was ridiculously fun, and a great way to release some steam from an intense first two weeks of the term. Self-care, my friends. It’s a good thing.