Placenta Previa

Things move so quickly, my understandings of things evolve at a rapid pace. I blink and something has changed profoundly for me in this place. It is quite an odd sensation, like the one you feel when you jump as the elevator touches the ground floor(if you haven't done that, you have not lived). For a moment you feel suspended in the air, you lose you equilibrium but then are grounded again.

Placenta Previa with a breech! A very rare thing... I now know what it looks like, sounds like, feels like. I didn't have to open a book to learn it, but had it walk into the clinic at 8am when this beautiful blue eyed woman came in for a labor check. I got a crash course in it. Heavy stuff you know, I am still processing how my day could begin with such an amazing birth (see last post) and end with such drama. Oh my, what a gift and what a difficult thing to witness. Mom is shaken (mostly with the expense of the hospital bills) and baby is great. I visited her the next day and despite quite a bit of blood loss, she was up and walking around.

What is a bit nutty about the whole situation was that an ultrasound had been done, and the condition went undiagnosed somehow (and how about that breech baby?). Crazy that a technician would miss it. I still have so many questions which may never be answered because there is very little communication with the hospital.

So...Universe? What is next?

Twins

Wed night before shift, I dreamt that I gave birth to twins. The dream was incredibly real. Shift on Thursday was an echo into reality of my dream or was my dream an echo of things to come?

When I came in, the clinic was hopping. One birth in the night, 1 woman pushing, 2 in labor. There had been 4-5 labor checks through the night...One of those labor checks was Esmeralda (not her real name). E was a mama that I had done a cita on 3 days before that was very difficult. She had many issues out of my scope of new student understanding, but the one that I could fully connect with was that she was 17 and afraid of labor. That day I hoped that somehow I would be able to serve her but who knew?
Before we went to morning class I was told that E had come in, I asked my group for a special request: if the opportunity presented itself, I would like to be at the birth even if it were not my rotation.
I love the universe and how it works out. After class, we came back and 4 of us were assigned various tasks, including shadowing a birth. I walked in to one of the smallest rooms to observe but it was so crowded! I slipped out feeling akward about watching such an intimate event and not being invited or without having the opportunity to ask permission as this mamma was pushing. I instead let the other student take that rotation who had less births than me.
As I walked through the kitchen from that room one of the interns grabbed me and asked: Do you know how to do labor support? Ok how am I supposed to answer that one? OF COURSE! She steered me into the sala (sectioned off part of the clinic because all of the birth rooms were taken) and right into the more intense gaze of E looking desperate for support.
My heart soared! She looked at me with her liquid brown eyes and softly said "no puedo, me duele, no puedo" (I can't, it hurts, I can't).
For the next 15 minutes I held her hand, emptied a vomit filled trash can, and said "si, se puede, lo esta haciendo, y si le duele" (yes you can, you are doing it and yes it hurts-I am not good at lying, I believe that, one of the worst things you can say to a woman is that it doesn't hurt). That little bit of encouragement seemed to work wonders and she settled into her labor with grace that awed me. A staff midwife drifted in and out during this sacred time, I took heart tones and vitals as well as gave labor support. After about 2 hours of this routine, she was moved to a room that became available. She was listless and tired, her family was difficult and this was the way she shut them out. She tuned in during contractions, and drifted off to sleep in between. At one point her mother yanked off her underwear and said "get this over with, have your baby, start pushing" I was stunned and ummm a little angry! But the gruffness of her mother was an indication that she was worried, I was able to help her understand and she eased up. Her energy began to change and her anger gone
.
After that E began to get a little grunty during the peak of contractions so she had a "tacto" and was 4-5 cm. Not time to push....This was a little torturous for us all as her urge to push became stronger in the next 15 minutes. Getting her to stop pushing is not fun and I just let up with my mantra "sople sople, no es tiempo para empujar"(blow, blow, its not time yet to push). There is a lot of anxiousness in the clinic over a swollen cervix. I don't share that fear(yet, who knows if that one will concern me) but I had to relay the message.
E was a determined woman, and she began to push pretty adamantly on her side. The staff midwife came in to make sure her cervix wasn't comepletely swollen (there was talk of transfering her) to find that there was a head there and not a cervix!!!

Now one of my favorite things is when a woman is so tuned into her body that her urges are right on. Only 6 hours had passed from her entrance into the clinic, she came in at 1cm. She was a 17 year old goddess in my opinion. I could hardly contain my enthusiasm as I watcher E push her baby into the world. At one point she reached down and touched the babies head as it was crowning. I was so excited that I docummented 5 minutes of of incorrect times on the labor flow sheet, including the time of birth! It was quickly remedied, I was made fun of and then forgiven.
A little girl 6 lbs 2 oz came gently into the world, into her estatic mothers arms. She had a solid latch within the 1st 30 minutes, very little blood, lots of photos, and mom, family and newborn left an hour early.

Such a gorgeous birth. What a wonderful blessing as it was the 1st time I was given responsibility and not just shadowing someone.

Now you might be wondering about the twin dream I had? Where is the other baby? Time has gotten away from me so I will tell the other story later. Suffice to say that I had an experience quite the opposite of that birth 12 hours later, as my shift ended. I will get to that story soon.

Emotions

I haven't written about all of the emotions. They flow from me, stop me up, overwhelm, build one upon the other until I don't know where they came from, which came 1st, which one is resolved, which one is breaking my heart and why. It is impossible to process them all at once, so impossible to be clear about any of them. They are hydras, chop off one head and another one appears. Forgive any errors in this post, it has been a long day (most of this typed on Wed. eve)
A common theme of this 3 week process that is called orientation (I am apt to name it disorientation) has been "midwife, come birth yourself" and that is what we are doing, all 12 of us, laboring through it all, swimming in the thickness of our emotions searching for the light, seeking to be born, sliding out slippery and vulnerable and crying bloody hell.
Crap.
We are such incredible beings, each unique, talented, intelligent, wise, angry, revolutionaries who seek to preserve a way for women in the world. We are guardians, we are fierce...The fierceness can come out at inopportune times, the fierceness sometimes directed at each other. We are not yet at a 2 am shift, tired, hungry, irritable, having our moons at the same time. What will happen then?
If now we are sitting on our a*** in class and getting a bit irritable at each other, what will it be like when we are really fricking exhausted. Perhaps we are fricking exhausted, knowing today was the last day of dis-orientation, we let a bit of our shadow selves out to prowl the weaknesses in others.
God what to do with these emotions that I am swimming in. I feel unbelievably irritated at other's faults, and feel more guilty for being in affect of it. Stupid cycle of feeling something, then turning around and feeling guilty for feeling it. Isn't that the definition of madness?
Then there is the digging up of painful memories, before breast exams we discuss in depth the development of our self image, dredging up some things I think I have healed from. People sob, Kleenex goes around, you are fine, then someone else gives their story, you emote for them, you feel the same thing you just got done feeling for yourself. You can't figure out which yarn is yours, it's a tangled mess of different colored threads. A massive bundle of nerves, sadness, shame, guilt, fear...

Full of Tamales

This is a photo from a hike in the Organ mountains last weekend. We hiked a beautiful in bloom desert trail up to "Dripping Springs". It used to be a resort and sanatorium. This window is from one of the buildings of the ghostly hotel that sits in silent ruin.

Has it been a week since my last post? It feels like a year has gone by, a years worth of learning, tears, frustration and joy. What a place I am in right now, and how fortunate I am to be able to experience it all.

Here is a sample of what I did yesterday:
1. Began the day with someone crying in our morning circle check in (not me-I don't cry, ever. Ok maybe once or twice I have. )
2. Hopped in the car and toured Thomason hospital with 11 other students, got lots of dirty looks when staff read our badges.
3. Stopped on the way home from the hospital at a local bakery that specialized in pumpkin empanadas and rockin tamales. I won't tell you how many tamales I ate.
4. Came back to MLL and participated for 100 heart thumping minutes in mock emergency scenarios. We dealt with shoulder dystocia, hemorrhage, baby with a serious birth defects, resuscitation of a baby and one normal birth.
5. Restocked the room where we had the scenarios.
6. I think I ate more tamales after that.
7. Umm...oh yeah, began a short shift from 5-8pm.
8. Did 3 blood draws, got stabbed twice myself. Oh yes and did a hemoglobin check and glucose check. All on my sister students.
We are quite comfortable experimenting on each other-yesterday we did pap smears. I will skip the description of that and leave it to your imagination.
9. Was handed a chart by one of the interns and told to do an observed cita (huh, I am not ready to do that yet) on a 17 year old with a STD. Needless to say I bumbled through it, was pushed out of the way because it was way to complicated and she had too many issues to deal with.
9.5 I did a successful finger stick on her-yippeeeeee. Am I truly excited that I hurt someone and drew blood? Yikes.
10. Came home and read 1/2 a story to my children while they drifted off to sleep. A sweet 10 minutes that I got with them. Sigh. They are better than all the tamales in the world.
11. Passed out myself at 9pm.

A picture worth a thousand words

A picture is worth a thousand words no ? Yesterday we had a 6 hour class on complications. Ugg, more talk about blood and I might spontaneously hemmorhage.

All jokes aside though, most complications are manageable and I will have a lot of learning on this front, by the time I leave MLL, complications will be pretty darn familiar occurances and I will be quite comfy will some things that might make others pass out.

Yes, there are more complications at MLL period. Hemmorhage being the most common of them. If you do research on the subject Hispanic women are more at risk for PPH. Perhaps they have a larger blood volume? Yes, one is tempted to blame poor nutrition, stress, poverty...but most of the women served at MLL are not living in poverty, if they were they would not be able to afford the out of pocket expense of care.

So why is it then truthfully? Perhaps because of their genetics, they have more blood to shed? What if it is just that, a normal physiological process that we clinically interpret as dangerous? I know, I am in innocence right now, but these are things to think of.

My 1st shift began with drama on Tuesday! Birth is an amazing process full of twists and turns, suffice to say that my first shift began with a baby crowning and having some sticky shoulders- easily remedied by a few maneuvers but nontheless dramatic. A big baby boy close to 10 lbs came vigourously protesting (screaming bloody hell as soon as his body felt the temperature difference) his entrance into the world. In the span of 1:30 very slow minutes I learned McRoberts and suprapubic pressure techniques for relieving a dystocia. I was so awed by how calm and efficient everything was, the family hadn't a clue what was going on, they were so wrapped up in greeting their new life.
An hour later I got to "labor sit" with a very dear human being (who's soft spoken presence is a joy to all her know her) and then witness a very normal birth at 8:00 pm of a 1st time mamma whos labor was 6 hrs long from start to fininsh. That baby decided it wanted to be born waving to the world, with its little hand by its head. Normally a nuchal hand creates a somewhat interesting labor pattern but this mamma was keen on getting her baby out without any bumps in the road. She was probably only 130 lbs pregnant too. Women continue to awe me!

What can I say about the strange art of venipuncture?
1. It is certainly painful being a demo especially when someone has a needle in you and moves your arm on accident.
2. It is strange bonding.
3. It causes random boughts of tears in the person drawing blood (not necessarily the person receiving).
4. It was less difficult than I thought.
5. It is quite triumphant finding someone's vein.
6. WHEW, most of the learning of that is over.

Circle at MLL
I cannot even begin to describe what it has been like the past 2 days. Look up "amazing" in the dictionary and get all the synonyms, look up "exhausting" too. 1st day everyone shared their stories, and it wasn't 12 stories, it was 20 something because staff midwifes and other students came to "circle" too. This day was filled with profound rituals and one of them was the telling of our individual stories.
This is a tradition at Maternidad la Luz, the welcoming of all the fresh shining faces by storytelling. Storytelling must take on different forms in different groups but for our group it meant profound sharing, it meant the falling off of the day to day facade that we erect, it meant tears, it meant laughter, and it meant truth. At the end of the day the air was thick with meaning, compassion and great love.
Yesterday we had a day learning about MLL logistics, protocols (some so very different than the way that I have learned, I am sure I will discuss this later on), and then an afternoon discussing Juarez and Mexico, most specifically the concept of a border city and the situation. The afternoon was tough, shocking, humbling. Google Juarez and you will see what I am saying, mostly articles about the violence against women and the murder rate, the maquiladores, the orphans.

It is all part of my reality right now, Mll is a mile from the border. We feel rather protected in our lovely birth space with pink walls and all kinds of birth art on the walls. We feel liberated ya know, man are we ever sheltered from most but not all of this.

I figured out how much about borders I know just living in San Diego and being a bilingual teacher for so many years. But I don't know and don't think I ever will know really. I still live in "gringolandia"....I am grateful for that card I drew in life. I feel a bit guilty saying that but despite all of the crap that I have been through, I am grateful for my life. It is a good life

So my little man is calling me out to play with him, and I must go, lego calls. Please keep me in your thoughts (in a good way)

Practice being open the moment....while washing dishes, while shaking hands, while changing a diaper, while walking through a door, whild taking a shower, while listening to music, while meeting a group of 12 amazing women. Practice being present for one minute, then two, then five. Watch as your breath changes, as the sensations around you change, as your interactions change, as your body begins to breathe in all of the energy of your surroundings. Watch as you open to blue, to red to beige...open to all colors of your surroundings and the people in them
Watch your pride melt away, your image dissolve, and watch what your heart does. It is pretty amazing, being in the moment suspends judgement, evaluation, fear and brings in the energy of the vastness of what is, not what the imagination creates.

If you have taken BFW, then you have a small glimpse of what I am writing about. Non focused awareness, combined with a bit of David Deida's Blue Truth (the book, amazing, has changed my life)...
A paragraph before I am off to my 1st day of MLL to meet those 12 ladies.