learning to midwife

List of traveling equipment in order of importance

2012-01-23T21:29:00.001-05:00

Passport
Wallet, cash, credit card , ID, eye glasses, book, note pad, pens, water colors,
Cell phone. iPod x2, iPad,kindle, mini speakers
Laptop, assorted chargers, vest, skirt x2 , pant x2, shirts x4, sandals , sneakers,, socks x2, bathing suit, snorkel equipment, 2 shawls, 2 scarves, 2 bras,
3 small tote bags , one back pack, one large tote. Tea , soap, toothbrush etc.

I did not mean to have a lap top but my son gave me my old one back and because it has a ton of music on it I am reluctant to discard it before downloading all that music.
to remember next time, incense, how can I forget how musty cheap hotels can be.

Acquired two candela , three small towels,
Fresh posts made daily.

2011-11-07T20:25:00.002-05:00

2011-11-04T21:16:00.002-04:00

I see young couple the story of their romantic adventures written in hieroglyphs on her bronzed legs by one hundred hungry mosquitoes . They are passionately kissing goodbye at the bus station. She looks near tears as she boards. He holds both hands to his face before inhaling deeply and sweeping his fingers upward through his long uncombed hair.

Is that love.

Fresh posts made daily.

Location:What is love

New Project

2011-10-25T08:08:00.001-04:00

There is a phenomenon happening where the American trained midwife CPM is bring exported either by invitation or as part of an NGO mission (some religious some not) to: bring her/our low tech , sustainable, gentle, life preserving techniques and knowledge to people around the world. I want to visit these projects and write a book/ documentary about this.

In this day and age it is hard to know if digital writing and photo/ video is best or flat out video. This is a Unique time in the world as far as this unique bird 'The North American Midwife' is concerned. I am excited about the prospect of seeing all the different environments she flourishes in. I can also imagine another project of reporting/photographing all the various birth and DEATH rituals around the world. How cool would that be!

San Fran

2011-10-24T18:03:00.001-04:00

There are so many interesting images to see while traveling. While not working I can meditate on the state of the world.

San Fran

2011-10-24T18:01:00.001-04:00

New post

2011-10-24T12:28:00.001-04:00

Trying to keep up or even go back ... Old technology once easily applied quickly seem as complex and as unknown as the new technology. Aside of not remembering my pass word I don't remember how to blog!

Blogged out

2011-04-10T20:46:00.000-04:00

Trust in timing

2011-04-10T14:41:00.002-04:00

Homebirth midwives take pride in trusting the timing of the baby. Yesterdays birth confirmed this and takes the cake as far as fantastic 'heard around the world' birth stories go.

http://www.dailymail.co.uk/news/article-1375412/Tenor-Juan-Diego-Fl-rez-delivers-baby-30-minutes-taking-stage-Met.html

Tenor helps deliver his own baby... just half an hour before taking to the stage at the Met

By DAILY MAIL REPORTER
Last updated at 2:25 PM on 10th April 2011

Most opera singers practise scales just before a major live performance.

But international tenor Juan Diego Flórez joined two mid-wives to assist his wife as she gave birth to their son, Leandro, just 35 minutes before the curtain went up on a performance being screened live around the world.

The 38-year-old Peruvian had stayed up all night with his wife, Julia, after she went into labour at their rented apartment on Manhattan’s Upper West Side.

Warm up: Juan Diego Flórez assisted in the birth of his first child, Leandro, 35 minutes before the curtain went up on his performance of Rossini's Le Comte Ory

While the couple awaited the birth of their first child, the world waited for the renowned performer to sing the tenor lead in Rossini’s comic opera Le Comte Ory at the nearby Metropolitan Opera.

The baby came into the world at 12:25pm on Saturday, just in time for his father to hold him for a minute before rushing to the Met for his 1pm performance.

But despite the rush, Mr Flórez described the birth as ‘calm’.

‘It was beautiful,’ he said. ‘It was a home birth with a pool, in the water. It was very nice and very calm.’

‘I gave the baby to Julia,’ said Mr Flórez in an interview after the performance. ‘I was so sad to leave.’

Renowned tenor: Mr Flórez's performance at the Met in New York was screened live around the world. He described the birth as 'calm'

‘I didn’t sleep all night, but I’m so happy.’

Mrs Flórez and Leandro are said to be doing well and are getting follow up care at Manhattan's Roosevelt Hospital.

Mr Flórez married his German-born Australian wife Julia in a private civil ceremony in Vienna in 2007.

The couple then had a religious ceremony a year later at the Basilica Cathedral in Lima, which was attended by some of Peru’s biggest celebrities, including President Alan García.

pubmed!!

2011-04-06T16:51:00.002-04:00

holy cow I am a published author!!

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Prendergast%20K%22%5BAuthor%5D

Status symbols

2011-03-27T18:02:00.002-04:00

I have had the good fortune to attend labors and births in a wide variety of homes. From million dollar mansions in exclusive suburbs , to one room cabins deep in remote mountain towns . Simple suburban tract homes and one room apartments in inner city neighborhoods to panoramic view apartments where the monthly rent was easily double my entire fee. Sometimes payment is whatever fee medicaid paid or what the family could afford, or nothing at all. No matter where or how the family lives or what the mother does, be it broadway star or check out girl at the supermarket; I strive to treat each family uniquely but the same. With respect and kindness. I strive to connect with that family and honor where and who they are. It is part of my job to find a way to relate to them without regards to their social or economic status.

Blogged out

keeping calm and questions about that

2011-03-26T18:42:00.004-04:00

What is am 'ideal' emotional attitude to hold at a birth?

Is there such a thing as having 'too much' personality at a birth?

I suppose to answer that, it might be useful to define terms like emotional attitude or personality.

It is my opinion that midwives and all medical care providers should use the ethical standards used by mental health providers. That is to say they should try and keep there own 'stuff' out of the situation. Emotions+ Personality= Stuff. Ok that may not be a helpful definition. The varied topics that go into the study of ethics for the helping professions is broad and deep, really too much for a blog post. So I will say that in the medical model the excitement level of the providers at a labor/birth/postpartum will peak with chaotic 'all hell breaking loose' energy and movement at the moment of birth and then quickly drops away. At home birth I think we serve best when we stay within a shorter/flatter emotional range. Perhaps not changing our exterior emotional expression one wit. If we do that, we leave the space undisturbed for the parents to have their personality and emotional response to the birth be the predominate feeling that pervades the room and the infants first contact with the world.

Sleep

2011-03-26T13:31:00.003-04:00

Being up all night at a birth, waking up after a long day after only a few hours sleep to a phone call from a woman in labor. How do we midwives do it? We just do! If a person can not cope with this then being a midwife is not the right work for them. They might try being a midwife in a Practice that let's them only be on call during the day but... Good luck finding partners who are ok with covering all the nights. I find I often need two nights of super long nights, to make up for one lost one. It is hard for me to sleep in most mornings. I tend to turn in early if I know I need extra sleep. The curative power of walking in fresh air can not be underestimated for restoring the mind and body.

Relax

2011-03-25T00:25:00.001-04:00

Safety starts in the heart of the midwife, she trusts in birth
She trusts the woman
She trusts the relationship
She trusts in her knowledge
She trusts in her actions
She trusts in the flow of timing
She trusts in the larger picture/ god/ universal love/life path

And from this field of trust the correct action or non action arises

- Posted using BlogPress from my iPhone

y I r a midwife

2011-03-21T10:46:00.008-04:00

Since my own first pregnancy in 1982 I have been an enthusiastic student of nutritional remedies and herbal medicine, growing , wild gathering and tincturing my own formulas. My first pregnancy stimulated in me a great interest in books on the topics of pregnancy, birth, health and parenting. At the time not many books had been written on the topic and the library in the small town I lived in had some very old books in the section for expecting parents. I read them all , books from the 1940's-50's-60's-70's up until "Spiritual Midwifery". I wondered how an event/process/human experience that must have been the same for 100,000 years could change so much. in 40 years. Of course I knew birth stayed the same, that the books each reflected a changing culture and view of woman. Thus began my fascination with the external pressures of culture and belief on the physiology of birth. I birthed my babies with midwives and immersed myself in being the best mother that I knew how to be. I did in home day care, In 1992 I opened and owned a health food store until 1996. I provided research and supportive information to consumers to address a variety of health concerns.

In 1996 I began an apprenticeship with xyz CPM and attended approximately 100 pre-natals , 15 births and post-partum exams in three years. At the same time I completed all but the suturing module of Heart and Hands beginning midwifery course. In 1999 I stopped my apprenticeship and began to work as a birth assistant and a birth and post-partum doula. Concurrently (1996 to 2000) I attended and completed the four year program at the Barbara Brennan School of Healing. This program gave me extensive skills in diagnostic, counseling and hands on comforting/healing touch. In addition history taking, family systems, psychology, professional ethics and presentation are core concepts covered in this training. I had a part time Healing practice until 2007 when I returned to Midwifery school.

As a doula from 1999 until 2010 I provided 10's of 1000’s of hours of Childbirth preparation, labor planning and support, lactation support and newborn care instruction to 100’s of families. My area of expertise as a post-partum doula was development of maternal instinct and healing maternal and infant trauma for families recovering from medicated and surgical birth. In addition; in collaboration with a MSW I created and ran a program to address Post Partum Depression. As a birth doula I supported VBAC 's unmedicated twin and singleton labors with a very low section rate >5%. and a very low epidural rate >3%.

While completing NCM, I attended 50 out of hospital births as primary under supervision. I became licensed in the state of New Jersey in 2010 and I worked with my former preceptors (for approximately 10 births to date) abc CNM and ghu CPM and as a supervisor and mentor to pdq , now a CPM.

I spent 6 weeks in Africa in the winter of 2010 as senior staff midwife at a rural maternity clinic Uganda, Africa. In this capacity I taught, supervised and created learning materials for a group of 50 local mostly illiterate midwives. Twenty seven births for which I was responsible happened during my time there including twins, breaches, pre-mature and post date births. Additionally supervision of pre-natal and post-partum exams as well as pediatric complaints, general illnesses and injury diagnosis, treatment and referral of both men and woman of all ages were within my responsibilities.

I incorporated my business in April of 2010 and partnered with mmm CNM in August of 2010, in our practice (as of 3/21/11) we have had four births (2 primips , 1 vbac, 1 multip) and are currently booked out to August 2011 with two births a month.

Since 2007 I have submitted five articles on a variety of topics to “Midwifery Today " every article submitted has been published.

Pattern and Management of long 2nd stage

2011-03-17T17:11:00.009-04:00

My goal in this article is to change the view of "Prolonged 2nd stage" as a dysfuntion of labor to a view of long 2nd stage that is normal and manageable. This situation may be caused by such issues as prima-gravida, large baby or less then ideal fetal head position. From the perspective of the midwifery model of care, labor can cycle through several phases of activity and rest after a woman has reached, or nearly reached, full dilation. This may go on for many hours, some midwives report days. If there is any question as to the safety of “allowing” a woman at full dilation to labor, one only need look to the medical model for confirmation that there is no harm. In a hospital setting, resting a woman (on an epidural and often Pitocin) at full dilation with membranes intact is common. This is called “laboring down” and is employed in hospitals so that a woman can be “delivered” by her doctor at his or her convenience. There is a double standard for unmedicated labors, as more than two hours at full dilation with any pushing effort is considered abnormal.

Rhythm of Labor in a Long Second Stage

When the woman is unmedicated, her contractions will cycle through phases of activity and rest. During active phases, the contractions may come every three minutes and she may or may not feel the urge to push. During the resting phase, contractions may space out to every 20 minutes and last only 30 to 45 seconds. She needs as many cycles of rest and activity as she needs. These resting periods are not “inefficient contractions” as the medical model labels them. We must allow these periods of rest and reassure everyone that this is normal; the baby’s head can change shape and elongate during periods of rest. Some midwives report ten hours of labor (or more) at this pace with healthy outcomes, and a relatively short pushing period once the baby has passed most of the occiput, past the pubic bone and is visible at the introits.

Midwives’ ideal model of care is one of patient waiting. The baby needs time either to accomplish moulding and/or to navigate the pelvis with a less than ideal presentation. In a primip or primary VBAC labor, when we suspect a large baby or when we determine asynclitic, posterior, military or face presentation, management of the resting and active phases of a long second stage may be called for.

It’s very important to discern when the following intervention of aggressive second stage management is needed. Perineal pressure and assisted pushing can hasten birth when heart tones are less then reassuring (emergency use) or when ordinary pushing and position changes fail to bring progress. Informed choice and cooperation of the mother are extremely important. In my experience, a rhythm usually develops whereby the mother informs me when a contraction is coming and when she is ready for me to resume working with her in this way. Avoid the risk of transfer and/or emotional trauma by engaging a woman’s strength and determination. In the course of prenatal care I inquire or listen for the challenges a woman has faced in the course of her life. This is a good time to remind her of what a strong woman she is, by using specific examples from the successes in her past. For example; running a marathon, swimming with sharks or opening a business. By believing in her and in birth we can help her dig deep and find determination and reserves of strength.

At all costs avoid bullying and coercion when using these assisted pushing techniques. The need for management like this, is only about 1 in 20 births. Not long ago, Jenn Head CPM and I handled a birth with a multip who did not speak English. After an hour of non productive pushing effort we employed these techniques. The mother indicated the start of the contraction and her wish for and willingness to be assisted this way, by snapping her fingers and pointing at her vagina. The large baby soon emerged with a beautifully molded head after an hour of pushing.

Intervention in Second Stage

If you determine that intervention is appropriate and you have consent from the mother, position changes, assisted pushing and a positive attitude are the most effective tools.

The most effective positions are standing, the birth stool and, surprisingly, dorsal/lithotomy on the floor. Make a padded surface for the mother with a pillow or support person behind her. Alternating positions and resting between contractions is important. If contractions slow again, encourage her to rest on the bed, walk or eat. Remind her to stay hydrated and empty her bladder.

Anne Frye describes assisted pushing and management of a cervical lip quite well in her book Holistic Midwifery Vol ll. The attitude of the midwife is crucial in preventing a situation where the mother feels violated by this active management. Honor her strength and determination, and do everything with her, not to her. I have found that in cases of a managed second stage, you can never stop checking for a cervical lip until the head is visible or prevents your fingers from reaching that high. I have also found in such circumstances that mothers often need assisted pushing. These things are done in a continual rotation, with a positive attitude, until you feel the descent of the head. Keep sweeping up for the lip and evaluating. Additionally, downward vaginal pressure can give mom direction for pushing effort. Finger forceps, which offer lateral vaginal pressure and ischial spine opening, is also useful. The attitude to hold in mind, body, tone and words, as well as fingers, has to be positive and intentional when doing this invasive and aggressive intervention. You have to know, feel and communicate compassion: it hurts but is needed. The intention is to make room for the baby and you have to believe it is going to work. The position for finger forceps is wrists crossed and the index and middle fingers all the way up to the ishial spines. Here again, you alternate between sweeping upwards with the fingers of one hand to feel for and manage the lip and downwards to palpate for the coccyx, stool, muscular tension on the pelvic floor and any other surprises ahead of the baby.

Pressure is steady and firm, the wrists are crossed, preventing excessive pressure, and the pressure is evenly distributed along the length of the fingers to the hand, preventing a “poking” sensation. You can try this in any position but lithotomy is most often used. Managing the lip and/or helping the baby shift head position while mother is in an open, knee/chest position is also very useful. Any position can be assumed after the baby clears the pubic bone and is descending, but the birth stool is often most useful to maintain progress. The use of a mirror at this point can encourage a woman and help her direct her pushing efforts as she watches the head emerge.

Shoulders, or at least slow emergence of the body from soft tissue dystocia due to swelling and size of baby, can be expected in such a case and calculations for space and assistance must be made in your head beforehand for getting the mother into (Gaskin) hands and knees, if needed. Be ready for resuscitation, especially if fetal heart tones are questionable. In an ideal world we would always have good fetal heart tones and a mother who stays focused and positive with only small expressions of doubt. These are very big considerations, but even with a flustered mother or slow recovery, a birth with a long pushing phase (4 to 10 hours) is very possible. Prevent maternal exhaustion by encouraging mom to eat, stay hydrated and empty her bladder.

Clean up as you go. Constantly evaluate the environment for the way it is organized and think (fluidly, not rigidly) about how to best use the space for different scenarios. Keep track of your supplies and promptly throw out glove wrappers, gauze, etc. Debris builds up quickly, especially during a long labor, if not attended to promptly. Fold and stack towels, remove soiled linen, shift and move your bags as needed, and, in general, scan the situation to make sure your actions and supplies are not impediments or hazards. At a long birth, these things can be important in keeping spirits and energy high. This also helps in the postpartum period when you feel tired and are packing up to go.

Minimize sudden movements and excessive talking. Graceful, slow movements and low, calm voices are always appropriate. Doing so conserves energy for the long haul, keeps mom calm and reassures normalcy. Cheerleading is tiresome, especially after many hours. It’s also important to be mindful of self-care. Take naps during the mother's resting phases and encourage doulas, husbands and less experienced midwives or assistants to also rest. Take the time to refresh yourself with nourishment and fresh air; take a walk and take long deep breaths. Make contact with people who recharge your battery. I call this last one the Ben Adam Maneuver, after my boyfriend, who made sure I ate and kept my own oxytocin levels high during a recent long primary HBAC of a 9 lb 8oz baby that inspired this article.

At this birth I thought I was using every midwifery trick in the book, only to find no book containing a description of such management. I had witnessed a few births managed this way during my training as a homebirth midwife and I had managed a few as well. Many experienced midwives I talked to agreed this was a labor pattern and management practice they were aware of but some were not. My intention was to gather or create teaching materials to support the normalization of such management and prevent unwanted transfers and unnecessary surgical births.

These techniques can and have been used in ways that traumatize or re-traumatize birthing woman. Also some midwifery students have been traumatized by being forced by preceptors to preform these techniques regardless of the need or efficacy . I hope I have been able to contribute useful parameters and guidelines for use. As well as a helpful description and how-to.

Guest Post on Holistic Doula NYC Blog

2010-10-12T07:35:00.000-04:00

http://holisticdoulanycblog.com/2010/10/11/guest-post-midwife-kate-prendergast-on-earth-birth/

reflecting

2010-04-09T13:52:00.004-04:00

The challenges in Uganda are so basic, most live without electricity and running water. Transportation other then feet and bicycle is rare, unreliable and unsafe. I actually enjoyed the simpleness of all that including being mostly confined to a few square kilometers and bathing from a bucket with the water falling back to the earth. Eating simple and only water a tea to drink. What I felt was really lacking was education, educational materials and information. There are no newspapers, books, computers, or other media commonly available. There is radio but the programing is not informative or educational. SO for example pregnant woman would not commonly know how many weeks is normal for a pregnancy. While I imagine most girls in the western world would know this sort of basic fact, there a woman having her 5th child may not know that. I gave the parish priest a rosary from Lourdes in France and he had never heard of Lourdes and was only vaguely aware of France. This isolation, perhaps a reflection of my own ignorance of so much of the world was the hardest thing for me...where do you start with education around basic health issues never mind deep healing . I saw many healthy babies born and much physical healing. I saw death, people who waited too long for help, others who could not get transportation to appropriate care.People often comment "how wonderful you went , you must have saved so many lives" Maybe, I aided in the saving of a few lives I am more hopeful that the teaching I did for local midwives might result in saved lives. However in general the culture is very timid and afraid to take leadership in situations that require bold action. There seems to be is no interest or idealization of being heroic . For example we flagged down a bus to transport a woman who needed to get to the hospital, the bus driver was not happy about it at all . When we went a few days later to inquire at the hospital if she had made it...well they had no record. So we do not know what happened. I wish I could have stayed longer and I wish I could go back I felt I was making some good progress. I was translating basic health and midwifery concepts into the local language. Repainting the Mary and Jesus statues in the local church - spiritually this was a high point. To tangibly repair the symbols of spirit and healing that had been damaged was gratifying. That is another thing I did not like was the dis-repair of so many buildings and the lack of effort to design or make pretty the surrounding environment, but again motivation to act and effect change is very low in general , almost seemed like a cultural thing. However people were very responsive when anything was made nicer or easier. Thanks for reading and if I go on to other adventures I will keep posting...

A. Bourdain on his visit to Africa

2010-04-06T10:44:00.000-04:00

It's hot here.
And by hot, I mean really, really, really hot. An absolutely pitiless sun beats down constantly, its skin peeling intensity in no way mitigated by the occasional cloud cover. If anything its rays are refracted--diffused--so somehow they envelop you from all sides. The air doesn't move. A puff of wind is an event. The ground is baking hot and the spaces--whether in crowded traffic of Monrovia or the dense vegetation of the bush--are close. Everybody--everybody--is covered with a thick sheen of sweat. On those rare occasions when your room does have an air conditioner or a slow moving fan, you will leave it and within moments find your clothes wringing wet as if you've just emerged from a pool.

Red dust from the roads mixes with the sweat, creating almost a paste around your collar and under your arms--clinging to everything. Even the cameras are covered with it. The air smells of burning palm fronds and I've been eating palm butter and food cooked in palm oil and drinking palm wine--and when people sweat around here--in the close quarters of the "palava hut" in Nimba Province, for instance: the whole village jammed together, or the airless scrabble club in Monrovia, or the markets, our sweat has the sharp, aromatic tang of palm oil.
In fact, I'm tasting palm now--as I crawl back from the bathroom for the 50th time--soon to return. I've spent the last 12 hours back and forth, never sure which end to point at the bowl first. Utter misery.

2010-03-29T08:02:00.001-04:00

charles and his madam

2010-03-29T07:09:00.002-04:00

it was all just a dream

2010-03-26T15:08:00.001-04:00

did that realy happen? did I realy see, feel, smell and experience that part of the world? so hppy to be in spring time and so many feelings (and suitcases) to sort thru...

boys and girls

2010-03-23T10:33:00.000-04:00

lots of them... doing the book keeping on that today and packing...

four more days

2010-03-21T05:20:00.000-04:00

am leaving soon... the church is no closer to being painted this week then last... I have had a wonderful time here learning about this part of the world and the people in it. British Airways is on strike but I hope that will not impact my flight home.

football

2010-03-19T10:43:00.001-04:00

the American kind....we had visitors of football players and medical people to town today...how nice to talk to Americans and how exhausting to be shmoozing in the hot sun on behalf of Earth-Birth. Definatly a nice change of pace and many promises all around of a willingness to help . A sun burn and a ton of pictures is what I have to show for it.

comment well recieved

2010-03-17T11:40:00.002-04:00

I realized sitting in church that Jesus and Mary are symbols of sacrifice and healing respectively. I also noticed that the church inside is painted a very dirty and faded blue and gold and that the windows are blue and gold glass, some broken but none the less I bet, the only glass windows in town. So my comments focused on that ...the church is meant to be like the cloak (local word Katanga) to shelter and heal. So who in the congregation wanted to make a sacrifice..maybe the cost of a beer? to fund the repainting of the church before Easter ? within 5 minutes the entire needed funds had been pledged by the local congregation. whooo-hoo. We have visitors from the US in the AM and I will report on that if I can get online. I know my comments have been breif, partly limited internet time and partly I am speechless by this experience.

sacrfice

2010-03-14T00:46:00.002-05:00

after painting JC I was asked to speak after church today ...wish me luck...my theme will be sacrifice...what do we have to give up to get what we want..if the priest and congregation want a nice church..can they give up something and put the $$ in the pot for restoration...I hope it goes well.

Madonna - Before the makeover

2010-03-13T11:30:00.001-05:00

about the pictures

2010-03-12T10:31:00.004-05:00

the pots were $1 for the little one and $2.50 for the big one, the animals are waiting for giraffe so they can start the meeting , that is Giovan with a victoria secret bag. Giovan is a very cute boy that lives here at the clinic. A monkey and if you must know: edible rat. Three sisters say hello to sister#4

Sunday is one day away and I have not found time to paint JC, I am nervous to do it....

another day another shilling

2010-03-12T01:19:00.001-05:00

Two more weeks here. The rains have become less and it is hot hot hot! but I like it hot so that works for me. I do not think I will be able to spend time in Kampala (sorry Aunt B) . Today is not too busy. This is typical: a woman came in complaining of pain with her period after many many translated questions and answers ...it turns out she has a broken rib... the health center sent a woman here whose baby had blisters (from sucking) here so we could transport her the hospital !!?? so it is alot of story finding to find out what is realy going on, so that we can; in what ever limited way respond as best we can. A boy delivered water today and refused to be paid the 200 shillings with a 2oo shilling coin since two 100 shilling coins are bigger (physically bigger) so that is the state of education of some of the people here. We have been gifted with a cock (rooster) and he is way loud..so he might make a nice dinner (just to shut him up).

Mary is Refreshed

2010-03-10T09:21:00.002-05:00

I was finally able to paint the blessed mother today, what a satisfying experience I will try and up load a picture but the bandwidth here is not large. I will donate the rosary from my dear friend Tracy , it contains water from Lourdes from France and the statue will hold it high over the heads of the congregation and I hope bring healing to this place.

n--e-w-s

2010-03-08T00:50:00.002-05:00

The mudslides are in eastern Uganda and I am in the North, there are not even foothills around here to slide anywhere near me if it did rain too hard...so thank you for the concern but it that regard I am fine. I did catch a cold and was miserable for a few days but otherwise I am fine. I have been enjoying the work here..continuing the work of translation and illustration of midwifery concepts into Acholi. We had a fetal demise..a 20 to 22 week footling breach with prolapsed cord. early loss and premature labor are common , the other common complication is too much bleeding. The resources here are sparse so having drugs to treat PPH is a spotty affair. We have a woman in labor and neither Olivia nor I can determine position..maybe twins, but the only place to get a scan is closed today because of a holiday, National Woman's day..I thought it would be a good day to paint The Blessed Mother Statue at the church but with two labors cooking I am not sure. Yesterday at Mass Father Arnold told the congregation that "a volunteer' had offered to paint the stations of the cross on the walls of the church!!! oh boy! give a preist an inch and he will take a mile. I do think repairs to the house of worship and spirit would go a long way to uplifting the people here. I cant wait to post pictures. Two political developments while I have been here is that the IDP camp (internaly displaced person camps) will no longer will be called camps and the world food program will no longer give away food here. Everyone I have asked says they feel the only hungry people will be the older one that can not work. I have noticed some workers demading higher wages.

as for the question

2010-02-27T07:32:00.002-05:00

where am I ...look at www.earth-birth.com.

We just returned from Safari and we saw lions and leopards, elephants, giraffe and cranes, floated down the Nile (we were supposed to motor up it, but the engine died...so we floated). tons of hipps, antelope , deer and wart hogs ...

I return to clinic tonight and Jenn Head returns home to the US in a few days. I am looking forward to learning and living simply.

Call Me!

2010-02-23T07:28:00.003-05:00

256-785787349
is my number here please feel free to call me , it is free for me to get calls-it would be up to you to figure out an inexpensive way to call or text me. The rains have started early this year here, and that has kept the dust down. I got some great shots of Jenn handling a birth on the birth stool this AM and then had what felt like a very busy day of prenatal, but it was only 3-4. The issues here are intense, what we would call psycho-social issues. One meal a day and a few glasses (maybe only one) of water is the norm here for pregnant women. And the reason are often that ...oh it is almost too complicated, but seem to be in the schmucky husband/bitchy co-wife category, and intense hard work :miles of walking, carrying babies on back and water on head. A young woman needed to be counseled to go home to her mother, since she was so overworked and undernourished. Another was told to bring her husband next week so we can tell him that she can no longer carry water for bricks now that she is 9 months pregnant. We have a lady in labor who is really in early labor but is happy to stay here where she can rest and eat. Tomorrow Jenn and I will go on safari for two days before she returns to her village.

Uganda

2010-02-21T08:47:00.002-05:00

Today is sunday , I arrived on Thursday night. So many adventures already.... caught a baby last night with sticky shoulders, I am realy here to teach and supervise the local ,midwives but the woman was on a birth stool and this is a new contraption and it clearly made the midwife nervous...the woman had a alot of blood loss, and we had no medication except homeopathics...it finaly stopped with ipacac that made the mom cough ...scarey. Jenn Head caught twins, baby b footling breach, the night I arrived. The mama and baby are still recovering here because her husband is not attentive. (AKA shmuck) In other news we went to mass this AM at a bullet riddled church where people had taken refuge dueing the last war and 250 perished. I offered to father Arnold to repaint the mother Mary statue when my bag with art supplies and other goodies finally get reunited with me. Father Arnold said re-painting Mary was nice but he realy wanted the 12 stations of the cross painted along the 12 foot high walls between the windows! I dont think I have enough Paint! or time! I had the basics with me as carry on and I arrived safely but my check on bag took a detour. Internet is not easy to come by, but I will do my best to make updates.

more gifts!

2010-02-06T11:59:00.004-05:00

A graduate of the same healing school I attended makes these essence blends and gifted me with these two for my trip. Here is what they are for:

Renew which will be helpful for staying grounded and in the vibration of courage. It also helps one remember their soul's purpose and is a general tonic for the system when traveling, integrating after an expansion or big release work, and healing from any illness.

The spray I sent is Relax and Calm- remember to shake it before spraying your field, take a deep breath and inhale the essential oils. I thought you might want to try it out for yourself and share it with others when you are in Uganda. Perhaps it might be very useful for the women giving birth to stay relaxed and calm throughout their labor. I am totally open to the possibility of donating a supply to Earth Birth if it proves to be a useful tool for the volunteers and mothers. I love the thought of sharing my creations with this effort.

You can read more about her products by going to www.zuvuyaheals.com.

gifts from WELEDA

2010-02-02T15:22:00.003-05:00

One of the items on the packing list was a small gift for the Traditional Birth Attendants (TBA) in Uganda ...50 of them!!...this sent me into a bit of a tizzy since 50 of anything was going to weigh something and cost something and oh my....but a local company was so kind to donate 25 each of two of my fav products..Arnica Massage oil and Skin Food. I am so grateful!

Prayers and intentions

2010-01-27T16:53:00.001-05:00

Specifically for my physical safety I want to be safe from pathogens and accidents of travel, that my contact with the vehicles of travel is protected from harmful chaos. That I easily encounter safe drinking water and clean food. I

For my emotional safety that I am shown those situations that deepen my medical knowledge and my understanding of the culture and my capacity to be with what is, no matter how far it is from my own limited system of understanding of how the world should be.

For those I meet, that my encounters do more good then harm, that any medical care I give or any teaching I do brings healing and positive movement for those I encounter.

new words

2010-01-15T17:15:00.002-05:00

http://akuganda.blogspot.com

Some words in Luo, the language of the Acholi people:
Birth- Nywal
Sisters- Lamego
Midwife- Lacholo
Mother-Mego
Latin Kienen- Mother & Newborn
Helping- Kony
Heart- Cwiny
Hands- Cing
Togetherness- Ribbe
Push (something I hear all day long)-Chol
Hard (the other word I hear all day long)-Matek or Chol Matek
Continue-Medii

You’ve done a good job- T’emo ma bei
Beautiful- bei
Baby is beautiful- Latin leng or latin bei

learning resource

2010-01-14T17:23:00.000-05:00

http://www.brooksidepress.org/Products/OBGYN_101/MyDocuments4/Procedures/procedures.htm

how to help

2010-01-06T08:33:00.002-05:00

you can buy a box of gloves or somthing more...

http://midwifesupplies.com/Earth-Birth.html

Uganda here I come

2010-01-05T15:54:00.002-05:00

Here is the update in the process of going from being an experienced doula to a midwife. I am still waiting to get my state lic. in the mail 5 months after passing the NARM exam. In this time I have continued to work as a doula and as a birth assistant. But this spring I expect to do the work of building my practice as a midwife, in the meantime I have decided to go to a Birth Collective in Uganda Africa. I think this will be great for deepening my skill base and be life changing into the bargain. I will try and blog from the dark continent.

waiting for finger prints

2009-11-14T07:40:00.002-05:00

At this point I have gotten my diploma, my CPM and now I am waiting to be finger printed for state license. Good thing midwives develop patience! I still have alot to do as far as "back office " set up.
I need
a business structure
a lab account
a billing service
an NPI number
a back up doctor
and a bunch of other things

2009-09-07T17:35:00.000-04:00

This was so funny!
If anyone needed a midwife it was this family!

North American Registry of Midwives Exam

2009-09-07T17:19:00.002-04:00

Today is Monday 9/7/09 and I found out two days ago I passed the NARM exam. We had company sunday so today is the first day I have completely relaxed in a long time. I was on vacation right after taking the exam and it was very nice, perfect weather. good friends, ocean, sun, lobster rolls....but not knowing my next step in the process made it hard for me to completely let go. I can feel my certainty about the next steps on the path and confidence that I can continue without too much effort to the goal of a helpful and successful midwifery practice.

study study study

2009-02-21T20:45:00.001-05:00

now it is time to do (almost ) nothing but study. This is not my favorite thing to do.

first birth at home as a midwife

2008-12-06T18:03:00.003-05:00

I was hired to be a midwife before I returned home and that birth happened this AM A wonderful little boy born at home after a very long hard labor. You can tell by the shape of his head what a journey he had.
There was a wonderful sunrise seen from the house

safe at home

2008-09-11T11:22:00.000-04:00

my trip is complete , it is good to be home!

2008-09-09T04:17:00.000-04:00

next to last post

2008-09-06T08:46:00.003-04:00

Japan is nice and restful, catching up on zzz's and then walking my legs off sight seeing. I'll post again when I am safe at home.

MD

2008-09-02T20:46:00.000-04:00

Elsa

2008-09-02T20:17:00.001-04:00

jr3

2008-09-02T19:30:00.001-04:00

JR 2

2008-09-02T01:04:00.000-04:00

in Manila

2008-09-02T01:01:00.000-04:00

I got my rail pass for Japan and my flight leaves in one hour !! wooo-hooo

JR

2008-09-01T10:53:00.002-04:00

I should have listened t Aunt B

2008-08-31T19:09:00.006-04:00

My Aunt B. said I should be making a documentary but (generic excuse) and then my camera went missing. I brought my lap top with built in cam to the clinic last night to scan charts and then Jane sat down next to me, the sound is really bad and you see me looking for a microphone in my bag but I did not have it with me, so if you can put up with the sound...I plan to cram in another interview or two before I leave in less then 24 hours......

more zipline

2008-08-30T00:31:00.001-04:00

today I got to ride on "the longest zipline in Asia", it was alot of fun and a good way to mark the close of my time here.

best catch ever

2008-08-29T18:45:00.004-04:00

It was a busy start of shift when I came on last night for night shift. Plus the midwives occasionally have friends labor in their apartment and just come down to the clinic for vital check and such was the case. Somehow although I really should have been first up, I wasn't. I was not worried because I knew a labor would come in later in the night. I did a little assisting and then went to sleep, at about 3.30AM I woke up and knew my labor was on the way, everyone else had put their gals in postpartum except the friend laboring upstairs. All the midwives were asleep. Sure enough a few minutes later (instincts intact!) in walks my gal she is told to go to the "CR" (comfort room/bathroom) to wash and pee, when suddenly I hear a huge grunt and I ziggy on into the bathroom, head is visible, by now super and a midwife are right outside the 'cr'. I call for gloves and towel, super tries to talk the woman into getting off the toilet and walking to a bed, but she refuses. The head delivers while the woman is on the 'throne' and I ask her to stand up and she does. Baby safely caught while she stands, she sits down again and holds her baby , A/S 9...by now the chart has been fetched and the super realizes the patient is her own continuity of care patient and so I don't have to do any charting or post care! I just assist the super with the placenta and cord clamping and go back to sleep! In the AM my fav. super comes on and I have her sign my skill verification sheet and she high fives me over the 'cr' catch. Perfect! I counted it as an assist.

begining to pack

2008-08-28T22:33:00.002-04:00

it is Friday morning, I leave early Tuesday morning for Japan. I am starting to pack up and sort. It is amazing how much stuff I accumulated in 10 weeks. I have three more shifts, if I catch 2 more babies it will be 30 total handles. If my nuber stays at 28 that is ok too, I am looking forward to using the skills I learned here in a home birth setting. The 600 hours of clinical time was very valuable too. I am coming close to the end of this blog as well, the purpose of it was to report on my experience here at NewLife/ Mercy Maternity center in Davao. I am told that the number of babies I caught is unusual, it is due to my taking almost 10 continuity of care patients.

Valderama connection...again!

2008-08-26T23:58:00.003-04:00

I went to visit one of the married students (NB) who lives with her family in a gated community where the Directors of the clinic live. NB had invited me for breakfast..mango crepes and fried bananas (fantastic) ..I had never been there before and it is a bit of a walk, I get to the guard house to ask permission/directions and who is the guard...non other then Mr. Valderama Sr. the grandpa of my first catch here, and patriarch of the Valderama clan. I would have taken a picture of him in his snappy uniform but my camera has gone missing and I am waiting until I get to Japan to replace it. The other picture worthy moment was seeing the son of NB who is about 5 getting on a motorbike to be driven to school. So cute.

and still counting...

2008-08-25T06:21:00.004-04:00

the total catches here 26 , and 7 more shifts before I go, and I might have another continuity wandering around out there! Ultimatly I am so glad I stayed past my 'minimum' number of catches because I am learning so much now, I even put an IV in!

almost unbelivable

2008-08-25T01:53:00.003-04:00

So, g4p3 mom with the IUD finally goes into active labor, I did epo on her last week as we must have thought she was post dates, but someone had written "edd 8/8/08 on her chart but inside the chart it was 8/18/08. I was not on shift but was called in because she is a continuity of care. It was the first day all the new students were in the clinic plus is was prime "baby check" time at about 11am, so I barely had a bed to examine her on. she was 6cm bow bulging during ctx, ...no IUD felt.. she labors a little more outside, less then an hour she comes back and indicates the way woman do here, that they are ready to push. With a sideways look and raising their eyebrows. All the birth carts are spoken for. Every bed has a laboring woman in it. So super just tells me to grab what I need from the cupboard and pile it on a chair. I indicate to one of the new students to ziggy on in if she wants to see a birth. Head crowns, head out, restitution, body out, A/S 8-10 , placenta ebl 100...and then I remind the super "any special consideration about this IUD?"...she tells me to do a manual exploration to feel for it after making sure it is not in the placenta. So if that isn't the perfect culmination to yesterday...unbelievable, fyi no iud felt by me or super and the 3rd woman in a row I had to put on antibiotics! Best of all she lives on Talikut the island of the giant star fish. Where her husband is a fisherman/farmer So I am going to try and get a home visit in before I go. In other news I caught 4 babies in 25.5 hours, and to think one month ago I thought catching one baby a day was the max! and I am on night shift tonight!

complication de'jour

2008-08-24T10:28:00.002-04:00

I was at the clinic 6am to 10pm a "double shift" think 6 babies at least were born today, I caught two of them and assisted at a 3rd (but the assist was the first of the day) and they all had the same complication in varied degrees from worse to bad to not too bad. First baby came out and we waited for placenta..no placenta , cord retraction with Brandt/Andrews, they have a way of getting a retained placenta out here that they call a cherry pop..no placenta with cherry pop...handling midwife goes in to do a manual exploration...says the placenta is adhered and ..no plaacenta,,supervising midwife goes in ...no placenta..head midwife is woken up..no placenta//patient transported for a D and C. I get a labor, she labors well, pushes out her baby..cervix is visible, she has ebl 700! placenta looks complete..3rd degree laceration making the vag. vault very lax. she continues to bleed 10cc...50cc when super goes to suture, more clots, she goes in, manual removal of placental fragments! she stops bleeding. I get another labor, one hour later she has a baby ebl 150, no laceration, but trickle bleeding..super goes in recovers 75cc clot. Go figure all in one day!

sorry for all the tech language

2008-08-22T18:30:00.007-04:00

having caught all the babies needed for certification and carefully avoided any wild complications , especialy ones that would result in transport to the scarey 3rd world hospital here (shudder) ... I can at last welcome some more challenging cases (don't you love how I imagine I am in control of these matters). So last night a g5 p4 comes in and is 5cm, she has a history of quick labor, but first off she is 42 weeks when admitted at 9pm and the supervisor says 'she better deliver by midnight..but new super at 10pm is more ok with the post dates and new supervisor just lays down and goes to sleep as my labor is the only thing happening in the clinic. This woman and her husband have very limited english so I just smile and try and be reassuring , she is getting very uncomfortable but is not bearing down. I start to think AROM might be good, for her since the head was not well applied and when I read her chart I see she normally has SROM and baby out 5 minutes later (starting to love reading charts)...but I would have to wake the super before doing anything so drastic ...Mama is moving around alot, there is a poster in the birth room of different positions and she is trying many of them on her own, she dosn't want to lay down after I check heart tones ...so I decide about midnight I will wake the super to ask about using the big birth stool. So super gets up, patient sits one minute on the stool and says she wants to lay down (??!) no progress after a few pushes..I recheck she is not fully...back to walking around , I mention AROM to super who asks the patient , but the patient can not decide if she thinks it is a good idea. So finally she trys pushing again and we start to see progress she if fully..but then... heart tones start to go down 90, 80, 90, 100, 80 and the decent is slow for parity, by this time I realize AROM is not possible there is not enough bulge in the bag, even super gives it a try.. so we get her in an upright position on the stool and ask her to really give it all the power she has. SROM -clear, Head pops out, there is cord, next nano second out flys baby all the water behind, flying terminal mec. (landed a foot away on the opposite side of the babies bum ??!). and within the same minute placenta... ebl 50cc. Nucal cord tightly coiled and detaching placenta contributed to low heart tones. Note to self ..stop thinking AROM is useful. So she was 42 weeks+45 minutes...term with a baby who had good reason to descend slowly.

I sure could have used this in the begining

2008-08-21T21:16:00.002-04:00

coming full circle

2008-08-20T11:48:00.002-04:00

I was reminded again about the importance of intuition in midwifery. Intuition that stays open to the unexpected, unknown and the unknowable. Intuition grounded in experience and open to learning something new. I started on this path because I had great faith in my intuition and greater faith in the power of woman to birth, I got a little hung up on those blue towels but ultimately I have landed back where I started. I have nine more shifts and about 12 more days..then a week in Japan soaking in Onsens' and then home lovely home!

a little shopping

2008-08-20T00:59:00.001-04:00

2008-08-19T00:49:00.001-04:00

what was I thinking

2008-08-18T18:49:00.002-04:00

I took a continuity of care who has a wild complication, she either got pregnant right after or more probably right before she had an IUD put in!!!!!! I have no idea how this is going to turn out. ultra sound confirms it's placement in the uterus, baby is term. This obviously would not be a candidate for home birth. Stay tuned...

are these the secret of safe birth?

2008-08-18T02:28:00.002-04:00

blue towels, please reassure me babies come out without these at hand.

update on Evy and others

2008-08-18T02:18:00.003-04:00

Evy named her baby Precious JENN not janne , after the precious midwife who endorsed her to me. So that is two name sakes for JEH and one for me, but as a wise midwife once said: it is not a competition unless I am winning. I allowed the 16 yo old to skip her 3 day as it was raining that day, gut said it was ok but of course I was nervous as her baby did not have the best latch and was small to start with. But at one week the baby has gained wonderfully and looked great, latch is perfect, milk over flowing and Jasmin was hard to say good bye to. Also saw another fav. mom the g5 p5 who won my heart after calmly walking away after 41+5 EPO with umbrella tucked under her arm. She is neighbors with one of the clerks here. not many of the 20 births stand out but these three do for sure.

Thanks JEH et al.

2008-08-17T01:17:00.000-04:00

I was sharing my newly felt concerns on my blog and with a student here, who reminded me that when I arrived and the students almost all said "oh I don't think I would know what to do at a home birth.." I had said that I thought they had been well trained and would simply need to observe a few home births in the states to re-adjust their way of thinking...so I suppose I just need to take my own advice and know...I will be fine, I will adjust, those blue towels most likely are not the secret to safe birth.

ripples of doubt

2008-08-16T18:55:00.004-04:00

I came to a new understanding of my concerns that I mentioned in my last post. When I first came here, I was very clear on what was 'different' from the lovely home birth I know. But now birth here seems normal and I 'fit in' know what the supervisors expect and want and I do that. One small example babies absolutely must cry, blinking, sticking their tongues out, showing off their reflexes are not enough. So I make them cry. Better to make them cry or they end up with deep suction. We use these course fiber towels here (very helpful for making a baby cry and supporting a perineum) and the thought came to me, will I need these at home? how will I catch a baby with out these blue towels? It is nice to have the approval of the supervisors because then they leave you alone more. But my dilemma is clear. In related news I realized why I have such good 'luck' with my continuity of care patients. I was watching another midwife struggle with a continuity and it hit me. I have been using the same criteria that would make a woman a good candidate for home birth. Healthy, married, multigravid, able to communicate and responsive to advise. So I am not sure what to make of my comfort with the charting and the protocols here. Where as charting overwhelmed at me at first. I can now get a baby inspected and injected, birth certificate filled out, birth recorded, mother up, fed and showered in 90 minutes. And I would do it faster if I was not so inclined to allow the baby to breastfeed for at least an hour. I suppose this place has made me a midwife fit for here and it remains to be seen how I do in the states.

wave of doubt......

2008-08-15T05:06:00.002-04:00

So I am peacefully sleeping on my beach chair...when I wake in a panic..at first when I got here many things seemed odd. It seemed odd that every woman gave birth either laying on her back or semi reclining on a wedge or supported by her partner, but still more or less reclining. Then after a dozen births it seems normal, then after 20...I am waking from a beach nap in panic. Will I know how to catch a baby, protect a perineum in other positions? How will I learn that skill if it is different from what I learned here. Is this why practitioners stick with lithotomy? Oh boy I have alot to learn. Due to a university convention at the beach hotel my overnight became a day trip :-(

more About Evy and baby Precios Jane

2008-08-14T11:19:00.003-04:00

Evy was a continuity of Jenn H. When Jenn left she endorsed her to me. Evy sent me a text at 6am to let me know shw was in labor. At about 6pm she texted me saying she was headed to the clinic. I was scheduled to work a day swing the following day so I was not looking forward to spending the night in the clinic. Evy was about 70% and 4cm at about 8pm, I wanted to send her home, but she lives far from the clinic and supervisor said to keep her. Her BP was high 130/96 so I had her drink a glass of water and lay down on her left side, but the high b/p persisted. SO I asked her if she was nervous and she said yes. As she lay on her side I rubbed her back and feet and asked her to close her eyes and breath. Her b/p went down to normal and then she went outside to eat with her husband. After 10pm endorsements I went to sleep in the clinic. At 11.05 pm I was woken up by one of the midwives telling me my patient wanted me and I went in to find head visible , srom had happened at some point. I gloved up and others readied the birth cart. JR was supervisor but she left me alone with a charter and an assist and just sort of peeked in after head out and again for placenta. That is a perk of being here so long, having the trust of the supervisor to handle the birth more or less alone. Precious Jane had nucal hand and cord so she was fine but caused a wicked laceration. I got the charting done, baby inspected and injected by 1am, mom sutured and into post-partum by 2am. At the start of day shift I was sent home to rest and had an un-eventful day. One interesting note was that her cousin came in , in labor and they had adjoining cubicles. I ended up taking care of the cousin the next day in post-partum.

Another teenage mom

2008-08-13T04:02:00.002-04:00

I don't know what it is about shift change but woman love to push then! I was working a double and a woman who had been in earlier and sent home at 1cm came in at 9.40pm right before the 10pm shift change. I did not think I was up, but since I was working the next shift I was elected midwife. Being a midwife here is a little like being a waitress. A family comes in and you say "Ako-si Kate I will be your midwife" (ako-si means 'my name is'). So I check vitals and try once more to convince another intern who still needs numbers to take her and just stay a little past shift but she is not interested. This 17 year old is already the mother of one so short story shorter, her water breaks and she pushes a few times and out comes her 2nd daughter at 10.18pm. 7.5 lb, 150 ebl, first degree not needing repair and she wants to shower by 12.30am. I checked her vitals at 1am and then everyone slept until 5am, as protocols require four hour vital checks. If I have a goal it would be to catch 7 more babies and to experience a few challenging presentations. I suppose I will have more time for blogging without Jenn to hang out with in off hours. I work a double tomorrow and then have nearly two full days off, so I am planning an adventure......

oh my goodness slide shows!

2008-08-13T03:56:00.001-04:00

I just figured how to put these mini slide shows on my blog! yeah for me

zapatita

2008-08-13T03:15:00.002-04:00

mini shoes

2008-08-12T19:04:00.000-04:00

friendship

2008-08-12T18:30:00.003-04:00

Jenn H.the intern went home yesterday and I am missing my buddy. We started our internship at the same time, shared our process about: being here, away from family, in a new culture. becoming midwives and just daily life. We giggled and gafawed, teased each other and had inside jokes. Jenn bought me a few flip flop key chain ornaments and I added to the collection as often happens with these things. Two things you should know about Jenn: she was endlessly fascinated by the uses of cellophane here and she wears orange crocs. Yesterday we went out for breakfast and her last minute shopping. I bought us each an orange croc key chain. Jenn had hers placed in a tiny cellophane and sealed for the journey home. I will carry mine close to my heart and photograph it, in any places where an orange mini croc in the foreground will improve the picture. I miss you Jenn...you seem distant...

officially complete with catches here

2008-08-11T17:32:00.004-04:00

I caught baby number 17 yesterday morning, The 3 remaining need to be continuityOC, I have one from home already leaving two. I doubt I will get those last two here as continuity of care. I keep taking continuity of care clients, in fact the last birth was one but I only had one pre-natal with her. (you have to have 4) Last week when I was doing prenatal s , I called this young girl and started as I usually do "How are you feeling?" she answered "very nervous". So at the end of the prenatal I asked her if she would be less nervous if I was her midwife and she said yes and looked noticeably relieved. I normally have only taken multi-gravid woman as continuityOC, but Jasmin is only 16 and thankfully pregnant for the first time. We had a great birth. Her Bana (partner) was so excited to become a papa he was bursting. Jasmin came in at 8 in the morning after 12 hours of labor she was 5cm While she was laboring I was supposed to be upstairs in the clinic doing initial prenatals but she kept texting me to let me know she was in pain and ask "Ma'am Kate, whn cn I hve my baby?" So I gave up on helping with prenatals and went to hang out with her in the birth room. She was fully by then with only a small lip. I asked her to get in hands and knees for awhile. Soon she was pushing and her daughter was born at 11.45 AM. Thankfully she only had a small skim split. Jasmin was so grateful and texted me a nice thank you after she went home. Everyone felt good about her birth. I was thrilled to be able to provide physical and emotional support as a midwife. Jasmin was more relaxed then she might have beem. The supervisor seemed impressed that I had taken a 16yo continuity and done so well with her. Later I scanned all the charts of my handles in case of audit. I feel so grateful for all the woman who helped me become a midwife, and all the midwives too. Jasmins birth means more then half of my births here have been with primia gravida. So I, for sure, am over my fear of first time moms. Ever since my visit with the Valderama family I feel a deeper respect and understanding of the families here and the life they live. I woman brought her baby in for a post-partum and was concerned that sometimes the baby coughs. I told her to keep the baby far away from the wood fire in her house if she could, that seemed to make sense to her. That people cook on wood fire here would not be something I would have known without seeing it myself. That people manage to be so well groomed when living without running water and washing machines is something that really moves me.

The Valderama Family

2008-08-10T09:16:00.003-04:00

Let me tell you about the Valderama family. They live out by the airport. After taking a jeepney you take a trike cab down the dirt road past the corn field and Banana orchard into their neighborhood. It is refreshingly rural, unpaved roads. Chickens and dogs roam around. The older Valderamas have four children, three boys and one girl. They are all married now and the daughter and her husband and her two daughters and their son and his wife and three children all live together. The daughter runs a 'sari-sari' store. That is a store that sells a little of this and a little of that. Another son lives near by with his wife. They have no children, put I promised to return to Davao if she got pregnant. The childless couple also run a sari sari store and raise chickens and pigs. They have a karaoke machine, TV, dvd player and a refrigerator! The picture of a typical kitchen is in their house. The house is about 20 feet long and 9 feet wide. The store is separate and it is possible to step from the doorway of the house into the back of the store when a costumer needs attention. This means you don't have to step down into the muddy ground. The floor is planks of wood and the walls are straw mats. The elder Valderamas do not live in such luxury. Their walls are made of tarps and they have not built a floor so, the floor is dirt. The elder Mrs. Valderama is very industrious. Coconut and mango trees grow all around. She makes a coconut dessert and mango relish to sell at market.

my mamas

2008-08-10T07:56:00.003-04:00

typical kitchen in Davao home

2008-08-10T07:48:00.000-04:00

My Family

2008-08-10T07:43:00.005-04:00

Today I went to do a home visit with the family who can claim me as their personal midwife. We sang kereoke and had a great time.

All about CPM's from NARM

2008-08-09T21:23:00.002-04:00

Just thought this was interesting.......

The North American Registry of Midwives, the Midwifery Education Accreditation Council, the National Association of Certified Professional Midwives, and the Midwives Alliance of North America are pleased to announce the release of An Issue Brief: Certified Professional Midwives in the United States. We have produced a concise and accurate document that provides the background necessary to understand the genesis of the CPM and its implementation as well as address issues related to the professionalization of direct-entry midwifery in the United States. The national organizations that collaborated in the writing of this document have played essential roles in the formation of the Certified Professional Midwife (CPM) credential and in the ongoing support for the development of the profession.

A new era in midwifery in the United States began in 1995 with the implementation of the CPM credential. Today these well-trained professionals serve more and more families. CPMs bring a deep understanding of normal birth, and the care that fosters normal birth, to the women they serve.

CPMs are a rapidly growing group of maternity care providers. This document is an authoritative source in describing the education, qualifications and scope of practice of CPMs for the benefit of childbearing women and families, other maternity care professionals, as well as legislators, insurers, and policy makers. We believe it also timely to describe the unique contributions that CPMs are making to national discussions about how to educate the numbers of midwives who will be needed to meet the needs of women in the next decades. And, perhaps most essential, it is important to describe the contribution that CPMs are making to the health care system itself by offering maternity care that is high quality, cost-effective and safe in an era when the efficient use of healthcare personnel and resources has become paramount

MORE INFO

http://mana.org/pdfs/CPMIssueBrief.pdf

Am I done?

2008-08-08T22:29:00.003-04:00

Having gone up the mountain and declared to all god's creatures within earshot "I am a midwife" and having completed my "numbers"...am I done, what is 'done' when every moment can be a new beginning? I am just at another place in my continuing journey to serve mothers and babies...ooops off to the pool

Eden part one and two

2008-08-08T07:44:00.002-04:00

uniform

2008-08-07T20:35:00.002-04:00

Uniforms are important here, on school children, office workers and here the gas station attendant matches the logo.

celebration in the mountains

2008-08-07T11:19:00.006-04:00

Jenn H and I were both one birth away from our "numbers" and to proclaim ourselves as midwives and to take a much needed break we zipped by taxi up to an eco resort in the mountains. The fresh air and altitude was so healing. The organic food so nourishing, the zipline so thrilling, yes that's right zip line! I'll make a movie soon but here is a starter. I think Jenn will catch her last needed birth tonight and then she is free to go home. I am going to stay my planned time because they are short handed and the more experience for me the better.

update, Jenn caught her last, after 3 primip's in early labor raised and dashed hopes. She ended up doing a bare handed catch because the woman was just that ready when she finally removed her shorts! The moms name is Angel and the couple is naming the baby Jenn! Yeah I love happy endings.

why is everyone smiling?

2008-08-05T22:59:00.003-04:00

Everyone is working extra hard because a few people are out sick or on vacation. The new intern is ill with a stomach bug and if anyone who knows her reads this blog or you feel inclined please pray for her speedy recovery. I suppose being around babies and birth just tends to make people smile.

the real 'big deal'

2008-08-05T14:47:00.005-04:00

As I suspected after years of assisting midwives
and being a doula, "catching" is not really the huge big deal it
is made out to be by whoever decides what is a big deal and what
is not a big deal. Catching just involves a few hand movements
that will make sense and come easily to you all after years of watching midwives
work and your own natural instinct. Woman know how to give birth, babies know to BF'd
and Midwives know how to catch babies. Good prenatel care. Post-partum monitoring and
making sure a woman is not in fear during labor, or at least
during pushing continue to be the most effective complication
risk reducers. I forgot to add to my stats that I had one sick baby and knew it right away when she was brought in for a baby check. I think all you students will know when 'not WNL' is in front of you. For non midwife student WNL stands for Within Normal Limits. Evaluating data, weighing risk factors is also something higher on the big deal scale then the actual 'catch' in my opinion. Thanks to my student peers who inspired this post. Thanks Deirdre and Aunt B for all your lovin.

thankfully no double shift this week

2008-08-05T10:42:00.002-04:00

Except for Friday, caught baby 16 today and realized that 8 of the 16 have been first time moms, the woman have ranged in age from 18-38, the babies have weighed from a low of 4lb 10 oz to 9lb 8oz, the highest number of babies was a fifth baby. 3 woman needed suturing and one had a significant hemorrhage. I think I did one transport in early labor but I didn't record the details. I am kinda sorta feeling like a midwife.

feeling better

2008-08-04T09:25:00.000-04:00

the restorative powers of the ocean, fresh fruit and massage seem to have cured me.

dilemma of the day

2008-08-03T20:16:00.003-04:00

I have been feeling sick, probably from fatigue, other symptoms beyond fatigue are achy stomach and clammy feeling skin. I hope I don't have any weird tropical diseases. in any case I have to decide how to restore myself on my day off. I have to go to the ATM as I am out of Peso's so that is not restorative but essential. I have to be back no later then 10.30 tomorrow morning in the hopes that one or more of my continuity of care women show up for a prenatal.

My choices after the ATM are:

Stay in the city and get a massage and laze about the rest of the time.

Go to a beach resort and get a massage and drink fresh tropical fruit juices all day and come back on the last boat at 5.30pm

Go to the beach resort overnight and follow the plan above with the added bonus of sleeping in a truly quiet and air cooled room. Returning on the 9.30am boat.

This experience is teaching me to make clinical judgment calls with alot of patience, information gathering and flexibility to change plans. So I think I will go with the moderate choice of beach for the day, but if I am not restored by 5.30pm I will stay overnight.

catch 15

2008-08-03T05:52:00.001-04:00

well the goal of 20 is easily in sight! now the issue of to leave early or not comes to mind

Aug 2 is birthday

2008-08-02T06:01:00.002-04:00

I am labor watching on what could be my 3rd catch of the day...........woohoo a g5p4 with .......stay tuned and say a prayer

g5p5, 3 babies in one day......what a day, i hope i never have to work that hard again, so the 3 all, boys all big, all mec, all shoulders, and all different, all healthy.

birth times 1am, 9am, 7pm, the 7 was on the nose and the rest had minutes after...

The big boy and family

2008-08-02T01:52:00.002-04:00

family midwife- lucky 13

2008-08-01T20:33:00.004-04:00

the uncle of my god child is having a baby today and I am the midwife! here is the same grandmother as in the picture from last weeks post. So I can expect more yummy coconut desserts later in the week. She is having a slight issue with high BP so send prayers.

update 9lb 8oz boy over intact