Sunday, October 25, 2009
Practice today was blissful. I am not sure what magic from the cosmos comes together on Sundays to make practice so great, but I am just going with it. A new teacher came today. Noah. I have worked with him before and I find myself fitting in quite well with his teaching style. Simple. Clean. To the Point. I had forgotten how much I enjoyed practicing under his guidance. He directed me on my gaze and some of the subtle points on my practice. I am stunned at how much power the gaze holds. I found great intensity in gazing at the tip of my nose in one pose (yes the eyes do cross...I can only imagine how silly I looked) and in another pose I lost all stability with my chin tucked down to my chest. This will be my practice point for a while...work the gaze. I look forward to continuing over the next two months with him. I am excited to learn and grown. Only four more weeks of my crazy clinical schedule and then I should be back to my practice full time. After suggestion from Noah I think 3rd series is drawning closer. We shall see.
After practice I grabbed a cup of coffee with some friends from the studio. Finally drawing back to the connection. The community. To home. We sipped hot coffee, talked yoga, and laughed about silly things. I took the puppies for a long walk today. It was lovely. The weather is beautiful and this day has been such a pleasure.
Tuesday, October 20, 2009
I will start with a birth story and then wallow in my own sorrow:) At 1230 in the morning, after only managing an hour and a half of sleep a woman came in with contractions. This was her 7th baby and while she had only been having contractions for abut 2 hours, she had a history of quick labors and didnt want to have the baby at home. When I checked her, she was 6cm dilated with her bag of water still intact. With no concerning past OB history and a great fetal heart rate, we took her off the monitors and let her walk. Now, with this population of women, my experience that 6cm dilated means delivery within an hour. I thought to myself, "oh, I will get to go back to sleep." Not so on the mark with this one. During active labor my preceptors protocol is to listen intermittently to fetal heart tones every 15 min. The woman would walk, come back in 15 minutes, and then off to walk again. Beautiful...this will fly and she will deliver in no time. After about an hour of walking she asked to be checked and so I did. Still 6. Off to walk again. After about another hour she stated she thought her water broke, as she was leaking fluid. Great! Now things should really get moving. No such luck. I checked her about an hour later and she was still 6. While I was pretty sure that she had been leaking fluid, I also felt there was a forebag (where one layer of the sac breaks, but not the other, making it seem the bag is broken but it is actually still intact). My preceptor had went to sleep for a while, so I decided not to break this bag. The mom decided that she wanted to rest and so I put her on the monitor and let her sleep. My plan...check her at 5:15am and go from there. When the time rolled around, I got my preceptor and we checked her again. She was 7cm and did in fact have a forebag. Good but not great. We broke her water and waited. I stayed with the mom and helped her with her contractions, while my preceptor when to check on another mom who was getting an epidural. As we are waiting the mom states she is feeling more pressure and will I check her. When I do, she is about 9cm but the baby is still pretty high up. I take off my gloves and sit down next to her. All is calm for about 2 contractions, at which point she looks at me and says she is feeling a lot of pressure. Not really great with the whole "call-button" thing, I poke my head out the door room an call for my preceptor...and that is when I hear "Its coming!" I run back into the room, grab sterile gloves and quickly lift the sheet. Yes this baby is coming. Just then my preceptor comes in, and as she is gloving up, the mom pushes and the baby flies out, on a huge gush of water, in to my hands. I am covered in amniotic fluid from the knees down and the elbows down, with a cry infant in my hands. It was amazing. It was beautiful. It was messy. The most interesting part was once we got mom all cleaned up and I got the chance to really look at the baby, we all noticed its whole face was bruised. This baby flew out so quickly that it bruised its entire face! I have never heard of such a thing.
Outside the world of babies and pregnant women, things seem very off kilter. I feel very disconnected to a world that I found myself thriving in. My practice last week was painful. It hurt. Not physical pain, but emotional pain. I miss my yoga community. I feel the disconnect of not practicing everyday. I feel the loss of not seeing my yoga family. Yoga is a like my metronome. It sets my pace for me and keeps me on point. It is my constant. My foundation. My home. I feel on the outside.
After my 24hr on Sunday, I had to run errands for the wedding with my parents and Mark, leaving me with only 3hrs sleep in about 40hrs. Not good. I felt the effects as my alarm went off this morning at 6:15am to go to practice, and I just couldnt. I was too tired. I spend the day fighting off a migraine headache and a bit of an upset stomach to boot. Lovely.
I know I will find my way. This is just temporary. I will find my balance. I will find my strawberry.
Saturday, October 3, 2009
1. Maybe dont give a woman who is in preterm labor with twins two "top-offs" of epidural medication, and then re-insert a new epidural catheter with even more medication. Outcomes = high spinal with bad side effects including trouble swallowing and difficulty breathing
2. Maybe listen to a woman when she looks you directly in the eye and says "something is wrong"
3. Maybe allowing a woman to VBAC (vaginal birth after c-section) after a poor obstetrical history, including 2 c-sections, 2 vacuum-assisted deliveries, 1 forceps delivery, and one failed forceps delivery, is not the best idea. And lets not forget an estimated fetal weight of 9lbs.
4. Maybe dont diet and loose weight during pregnancy. IUGR (intrauterine growth restricted) babies are no joke.
1. Do trust women
2. Do take lower uterine segment pain (with an epidural) seriously
3. Do believe that a first time mom can show up at the hospital 10cm dilated and only push for 20 minutes
4. Do prepare yourself for 4 deliveries in one shift
5. Do know that a 13th time mom (yes, I said 13) can have a quick induction of labor process, even if the last one took 2 days
6. Do trust that I can help to deliver twins!
7. Do learn how to explain things in the most simple, clear, and concise fashion
Yes. My week in a nutshell. It has been a busy one with lots of crazy stories and lots of sleepless nights. I learned a lot this week and found out how much I love normal birth. I had a mom this week, who was new to midwifery care...not new to birth, as she had 6 other children at home...who told my preceptor and I how great midwifery care was. She felt so supported and when she thought she couldnt do it anymore having us there got her through. Awesome. Makes everything worth it.
On another note. My yoga practice is struggling. I have had two 24 hrs shifts in a row, with no time to practice. I miss my yoga community. Period. End of story. Still looking for the strawberry in all this.
Sunday, September 27, 2009
A few weeks ago I blogged about the plateau in my practice. That I had hit a lull and a stillness. Today's practice, however, was completely the opposite. I was thrilled to have my alarm go off this morning, and wasnt even agitated when the parkway was closed and I had to divert around the city. When I arrived I was greeted by just the person I wanted to see, Karen, one of my teachers. Her face has met me at the door so many mornings, but this morning brought such relief. She asked me how I was and I spilled the beans. It was then that she said exactly what I needed to hear. "This is good for you. It is temporary and is just what you need." There was no concern about my dedication to the practice or lack of trying to make it to the studio, all that was there was love. Have I been looking at this all wrong? I have been so disheartened by not making it to the studio. So angry at the disruption in my life. Frustration about my lack of control. Oh, Karen...she knows me too well. There is a lesson here, isnt there? I will learn something from all this. Maybe to let go of what I cannot control. I cannot change my schedule. It is what it is, and I must do what I can do. In those words Karen gave me permission to relax and try to accept where I am. Who knew it was not as tragic as I created it to be. Practice was so so sweet today. Juicy from start to finish.
I realized this morning as I practiced, that it is not just about the physical practice of yoga. When I could not practice this week at the studio, I practiced alone at home, but it is not the same. I felt it deeply today, while on my mat, that I had come in touch with what makes morning practice at Y2 so special and transformative. It is the people. We come together as this collective whole, committed to practicing together. We meld our breath into one. I gather so much energy and strength from my friends and fellow practitioners. When I am low their energy lifts me, and in turn I hope I lift them. Our struggles, on and off the mat, become a group effort. There is a connection that is almost tangible. It sounds so cheesy and corny, and I am sure that the impact does not translate into words, but to sweat, learn, grow, struggle together is immeasurable.
Saturday, September 26, 2009
I just returned home from my second 24hr shift at the hospital, and I have to say that is went better thank the first; however, this could be due to the fact that (and I say this with love and great sarcasm) God is preventing these women from going into labor till after the holiday on Monday. Thing were somewhat low-key during the day. I got to do my first actual post-partum rounds, as this is something that is not present in home birth. I think I will really enjoy postpartum rounds, especially if I can see patients whose delivery I attended (or perineums I sutured). Because of my experience at HUP as a laborist and the fact that only two of our home birth mamas had lacerations, I rarely got to see how my suturing panned out.
I had one delivery during call. I got my first crash course in the phenomenon of “I have given birth to 8 other children and yet I am still super anxious.” Around 7pm the woman and her husband came in stating that her contractions were 10 minutes apart, but that she wanted to come in for fear she would go fast. She stated that she wanted an epidural because she was exhausted and tired. From the start her worrying and anxiety began to fly off the charts. She wanted to epidural, but was so concerned about potential negative effects for all parties involved. We decided to first check her and find out how far a long she was….8cm. AWESOME (I have to say I really enjoy it when women come in this far a long). We decided that a spinal was probably the best route…quick acting, since she was probably going to progress pretty quickly. The procedure of getting the spinal amplified her anxiety. It was beginning to take on a life of its own. I just wanted to hug her and squeeze all her concerns out. Once we got her settled and comfortable, she happened to mention that she had take a Motrin the other day for a headache. My preceptor asked if that was the only time, and she said yes, but then proceeded to be very upset about the potential effects on the baby from one time use of Motrin after 32wks. My preceptor did an incredible job working to put her at ease. Soon after she began to experience increased pressure and when I checked her the baby was very low, +2, and she was ready to push. We gowned up, quickly thank God, and within two pushes her baby was out. The umbilical cord had a very interesting vessel structure where the two arteries were squiggly and “spiraly.” Very interesting. I am also starting to think that everyone in this population has trailing membranes. Got to love the ring forceps. Her birth was beautiful. Perfect. And no effects from the Motrin on baby:)
I learned a lot with this woman. Just because she has done this before does not mean that she doesnt need support, guidance, and compassion. Take nothing for granted. Be present with women. Loving kindness and 5minutes of explanation can make a world of difference.
I love working with my preceptor, but I am having a hard time connecting with the women. There is such a huge divide between the world that I live in and the world of these patients. In writing that, it seems odd because most of the patients I have worked with through out midwifery school are very different from me. I am not sure what the difference is when working with these women. I have never before felt that I could not connect with my patients. I have always been able to find some common ground from which to meet them on. My ability to talk and put women at ease is something that I am proud of, and is one way I can distract women from the fact that I am a student. I am really having a hard time with this. I already get nervous about my skills and whether or not women will find me to be a competent provider, but I always felt that I could rely on my personal skills. I feel sunk. At a loss for words. I have so much to learn about this culture and belief system, a whole new vocabulary, a whole new everything. For me, midwifery is all about the connection, the bond and the relationship we get to develop with women and their families, and I am sad that I am struggling with this during integration. I am sure, or I am hoping, that this will get better.
Wednesday, September 23, 2009
I did office hours first and then headed over to the hospital for a 24hr shift. My first official 24hr shift. The midwifery practice delivers in a small community hospital, that is very different from my huge tertiary-care hospital and home birth experience of last semester. This are "quiet" and not as chaotic, and there are actually a lot of niceties, such as jacuzzi tubs, birth balls and telemetry (so that women can be on the monitor but not tethered to a machine:). When we arrived there were two women in labor, one was only 3cm dilated and the other was about 6cm dilated. The first mom was really uncomfortable and had a platelet level of 103, which is only 3 above the cutoff for an epidural, so she got her epidural and got some rest. The other mom got an epidural as well and then we all just "hung out."
I managed to get in about 45min of sleep in a room down the hall while my preceptor slept in the call-room. When she came and got me she said one of the mom's was ready to push. This birth was observation only, as the mom did not want me to actually deliver her baby. This ended up being ok because her baby was OP (facing sunny-side up...which is really hard to push out a baby in this position). I have never seen a woman push so awesomely (i dont know if that is a real word). She was a champ! But no matter how hard she pushed her baby never really came down. Combine this with the fact that she had ruptured for moderate to thick meconium, we consulted the doc to come and assist with forceps. With just a little help and a small episiotomy mom was able to push baby right out....face up staring at all of us:)
After mom got settled and we checked on our other mom (who was plugging along very nicely despite getting an epidural during the latent phase of labor) we heading back to bed for about 2hrs. I was awoke by my preceptor who told me two more mom's had arrived in labor. Oh my! I think at this point all of the rooms were full! And, it wasnt even a full moon. I got to completely manage one patient who had come in at 8cm. While talking with her, I found out that her favorite birth experience was her one baby that had been born in the car because she was able to move around as she wanted. How awesome is that (and at the same time isnt that sad that the only way she was able to have a birth the was she wanted to was in her car on the way to the hospital) !? I sat with her, rubbed her back, and allowed her to just move and shake as she wanted. Her face absolutely lit up when I suggested a birth ball. She loved it! And so, I caught her baby, with her on hands and knees. She did beautifully! Her baby was big, healthy, and very cute. She cried. I cried. She thanked me. I thanked her.
I was tired. I was exhausted. 24hr shifts are no joke and a long ride home only adds to the fatigue. I am caught at the moment between loving everything and being totally overwhelmed. My yoga practice has suffered greatly and being sick doesnt help anything. I have been thrown a bit off-kilter. I have not yet found myself in this whole semester of Integration. I know it will come, but at the moment I feel a bit lost. Grasping at straws. But I do know, that every birth is worth all the fatigue, tears, anxiety, and fear. It will all come to pass. I must trust that these next two months will work themselves out and that I will not loose myself in the shuffle.
PS. I sent my application to the yoga shala in India today! One step closer to my trip in January.
Friday, September 18, 2009
I was on my mat the other day, practicing in the corner (which has a very calming effect for some reason) and I began to think. Yes, thinking on the mat...something that I try to get away from. My mind is often a whirl of constant thoughts, concerns, anxieties. While for some people their bodies are their limitations, like their hamstrings are tight or their back hurts, for others it is their minds that present the limitations. I am in the latter of the two. Years of gymnastics have conditioned my bdy to be flexible and strong, and while it has also left me with some injuries that often rear their ugly heads from time to time, it is my mind that gets in the way. I think and over-analyze everything. I am constantly scrutinizing my practice, my asanas, my life in general. As I head into this coming semester with a new preceptor and a new clinical site, I am thinking about all that can go wrong. Not wrong with birth, but wrong with me. What will I forget? What will I mess up? What chapter in Varney’s will I skip over in my brain? I know this is ridiculous. I know deep down inside that I have gained a lot of skills and know how to manage a lot of different situations, but just like on my mat, my mind is my limitation.
In looking back at last semester I am trying to remind myself of the big over-arching things I have learned. Here they are:
1. If you just sit back and watch, birth will happen...especially if you trust it
2. Always, always, always bring a second pair of scrubs to a water birth
3. Never underestimate a 5th time mom with a small baby...they can be a shoulder dystocia
4. 3rd babies are stubborn and love to follow their own path. All bets are off!
5. I do not like to rupture membranes
6. No woman has an estimated blood loss of 150cc
7. Tug-of-war is a great way to get a first-time mom to deliver
8. 4 hours of pushing is exhausting (for the mom too:), but with a little Beyonce is the background to motivate mom it is all good
9. A "test push" can most definitely deliver a baby
10. I love midwifery
Friday, September 4, 2009
Mark and I went to DC on Monday. I love DC. There is something about it that stirs my inner patriot. The patriot that fights against the system, changes what needs to be changed, and storms against injustice. It reminds me what I value, choice, freedom, and equality. DC invigorates my deep desire to change the world around me and makes me thankful for all the people that fought for those who had no voice. I love DC.
Mark knows this. He always laughs a little when I stand on my soap box and proclaim the power that DC has over me. My ever present optimism makes him giggle.
We have been planning this trip for a while. I am off for a week from school and Mark has Monday's off. The intention of out trip was to go and photograph the new WWII memorial that is on the Mall. His great grandfather landed on D-Day, and so Mark wanted to put together an album to give to him for his 90th birthday in November. So, we dragged ourselves out of bed at the crack of dawn and headed out. When we got there, we headed straight for the Mall, working our way from the Capitol Building, to the Washington Memorial, then on the the WWII Memorial, Vietnam Memorial, and finally the Lincoln Memorial. As we headed back down the steps of the Lincoln Memorial, Mark mentioned that he wanted to get a picture in front of the reflecting pool. When his grandmother was in the military she was arrested for swimming in the reflecting pool...how awesome! I hate pictures. I always resist when it comes to taking photos. I suggested that I could just take Mark's picture, but he played the "you always say we have no pictures of the two of us" card. I gave up. He found a couple to take the picture and I unwillingly took my spot at the end of the reflecting pool. After on picture, Mark asked the guy to take one more, and that is when he got on his knee! And asked me to marry him! Who knew?! Apparently everyone but me.
The past few days have been a blur of excitement and planning. We wanted to get married next fall, and like the anal retentive person I am, I knew we had to get a place asap. After looking at only two places we found the perfect place for our ceremony and reception! It called the Phoenixville Foundry. It is a refurbished steel foundry, that is the perfect mix of industrial meets modern/elegant. To add to the space, both my grandfather and Mark's great grandfather were both steel mill workers. So, the date is final October 23, 2010. 10-23-10!!
I now have much more to blog about, weddings, babies, India, oh my!
As promised, my next post will be all about babies!
Sunday, August 30, 2009
I love Sunday practices. I think they are especially juicy because I get to sleep in and I usually have no where to be during the day. This day in particular I had no work to do, no tests to study for and no house to frantically clean. There is something to being able to "lolly-gag" on the mat and really sink into the practice, loosing track of time. However, this was not the case this morning. I had come to think that this pervading feeling of "stagnation" that I am experiencing recently during my yoga practice would come to fade when the stress and anxiety of school wore off, but as I practiced I felt myself riding along this forever stretching plateau. It is not a lack of enjoyment or excitement, but more of a lull. In the past two years I have moved through primary series and into second series with a steady pace. New poses bringing new challenges and hurdles. However, I am now into month 3 of consistency, sameness, repetition. No new poses and no new challenges, just the same struggles...jumping back, rising out of karandavasana, backward bends. It is as though I am sitting in my own stew, marinating in the difficulty and lack of progress. It is hard and it is frustrating. It is uncomfortable.
I decided, while biking home, that I need to change my perspective. I will now be trying to refer to this period, not of stagnation (because somehow that conjures up flies and stale sewage) but of stillness. Maybe this is where the learning really takes place. Where the understanding and connection grows. Where practice meets theory. It is so easy to get caught up in the bustle of everything, to get dragged by the current, that when the water becomes still it is as if I have forgotten how to swim. Without the pull and push, I am left to do all the work. But I am thinking this is where development and growth happen. In this stillness. There is a strawberry here somewhere. I might just have to sweat it out for a bit.
As this is my last day on call, I have been thinking a lot about this past semester and the 22 babies I have caught. I have written a lot for today, so stay tuned for some thoughts on the whole baby catching business:)
I was talking with a friend today about blogging and said that I felt it could be a bit narcissistic in some ways. Here I am, assuming that I have something interesting to say, when maybe it is all just a bit of chatter. She suggested that blogs can be a great way to share information. So in light of her brilliant suggestion, I think I will try to share one interesting thing when I blog, whether it be an article or a beautiful picture, or maybe just a silly joke. Here is today's. My cousin's wife is an amazing artist and I am deeply moved by her paintings. There is a youthfulness and playfulness to her work, yet at the same time there is so much depth and mystery. I wish I could crawl into her paintings and get lost in the details. Check out her website!
Mark and I are off to Washington D.C. tomorrow to explore and enjoy. Pictures to come (once I figure out how to post them...and if we remember the camera:)
Saturday, August 29, 2009
What you ask is the topic? I have no idea. I do not see a clear or set path, no outcome or goal desired. Simply a place to place my thoughts. I am transitioning into a time of great change, something that I must admit I am not good at. I am heading into my final semester of Midwifery school, actually my final semester of school period. This semester is quite different than the past 20years of schooling that I have participated in. I will be "out there" really working as a student-midwife. I will take on the schedule of a practicing midwife and work with her as she does. There is no class, no exams, no paperwork, and no case studies. Only good old fashion work...catch babies, work in the office, and come home...sometimes. The only exam that I have to worry about is our comprehensives at the end of the semester. This semester is about honing all the skills I have gained over the past 4 years and putting them to use. A scary transition into a role of great responsibility.
I have never not been a student. I went right from high school, to college, to nursing school, and right into midwifery school. The short break 4 month break after nursing school, I did a yoga teacher training program...again still a student. I will always be a student, but come December I will not be a student in the most concrete of terms. This is a huge change.
Once I graduate in December I will be heading off to India to practice yoga in Mysore, India fr two months. I am an Ashtangi, who is completely captivate by the practice of Ashtanga Yoga. From the time I stepped on to the mat to practice this beautiful tradition on January 4th, 2008, I have been taken away by its impact on my life. I am devoted to this practice and am excited to share my journey here.
The relevancy of this blog in the grand scheme of things is probably small and insignificant, but I enjoy so much to read the blogs of friends. There is a sense of connection that, while they may be far away, or I didnt get the chance to talk to them that day, I am still part of their lives. I get to participate, feel what they are feeling, or ponder what they are thinking. I enjoy their words. Maybe someone will meet that enjoyment here.
So, with my first post I shall set the scene as to the choice of my title for the blog..."Finding the strawberry." I was taking a yoga class a few years ago with a great teacher who had a talent for telling stories. She began with the Zen story below:
There was once a man who was being chased by a ferocious tiger across a field. At the edge of the field there was a cliff. In order to escape the jaws of the tiger, the man caught hold of a vine and swung himself over the edge of the cliff. Dangling down, he saw, to his dismay, there were more tigers on the ground below him! And, furthermore, two little mice were gnawing on the vine to which he clung. He knew that at any moment he would fall to certain death. That's when he noticed a wild strawberry growing on the cliff wall. Clutching the vine with one hand, he plucked the strawberry with the other and put it in his mouth.
He never before realized how sweet a strawberry could taste.I am not sure this is the exact translation, but it is the heart of the story. Somehow, in reading it there is a loss of emotion and energy that was tangible when it was shared by mouth. "Finding the Strawberry" is a mantra that I have used to help get through the trials and tribulations of nursing and midwifery school, as well as all the major life changes that come with more trips around the sun. While I am sure there are many meanings behind this story, I see it as the constant reminder to find the good and focus on that, instead of all the things that are crumbling down around you. These past few years of school have been hard and the struggle to stay afloat seems to become more and more difficult. But, as my dearest friend Elsa always reminds me, we MUST find the strawberry.
Welcome to my blog. I hope you enjoy your stay!