A "Good" Outcome

Yesterday was a slow day on call, so I was entering birth data. As I entered data for 20 normal vaginal births in a row, I was mentally giving myself and my midwife colleagues a pat on the back for our excellent outcomes. Of all the births I entered, not one was a c-section! There were some close calls, but in the end, our patients and their babies came out healthy and with no uterine scars. Amazing, especially considering our nation's 31% c-section rate!

Then I heard a fourth floor stat call, wondered what it could be, and went out to the L&D unit. By the time I got there, they already had the patient I had just admitted in the OR for a crash c-section. She was a preterm patient whose baby had been found to have severe growth restriction and extremely low amniotic fluid on a specialized ultrasound just that day. The little boy's heart tones looked ominous on the monitor, so our OB consultants rushed to deliver him. He weighed just 2 lbs 13 oz at birth, but thankfully, was breathing on his own and the NICU doctors gave him a good prognosis. After a phone call to the patient's husband (trust me, not a fun one to make) and a question and answer session with both parents, I took the dad to see his little boy in the NICU. He was sleeping in his tiny bed, looking like he had some growing to do, but otherwise seemed sweet and angelic and, well, ALIVE. Both parents were relieved, and remarked that it was a good thing she happened to have that ultrasound planned for today, because who knows what would have happened otherwise.

So there you have it: a "good" outcome. When the student who was following me yesterday asked what I like most about my job, I told her it was the excitement and unpredictability of it. Try as I may, I can't control all the forces that make pregnancy and birth happen the way they do. I can only tweak the circumstances slightly in hopes that it leads to a better outcome. And I'm constantly reminded not to get too narrow minded in what I view as a "good" outcome.

Setting a Goal

A family picture before the Tyranena Beer Run 1/6th marathon

They say that those who write down their goals are more likely to achieve them, so I'll just say it: I'd like to run a half marathon. Lots of supportive friends and family have let me know they think I'm capable of running this distance, but I'm like that childhood playmate who, when challenged to do something particularly difficult says, "I could do that if I wanted. I just don't want to." Here are the reasons I often give for "not wanting" to run a half marathon.

1. I don't have the time to train. Taking 1-2 hrs out of my day to run seems like a waste when I have a baby, a husband, and a career to worry about.

2. Shouldn't I be devoting my time to something that actually helps people? Sure, long distance runners often say that their running is for this cause or that cause, but wouldn't it be better to spend the two hours a day it takes to train volunteering at a soup kitchen or something?

3. The American Heart Associate says 30 min of aerobic exercise a day is all that's needed for great heart health. So doing any more than that has very little health benefit and, to be honest, is probably unhealthy when you consider the wear and tear on your body and frequent injuries of runners.

4. I'm an extrovert. There's nothing fun to me about spending 2 hrs running through the woods by myself. An Ipod is no substitute for real human presence and conversation.

5. Running is an addiction. Let's just be honest. People who run a lot get addicted. Addictions are bad. I shouldn't need to "depend" on exercise like that.

6. If I run, I'll need to consume more calories. People in Africa are starving. Why should I do something that will cause me to need to eat more than my fair share of the world's food?

7. I don't have the appropriate running gear, and running gear is expensive. Besides, it's too cold to run in the winter in Wisconsin and there's no gear that makes it okay to run in -10 degree weather.

Yes, I realize these last three "reasons" are more "excuses" than anything else. So, runners, I hope you're not offended. I'm not writing these down to criticize you, but to clearly identify my roadblocks-the things that are keeping me from throwing myself into this. I feel at liberty to write these down because the fact is, in spite of all this, I want to run a half marathon!!!!

This past weekend, Kyle and I ran a sixth marathon. The running was fine until about mile 3, where the route conveniently went up hill at the same time we hit the proverbial wall. But when we were finished it felt so good! We weren't trying to set any records (and didn't, in case you were wondering ;) But there was something so refreshing about a nice run on a beautiful fall day, and having achieved a goal, however small it was.

Kyle and I finishing a measly 1/6th Marathon

Sitting on My Hands

A colleague of mine said she once heard a saying that resonated with her. "Midwives have good hands, and they know how to sit on them." I aspire to be that kind of midwife, but to be honest, when you're revered as a "medical authority," sitting on your hands can be kind of tough.

Today was my first time facilitating a Centering Pregnancy group. This is an alternative model of prenatal care which gathers 8-12 pregnant women due around the same time and has them meet in a group instead of one-on-one with a health care provider (we still do belly checks, fetal heart tones and all that, but in a corner of the room during a small portion of the two hour session). Women take their OWN blood pressures and their OWN weights and share them with me, instead of the reverse, which gives them ownership of their health care during pregnancy. The midwife is there to focus and guide discussion, but is called a "facilitator" and is ABSOLUTELY NOT supposed to be didactic. She is supposed to guide the discussion toward answering the questions and addressing the concerns of that specific group of pregnant women. And worst of all (GASP!), she's supposed to let women answer each others' questions instead of jumping in to answer them herself.

As an undergraduate anthropology major, I am in love with this model of care. It has all the hierarchy-busting, authority-challenging, alternative characteristics that I've wanted to shove in the medical establishment's face ever since I became a nurse-midwife. AND it actually improves outcomes, unlike most routine medical interventions in obstetrics. In my opinion, it's because this model of prenatal care acknowledges truths that no one else wants to acknowledge, namely:

1. It's not my machines and tests that keep the baby alive, but the pregnant woman herself.

2. No matter what I say, women will always trust their mother, their sister or their best friend more.

3. Most women who ask me questions already know the answers.

So why is this model, which makes so much sense to the anthropologist in me, also kind of challenging for my nurse-midwife self? Well, it turns out that I kind of LIKE being the authority. It's a little hard to sit on my hands when I have the opportunity to make myself look smart. Sometimes I feel like that obnoxious grade schooler popping her hand up all day long..."Call on me! Call on me!" I get some satisfaction from being the one with all the answers. In addition, part of me fears that my patients DON'T know what they're talking about and, like little children, require my guidance to avoid going astray.

How conceited of me. It turns out I underestimated my patients badly. Take this situation for example: Today in group the women were asked to evaluate several areas of their lives and decide whether they're "contenta" or "podria mejorar." Several women stated that they could improve when it came to exercise habits, and a discussion ensued. One woman said she likes to walk. Another said that she did too, but it's hard because there's no where to walk in Wisconsin in the wintertime. I said that the mall was a good place to walk. The woman laughed and said she was afraid she'd spend too much money if she walked at the mall. Just as I was about to jump in to defend myself, another participant shared that the mall is open for walkers in the morning long before the stores open, and suggested they might walk together then. Now THAT's what you can't do in a 15 minute visit to the doctor's office.

So sitting on my hands isn't yet easy, but I've decided it will be an important skill if I'm going to be a good Centering Pregnancy facilitator. Today in the "relationship with the baby's father" category, one participant answered that she could improve. When asked if she wanted to share, she confessed to the group that her partner is currently in jail for 18 months for beating her, and that he wouldn't make the birth of his child. After her lengthy explanation of their relationship, fraught with difficulty, there was silence among the group. For once I found it easy not to jump to answer. Then a quiet woman across the circle, with a look of deepest sympathy in her eyes, nodded and said "Si. Podria mejorar."