Off to the Suburbs

As a senior in college, I distinctly remember saying to my group of girlfriends, "If I end up in the suburbs with 2.3 kids, just shoot me." Fresh out of college, off to Puerto Rico to work with the homeless, and with tons of idealistic notions about my ability to make a difference in the world, I was looking forward to a life of fighting for the little guy.

Now I find myself almost 30, just weeks away from moving to the suburbs, and only 1.3 kids short of the national average (and sure to catch up some day soon.) Yet, I'm surprisingly comfortable with this scenario. In fact, I fantasize daily about how great it will be once we have more space, a yard, a quiet evening at home without our neighbor's video games in the background, etc. But my comfort with my future as a mom, housewife, and midwife who lives in, well, the suburbs, has led me to ponder one thing.....

Would my idealistic, worldly, goal-driven 22 year-old self be disappointed in me?

Part of me scoffs at her. How easy it is to look down on others when you yourself do not have to answer to anyone. Gosh, what a sacrifice to work with the homeless in Puerto Rico...yet let's face it, Ann, the hours you spent on the beach are at least equal to the hours of service you did! Living on $400 a month-that's tough, but you had no one but yourself to spend it on, with rent paid and with no college loans to worry about (thanks, Mom & Dad!) Now I have a husband and a daughter, grad school and car loans to pay off, and I am about to add a mortgage payment to the mix. Is it so wrong that my husband and I have to hold steady jobs in order to support these things? Am I supposed to ditch my family and go do service in Latin America? Or should I bring my daughter along and let her hang out with prostitutes and drug addicts?

Still, there was something in my 22 year old self that I admire, and well, miss a little bit. That girl was very comfortable being uncomfortable. She was good at fitting in with people so different than herself. She attended quincenera parties where she was the only white person, spent time with HIV positive drug addicts, and walked through "dangerous" neighborhoods without batting an eye. She was unmaterialistic, requiring very little to be happy. She could deal with life with no air conditioning, no hot water, sewage backups into the toilet, sharing a room, sleeping on the floor, mosquito bites daily, crappy food and second hand clothes.

In contrast, the me that I've become requires a king bed to be comfortable and is way, way too good to sleep on the floor. She whines excessively when she's too hot or too cold. She hates to camp because it involves "getting dirty." She hasn't left the country in almost 2 years, and when she does think about leaving, it's for some comfortable vacation to Europe, not to anywhere in the 3rd world. This me has developed a taste for fancy food at nice restaurants, and turns her nose up at greasy spoon diners, which used to be all that she could afford. She usually looks away when she sees a homeless person on the street, not because she doesn't care, but because she doesn't think there's anything she can do to help. She's twice committed to service projects and then backed out because she just doesn't have the time now that there's this baby to care for...

Sigh...it's true that I've lost some things, but I like to think I've gained some abilities as well.

My almost 30 year old self doesn't need to leave the country in search of adventure. She can find fun and amusement in simple things, like her daughter's giggle when being pushed on the swings at the park or her excitement at opening her Easter basket. Any plans this self makes require thinking about someone else's needs first, as in "I'll cut my Target trip short because Eliza's clearly not handling this" or "I guess that instead of jogging those 4 miles I was trying to get in, I'll walk that last 2 while carrying my baby and pushing the jogging stroller...sigh" or "Better do that laundry so Kyle actually has underwear to wear to work."

I guess what I'm saying is, while I don't want to devalue my 22 year-old self's opinions, there has to be a way to mix the old and the new in order to become a "me" that I can be proud of. I made some choices as a college student and young person, such as the choice to learn Spanish, that are still guiding me today in my work and family life, so the challenge is to keep letting that spirited young woman guide me while not losing sight of my current responsibilities. Perhaps she was right to be wary of my inevitable transition to the suburbs. It will undoubtedly be a struggle to avoid falling into the privileged white, middle class bubble where a person quickly starts to loose interest in the rest of the world and it's problems. But it doesn't have to be like that. I may be off to the suburbs in a few weeks, but I'm still committed to making the world a better place, albeit in a very different way than I had imagined as a 22 year old!

Reflection for Church

I had to write this scripture reflection for church, and thought I'd share it here too.

“I will take away your stubborn heart and give you a new heart and a desire to be faithful. You will have only pure thoughts.” Ezekiel 36:26

I never thought of myself as a stubborn or hard-hearted person until I became a parent. Yet, in the middle of the night, I find myself not-so-sympathetic to a very fussy little teether. The minutes and then hours pass by and my patience wears thin. First, I think angry thoughts. Then, I say angry words. I push her aside and then stubbornly refuse to pick her up when she cries for me. I reflect on blissful nights of sleep before I was a parent, remembering how I didn’t have to answer to anyone. I blame her for destroying it all.

In the morning, I’m disappointed in myself, but I make excuses like “I’m just not one of those people who functions well on three hours of sleep” and “Must be those postpartum hormones still affecting me.” But I know it’s a lie. Unlike my daughter, I’m an adult perfectly capable of controlling my own words and actions. I wish I could claim this “monster-me” isn’t the real me, but when I am honest with myself, I realize that I am a sinner in need of a new heart, better faith, and much purer thoughts. Faith in God requires that I step back for a minute, leaving anger and stubbornness behind in order to recognize that the small challenges God gives me to cope with are nothing compared to the rich blessings in my life.

God, I believe that you will give me a new heart, if only I am willing to let you enter in. Give me the faith to call on you throughout the day and in the middle of the night. Let my thoughts be of you and in you. Amen.

Ann Ledbetter

The First Placenta of the New Year

Let's face it-if I'd been in it for the fame, fortune or favorable public opinion of me, I wouldn't have been a midwife. There are a ton of negative stereotypes that the word "midwife" conjures up. Explaining what I do to the average person isn't much fun, and the jokes get old too ("So, you deliver babies in barns?") Still, I try to remember what my favorite midwifery professor taught us in school: that we are ambassadors of our field and it's our job to help the public to understand what we do, and why there is a need for it. Sure, we could get defensive and angry every time someone misunderstands our field or asks a naive question, but wouldn't it be better to politely explain the role of midwives and how our training and skills can lead to a better birth experience?

With this in mind, I went to work on New Year's Eve hoping to catch the first baby of the new year. I imagined the headline: AREA MIDWIFE CATCHES FIRST BABY OF NEW YEAR. I imagined a touching article about a heroic midwife who gave up her New Year's Eve party with friends and that New Year's kiss from her husband to stay by a laboring woman's side through a difficult labor. With expert care and precision, she guided a new life into the world as the new year approached.

So the real scenario? I was home playing board games with family when my pager went off. It was the hospital, calling to say I had a patient in labor with her fourth baby. I left for the hospital, knowing that multips can be unpredictable. When I checked the patient at 10 pm and she was already 8 cm, I had a feeling that we'd not be successful at having the first baby of the new year. Her labor was going too fast. So I sat with her and her husband. She was coping beautifully with natural childbirth. The clock ticked, and no urge to push...finally, around 11 pm she was saying she felt some pressure and I encouraged her to listen to her body, to push if she felt the urge but to not feel pressured to push unless she was ready. The clock kept ticking...could we have a chance? At 11:30, still not seeing the head, the nurse and I exchanged glances. The excitement in the room was building with each passing minute.

But alas, at 10 minutes until midnight we started to see head. At 7 minutes before midnight, out came the baby boy, greeting December 31st, 2009 with a shrill cry, as if he too were disappointed in his rather unceremonious arrival. I placed him on his mother's tummy and covered him with a warm blanket, rubbing him gently to encourage his breathing.

My only claim to fame this New Year's Day is having caught the first placenta of the new year, which happened to pop out at 12:01. It's a good lesson for me, I guess, because midwifery isn't supposed to be about fame and fortune. As I tell myself time and time again on the job. "Just be thankful to be present in this special moment."

So that was how I spent my New Year's Eve. I can't think of a more beautiful way to spend it. And gosh, what a nice placenta!

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."