Tag Archives: Nurse-Midwifery

“Sometimes You Have to Just Walk Away…”

There is a particular statement that I have heard on Labor & Delivery units — not just on one, but on every single unit where I’ve attended women’s births. I have heard it from nurses, I have heard it from OBs and anesthesiologists, I’ve even heard it from midwives.

What happens before the statement is made is that a woman is laboring. She is in pain, and she is doing something to express that pain: perhaps she is calling to her family members for help; perhaps she is unable to keep still in the bed, causing the fetal heart monitor to fall off. Perhaps she is saying over and over that she can’t get comfortable, or begging to be allowed up out of bed to walk, although she will not be allowed to because of her epidural. She may be asking why she is still in pain despite the fact that she had an epidural. She may be loudly vocalizing her contractions — she may be screaming as they occur. Perhaps she has been doing some combination of these things for hours.

The nurse has wandered in and out of the room and said that the woman can’t possibly be in that much pain at only 4 centimeters dilated. The anesthesiologist has been called in and swears that the epidural is in correctly and that the woman is just feeling pressure, not pain. The midwife, shame on her, has stood three feet from the woman’s bed and said that she can ask the anesthesiologist to replace the epidural catheter, if that’s what the woman would like.

Everyone clears out into the hallway, leaving the woman alone in her room. And then someone turns and says to me, the student, as if offering some great wisdom: “Sometimes you have to just walk away and then she’ll calm down.”

I am recording this here because this statement should never become normal or acceptable to me, no matter how nonchalantly it is said, no matter how reasonably intentioned the person who says it. Bear in mind that I don’t mean a situation where a woman asks for privacy to labor (privacy being something that she will never get in a hospital), but rather one in which the clinician judges that the woman would be better off by herself.

The assumption behind this statement is, first and foremost, that the woman will essentially be alone in her labor. There is no expectation that she should be continuously supported throughout labor (as has been shown over and over again in research to lead to the best outcomes), no expectation that one should do anything other than spend a few minutes at a time dealing with her.

This statement also represents the feeling that a woman asking for help in labor is, after a certain point, just a complaining, attention-seeking, pain in the ass. Her pain, discomfort, or distress isn’t real — especially if you already gave her medication. She’s just being melodramatic, and what she really needs is for you to ignore her a little bit so that she can spend some time alone in her room. Like a child. You acknowledge that the woman is having anxiety and frustration — and your reaction is to walk out.

I have recently had the realization that the people who make this statement are also fundamentally ignorant — despite being professionally involved with women giving birth, they have almost no idea how to comfort them, calm them, and make them feel cared for. It’s not exactly their fault; most clinicians have lots of patients and are taught to use very few tools to relieve suffering apart from epidural anesthesia. Nevertheless, it is galling to see that this is apparently good enough for them, and that they consider it natural not just for women to be in pain in labor, but to suffer deeply as well. (The difference between these things is a topic for another time, but sufficed to say that they do not have to go hand in hand.)

Finally, this statement begs an obvious question: If you’ve left the room entirely, returning only hours later or when she shouts loudly that she is going to push the baby out right now so you’d better get in here, how on earth would you know if you helped her to calm down?! You left her alone, you fool — you have no idea whether she is curled up in a knot of suffering, or whether she’s actually glad to be rid of your ham-fisted, anxiety-provoking presence.

I know that there are some future midwives reading this post, so my reminder to all of us is this: the next time you hear someone offer you this particular “wisdom”,  remember that a gentle hand, a low voice, and a calm, steady presence can be the difference between a happy, healthy birth and a violent, traumatic one. Go back into the room and stay with her.

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Encountering the Newborn

When I first decided to become a midwife, people would often remark, “Oh, you must just love babies!” or “You probably can’t wait to have your own babies!” (Do people who announce they want to become obstetricians get the latter reaction too? I’m guessing not so much.) In reality, midwives mostly care for babies when they’re still inside the mother. Midwives take care of women, pregnant and not; once a baby is out in the world, it’s generally the midwife’s purview only for the first few weeks of life.

The truth is that prior to nursing school, I didn’t think that babies, especially newborns, were all that fascinating. I was sure I would be fascinated by my own, but newborns as a whole seemed largely to sleep, and when they were awake they seemed largely to scream. Nothing too thrilling there.

Then I got to do my OB nursing rotation, and had an excuse to spend hours inspecting newborns: observing their entry into the world and their adjustment to its climate; their experimentation with their limbs, muscles, joints; the perpetual, quiet movements of their mouths; the almost elderly expressiveness of their foreheads.  As obvious as it may seem to anyone who has actually had a child, I discovered that for the brief periods when newborns are awake and alert, they get up to plenty of very subtle business. You just have to be paying attention to see it all.

But there is an encounter even beyond that. If you are attending a woman’s birth, and you get very lucky, you get a chance you stare into the eyes of a human being only a few minutes old. The conditions must be right: the room cannot be so bright that the baby refuses to open its eyes; the nurses cannot have applied so much antibiotic ointment that the baby physically cannot open its eyes; the baby cannot be too exhausted from a difficult labor or too dopey from analgesic drugs — and of course, the woman has to allow you to do it.

Today I got lucky. Despite enduring a long labor, the tiny girl emerged pink, alert and calm. Once she had been tidied and bundled according to hospital policy, and had a chance to be adored by her mother, I held her while the mother made herself comfortable on the bed. The girl fixed her eyes on mine, and I was reminded of the special color of the irises that only newborns have: a deep, dusky blue like the lightless ocean floor.

As a child, I remember the first time that I stared into the eyes of a bird — a pet canary — and was startled and frightened to find that they were not human eyes. It was my first understanding that my perspective was not that of all creatures, and that the minds of almost all others would be unknowable to me in the most fundamental way.

The eyes of a newborn force me to confront this fact again; there is a recognition that we come from the same root, but their look is otherworldly, ancient. As if they were a new immigrant from another universe. I am reminded that they have just gone through a process that I also went through, but have irretrievably forgotten. The preciousness with which we cradle them seems the only reasonable response.

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Ripping Off the Band-Aid

When I moved to China in 2009 with the intent of writing about my experiences there, I believe I began simply by beginning. When too much has happened in your life, you begin to feel as though you can never catch up in recounting it all — meaning that perhaps you never try. So now, as then, I’ll just begin again, and hope that the stories of the past year that I have wanted to share will simply surface.

If this is the first of my posts you’ve read, let me save you a little trouble: when I moved back to America in 2012, I tried writing about nursing school as it was beginning — but what ended up coming out was a lot of narishkayt about how much homework I had. It’s true that in the past 16 months I’ve sat through lecture upon lecture, studied for hours and days on end, and passed my nursing boards a few months ago — but so did everyone else in my class.

I’m now in my second semester of midwifery school, and since this past week I had my own patients for the first time (as in, alone in a room with a pregnant woman doing her 20-week prenatal visit), I have been thinking about the many firsts of the past year: the first patient I cared for as a nursing student (a 54-year old man with liver failure), the first patient whose body I bathed (an 81-year old woman with a small bowel obstruction), the first patient I had who made me feel so insignificant and incompetent that I cried in the medication room (a 16-year old girl — of course — with bone cancer and a serious attitude).

The first patient I had who died in my care. She was 3 years older than I am. I was alone in the room with her, my hands on her chest.

The first patient I had whose life I knew I had changed, and who in turn changed me. She was a Chasidic woman, and though I have now seen perhaps 75 women give birth (not many, in the life of a midwife), this woman immediately held some special power over me. I stayed with her for 12 hours as she labored with her 6th baby, predicted to be not much larger than the 7 lbs of each of her previous children. She labored all day, struggling with her daughter still inside her, doing the slow dance of the birthing woman that speaks of a deep and private pain. Towards the end of her labor she lost almost all of her English, speaking only Yiddish, a language in which I could not then communicate — but she dropped her head on my shoulder and wailed to me that she could not, that this work was not possible. And somehow, with the low words that were all she wanted, I helped her to believe that indeed she could. She gave birth to her 11-pound daughter not long after, and the love I felt for that moment, for her strength, is still with me. One of the great moments of my life.

I began learning to speak Yiddish in earnest a month later, and found a deep ethnic identity that I did not know I had lost — another first. Perhaps more about that later on.

*****

Autumn has arrived in earnest in the past few days, and it’s approaching midnight — both of which I will blame for the mawkish turn of this post. I used to write poetry, and this moment in my life is a time that is probably deserving of such attention, but I’m finding it enough to read the poetry of others. I recently found Rachel Eliza Griffiths’ slim volume,”Miracle Arrhythmia,” on the shelves of a second-hand bookstore in Brooklyn. Recently I’ve been thinking of ordinary things that anchor a life — of food, of sleep, of mending tears in a shirt. This is what I read tonight:

Portrait of a Sunday Woman

Once I saw your mother as a wife.
Sunday morning she stood at the stove,
pressing her wrist simply against her hip.

She wore a robe, red as temper.
Her shorn hair glowed like a burn. Fire
haloed the filter of her cigarette.

One bare breast welcomed the sun; steam
curved from the tin kettle. She wiped
her eyes, over and over.

Turning her head, silent as a bird, your mother
lifted a wedge of lemon and sucked
the dull dream from rind.

By then I had been kissed by a man and knew
something of the crumple around the corners of
the mouth on those godless mornings.

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Forged

When I was considering applying to nurse-midwifery school, I read a lot of nursing students’ blogs. Invariably, these students reached a certain point at which they caved; they had previously had lots of nice ideas about how they were going to lead balanced lives, in which school was simply one of their pursuits, but eventually they gave up that pretense. FINE, they would say, addressing nursing school as an evil taskmaster. You win! Here is every ounce of my energy and every hour of my time! Let me know when you’d like a pound of my flesh!

Since I’m an arrogant jerk, I thought that they were kidding. Or that they didn’t know how to manage their time well. Or maybe that they were just sort of slow. You will notice, however, that I stopped blogging after week 3 of the summer term – that’s about when I too gave in and acknowledged that basically all I was going to to do this summer was commute, sit in class, go to the hospital, and study – every day, approximately 16 hours a day.

I’m now on vacation, which means that I made it through the first term and am gearing up to begin the second in less than two weeks. Before it all gets going again, I want to try to write something here that might be helpful for anyone else considering this education.

The kind of accelerated BSN/MSN program that I’m in involves a totally unreasonable, uncivilized amount of work: all-day lectures, constant examinations, basic care of real patients beginning in week 2. It’s also a kind of academic work that, for someone with a liberal arts undergraduate degree, resembles nothing so much as weight training. Whereas most of my previous education involved polishing my skills of writing, critical analysis, and argumentation, 80% of my work this summer has been the straight memorization and application of large quantities of information: I spend my weekends bench-pressing pharmacology. It has been a muscular, at times numbing, process.

The rapidity with which this process not only educates you but prepares you to take on a new identity as a clinician is breathtaking, and quietly thrilling. They call this first summer Boot Camp because it is the academic and clinical equivalent of shaving your head, waking you up at 5am with reveille, and running you through combat drills until you’re not totally positive that you remember your full name.

Your vocabulary is remade, and you annoyingly delight in telling friends and family members the medical terms for common conditions and physiological processes. (“Did you know that your stomach growls are called borborygmi?” “I see that your baby has a club foot – did you know the name for that is actually congenital talipes equinovarus?!!”) You can see how completely insufferable you are becoming but you can’t do anything about it because you’re so stuffed with new information that you JUST HAVE TO TELL SOMEONE.

You come to find it normal to get up at dawn, spend a full day at the hospital, come home and study for six or seven hours. You ask unsuspecting friends to remove their shirts so that you can listen to their lungs. You conduct full physical assessments of your parents, figuring that if they’ve agreed to support you through grad school they might as well see that you’re learning something. You practice identifying physical anomalies by scrutinizing fellow passengers on the subway. (Nail clubbing! Bouchard’s nodes! Acanthosis nigricans!)

When your lab instructor sets out a table of needles, bottles of saline, and sterile swabs and offers you the chance to inject your classmates, you feel not horror but elation and recognize this as the highlight of your week.

After a couple months in the hospital you realize that you can no longer smell the eerie, sterile, chemical aroma of the unit that you initially found so disturbing. You find that you are increasingly comfortable touching the bodies of sickly strangers. You are humbled, but no longer surprised, when patients stand in front of you naked as the day they were born, asking for your help to clean themselves.

This is how these programs begin to turn a bunch of East Asian Studies majors, financial analysts, and Peace Corps volunteers into advanced practice nurses and midwives: they kick your ass until you’re pretty sure this is what your life has always been like.

I know I’m going to regret saying this, but I can’t wait to start again in September (when I am considering blogging about something other than the sheer volume of work that I have). Having finished the first term of this education, and with the perspective that comes from being on vacation, I feel completely remade – and exhilarated.

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New Phase, New Blog: This Woman’s Work

Tomorrow begins a new chapter of my life: the first day of class in my nurse-midwifery program. For three years I housed my thoughts on trusty ole BirdAbroad, but this is a transition large enough to warrant a blog makeover. Welcome to This Woman’s Work, where I’ll be blogging about life as a student nurse-midwife, women’s health, healthcare in America, New York City, Jewish life in Brooklyn – and whatever else is on my mind.

I decided to become a nurse-midwife over two years ago, when RP and I still lived in China, and getting to this point has involved endless little steps: postbac prerequisites, training as a birth doula, harassing every midwife from New York to Beijing for their advice and guidance, applications, interviews, and decision-making. Having settled on a combined BS/MS program in New York City, RP and I have moved back here and settled into an apartment on a leafy street in Brooklyn; the thousand tiny tasks a new home demands have distracted me for a solid month from the fact that tomorrow is actually going to happen. It’s time to hang up my frame pack (at least temporarily), go back to school, and finally make this dream real.

What’s with the new blog title, you ask? There’s the Kate Bush reference, of course. For the uninitiated:

But the larger significance of this title is related to how my thought process has evolved about “women’s work.” As a feminist, I have been loathe to be too involved in this category of work – that is, the customary activities and skills not necessarily chosen by individual women, but foisted upon us as a group through tradition and sometimes with force. Care-taking, for example. Home-making. Mothering. Handiwork.

It’s not that I take issue with these activities themselves, but rather that I have a fear of leading a life unexamined, of embracing tradition without challenging it first. (God forbid anyone should think that I baked that bread because it’s my duty as a woman to have such skills, or that I wore a skirt because I think it’s my main job in life to look pretty!…etc.) The truth is that my fear of “women’s work” actually kept me from admitting that the issues I wanted to make my life’s work, the topics that most interested me intellectually, were “women’s issues”: reproductive and sexual health, pregnancy, birth, abortion. I wasted a lot of time trying to divert my mental energies into areas deemed more muscular, more formidable, more estimable.

So please don’t give me a quizzical look and ask whether or not I’ve considered medical school – I’ll get into that later. Please don’t ask if I’m becoming a midwife because I really want to get pregnant and have lots of babies. Please don’t lower your voice and say, “You’re not going to have to, ya know, clean up shit, are you?” (For the record: yes. That’s part of my training as a nurse.)

For the moment, just know that I am embracing what I really want to do in the world – which, I’ll admit, is “women’s work”: the arduous, astonishing, and worthy work of a nurse-midwife.

This is not to say that I’m over all of my hang-ups. When my stethoscope arrived in the mail and was pink, I have to say that my first thought was, “Oh come on! I’m already going to be a nurse, and now my stethoscope is PINK?!” And when I first tried on my regulation white nursing shoes, regulation white socks, and “honey beige” compression stockings, I was not so much thinking, “What a noble profession I’m joining,” as, “I’m pretty sure that nursing school is where radical feminism goes to die.”

At least what goes over this is blue scrubs instead of a little white dress.

My point is that I’ve got plenty of internal mishegas to deal with, which I’m sure will only become more pronounced as I move forward in my education. And tomorrow is Day 1.

After so much wind-up, I’m a bit of a nervous wreck – so let’s just rip the bandaid off and get started.

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Journey’s End: Sudden and Complete

Well now. How was that for some quality silence, hm?

I am, somehow, back in America; I’ve been back for over a month, actually. Having gotten so used to living Elsewhere, RP and I now find ourselves in a place as strange as Brooklyn, as William Styron wrote.

I’m always amazed by the suddenness of the end of a journey; the hiking trail opens out onto the road, and suddenly you’re on a bus or in a car being whisked back to civilization. Or your backpacking travels end and you’re on a plane, seemingly entering the country whose airline you’re flying as soon as you board. You watch a movie, perhaps you sleep, and twelve hours you’re on the other side of the world.

It’s unnatural and confusing to cover so much distance so quickly. The flight from New York to Shanghai is 15 hours; that’s 10 hours shorter than the bus ride RP and I took in May just to get from New Orleans to Miami, although the cultural distance we traversed was far greater in the first instance. If we still regularly traveled more slowly – walking instead of driving around our cities, taking boats across oceans and trains overland instead of flying – I think we would have more respect for the cultural differences we inevitably encounter when we travel. If it took you four weeks to get to another country instead of five hours, you would certainly expect it to be unlike the place you had come from.

For whatever reason, I usually find the culture shock of going to China far less severe than the shock of coming home. I used to have a personal myth that I didn’t experience culture shock at all when going to China – but one benefit of keeping a blog is that I know that isn’t true, since I wrote about it here, here and here.

I suppose I’ve gotten used to going between the US and China, such that I don’t experience the effects of reentry as acutely as I once did. Every time I come back to New York City I marvel at the charming streets and the small scale of city compared to the average Asian capital. I am astounded by how well ordered the public services are and, unavoidably, how much money there is sloshing around this town.

After my first stint of living in China in 2004 (I taught English in a small town in Guangxi province), I returned to New York during the peak of the city’s fine and fragrant late spring and cried for two days straight. (Something about being overwhelmed by the technicolor glory of Manhattan, as well as having a well-developed flare for the dramatic.) Coming back this time, however, has been a quiet experience; mostly mellow and happy. I remember that when I was newly arrived in Kunming in mid-2009, it struck me that I had made it back to China! Finally! With a job and an apartment and everything was going to be great! I was so joyful and optimistic that I did a little dance around my living room. And on my second night back in New York this November, I did the same little dance of joy – so I guess this must be the right decision, for now.

The relative speed with which you can now travel from the US to China is enough to give you cultural whiplash, but what makes it worse is that each of those countries is such a world – no, a universe – unto itself that being in one utterly erases the experience of the other. While living in China I couldn’t quite believe that I had ever lived in America – and I’ll admit that I’ve been hiding from my blog because I can’t quite believe that the experiences I describe here were ever really my life.

Still, I have plenty of moments in which I lift my head to survey my surroundings and wonder where on earth I am and – more to the point – why I don’t have a ticket booked to somewhere else.

A minor remedy to this feeling came recently, when I found out that I have finally (after many weeks of anxiety, 20 months of preparation, and boring RP to death with the details) been accepted to grad school to study nurse-midwifery. I am absurdly excited – but I’m also still waiting to interview at two other schools in January before committing to the place I’ve been admitted.

To that end, we’ll be on the road again in a few weeks’ time: we’ll vacate the sublet we’ve been holding down in central Brooklyn and take the train across the US from NYC to Chicago, and from there to San Francisco. At only 68 hours, the journey won’t come close to competing with the Trans-Siberian, but I’m entranced by the route we’ll be taking: during the first leg we’ll head north from New York City, and then west past three of the Great Lakes – Ontario, Erie, and Michigan.

From Chicago we’ll be riding the California Zephyr through Illinois, Iowa, Nebraska, Colorado, Utah, Nevada and California. For you seasoned American travelers out there, perhaps this seems old hat. But honestly, I know more about Laos than I do about Nebraska. I’ve spent more time in Indonesia than I have in Illinois.

So what do you think: can I be a tourist in my own country for a while? BirdAtHome? Let’s give it a try.

I do have a backlog of stuff from my final travels in China that I’ll post over the next couple weeks. Here’s a sneak preview from the city of Hangzhou:

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Experience Overload Part 4: Danger in the Valley, and Making it Out

Barbara and I made it out of the Valley without incident, which is certainly not always a given. Last time we made our 5am exit (I kind of love doing that – stealing away under cover of darkness!) there was a giant mudslide following a night of torrential rain, and it looked like we wouldn’t be able to leave at all.

Before going to the Valley I had never encountered a mudslide and didn’t understand what the big deal was. So it’s some mud, right? Can’t you just…go over it? No, it’s not just “some mud” – it’s like a giant flood of rocky pea soup, up to your knees, or waist, or higher. You do not just “go over it”. Earlier this year, farther up the Valley, there was a mudslide that killed 30 people when it submerged an entire village – so don’t mess around with mudslides.

Life is full of little horrors like that in the Valley. It is a deeply beautiful place, and one in which life has become easier for the Azu over the past couple decades as they have become wealthier. On this past trip, all of the fields were ripe and bursting with greenery – mostly corn and rice, but there are also little orchards of peaches and apples,  and fields of tea bushes.

The Valley in April, when the rice was just starting to come up.

But the beauty and increasing fortune of Valley life belie the many dangers of living there.

The River that cuts through the Valley is a beast – broad and muddy, swirling with rapids and hidden boulders. Every year some number of people are carried off in it and drowned, including a little boy this summer who was pulled out into the River and died, after playing alone on its shores. He had been living with his grandparents, his father having run off and his mother away in another province working as a migrant laborer. Local authorities called his mother back to the Valley, telling her that her own mother was very ill. They feared that if they told her what had actually happened she wouldn’t even be able to withstand the journey, and they were probably right; upon hearing the news that her only child was dead she seemed to lose her mind, and was closely watched in case she should try to commit suicide.

Any little incident can turn into an emergency in a place like the Valley; even those who live on the Valley floor near the main road, and who are likely better off financially, are hours away from a hospital that could deal with any remotely serious issue. This is to say nothing of the poorer people who live many hours up into the mountains, which can only be accessed by footpath. A minor injury from a fall goes untreated and becomes a lifelong limp; a small cut from a tool or animal bite becomes infected and festers, turning deadly.

One day we were in the Valley, Barbara and I were riding down the main road in a little motorized vehicle when we saw a teenage girl we know pass us on her bike. We called out a greeting to her and she smiled, disappearing over a dip in the road. Sixty seconds later I spotted her again, this time lying unconscious by the side of the road. Her arms were bloodied and she couldn’t move – fortunately this was temporary and she was only in shock, probably having had a moderate concussion (wearing a helmet, thank god).

But what if she hadn’t been wearing a helmet? What if she had broken her back instead of cutting up her arms? The hospital in the Valley doesn’t know how to treat head injuries or perform involved, emergency surgery.

We managed to get her home and she is perfectly fine now – but you see how fortunes can change in an instant in the Valley.

I don’t know when I’ll next be able to go back with Barbara; the next few months are full of plans made or half-made, and then RP and I may be going back to the US. I’m trying to savor the experience of having been there as if it will never happen again. There is no classroom that offers the education that going to a place like the Valley can, but I’m excited to return to the classroom nonetheless; these experiences show you all of the gaps in your abilities, and teach you how insufficiently educated and unprepared you are to help people in situations of real hardship.

Here’s hoping that one of these nurse-midwifery programs will take me!

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