A Boy

Walking past closed doors, I knew each room held its own pivotal event, and I felt like a voyeur. I had heard report at 7am: sorrow and joy about to happen behind every room, most likely on our shift. And then sitting at the foot of of the bed in 19, I was in the core, the axis around which every other event would unfold. The third child, the first son, was born with his hair pressed slick with vernix into a beam of light and the smiling sobs of his father. Everything outside our circle vanished. There were no walls, no rooms with sick babies, new babies, and mothers in pain. There was no hospital, no city, no time. We could have been anywhere, anyone.

This birth was the first I have attended in five years. I was anxious for months leading up to Tuesday. Amidst moving, selling our home, planning for the new house, my return to deliveries was never far from my thoughts. They say it's like riding a bike, and it is, in a way. Obstetric fads come and go, one research trumps another, and we go from VBAC to cesarean, obsessive fetal monitoring to broad strokes, cervidil to cytotec. But the central pieces of watching a woman's perineum bulge, checking for a cord, celebrating the child, waiting for the placenta- these hold true.

This one is up there on the list of really shitty days

How can you not imagine the details of your new home when you offer fifty thousand dollars over asking price on a house your whole family genuinely loves? Who would think that when you offer to close in 21 days and say you won't even inspect the home that someone else would nab it from you?

I am heartbroken tonight. It was honestly a shitty day from start to finish. I woke at 5:40am to a jealous, screaming Stella, who wailed "pick me UUUUP!" when I managed to get Otto to sleep again in bed. He was asleep on top of me, so I couldn't get out from under and Stella would not shut up. I finally moved him to grab her and put her in bed with us (Augusto left before 5 am for an overnight to LA). Naturally he woke, cranky again after I jostled him. So that's how it began. We fought over shoes and teeth and exactly how to get into the car, and I arrived late to work only to learn that a term pregnant patient's entire family and fiancee were killed in a political-religious fire bomb riot half a world away. And another woman's baby died. And a colleague's father murdered his mother when he was a kid. And then we were out bid by someone who offered a little bit more and could close on the house in 14 days. And then the kids were shitheads, so I chugged two glasses of wine and bickered with them until they finally went to bed at 9:45 pm.

Oh, but they wanted to sell the house to us. We've heard that twice now and it only makes me feel worse. We wrote a letter to the sellers, spilling our visions of the future. What if we do find another house to bid on? How can any other letter be genuine after that one?

Now it's night two, up too late, barely keeping my eyes open, and I am still imagining our now non-existent lives in the house on the hill, not getting out of my head the many children under age five who live a house or two away, where I would put the hook for the dog's leash, curl up to read the paper, or plug in my phone to charge. And I am totally unable to imagine how you undo the visions of your life with baby and husband and grandparents and suddenly a friend of the family calls long distance and it is all gone.

I wish I could offer some perky optimism, but I used up this week's hope already.

I Hold Them in My Heart

Why can't it be "April Fool's!" now that my patient's baby died at 6 months and my dad euthanized his cat, and I got an asinine crank call telling me I had so many days to live?

Yesterday. Can't I wish it one big joke? Ha ha, just kidding?

The mom came in for her routine prenatal. Mentioned no movement. Watched her daughter draw happy pictures of the baby. I searched for the heart. The quick beat I love to share with the big siblings. Is that a horse in there?! A train? I searched again. I prayed. I tried to make my face neutral, my eyes soft. I took her into the room with the ultrasound. And the little one only floated with his mama's breaths. Not still, but swaying in the fluid. I couldn't get the words out before my heart cried. My tears fell. I think your baby died. You need to go to the hospital for a better ultrasound. But I knew. She knew.

In 10 years, this was the first fetal demise. Nasty jargon for a loss inexplicable. The term you don't share with the family. Fetal. Oh, no... a baby, a loved member of the family. Demise. Should that soften the blow? Make it so that the midwife doesn't cry when she collapses in the chart room, her colleagues with no choice to hear it out? I was unprepared for the moment, caught in the disbelief. Consulting with the perinatologist like I would for fibroids or diabetes, while the majority of my soul paced the room, asking why?

And when I came home to tell it all again to Augusto, it was too familiar. The same sequence of sadness when we lost our first son. That empty, empty sound on the doppler. The panicked face of the resident. Then the words that became only the sound of nothing in the room, of everything lost in our hearts.

I told the family of my loss. Felt strangely grateful for some small connection to their crumbling souls. I am so sorry. What else is there, really, to say?

Busted!

There are events every parent dreads- yet expects- will happen. Like the kid who asks why that man is so fat- in front of that man. Or repeats something unsavory you said about the neighbor. Today I exited the shower to find the kids playing tug-o-war with my vibrating dildo. Moments before, when it became suspiciously quiet, I peeked around the curtain and saw Otto waving a naughty feather duster. Hastily rinsing only half of the conditioner, I told the kids to stay out of mommy's drawer and rehearsed all the answers to all the questions I would hear. The experts recommend preparing for such challenging times. Scripting your answers just in case. Like when the 4 year old walks in and sees naked Mommy on top of naked Daddy and asks, "What are you doing?"

I am very interested in raising sexually healthy future adults. I want to my children to have confidence and pride in their bodies. I want them to learn to love in their own ways. I read a great book on the subject before I was even pregnant. Every day at work, I hear and give advice on the intimate details of a wide variety of sexual issues. I love asking my 70 year old patients if they are sexually active. Stella knows what her vulva is and that touching it is a private affair. And yet, I was wholly unprepared to see the Blue Ripple in Stella's hands and the speed controller in Otto's.

"What's this, Mama?"

Pause.

"Give it to me."

"What is it?!"

"It's a tool. Give it to me."

"What kind of a tool?

"It's a tool that Mama hasn't used in a long time. Let's put it back in the drawer now."

I walked out of the bathroom and saw the contents of one bedside drawer strewn on the floor. Things I honestly forgot were there, but instantly knew I should have put under lock and key long ago. Edible Undies. Liquid Latex. A colorful volume on intimate massage. The naughty feather duster.

"Is this a pompom?"

"Yes, it is!"

"Can I play with it?"

"Right now you can."

I replaced the toys with a mix of emotions. Here I was in one of those Moments I had waited for, albeit earlier and different, of course. I felt sure I would be the mother who could talk with her kids about sex. I would give them the information they needed to make safe and healthy choices. I would make sure they felt comfortable asking tough questions. Yet here I was putting away sex toys I received at my bachelorette party, mostly unopened and waiting six years in that drawer for what? Time? Inspiration? Boredom? Six years. And who finally plays with them? My children. And how did I answer the questions? It's a tool? Yes, it's a pompom? You can play with it. Geez.

So we haven't used the toys in years. Texans waited how long to be able to buy butt plugs without breaking a law? It's not that I think sex toys make sex better, or that sex without toys is boring. I'm bothered by the waste. The waste of drawer space. The fact that they sit there when someone else would love to play with them (and I don't mean my children). That they were well intentioned gifts gone stale. And know I know for sure the time to use them has passed. If we can't get some action in the 10 minutes before I pass out, then forget it. It's comical to think there's time for role playing or cleaning the "tools." But can I give them away on Freecycle? Sell them on Craigslist? Drop them off at the Salvation Army? If you, gentle reader, want a tub of paint-on latex clothing or a bright orange soft rubber whip, let me know. My girlfriends were generous.

But the other emotion is joy. Everyone always says that kids call us on our own shit. Help us to see ourselves. Help us laugh at ourselves. You can't hide a bad day from a teen or fake listening to a toddler. And you can leave it to a one year old who will open any drawer and his question asking sister to remind you that you don't need a drawer full of sexy toys to feel sexy. You don't need edible undies to feel consumed. But you do need some clever answers pretty darn quick if you don't want the whole preschool to hear about it in your 3 year old's version of events.

So I'm back to the drawing board. What will we say that time we forget to lock the door? Will it ever be wrong to dress or shower in front of the kids? And what if we differ on these answers, how will we be ourselves? How will our words and body language affect their sexual development? The drawer was a warning, a practice session for the foibles ahead.

What was I thinking?!

We now have two creatures in the house who want to chew, rip, and mess up everything from balls, to plants, to toilet paper. Just as I tear a throw pillow from Rex’s mouth, I turn to see Otto grabbing the phone. I pluck Otto from the phone corner, put him down, and find Rex chewing a hole in the rug. I give Rex a toy, then Otto pounces on the dog and I’m separating them again. Is this what it is like to have twins? And this ritual doesn’t even include Stella. Add her to the mix, and it involves a lot of whining and stomping for something she can’t have, such as chocolate at 8pm or messy painting as we’re about to leave the house. It’s background music for the dance.

Rex needs to be trained. He nibbles on pant legs and wrist bones when he wants to play. Any kid toy is his to eat, apparently. And he jumps, of course. Otto needs to be trained too, but it’s a longer process for which I have more patience. And Stella? She’s training me how to take ten deep breaths when we’re late for work, how to stop and see the spider webs. How to think it’s funny when Rex steals Otto’s food from the high chair.

I had a patient yesterday who was pregnant with baby number 4. Her other children are 5, 3, and under 1. She is happy, but her primary-caregiver husband is scared. So scared he barely spoke and just teared up a lot. I made my other patients wait 45 minutes while they tried to talk about the future, their options, and how they’ll afford 4 kids under 6. I know how stressed I can get with two kids on a bad night. And how adding Rex increases the stress on those bad nights. And to think of adding a baby 8 or 9 months from now? Forget it. I’d be terrified. Thank goodness for good birth control. I think that dad is probably getting his vasectomy as I type. His fear clings to me. I just hope she can carry them all.

WhyMommy

I’ve been stewing a post in my head about nose picking and educating our children. But I’ll need to come back to it, because all I keep doing is checking WhyMommy’s posts on breast cancer. I am nursing as I type, enjoying it before Otto gets too distracted by the click of the keys. And there is a mother in DC weaning her son. She has a serious cancer (I guess that means we’re making progress if “serious cancer” isn’t actually redundant anymore) and cancer treatments aren’t good for breast milk. Her baby is three days older than mine. And she is strong now. Asking Demanding that her readers’ comments be positive. Typing her truth. Not changing her name, her tune to WhyMe.

Another mother in DC just beat colon cancer. She shared her journey through mass emails. The same emails that a two years ago were updates on her daughter’s running and music achievements. Quick notes about a new job, a move, other people’s health. I was with this woman nine years ago, steadying her as she signed the papers for the Chinese adoption, as she pulled the first picture of her daughter from the cardboard envelope. We were coworkers, and I was a new midwife. She was too moved, to already in love, to drive to the post office alone. She calls me her midwife. For years after she moved East, I didn’t read all of her emails in detail. Other than the updates, we lost touch. But then one day she found out she had cancer, and all I could think about was that lunchtime trip. Her dreams coming true.

We imagine our lives. We see the splendor of it rolled out ahead. Parties. Graduation. Celebration. We piece together “normal” in relation to others. How much sleep do you get? How often do you fight with your husband? We read the paper and swallow hard at kidnappings, kids caught in gunfire, fathers killed in a convenience store. But life as a parent is mostly just day to day. What’s for dinner? Is the dishwasher empty? No, you can’t stand on that chair. I can’t figure out how one becomes the person in the news with the sad, sad story. No. I know how these things happen. What I can’t wrap my head around is how you live with them. How you live.

The year my mother had breast cancer and my uncle had brain cancer is the year we lost our first son. It’s not so clear to me now how we lived. I remember crying on the couch an awful lot. I remember my milk darkening circles on my shirt. I remember believing I had the worst luck on the planet. But then the days moved one by one along the squares in the kitchen calendar. My mom came and went from the community chemo room. She mailed pictures of her bald head. We threw ashes into the Pacific. Hours became weeks became years. And now we are parents of two. My mother and uncle survived. And I sit here now thinking how lucky we are to have more than just a “normal” life: health, and wealth, and love. How lucky I am to feed my son and dream of his first day of school… that quintessential vision of the backpack, the glance backover his shoulder. How easily it all can change.

What does WhyMommy think of now in those moments when she's not strong? What is normal in her house? I swallow hard now and hold a future for her in my swelling heart.

Working Mother

Today was my first day back at work. Not only did I survive it, I loved it! When I left Stella when she was 3 1/2 months old, I cried all the way there and called no less than 3 times before I returned home. Today I felt a lump in my throat as I kissed Otto, but it was brief. I only called to say I'd be a little late. When I got home, Stella ran to hug me and Otto took me back without question. I felt like a whole person. It didn't hurt that my in-laws were caring for the kids.

I loved seeing patients, catching up with my coworkers, and finding my drawers organized and ready to go. The work made me dig into my mental reserves. I forgot some paperwork details, how Sickle Cell Genetics work, took too long to chart my visits, and found myself chatting away with patients while I had others waiting. Midwifery is like riding a bike; it will come back very soon.

Talking was the best part. I thrive on grownup conversation. Uninterrupted experience. That's what I get at work that I don't get at home. And it's behind a closed door- no one to bother us! It's a marvelous thing. Pumping wasn't too bad. I got 3oz out of 2 sessions. That's half of what some women get from one boob in 5 minutes, but for me, it was ok. The pump didn't romance me the first time, so I wasn't expecting much. Otto will start eating cereal in a few weeks, and I have about 30 oz of frozen milk, so I'm not stressed.

It was a challenge to write, however. My handwriting has always been a mess, but after six months of writing only shopping lists, checks, and brief thank you notes, it is officially illegible. Once my father received a note from me and asked politely, "Did you write it so that I couldn't read it... on purpose?" I'll work on the writing. Every year it's my resolution- that and flossing. I never achieve my goals.

Midwives Misunderstod.... Again

Every time Augusto puts some midwife news from the SF Chronicle in my To Read pile by the toilet, I feel dread. Truthfully, the dread follows naïve excitement- ooh! Somebody is paying attention! Quickly I come to my senses. I remember that only a select group understands midwives. The mainstream media is not part of this group.

Glaring from the pile is the headline “Fewer options for those who seek natural births: Midwives becoming less popular as cesarean sections gain ground.” The empathetic (?) journalist covered the upcoming closure of Homestyle Midwifery. Homestyle is a popular, personalized in-hospital midwifery service. Contrary to the headline, I actually met two people in Hawaii who delivered with that service. After we passed on our homebirth practice, my former partner, Cynthia Banks, worked for Homestyle for a couple of years. She is an excellent midwife, and she loved that practice. Then California Pacific Medical Center came in, took over St. Luke’s Hospital, and the well-loved, extremely safe midwives are done.

It’s all very sad, but what is worse is that the media can’t get it right, so the general public doesn’t understand, and with the pressure of OBs who are threatened midwives will steal their normal birth- big business, i.e. medical systems like CPMC, follows suit. Let me state two facts:1.Midwives are autonomous providers. 2. Birth with midwives is safe. The article gets it wrong on both accounts. It’s a common misconception, as follows:

1. “For doctors, the decision to allow a midwife to handle the birth or to intervene medically is often a matter of weighing the potential risks against a woman's wishes during labor. The vast majority of births are trouble-free, but few doctors want to risk complications just because a woman would prefer to avoid a medical procedure, physicians say.” Doctors don’t decide to ALLOW a midwife to do anything. We have our own patients. If they meet set criteria for having a low-risk pregnancy, they choose us. When there is a concern of complication with a woman’s health, we consult with a doctor. That means we ask for their opinion, consultation, guidance, or to take over care of the patient- whatever is appropriate.

2. "Some women may say, 'I'm willing to risk a little in terms of safety to have the birth I want.'” Dr. Elaine Gates, vice chair of the obstetrics and gynecology department at UCSF made that statement. Birth with midwives has been shown over and over again to be as safe as or safer than birth with OB-GYNs when you match women of similar risk in similar settings.

It’s really a shame that midwifery is so misunderstood- since the research also shows that patients of midwives are overall more satisfied with their experiences than patents of doctors.

It WAS the Real Deal

It’s been two weeks since those irregular contractions. Our son is two weeks old. At 2:30 pm, just after I last wrote, I tried to take a nap, but lay awake noting every twelve minutes on the clock. After an hour or so, I called Augusto and asked him to come home. His commute can often take more than an hour, so I wanted to be sure he was on his way. I chatted with my neighbor about her plans for a Sunbrella hot tub cover. Every few minutes I paused to lean over her compost bin or kitchen table and breathe a little bit. Stella would be awake soon, so I dashed back inside and was greeted by her waking-up sounds. I brought her downstairs and got her snack ready, then my body let loose. The contractions were three to six minutes apart and took my full attention. I made sure Augusto was close then called the midwives and our friend Libby to pick up Stella. Augusto and Libby arrived at 5pm, just two and a half hours after I had laid down for my nap.

By this time I was burying my face into pillows, towels, and blankets while digging my still-humid pedicure into the rug. The sounds from my throat were curious- somewhere between a Gregorian chant and a large animal near death. While Augusto installed our car seat in Libby’s car, Libby slid her fingers across the small of my back. The light touch gave some relief from the band tightening on my middle.

When Augusto and I were finally alone, I waddled to the bathroom for the epic emptying of my bowels. At 2-minute intervals, I threw myself onto my hands and knees and made the dead animal chant then climbed back up to the toilet for more. Augusto ran the tub and then ran around the house. I could hear his feet stomping down the hardwood at a hare’s pace. Run to get water. Run to get the phone. Sprint for the phone list. Race back to stroke me when the contraction comes again. The baby’s head was low, but my dilation was unclear when I checked at 5:30pm. We paged the midwives. The tub didn’t provide the relief I wanted. With contractions on top of one another, all I wanted was one moment of rest. I also wanted to pee. The need to go was so strong- yet I was completely unable to sit on the toilet or release any pee in the tub or anywhere else I tried. A little after 6, when one midwife had arrived, the bright orange rug on bathroom floor called to me. I lay down on my side and stayed there until the end. I still couldn’t pee, but the contractions spaced out enough to drink some water and rest for a glorious minute.

Pressure. I felt pressure. Two contractions later I was pushing. We had just decided to check my dilatation, and I had only half-jokingly declared if I was 2 cm, we were heading to the hospital for a c-section. With only the tip of her finger inside my vagina, our midwife felt the head. Since I still needed to pee and the head was right there, I reached around my belly and felt his head myself. It was exciting to know I was close, and my hand between my legs gave a grammar school relief to my peeing urge. I could feel his head descend with every push. The feel of his squishy scalp over his firm skull made me forget everything else. It helped me focus on the task of getting him out. I pushed until my labia burned, then I puffed air until the burning stopped.

A few minutes into it, the other midwife arrived, and I gave her detailed directions on where to find and how to turn on the camera. I was vividly alert and knew exactly what to do. I instructed my husband to hold my leg in just the right place. I knew just how much to push each time. I asked for water when I wanted it. I smoothed my fingers over my baby’s head as he emerged a little more with each effort. There was no fear. No doubt. There was only the strength of each push and the burn as my body stretched to accommodate our second child.

At 6:37 pm, in our house in Oakland, Otto squeezed out with a tiny cry. His father, joyous with laughter, lifted him to me. Otto blinked his eyes and looked at my face, my breast, my belly that had been his home. He was pink, and warm and calm. I was elated.

Spilt Milk

I just spilled all the milk I just pumped on the kitchen counter and up my sleeve. After the obvious thought “this is where crying over spilled milk comes from,” I thought of a class I took in graduate school about nursing leadership. The majority of the course was a snore of 90 minutes on nursing history and the greatness of the profession. If only I had been a knitter earlier on my path to becoming a midwife. It was a great class for knitting. All I can remember now was the time spent discussing a seminal publication called “Novice to Expert.” The highbrow content of Patricia Benner’s classic demonstrates how one travels along the learning curve (steeply or not) to arrive at that place of dependable clinical judgment and truly caring practices-- the kind of knowing that others look to for answers.

Ten years later my classmates and I have all arrived in our own way. I opened a private practice and caught a bunch of babies. I started a free clinic. Others became professors, researchers, and went on for PhDs. And most of us, being women of childbearing age, became mothers.

So how it really goes is this: I spilled the milk, shouted one of many expletives I’m trying to curb before my 10 month old starts to talk to strangers, had thought #1 about the crying, started to cry, then had thought #2 about Benner’s book. In that milky moment I realized that I have done just the opposite. I have gone from expert to novice in the steepest un-learning curve known to womankind. I understand less and less every day.