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Sep. 28th, 2009

Laying on Hands

Gestating Halley: 2nd Trimester

As 2008 began, I saw "The Business of Being Born" with my mom and my roommate Katie (and instantly turned two skeptics into staunch supporters). I can't say I learned anything new when I watched that movie (I had spent the past year researching maternity care!), but it did shake me up. It dawned on me that birth was not just something that affected ME as a career path, but something that would profoundly affect all the women I know and love -- most of whom live in Missouri, where midwifery was at the time a felony. In early February I discovered Friends of MO Midwives, our statewide advocacy organization. I decided quickly that I had to do my part to contribute to the legalization of midwifery in my home state. I made a batch of brownies and drove to Jefferson City for "Cookie Day." The Capitol loomed before me, and somehow it looked even bigger than it did on my 4th grade field trip. My heart pounding within me, I set foot into senators' and representatives' offices, gave them my brownies with a note "From an aspiring midwife" stapled to the bag, and asked to speak to them about the matter closest to my heart. I did not feel like a worthy authority at all, but I did know that doctors should not be slicing women's vaginas open without their permission or awareness. I knew that mothers -- not health care providers -- know what is best for their bodies and their babies. I told the elected officials what I knew and what I wanted. Although I know realize that some of the people who "listened" were just being politicians, it was enough to make me want to come back.

And I did come back. I came to the Capitol every Wednesday for the rest of the 2008 legislative session, and a couple times a week at the end. It worked out nicely because I didn't have any classes or clinicals on Wednesdays. However, at a crisis point towards the end of session, I called my nursing instructor the morning of our Thursday clinical and told her it was more important for me to be at the Capitol lobbying than for me to attend my mental health clinical. Part of me can't believe I had the gall to do that, but what's even more amazing is that my instructor agreed with me! Now that I think about it, making that phone call was an outward declaration of what I had been feeling about nursing school all along: indifference. I just didn't care about it very much. (I cared about doing well, but that had more to do with my disease of over-achievement than it did with a passion for nursing). What I did care about was justice, and safety, and excellent care for women and babies, and I knew that I would need a voice louder than an RN's to make a difference.

The 2008 legislative session ended in mid-May. It came down to the wire: the Senate waited until the afternoon of the last day of session to pass our licensure bill, and the House was not able to get it passed before the solemn hour of 6pm tolled. I cannot and will not speak of the politics involved, but it was messy and ugly. I prayed and prayed and prayed that our bill would be passed and midwifery would be legalized. But 6pm came, and midwives remained felons. I was numb. I was heartbroken. I couldn’t imagine how my friends felt, who had already spent four years at the Capitol trying to legalize midwifery, and had already tasted such bitter disappointment four times over. It was so unjust. But we still had a small glimmer of hope: at the end of the 2007 legislative session, a bill legalizing certified professional midwives (or someone holding “tocological certification”) was passed. When the state medical organizations realized what had happened, they challenged the law in court. We hired an attorney and fought back. Those big wigs assumed we were just a bunch of silly housewives, but they were about to learn we were a force to be reckoned with. When the 2008 session ended, the Missouri Supreme Court still had not ruled on the tocology law. And so we continued to wait.

I was cruising on the Mediterranean Sea with my mother when it happened. Knowing the Supreme Court was going to announce their decision any time, we (well, she, honestly) shelled out the cash so we could check our email on the cruise ship. It was about 3am in Missouri on June 25th when I logged in and saw the email that dumbfounded me and brought tears to my eyes: “MISSOURI WINS!!!” It couldn’t be! But it WAS! The Missouri Supreme Court had sensibly determined that the Missouri State Medical Association (MSMA) and the other physician groups didn’t have standing to sue, so they threw out the case, thereby making the tocology law immediately effective and making midwives instantly LEGAL!!! After half a century of Missouri women not having legal midwives, and Missouri midwives running from the law, justice was served. My mother and I spent the rest of our delightful European vacation on Cloud 9, and I knew I would not be returning to the same Missouri I had left.

I returned to a Missouri where midwives were legal, to a Missouri where my sisters and daughters could have homebirths with legal midwives, and a Missouri where I myself could BE a legal midwife. It was an awesome feeling. I do not have sufficient words to describe how huge that was, how huge that is, how huge that will always be. I started my final semester of nursing school, and I could no longer deny that my graduation from college was around the corner. Full-blown adulthood was screaming toward me like a bullet train, and every day went faster than the one which preceded it. Ever since I had first become interested in midwifery – two years before this time – I had thought about it in a future context. When I’m done with nursing school, then I will pursue midwifery. Or, when I’ve graduated college, then I can start midwifery school. All of a sudden, I could think about midwifery in a PRESENT context: the time has come! It’s here, it’s now! If I’m honest with myself, it was just as nerve-wracking as it was exciting.

I decided about this time that I was going to stop battling God over whether or not I should go to Newlife/the Philippines, and just take the cosmic hint, and apply. (I’m a little slow on the pick-up sometimes). Newlife started in the fall, like all schools do, so I knew I would have an awkward eight-month chunk between graduation and when my “real life” would begin. I quickly decided that I would get some “silly nursing job” to bridge the gap and save money for tuition. I applied at University Hospital here in Columbia, where I had done the majority of my clinicals. My classmates were all flustered about applying to ten different hospitals and getting a jump on things on September 1st. Myself, I applied for two University jobs in mid-October, roughly two months before graduation. I had two interviews, one with 5 West and one with Labor & Delivery (I’ve thought soooo many times, Maybe I could *change* L&D, maybe I could make it a whole different world all by myself…). But I always wake up from that fantasy pretty quickly. Plus they wanted me to work nights, which I could not do because I had already committed myself to lobbying at the Capital in the 2009 session at least two days a week. (Plus I have a firmly ingrained circadian rhythm).

I knew I had to take a “silly nursing job” that wouldn’t (a) get me fired, or (b) make me go home crying every night. I had already done my senior practicum on 5 West, so I knew the people and the protocols. It made for an easy transition. The patient population on 5 West comprised all things traumatic: car accidents, motorcycle accidents, gunshot wounds, knife wounds, horseback riding accidents, falls from ladders/balconies, you name it. It also included all things surgery: hernia repairs, gastric bypasses, dialysis accesses, appentdectomies (appendix removal), cholecystectomies (gallbladder removal), and surgical complications (chronic wounds that never heal). Nothing about this excited me; in fact I found it pretty lame. However – I had no ethical problems with trauma/surgery nursing either (at the time -- I do now, wouldn't you know it?), which is a LOT more than I could say for OB nursing!

I got my silly nursing job squared away with as little effort as possible as I poured myself into my Newlife application. I prayed over it. I wrote a book of an answer to each essay question (they said to be thorough!). I had multiple people read it and edit it. I finally submitted it in early February of 2009, right at the deadline. Meanwhile, graduation had come and gone, which was celebratory and awesome, yet surreal and frightening. Christmas had come and gone, and I felt like the happy-go-luckiness of childhood slipped permanently away from me, tossed to the curb with the wilting Christmas tree. I was stricken with fear. What had I been thinking? How could I possibly manage to work as a full-time staff nurse (which I had never done before) AND be a full-time lobbyist (which I had never done before)?? I felt very alone. January 5th came all too quickly, and, seemingly without my permission, my life crossed the threshold into “the real world.”

Sep. 25th, 2008

Wrinkles

Breeching the Plan

I have had a lot on my mind today. This morning I finally got around to reading the accounts of the Virgina CPM who tragically lost two breech babies within a 6-wk period. It was a really sobering experience for me to read the statement from the medical board, and really expanding to read the blog from the other midwife. When I first sat down to read about it, I thought I would find an account in which the parents/hospital were to blame and/or there was nothing the midwife could have done, because I am partial to midwives, they can do no wrong, right? WRONG! This midwife made some decisions that I feel (in my limited knowledge) were questionable, and a few that I think were outright dangerous. *I fully acknowledge that I wasn't there and can't fairly judge, but the point I'm making is that I surprised myself that I was surprised that midwives could make poor decisions at all*. And then I went on to read the commentary from the other midwife, about her own surprise breech delivery, and how she transported to the hospital (which I think was absolutely the right thing to do considering her lack of experience and the volatile legal climate), and about how she doesn't want to learn to attend vaginal breeches. Interesting.

I have always planned on pursuing experience in attending breeches and twin births. I think that it's important that these skills are preserved, because I believe in most cases breech and twin deliveries can be healthy and normal, and women should not be forced to have cesareans if it is safe to deliver these babies vaginally. But I must admit that it was scary to read that blog and to think about those breeches gone wrong. Head entrapment...cord compression...death. Wow. That's a really big deal. And it's convicting too, because we constantly bad-mouth (or at least I do) OB's for not trusting birth, but...I guess sometimes you really can't? But I know in the fiber of my being that birth CAN be trusted...I think it's really about balance. It's about trusting birth, but it's also about RESPECTING it, and having the humility to accept that sometimes it doesn't result in a healthy mother and baby. I read through the comments after the author's post, and I was particularly intrigued by the one that pointed out the following: we regard it as prudent when a midwife isn't comfortable accepting responsibility for breeches, but we think it's unacceptable when an OB isn't comfortable accepting responsibility for VBAC's? It does seem like a catch-22 to me. I enthusiastically support VBAC and know that it is generally so much safer than repeat cesarean...but aren't vaginal breeches also safer (for the mom) than cesereans? I know I'm playing devil's advocate here...I'm processing...all of a sudden I'm more aware that birth politics and practice styles are sooooo much more gray than black & white.

Also on my mind today is the phone conversation I had with Steff. It was really good for my heart. She suggested that maybe I hold off on getting a (nursing) job until after the legislation session is over. The thought had occurred to me before, but there's just something about someone else suggesting something to you, ya know? It was like I was granted permission to consider this scandalous idea of not taking a hospital nursing job. My mom is going to be nervous/upset already when I finally tell her that I am going to be the "new Mary," imagine if I tell her I'm not going to get a job! She'd blow her top! I know I am an adult (as bizarre as that sounds) and have the freedom to make decisions without my mother's approval, but I keep forgetting. My whole life I have had to ask my parents' permission. So I'm still getting used to the fact that I no longer need permission from anyone to run my own life :) It would just be so great if I could make my work at the Capitol my only work. It certainly should be my only work, it's so incredibly important. But how will I buy my groceries and pay my rent? I wonder if I can get a computer job I could do from home on my own time like Steff said...maybe I could do something for The Crossing...or work at Barnes and Noble and spend all my paychecks on books I won't have time to read? :) And I could purchase my own health insurance if necessary? What a concept. It IS just so insane to think about working full time as a new lobbyist AND a new nurse and never go anywhere except the Capitol and the hospital. I think I might go totally insane. I am not the type of person who intentionally over-books herself. Ever. I know that rest is vital and I make time for it. No decisions yet regarding post-graduation employment, but I now have been affirmed that putting off employment wouldn't be crazy, and I will continue to freely explore my options...

And what a sweet end to a thought-provoking day: my baby sister just called to tell me she is going to write her first college paper about midwifery and homebirth. She said everyone has to write about a controversial topic, and she wanted to call me to make sure midwifery would qualify, because "there are no good arguments AGAINST midwifery, right Halley?" It was so incredibly precious and uplifting...my heart may be bleeding with pride.

Sep. 23rd, 2008

Birth Art

"She's a Woman-Child in a State of Grace..."

You said it, Faith.  That is a very simple but optimistic breakdown of I am feeling as of late.  A woman-child...she has big responsibilities and big dreams, but still wants her mama to tuck her in and kiss her forehead when the world is too overwhelming.  In a state of grace...a place of falling down and getting picked back up again, repeatedly, with great love and compassion from the Picker-Upper (aka God).  Reminds me of the lyrics from "The Chasing Song": Falling down ain't graceful, but I thank the Lord that falling's full of grace.  

Lately I feel like I am being forcefully shoved into my role as "Woman," all the while I am clinging to my role as "Child."  I am graduating from college on December 19, 2008 -- less than 3 months away!!!  What an exciting and absolutely terrifying thought!  And then what in the world am I going to do after that?  Should I apply for a job on 5 West at University?  That's where I'm doing my practicum right now, so it makes a lot of sense to me...I'll already have 15 shifts under my belt when I start orientation!  But then I hear about how they have such a critical shortage, and everyone who gets wind of me applying just BEGS me to work there...is it really that bad?  Or is it just burnout in the other employees?  The great part about taking a job on 5 West where they are so needy is that I could just about set my own schedule...I think three 8's and one 12 would be perfect for me...

Especially if I am going to up at the MO Capitol 3 days a week!  Crazy!  Although the weight of responsibility is weighing on my shoulders regarding stepping up to the plate in Jeff City, it is truly something I care about, something I want to devote my time to and pour my soul on.  And all of a sudden, I find that it's already happening.  I am testifying at a public hearing on October 7th regarding the Board of Healing Arts' ridiculous definition of medicine.  I have to go out and buy a suit (umm...what?!).  I am on the Big Push Yahoo group and getting a crapload of emails about a lot of stuff that is over my head.  How did this happen?  Did I decide this?  I did, right?  Well, God did.  And I trust Him.

The problem is that I feel so conflicted between being a new nurse (which will be very challenging and stressful...thrown to the wolves, seriously), and being an (almost) new lobbyist (which will also be very challenging and stressful, but at least it's something I'm passionate about!)  It's not that either of them alone is more than I can handle -- but the combination of 4 hours a week in the hospital and 3 days a week at the Capitol (and no hint of a weekend anywhere) is quite daunting.  I sort of wish I could JUST do midwifery lobbying...I could devote myself fully to it, and I could still hang out with my sister or go out with my friends once in a blue moon.  I mean, come on, who needs health insurance and a paycheck?

"Shes a wild one
With an angels face
Shes a woman-child
In a state of grace
When she was 3 years old on her daddys knee
He said you can be anything you want to be
Shes a wild one...
Runnin free."
-- Faith Hill



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