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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.”

Apr. 23rd, 2009

Desert

What's Next?

As I lay outside atop our trampoline, with the birds singing to me and my skirt ruffling in the April breeze, the Cardinals victory still fresh and sweet, everything seems so simple. The Capitol and the hospital feel very far away. Thursday is my Saturday, and for another 24+ hours, nothing can steal my peace. I don't have to fret about any amendments getting tacked on to any bills, or what Senator so-and-so said about Rep so-and-so regarding issue such-and-such. There is no charting to be done, no meds to be passed, no assessments to be completed...I am not responsible for anyone's life right now except my own. My heartbeat is the only heartbeat I hear...S1, S2, clear, regular, steady.

I wish I could bottle up this tranquil afternoon and keep it forever. It's a sweet escape from the uncertainty and frustration that has accompanied me the past several weeks. About a month ago I received word that my application to Newlife International School of Midwifery was not accepted for admittance into the program. I was shell-shocked, numb, peaceful, crushed, peaceful again, and now lost, in that order. That was the plan! I was supposed to work at University -- and moonlight as a lobbyist -- until September, when I was going to move to Davao City, Philippines to begin the rest of my life as a midwife. God spoke "Newlife, Newlife, Newlife" into my heart for TWO YEARS...TWO YEARS! So I finally listened (it takes me a while sometimes) and applied! I POURED over my application for months, making it as perfect as I could. I didn't renew my cell phone contract. I came to terms with the fact that I was going to miss weddings and Christmases, and silly as it sounds, that I wouldn't get a haircut for over a year. I took a job in Columbia because it was pointless to move somewhere else for 8 months just to pack up and leave the country. I WAS READY TO GO!!!! Yes, I was scared sh*&less, but I was willing! Here I am Lord, send me!!! I was going to uproot my entire life and move to a 3rd world country to catch babies and tell people about Jesus!!! Since when does God tell would-be missionaries to stay home?!How is that not the right plan for me???

But it's not. I don't know why. I wish I did. But I got the email saying I'm on the waiting list and to try again next year. I have to make alternative plans now. I wish I could say I'm not at all resentful of the Lord, but I am...(Lord, it hurts. It sucks. I hate it. I know, and I believe, You work all things for the GOOD of those who love You and are called according to Your purpose...but I don't understand how that is so this time. I know it is not my job to know. I know I know all I need to know right now. Help me trust You like I profess to trust You. Remake me once more and gracefully give me peace)...So I'm not going to the Phiippines. The Lord has a plan bigger for me than the one I made for myself, the one I thought was His plan for me. Seeing as He desires for me to do His will elsewhere, I am grateful He caused my application to be rejected, rather than calling on me to turn down an invitation into the program on my own strength. So what is next? Good question.

A few days ago I signed my lease for next year, to stay here in Columbia for the next academic year, until August 2010. Do I want to stay in Columbia? No, not exactly. Do I want to get out of Columbia? No, not exactly. I just want something different. Do I hate my job? No. Do I hate lobbying? No. Does either bring me great joy and make me feel alive? No...no. Does journeying with women from maidenhood to motherhood bring my great joy and make me feel alive? YES! That is what I want to do! I know what I want to be when I grow up! Awesome! Is there a way to do it right now? Maybe, maybe not. One of the great practical perks of the school in the Philippines was that there were no living expenses..."just" tuition, books, and a couple flights around the world. I've been saving 80-90% of my paychecks, each one going into my midwifery savings fund. I was hoping to raise support for the rest, and count on God to bring in the money for the school I thought He had called me to. So now instead...there are U.S. schools, yes. But I would have to pay rent and utilities and gas money and food in Florida, or Washington, or California, or Maine. On top of tuition and books. And I wouldn't be able to work while in school, because such is the life of a midwife: you are on-call 24/7 because babies come into the world whenever they feel like it! So, more expenses an no way to pay them. I'm still saving nearly all of every paycheck I get, but it will take significantly more savings to go to midwifery school in the U.S. I know God is bigger than money, and He will make it fall from the sky for me if it is His will, but my puny human understanding of His power is, well, puny.

Apprenticeship is certainly an option, and an option I'd love to grab on to! The problem is, we have a midwife shortage...which means we have an apprenticeships shortage. My dear friend may possibly be able to take me on as an apprentice this fall (which would be amazing!!!), but she lives 3 hours away from me...I haven't ruled it out but the distance does create a bit of a head-scratcher. Just as I could not work (a typical job as a nurse) during midwifery school, I could not work during an apprenticeship either...and Ameren and the City of Columbia and my landlords will still want money from me in exchange for electricity, and heat and water, and the roof over my head. I could move back to St. Louis and live with my parents (and then they instead of me, in their incredible love and sweetness, would pay for the roof over my head!), but there don't seem to be any apprenticeships available in the STL area. Maybe I just have to wait for Mr. Right to come along so he can bring home the bacon! (Mr. Right, if you're out there reading this, I would appreciate you presenting yourself sooner rather than later).

So, in the meantime, if, as I am starting to come to terms with, I cannot pursue becoming a midwife in the very near future, I must do something else. Starting in July, Mizzou will pay 75% of any Masters program I may want to pursue, so long as I continue to work for them full-time. It is an accessory dream of mine to get my Masters in Public Health. Mizzou has a very new MPH program...but I hear lots of good things about it. Tomorrow morning I have an appt in the Nursing School about the Nurse Practitioner program...do I want to be a NP? I don't think so...but maybe I could be persauded? (I am going to stare at this poor lady tomorrow morning...I don't even know what to ask). It just seems so silly, I *KNOW* exactly what I WANT to do, but life is preventing me from doing it! Will I keep working on 5West, doing the Med-Surg thing? Will I transfer into a OB position? Will I go back to the Capitol next January? Will I have to keep working weekends and forego having a social life? Will I take on the PR Board position for the birth center? Will something take me away from Columbia?

So many possibilities and so many unknowns! I cannot pretend I am not defeated about feeling that the one thing I REALLY want to do is an arm's length (or, on some days, lightyears) away from me. But His plan for my life is for my highest GOOD. And it is for His glory. I have to believe that. My life is bigger than just me. He is at work, and He will not stop halfway. The tranquility will return, despite the passing of this April afternoon. Jesus, make me an instrument for Your peace. And make me at peace with the instrument you fashion me into.

Feb. 23rd, 2009

Heart & Hands

RN -- Real Nurse!

I am a registered nurse!!!! Halley Watson, RN, BSN! Yeah! It's such a weight lifted from my shoulders, and I am so relieved to have the NCLEX behind me! It was long and hard and very anxiety-producing, but I did it! I am going to be getting my LICENSE in the mail very soon! Thank you Jesus!!! You are so good and all the glory goes to You!

My orientation to 5 West (and the nursing wold in general) has been interesting...I spend most days feeing like an idiot! My preceptors are wonderful -- Jessica graduated from nursing school just about 20 months ago, so she's not so far removed that she's forgotten what it feels like to be new -- but she's also been around long enough to know how everything works! Kevin is my weekend preceptor, and he is like a big brother looking out for me but letting me do my own thing. I feel somewhat conflicted regarding my competence in all things 5 West: Trauma and Surgery Services. On the one hand, I scramble around all day (chicken with no head, precisely) trying not to fall behind and lose all control. On the other hand, apparently I am one of the best new nurses on the floor! My preceptor brags about me to the other nurses, and I keep hearing comments from other staff like "Oh you're that awesome orientee I keep hearing about!"

It's encouraging to hear for sure. Just a little strange when I feel so lost a lot of the time. There certainly have been "punch-your-fist-in-the-air-cause-you-just-kicked-butt" moments. I inserted an NG tube (a nasogastric tube...plastic tube that goes down your nostril into your stomach and gets connected to suction to relieve pressure/vomitting) for the first time and I did it with finesse -- my patient has had one put in before, and as you can imagine, it is not a pleasant experience by any means, but he told me I did a great job! A few weeks ago, in the middle of a high-pressure, hellish shift, I started an IV successfully all by myself with no supervision! Heck yeah! My preceptor said "You got it in on the first try?! Awesome! Who helped you?" I smiled back at her and said "No one." Yesterday my patient started having chest pain and was showing changes on his telemetry...I recognized the problem, took action, and pretty soon I was giving nitroglycerin, drawing cardiac enzymes, and trying to assess an EKG! Turns out his Troponin I was indeed elevated, not by much but still -- I recognized and intervened for a heart attack!

What a sweet, sweet day it is today. I am an RN. I am really proud of myself. It reminds me of what that mother said in Orgasmic Birth..."There are very few times in life when you can tell the world you are proud of yourself. But I am proud of myself. I am SO proud of myself!" Now granted, I didn't push out a baby today. But I have been gestating this RN for 4 years and today was the delivery! Thank you Lord for bringing my journey to fruitition!
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Sep. 28th, 2008

Laying on Hands

Pros & Cons of Postpartum Nursing...

So now I am rethinking considering taking a job in postpartum nursing. (I know, I go back and forth on what I want like every day). So, assuming I decide I need to take a nursing job after I graduate, what would be better: postpartum nursing, or med-surg (aka adult health, diabetes, heart disease, cancer, etc) nursing? Labor & Delivery is totally out -- I tried it for a month-long internship and it was more heartbreaking than I could bear -- I just could not live with myself, and despite restraint would learn the wrong way of doing things, and plus I'd probably get fired :) Here are what I think would be the pros and cons of PP nursing...

PROS
- I would gain valuable assessment skills. I would get really good at assessing lochia, palpating the fundus, identifying barriers to successful breastfeeding, etc. In other words, I would be gaining skills than actually pertain to midwifery! (Although med-surg experience would pertain to the "womb to tomb" philosophy).
- I would learn how to manage a postpartum hemorrhage. And while it's often true that a hemorrhage is treated differently in the hospital than it is at home, the point is I would learn to recognize hemorrhage, and know when to take action.
- I would get to do a LOT of patient teaching. All new moms have the same basic needs regardless of their birth setting: the need for information, the need for reassurance, the need for confidence in their mothering skills. I would get to educate families all about nursing, baby-wearing, diapering, SIDS, circumcision, infant sleep, bonding, and on & on.
- Postpartum nursing is much more my kind of pace as compared to med-surg nursing. Healthy moms, healthy babies. I am not an adrenaline junkie, so even though med-surg is not the ER or an ICU (Lord, I can't imagine working in an ICU or the ER! I would be so freaked out and on edge all the time!), it's much more crazy/fast-paced/unpredictable than postpartum is.
- Most people give birth in the hospital. Many of my future clients will have experienced hospital births. I think it would be beneficial to me to have experience in hospital birth policies and politics, and for those who plan to have future hospital births, how to "get around the system."
- I think legislators will find it more impressive for a postpartum nurse (aka someone who is knowledgeable in women's health) to support midwifery and homebirth than a med-surg nurse (aka someone who may not know anything about pregnancy and birth.) The title of being a postpartum nurse brings additional credibility.
- I like working with women and babies much more than I like working with wrinkly whiny old men. Ha!
- When you're having a bad day, you can pick up a baby and everything is so much better :)

CONS
- I fear I would learn the WRONG way of doing a lot of things, the medicalized versions, and that this would impede my growth as a midwife. I fear moral conflict!
- I worry that I would be asked/required to do things that I cannot morally tolerate. While there isn't much (a relative term) in postpartum I disagree with, at Columbia Regional the RNs rotate between postpartum and the well-baby nursery. And that's the part that worries me -- poking and prodding babies with needles, giving breastfed babies formula, assisting with circumcisions?! God, how COULD I???
- I believe that to some degree, you are a product of your environment. When I was doing my internship, I caught myself adopting a little of the mindset of some of the other nurses..."Man, this labor is taking sooo long! Can't we up the Pit?" Or "Dang it, stop moving in bed! I'm tired of readjusting the EFM!" And then I'd immediately catch and scold myself for thinking such things! But is it just a matter of time before you become "one of them?" I fear becoming indoctrinated.

Please leave a comment with your thoughts on this matter...thanks!

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.

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