After dinner on my last night as a courier, walking from the big house to pack up my little room everything sat in the right light. Rainbows of flowers in the gardens along the walkway seemed to sit perfectly on their stems. A late evening light glazed the heavy forested hillside in a golden hue. Down in the valley, fog laid on top of the river, skating down stream with the current.
Maybe that’s what it’s like when you realize you’re leaving a great place. All the pieces unite, matching up and playing off each other. As I ascended the stairs to the courier quarters, I relished in my experiences, acknowledging that it would never be the same again. I had come to rural Kentucky, made handfuls of friends, seen many births, spent countless hours in the women’s health halls, eaten poke sallet, celebrated a coon-on- log fourth of July, dug up potatoes with my hands, had a snake fall on my head, learned to sew, kicked open a piñata, - it’s endless.
As I my mind wandered through the piles of my courier experiences, I reached the top of the stairs. I look a final evening look into the wooded atmosphere. It was unmistakable, pronounced even - Wendover in all it’s glory and magic all the way to that final night.
-Amanda
Monday, August 17, 2009
Passages and roadways are frequent topics of conversation in the Appalachian Mountains of Kentucky. Whether the focus is on a washed out dirt road, the Parkway, the Spur, a path through the woods, a river, a holler, or the ATV trail, a constant reminder of the energy required to create this motion is ever present. Energy in these mountains is a limited resource. Yet it is a requirement for physical function, psychological awareness, and utility. The mountains, tall and worn, confine us to the small beautiful valleys between them.
I came to Kentucky knowing very little about midwifery, fried foods, rural health care, or Mrs. Breckinridge, and expected to learn many things related to each of these areas. This expectation was fulfilled, yet I have come away with something more: unanticipated knowledge. I now possess a deeper understanding of what a “modern’ or “scientific” 21st century birth entails. I have listened to stories of how this differs from the previous era. I have become more comfortable with the idea of cultural isolation. And I have witnessed illiteracy in America, a sight that caused my eyes to swell with tears.
I was initially startled by every toothless smile, saddened by the worn out faces of so many young women, and frustrated by the diet and lifestyle trends that have opened the flood gates of illness; particularly diabetes, hypertension, and obesity. Now however, I might not even notice the toothlessness of a smile. Instead, the focus has turned to the fog rising from the valleys, the savory taste of the terrible food, and the mysteriousness of coal mining.. I have learned what is meant by the term “strip job”, and that the definition of a house contains infinite possibilities, including once abandoned shacks and old buses, that a “toilet” can be many things, that even the most distracted students have something to give and gain, and that it is entirely possible for 13,000 people to be served by 6 emergency room beds. Not ideal, but possible.
As I sit here on Mrs. Breckinridge's front porch, listening to the rippling of the river below, I am filled with a sense of inspiration, to challenge my own expectations of comfort, and to offer service to those around me. I am moved by energy of Mrs. Breckinridge and will leave Kentucky with a small piece of the spirit Appalachia stitched into my heart.
-Elia
I came to Kentucky knowing very little about midwifery, fried foods, rural health care, or Mrs. Breckinridge, and expected to learn many things related to each of these areas. This expectation was fulfilled, yet I have come away with something more: unanticipated knowledge. I now possess a deeper understanding of what a “modern’ or “scientific” 21st century birth entails. I have listened to stories of how this differs from the previous era. I have become more comfortable with the idea of cultural isolation. And I have witnessed illiteracy in America, a sight that caused my eyes to swell with tears.
I was initially startled by every toothless smile, saddened by the worn out faces of so many young women, and frustrated by the diet and lifestyle trends that have opened the flood gates of illness; particularly diabetes, hypertension, and obesity. Now however, I might not even notice the toothlessness of a smile. Instead, the focus has turned to the fog rising from the valleys, the savory taste of the terrible food, and the mysteriousness of coal mining.. I have learned what is meant by the term “strip job”, and that the definition of a house contains infinite possibilities, including once abandoned shacks and old buses, that a “toilet” can be many things, that even the most distracted students have something to give and gain, and that it is entirely possible for 13,000 people to be served by 6 emergency room beds. Not ideal, but possible.
As I sit here on Mrs. Breckinridge's front porch, listening to the rippling of the river below, I am filled with a sense of inspiration, to challenge my own expectations of comfort, and to offer service to those around me. I am moved by energy of Mrs. Breckinridge and will leave Kentucky with a small piece of the spirit Appalachia stitched into my heart.
-Elia
Sunday, August 2, 2009
in retrospect
My summer at Wendover has ended and I am back in my home state of MA. This morning when I woke up I had the greatest impulse to throw on khaki and white, only to realize that a uniform is not required for this part of my summer. The lack of khaki and white left me standing awkwardly in front of my bureau, completely unable to dress myself.
This basic confusion may have subsided quickly, but it creates a nice metaphor for my departure from Wendover. I had such a schedule, such a daily goal, that without the structure of Frontier Nursing Service and the courier program, I find myself aimless.
I never could have imagined I would learn all that I did this summer. Of course, based on the literature regarding the service and the program, I knew I would be shadowing some health providers and doing some community service, and thus learning about healthcare and community building. But I had no idea of the magnitude of the learning, and the wide array of information I would accumulate through daily interactions, various chores, and specific circumstances.
I ended up seeing four births: three vaginal and one c-section, and each one was wildly different than the others. I was able to witness the different methods and tendencies of each midwife, as well as the varying birth plan of each mother. Obviously the c-section had very few similatrities to the other births, but even amongst the three vaginal births there were great discrepancies in the midwifery, the duration, the epidural, etc. I knew each birth would be its own, distinct moment of glory, but I didn't really know what that meant. Nor did I have any idea that I would begin to understand the delivery room lingo and jargon.
The experiences I had each day in town or in the clinics alone were enough to fill a whole summer. But the learning didn't stop there at all; the staff of FNS at Wendover provided me with a family of distinct and exceptional members. I will forever remember the converstations in the Garden House while signing out the service car, or the conversations in the kitchen over the steam from the massive dishwasher. I learned about poke sallet, about family function and dysfunction, about fondant cakes, and probably more about snakes than I'll ever (hopefully) need to know. Each person at Wendover brought to the table personality, stories and friendship. Living at Wendover was like being in a perpetual hug.
When I signed on to spend a summer in Southeastern Kentucky, I knew there would be a few other couriers there with me. And I knew, just because of the instinctual tendencies of young women, that we would beomce friendly and chatty. But I had no idea that my relationships with the other couriers would be as enjoyable as they were.
Everything I learned this summer seemed to come full circle -- things I learned from one area of my couriership frequently tied into something I was learning in another area, and lended to a greater understanding. With one birth, the midwife asked me to assit her by propping the mother's leg up and helping her through her contractions and periods of pushing. While I would have done this in the beginning of the summer, I felt much more well-equiped to do so after the Doula Training that we went through. Similarly, I began to see the same people around town or in different clinics, and it felt like we were succeeding at delivering well-rounded care and aid to the residents of Leslie County.
Not only could I take acquired knowledge from one task and apply it to another, but I started to be able to apply this acquired knowledge to my own life. On a smaller scale, I learned how to make butter at the Library camp, only to make some more at Wendover, and other such things. But on a greater scale, I learned from the people of Hyden and Leslie County. I learned the meaning of certain social graces, I learned the importance of kind interactions, I learned tolerance, I learned acceptance and I learned what 'southern comfort' really means.
-frances
This basic confusion may have subsided quickly, but it creates a nice metaphor for my departure from Wendover. I had such a schedule, such a daily goal, that without the structure of Frontier Nursing Service and the courier program, I find myself aimless.
I never could have imagined I would learn all that I did this summer. Of course, based on the literature regarding the service and the program, I knew I would be shadowing some health providers and doing some community service, and thus learning about healthcare and community building. But I had no idea of the magnitude of the learning, and the wide array of information I would accumulate through daily interactions, various chores, and specific circumstances.
I ended up seeing four births: three vaginal and one c-section, and each one was wildly different than the others. I was able to witness the different methods and tendencies of each midwife, as well as the varying birth plan of each mother. Obviously the c-section had very few similatrities to the other births, but even amongst the three vaginal births there were great discrepancies in the midwifery, the duration, the epidural, etc. I knew each birth would be its own, distinct moment of glory, but I didn't really know what that meant. Nor did I have any idea that I would begin to understand the delivery room lingo and jargon.
The experiences I had each day in town or in the clinics alone were enough to fill a whole summer. But the learning didn't stop there at all; the staff of FNS at Wendover provided me with a family of distinct and exceptional members. I will forever remember the converstations in the Garden House while signing out the service car, or the conversations in the kitchen over the steam from the massive dishwasher. I learned about poke sallet, about family function and dysfunction, about fondant cakes, and probably more about snakes than I'll ever (hopefully) need to know. Each person at Wendover brought to the table personality, stories and friendship. Living at Wendover was like being in a perpetual hug.
When I signed on to spend a summer in Southeastern Kentucky, I knew there would be a few other couriers there with me. And I knew, just because of the instinctual tendencies of young women, that we would beomce friendly and chatty. But I had no idea that my relationships with the other couriers would be as enjoyable as they were.
Everything I learned this summer seemed to come full circle -- things I learned from one area of my couriership frequently tied into something I was learning in another area, and lended to a greater understanding. With one birth, the midwife asked me to assit her by propping the mother's leg up and helping her through her contractions and periods of pushing. While I would have done this in the beginning of the summer, I felt much more well-equiped to do so after the Doula Training that we went through. Similarly, I began to see the same people around town or in different clinics, and it felt like we were succeeding at delivering well-rounded care and aid to the residents of Leslie County.
Not only could I take acquired knowledge from one task and apply it to another, but I started to be able to apply this acquired knowledge to my own life. On a smaller scale, I learned how to make butter at the Library camp, only to make some more at Wendover, and other such things. But on a greater scale, I learned from the people of Hyden and Leslie County. I learned the meaning of certain social graces, I learned the importance of kind interactions, I learned tolerance, I learned acceptance and I learned what 'southern comfort' really means.
-frances
Saturday, July 18, 2009
a transitional age
I am 21 years old, and in no way am I treated like a child in the other areas of my life. But it wasn't until I began work here that I really began to understand my age and the duality of youth and maturity within it. Within such a transitional age as 21, there is a lovely dichotomy between childish play and adult responsibility. Many places or experiences would try to create a tension between the two contending halves, but here at Wendover and FNS, this tension has been replaced by celebration and clarity. While the day of a courier, and therefore the lifestyle of courier, is often described as reduced to an easy simplicity, I have found this easy simplicity to be wonderfully complicated. FNS and the staff at Wendover allow us couriers to fully realize and exercise our adult capabilities; we are trusted to get the most out of our days, fulfill our commitments, and turn the fan on when we cook at the stove. This understanding that we will be self-motivated and also responsible to ourselves and our surroundings helps me remember that I am in fact a young woman and no longer a child. Yet, there is a playfulness and comfort found at Wendover and FNS that leaves room for execution of hobbies, games, splashing in the river, and the provision of support should we seek it. Never before have I lived in a community that fully recognizes and extracts both sides of my age. There is an incredibly fantastic depth to my life right now; I wake and put on my uniform, and face my day with the knowledge and understanding that while I am here to learn for my own benefit, I am also, if not more so, here to make myself available to whatever and whomever. But then at around quarter after four, I pull back into the drive of Wendover, and my professional side sheds itself to reveal its youthful counterpart. The day, very much so still young, becomes our own to explore.
It would be facetious of me to suggest that between the two adjacent halves of 21 the is no overlap. The glory and suprise and joy of each day comes in finding the give and take between the two sides. It is wonderful when it is your childish demeanor or youth that affects a patient or allows you to fully tackle an assignment. Similarly, it is wonderful when adult moments of the day permeate the childish hours and leave you reflecting upon what you saw, did, or experienced. The almost ven diagram existence of these two personalities, if you will, makes Wendover and FNS what they are. I have not reflected on this complication in my life before, and I have just come to realize, that until the reflection has been noticed and digested, this age cannot be fully understood or harnessed.
I would not have come to realize this duality within myself had I not met the other couriers here. We cross a span of ages and a span of life stages. While we all exist in our own small worlds and are all so seemingly different in so many ways, it has been incredibly revealing to me the way in which, regardless of our different ages and stages, we can come together around the dinner table and have a conversation that expresses both sides of age that I mentioned above. For instance, this past week, two of the other couriers and I were waiting for a dinner party to be done so that we could do their dishes. While we waited we made tea and sat on the kitchen floor, relaying the details of your days, the romantic stories in our lives, and the funny moments we have stumbled upon. Amidst the mixture of digestion of terms and sights from the day with the giggles from bad break-up stories, I took a moment to realize the wonderful youth found within young women and the wonderful maturity found within the same young girls.
The complexity of life, and the stereotypes of age, are also made clear in the day to day work of a courier. Often I have witnessed prenatal care to a woman multiple years younger than myself. Until I see the birth dates written on her medical forms, the age is completely unknown. These young women, despite their youth, are giving birth and raising families, and are so mature and composed. Yesterday when I was shadowing the midwives I met a woman who was 20 years old and onto her fourth child under the age of five. I was stunned by her ability to lead her life with a control, stability, and composure that would suggest she was 35.
On the other end of this spectrum are the senior patients visited on home visits or seen in the nursing home. There is a youthful glint in their eyes and a desire to tell stories and crack jokes that only succeed in exposing their inner child. Last week I made a home visit to a woman who was 95; an age that I again did not expect or realize until glancing at her records. We had a variety of age conflicting conversations; one about her plethora medications and the lesion on her hand, and another about her chase with a cat, and her flirtatious banter with her husband.
Having frequent exposure to both of these age defying experiences has made me realize the continuity and resilient nature of childhood, and the deeply rooted and innate tendency to be grown-up. It has also made me understand and appreciate FNS and Wendover more, the way in which they allow us and encourage us to embrace, and in turn celebrate, our ages and our lives.
-frances
It would be facetious of me to suggest that between the two adjacent halves of 21 the is no overlap. The glory and suprise and joy of each day comes in finding the give and take between the two sides. It is wonderful when it is your childish demeanor or youth that affects a patient or allows you to fully tackle an assignment. Similarly, it is wonderful when adult moments of the day permeate the childish hours and leave you reflecting upon what you saw, did, or experienced. The almost ven diagram existence of these two personalities, if you will, makes Wendover and FNS what they are. I have not reflected on this complication in my life before, and I have just come to realize, that until the reflection has been noticed and digested, this age cannot be fully understood or harnessed.
I would not have come to realize this duality within myself had I not met the other couriers here. We cross a span of ages and a span of life stages. While we all exist in our own small worlds and are all so seemingly different in so many ways, it has been incredibly revealing to me the way in which, regardless of our different ages and stages, we can come together around the dinner table and have a conversation that expresses both sides of age that I mentioned above. For instance, this past week, two of the other couriers and I were waiting for a dinner party to be done so that we could do their dishes. While we waited we made tea and sat on the kitchen floor, relaying the details of your days, the romantic stories in our lives, and the funny moments we have stumbled upon. Amidst the mixture of digestion of terms and sights from the day with the giggles from bad break-up stories, I took a moment to realize the wonderful youth found within young women and the wonderful maturity found within the same young girls.
The complexity of life, and the stereotypes of age, are also made clear in the day to day work of a courier. Often I have witnessed prenatal care to a woman multiple years younger than myself. Until I see the birth dates written on her medical forms, the age is completely unknown. These young women, despite their youth, are giving birth and raising families, and are so mature and composed. Yesterday when I was shadowing the midwives I met a woman who was 20 years old and onto her fourth child under the age of five. I was stunned by her ability to lead her life with a control, stability, and composure that would suggest she was 35.
On the other end of this spectrum are the senior patients visited on home visits or seen in the nursing home. There is a youthful glint in their eyes and a desire to tell stories and crack jokes that only succeed in exposing their inner child. Last week I made a home visit to a woman who was 95; an age that I again did not expect or realize until glancing at her records. We had a variety of age conflicting conversations; one about her plethora medications and the lesion on her hand, and another about her chase with a cat, and her flirtatious banter with her husband.
Having frequent exposure to both of these age defying experiences has made me realize the continuity and resilient nature of childhood, and the deeply rooted and innate tendency to be grown-up. It has also made me understand and appreciate FNS and Wendover more, the way in which they allow us and encourage us to embrace, and in turn celebrate, our ages and our lives.
-frances
Monday, July 13, 2009
rural self-sufficiency and comfort zones
Last week I went on my first solo home visit to a home health patient’s house (home health identifies patients who need extra help around the house and each courier attends to one patient). As I sat at the bottom of her driveway, I looked up the steep, rocky, washed-out road then I looked back down at my little car, “There’s no way I can do this,” I thought. After taking a few moments to regain my composure I stepped on the gas and made my way up the hill, car bouncing, tires spinning, coffee spilling, mind racing.
Like so many other times here, I pushed myself out of my very narrow comfort zone to get something done. With no strong background in education or nutrition, I’ve helped to compile a resource book for an after-school fitness club and designed a healthy-eating handout for a health fair. Even though I’ve never painted before in my life, my last few Thursdays have been spent repainting the Habitat for Humanity ReStore. And while I am a million times more content to stand silently aside while others do the talking, I have been going alone on my own aid and companionship visits to hospice and home health patients.
These all may sound like minuscule feats, but they echo the sentiments conveyed in my favorite rural doctoring blog and in my conversations with local practitioners. While I step out of my normal comfort zone by driving up a steep driveway to clean house for and visit with a 95-year old woman, rural health care providers are stepping out of their comfort zones to treat hyperkalemia without nearby dialysis or to provide prenatal care to women when their expertise lies elsewhere.
This “rural self-sufficiency” is what attracts me to Wendover and to the rural health care field. If I had decided that the driveway were too rocky and steep or a nurse practitioner decides she doesn’t know enough about prenatal care, that leaves one old woman would wouldn’t have her house vacuumed and her porch swept and one young woman who wouldn’t get regular prenatal care. In medically under-served areas like Leslie County and my own hometown, you learn to expand your own boundaries, to traverse new frontiers because if you shy away from a task, there’s no one to step in and do it for you.
--jordan
P.S. Perhaps I’m not the first courier to feel this way:
from Mary Breckinridge: The Frontier Nursing Service & Rural Health in Appalachia
Like so many other times here, I pushed myself out of my very narrow comfort zone to get something done. With no strong background in education or nutrition, I’ve helped to compile a resource book for an after-school fitness club and designed a healthy-eating handout for a health fair. Even though I’ve never painted before in my life, my last few Thursdays have been spent repainting the Habitat for Humanity ReStore. And while I am a million times more content to stand silently aside while others do the talking, I have been going alone on my own aid and companionship visits to hospice and home health patients.
These all may sound like minuscule feats, but they echo the sentiments conveyed in my favorite rural doctoring blog and in my conversations with local practitioners. While I step out of my normal comfort zone by driving up a steep driveway to clean house for and visit with a 95-year old woman, rural health care providers are stepping out of their comfort zones to treat hyperkalemia without nearby dialysis or to provide prenatal care to women when their expertise lies elsewhere.
This “rural self-sufficiency” is what attracts me to Wendover and to the rural health care field. If I had decided that the driveway were too rocky and steep or a nurse practitioner decides she doesn’t know enough about prenatal care, that leaves one old woman would wouldn’t have her house vacuumed and her porch swept and one young woman who wouldn’t get regular prenatal care. In medically under-served areas like Leslie County and my own hometown, you learn to expand your own boundaries, to traverse new frontiers because if you shy away from a task, there’s no one to step in and do it for you.
--jordan
P.S. Perhaps I’m not the first courier to feel this way:
" Couriers especially had to step out of their comfort zone to meet Breckinridge’s expectations. Working with the FNS, one former volunteer explained, forced them to leave their “sheltered existence” and “look…at life” in a new way. These young women arrived in “lovely riding boots and the most elegant jodhpurs” but soon found themselves rising at dawn, sleeping on cots and standing in line to brush their teeth. Tasks they would have never imagined performing, such as leading livestock over the mountains between nursing centers, became routine. "
from Mary Breckinridge: The Frontier Nursing Service & Rural Health in Appalachia
doula training
What is a doula?
"A doula is someone who supports and guides a woman and her family through pregnancy and labor. They provide well rounded, women centered care. Doulas can teach, encourage and give emotional and physical support to mothers and families. Doulas can help in any birth, including c-section births, homebirths, and births in hospitals. Many doulas are trained in massage, birthing positions, and other pain coping methods in order to comfort a woman through the birthing process. Most importantly, doulas believe that birth is a normal process and that every woman is capable of giving birth with confidence and joy!"
- Birth Hands Doula Cooperative
Last night I completed my second Doula training. Two women from Boston who founded and run Birth Hands Doula Cooperative came down to Hyden to plant ideas for a labor assistance community here through a doula training and offering their services to laboring women in the community.
The formal training was last week. We discussed “doula-ism” from every angle:
1.) Philosophically – what is a doula? How do doula’s aid with pregnancy, birth, and post-partum?
2.) Practically – prenatal visits, nutrition, positions, massage, stages of labor, breastfeeding, general education
3.) Business – doula as a profession, finding clients, what you offer, how to get started
4.) Emotionally – intuition, reaction, objectivism
They provided us with the tools to step into the world and offer our assistance to the full range of pregnant women (natural births, medicated, c-sections, water births, hospital, home, and birth center births).
Being at a woman’s birth is one of the greatest gifts - To attend and be involved in this truly transformative process, to support a woman as she goes through difficult moments, to be that encouraging voice and reliever of back pain.
My favorite part of the training was the Questions and Answer follow-up session last night. Twelve women sat around a wooden business table on the top floor of the small town hospital and talked about birth.
We brought attention to the lack of space in our culture to discuss birth, especially positive birthing experiences. With the arrival of the child, women often feel the birthing process has lost it’s relevance and no longer needs to be talked over.
Their focus should be solely on their healthy child, not how they felt during contractions. Or, mother’s with great birthing experiences feel bad sharing their birth story because it could hurt their friends’ feelings or make her sound self-righteous.
On the other hand, progressive young women are encouraged to responsibly take control their reproductive systems. We talk about having sex when you want to, using birth control, giving thought to abortions. Rarely, if ever does the conversation turn to birth - just how WOMAN and what a source of female empowerment (especially natural birth) pregnancy and childbearing is.
As a doula you provide education, advocate for laboring women, support them (and their partners) physically, mentally, and emotionally, and after the birth you give them that space to say as much or as little as they want about their experience.
There are many problems and setbacks in today’s birth culture. Like anything, discussion, the rise of consciousness, is one of the strongest catalyzing forces to increase education and provide women with a full spectrum of birthing possibilities and care.
Last night we emerged from the hospital into the late evening glow. The five of us couriers strolled through town in our khaki and white. As we passed the hardware store and county court, birth and women were running through our minds.
For more information about Birth Hands go to:
www.birthhandsboston.com
amanda
"A doula is someone who supports and guides a woman and her family through pregnancy and labor. They provide well rounded, women centered care. Doulas can teach, encourage and give emotional and physical support to mothers and families. Doulas can help in any birth, including c-section births, homebirths, and births in hospitals. Many doulas are trained in massage, birthing positions, and other pain coping methods in order to comfort a woman through the birthing process. Most importantly, doulas believe that birth is a normal process and that every woman is capable of giving birth with confidence and joy!"
- Birth Hands Doula Cooperative
Last night I completed my second Doula training. Two women from Boston who founded and run Birth Hands Doula Cooperative came down to Hyden to plant ideas for a labor assistance community here through a doula training and offering their services to laboring women in the community.
The formal training was last week. We discussed “doula-ism” from every angle:
1.) Philosophically – what is a doula? How do doula’s aid with pregnancy, birth, and post-partum?
2.) Practically – prenatal visits, nutrition, positions, massage, stages of labor, breastfeeding, general education
3.) Business – doula as a profession, finding clients, what you offer, how to get started
4.) Emotionally – intuition, reaction, objectivism
They provided us with the tools to step into the world and offer our assistance to the full range of pregnant women (natural births, medicated, c-sections, water births, hospital, home, and birth center births).
Being at a woman’s birth is one of the greatest gifts - To attend and be involved in this truly transformative process, to support a woman as she goes through difficult moments, to be that encouraging voice and reliever of back pain.
My favorite part of the training was the Questions and Answer follow-up session last night. Twelve women sat around a wooden business table on the top floor of the small town hospital and talked about birth.
We brought attention to the lack of space in our culture to discuss birth, especially positive birthing experiences. With the arrival of the child, women often feel the birthing process has lost it’s relevance and no longer needs to be talked over.
Their focus should be solely on their healthy child, not how they felt during contractions. Or, mother’s with great birthing experiences feel bad sharing their birth story because it could hurt their friends’ feelings or make her sound self-righteous.
On the other hand, progressive young women are encouraged to responsibly take control their reproductive systems. We talk about having sex when you want to, using birth control, giving thought to abortions. Rarely, if ever does the conversation turn to birth - just how WOMAN and what a source of female empowerment (especially natural birth) pregnancy and childbearing is.
As a doula you provide education, advocate for laboring women, support them (and their partners) physically, mentally, and emotionally, and after the birth you give them that space to say as much or as little as they want about their experience.
There are many problems and setbacks in today’s birth culture. Like anything, discussion, the rise of consciousness, is one of the strongest catalyzing forces to increase education and provide women with a full spectrum of birthing possibilities and care.
Last night we emerged from the hospital into the late evening glow. The five of us couriers strolled through town in our khaki and white. As we passed the hardware store and county court, birth and women were running through our minds.
For more information about Birth Hands go to:
www.birthhandsboston.com
amanda
Wednesday, July 8, 2009
my first birth
I was lucky enough to witness a birth in the first week of my stay here in Eastern Kentucky. I felt strange and intrusive as I entered the birthing room. It seemed invasive and nosy to butt-in on such a magical and personal experience between a woman and her body and her baby. But the mother in the room was warm and receptive to observers. Her temperament was calm and controlled; it was her third birth, and her husband was providing attentive and focused support.
At this point the mother was in the early, but full on, stages of labor, experiencing frequent contractions of some force. The mother was enduring her labor with a heavy epidural, hardly feeling her contractions, but made aware of them by the monitors that surrounded her. Her spirit was high, and I was impressed by her relaxation with the process. It was clear that she was a practiced mother, and that giving birth was a cultivated skill of hers.
As the contractions progressed, the midwife occasionally felt for the expansion of the cervix and for the crown of the infant. After some time, she grew curious; she was feeling topography that did not feel familiar to a normal infant head: a dimple or two hypothesized to be either an ear, a fist or an anus. The midwife had her nurses feel for confirmation. Upon reaching a consensus that there was a possibility that the baby had breached, the doctor was called.
The mother's OB/GYN came to the room and did his own investigation of the situation. He agreed that the contours he was feeling weren't appropriate for a normal birth arrangement, but deemed the situation to be something far more different and far more rare than a breach. The baby was to be born face present, meaning the face of the child was facing up, as opposed to down as in a normal birth. It is hard for a woman to give birth to a baby in this position, as the shape and arrangement of the head and its upraised chin and subsequently the rest of the body do not compliment the shape of the uterus and pelvis as appropriately as a normal birth. The doctor decided that the mother would be able to have a normal vaginal birth, given her success in contracting and pushing during the other stages of her labor.
Faster than I had expected, the mother gave birth, with a serious strength and endurance, to a healthy girl. As I watched the new parents handle thier daughter, I had a moment to digest what had just happened and what I had just felt. Bearing witness to the successful growth of a family was more powerful than I ever imagined it could be. My prior experiences with birth had all come from media or literature, and so to see it all in real life and to be exposed to a tangible love and relief was a moment I won't easily forget.
I have always known birth to be a magical moment; I have never had any doubt of that. Nor have I had any doubt of the incredible capabilities of the human body and the human spirit. However, as I watched this mother give birth in this uncommon, unpredictable and even more challenging position, I was reminded of the strength, resilience and flexibility of our bodies. The situation made me think about how all advances in science and technology aside, a woman's body is designed for this function, and with a little trust and patience, it's biological tendencies will achieve variety of tremendous physical feats.
Similarly, watching the midwife react to the face present birth with pure fascination and joy made me really understand the surprise and bonanza of each individual birth. A face present only happens 1 in every 600 births, and this midwife was beyond amazed that she had witnessed one. A camera was brought out to capture the moment that the head began to emerge from the vagina, face first, and various print outs of the photo were handed around the room and the entire maternity ward. I watched the midwife scurry around the room talking about the rarity and 'coolness' of such a birth, and I realized what an ideal profession midwifery really is. To be moved and taught and surprised by each birth, each day on the job, is something that is fantastically wonderful and enviable.
-frances
At this point the mother was in the early, but full on, stages of labor, experiencing frequent contractions of some force. The mother was enduring her labor with a heavy epidural, hardly feeling her contractions, but made aware of them by the monitors that surrounded her. Her spirit was high, and I was impressed by her relaxation with the process. It was clear that she was a practiced mother, and that giving birth was a cultivated skill of hers.
As the contractions progressed, the midwife occasionally felt for the expansion of the cervix and for the crown of the infant. After some time, she grew curious; she was feeling topography that did not feel familiar to a normal infant head: a dimple or two hypothesized to be either an ear, a fist or an anus. The midwife had her nurses feel for confirmation. Upon reaching a consensus that there was a possibility that the baby had breached, the doctor was called.
The mother's OB/GYN came to the room and did his own investigation of the situation. He agreed that the contours he was feeling weren't appropriate for a normal birth arrangement, but deemed the situation to be something far more different and far more rare than a breach. The baby was to be born face present, meaning the face of the child was facing up, as opposed to down as in a normal birth. It is hard for a woman to give birth to a baby in this position, as the shape and arrangement of the head and its upraised chin and subsequently the rest of the body do not compliment the shape of the uterus and pelvis as appropriately as a normal birth. The doctor decided that the mother would be able to have a normal vaginal birth, given her success in contracting and pushing during the other stages of her labor.
Faster than I had expected, the mother gave birth, with a serious strength and endurance, to a healthy girl. As I watched the new parents handle thier daughter, I had a moment to digest what had just happened and what I had just felt. Bearing witness to the successful growth of a family was more powerful than I ever imagined it could be. My prior experiences with birth had all come from media or literature, and so to see it all in real life and to be exposed to a tangible love and relief was a moment I won't easily forget.
I have always known birth to be a magical moment; I have never had any doubt of that. Nor have I had any doubt of the incredible capabilities of the human body and the human spirit. However, as I watched this mother give birth in this uncommon, unpredictable and even more challenging position, I was reminded of the strength, resilience and flexibility of our bodies. The situation made me think about how all advances in science and technology aside, a woman's body is designed for this function, and with a little trust and patience, it's biological tendencies will achieve variety of tremendous physical feats.
Similarly, watching the midwife react to the face present birth with pure fascination and joy made me really understand the surprise and bonanza of each individual birth. A face present only happens 1 in every 600 births, and this midwife was beyond amazed that she had witnessed one. A camera was brought out to capture the moment that the head began to emerge from the vagina, face first, and various print outs of the photo were handed around the room and the entire maternity ward. I watched the midwife scurry around the room talking about the rarity and 'coolness' of such a birth, and I realized what an ideal profession midwifery really is. To be moved and taught and surprised by each birth, each day on the job, is something that is fantastically wonderful and enviable.
-frances
Wednesday, July 1, 2009
birth number ONE
(written Wednesday, June 4th)
Everyday I get a little clearer sense what the life of a nurse midwife looks like. Today I opened an entirely new door, the exhaustion of laboring. Yesterday I attended my first birth. Today I can feel it.
On some levels I feel there was some fate in it, well fate and luck. I showed up at the wrong clinic and ended up shadowing a different midwife than I’d been scheduled with.
As I was walking into the hospital clinic I saw a woman who had agreed to allow me at her birth, sitting outside, cigarette in hand, hair recently washed and done. It didn’t take the looser belly to know the deed had been done. I approached her to see a new whiteness in the irises and an exhaustion laid heavy in the pupils of her eyes. The baby came out the previous night and she was doing well.
Inside the Labor and Delivery Ward another mother, E, who I had seen on a couple of pre-natal visits in the clinic was in the initial stages of labor. The midwife suggested I visit her and ask if I could attend her birth. First thing in the morning, I opened the door, to see this young, beautiful woman laid flat on a hospital bed breathing with great concentration. She was holding on to the bars on the sides of the bed, bracing herself. Long brown curls (which are a rarity around these parts) fell onto either side of her chest. Nervously, I asked if I could be at the birth, she said “everyone else will be here I don’t see why not” and gave me a sweet, teasing smile.
As soon as the midwife told Eve it was better not to stay in the bed, she was up and around the majority of the day. When I left the building for lunch, she was breaking from lapping the hospital parking lot to lean on your partner during a contraction. When I left for dinner, E, in hospital gown and bright red corduroy, velor paints, was seated on a bench in front of the hospital surrounded by what seemed to be an entire family.
The midwife told me that E wanted to go through labor without any drugs. Many of the pregnant women in this midwifery practice had been recreational drug users. Most pregnant drug users cannot get pre-natal care or any help getting off the pills. This clinic runs a program that puts these women on Subutex, an opiate blocker, to help them stay clean through the pregnancy (and hopefully permanently). They also monitor the babies very closely.
Eve was one of these women. When she first came to the clinic the midwives weren’t sure she’d make it through the program. All sorts of terrible events occurred her during pregnancy – her car was broken into, she was assaulted, her car broke down, she got kicked out of her apartment. The whole time she stayed clean and followed the rules of the program. I can’t help but think that her ability to stay off drugs over the nine months was inspiration and motivation to go through labor without medical intervention.
The midwife was committed to helping her succeed. She said we’d stay in the room as much as possible to help E stay calm and on track.
After dinner E’s labor picked up, the contractions were stronger and closer together. Her mother, aunt, mother-in-law, and partner were all her hospital room. The first stage of “extremely” active labor lasted for 3-4 hours, in which the contractions are crampy. She mostly sat on the “birthing ball” (blow up exercise ball), rolling her hips around in a circular motion, with her head on bed next to her. She hated laying on the bed, swearing the pain was 10 times worse. Following the midwives lead, we rubbed her back and whispered encouraging words into her ears: “You’re doing great”, “This contractions is almost over”, “You are so strong”.
Before long she was in transition, which is when the contractions are extremely close together and intense. It pushes the woman to her edge. This period is borderline intolerable. E stated she’d never get pregnant again, that she couldn’t do this, that she was dying. Tears rolled down her face. She clenched her partners hand with desperation, her green tipped acrylic nails shaking.
And then it was over. E was 10 centimeters, or her cervix was fully dilated. The contractions calmed down. E was still frazzled and scared of what was to come next. She was especially afraid of pushing the baby out, the pain it would bring. The midwife helped her relax. She told her what it would feel like. She explain that an epidural would take away some of the pain, but that it was better for the 1st stage of contractions, which she had already made it through with brilliant courage. The midwife never told her what to do. She gave E options, explanations, enough information for E to make the decision herself. E chose to keep going without medication.
In Stage Two of labor the contractions shift from cramping to pressure. It was 2-3 hours of pushing before the baby came out. E started on the ball and moved to a hands and knees position on the bed. We were all around her, cheering her on through massage, kind words, holding her up, giving her our necks to grasp around and hands to squeeze. First she pushed the membranes out. The midwife suggested she rotate onto her back. At this point, the midwife put her sterile gown and gloves on and rolled the table of delivery equipment into the room Her intact water sack was at the lips of her vagina. The midwife broke it with a tool similar to a plastic crochet needle. The baby’s head crowned, hints of its black hair peaking through.
E breathed the baby out into the world. With each exhale the head moved 2 steps forward, and with each inhale the head returned to the womb 1 step. Slowly, with great control, over the course of 4 contractions a child emerged from the vagina. Once the head was fully out, the body followed in one smooth, goop-covered, movement, like coming down a slide. It was 11:45pm, just moments before the next day. Within seconds the room was in tears. The midwife worked with calmness and precision, smiling assurance into the room. As she bulbed liquid from the babies mouth, he made his introduction to this room with strong stream of urine up into the air. The purple and white candy-canned umbilical chord reached from mom’s vagina to the baby’s belly. Still connected, the midwife handed the tiny purplish boy to his mother. Extending her arms forwarded, with a look of surprise and uncertainty, she reached for him, bringing him to her chest. For a few moments they were joined in two incredibly profound connections.
The midwife handed the father the scissors and clamped the umbilical chord in two places. Dad cut between them.
The final step of labor is delivering the placenta. With one push, E urged the purple-red mass out of her body. The midwife laid it out on the table and showed the mother her healthy placenta.
The mother’s body quivered from the loads of lactic acid built up in her body. The nurses checked the baby with the dad looking over their shoulders. A fine little boy. Before I left for in the early morning, E and the baby were practicing breastfeeding. A perfect culminated to long sought union.
I’ve looked forward to my first birth for some time now. It was the ideal delivery for me to participate in – all natural, spontaneous, vaginal. I saw the stages of labor clearly over the course of the day. I experienced the power of a birth in the company of loved ones. I observed a midwife work in an ideal condition. I had expected to be most blown away from by the moment the baby emerges from the vagina, into the world. Although I shed a tear or two, what impressed me the most were the steps the midwife took to keep the mother clam and fully inform her of all her options. Throughout the birth, the midwife was the mother and child’s advocate.
My alarm went off this morning after 4 hours of sleep. Signs of darkness where still in the air and rain was pouring down making that sound that streams “stay in bed”. Knowing, if I was a midwife I’d have to get up, I hit the snooze button twice and jumped out of bed with no complaints. I structured my crazed curls into a semi-appropriate style and hopped in the car at 7am to head to the elementary school to assist health education lesson. Now I sit, sipping soda to keep my eyes open at the Habitat for Humanity Thrift Store in town. I was planning to start painting the walls. The weight of birth has slowed me. Rocking back in forth, old time mountain music singing over the radio, and rain ringing patterns on the sidewalk, I am grateful.
- amanda
Monday, June 29, 2009
the beginning
No doubt, you’ll drive to Wendover and think you’re on the wrong road. It’s barely one lane, full of pot holes, and seems like it could come to an abrupt end at any second. Then, out of nowhere, Wendover's single-room post office turns up on your left. Just past the only official town building, the original Frontier Nursing Service (FNS) compound peeks down on you from the hillside above.
Up a rocky, green, blanketed slope sits a series of turn of the century buildings, including Mary Breckinridge’s log house (“the big house”).
With the Middle Fork of the Kentucky River rolling on your right, you turn up the gravel drive.
This is where the adventure begins.
Up a rocky, green, blanketed slope sits a series of turn of the century buildings, including Mary Breckinridge’s log house (“the big house”).
With the Middle Fork of the Kentucky River rolling on your right, you turn up the gravel drive.
This is where the adventure begins.
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