One Month In

I got to see an old college friend last night. She wants to be a midwife too, and so she went to my alma mater for an info session and then trekked even further north to grab a glass of wine together and camp out with me for the night. I had worked all day on the floor and I was beat. I caught a woman's baby who from the moment I walked in her room at 8:00 AM, I knew she was a survivor, and it was going to be a tough day. There is something so gut-wrenching about trying to help a woman who has survived sexual assault, abuse, and/or rape experience labor and birth and it will, I am sure, remain to my dying day one of the worst and hardest and most important parts of my job. It is exhausting and soul-sucking and deeply unsettling and scary, and a million times worse for her. By 8:00 PM, I wanted to lay down and die. She had had her baby, against huge odds, and I just wanted to go home. But I rallied and went and saw my dear friend and we drank wine and ate some french fries and even though I was so, so tired, I could feel my heart slowly filling by being with her.

She is so excited, and passionate, and worried she won't get into midwifery school, which I can only scoff at because she is at least doubly more qualified than I was, and I somehow managed to trick them into admitting me. I watched her gesticulate and talk faster and faster, with bright eyes and a big smile, about why she wants to do this with her life and what she thinks being a midwife means and is all about, and how desperately sick of waiting for this thing to start she is, and I thought, wow. Because that was exactly me, four years ago. To the absolute letter of it all. And even after the terribly hard day I had had, I felt such a swell of gratitude that I teared up a bit sitting in our old college haunt of a bar, in my clunky midwife clogs and giant wool sweater with my sweaty tangled hair tied up on top of my head.

I still can't believe that I get to do this thing, every day. This thing that is so hard but that I love so much. I am learning more than my brain feels it can hold, every minute of every day. I am grateful to have decades of being a midwife ahead of me (God willing), because it will take me three times as long as that to learn all there is to know.

I sit with women while they cry about how they don't know what to do, because this baby is not their husband's, and what should they do?!
I look into women's eyes while they tell me I'm lying to them when I tell them, give me one more push, she'll be here soon.
I laugh with patients when they hear their growing baby's heartbeat for the first time, a sound so joyful that if all I heard was that for the rest of my days, I would die happy.
I cry with patients when I tell them that their baby doesn't have a heartbeat anymore.

I come home to my empty house, snuggle my fur-babies while we all adjust to the single life, and I still, sometimes, feel like I want to curl up and die. But most of the time not. Most of the time, my heart is full of the sweet downy fur of baby heads and the bone-crushing grip of labor, and the love and support I can feel from the amazing colleagues who are mentoring and teaching me every day. I don't eat quite enough. I drink maybe a touch too much wine. I fall into bed, exhausted, every night. But I'm figuring it out. Slowly but surely, I'm finding my place here. It's a good place to be, and one I could barely have imagined four years ago.

I know, beyond a shadow of a doubt, that my friend will get into midwifery school. I know it with the same certainty that I know all babies come out and that you can always push a little harder than you think you can and that commanding a uterus to clamp down and stop bleeding is not something to laugh at. I know it because I did it. I know it because this world needs a lot of things, and one of those things is more midwives.

When It's Someone You Love

I thought I knew what it's like to be with someone in labor. And I did, in a sense. With my patients. My patients are lovely and amusing and sometimes frustrating but brave and powerful and utterly remarkable. But I am their midwife, and they are my patients, and those are our roles.  

Two weeks ago, my oldest friend had a baby. She is brave and powerful and amazing, just like my patients are, but I am not her midwife and so I was a wreck. I was a wreck because I love her so much and I loved her baby even before she was born and I didn't know how different it was to be with someone, really with someone in that space, someone that you love. 

I drove the six hours to be with her because I couldn't imagine missing it. I met her boyfriend for the first time when I got there, and gladly accepted hugs from her mother, who I've called "Mom" for as long as I can remember.

I made her walk the halls with me for four hours and we caught up on life as it is now, and reminisced about our high school antics until she couldn't talk during her contractions and we were running out of ice chips. I tried very hard not to hover over her when the midwife would check her cervix, and I tried to be helpful to her nurses who were, every one of them, so kind. I listened carefully to everything every doctor and midwife said and then explained it all again to her family, drawing little diagrams in the air when the baby turned out to be OP, and explaining what the fetal monitor meant with all its squiggly lines.

I held her hand and dozed in between her contractions, because her epidural only took the edge off and she woke up with every one. Twice, through a haze of Nubain and Benadryl, she woke up and looked at me and told me, "I'm so glad you're here. I couldn't do this without you," and I smiled and told her there was nowhere I'd rather be. She closed her eyes again and I felt like breaking open as a tear leaked down my nose because I wanted to take all her pain and hold it inside me and bury it deep but I couldn't.

I changed the pad under her every time she felt wet, and I made her open her eyes and look at me when she couldn't stop saying, I can't, I can't, I can't, and I told her that yes she could, she already was, and to squeeze my hand as hard as it hurt and to push through the pain even though it felt impossible.

And in the end, after the consent had been signed and her epidural was bolused, I pulled the curtain around us and sat on her bed and told her that it wasn't her fault, that the baby wasn't moving down because of how her head was positioned and that she did such a good job, the best job ever, and that everything was going to be okay. I told her how brave she was, and how strong she had been, and how after 48 hours of labor, the doctors were right, it was time for a Cesarean.

They wheeled her away and I fell apart. I felt like I'd failed her, like I'd let down my oldest and dearest friend by not being able to doula her out of an OP, asynclitic and unflexed baby's head. I am blessed to have midwifery friends who very gently and matter-of-factly pointed out how ridiculous that was.

So I waited till she was out of surgery, and helped her get the baby latched on, and stayed just a tiny bit longer and then drove all the way back to Connecticut in the wee hours of the night, already missing her sweet face and the baby's soft downy hair. 

I couldn't be her midwife, but that was okay. Because I am so lucky to be her friend.

The First

The first birth was awful.

I wanted it to be amazing. I wanted it to make me feel like a real midwife, like I could be good at this thing that I am both in love with and utterly terrified of. Instead, this woman I was with, she was only a couple of years younger than me and she did not trust me. In hindsight, this does not faze me. I get it. I'm 26, I was doing a less than spectacular job at faking any semblance of aptitude or confidence, and she was just done. Done with her contractions, done with the baby's father talking on his phone while she was racked with pain, done with her mother-in-law asking loudly when the hospital was going to do paternity testing because she was sure, she was positive that this baby was not her son's, and of course, done with the student midwife even being in the same room as her. So I did my best and offered to my preceptor to sit this one out and merely observe, in a genuine attempt to respect this woman's wishes, and was met with deaf ears.

"This is a teaching hospital. She needs to get over it."

Um, okay. Wow.

So in the end, no one was happy. My preceptor was annoyed that I dropped my hands away from the baby's head when the mother screamed, "No!! Don't touch me!" I was done trying to walk a fine line between respecting a person's body integrity and right to refuse whatever the hell they want to refuse - including having a student catch your baby - and trying to please whichever random "teacher" I'm spending a given 12 hours with. I was shaken by being so despised, in that moment, by someone who didn't know me at all, and - I'll admit - I was hurt and upset and took the whole thing far too personally. I grazed the baby's ears as they emerged and then, a few minutes later, managed to very messily deliver the placenta with shaking hands, waiting to be screamed at again by someone (anyone, really).

Ten minutes later, we were sitting in the chart room and my preceptor says matter-of-factly, "Okay, great. So that was your first catch. Here's the birth certificate, can you fill this out? Front and back."

I nodded, smiled, and excused myself to the bathroom where I sat on the floor, shivering uncontrollably, and took deep cleansing breaths until I'd breathed out all the adrenaline and guilt and fear and disappointment and anger and confusion until I was an empty shell of somebody calm and detached and wholly unlike me. That night, in the dark of my bedroom, I finally gave in to the sharp stab of hurt at being unwanted, of being terrible at something I so badly want to be excellent at, but mostly, at feeling such overwhelming sadness and guilt that I had been a part of something awful. Of a woman having a birth that was not her own, and not what she wanted. I hated everything about my implicitness in that.

If I've learned anything so far in school, it's that resiliency is far more important than aptitude. I still hate that school is a place where I am not the midwife I will be one day. Where I jump at the chance to perform amniotomies and place intrauterine pressure catheters because if I don't do those things now, I'll never learn how. Where I'm at the mercy and whims of every single preceptor, all of whom want different things, and none of whom are wrong. Where I spend 12 exhausting hours doing labor support for a primip only to be told to walk away at 7 PM so that the ER resident can catch her baby at 7:15. But - and this is a big but - the moments of wet squalling babies whooshing out on a wave of fluid, the pulsing cords, the reaching hands, and the tears that cross every language barrier in the room, those moments remind me why I'm here.

And they're what have finally brought me back to writing, after far too long.

What I Know Now

My patients, they do not leave me.  We exist now as a group, I feel them stringing along behind me when I walk to class or to my car, they hover over my head when I lay down and try to sleep.  Their voices echo in small phrases, glimpses swim in front of my tightly shut eyes while I rub the now permanent line that is etched between my eyebrows.  I struggle to recall faces, instead my mind is filled with a collage of body parts that I try to piece together - clenched hands on the exam table, the paper crinkling under their white knuckles, pale inner thighs that shrink away from my touch, chapped lips that answer my questions in whispers, eyes that won't meet mine.

Sometimes my patients are like the horses I grew up drawn to.  They size me up as I walk into the tiny exam room, the whites of their eyes following my every move.  I sit and lean back against the wall - I have no agenda, I want them to know.  I have tamed the single-minded eagerness to explain, to educate, to inform, to counsel that often fills us as we learn.  I know so little, it seems, I have been trusted with so much, I want to impart every speck of what I can offer, because even that is not enough.  Instead, I sit down and say hello.  I smile.  I ask how they are, and what brings them to me.  I set my pen down and listen.  I nod, and they seem unsure if they should continue to speak when I don't interrupt them immediately with questions.  I've stopped trying to have all the answers, but sometimes the questions still make my heart pound with anxiety.  I ask them anyway, my voice soft, the walls are thin, do you feel safe at home, where are these bruises from, how many partners in the last year, can you tell me how often you're shooting up, are you planning on becoming pregnant at this time, have you ever had symptoms like these before, how long have you had this pain?  I say, I'm so sorry that happened, that sounds really difficult, you don't need to apologize, ever, can you let your legs fall out just a bit more, you're in charge here, okay?, will you tell me if this hurts, let's use the other arm for this blood draw, let me know when you're ready.

I think back to a before time, when it felt important to do it all perfectly, to remember the order for collecting a Pap and how many centimeters into the cervix to insert the cytobrush in order to extract a sufficient sample, to perform a breast exam so flawlessly that no inch of tissue went unexamined by my probing fingers.  I think back to when I would recite my pelvic exam "lines" in my head on the drive to clinical, terrified of forgetting our textbook's directions for the best way to elicit cervical motion tenderness and what that would mean.  The words fall out of my mouth now, scoot all the way down, this is my hand on your leg, these are my fingers, this is the speculum, lots of pressure now, cervix looks good, little crampy now while I take a sample for the lab, you might have some spotting today, no need to worry, speculum coming out now, we're almost done, these are my fingers again, I'm going to press on your belly, any pain while I do this?, I'm making you have to pee, I know, okay, you are all set, you can scoot on back and up.

I know now that a sufficient sample and a smoothly performed exam do not erase the bruises on her inner thighs.  I know that my ability to rattle off the medication regimen for gonorrhea, chlamydia, pelvic inflammatory disease, and herpes does nothing for the woman whose trust has been shattered by a disease she did not give herself.  I hand her tissues and say, again, I'm so sorry.  I hope, maybe, that this tiny exam room with the fake wood paneling and the ancient posters on the walls can be something more than a bizarrely furnished box.  This tiny space we share where I ask them about their day, their dogs, their children, where I admire their socks and listen to what they say and even harder for what they do not say.  It is in this place I think, maybe, that in spite of all my weird and deeply probing questions, in spite of my hands inside them and my far from perfect technique, even in spite of all that I fumble and trip over and the answers I do not have, it is my hope that they feel safe.  That she sees that when the door shuts, I am with her and that is all that there is.  That I am long past the point of ever batting an eye no matter what she may ask or tell me, and that I will do my best to answer her questions but will tell her frankly if I cannot.  And maybe for five or ten insignificant minutes, maybe that is enough.

I've stopped trying to be right.  I only try to be kind.

Long Days

I hear the whispers outside the room in which I'm sleeping.  They float through my subconscious even as my body pleads, No, no, no it's not time to wake up yet, please no.
"Mommy, can I wake Cakey up yet?"
"What time is it?"
"Almost 6."
"Okay, but be gentle."

Tap tap tap.  I feel her feather hand on my shoulder and crack my eyes open to see her smiling face.  "Hi, Sage," I whisper sleepily.  She grins and flings herself in for a hug while I try to pull myself upright.  She is so grown up in daylight hours, eloquent and mature, and achingly in between childhood and adolescence, but at 6 AM on Thursday mornings, she is my sweet warm buddy again, crawling into my lap and telling me in excited whispers about her school's hiking and overnight trip she's going on today and do I want oatmeal for breakfast and how was my clinical yesterday and should we wake up June so she can see me too?

Half an hour later, June is still not awake.  I sneak into her room, where she is splayed across her mattress, naked except for her wedgied pink underpants, blankets tangled about her feet.  I stroke her back softly, whisper, "Juney-Bee, wake up..."  She turns toward me blearily, her hair in her face.
"Mommy?" she asks.
"No, sweetie, it's Cakey."
"Cakey??!  Is it really you?"  Her sleepy eyes wide open now, she pushes her bangs away, sees it's really me and scrambles her hot little monkey body into my lap and wraps all four impossibly long limbs around my torso and squeezes till my eyes tear up.  She lays her head into my chest and sighs.  "I'm so happy you're here, Cakey.  I love you."
"I love you too, sweetness.  I'm so glad you're mine."

We eat oatmeal at the table and the chatter washes over me while I pour milk and slice apples and we talk about what to wear for school picture day and hiking trips and their mother, a former boss, and now a friend, smiles at me over their heads while I mouth, Thank you for all of this, and she only laughs and shakes her head and wraps me in another hug.

It's a long drive to Massachusetts every Wednesday afternoon for a clinical shift in a tiny community sexual health center whose two exam rooms are each big enough to touch all four walls while you stand in the middle.  I cram myself by the door while my midwife preceptor wedges herself behind the exam table and moves mountains for her patients and teaches them about birth control.  I leave with my face hurting from smiling and my stomach rumbling its emptiness.  I drive to the home of the only nanny family I still keep in touch with, where I bask in the light of being loved and needed and welcomed and family, even while I miss my own family so much it hurts.  I drive the two hours home, shower in a flurry, drive to work and prop my eyelids open for the rest of the day, momentarily panicking when I remember I have a midterm on Monday, a test on Tuesday, an assignment due Wednesday, and a mountain of work before clinical next week.

But today I got to wake up to my two favorite girls and for now that is more than enough.

Birth

You know what's awesome about birth, babe?

What's that?

It's like...today was one of the biggest days of these two women's entire lives, because their babies were born, and - and - you get to be there for it.  And for me - all it is is Thursday.  But for them - it's a day that they'll never forget.  I can't believe I get to be there for all of those days for the rest of my life.

Well, I can't think of anyone better to be there for them than you.

I'm so lucky.  I just can't believe how lucky I am.

So are they, he tells me.  And I laugh because this can't possibly be my life.

And yet it is.

Welcome to the world, baby girls.  Today was an awesome day to be born.

The Blank Page

The second-year specialty midwifery students (me in two years) are officially done with "school" tomorrow - in the spring, they do an extended internship/job situation where they work as a midwife under a preceptor before graduating in May.  At a send-off dinner for them tonight, we sat around and listened to stories and memories of their last two and a half years here at Yale and I sat and thought two different things, overlapping in my head like two lines of melody in the same piece of music.  One was, "That's only two years away, and that will be you.  Holy shit."  The other was, "What makes you think that you will ever be up to the task of doing this thing, this sheltering and fostering and holding and catching and guiding of new life into this holy glorious fucked up world we are in?"

I don't know if I will ever stop grappling with that second question.  Truthfully, I don't think I ever should.  Because birth is a small thing, yes.  It is everywhere, it is billions upon literal billions of people.  It is over and over and over, the hormones and bones and muscles and breathing and work and sometimes it goes horribly wrong, but mostly it goes so right that it becomes just another whisper in the babble that never ends.  And sometimes, I can picture myself doing it.  I can see how it might look, and I can see students like those I saw tonight, who are doing it and have done it and look, Cait, yes it's a real thing and it will happen to you because you are here and that is why you are here.  But so much more often, and probably for years to come, what I feel more is the vast and gaping space between my fierce intention and my complete and full acceptance of the knowledge that this is just all so much bigger than me and bigger than I can catch and bigger and scarier than anything I could ever do.  And how on earth did I think that I could be that person, catching life and bringing it in?

Because birth is also huge.  It is everything.  It is the dark and terrifying tunnel, it is the orbit, and it is the way out.  It is endless hours, the single moment, it is the breaking down and the building back up.  It is sometimes the end, but it is so much more often the beginning of the very beginning.  The very first page.

There is something that I repeat to myself a lot, ever since starting this program.  One of those things is that, "Done is better than good."  This helps, sometimes a lot.  But another is this: The first and most important thing you need to do is show up.

You have to show up.  That's always the first step.  There are steps beyond that, and they might be hard, and you might never feel like you were ready until after you've done your first (or tenth) one.  But you have to be willing to show up.  You have to be willing to write the first page.

Looking for a new mascot, Yale?

March 1, 2012

Dear Caitlin:

On behalf of the Admissions Committee, I am pleased to inform you that your application to the 2012 Graduate Entry Pre-specialty in Nursing- Nurse Midwifery program has been accepted.  I want to offer my congratulations and invite you to join the vibrant Yale School of Nursing community.

Can't believe this is really happening.  Start to finish - I did this.  I did this.  Myself.  With no one else.  This is MY dream.  And I am making it come true.  Sometimes?  Dreams really do come true.  Because you make them come true.  Here's to my dream, coming true, right before my eyes.

Go Ahead. Interview Me.

Ask me anything you'd like.  Ask me why I'd like to be a midwife.  Ask me about how much I want to help women, to help babies, to be present and participate in the process of life beginning and you better believe it, Yale, I will answer.  I will answer articulately, and with poise, and with the knowledge that my black heels are a little bit bad-ass because they are pointy-toed (but it's okay because my gray and black dress is very demure [it helps that I have no cleavage. At all.]).  Ask me why I want to do this for the rest of my life.  Ask me how it felt to watch a baby being born.  Go ahead.  Ask me anything you'd like.  Because I'm ready.  And I'm coming at you, tomorrow morning.

Boo yah.

Procrastinate Now! Don't Put It Off!

In a highly uncharacteristic moment of procrastination the other day (Ha. Haha. HAHAHA.), I was reading a novel instead of studying from my GRE test prep book.  Not to get all dramatic and stuff, but that seemingly not-very-significant moment may have altered my entire future:
The book is called Delivery and it's about (what else?) a midwife.
The main character mentions, in passing, the Yale school of midwifery.
I ambled online and began to peruse the Yale School of Nursing's website.
I clicked on the Admissions tab and saw these three magical little words: no prerequisites required
.
Let me stop and explain.  As I've mentioned, when I was at Smith, I thought I wanted to go on to medical school.  Thus, I took all the prerequisites necessary to get into medical school.  These occupied all four years of my education there, demanded more brain cells than I've ever collectively possessed, and drove me to tears about once a day.  I also took the entrance exam for med school, the MCAT, which required eight months of studying, a Kaplan prep course, and again, more brain cells than I can ever hope to regain.  What Smith did not offer (nor was I interested in at the time), were the courses required for admission into nursing school.  Yes, the two sets of requirements are different.  So, around about the time I started backpedaling furiously on the pathway to medical school and started sneaking peeks over the fence into the land of nursing school and midwifery, I came crashing unceremoniously into the fact that I'd have to go back to school and take four to five more college courses before I could even apply to nursing school.  This was a real blow.  Months went by before I came to begrudgingly accept that it was just a reality I was going to have to swallow and that I'd still wind up happier in the long run.  I hadn't yet advanced to the "how will I pay for these classes/when will I take them/where will I take them" stage, except to acknowledge such questions' existence and then promptly look in the other direction and start whistling.  Loudly.

But there those three words were.  No. Prerequisites. Required.
I read faster.
The program is ranked seventh in the nation.
I'd be a midwife - a real, honest-to-goodness midwife - in three years.
The application deadline is November 1st.
And then, I came to a screeching halt.  I needed to find out if they would accept my October 6th GRE scores, even though the scores might not be released before November 1st.  I hung in suspended animation as the phone rang and a nice woman picked up.  Oh yes, she told me.  They're accepting scores well past the deadline this year since the GRE has an altered format and score release schedule.
Boom.
I thanked her, and hung up the phone with shaking hands.
Today is September 1st.
I'm taking the GRE on October 6th.
My application to the Yale School of Nursing is due on November 1st.


Excuse me while I go jump up and down and squeal at decibels only Rupert can hear (poor guy).

Trusting Your Insticts

I have a new little one in my life to love.  An 8-week-old, eleven pound, pink clad little munchkin who has already melted my heart into oogey gooey I-want-a-baby-NOW-ness.  Starting yesterday, I get to spend Wednesdays hangin' with this chickadee while her mom does stuff around the apartment, goes to the gym, and participates in adult activities like conversation.  Speaking of which, she and I had a great one yesterday...

J., the mom, is quite possibly the sweetest woman I've ever met.  Case in point - she gave me a hug and called me gorgeous when I walked in the door (we'd met once before).  We also spent all day together yesterday and truly enjoyed each other's company.  In the land of mother-nanny relationships, this is huge.  We talked, we got coffee, we oohed and ahhed over her daughter and she asked me a million questions about baby-raising that I tried to field as best as I could.  It turns out that she and her husband had hired a baby nurse to come in after the little one arrived and the nurse has only left within the last week, leaving J. feeling a little scattered.  (Yes, this is New York City.  Yes, "normal" people get baby nurses that live with them full-time and charge exorbitant amounts of money to, in this case, wreak havoc.)  Now, to be fair, I think that a baby nurse can have a lot to teach first-time parents and if that's how people want to spend their money then it's no skin off my nose.  What does get my panties in a knot is when baby nurses make sweet, capable, loving women like J. feel like she's a horrible mother and that none of her instincts are correct.  Which is exactly what happened.  Apparently, the nurse went so far as to follow J. around, correcting her every move and telling her in no uncertain terms that she was going to "ruin" her daughter by "spoiling her so young."  Grrr....

Your daughter is eight weeks old.  She needs you.  Being needed and responding to your child's needs is called parenting, not spoiling.

I said as much to J. when we were discussing whether or not to go get her little girl when she's woken up from her nap.  The first time, J. asked me to wait to get her, and so we both waited for two or three agonizing minutes while the little peanut worked herself into a screaming, squalling, inconsolable mess.  J. was also a mess - her milk had let down, she was flushed and anxious, and when she finally let herself pick up her daughter she was practically in tears of her own.  I kept quiet, knowing it wasn't my business to interfere.  Later that day though, J. came back from the gym looking refreshed and bright-eyed and she told me that she thinks she'd like to forget what the baby nurse said and get the little one as soon as she wakes.  I applauded her.  I told her that was fine, that was great, that's what feels right for her and she should be proud of herself.  I told her she was a rock star mom and that there's a school of thought that responding right away to your infant's needs helps them learn to trust you and know that you are there, responding to them when they need you.  It sets up a foundation for teaching them patience later, when they're emotionally and psychologically ready to be told to hang on a minute while you put the dishes away.  I told her gently that I'm sure there were some awesome things she learned from the nurse, but that hey, the nurse is gone.  Your daughter is here to stay - with you, her mom.  And doing what feels right, trusting your instincts, all of that will help create the loving, safe, consistent atmosphere that her daughter needs to thrive.

Her relief was visible.  She smiled at me over her daughter's downy head.  "Do you really think so?" she asked me.  Yes, absolutely.  You've got this, I told her smiling.  You've so got this.

This is what I want to do with my life - helping women believe in themselves, helping them to know that they are strong, they are capable, they are rock stars in their bodies and in their ability to give birth, to parent, and to love.  No one, I don't care how young or old or inexperienced or scared they are, should be made to feel like they aren't capable of being a good parent.  And if I can help women learn to trust their instincts, to trust their bodies and their hearts and minds for this awesome, amazing, terrifying journey called motherhood, then hot damn, I can't wait to be a midwife.