My husband says I'll be able to go to school in 2012. I know that's a ways a way but it's a date. An actual time has been set when I can get on with my formal schooling. (Although I'll be gaining a new certification in the Fall....the doula grant has been approved so I'll be getting some training in that)
And I've decided. I'll be going to nursing school. Don't know yet if I'll start at the tech school with my LPN (liscensed practical nurse) or if I'll go directly back to college for my BSN(bachelor of science in nursing). My longterm goal is to become a CNM(certified nurse-midwife). I just don't know which route is going to be the best.
At first I wasn't sure if I wanted to become a CPM(certified professional midwife) or a CNM but I decided I really do want to go for the CNM. I figure even though not many CNM's attend homebirth being a CNM isn't a big a barrier to attending homebirth as being a CPM is to attending hospital birth. And let's face it most births in this country take place in the hospital.
It was actually this post from Public Health Doula that helped me decide.
In the post she's talking about the pros and cons of getting a masters in public health as opposed to well anyhting else. ANd she talks about the thought process involved.
As I reflected I realized I will have more opportunity to be "with woman" WHEREVER SHE CHOOSES TO BIRTH as a CNM.
Iwould love to hear from anyone else on the journey though and hear your thought process....
6.16.2010
6.14.2010
australia, male hormonal contraception, oxytocin
I came across this blog all about the situation in Australia. While some of the posts are specific to the situation there some are applicable to midwifery everywhere. Hope ya'll enjoy!
Birth control may soon be shared more equally between men and women. This article from USA Today details research efforts underway to develop hormonal contraception for men. Researchers are most interested in investigating testosterone as a sperm production blocker though some studies have involved progestin. Likely routes of delivery include injections or topical gels. But Dr. John Armory an associate professor of medecine at The University of Washington says "Everybody's been saying 'in the next 5 years' for the past 30 years."
New research on everybody's favorite hormone, oxytocin. This article from The Telegraph discussesnew findings regarding the effects of oxytocin on soldiers in battle. According to the article "The results indicated that oxytocin drives a “tend and defend” response, promoting in-group trust and co-operation and defensive, but not offensive, aggression toward competing out-groups."
Birth control may soon be shared more equally between men and women. This article from USA Today details research efforts underway to develop hormonal contraception for men. Researchers are most interested in investigating testosterone as a sperm production blocker though some studies have involved progestin. Likely routes of delivery include injections or topical gels. But Dr. John Armory an associate professor of medecine at The University of Washington says "Everybody's been saying 'in the next 5 years' for the past 30 years."
New research on everybody's favorite hormone, oxytocin. This article from The Telegraph discussesnew findings regarding the effects of oxytocin on soldiers in battle. According to the article "The results indicated that oxytocin drives a “tend and defend” response, promoting in-group trust and co-operation and defensive, but not offensive, aggression toward competing out-groups."
6.13.2010
ella
From the Washington Post Next week the FDA convenes to consider the approval of a new emergency contaceptive. Ella (ulipristal acetate) works for up to 5 days after contraceptive failure or unprotected sex. It is already available in at least 22 countries. The usual suspect are trotting out the same arguments, against the new pill that were used against Plan B . Because of a chemical similarity they are also linking the new contraceptive to the abortion pill RU-486 (Mifeprex)
6.09.2010
biting my tongue: when is it appropriate?
When to share our knowledge and when to bite our tongues: I think this is something many of us involved in birth or breastfeeding issues struggle with. I had one of those opportunities at work yesterday. (FYI my paid employment doesn't really have anything to do with birth)
Actually 2 different birth related scenarios played out. The 1st was one of the times I think its usually best to refrain from sharing. A customer came in and was talking about her elective repeat cesarean, scheduled for tommorrow. No need to share VBAC knowledge there. Her mind was already made up. Besides, she wasn't even talking to me. (You fellow birth advocates know how you can hear the words "cesarean", "VBAC", "induction" and the like from way across the room :lol)
At least no need for me to share with her. Talking later with my co-workers I was able to say that VBAC is a reasonable option for most women. Not alot of sharing because, well, nobody asked for further info.
Which is a part of deciding what if anything to say in those kinds of situations. How much interest is there? How much chance is there that anything you say will make any difference? Not that the reasons to discuss birth solely involve changing people's minds. Because quite frankly theres very little mind changing going on in a casual discussion at work. Informing women of their options might happen though if you watch what you say.
Later at work as I mentioned that birth is my thing. A co-worker shared her family history of cesarean. As much as I wanted to go on a spiel about pelvic adequacy and the rarity of cephalopelvic disproportion. I didn't. Why didn't I speak up that time and why did my silence nag at me so I felt compelled to post on the topic?
Well for one I don't like to contradict people. I couldn't figure out how to share information w/o contradicting. Maybe I could have said something about the capacity for even a small pelvis to expand?
btw here is a great link to an article from the great Gloria Lemay about pelvis's (pelvi? :lol how about pelvic variety?) http://www.midwiferytoday.com/articles/pelvis.asp
Actually 2 different birth related scenarios played out. The 1st was one of the times I think its usually best to refrain from sharing. A customer came in and was talking about her elective repeat cesarean, scheduled for tommorrow. No need to share VBAC knowledge there. Her mind was already made up. Besides, she wasn't even talking to me. (You fellow birth advocates know how you can hear the words "cesarean", "VBAC", "induction" and the like from way across the room :lol)
At least no need for me to share with her. Talking later with my co-workers I was able to say that VBAC is a reasonable option for most women. Not alot of sharing because, well, nobody asked for further info.
Which is a part of deciding what if anything to say in those kinds of situations. How much interest is there? How much chance is there that anything you say will make any difference? Not that the reasons to discuss birth solely involve changing people's minds. Because quite frankly theres very little mind changing going on in a casual discussion at work. Informing women of their options might happen though if you watch what you say.
Later at work as I mentioned that birth is my thing. A co-worker shared her family history of cesarean. As much as I wanted to go on a spiel about pelvic adequacy and the rarity of cephalopelvic disproportion. I didn't. Why didn't I speak up that time and why did my silence nag at me so I felt compelled to post on the topic?
Well for one I don't like to contradict people. I couldn't figure out how to share information w/o contradicting. Maybe I could have said something about the capacity for even a small pelvis to expand?
btw here is a great link to an article from the great Gloria Lemay about pelvis's (pelvi? :lol how about pelvic variety?) http://www.midwiferytoday.com/articles/pelvis.asp
homebirth in australia: legal but not supported
Homebirth has been a contentious issue in Australia for a long time. A big country with vast stretches of sparsely populated area, the homebirth debate is perhaps less philosophical and more practicle than it is in more densely urban countries. And the woman and babies who face long travel times if they are forced into hospital births are caught in the middle.
The Minister of Health recently required professional midwives to carry indemnity insurance. They are being required to pay a minimum of $5000 for hospital services. Indemnity insurance for homebirth services is not available at this time. http://bit.ly/9JH0gv The Health Minister released a statement praising the new insurance requirements and detailing the benefits for mothers and babies. http://bit.ly/cc2n0l
Homebirth is still an option a woman may legally choose for herself and her baby. However there is the concern that midwives will be forced to pass on the cost of the new insurance to home and hospital birthers alike. Despite loft ideals, for many women place of birth is choice often defined at least in part by cost considerations.
Even women who have read the research on homebirth option and determined that it is a safe choice for their situation (as it is for most mother/baby dyads) must balance that knowledge with their financial particulars.
Additionally it is being reported that some homebirth mothers are being denied medical care when they do seek a physicians consult. http://bit.ly/9t1jEc
The Minister of Health recently required professional midwives to carry indemnity insurance. They are being required to pay a minimum of $5000 for hospital services. Indemnity insurance for homebirth services is not available at this time. http://bit.ly/9JH0gv The Health Minister released a statement praising the new insurance requirements and detailing the benefits for mothers and babies. http://bit.ly/cc2n0l
Homebirth is still an option a woman may legally choose for herself and her baby. However there is the concern that midwives will be forced to pass on the cost of the new insurance to home and hospital birthers alike. Despite loft ideals, for many women place of birth is choice often defined at least in part by cost considerations.
Even women who have read the research on homebirth option and determined that it is a safe choice for their situation (as it is for most mother/baby dyads) must balance that knowledge with their financial particulars.
Additionally it is being reported that some homebirth mothers are being denied medical care when they do seek a physicians consult. http://bit.ly/9t1jEc
6.04.2010
thoughts on contraception
I've been thinking about various issues surrounding contraception lately.
I've had some fatigue and lightheadedness lately which has one of my bosses convinced I'm preggers again.... thankfully my chart says "no!" http://www.tcoyf.com/charts/pdf/bc_fahr.pdf
I use over-the-counter birth control. Depending on where I am in my cycle we use either film http://www.vcf-contraceptive.com/whatisvcf.html or condoms. For the past 2 years we've use flexible spending to pay for it. But my flex spending just changed the rules about otc items being eligible. So I've been thinking about if I want to change methods. (decided we're actually pretty happy with what we're using. gonna see if I can get an rx for it. it'll be covered with an rx)
I recently read this article http://bit.ly/aWDABa in The Nation regarding contraceptive sabatoge (thanks momstinfoilhat http://momstinfoilhat.wordpress.com/2010/05/28/accepting-responsibility/ for alerting me to this btw)
And then today this article shows up on my google alerts http://www.rhrealitycheck.org/node/13599 As part of the Patient Protection and Affordable Care Act enacted in March "preventative care and screenings for women" will be required to be covered by insurance. This will go into effect 6 months from March 23, 2010. So sometime before September 23 it must be determined exactly what services will be covered under that umbrella.
In light of goals set by the Department of Health and Human Services (Healthy People 2020 http://www.healthypeople.gov/hp2020/Objectives/TopicArea.aspx?id=32&TopicArea=Maternal%2c+Infant+and+Child+Health and http://www.healthypeople.gov/hp2020/Objectives/TopicArea.aspx?id=21&TopicArea=Family+Planning family planning, including contraceptive services, as part of preventive care makes sense. Even though unintended pregnancy is not a disease state, its prevention has important health considerations for both mother and child. Women are fertile from the age of roughly 13-50. Tha's almost 40 years. We spend most of that time actively avoiding pregnancy. So some kind of contraception is going to be necessary for most women for a large portion of their lives.
I've had some fatigue and lightheadedness lately which has one of my bosses convinced I'm preggers again.... thankfully my chart says "no!" http://www.tcoyf.com/charts/pdf/bc_fahr.pdf
I use over-the-counter birth control. Depending on where I am in my cycle we use either film http://www.vcf-contraceptive.com/whatisvcf.html or condoms. For the past 2 years we've use flexible spending to pay for it. But my flex spending just changed the rules about otc items being eligible. So I've been thinking about if I want to change methods. (decided we're actually pretty happy with what we're using. gonna see if I can get an rx for it. it'll be covered with an rx)
I recently read this article http://bit.ly/aWDABa in The Nation regarding contraceptive sabatoge (thanks momstinfoilhat http://momstinfoilhat.wordpress.com/2010/05/28/accepting-responsibility/ for alerting me to this btw)
And then today this article shows up on my google alerts http://www.rhrealitycheck.org/node/13599 As part of the Patient Protection and Affordable Care Act enacted in March "preventative care and screenings for women" will be required to be covered by insurance. This will go into effect 6 months from March 23, 2010. So sometime before September 23 it must be determined exactly what services will be covered under that umbrella.
In light of goals set by the Department of Health and Human Services (Healthy People 2020 http://www.healthypeople.gov/hp2020/Objectives/TopicArea.aspx?id=32&TopicArea=Maternal%2c+Infant+and+Child+Health and http://www.healthypeople.gov/hp2020/Objectives/TopicArea.aspx?id=21&TopicArea=Family+Planning family planning, including contraceptive services, as part of preventive care makes sense. Even though unintended pregnancy is not a disease state, its prevention has important health considerations for both mother and child. Women are fertile from the age of roughly 13-50. Tha's almost 40 years. We spend most of that time actively avoiding pregnancy. So some kind of contraception is going to be necessary for most women for a large portion of their lives.
5.21.2010
what is a partogram?
Thanks to moms tinfoil hat http://momstinfoilhat.wordpress.com/I found this great piece of research http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937808007758.pdf
The authors take a look at a large number of common interventions during labor and delivery and determine if they are supported by evidence or not.
One of the things they looked was using a partogram. Now this is a term I had never heard before. Naturally I had to google it. I don't know if this is the best page to define the term http://staff.um.edu.mt/csav1/lectures/partogram.pdf but it sure has a lot of charts. As best as i understand a partogram is basically a chart with an "action line" and anything that falls into the range of the "action line" requires some kind of action. Something like the Friedman's Curve.
Barbara over at NavalGazingMidwife http://navelgazingmidwife.squarespace.com/ kindly posted this link to an article that gives a good explaination of that http://emedicine.medscape.com/article/273053-overview
Something I'm going to have to learn more about for sure.
If you're interested they concled that the evidence is insufficient to recommend routine use of the partogram.
The authors take a look at a large number of common interventions during labor and delivery and determine if they are supported by evidence or not.
One of the things they looked was using a partogram. Now this is a term I had never heard before. Naturally I had to google it. I don't know if this is the best page to define the term http://staff.um.edu.mt/csav1/lectures/partogram.pdf but it sure has a lot of charts. As best as i understand a partogram is basically a chart with an "action line" and anything that falls into the range of the "action line" requires some kind of action. Something like the Friedman's Curve.
Barbara over at NavalGazingMidwife http://navelgazingmidwife.squarespace.com/ kindly posted this link to an article that gives a good explaination of that http://emedicine.medscape.com/article/273053-overview
Something I'm going to have to learn more about for sure.
If you're interested they concled that the evidence is insufficient to recommend routine use of the partogram.
5.13.2010
International Doula Month
Happy International Doula Month
With all the excitement over international day of the midwife I'm a bit late celebrating the doulas. But now that I'm on it:
Just in case you aren't familiar with the word "DOULA", from the homepage of DONA International
Did you know the benefits of having a doula present at birth is proven by research?
DONA (doulas of north america) goes over the research here http://www.dona.org/resources/research.php and sage birth gives a neat little summary of some of the specific figures here http://sagebirth.com/Doulabenefits.htm
and here are more links:
from the american pregnancy association http://www.americanpregnancy.org/labornbirth/havingadoula.html
from midwife ronnie falcos archives http://www.gentlebirth.org/archives/doulnots.html
from one of my doula friends on facebook
http://dou-la-la.blogspot.com/
I'm really excited to be reminded of Doula Month. I'm still hoping to do some training in that area as soon as the grant money comes through.
With all the excitement over international day of the midwife I'm a bit late celebrating the doulas. But now that I'm on it:
Just in case you aren't familiar with the word "DOULA", from the homepage of DONA International
The word "doula" comes from the ancient Greek meaning "a woman who serves" and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.
Did you know the benefits of having a doula present at birth is proven by research?
DONA (doulas of north america) goes over the research here http://www.dona.org/resources/research.php and sage birth gives a neat little summary of some of the specific figures here http://sagebirth.com/Doulabenefits.htm
and here are more links:
from the american pregnancy association http://www.americanpregnancy.org/labornbirth/havingadoula.html
from midwife ronnie falcos archives http://www.gentlebirth.org/archives/doulnots.html
from one of my doula friends on facebook
http://dou-la-la.blogspot.com/
I'm really excited to be reminded of Doula Month. I'm still hoping to do some training in that area as soon as the grant money comes through.
trying to start good habits
Once again I am cleaning my in-box of old e-mails. This has been a huge problem for me so I'm posting even though this isn't especially birthy.
I changed my settings on face book so i don't get a new e-mail everytime anybody sneezes ( :lol)
I unsubscribed to a few newsletters i'm not really interested in anymore.
Hopefully these small steps will help keep it from getting to the point its at now ever again.
Also while going through whats left. i'm doing by the page. I just click "select all" then QUICKLY skim the titles/senders. Very little is making the cut to even be read. Much of what I bother to read can be deleted. And that which I really want to keep I'm labeling into folders so I can find it later.
BABY STEPS BABY STEPS.....
(although i admit i just did a huge step tonight. i have halved my inbox. down from 4000+)
I changed my settings on face book so i don't get a new e-mail everytime anybody sneezes ( :lol)
I unsubscribed to a few newsletters i'm not really interested in anymore.
Hopefully these small steps will help keep it from getting to the point its at now ever again.
Also while going through whats left. i'm doing by the page. I just click "select all" then QUICKLY skim the titles/senders. Very little is making the cut to even be read. Much of what I bother to read can be deleted. And that which I really want to keep I'm labeling into folders so I can find it later.
BABY STEPS BABY STEPS.....
(although i admit i just did a huge step tonight. i have halved my inbox. down from 4000+)
5.09.2010
thoughts on international day of the midwife 2010
This past Wednesday we celebrated International Day of The Midwife 2010. http://internationaldayofthemidwife.wikispaces.com/International+Day+of+the+Midwife+2010
I took the day off work so as to attend as many online discussions/presentations as possible. As an aspiring midwife it was a tremendous opportunity to hear perspectives from midwives who've been at it far longer than I.
I caught a discussion regarding midwives perceptions of working in a birth center. While it wasn't terribly relevant to me now it did reinforce my notion that the hospital birth culture is not currently woman center-ed.
I'm not sure how I feel about having that notion reinforced though. I do feel that midwives are needed as much or more for hospital birth as for home birth. I feel strongly that every woman deserves midwifery model care http://cfmidwifery.org/mmoc/define.aspx
I can't see how I can take the many years of schooling required to become a CNM (certified nurse-midwife) just to be able to attend hospital births, though. Taking the direct entry route to midwifery and then providing out of hospital birth AND in hospital doula services, childbirth education or other non-medical forms of support for women who prefer to birth in a hospital would allow me to work towards changing hospital birth culture. But it would be quicker and a lot less expensive. I also think i could work "with woman" as a labour and delivery nurse.
So who knows what i'll end up doing?
After that i watched a presentation entitled "Cesarean Delivery on Maternal Request" http://www.slideshare.net/VirtualIDM/cesarean-delivery-on-maternal-request while I listened to The Feminist Breeder's http://thefeministbreeder.com/ podcast interview w/ Amy Romano, Mary Murray and Amie Newman and simultaneously joined the twitterfest @ #idm2010. The feminist breeder's show was dedicated to midwives online presence and tied in nicely to the next presentation "Online Presence for Midwives".
Next up was a session from Gloria Lemay on "Nutrition for Two". Iloved simply Gloria presented the task of eating healthfully. In fact I'm trying to incorporate some of her suggestions into my own eating even though i'm not pregnant.
The presentation on "Fetal Monitoring for Low-Risk Women" went a little over my head at some points but was fascinating nonetheless. I think the important thing I took away was how inportant it is for midwives to learn "high touch/low tech" means of monitoring the mama-baby dyad. These skills are being lost and its up to midwives not to let that happen. If skills like ascultation, palpation, and simple observation are lost what will happen to women when the power goes out? or women who have unplanned out of hospital births?
The drop in sessions for student midwives was a bust but i did enjoy the story telling that took place in its stead.
One session that I missed that I really wanted to participate in was the one about midwifery in South Carolina. That's so close to my location!
Even though these session were mostly targeted towards midwives I came out feeling highly motivationed to get back out in the birth related relms of the internet. (Look, ma! I'm Blogging again!) I'm not a midwife yet but that doesn't mean I don't have a voice to contribute. I have a desire to share what I know and to learn MORE MORE MORE.... and then pass that on.
Additionally I feel motivated to take a few baby steps towards midwifery . I've earned one credential that relates to my midwfery aspirations. Last year I earned my CLC (certified lactation counselor) which I see being really beneficial in postpartum doula work and in childbirth education. Next on my list is to earn my CPR certification and my NRP certification. Beyond that I plan to take advantage of some local networking opportunities. I'm involved in a local Healthy Start group http://www.heartofgeorgiahealthystart.org/ http://www.healthystartassoc.org/ so I want to become more active in that group and make inroads into other groups as well.
I took the day off work so as to attend as many online discussions/presentations as possible. As an aspiring midwife it was a tremendous opportunity to hear perspectives from midwives who've been at it far longer than I.
I caught a discussion regarding midwives perceptions of working in a birth center. While it wasn't terribly relevant to me now it did reinforce my notion that the hospital birth culture is not currently woman center-ed.
I'm not sure how I feel about having that notion reinforced though. I do feel that midwives are needed as much or more for hospital birth as for home birth. I feel strongly that every woman deserves midwifery model care http://cfmidwifery.org/mmoc/define.aspx
The Midwives Model of Care is
based on the fact that pregnancy and birth are normal life processes.
The Midwives Model of Care includes:
Monitoring the physical, psychological, and social well-being of the
mother throughout the childbearing cycle
Providing the mother with individualized education, counseling, and
prenatal care, continuous hands-on assistance during labor and delivery, and
postpartum support
Minimizing technological interventions
Identifying and referring women who require obstetrical attention
The application of this woman-centered model of care has been proven to
reduce the incidence of birth injury, trauma, and cesarean section.
Copyright (c) 1996-2008, Midwifery Task Force, Inc., All Rights
Reserved
I can't see how I can take the many years of schooling required to become a CNM (certified nurse-midwife) just to be able to attend hospital births, though. Taking the direct entry route to midwifery and then providing out of hospital birth AND in hospital doula services, childbirth education or other non-medical forms of support for women who prefer to birth in a hospital would allow me to work towards changing hospital birth culture. But it would be quicker and a lot less expensive. I also think i could work "with woman" as a labour and delivery nurse.
So who knows what i'll end up doing?
After that i watched a presentation entitled "Cesarean Delivery on Maternal Request" http://www.slideshare.net/VirtualIDM/cesarean-delivery-on-maternal-request while I listened to The Feminist Breeder's http://thefeministbreeder.com/ podcast interview w/ Amy Romano, Mary Murray and Amie Newman and simultaneously joined the twitterfest @ #idm2010. The feminist breeder's show was dedicated to midwives online presence and tied in nicely to the next presentation "Online Presence for Midwives".
Next up was a session from Gloria Lemay on "Nutrition for Two". Iloved simply Gloria presented the task of eating healthfully. In fact I'm trying to incorporate some of her suggestions into my own eating even though i'm not pregnant.
The presentation on "Fetal Monitoring for Low-Risk Women" went a little over my head at some points but was fascinating nonetheless. I think the important thing I took away was how inportant it is for midwives to learn "high touch/low tech" means of monitoring the mama-baby dyad. These skills are being lost and its up to midwives not to let that happen. If skills like ascultation, palpation, and simple observation are lost what will happen to women when the power goes out? or women who have unplanned out of hospital births?
The drop in sessions for student midwives was a bust but i did enjoy the story telling that took place in its stead.
One session that I missed that I really wanted to participate in was the one about midwifery in South Carolina. That's so close to my location!
Even though these session were mostly targeted towards midwives I came out feeling highly motivationed to get back out in the birth related relms of the internet. (Look, ma! I'm Blogging again!) I'm not a midwife yet but that doesn't mean I don't have a voice to contribute. I have a desire to share what I know and to learn MORE MORE MORE.... and then pass that on.
Additionally I feel motivated to take a few baby steps towards midwifery . I've earned one credential that relates to my midwfery aspirations. Last year I earned my CLC (certified lactation counselor) which I see being really beneficial in postpartum doula work and in childbirth education. Next on my list is to earn my CPR certification and my NRP certification. Beyond that I plan to take advantage of some local networking opportunities. I'm involved in a local Healthy Start group http://www.heartofgeorgiahealthystart.org/ http://www.healthystartassoc.org/ so I want to become more active in that group and make inroads into other groups as well.
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