how a baby is born

if you're reading this, you probably have noticed that I have not written a blog post in over a month and a half. if you know me, you know that that means I probably have a whooole lot to write about. where to begin?

Well, to start, I just completed my month as the intern running the labor and delivery floor. I use "running" loosely, as I'm definitely and positively the intern. I also use "labor and delivery floor" as often it felt more like a cardiac floor or an Emergency Room or a psychiatric ward or a nephrology consulting office.

Oh yes, there were also beautiful normal vaginal deliveries.

One woman had been working for approximately 9 months on her "delivery playlist" which was just amazing - so much Alicia Keys.

One new dad kept saying to me "Can you believe it? Can you really believe it? We are parents!" about a million times with this huge grin on his face like he had just won the world's biggest prize without very much work at all (which, in some ways, is exactly what happened, right?).

One woman delivered her baby and then literally moments later was up walking in the hall with her three year old, saying hello to all the nurses.

One woman delivered beautifully in a squatting position and told me that she thought her delivery was smooth because she had been swimming throughout her pregnancy; in fact, she had been swimming comfortably only hours before her contractions started.

But there were a lot of stat cesarean sections, a lot of baby's born early and requiring more support from the pediatricians than anyone wants their baby to need. There were a lot of sky-high blood pressures that scared us about seizures. There were placentas that broke off the wall of the uterus and threatened to deprive the baby of oxygen and have the mother bleed to death. There were babies that were so big that even making a large incision, delivering them took a lot of strength and pressure.

But birth is amazing.

And the things that we can do - that I can do - to help make it safer and better, are amazing.

Despite having been on for about 6 weeks straight (yes, weekends and all),
there's nothing like looking into the eyes of the world's newest human being and getting to be the first one to say,

"hey baby, welcome to the world; we are so happy to have you here"


more soon.

spring cleaning 2013!

Home wasn't a set house, or a single town on a map. It was wherever the people who loved you were, whenever you were together. Not a place, but a moment, and then another, building on each other like bricks to create a solid shelter that you take with you for your entire life, wherever you may go.” 

― Sarah Dessen, What Happened to Goodbye

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yesterday at approximately 1:30 am we returned to our lovely home in Vermont!  While we did immediately drive down to Stowe to meet friends at the end of their long weekend bash in an incredible house down there, we have since had time to revel at home.  With only a few short weeks left in this place that's been my home for four years, with people who have been my home for four years, and with thoughts about designing my next home (stay tuned for more on that soon) I've been thinking about ways to REALLY immerse myself in feeling home - leading me to the question:

what makes you feel home?

(seriously, tell me!)
for me, it's FULLY unpacking and settling things back into their places - it's planning impromptu runs and walks with friends - it's lacing up my running shoes and just going, not having to plan out a route because this is my home - it's making my own coffee just how I like it, instead of hoping I can ask the barista at the closest coffee shop for just the right amount of soy milk without sounding obnoxious - it's curling up with the manfriend in our most comfortable bed and feeling like we are back in our places too.

unpacking and changing to a spring/summer closet!  yay dresses!!

morning coffee ritual at home

 all our shoes are ready for any kind of spring weather in our mud room

(note the bean boots, running shoes and birkenstocks - one can never be too prepared)

plans for the next few weeks in Vermont include:

* hiking the presidential traverse
* canoeing in lake champlain
* visiting the kitchen table restaurant (on our list for a long time along with all the farm animal restaurants including: the black sheep, hen of the wood, the belted cow, the prohibition pig, the bearded frog, the starry night cafe, the bluebird tavern, and of course, to keep them all in one place, the farmhouse) 
* walking/running in Shelbourne farms
*the burlington farmers market (now outside!)
*hike camel's hump for the last time in a while
* get creamies with buddies from Burlington Bay Cafe
*play paintball in our white coats
* boat cruise on lake champlain
* pack up our whole house!

believing the whole concept

Back to Sarah* (*obviously not her real name) and our counseling session.  Sarah started the session by listing quickly - before we could even ask her any questions - all the reasons why terminating her pregnancy was the right thing.  Reasons that she - and many other woman- have cited included that her "life is a mess" and she could not responsibly bring a new life into it.  Sarah* was living with an on again/off again boyfriend who she loved, but struggled with uncontrolled and unpredictable bipolar disorder.  The two of them had been living in a van under a bridge for the past several months.  They were both having a hard time finding work.  Neither one of them had any support from or connection to family in the area, nor did they have any other resources to draw on.

She went on for several minutes listing these reasons and more.  We listened.  Then she stopped and paused, looking at us to see if we had anything to say, almost looking for our agreement with her reasoning.  But the very wise and experienced counselor said nothing, just waited.  I wasn't sure what to do, so I said nothing, and waited.  Then Sarah* said, "but the truth is, I want to be a mother more than anything else in the whole world.  Even though it doesn't make sense.  Even though it's not responsible.".

And that's when the counseling began, as the counselor started asking questions to help Sarah* work out what she thought and felt.  To help her see her situation in the truest light - without judgement, but without rose colored glasses either.

Sarah* said that she was concerned that if she terminated her pregnancy, that in several months - when the baby that would have been actually would have been - what if her life was better?  What if it was now responsible for her to bring a new life into it? What if she and her boyfriend had figured out jobs, had found an apartment, had organized their lives - would she then feel incredibly guilty and regretful that she had ended the pregnancy?

The wise counselor listened and finally said, "You know, Sarah*, no matter what you decide to do in this situation, your life will be different in several months.  And if you decide to end the pregnancy and your life is better in several months, how will you know that this decision didn't help you to make your life better? And if you decide not to end the pregnancy and your life is better in several months, how will you know that this decision didn't help you make your life better?  We just have no way of knowing how our lives would have turned out if we made other decisions, but I can tell you that this decision you are making now will absolutely affect your life over the next few months - because it will be very different if you are pregnant and expecting a baby than if you are not.  Only you can make this decision, but once you have made it, don't judge yourself for it, or think of all the other possibilities that could have been - because it will be different."

Later, after Sarah* left, without terminating her pregnancy, to think more about her decision, the wise counselor and I debriefed.  We talked about how even though her reasons for why she should not be a mother right now make logical sense to us - that if we really believe in a woman's right to choose, a woman's right to make decisions about her own body, then we cannot judge her decision, we cannot think to ourselves that she should make one decision over the other.  Our role is to help her make the best decision for her, in a non-judging, non-assuming way.

It's definitely hard, but feels incredibly important.

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"A woman's life can really be a succession of lives, each revolving around some emotionally compelling situation or challenge, and each marked off by some intense experience"

-Wallis Simpson, Duchess of Windsor (1896-1986)

night float

so I started my month of night float on labor and delivery two weeks ago (or was it three?  the days sort of blur together when you leave work, sleep for a few hours and come back to work and it's the same day)  you'd think wishing so many new people their first birthday I'd at least know what day it is, but usually I don't.

what is night float?, you may ask -
well I go in around 5:30 pm, change and get ready for sign-out at 6pm, take over patients from the residents who have been there during the day and then manage all patients who are already on the floor or who come in laboring over night, then I sign out around 7am the next morning back over to the day team.  Usually this is followed by a lecture or a didactic session until about 8:30 or 9, after which I bike home, shower, maybe eat something, and crawl into bed to sleep for a few hours before heading back in later that night.

it's a total shock to the system, to say the least, but it's also pretty amazing.  babies are definitely meant to be born at night.  if you take an evolution view, if you're going to be in a state where you are pretty unaware of your surroundings and spending all your energy on something that leaves you pretty defenseless - best to do it when it's easier to hide and there's less going on in the forest.

it's been an amazing few weeks of actually getting to deliver babies, managing women in labor - and learning what's normal and what's not, how to follow the heart tracing of a baby about to be born, how to check the cervix as it gets ready to open and let a baby out, and getting the honor of supporting women in some pretty vulnerable - but also incredibly powerful moments, it's truly awe inspiring and even though I'm exhausted, I don't know if there's anything cooler or more exciting than helping a new life come into being.

some tips I have for anyone working nights (this is also so when I'm a resident on months of night float I can look back and remember what I did to make it through):

1. first thing you do when you get home is shower.  I don't care how tired you are, [other people's] amniotic fluid should not be on your sheets.
2. bring lots of healthy snacks - especially water-heavy snacks (fruits, veggies, just plain old water)
3. when you wake up (or if you feel alert before heading to sleep): work out.  even if it's short, ugly, traumatic - there's not a day when it will feel good so if you start using that as your measure if you should go work out, it'll never happen.
4. make your off days count - get in a good run, go on a good date, take some lazy slow moments
5. have easy to prepare delicious food at the ready - it's good to still try to eat meals, even if you don't know what meal you're eating (otherwise you're just snacking, literally 24 hours).
6. make sure everyone around you knows that you're on nights, and that they should lower their expectations of you temporarily as a friend, partner, roommate, daughter, etc.
7. drink coffee when you wake up.  not too much, not to often, but just enough. (stop at palpitations)

that's all for now.  gotta grab some healthy snacks and head out for another night of birth!

Markings of Birth

I'm in rural Vermont without internet for a few weeks, but I dipped back into town long enough for a little skiing, a little time with friends, and to post this video, courtesy of my friend Arielle about the beautiful changes of a woman's body** that happen after pregnancy.  And how even though abdomen's may not be flat anymore (though they can be), they have scars that tell such a story.  

(**don't worry, it's only photos of abdomens - no other body parts!!)

If you're interested in reading about it, check out the website here!

Stereotypes and Tents

A friend of mine just sent me this awesome article written by Mindy Kaling, one of the writers of the office, about female stereotypes in film that are absolutely ridiculous - but we love them, and maybe crazier, start to aspire to be like them or think we are like them.  For example:

The Woman Who Is Obsessed with Her Career and Is No Fun at All

I regularly work sixteen hours a day. Yet, like most people I know who are similarly busy, I’m a pleasant, pretty normal person. But that’s not how working women are depicted in movies. I’m not always barking orders into my hands-free phone device and yelling, “I have no time for this!” Often, a script calls for this uptight career woman to “relearn” how to seduce a man, and she has to do all sorts of crazy degrading crap, like eat a hot dog in a sexy way or something. And since when does holding a job necessitate that a woman pull her hair back in a severe, tight bun? Do screenwriters think that loose hair makes it hard to concentrate?

Other gems include "The forty-year old mother of a thirty-year old male lead", the "ethereal weirdo" (think juno or the female lead in garden state), and "the skinny woman who is beautiful and toned but also gluttonous and disgusting" (think skinny girl stuffing her face with cake).  I've been on my own sort of stereotype smashing spree because, sparing you the details, I've been getting some pretty awful reactions to my telling people that I am strongly considering the field of ob-gyn. 

the consensus generally seems to be that I'm not going to be a very good mother, a very good surgeon, very good at diagnosing things other than pregnancy, surrounded by mean awful people, and overall pretty miserable with my life.  The field itself is sometimes perceived as being "too estrogen heavy" (helllloooo it's birth, it REQUIRES estrogen) which inevitably results in catty gossip, backstabbing, and comparing who has cuter dansko clogs, right?  NO.  From what I've seen, ob-gyn is not a field of just women, and the women and men in the field are serious, smart, competent doctors who went into ob-gyn because the physiology of pregnancy is like nothing else, because we still haven't figured out fertility, or menopause, and the reproductive cycle of a woman is one of the only topics in health vital to the continuance of our species, so it's been pretty fine-tuned by evolution and involves tons of genes, messaging cascades, and signals.  And  while some of my very favorite ob-gyn attendings were men and many of the people I love and respect in my life are men, I feel a different kind of energy in groups of just women.  It's not catty or gossipy or back-stabbing energy, but strong, calm, nurturing power.  Especially with pregnancy, it feels like going back to our tribal roots, when the birthing process was a tent filled of the women of the tribe who each had been through it or would soon, who had felt twinges in their own bodies that resembled this sensation, who empathized with the feeling of looking at your child for the first time, of the power of that bond, the implications of how the rest of your life will change, that's a lot to hold and I think there's something programmed in women to understand that in a different way.

And if we can bring medical knowledge and skills to the tent, well then, all the better.  

first test of motherhood

around 4am last night, on the 26th hour of my 28 hour call day, I was standing at the side of the bed of a 29 year old woman who was trying to push out her first baby and screaming "help me, help me, help me. I can't do it. I can't do it" and I was thinking (amidst telling her she was safe, her baby was safe, that she was doing a great job, to KEEP. FREAKING. PUSHING.) that birth is really the first test of a mother. I have yet to see one first vaginal birth where the mother didn't actually tear through her vaginal opening. Not like, it happened to tear. Like, she pushed so hard to get that baby out that she is actually TEARING HER OWN SKIN. It seems like a pretty good test of what's to come: are you willing to tear yourself from the inside out in order to give life, air, comfort to this brand new baby that you aren't even sure what it will be like, but you already know you love it enough to rip yourself open.

The best part is that after the big, (often) tearing push, the baby goes on the mom's chest, the partner leans over and pushes her sweaty hair back from her face, they gaze at their new, crying baby who is covered in white vernix together and glow. They all glow.

Terrifying and amazing.

oh, yeah. so I started my ob-gyn rotation and freaking love it.

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"a healthy woman is much like a wolf: robust, chock full, strong life force, life-giving, territorially aware, inventive, loyal, roving".

-Clarissa Pinkola Estes, author of Women Who Run with the Wolves

2 times 2

so last night was my last night call on pediatrics and it was AWESOME. instead of being in the ER admitting really sick kids all night (which we also did, and which I also really like, actually), we got to be the peds team for a C-section of newborn twins!!!

and then we got to do it again for a C-section for ANOTHER SET OF TWINS!

it was a little crazy for a while with the second set because they were really small and came out a little bit blue and not breathing, but with some quick resuscitation and waiting for their little lungs to kick into gear breathing outside the uterus, they did just fine.

They always say the true test of if you should be a pediatrician or an OB is where your attention is in the delivery room - are you focused on the woman or on the baby?

what if I am a really good multi-tasker and am interested in both?

gahhhh

and here's my fellow med-student and me in the ED after the deliveries, around 3am.

(which explains why we look kinda silly - I have to stop sticking my big chin out in photos)

(**these are obviously not actual pictures of our patients, but newborn babies sorta all look the same anyways, right?

plus more or less vernix (the white stuff) and blood on them)

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"med students are JUST like people -

there are some good ones and some bad ones out there"

-my senior resident