11 January 2014

2014 Goals, Reduced Speed Ahead

2013, like 2012, was a very hard year. The first half was studying, NARM exam, finishing up homeschooling. The second half was dealing with major medical issues (still ongoing), finding alternative options, taking care of myself… along with a few wonderful births in the mix. Due to medical issues, I’ve been granted an extension on my midwifery studies, which gives me a big breath of fresh air with less stress having to finish in less than a year.

Here were my goals for 2013:
Every semester – submit AAMI midwifery studies assignments
Every day – study for the NARM exam up until the 2nd week of Feb
February - fly to the US for 2 weeks, sit for the NARM exam and then enjoy some time with my mom
March/April - wait nervously for the NARM results
May - work on starting an ICAN of Thailand (Cesarean awareness chapter)
September – fly to Sydney, Australia for the Trust Birth Conference
December – finish the breastfeeding counselor certification (time to stop dragging my heels on this one!)
All year – not so many births.

So how did I do during 2013? I did submit AAMI work, I did study for the NARM exam and took the test in February and found out in March that I did PASS. I decided that ICAN will not work so well from here and am brainstorming other Cesarean awareness/recovery support options. I did attend the Trust Birth Conference in Sydney, an amazing experience where I met so many midwives and like-minded birth workers (another blog on that someday). I did attend a few births last year. One special birth comes to mind: first time mother, waterbirth, caught her own baby… amazing!

Here are my goals for 2014:
Every semester – submit AAMI midwifery studies assignments
Every day – work on midwifery studies a minimum of 30 minutes a day
June/July – hopefully visit the USA and while there recertify for CPR/NRP
All year – not so many births. Just enough to be able to start precepting an apprentice.

I really am slowing down. I have been push push pushing for about 8 years, when I first started with CBI studying to be a doula. 8 years, 1000s of study hours, CPM, 150 births later… I’m tired.

Longterm Goals
Fall 2016 - graduate from AAMI. This keeps getting pushed back. I’m making steps and getting closer. Was due to finish Dec 2014, but if I pace myself without overdoing reading/studying, which is hard on my eyes, I think I can finish by then. I’ve been given an unlimited extension, but if I focus on “unlimited” I’ll procrastinate, so let me make the Fall 2016 deadline public so I’m held accountable!
2016 - I am seriously considering going beyond my Masters in Midwifery. Naturopath Doctor is next.

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06 November 2013

It's Official, I'm a CPM!

Life is busy with family, school, health issues, birthing moms, etc. so I totally forgot to update here!

I sat for the NARM exam in February and found out in March that I passed.  I was so excited to get my CPM certificate in the mail!  So that is a HUGE goal that I have finished!

That said, certification/papers/licensure don't make a safe a midwife. I will say that I didn't need NARM or the CPM to make me a good midwife.  My education and experience do that.  Please ladies, don't hire a midwife based on the initials after her name.

My father died in October 2012 and one thing that I learned from him over the years is that the day is wasted if we haven't learned something.  And so my research, studies, conferences and such will continue.

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03 February 2013

Studying for NARM

In January I logged 120 study hours.  That's really good... about 4 hr a day.  Considering I have four small children, homeschool, clean (kindof) my home, cook, etc.  My study hours tend to be between 9pm and 3am... YAWN!

In 120 hours, I read and/or skimmed 22 books.  6 of those read cover to cover.  Plus I made 850 study cards.  (see pic below)

I have just 19 days until I sit for the NARM.  I'll fly to the USA on  Feb 14th, the test is on the 21st.  I fly back here on March 2nd, and wait until around the end of March to know the results.

Pray for good retention/synthesis of the materials that I'm studying!


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01 January 2013

Goals 2013 - Here We Go Again!

2012 was a really hard year.  Really really really hard.  Sickness and injury.  Homeschooling a child who doesn't like any form of school.  My father died in October.  My grandfather (his father) dying just 52 days later.  Helping my mom with all death-related issues.  I am happy to see 2012 gone.

The one nice glimmer was the 6 weeks we spent going quickly through FL, GA, and SC to visit family.  Saw midwifery friends as well as a friend from 1st grade. It was wonderful to dip my toes in the Atlantic Ocean!

I did manage to accomplish a lot of midwifery related things though... other than keep up with this blog!

Here were my goals for 2012:
Every semester – submit AAMI midwifery studies assignments
Every day – study for the NARM exam
February - submit final NARM application
June/July – visiting the USA and hopefully lugging along one textbook to finish a project
September – fly to CA for the NARM exam and attend the MANA conference that same weekend
December – finish the breastfeeding counselor certification
All year – lots of births (and they will count towards me precepting other students)

The number one thing that prevented me from accomplishing submissions for midwifery school has been homeschooling.  Never enough quiet hours in a row to finish anything.  Instead I just read a lot, finished a few projects.

I did finish up my apprenticeship in January.  I didn't need births at that point but it was piles of paperwork!

And I DID submit my NARM application in the spring!  And I was audited.  And audited again.  And audited yet again!  After 5 months of me sending more and more paperwork, they were finally happy with the application.  They really do not like international students!  Because of the long time auditing, I will be sitting for the NARM exam in February.

I recertified in neonatal resuscitation (in FL) and then CPR for the Professional Rescuer (in NC) this summer.

I also attended many births this year.  Missed a couple births... super fast births combined with a big city/transportation!  Helped many women with breastfeeding support, including twins, which I of course have tons of breastfeeding knowledge for twins... my own twins finally self-weaned in February at the age of 4.5 years!  A lot of time has also been spent working with some refugee families... teaching English, pregnancy/birth/breastfeeding Hmong twins, using Google Translate to muddle through it all.  A lot of wonderful families that I have been blessed to serve.

Here are my goals for 2013:
Every semester – submit AAMI midwifery studies assignments
Every day – study for the NARM exam up until the 2nd week of Feb
February - fly to the US for 2 weeks, sit for the NARM exam and then enjoy some time with my mom
March/April - wait nervously for the NARM results
May - work on starting an ICAN of Thailand (Cesarean awareness chapter)
September – fly to Sydney, Australia for the Trust Birth Conference
December – finish the breastfeeding counselor certification (time to stop dragging my heels on this one!)
All year – not so many births.  Mostly repeat moms.  I'm taking time to study and then slow down a bit.  It's been a crazy 5 years of studying and births!

Let me just stop right here and say please please please pray for me that I can pass the NARM exam in one try.  So many fail.  And it is a big expensive trip for me to fly to the USA to do this exam.  I am nervous.  My apprenticeship was in Indonesia, and the test is for American midwifery practice.  I live and serve in Thailand, and the test is for American midwifery.  I am studying hard but the way I was trained is so different.  Pray that I have discernment in the books, topics, etc that I choose when sitting down to study, and that I am really good with time management.

Longterm Goals
Fall 2014 - graduate from AAMI.  This has been pushed back because I've lost basically a year of full-time study due to homeschooling.  That child will be back in regular school next August, so realistically I could finish AAMI a year later.
Spring 2015 - Begin legal process and final language study to be the first licensed foreign/Western midwife in Thailand
2015 and Beyond - I can dream about opening a birth clinic here.
2016 - I am seriously considering going beyond my Masters in Midwifery.  Naturopath Doctor is next.

12 January 2012

Goals 2012

Every year I set new goals after looking at how I met my goals the previous year. I am mentoring 2 other students from my midwifery school, and I also ask them to set goals, both short- and long-term. It really works to get the goals out there to be accountable.

Here were my goals for 2011:
Every semester – submit AAMI midwifery studies assignments
Feb – NARM secondary skills checkoffs (hopefully all of them)
June – NARM protocols finished
June/July – back to Bali to complete my apprenticeship!
August – begin intense studies for the NARM exam
Nov – quick 4 day trip to Bali to finalize all NARM paperwork
Dec 2011 - complete breastfeeding counselor certification
Dec/Jan – back to Bali for catching babies without stressing over requirements!

So what did I accomplish? Everything on the list except for the breastfeeding counselor certification and a submission each semester. The NARM paperwork took me a bit longer to accomplish due to having a foster baby and flood days in the fall, but I am very very happy about what was accomplished! The secondary checkoffs were easily done with a midwife that was visiting the country. Bali was amazing and meant that I got lots of extra experience.

And now my…
2012 Goals
Every semester – submit AAMI midwifery studies assignments
Every day – study for the NARM exam
February - submit final NARM application
June/July – visiting the USA and hopefully lugging along one textbook to finish a project
September – fly to CA for the NARM exam and attend the MANA conference that same weekend
December – finish the breastfeeding counselor certification
All year – lots of births (and they will count towards me precepting other students)

I am soooo close to being DONE!!!!

Longterm Goals
Spring 2013 - graduate from AAMI, a very lofty goal and not likely to happen but I can dream and hope to graduate at the conference in Sydney that spring.
Spring 2014 - Begin legal process and final language study to be the first licensed foreign/Western midwife in Thailand
2015 & Beyond - I can dream about opening a birth clinic here.

28 September 2011

Hit the Ground Running

I returned to Thailand the end of July and was immediately back to life away from apprenticeship and no sleep. Here's a summary of all that's been going on. Pictures and individual posts on each to come later (in my spare time HA!).

Apprenticeship: There will be a much bigger post about this later. 50 days in Bali and 40 births! After 2 years of apprenticeship there, a total of 100 births under my belt. So many life-changing experiences. I left with confidence!

World Breastfeeding Week: The first week of August saw me participating with breastfeeding events around Bangkok. One was a big media promo at a local hospital with lots of Thai celebrities that support breastfeeding. My family and I also attended a Thai breastfeeding flash mob at the biggest shopping mall. My children got their picture in one of the local papers.

Church: With 4 children in school, I can be more active in outreach ministries. The one in focus right now is at the Immigration Detention Center (IDC) aka PRISON for refugees and others. A group from our church goes to visit 1 hour a week with various detainees. Food is horrible, living conditions are deplorable. My visits were with Wesley, a wonderful man from Cameroon. We brought him and others fresh foods, laundry soap, shampoo, a Bible, and so much more. I was thrilled to be the one to tell Wesley that we were successful in getting him released and repatriated. 100s more (and many children there) are still waiting, with much more difficult situations with little hope of freedom in the near future.

Bangkok Birth & Beyond: I try to not be booked for more than one birth a month, but sometimes it's hard to say NO, especially when it's repeat clients! One in August, waiting for one in September. Two in October. One (many two) in November. I'm also already booked for 2 in April and one in May! Mix in a lot of private childbirth and breastfeeding visits, and I'm filling up my part-time hours quickly.

Foster Baby: I am doing foster care for a newborn that was born the end of August. Her mother first contacted me in May looking for options but heavily leaning towards abortion. I was able to counsel her and told her that I would support her however I could if she chose to give birth and arrange adoption. She gave birth to a beautiful 4.5 lb baby girl and was so happy to give her life. I caught her baby in the hospital! I am caring for the baby most days and nights. I have low breastmilk supply but can comfort nurse her while bottle feeding her donor breastmilk that amazing Thai women (that I've never met!) have gifted to us.

School for kids: Yay for four kids in school! Grace started 3rd grade and has an awesome artsy teacher that works with Grace's unique (dreamy) learning style. Isaiah started K5... pray for his teacher with 8 out of 12 in the class being very active little boys. The twins started K4 and are loving school. No tears for them!

Midwifery studies: With all of the above going on, I am barely able to focus on finishing this Masters of Midwifery Arts and Sciences with AAMI. The assignments I'm currently working on are geared towards sitting for the NARM exam next fall. I'm mentoring 3 other students, doing research, writing papers, creating protocols, and more.

CPM process: My apprenticeship is done, so all that I have left is compiling my protocols, informed consent document, and documents for practice. These papers plus finalized birth, newborn exam, etc. forms will all go with me to Bali in Christmas for signing and notarization with my preceptor.

Speaking of my preceptor... Robin Lim has been nominated for CNN Heroes 2011!!! Please go vote for her 10x a day from now until Dec. 7th. http://heroes.cnn.com/vote_en.aspx

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05 June 2011

4th trip to Indonesia

This Tuesday June 7th my family and I will be going back to Indonesia for 7 weeks. This will be my 4th and last trip as a student! The focus will be filling in the holes of missing things, like a few initial prenatals, a couple newborn exams, and the most important continuity of care births (3 postpartums, birth, postpartum, newborn exam). We will go back again in Dec, but I won't be considered a student. At that visit, my preceptor and I will sit down and do loads of final paperwork. I am so so excited going back because I was just there and I can pick up where I left off.

In March I attended 3 births. Due dates never match up of course. I had one mom due Mar 12, and two moms due on Apr. 3. Well one of the Apr 3 moms birthed on Mar. 10, the Mar 12 birthed on the 14th, and then the Apr 3 birthed on Mar. 29.

Also in March, I was able to have all of my secondary skills checked off by a visiting CPM midwife from Idaho. She was here for her sister's birth and was capable and more than willing for me to test with her. So I flew up to ChiangMai once to do the prenatal things, sterile technique, injections, etc., and then I flew up again after the birth to do the postpartum and newborn exams. The mama was so sweet and didn't mind at all that I was using her or her adorable baby as test subjects!

After we get back from Indonesia, we have 1 and half weeks until school starts, and ... I can CELEBRATE! All four children will be in school! I'll be sad that I'll have no children at home but at the same time I can do 10x the studying, and serve other women as well.

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17 March 2011

My Supervising Midwife on CNN!

Every year CNN produces CNN Heroes. The heroes are people from communities that have done amazing things for their communities and others. My supervising midwife / preceptor was nominated for CNN heroes. I am so so blessed to be able to work with her and I can't wait to go back and volunteer and train with her more in June.



And a pic that my 7 year old took of me and Robin in January :)


28 February 2011

Breastfeeding Help in Thailand

I have been so busy with my midwifery training that I've been letting my lactation counselor certification get pushed back and back. I decided back in October of 2008 to do the training with CBI.

So today I looked up what I had left to do. I finished up the book reviews today... I realized I had read about 20 birth/breastfeeding books over the last couple years and had plenty that I could submit. Submitted a survey of breastfeeding help options in my area (more on that in a minute), and then looked at what is left. I have 6 breastfeeding scenarios that I need to research and write up action plans for. Then I have to do 30 hours of supporting at least 8 women or 4 hours of that teaching breastfeeding. I just need to go back through all of my records over the last year or so and log many of those mothers/babies. I'm sure that I've done at least 30 hours in the last year alone!

So what else is new with breastfeeding options for women in Thailand?

1) K. Meena at the pro-natural birth hospital. She is very busy with the hospital and IBCLC meetings. She works with training other nurses/staff on breastfeeding. I would like to go with her to the next national meeting and see what is going on. I am not happy with how much training is going on when really trainings do nothing if the OBs, pediatricians, and hospital administration is not on board.

2) La Leche League. There has never been one in Thailand until this past year. A leader from the USA moved here and she is now running a group and does free home visits to help women.

3) Bumps and Babies. A pregnancy and breastfeeding group for expecting and new mothers. They have special speakers and usually there is someone there that can help with breastfeeding. Next year when the twins are in school, I can volunteer there occasionally.

4) The Breastfeeding Cafe. This is held at a knitting/yarn shop in the center of town that has opened up its meeting room to anyone doing birth/pregnancy/breastfeeding meetings. Women can meet there on certain days of the month and ask their breastfeeding questions.

5) The Parent Vine. This is a new website/forum specifically for mothers, mother-to-be, and families. The site owner is extremely breastfeeding friendly and advertises all breastfeeding help for mothers.

6) My new Thai friend. I discovered Khun Bee on Facebook. She and I were both posting on KellyMom and I found out that she runs the "Nom Mae" (mother's milk) Thai breastfeeding group on Facebook. She is also heavily involved with a wonderful Thai breastfeeding website. She and some of her friends are doing a grassroots initiative together working on legislation and to help fight the formula companies that are illegally advertising and pushing formula on new mothers at offices, hospitals, and government offices!

7) ME. I'm averaging about 1 home visit a week to help new mothers with breastfeeding or other baby questions. Once the construction in our apartment is done, I hope to have a nice office area for breastfeeding appointments!

Women struggle here as they learn to breastfeed. Hospital policies go against breastfeeding, and formula companies are waiting to exploit that. With the few above resources though, more and more women are having success!

14 February 2011

Busy January

From Dec 21-Jan 9 my family and I were back in Indonesia for me to do more birthwork.

I attended 8 births and also finished my primary skills checkoffs with my preceptor. I was hoping that I would be able to see another CPM there at the time to do the secondary checkoffs but none were going to be there when I was there this time or in June-July when we go back. I did loads of prenatals, especially with women due late-May through early August, so that I can see them again when I'm back and also get more continuity of care births. I did a lot of initial prenatals/physical exams with women, especially any English speaking moms. A mom expecting triplets came through and my preceptor told her that I was the multiples expert. Pretty high praise coming from a preceptor that has 1000s of births under her belt!
My preceptor and I - photography by my 7 year old!
The twins try out the newly donated wheelchair.

Grace joins in with the prenatal yoga class!

Novi and her new baby girl - beautiful waterbirth!!! - permission given to share


We had a wonderful Christmas dinner at my preceptors house along with over 100 other people. New Year's Eve was the most exciting because Michael Franti came to the village and did a huge concert and fund raiser for the clinic. I got to hold down the fort at the clinic with one of the other midwives while the rest went to the concert. It rained so much that I was getting texts back that it was more like Woodstock with all of the mud. The only clinic excitement that night was drunks coming through needing stitches.


Christmas morning stockings in our big bamboo house

Michael Franti popped in for Christmas dinner and sang a couple songs!


Our house this time was in another village across the river from the clinic's village. We were right on the edge of a cliff that went down to the river and it was nice to hear the river at night or after big rains, and there were lots of big rains! Whenever I needed to go to the clinic I would call one of the maids or gardeners for the housing compound they would motorbike me over. The walk was 25 minutes and not the safest so we payed a guy in the village to drive us where we needed to go. Our house was completely bamboo and we had all kinds of creatures in our house: geckos (big and small), spiders, ants (4 kinds), termites, praying mantis, big flying Japanese beetles, wasps, squirrels, mosquitoes (of course!), bats, and other unidentifiable creatures! We were very thankful for mosquito nets at night due to Dengue fever going around. Outside there was all kinds of stuff for the kids to explore and they spent most of their time around a rabbit hutch trying to make friends with the bunnies.

Our big bamboo house - we had weeds growing up through the floor and a visit by monkeys late one night


Our kitchen - my husband kept the kids entertained and fed for me.

I've put a deposit down for a house for June/July becausing housing is so difficult to find. It will be a 1 minute walk from the clinic! Can't wait to go back and FINISH my apprenticeship!

When we got back in mid-January, I had a lot of breastfeeding visits lined up. I've done a lot of counseling and assistance and feel so much more confident each time. Towards the end of January I started up another childbirth class series, teaching it from a more "trust birth" perspective. (I just finished the class 3 days ago and they loved it!) I'm also working with 3 other women due over the next few months.

I found out at the end of January that a CPM was coming to the country for sure for her sister's birth in ChiangMai. She met all of the requirements for the secondary skills checkoffs! So I flew to ChiangMai (northern Thailand) the first week of February and did the checkoffs for physical exam, prenatal (28+ weeks) exam, sterile technique, drawing/injecting meds, and oxygen setup. I will go back around the first week of March after the CPMs neice/nephew is born to do the checkoffs for postpartum exam and newborn exam. I was mostly ready for the checkoffs but did a few days of review and practiced with another midwifery student in town.

So busy busy winter (if you could call it that here!), and now I'm prepping for some private childbirth classes, a doula birth in April, prepping for final stuff in Indonesia, and trying to get as much midwifery school studying in as possible. I'm focusing on the school assignements/projects that will help prepare me most for sitting for the NARM exam, hopefully in fall of 2012.

As for future blog posts, I'm going to focus a bit on topics that people are googling, etc that send them to my blog. Topics such as dopplers, missionary midwifery, birth in other countries, and much more!

17 January 2011

GOALS 2011

Here were my goals for 2010:

“Every quarter - submit AAMI midwifery studies assignments
June/July 2010 - visit USA for visiting family and do some midwifery networking and/or workshop
Dec 2010 - complete breastfeeding counselor certification
Dec/Jan - another short visit for apprenticeship and apply for 2 months following summer (I think this will become an annual Christmas visit and then every other summer visit)”

So what did I accomplish? I only submitted one quarter of work. I did not plan on having so many births this year or going to B---urma, or going to the USA on an unplanned visit, or my dad getting terminal cancer. And I feel OK with only that submission. I worked a lot on other assignments that I can submit this next year. I was able to do a lot of networking while in the USA for the summer and also while there managed to complete my Neonatal Resuscitation certification and my CPR for the Professional Rescuer certification. Still working on the lactation counselor certification. I did complete some reading for it and also got special permission for some of the readings to be altered so that the same assignments would also work for midwifery school. I did just get back from Bali (that’s another post) and did more births and initial prenatals there.

My goals for 2011 will be fewer as I can’t predict what my father’s health will do. But I’m doing fewer births here in Bangkok so that I can focus on my studies, and once the twins start school in August, I will have more time during the day for studies. Our house will also be under construction this spring so I’ll have to pick assignments that will work if my office area is in shambles. Once the construction is done, I should have a nice area for doing breastfeeding support and prenatals. And my library should be organized (I love my books!).

2011 Goals

Every semester – submit AAMI midwifery studies assignments

Feb – NARM secondary skills checkoffs (hopefully all of them)

June – NARM protocols finished

June/July – back to Bali to complete my apprenticeship!

August – begin intense studies for the NARM exam

Nov – quick 4 day trip to Bali to finalize all NARM paperwork

Dec 2011 - complete breastfeeding counselor certification

Dec/Jan – back to Bali for catching babies without stressing over requirements!


Longterm Goals
Fall 2012 - take NARM exam at the MANA conference
December 2013 - graduate from AAMI
Spring 2014 - Begin legal process and final language study to be the first licensed foreign/Western midwife in Thailand
2015 & Beyond - I can dream about opening a birth clinic here.

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07 December 2010

Beautiful B.....urm....a

Finally getting around to blogging about my trip. I was in the USA the last week or so of November visiting my family and spending time with dad who has terminal cancer. Wonderful times!

To make typing easier, I'll just call the place where I went B-Land.

Have you ever seen any TV shows about the world's most dangerous roads? Well, I'm pretty sure I was on some of them! 4-wheel drive straight up and over mountain ridges with a sheer drop off on each side. But the views were heavenly! After flying into ChiangMai (northern Thailand), it was a 4 hour van/bus ride to a town near the border, then a truck came and picked me up for the scary 3 hour ride into the training site.

The training site was on a military base for the "other side", not the B-Land regime. I saw lots of cammo and soldier boys in underwear! The people were lovely and gracious and of course had a great sense of humor. I lived in the building where the trainings took place. Most nights my bed was a hospital bed with a mosquito net. And it was very cold up high in the mountains, on the ridge, and nothing to break the wind, so we were bundled up when we weren't taking cover from pouring rain.

The only electricity was for 2-3 hours in the evenings when the generator was on, and this was the one chance to plug in everything for recharging and getting 10 minutes of internet. The toilets were in an outhouse, with squat toilets, and cold bucket showers. The only water source was rainwater, so that was boiled for drinking. The food was yummy, especially the cabbage salad I think I can replicate. Most meals were rice with one of the following: cabbage, eggplant, pumpkin, cabbage, yellowbean, eggplant, no meat, more cabbage, and a lovely vegetable called : "Fuck me low" Not kidding! The nurse I was working with and I had to ask them to repeat it a few times because we couldn't believe what we were hearing!

I am so thankful that my Thai language is pretty good. The Sh@n language is considered big brother and the Thai language is considered little brother, evolving from Sh@n. I understood a lot of it, especially once I figured out that P's and F's were switched. For example, "twins" in Thai is "FaaFed" and in the other language is "PaaPed." Or the words were slightly different, so "girl and boy" in Thai is "puu ying puu chai"; in the other language it was "fuu ying fuu sai." The medics in the training were thrilled that I could communicate basically, and it was a huge help when I would listen to the translator and know that she wasn't understanding and therefore translating the wrong information!

I was able to teach for about 4 days. We started out by taking a survey of all the local birth practices and labeled them as "helpful" "harmless" or "harmful". I learned so much about this that I am considering writing an article about it for Midwifery Today. The next classes were about taking a prenatal history, doing a basic prenatal exam, the stages of labor, hemorrhage, breast exam, breastfeeding (importance of colostrum; not how, but dealing with mastitis, etc.), fertility awareness method (some access to condoms but not much else), and cord burning.

There were 2 main things that I emphasized through out. First, that what I was teaching was practical for attending births in the jungle. They had been taught some about birth already but so much of it was over-medicalized and appropriate only for hospital. For example, how can someone go in and teach about a "managed 3rd stage" when there is NO PITOCIN AVAILABLE. Or how can someone teach about cutting a cord when there is NOTHING CLEAN to cut it with?? I know these medics will be getting all kinds of information, a lot not evidence-based, and not practical for birthing. Hopefully what I taught will make them think and know that they have other options. Dealing with hemorrhage with only having been taught what to do using pharmaceuticals is dangerous... they needed other options, which I gave.

The second thing I emphasized was working with TBAs (Traditional Birth Attendants). I started by asking a question: "who knows more about birth? TBAs or medics?" They all answered: MEDICS. And so I said, "Oh really? If you have seen 5 births, and a TBA has seen 200 births, who knows more about birth?" Lightbulb moments for all of them, and this opened up a discussion. The medics cannot be at every birth all over their area of northern B-Land. TBAs will continue to be the main source of birth attendants. By working together, they can teach each other. The medics can learn more about normal birth and complications from TBAs while the TBAs can learn about some complications and sanitary birth from the medics.

So my week in B-Land was challenging and fun. I got to hike around a little bit and learned that I'm not as fit as I thought I was. Got to see a Buddhist funeral in the jungle. Learned some things while observing their clinics. Yes I can now differentiate between kidney stones and appendicitis. Enjoyed some "me time" in the evenings just reading or watching DVDs with the other volunteers. And I was very very happy to get out of the country. They closed their borders due to upcoming elections about 3 days before I was supposed to leave. I was in the only truck allowed out!

I took a lot of pictures, but most I cannot put online. Mountains are a no-no because they are identifying landmarks. Faces are a no-no because the medics are at risk. Here are a few that made the cut:

The building where I lived and taught.

Our handwashed clothes hanging up to dry. No clothespins so we used medical forceps and hemostats.

The kitchen.....

Some of the guys playing Takraw (foot volleyball with wicker ball).

The ... birth... bed.... (we had long discussions about this one and we all agreed the floor with a clean mat was a way better option!)


Coffin getting ready to be toted down the side of the mountain to the cremation site.




So many butterflies.


Teaching breast exam. On the table, you can see my doll, pelvis, and placenta - all were a last minute decision to pack, and I used them so much!



I'm really hoping that I can do a repeat trip next year. I am so thankful for the opportunity to go serve and teach in a place where so few foreigners can go.

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12 October 2010

Going to B.....urm......A

From October 22-31 will be my B-urm-@ [yes, I will be editing certain words for security purposes] trip. I will fly up to Northern Thailand, then catch a bus up to the border. At the border, a guide will take me 2 hours into B-urm-@. Please pray for my safety.

Back in April, I was researching what current groups were doing midwifery/dental/medic trainings in Thailand. Global Refuge International (GRI), a Christian organization, was looking for some long-term volunteers (doctor, nurse, and/or midwife) for a project on the Thai-B-urm-@ border.

I contacted GRI and asked for more information. They immediately responded and said that I could come visit the project if I wanted to as a local observer, student, teacher, and accountability partner. And by the way, it's not in Thailand. Instead, Thailand is their base, but they are actually going into Sh-@n State, B-urm-@ and running a 6 month medic training.

Sh-@n State is a disputed territory between B-urm-@ and China, and the training site is at a Sh-@n State Army base. GRI has permission from the Army to come in and do this training. Sh-@n State has no hospitals or clinics. GRI is training these medics to go out with their "hospital in a backpack" to their own communities. They are trained at beginner and intermediate levels, and if they show higher capabilities are given advanced skills. Currently there are 18 medics, ranging in education from completing 3rd grade all the way up to university degree.

The reasons I am going:
1) Accountability partner for GRI.
2) Research international birth/midwifery trainings.
3) Observe the obstetric training: is it culturally sensitive? are they teaching evidence-based skills? are they teaching potentially hazardous information?
4) Learn more medic skills: my training has been 90% midwifery and I would like to learn whatever I can learn.
5) Assist in teaching: Midwifery and breastfeeding, and some English classes.
6) Hopefully observe or attend a birth if any women come to the base to give birth, or maybe I can go into the nearby village.
7) Working to prevent unnecessary maternal and infant mortality: B-urm-@ has a very high maternal mortality rate, with a lifetime risk of 1 in 100 for dying in childbirth.
8) Opportunity of a lifetime!

So for a little over a week, I'll be eating only Sh-@n food and sleeping in a sleeping bag. I will get to experience COLD weather for once. The Sh-@n language is similar to Thai, so hopefully I can communicate some. I hope I can make a difference somehow and be an encouragement to the foreign staff who have sacrificed 6 months of their lives as they live far from home. I can't wait to come back and blog all about it!

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17 August 2010

Summer 2010

No posts for June or July and now back to the grind. Here's an update, both midwifery related and personal.

In order to sit for the NARM exam in early 2012, I have to have done a list of things first. I have to be certified in CPR for the Professional Rescuer and certified in Neonatal Resuscitation (NRP). I totally forgot that this summer was my last time in the USA before sitting for the exam. I forgot until halfway through June! So then I scrambled and landed a CPR class in FL about 10 miles from my parents' house. A fun class with other nursing students, EMTs, etc.. I also managed to find an NRP class offered in Charleston SC, about 100 miles from my in-laws, but that was my only local option. The class was for nurses and residents at Medical University of SC. I rented a cute 2010 yellow VW beetle and had a nice day by myself driving back and forth to Charleston and sitting in a class for NRP. The NRP they taught was what's needed for certification but not very applicable for out of hospital birth, especially in developing Asia. I also managed to get a few study hours in after family/relatives were asleep for the night.

And now for the personal: About 6 days before we returned to Thailand, my dad had brain surgery to remove an orange-sized tumor. Since then, he has been diagnosed with late stage cancer in his liver, lungs, and abdomen. I am on-call to return when my parents ask for me. I've said no to all births until next year, other than going to Indonesia for Christmas as usual (though that of course can be canceled if I need to). I also have tentative plans for going to Burma the end of October.

I'm enjoying not being on call for births but still do breastfeeding visits and phone assistance. I'm using the time for cleaning my house, organizing, watching the twins at home, and studying (though studying isn't happening much right now). Our 800 sq.ft. apartment will be expanding! Our next door neighbors have agreed to sell to us, so we will soon have 1200 sq.ft. I will be using the "not on-call" status to plan for renovations. Maybe I can squeeze a tiny office into this!

Please keep my family in your prayers. I'll continue to update here.

29 May 2010

Trust Birth Conference 2010

The TBC 2010 was over two months ago and I'm finally getting around to writing about it. I've been busy with 4 births, assignments due, and planning to be in the USA for the summer. Here was my trip to Redondo Beach, CA:

The traveling: Looooong flight there. And even loooooooooooonger flight back. Easy to get to the hotel. Lots of restaurants, Whole Foods, etc. within walking distance. Great roommates that were also AAMI students. One was nice enough to drive me to Target to do a bit of shopping for stuff to take back.

The fellowship: I must say the best part of the conference was being surrounded by like-minded people. I met many wonderful Christian midwives and some were interested in our missionary work here and what I do. One midwife is friends with one of my friends here in Thailand... small world!

The preconference/skills lab days: For 2 days I sat in the midwifery skills labs. I knew a lot of the skills already from my time in Bali. Others were new, and hearing the philosophy of why/when/how behind each of them was important. I especially enjoyed learning how to do blood draws, IVs, and pelvic exams. Some of the other students were great models for us to learn on. The suturing on turkey legs was interesting and smelly! The two midwives that taught were very knowledgeable and funny too. On suturing, one of them (Jenny West) said, "If there are two pieces of vagina in the room, they should come together on their own"... meaning that vaginas can heal themselves usually. She also was the one to state that, even if we don't do many of these skills often, it is not an excuse to not do them well.

Other great people I met: Carla Hartley (AAMI founder), Gloria Lemay (famous Canadian midwife), Sarah Buckley (fabulous Australian author of Gentle Birth, Gentle Mothering), and many more. I especially enjoyed meeting and eating lunch with Laura Shanley, author of Unassisted Birth. She had read my birth story of my twins' unassisted birth and was excited to meet me!

On to the conference sessions:

Opening session: Dr. Jeanne Ohm is a chiropractor and natural birth advocate. What I gleaned most out of the whole session was the importance of NOT touching the baby's head at birth. Do not mess with the mechanisms that are in place already!

Session One: Prenatal/Postnatal Depression: Pamela Hines-Powell gave a good description on the various mood disorders and how to use natural and pharmaceutical options for them. Very well researched, and I took pages of notes.

Session Two: Jodilyn Owen spoke about the newborn exam. She had some wonderful ideas about how to involve the parents in the exam.

Session Three: The postpartum hemorrhage (PPH) and 3rd stage difficulties discussion with Gail Hart was extremely useful, and I know a lot of what I learned can be directly applied to the PPH situation in Bali.

Session Four: Practical Skills for Midwives in 3rd World Countries was more a discussion about how to practice in 3rd world settings. Preparation, cultural sensitivities, etc. I wished we could have talked for hours more!

Session Five: Another Gail Hart class - this time about the first 60 minutes of life. Maternal bonding, hormone flows, and baby hats (not to use them) were discussed.

Session Six: The toxins in breastfeeding class was cancelled so I very luckily ended up in Lisa Barett's class about variations from normal - specifically breech and twins. She was an inspiring midwife to listen to and learn from.

Session Seven: This was an almost 3 hour discussion with a panel about the pros and cons of licensure in the US, specifically the CPM credential. I learned a lot about American midwifery politics and midwifery bullying. Many perspectives were given and I feel that I understand midwifery in the US much better now.

Session Eight: The waterbirth talk by Jenny West was definitely the funniest. And it was very informative with lots of information and research. I decided to buy her book and asked if the book was as funny as her.... she said, "almost!"

Session Nine: Karen Strange's presentation on meconium was well-researched and something I ended up using at a birth a few week later. I took pages of notes and will continute to learn about this topic.

The ending session was incredible. Carla Hartley challenged us in two ways. First, she said that we need to ask ourselves not just what we stand for, but what do we NOT stand for.

Second, she challenged us to continue to shout out the message that BIRTH IS SAFE. Here is the video that she made and used to inspire us:

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04 April 2010

50 Best Blogs for Midwives

A big thank you to NursePractitionerSchools.org for listing me in their "50 Best Blogs for Midwives".

I am humbled to think that I'd be included in a list with such wonderful midwives like Jan Tritten, Pamela Hines-Powell, Lisa Barrett, Barbara Herrera, and Gloria Lemay.

Go visit their blogs and learn something! *

Thanks to all my readers and Happy Easter!


* Just don't go to #41 or you'll seriously get pissed off.

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07 March 2010

Conference choices & Excitement

When registering for the Trust Birth Conference there were so many choices for the classes. I decided that even though some topics seemed more "fun" or maybe some speakers were on my "want to hear before I die" list, that the topics necessary to fill in my educational needs were more important.

Pre-conference is the 2 day skills lab. Most of these skills I already know but I feel I need a refresher and to see how other midwives do these. And there are a few skills I do still need.

I get to hear Dr. Jeanne Ohm (chiropractor and natural birth advocate) and Dr. Sarah Buckley on opening night.

And for the classes and why I chose them:

Track 1: Pamela Hines-Powell: Pre and Postnatal Depression
I had PPD. Others I know have had PPD. I feel that I can never know enough about PPD. And the midwife Pamela was the phone backup midwife for me with my twins homebirth.

Track 2: Jodilyn Owen: Newborn Assessment for Midwives
My newborn assessment is rusty. My preceptor doesn't teach it very well and I don't want to miss something on a newborn!

Track 3: Gail Hart: Postpartum Hemorrhage & Other Third Stage Difficulties
I have seen lots PPH in my time in Indonesia. Even there we did whole discussions on this. Again, can never know enough about PPH.

Track 4: Panel (Combest, Denny, Craig): Practical Skills for Midwives in a Third World Country
This is the class I'm most excited about. All of my midwifery training and work has been in 3rd world countries/environments.

Track 5: Gail Hart: The First Sixty Minutes of Life
What to do and not to do with newborns in the first 60 minutes when it comes to protocols, interventions, etc.

Track 6: Amanda Hofedetz: Toxins in Breast milk: A Global Perspective on the Effects of Diet and Lifestyle
One of my specialties for AAMI is on breastfeeding.

Track 7: Panel (Combest, Edmonds, Hart, Hartley, Zittle): Licensure—Planning to Practice With or Without
I have decided to work towards the CPM (see previous post) but still want to know more of the pros/cons and how to work with those.

Track 8: Jenny West: Water birth—Promoting Trust and Less Interference
I love waterbirths and see a lot of them. I also see a lot of them done wrong in the hospitals here.

Track 9: Karen Strange: Meconium: Facts, Implications, and Perspectives
I really wanted to take Karen's neo-natal resuscitation class but it's the same time as the skills labs. So, I'll settle for 2nd best and at least hear her on a different topic that is somewhat related.

I am so excited about this conference. Leaving in less than 48 hours. The weather in Bangkok this week is supposed to reach at least 100F. Weather in Los Angeles? Highs in the mid-60s. After 9 years in Bangkok and no winter, I'm gonna freeze my butt off and looking forward to it!

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01 March 2010

Working towards my CPM

It's hard for many midwifery students to decide which route to take when working towards that midwifery goal, whether it's school, certification, or not.

I was not sure in the beginning if I wanted to pursue the CPM (Certified Professional Midwife) certification with NARM (National Association of Registered Midwives) or not. There are many routes out there: DEM (direct entry), lay midwife, licensed midwife (by the state), CM, and CNM. Now that I'm much further into my studies, and with my overseas situation, the CPM is necessary. For one, if I have any chance of working in this country legally some day, I have to have national certification from my home country. Also, some day, we will be returning to the USA. The CPM credential or the NARM exam is what is necessary for licensure in most states, if recognized by that state.

I like that the CPM shows a decent standard for midwifery studies. Do I think that the minimum CPM requirements are enough (as in # of required births, newborn exams, etc)? NO. This is why I will continue to do midwifery trips and training after I get my CPM. Do I think that the CPM should be mandatory for all states (as in the Big Push for Midwives)? I'm not sure.

For my CPM, I'm doing the PEP process, which is essentially, a portfolio. It documents all births, prenatal exams, postpartum exams, newborn exams, etc. where I acted as assistant or primary midwife. I'm almost done with these. I also have to demonstrate clinical skills. I am done with most of these, except for the well-woman care (such as pap smears, etc). I also have to document my education (doing that through AAMI), my protocols, and much more. The more I do this, the more attainable it seems to be. I am so thankful for a preceptor that is willing to work with my unique situation. I'm also making connections with other CPMs around the world that are willing to help me out.

When I posted my goals 2 months ago, those were conservative estimates. But after going through all of my paperwork, I'm almost sure that a midwifery trip this winter and a longer trip next summer (2011) will fulfill ALL of my clinical experiences/births. Which means I technically could sit for the NARM exam in Feb. of 2012. Why the rush? NARM is revamping their overseas experience requirements and may eventually not allow primary births at overseas sites to count towards CPM certification. This is scary to me because ALL of my experience is overseas, where I live. Hopefully they will have exceptions for students like me.

In a week I will be leaving for the USA to attend the Trust Birth Conference in California. It is expensive for me to do this and takes me away from my family for a week. It is also a huge advantage for me as student. I will take the 2 days of pre-conference midwifery skills labs. And then 3 days of classes that I've chosen to fill in the gaps of my education. I will also meet many midwives that will be those contacts I'll need over the next few years. I'm excited, nervous, and can't wait to learn learn learn, and meet other students I've only known online for a years.

So this is the "how will I do this midwifery thing" update. In some ways it's easier from overseas and in other ways much harder.

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31 January 2010

Goals 2010

Here were my January 2009 goals:


* Every quarter submit AAMI midwifery studies assignments

* June/July 2009 - gain a lot of experience during my short-term apprenticeship

* Dec 2009 - 1/2 way through breastfeeding counselor assignments and support

* June 2012 - apprentice, take NARM exam during our 1 year sabbatical in the US

* December 2012 - graduate from AAMI

* Aug 2013 - return to Thailand and begin legal process to practice midwifery while teaching CBE, labor assisting, and giving breastfeeding support

* Blogging more on my green blog. Updating my twin blog because, you know, babies grow.

* Doing my Bible reading BEFORE studying midwifery!

So how did I do with my 2009 goals? I did manage to submit 2 quarters of assignments and got honor roll one time! Had a fabulous apprenticeship in June/July and ended up doing a second one in Dec/Jan. Completed 2/3 of my clinical skills. Finished more than half of my Breastfeeding Counselor certification. I've done all of the support hours, just 4 more books to read and a couple written assignments to go. Did I update my twin blog last year? I don't even know, so probably I didn't LOL. And I did manage to do a lot more Bible study before midwifery study :)

After my apprenticeships this summer and winter, I was able to get a better idea of what I need to do to graduate from AAMI and get my CPM, so my goals for 2010 will show some of that. And here are the 2010 goals.

2010 Goals
Every quarter - submit AAMI midwifery studies assignments

June/July 2010 - visit USA for visiting family and do some midwifery networking and/or workshop
Dec 2010 - complete breastfeeding counselor certification
Dec/Jan - another short visit for apprenticeship and apply for 2 months following summer (I think this will become an annual Christmas visit and then every other summer visit)

Longterm Goals
June/July 2012 - (if no sabbatical) network with local midwives to finish NARM/CPM requirements
Fall 2012 or Spring 2013 - take NARM exam
December 2012 - graduate from AAMI
Spring 2013 - Begin legal process and final language study to be the first licensed foreign/Western midwife in Thailand
2015 - Open Birth Clinic!

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18 January 2010

Intense Indonesia

I had the privelege of going back to Indonesia for 3 weeks during our Christmas vacation. It was a very intense time as I was the only student for all but the last 4 days and ended up doing 20 births in that time. I saw a lot of VBACs, waterbirths, got to suture more, and learned a lot in addition to what I learned last time. My Indonesian is improving and by the time we left I was piecing together sentences... so much easier than Thai! I got to do quite a few Primary births and am actually almost done with the clinical side to my apprenticeship (more on this in a separate post).

I got to meet Stacy. I first found out about this birth center from her over two years ago and we both were back for our second time, overlapping by a few days. It was like sisters chattering as fast as we could to make up for the little time we had. Plans are underway to see each other when we visit the USA in June/July.

We got to spend Christmas with "family" and Christmas lunch ended up with about 200 people! Our children enjoyed the time, especially Isaiah with all of the dirt, rice paddies, chickens, and dogs. Even though I was very busy, there were no births on Christmas Eve, Christmas Day, New Years Eve, or New Years Day, so I could actually enjoy the holidays! I did get to catch the first two babies of the year :)

We didn't take as many pictures this time, but I'll post a few when I get a chance. It's also January and time for my yearly update on my midwifery progress and goals.

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17 December 2009

Back to Indonesia

When we were in Indonesia this summer (now been gone 5 months), we were invited back for Christmas. We decided that would be a great idea, and I went through an abbreviated application process to go for 3 weeks. The clinic's volunteer program changed right after I left (4 month minimum plus required language study), but because I'm a "special circumstances" student midwife, plus already know the clinic and staff, plus know a bit of the language, plus my preceptor loves me, means that I can go for even 3 short weeks!

While writing the previous blogs about my experiences, I was able to think long and hard about different aspects of my apprenticeship. I learned so much, and not just about midwifery. About myself, life, goals. Going back this time, I have a different perspective, some different goals, etc. I am so excited to be working with the same wonderful midwives and women. My family is going again and they will love life there like before. Lots of children and places to play.


I've also received monetary donations, combined with my own, and bought some much needed supplies for the clinic. My budget was about $300, and I bought what I could find here in Bangkok. It took a lot of exploring the town and the help of my language teacher to find it all: 4 cases of sterile gloves, 200 cord clamps, 20 catheters, 20 syringes, 2 Eldon cards, 1 infant oxygen mask, Ciprofloxacin (antibiotics), Bactroban, and gentian violet (for thrush). Now I just have to fit it all in with our luggage allowance!


So here comes my next midwifery adventure! Dec. 20th to Jan 11th will be full of many longs days, sleepless nights, and lots of sweet little babies born into my hands!

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12 December 2009

Indonesia's Most Memorable Births

All 32 births that I attended were special in different ways. As I mentioned previously, as each baby was born, the midwives and others in attendance would sing the Gayatri mantra. If the mother was Christian/Catholic, they (or usually me!) would sing Amazing Grace. Other religions would choose the song they wanted.

These are the births I remember the most.

The first birth I actually didn't attend. The day I showed up at the clinic, the midwives put me to work doing labor support for a first time mom. I had a total of 6 hours of sleep plus travel time the previous 48 hours so was doing my best! I started labor support around 9:30am. When the woman was doing well, I'd go make sure my family was settling in and finding food. At 8pm, I went and nursed the twins and headed back to the clinic. I continued the labor support until 2am, and at that point, I had dozed in my chair and almost fell off, much to the amusement of the woman and her husband. I told the midwives that I could not continue and they said they'd call me when she was ready to give birth. I went home and crashed, they didn't have my number yet (!), and the woman gave birth 30 minutes after I left! The next morning the new mother was so thankful to me for my help and was excited to show off her new baby. I saw her again a few weeks later at a well baby clinic. Still 100% breastfed and very healthy!


Birth #1 - my preceptor hollered over to me to hurry up because there was a baby coming fast. So I went in and saw my first birth at the clinic!


Birth #3 - My first waterbirth at the clinic!


Somehow I managed to see most of the scary births that summer...


Birth #4 - This was the first birth that I was told I was going to be the one to "catch". I was there for all 3.5 hr of pushing in a variety of positions and the baby's heart tones all over the place. Everyone was ready for resuscitation if needed. The baby I caught came out completely floppy as I placed her onto her mother's chest. After that, I stood back and took orders as my preceptor took over with CPR and works. It took 45 mintues before the baby was stable! This was the first resus I had seen and the whole time my heart was in my throat. I kept cool and prayed a lot! The next day the baby would not nurse and the mother was worried that something was wrong. As I watched her try to nurse, I knew that something was "off" but I couldn't figure out what. I called in "M" a volunteer L&D nurse who had worked with 100s of babies. When she came in to check heart, respirations, etc, she didn't notice anything and the baby was not acting strange anymore. I went home for lunch and mentioned the odd behaviour to my preceptor and she said, let's go back and take a look. When she walked in, the baby was acting "off" again. The baby was having petite mal seizures. The clinic decided to transport the baby to a NICU in Denpasar (about 45 minutes away). The day after I left Indonesia, at 6 weeks old, she passed away.


Birth # 6 - Recognized my first posterior baby at crowning. One of the fabulous Indonesian midwives worked with me to help deliver the head with minimal tearing. The tear still needed suturing, and I got to assist with suturing for the first time.


Birth # 7 - These women love crowds in the room for giving birth. 10 women (mother, midwives, family, etc) plus the father, plus my daughter Grace watching! (At the time of this blog, my 6 year old has observed 7 births!)


Birth #9 - This mother worked for hours but finally when the heart tones got too high, she transferred to the hospital for a Cesarean. The baby's head was asynclitic (crooked) and posterior. She tried so hard with a great attitude through any position change we could think of to get him out, but it just wouldn't work. I went the next day to the local hospital to see her and she was already breastfeeding well. That was also my first experience with the local hospital... not good!


Birth # 11 - the "doughnut lady" - this is how I will always remember her! A very young mother who did not want to eat the healthy foods/drinks we brought her. She finally decided to start pushing when her husband brought her a doughnut that she inhaled! She pushed in a variety of positions and finally ended up on hands and knees on a pile of towels on the floor. It was suspected that the baby was 4 weeks early, and the next two days I spent a lot of time helping her get this tiny baby to the breast.


Birth #12 - One of my most memorable! This mother's obstetric history is typical for a 3rd world country. Her first baby died during labor due to horrible mismanagement by her village midwife (who is still practicing). Her second baby, she decided to skip labor and have a live baby by paying a lot of money for a cesarean. She finally came to the clinic wanted a happy birth, and a VBAC. She had a vertical scar and labored for 2 days. Until this point in my career, I had NEVER seen a woman work so hard for what she wanted. This was also my first shoulder dystocia, and I learned a technique from my preceptor that I'd never read in any books!


Birth # 14 - My biggest baby ever! 4,650 grams aka 10lb 4oz. Not only was this the biggest baby I had seen birthed, but it was the biggest placenta my preceptor had ever seen!


Birth #16 - Saw manual removal of the placenta. Not pretty, but necessary in this case. It's rarely needed but it was this time. The mother did really well despite the interventions.


Birth # 17 - My favorite birth for the summer. Most of the families coming to the clinic were Hindu or Muslim but this time a Christian woman came in with a lot of her family plus others from her church. She had wonderful moral support from her older sister, and by the end of the birth, her sister and two other women were singing praise songs as the baby came out. When I got back to Thailand, the first song we sang in church happened to be the same song as this baby's birth and it brought tears to my eyes in memory.


Birth # 18 - This was a special birth because it was so simple. A 19 year old's first birth with no fear. She just came in, did her thing, pushed her baby out and put him to the breast.


Birth # 19 - Pushing was going so well. And then the mother reached down, felt the top of the baby's head, yelled "BAYI!" (baby) and pushed like crazy. She had an awful tear which was confusing to me when watching the suturing. Oh, and baby's one thumb was actually 2 thumbs fused together.


Birth # 20 - My first birth as primary midwife. One of the longest labors, 6.5 hr of pushing, 3rd degree tear. I had a fabulous Australian CNM working with me and she took on the "doula" role for me and was great whispering encouragment in my ear through the whole thing!


Birth #21 - See previous post about my first time suturing!


Birth # 23 - In general, boys are desired, and girls are OK if you already have a boy. So some births were sad when the mother was obviously disappointed in the birth outcome. For this birth, finding out the sex was quite funny and they were very happy with the outcome. Dad thinking: Boy or girl, I will look. Hmm, I'm not sure, from this angle, I guess I'll wait. Mom (5 minutes later feeling the baby): Boy or girl, I'll feel it out. Boy? Hmm, oh it's a girl!


Birth # 25 - I'll call it "Bucket Brigade Birth". The gas wasn't working in the water heater, so we had to carry bucket after bucket from the other birth room, and it was barely filled in time!


Birth #26 - We finally convinced the older brother (10 yr old) that it was OK to come in for the birth. Even though at this point my Indonesian was still in the baby stages, I could figure out that this kid was hilarious. His questions had the midwives cracking up the whole time. The birth was noneventful but the baby had a hard time breathing on her own. She had multiple birth defects, especially odd sutures, and she was transferred to the hospital a few hours later.


Births # 31 and #32 were the hardest two births for me ever. I'll start with # 32.

Birth # 32 - My preceptor and I had just finished birth #31 and ended up at the hospital for an induction. The father made all of us uneasy and as the night and then morning progressed, he basically decided that he wanted his wife to have a Cesarean that she didn't want. She had gone from 0 - 10 cm with induction and pushed for 2 hours with progress, but he was quite forceful that she was to have a C/S. I saw the Cesarean and stayed with the mother until she got to recovery. My preceptor stayed with the father because she was asked quietly by the nurses to keep an eye on him because he even made them uneasy. After we saw that the mother was breastfeeding and doing well, we went to leave but the father blocked our way, shoved my preceptor and demanded why we let her have a Cesarean. It was a really scary situation and the nurse in the room called security to make sure we could get out. That was my last birth in Bali.


Birth #31 - Not a day goes by that I don't think of "K". She was an older Muslim woman that I saw a few times for prenatals. At her prenatals she was measuring large, suspected polyhydramnios (excess amniotic fluid), and an ultrasound showed only one baby. "K" had decent English so we made a connection and she was happy to have me as her midwife. I came to the clinic as soon as I heard she was there and helped her with labor support. She was all alone and had very little in her birth kit. She labored well, pushed an hour, and her baby boy was born. After holding him a few seconds, we placed him on the bed and started resuscitation. All of the senior midwives and a nurse with high-level resus skills was there. We could see that he had problems. He also had no desire to breathe on his own. Two midwives and two students eventually took him to the hospital in Denpasar helping him breathe the whole way there. I stayed with "K" and reassured her that everyone was trying their best to help him. Of course I'm leaving out many many details here, but it was an awful situation.

A few hours later, "K" was stable enough for her, my preceptor, and me to go to see her baby. We got to the hospital and I held "K"s had tightly as we walked to a waiting room to sit while my preceptor and her husband searched the hospital for her baby. My preceptor and I made eye contact and I knew. We walked with "K" to the room where her baby was and held her up as she saw her baby laying in a baby bed in the corner with his blanket pulled up over his face. He had passed away just 30 minutes before we arrived. I can't say more about this here. We stayed with "K" until her husband could come and collect the death certificate. The last I saw "K" was her wheeled away in a wheelchair, holding her baby in her arms, off to ride away to the graveyard.



I saw so many wonderful and sad things in Indonesia. All of these women willingly allowed me to share their beautiful experiences, and I am forever grateful to them.

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14 November 2009

Journal Day 33 - I sutured

I tried to journal every day and then caught up on journal entries after I got home. Some of the entries are too short or confusing and some are too scary or revealing. Keep in mind when reading any entries that this is a clinic in a 3rd world country with some high-risk mothers.

Here is Day 33.

Got called in early for a birth, and it turned into my 2nd primary; nice waterbirth but with tear needing stitching. "R" said, OK Erin you suture.... (EEK!!!) So I said, OK let's do it. They gave me size 7.5 gloves and after about 2 minutes of watching me struggle with them (I'd mentioned they were too big) they found me smaller ones to trade. Getting in the lidocaine [pain killer for suturing] wasn't hard; between "S" and "R" it worked OK; "R" was quite intense telling me to hurry up. Duh! Lidocaine only lasts 20 minutes! I had trouble with needle angles that I'll have to practice with. Afterwards I was quite "cotton mouthed" probably from the adrenaline of being up all night and suturing at 8am! "R" apologized for being too intense but I told her I totally understood with the limited time.

Three hours later was another baby. "R" and "D" helped me support the baby's head and try to protect a prior episiotomy scar. Baby was fine despite odd FHT's. "K" sutured and it was great to watch how precise she was!

Went out to dinner with friends and decided to walk home. It was totally dark. And we had to walk through Monkey Forest. Pitch black with 4 kids and stroller. I had to use the tiny light on my cellphone and we made it. It was so awesome to look up at a sky full of stars... so different to see Southern constellations!


Update - 4 months later. I have studied more suturing and am practicing at home with my equipment and expired suture material. I'm ready for more practice with supervision when we go back to Indonesia in Dec/Jan for 21 days. I still can't believe that in less than 5 weeks there I was actually ready to suture. I watched every other suturing job there and have watched at doula births here. "R" sutures with finger ties and very quick. "K" and "S" would suture and not use finger ties - they also went slower and would show me how they decided where to put the needle. "R" could suture in her sleep probably (and does kinda if she gets called at 2am to do a suturing too difficult for others).

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07 November 2009

Clinic Postpartum Care

Women at the clinic stay for 48 hours after their birth. They cannot go home until their baby is breastfeeding well and the mother has shown she can care for her baby. Some people have questioned this 48 hours saying why not go home early if all is well. As soon as the mother goes home, she is back to taking care of everyone and everything, handwashing laundry, or out in the rice fields, or picking through the garbage dump. This is a way to make sure that the mother has 2 days of food and rest before going back to hard labor.

After the baby is born, the mother stays in the birth room for a couple hours. Less if there are more women needing the room. (I heard from my friend there that they had 2 days of 8 babies each day over the last week!) There are two postpartum rooms, with 3 beds in one room, and 4 beds in another. If overflow is needed, there is an extra bed per birth room that can be partitioned off, and room for another 6 beds in the open acupuncture clinic area if needed.
The first morning, the cord is cut if it wasn't done sometime during the night, the baby is weighed, has the newborn exam, and receives it's Vitamin K shot. Later in the morning or the next morning, the mother is shown how to bathe the baby and care for the cord. At some point during the morning, all of the new mothers sit outside in the sun and nurse their babies so the babies can get some direct sunlight to help with any jaundice.

(midwife Ibu Agung Mas, new baby boy, and his mother Nyoman)

The mother is fed breakfast each morning and her family brings her food for the remainder of her meals. A mother, her husband, the newborn, and maybe another small child, will all share the twin bed together, or the men will go out and snooze on the plastic covered acupuncture tables or on one of the sofas outside. With all of the mothers together in a room, they can chat, share stories, and help each other out. The aunties and grannies share plenty of advice as well! It is also a great way to teach as a midwife can help one mother and the others will watch. Or as the pic below, my friend Kate was teaching baby massage and many mothers, and grandmothers, and children circled around to watch.


I loved going into the postpartum rooms, trying to communicate with the mothers, ooh and aah over the new babies, helping with breastfeeding, or just observe how the mothers interacted with their babies. It's the mother's special pampering time!

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31 October 2009

The Placenta & Cord Burning

In Balinese culture (and many other cultures around the world) the placenta is considered sacred. At the clinic, this is respected and the cord is not cut for a while, if at all.

Some women choose "lotus birth" - when the cord is never cut and the baby is separated from his placenta when his cord loosens and falls off. However, most women choose for the cord to be cut within the day because the placenta can be given as an offering in their family temple. The placenta, cord, and flowers (placed right after the birth) are wrapped and placed in a ceramic jar and are eventually buried.

How does the clinic honor this? After the birth, the midwives wait a minimum of 3 hours. Then the cord is cleaned at the cutting site, clamped, cut, and then checked for 3 vessels. The only time a cord would be cut sooner (never immediately at the birth) would be if the baby needs to be transferred to the hospital or if the health department was coming. The health department does not understand or respect delayed cord clamping and cutting.


If not chosing a lotus birth or cutting after 3 hours, there is another option: the parents will have the cord burnt. This is an amazing sight! I now know how to do this and have had the priviledge of doing it for one of my clients.

To burn the cord, two small pieces of cardboard, each with a narrow slit cut into it, are place around the cord to protect the baby's stomach. The mother usually places her hand behind the cardboard to make sure it doesn't get too hot. Then the cord is stretched over a bowl and held in place as one of the midwives and the father hold a candle on each side and begin to burn the cord. They again sing the Gayatri Mantra. The cord hisses and pops and smokes, and in about 10 - 15 minutes, it chars and breaks off. Less than 10cm is left on the baby. The candles are placed, still burning, upright into the wax at the bottom of the bowl and remain burning until they burn down to nothing. Blowing out a candle can signify blowing out a life.

Not only is cord burning a spiritual or religious decision, it is also a safe decision. There is no chance for tetanus by cutting it. This method can be done in any birth setting around the world, especially in countries where there are no instruments for cutting a cord or no way to sterilize the instruments. Newborn babies like cord burning as well. A screaming baby turns instantly quiet and alert and dozes off during the cord burning.

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24 October 2009

A Typical Clinic Birth

I managed to see a variety of births at the birth clinic. For some reason I ended up with the difficult ones full of complications. But there were some wonderful beautiful births as well. Here is a normal birth!

"Made" (pronounced Ma-Day) arrives with her husband at 3am. She slides off the back of their motorcycle where she rode side-saddle for anywhere from 5 to 30 minutes in labor. It is actually not as common for women to arrive in the middle of the night because that would mean driving past graveyards in the pitch-black night with a chance of encountering ghosts. But this is Made's second baby and she knows she is in labor. While she walks along the front porch dealing with a contraction, her husband "Wayan" knocks on the midwives' door.

The midwives share one big room. Two double beds are pushed together for anywhere from 2 - 5 midwives to share during the night, wrapped up in sarongs or a mosquito net. One midwife gets up to answer the knock, pushing her glasses back onto her face. Tonight it is "Ibu Agung" that checks on Made with me trailing behind to help with taking a blood pressure and gathering supplies. (If we hear a mom bellowing from the parking lot, one of us scrambles to make sure everything is laid out in case of a fast birth). Made is taken into a prenatal room where Ibu Agung checks her dilation and asks questions to make sure labor has really begun. 5cm dilated and laboring well, and wanting a water birth.


While the mother labors in her room, I begin to fill the water tub, put down a slip-proof mat on the floor, find extra towels, and make sure all of the supplies are ready: homeopathy, herbs, resus equipment, sterile gloves, yunan bayao, etc. The mother takes a sip out of her large water bottle and hands it to me. I take it to the fridge in the midwives' room and put 3 large squirts of liquid chlorophyll into it. When I get back water tub isn't ready yet so I help the dad help Made through a few contractions. Every 30 minutes or so I listen to the baby's heart and record everything on the chart. Her contractions get stronger and she gets into the tub. I tell the other midwives that Made is progressing quickly and a they get out of bed and wait around.

On my way to the clinic that night, I collected flowers. As I walked out of my house, I pulled a few from the trees as I passed and picked up more off of the street as I went, using the flashlight on my phone so I don't trip over rocks in the road. The flowers are for any births to come that night. I retrieved the flowers from earlier and dropped them into the water tub with Made. She takes a deep breath and smiles at me. I ask, "Bagus?" Good? She nods ands closes her eyes. During one contraction her water breaks and I lean down into the tub with the doppler to check on the baby. He or she is just fine, and I can see Made's labia beginning to open as she begins to push.
I have a baby blanket over my shoulder and the dad has a baby hat in his shirt to keep it warm. My senior midwife breezes in and squeezes my arm. I smile and say, hey you finally woke up! Even after 3000 babies, she can't help but come to births. Sometimes the clinic will call her to come with a difficult birth, and other times, she just wakes up and knows somehow that she should come. Made is so happy that she came as her first baby was also born at the clinic.

We all watch as the baby's head begins to appear and the midwives begin to sing the Gayatri Song. It is the most revered Hindu prayer and the first thing a baby hears. All of the midwives and the father sing... an amazing sound as it echoes through the room. Outside the birthroom it is silent. The mothers with newborns in the postpartum room have heard the labor and listen in anticipation. The family members outside hold their breaths. Made's firstborn, a daughter, is brought in by her mother-in-law to watch. I reach down to slow the baby's head down from tearing through and soon my whole hand is filled with a soft baby's face. I check for a cord and there is none. And the a baby slides out into the water, into my hands, and then is lifted up onto the mother's chest while the room echoes in song. Chills go down my spine!

I lay the blanket over the baby, and a midwife puts the warmed hat onto the baby's head. We wait for a few minutes as the water drains, scooping out bits of blood and membranes, while waiting for the placenta. The mother shifts uncomfortably and I catch the placenta as it slides out. I inspect it quickly for any missing parts, wash it off in the tub and carefully place it in a bowl, without clamping or cutting the cord. I scoop out the flowers, rinse them off, and place on top of the placenta. Made looks down at her baby and lifts a little leg. She sighs a huge sigh of relief.... a boy! Now that she has birthed a boy, she can stop having babies.

As soon as she can, Made gets up and is showered off while one of the midwives takes the baby and placenta to the bed. She dries off with help and lays down where the baby is immediately putting him to her breast. The senior midwife and I check her perineum and discover no tears! Made has already drunk her yunan bayao drink to help prevent hemorrhage and I sprinkle dried yunan bayao over the tender tissues to help them heal. I take a warm wash cloth and wipe her down again, and help her put on underwear with pads. The dad helps me take one of her sarongs and lay it over her, tucking her and baby in together.

By now, the student midwives have finished cleaning the tub and putting things away. I make sure the placenta bowl is close enough to the baby so it doesn't pull on his cord. He is beautiful and the mother is sleeping. I quietly close the door behind me and will check on her off and on until later in the day. I look at my watch and it is 8am. On that day, it is one birth finished and three to go.

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18 October 2009

Prenatal care - clinic style

The clinic that I worked at this summer does assembly line prenatal care for 100s of women but in a very non-assembly line way. Each woman does get one-on-one care from the midwives. There are 3 prenatal days, and each day sees 20-50 women.


Here is a typical prenatal visit by "Ketut" at 34 weeks along: Ketut walks into the clinic with her husband and approaches the intake desk. She hands over her special green government card that her pregnancy stats are kept on, takes a number from the pile, and sits down to wait. When there is a seat available at the intake desk, the Indonesian student midwives take her card, find her prenatal form, check the pregnancy wheel for her current weeks of gestation, and weigh her.
The foreign student midwife (me for the 1st hour most days) takes her blood pressure, attempts to speak with her just a little, even if just to ask her name again and how many children she has. Ketut then goes to sit and wait until her number is called from the prenatal room. When she enters the room, there are 2 beds for 2 appointments to happen at once. There are 4 senior midwives and usually 2 student midwives. The student asks the mother to lay down on the bed, measures the fundus, palpates for position, listens to the baby, checks for swelling, checks the eyes for anemia, and asks a few questions.
The student relates the info to the senior midwife who records it. If the student is unsure of position or has another question, the midwife will help out. Urine is not checked unless there is reason to suspect that something is up. Ketut sits up on the bed and talks with the midwives for a few minutes, either chatting about life or discussing issues that need covering. If she hasn't gotten a tetanus shot this pregnancy, she is required by the government to have one done right there. She is then given a tiny ziplock bag with prenatal vitamins. (A one month supply if coming 1x a month, 2 week supply if coming 2x a month, and 1 week supply if coming every week). With no more questions, she is on her way until her next appointment. As she leaves the property she puts a small donation in the box, usually around 20-50 cents.
Of course this type of appointment could be better but in this setting, it's so much better than any other options. The mothers sit together and chat about their pregnancies. If they come on an acupuncture day, they may be sent to acupuncture for breech baby, high blood pressure, or something else. If they come on a prenatal yoga day (the most popular day!), they can participate as much as they can.

For me as a student, I went in thinking I would just be a beginner. But taking blood pressures was no big deal. Palpating, which was totally self-taught, thanks to my many pregnant friends who let me practice on them, ended up being a great skill of mine. The senior midwives actually let me teach the Indonesian student midwives! If I ever had a question about head engagement, or baby position, I would call someone over to double check for me. My favorite prenatal was when a twin mom came in. I got to palpate the twins and find their heartbeats. I ran to the office to get my own twin-birth pics and ephasized that yes she can birth them vaginally and breastfeed them too!

Prenatal days were whirlwinds of activity. Some nights I walked home with aching ears from using the stethoscope for 2 hours straight! Some women I would see more than once, and some up to 3 or 4 times. If I was lucky, I'd be on shift when they came in to birth. With a relationship already made, the mother would feel comfortable having me at the birth.

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