Missionary Midwife Mama

Goals 2012

2012-01-12T15:11:00.002+07:00

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.

Hit the Ground Running

2011-09-28T13:21:00.003+07:00

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

4th trip to Indonesia

2011-06-05T22:05:00.002+07:00

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.

My Supervising Midwife on CNN!

2011-03-17T22:51:00.003+07:00

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.

Here's is "Mother Robin" delivers for poor women in Indonesia

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

Breastfeeding Help in Thailand

2011-02-28T15:09:00.004+07:00

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!

Busy January

2011-02-14T14:00:00.004+07:00

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!

GOALS 2011

2011-01-17T15:17:00.003+07:00

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.

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

2010-12-07T10:54:00.005+07:00

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.

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

2010-10-12T09:45:00.004+07:00

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!

Summer 2010

2010-08-17T22:00:00.005+07:00

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.

Trust Birth Conference 2010

2010-05-29T10:55:00.005+07:00

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:

50 Best Blogs for Midwives

2010-04-04T23:36:00.004+07:00

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.

Conference choices & Excitement

2010-03-07T20:52:00.002+07:00

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!

Working towards my CPM

2010-03-01T16:08:00.005+07:00

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.

Goals 2010

2010-01-31T22:21:00.002+07:00

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!

Intense Indonesia

2010-01-18T18:44:00.002+07:00

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.

Back to Indonesia

2009-12-17T22:50:00.004+07:00

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!

Indonesia's Most Memorable Births

2009-12-12T17:17:00.004+07:00

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.

Journal Day 33 - I sutured

2009-11-14T23:41:00.003+07:00

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).

Clinic Postpartum Care

2009-11-07T17:03:00.004+07:00

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!

The Placenta & Cord Burning

2009-10-31T15:03:00.005+07:00

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.

A Typical Clinic Birth

2009-10-24T16:04:00.005+07:00

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.

Prenatal care - clinic style

2009-10-18T20:52:00.005+07:00

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.

Incredible Indonesia

2009-09-13T23:02:00.004+07:00

When I left for Indonesia on June 10th, I knew that I would learn so much in the next 45 days. And I learned more than I thought I would learn and saw more than I ever thought I would see. I attended 32 births. I saw many many complications. I wanted to see complications in a bad sort of good way. Who wants to really see them, but I needed to see them for the experience. I saw things that some homebirth midwives would never see in their practices. I mastered some skills and learned some new ones. Sutured a perineum! Many breastfeeding hours put in. Many 36 hours days.

Joys: seeing women become mothers and men become fathers, palpating so many tummies, sitting at the feet of an amazing mentor, a VBAC mom with vertical scar push for 6 hours and never stop, the birth song as each baby emerges. Sorrows: mothers disappointed in having girls, seeing previous birth traumas, some I still can't bring myself to share.

I went tentatively and unsure as a student midwife. I came back a strong, confident midwife.

Indonesia changed me. I left a chunk of my heart behind. And I have to go back and find it.

Hello from Indonesia

2009-07-20T11:57:00.004+07:00

I know I had promised blogging from Indonesia, but I've had no time! I've been here almost 6 weeks and am waiting on birth # 30 right now. I don't know how I will share about my time here - some is so hard to put into words, some so personal, and how to fit 6 weeks of crazy living onto a few posts? Thankfully I did some journaling while waiting during births so I can reconstruct some of that later. There is a "no blogging" clause from the clinic so I'll have to be careful with details as well.

We'll be returning to Bangkok on Friday and then the blogging can start! I'm thinking of sharing by category, such as prenatal clinics, twin experience, life in Indonesia, difficult births, midwife certification, and more.

And we are planning now on how to come back in a year or two! A 4-hour plane ride and a cheap place to live makes it totally possible. My preceptor/supervising midwife is amazing and would love for me to come back. And of course we've made many new friends along the way.

Busy busy busy

2009-05-11T23:30:00.004+07:00

Somehow I will find the time to plan and pack for leaving in less than a month to go to Bali. Things are slowly coming together and everyone is getting so excited about our summer adventures.

I've attended 3 births so far this year which may not seem like much except that one birth also means 2 prenatal and one postpartum meeting. Those have to be worked around our family schedule. So far it seems that until the kids get older, one birth a month will have to be my quota. If I have no birth booked for that month then I can be backup for another doula. I'm doing no more births until I get to Bali, and I have a repeat midwifery client due in August when I get back. Anyone need me in September? :)

I've also been really busy with my school work. I've been putting in 20 hour weeks to finish 2nd quarter work, which I finished yesterday and will put in the mail this week. It's ready 2 months early! I just really needed that big project out of the way so my mind will have room to process everything else that needs to get done. So far, I've met my goals for each quarter, which are to submit projects and requirements every quarter, with no exception. I even plan on taking a small project with me while I'm gone to work on during down times.

I attended/missed a great birth in Korat in March. It's a 3+ hr drive and I left as soon as I was told to come but didn't make it in time. But I still learned a lot from helping with the placenta and inspecting it and all of its "issues". I drove 600km in less than 24 hours, through mountains and rice paddies! Thankfully that birth came right on time as I had one scheduled 10 days later which also came right around the due date. A fabulous first-time mom who got her waterbirth. I really enjoyed watching a man become a father at that birth... it was beautiful!

Unless I get a chance to update between now and when we leave, the next post will probably come from Bali!

My newest article 3 of 3

2009-05-05T23:01:00.005+07:00

I just had published my final of 3 series articles published in the BAMBI magazine. It's the main pregnancy and parenting magazine for expats in Bangkok. So exciting to open it up and see it in print! I have been getting a lot of thumbs up from all over the globe for these, so thank you readers!

Here it is:

Breastfeeding More than One: Tandem Nursing
By Erin Kannon

I have a problem and there is just no solution: I have three children wanting to breastfeed and I only have two breasts! How did I end up in this situation? I have 17 month old twin girls and a three year old little boy who all love to be breastfed. I never thought that I’d be breastfeeding a toddler at three years old or that I would ever have twins but here I am breastfeeding all three. My situation is a little extreme but many women out there are breastfeeding two or “tandem nursing” twins or a baby and a toddler.

Women choose to tandem feed their children for a variety of reasons. The main reason is that their breastfed toddler wanted to continue after the new sibling is born, especially if the toddler is still very young. As stated in a my previous article “Breastfeeding Your Toddler”, there are many benefits to breastfeeding a toddler and these benefits reach far into the second, third, fourth, or more year of life. A pregnancy and new baby are no reason to stop breastfeeding and cut short those benefits. Older children have to adjust to a new baby, and breastfeeding helps with the adjustment and continued bonding time that he craves. If your toddler stopped breastfeeding during your pregnancy due to a diminishing milk supply, it is possible for him to be breastfed again. You may have to re-teach him how to have a proper latch on your nipple.

Preparation for tandem nursing is important during pregnancy. Continue eating and drinking enough for breastfeeding through the pregnancy and even more after the birth. If your toddler is breastfeeding as much as the new baby, you may need 1000 extra calories a day, paying special attention to high quality foods. One risk for tandem feeding mothers is a lack of nutrition, especially if your children are spaced close together.

After the new baby is born, your breasts will make colostrum again, so make sure that the baby gets the majority of it. Expect to have some soreness and pay attention to correct latching from both children. You can choose to feed each child separately or together. If you decide to feed them separately, the child who needs the most volume for weight gain or the child who can handle a heavier flow of milk should be breastfed first. The toddler can also help with engorgement and reduce the risk of plugged milk ducts.

You body should have plenty of milk for tandem feeding. The “supply and demand” that works with one baby will work with two children as well. Pay attention to the number of wet or dirty diapers, frequent feedings, and normal weight gain for the baby as you would if only breastfeeding one. Your toddler will be receiving creamier milk than usual, may fatten up, and could even have newborn looking poops! The best part about this stage of milk is its high levels of immunities that your toddler will receive. If there seems to not be enough milk for two, the younger baby should take priority and make sure that your toddler is being given enough other foods to make up for his need in calories. If one child becomes sick, there is not much risk of cross-infection between children or the breasts, except in the case of thrush (yeast).

The logistics of breastfeeding two (or more) will work themselves out over time. There are advantages of breastfeeding only one at a time. Each child will have undivided attention, especially if there are jealousy issues, or you may find that the child not being fed will be jealous while waiting and you’ll end up feeding them together. If you find that you are feeling “over-touched,” feeding one will help. The biggest disadvantage to breastfeeding one at a time is TIME, as you will spend a larger portion of your day feeding if your children have to take turns. You will also have to figure out a way to keep the other child occupied during feeding times.

To get into position for breastfeeding both children together, it is easiest to correctly latch on the newborn first and then let the toddler figure out his position. You may need pillows or a footstool and maybe even an extra hand to get situated until you get comfortable doing it on your own. Double cradle, upright, or football holds work well. As the newborn grows, you can get more creative with positions. Side-lying with the older child draped over onto the top breast works well, as does lying on the back with a child in each arm.

When tandem feeding, your levels of oxytocin will be very high so feeling a little “foggy-brained” is normal. Make sure that you get enough rest as your body is working harder to produce extra milk. It is also normal to feel “over-touched” or to not like the sensation of breastfeeding the older child. Some mothers only let the toddler have one side or come up with “rules” for breastfeeding, such as only before naptime. Breastfeeding is an ever-evolving relationship between you and your children. Your children will bond together as they feed together and may even wean together as twins usually do. This is also a time where you can work with their communication and how they interact together.

Tandem feeding can be challenging. In today’s society we rarely if ever see or hear of other women breastfeeding more than one child at a time, let alone just one child past a year or so. There is very little “group wisdom” to be passed down. Tandem feeding is normal in many cultures, yet women often breastfeed in private because of peer pressure and are embarrassed to say that their toddler is still breastfed. Our bodies are designed to make milk and plenty of it. Surround yourself with supportive friends and family and know that you are giving your children a precious gift.

For further information:
Mothering Your Nursing Toddler by Norma Jane Bumgarner © 2000 (in the BAMBI library)
Adventures in Tandem Nursing by Hilary Flower © 2003 (also BAMBI library)
http://www.kellymom.com/ (general research-based information and forums)
http://www.mothering.com/ (articles and breastfeeding forums)

Doppler & Ultrasound

2009-04-09T23:27:00.004+07:00

I have never been a big fan of ultrasound [which will now be shortened to U/S from here on]. If you have read anything by Marsden Wagner, he has some great articles about U/S. One of his best is "Ultrasound: More Harm Than Good?". This really lays out the history and development for it's use in obstetrics today and the questions that have been raised about its safety.

How will I use U/S when I practice as a midwife? I really prefer to use a fetoscope as there is no U/S emitted. It's fetal stethoscope that takes practice to learn how to use but there is no harm in using it. I've had a lot of success learning it and loved listening to my twins during that pregnancy. The heartrate of the fetus can usually be heard around 18+ weeks gestation in most pregnancies, and later if the mom has some extra fat on the stomach. Using an U/S or doppler (the handheld type) is used to hear the heartbeat usually around 12 weeks gestation. During labor, a fetoscope can be uncomfortable as it presses into the abdomen. If the mother is in the water or in an awkward position, it's almost impossible to use unless the mom rolls over onto her back, which is not fun for anyone in labor. As the baby rotates lower into the birth canal, the fetoscope cannot pick up the heart rate as well. Using a doppler can work in the water, in awkward positions, and as the baby moves down.

I have decided that I will use education for my clients. By providing the pros and cons of doppler or U/S they can make an informed decision on if they want doppler use during their pregnancy. My standard practice will be to start listening by fetoscope at 18 weeks. If a mom wants the baby listened to by doppler before that she needs to give informed consent. During the birth, I will use fetoscope if possible but most likely will switch to doppler if listening is necessary.

Of course this is all my feelings at this point and as I learn more, I'm sure I'll clarify this more.

Here is what a fetoscope looks like. Thanks to my many friends who let me practice palpation (feeling the uterus for the baby) and auscultation (listening to the baby), I've gotten good at using it!

I had an opportunity to find a decent doppler here. The price was right and I went ahead and bought it for those rare times that I will need it. Minimal use is best! I chose this one because I like its simple features and it can be used in waterbirths or in the shower. Well the probe can, not the machine!

What about U/S to view the baby during pregnancy? As with any test or procedure, one needs to think of what important information do they need to know, and what would be done with that information. Just to get a cool picture of the baby is not medically indicated. To rule out twins or if placenta previa is suspected, U/S can be bonus. It is rare for women to go through pregnancy without an U/S. Insurance, depending where you live can dictate how many you may have. In general, it is typical for most practices to recommend a structural U/S around 20 - 22 weeks. This is to check on basic growth, heart/lung/brain development, and to look for structural abnormalities. This is also the best time to find out if it's a boy or girl if you don't want to wait until the birth to find out. If you are only going to get one U/S this is the one to get. U/S for dating the pregnancy is only accurate done during the 1st trimester. U/S done during the last trimester can be off by +/- 3 weeks for the due date and size-wise off by +/- 2 lb (1 kg).

As with any medical technology, it can be useful, and it can be overused and abused. For me, less will be more.

My new website!

2009-04-01T21:41:00.004+07:00

After much contemplation on business names, I've changed it. I needed something that encompasses all that I do. And then thanks to another doula friend, I was introduced to a company/program that makes doing websites on your own not too hard of a thing to accomplish.

So I am now the proud owner of:
Bangkok Birth & Beyond

I've gotten some great comments on my logo. Yes I made it myself! It all started with drawing squiggled bellies while doodling during a sermon at church. When I got home there was one doodle I really liked so saved it in a pile of papers next to the computer. 2 months later, I decided on a new business name. Then while working on the website and thinking I needed a logo, I remembered my doodles. I found it and scanned it into a photo editting program. Then I just started playing around with it. Didn't like just one squiggle so thought I'd try more than one. Hey it looked like 3 B's. But B's need backs and so do pregnant bellies. And then Tada! 3 Squiggles that look like 3 B's and 3 Bellies all in one. Editted to a better color and thickness and done. So easy and I didn't have to hire anyone to do it for me.

So yippee for a new site that will bring in more women and families who need assistance.

My newest article 2 of 3

2009-03-03T21:46:00.002+07:00

I just had published my 2nd of 3 series articles published in the BAMBI magazine. It's the main pregnancy and parenting magazine for expats in Bangkok. So exciting to open it up and see it in print!

Here it is:

Breastfeeding During Pregnancy
By Erin Kannon

One day as I was breastfeeding my son, I realized he was not a baby anymore. I began thinking about babies, wanting more, and realized, “wait a minute, I missed my period this month, could I be pregnant?” The next morning, two pink lines on the pregnancy test stick revealed that I was definitely pregnant. During the next month, my nipples hurt some and I wondered if I should stop breastfeeding my son, who was definitely no longer the baby since there was a new baby on the way.

Welcome to breastfeeding during pregnancy. If you read my article “Breastfeeding Your Toddler” you know that there are many benefits of breastfeeding your child well past the first six months and on into his second, third, or fourth year of life. Breastfeeding is intended for years and not months, continues attachment with your child, and has unique nutritional and immunological benefits. A new baby does not need to end the breastfeeding relationship that you have with your older child. The dynamics of breastfeeding during pregnancy are a little different, and as an expecting mother, you will need to take care of yourself and your growing baby inside.

Breastfeeding during pregnancy will most likely require a little bit of determination and a whole lot more of extra food. This should not be a problem as most pregnant women love to eat! If you are still nursing a very small baby exclusively you will need about 300 extra calories for pregnancy and another 350 for breastfeeding. If your child is older you will need about 200 extra calories. If you find that you are not gaining enough weight, increase the amount of calories you consume, especially in protein. Protein builds breastmilk and protein builds your growing baby. If you are hungry or feel fatigued, eat more! Remember that you will need extra fluids as well.

When breastfeeding during pregnancy it is common to have some nipple discomfort. You may or may not have sore breasts and this can change during the months of pregnancy. You might also feel a little nauseated, restless or “creepy-crawly” during the feed. This is your chance to practice those breathing exercises for birth! Try to remember your motivation for wanting to breastfeed your toddler and make some breastfeeding “rules” for him if needed. Check that your child has a good latch to help with your comfort level. Fatigue is also common, especially if you are chasing a toddler all day. Take care of yourself and make sure that you are having restful nights and a nap during the day if possible. Try lying down to breastfeed your toddler and nap together.

Your milk will change during pregnancy. Many women notice a change in production, and about 70% of women will have a decrease of supply. Your toddler will most likely notice a reduced let-down reflex and a more salty taste. You can explain these changes to him and he may continue to want to breastfeed even if your supply drops or goes away. There are no known safe options, pharmaceutical or herbal, to help your supply during pregnancy. Some foods, such as oats may help. If your milk goes away, your child can still “dry nurse” if it is not too uncomfortable for you. Expect him to switch back and forth between breasts trying to find more milk! Your body begins producing colostrum by your 20th week of pregnancy and he may want to breastfeed for longer periods of time again.

As your pregnant belly grows, your toddler will run out of room on your lap during breastfeeding. Expect to find yourself using new positions and your toddler experimenting with “nursing gymnastics”. Some breastfeeding positions that you can try while navigating over your bump are the cradle-hold (modified), football hold, toddler standing, seated side by side, back-lying, side-lying, or any which way!

At some point during your pregnancy, you may consider weaning your toddler. Many toddlers choose to wean due to the change in taste or supply. Some wean gradually and others abruptly. An older child is more likely to want to wean, though once the new baby has arrived, he may show interest in breastfeeding again. Weaning is common during pregnancy as your hormones change. Studies have shown that of those breastfeeding and pregnant, 57% weaned. Your decision to wean or not will come down to how you are feeling (body wisdom), cultural preferences, if you want to tandem feed, and what feels the most natural to you. Your needs are just as important as your child’s needs.

Is breastfeeding during pregnancy safe for your unborn baby? Research shows that breastfeeding does not cause premature labor or dilating contractions. The hormone oxytocin that is produced from nipple stimulation does not have an effect during pregnancy due to interaction with other hormones and oxytocin receptors in the uterus. If your healthcare provider tells you to wean because you are pregnant, ask for the reasons why. As long as you have no major health concerns, you are gaining enough weight, and you feel well, there is no reason to stop breastfeeding. One advantage of breastfeeding a toddler is that if you do have a premature baby, you already have a milk supply going. Breastfeeding during pregnancy does not affect the milk supply after the birth.

I continued to breastfeed my son during the first three months of my third pregnancy. I then learned that I was carrying twins and was told that I should immediately wean him. An abrupt weaning would have been devastating for us both, but I knew that weight gain would be of utmost importance for a twin pregnancy. I slowly weaned him as my supply diminished and by my 6th month, he had weaned though he never stopped asking to breastfeed and would occasionally dry-nurse. I was relieved and so happy that he remembered how to latch on correctly after the twins were born. This helped him during those first few months of craziness with new babies and gave us some very special sharing time.

For further information:
Mothering Your Nursing Toddler by Norma Jane Bumgarner © 2000 (in the BAMBI library)
Adventures in Tandem Nursing by Hilary Flower © 2003 (in the BAMBI library)
http://www.kellymom.com/ (general research-based information and forums)
http://www.mothering.com/ (articles and breastfeeding forums)

My Birth and Midwifery Library

2009-02-23T16:07:00.005+07:00

I have amassed quite a collection of birthing, breastfeeding, and midwifery books over the past 4 years. It started with a purchase of Heart and Hands and has slowly morphed into a whole bookshelf. In fact, I'm already past a whole bookshelf now with all of my folders and related materials. When making up my inventory lists I was shocked to find that I own over 200 books and then videos, periodicals, and teaching visuals on top of that.

There is no interloan library here. My husband's school librarian gave me the access code to the online periodical library they use in order for me to have more resources. The highschool library only has 5 medical books, the newest of which is copyright 1977... older than me! The BAMBI group here has a lending library, and about 200 extra titles and piles of videos that I can supplement with.

Of course, there are still many books that I will need eventually, but what I have has been amazingly useful for my first year of midwifery school. How did I come by all of these books? Was it expensive? Well, thanks to half.com and other similar sites, I spent about 45% of retail price, including shipping. Last summer I had a huge pile(s) shipped to my sister-in-law's house which ended up taking over a corner of her bedroom. 10 suitcases later and upon final count, 100kg (over 200lb) or our 200kg of luggage was books for me! Half of our luggage was books. I love books.

And for those midwifery student friends of mine who want to drool. Here's a pic, with the best midwifery book having it's rightful place front and center... HMII.

If only it were still so nice and organized... now it looks well-used and borrowed from!

Artwork by Grace

2009-01-25T23:50:00.004+07:00

My 5yr old daughter drew this for me tonight. It's me holding her when she was a baby.

Being a Bangkok Doula

2009-01-23T23:24:00.003+07:00

Ah the joys of being a doula in Bangkok. You never know what kind of birth you'll get to see next.

Take this morning for example (without sharing too much online of course).

A) Hiring a doula is a good thing, especially if it turns out that your husband is still on a plane trying to get to you when the baby pops out.

B) Traffic police can be wonderful in rush hour in a city of 12+ million people. Two cops on a motorcycle (yes TWO) heard the mother hollering in the apartment building lobby and followed our taxi. They got the cop at the intersection to hold the light and let all of the cars through until our taxi got through.

C) Maybe it's a good thing I used to swear like a sailor because I think I heard every combination in the 8 pushes it took to get the little guy out :)

And that was my day.

Oh and it was not fun going 9 hours plus without pumping. The girls usually nurse every 2 - 3 hours during the day, but I think they did better than I did!

My newest article 1 of 3

2009-01-07T18:49:00.003+07:00

I just had published my 1st of 3 series articles published in the BAMBI magazine. So exciting to open up the magazine and see it in print!

Here it is:

Breastfeeding Your Toddler
By Erin Kannon

When I started on my breastfeeding journey over five years ago, I did not know a single woman who had breastfed her baby for more than a year. I was not aware that nursing a toddler was an option! As I read more about breastfeeding and had such success nursing my firstborn, I did not want to force my daughter to wean and learned that many women breastfeed past one year. During my research I was surprised to find that the World Health Organization (WHO) recommended breastfeeding for at least two years.

Breastfeeding a toddler can be a satisfying experience. Your breastmilk offers optimum nutrition because it contains everything your baby needs that he is not getting from solid foods, especially when he reaches the finicky or picky eating stages. Breastmilk will also promote better health past infancy as your body passes on antibodies as it did in the early months. You can expect fewer ear infections, more resistance against infection, fewer allergies, better dental health, a stronger immune system (from bloodstream to respiratory system to intestinal tract), and fewer skin problems such as eczema. If your child does become ill, breastmilk aids in hydration and is easily digested.

When breastfeeding a toddler, there are a few things that you need to keep in mind. Breastfed babies and toddlers tend to grow slower and do not “measure up” on growth charts. Remember that these growth charts are based on formula fed babies or toddlers that are weaned and drinking cow milk. Iron-rich foods are needed after one year as iron absorption is reduced after the addition of solids. Cavities are rare from breastfeeding at night but remember that you still need to practice normal dental hygiene with your toddler.

The toddler years are a time of emotional development for your toddler. Breastfeeding during this phase aids in attachment to the mother while feeling safe to explore and gain independence. You can also calm a child easier when he becomes hurt, is teething (natural analgesic), or needs to take a nap or go to bed.

Breastfeeding during the toddler years goes through phases. During the second year (13 to 24 months, the toddler is still more like a “baby” and will continue to breastfeed frequently. Many toddlers at this stage go through a “nursing strike”. Assume that your child is not ready to wean and look for other areas of discomfort such as a stuffy nose, sore mouth, or broken tooth. Also use this phase to teach a nursing code word, such as “Milkies” or “NumNums” or as it is in my house, “Mama Milk”. Expect your toddler to want to experiment with a variety of breastfeeding positions and want to use his hands all over the place, including your hair, belly button, ear, your other nipple, or his lunch. Consider using a “nursing necklace”, toy, or stuffed animal to help redirect those hands.

Breastfeeding through the “terrible twos” (24 to 36 months) can help to head off tantrums. Tantrums are usually a result of a situation that feels tense for a toddler who cannot yet communicate his needs. Breastfeeding can diffuse the situation and also help you calm down as well! Frequent breastfeeding at this age can come from stress, over-stimulation, or boredom. At this phase expect your toddler to discuss breastfeeding with you. He is old enough to understand any breastfeeding rules you may have such as waiting until naptime or after dinner.

Some women continue to breastfeed their toddlers when they reach three years old. A nursing strike at this age could be weaning. Many women find it easier to breastfeed at this age compared to the two year old stage. Expect to have more conversations during breastfeeding. Last week I was breastfeeding my son (he’s three) and he stopped to tell me “I fight dragons!!!” and went right back to eating! This is usually the age when toddlers will discuss breastfeeding and think about when they want to stop. You are definitely not nursing a baby anymore. If your child is breastfeeding at the age of four and beyond, he is still enjoying the time he spends with you and continues to receive the benefits of breastmilk. Breastfeeding will become a memory for your child.

You also benefit from breastfeeding for more than a year. You will have stronger bones and a lower risk of breast and other cancers. Breastfeeding can also suppress menstruation which helps with natural child-spacing. Note: You can NOT rely on breastfeeding your toddler for contraception! It is important for you to have good nutrition. Focusing on protein, calcium, iron and zinc will help you to continue producing a quantity of milk. One side affect of nursing a toddler is also a side affect when nursing infants: lower estrogen levels resulting in vaginal dryness. This may also decrease your interest in sex when the decreased hormones are combined with fatigue and sense of “constantly being touched” or “touched-out”.

A common breastfeeding difficulty that continues into the toddler years is nipple discomfort. It is still possible to get mastitis or thrush (yeast) so continue regular hygiene but no soap on the nipples. If you are pregnant again, expect to feel some tenderness. Discomfort can also come from the toddler teething. Work with your child’s latch and make sure that he knows how to let go of your nipple without grazing it with his teeth. “Gymnastics nursing,” when your child decides to breastfeed in any sort of creative position, can also lend to some discomfort as well.

Depending on your culture and where you live, you may or may not have to deal with criticisms of breastfeeding a baby past one year. Pressures from family, partner, or strangers can make you feel like weaning for not doing what everyone else does. Remember that breastfeeding your toddler is a mutual choice for both you and your child. You can choose to breastfeed in public or in private. Older toddlers can be delayed or use a “code” word for nursing. Any doubts can be overcome when you see that your child is happy, learning, and growing. This is chance for you to educate others about the benefits of extended breastfeeding and the recommendations by the WHO to breastfeed for longer.

At some point during your breastfeeding relationship with your child you will consider weaning. If you become pregnant you may or may not want to wean, but it is possible to continue breastfeeding during pregnancy. As your milk changes, your child might not like the taste and decide to wean on his own. If you feel that you need to wean, you can choose to do so gradually. Abrupt weaning is usually not easy for the child and can cause engorgement for you.

When do most children wean? Consider that our ancient ancestors breastfed for at least two to three years. Large mammals wean when their birth weight is quadrupled. For humans, this is two to three years old. Large primates wean when they reach 6 times the length of gestation, about 4.5 human years. Ultimately, it is up to you and your child. Child-led weaning tends to be the best for your child as he can determine when he no longer needs to be breastfed, emotionally or physically.

I never thought I would be breastfeeding a toddler. It has been one of the most fulfilling and satisfying experiences of my parenting years. Yes, there have been times that I felt like quitting, but I know that his health and bond with me are more important. You do not have to breastfeed your child forever. Take it one day at a time and enjoy every minute of it.

For further information:
Mothering Your Nursing Toddler by Norma Jane Bumgarner © 2000 (in the BAMBI library)
http://www.kellymom.com/ (general research-based information and forums)
http://www.mothering.com/ (articles and breastfeeding forums)
http://www.drjacknewman.com/Breastfeeding-help.asp (breastfeeding articles)

New 2009 and Beyond Goals

2009-01-02T13:28:00.003+07:00

The last time I wrote out goals was September of 2007 when my twins were just 3 months old. A lot has happened since then.

Here are the goals then:

17 September 2007
New Goals for 2007 and on

Dec 2007 - finish certificates in Natural Living and Natural Health with HAcres

Jan 2008 - do full-time enrollment with AAMI's midwifery program

Dec 2008 - complete CBI doula certification births

between these dates, I'd like to find some lactation education/consultant courses as well

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

Aug 2013 - return to Thailand and begin legal process to practice midwifery while teaching CBE and labor assisting

Wow, this is all so daunting, but seeing how many goals I met in the previous post make this seem a little more possible!

How did I do with those goals?
*I did not complete the Natural Living certifications yet BUT a lot of those books and assignments correspond with my midwifery studies so they'll be done when working on that segment.
*In Dec. of 2007 I got a scholarship for AAMI and enrolled. Deferred enrollment until the babies were one yr old and started up "full time" August 1st 2008.
*Finished the Doula Certification, so now I'm a certified doula!
*In October of 2008 I did enroll with a lactation counselor program. I've had many opportunities since then to help women with breastfeeding.

And now for my goals for 2009 and beyond:

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

It's hard at this point to give specific dates for accomplishing things as really it's just from one quarter to the next. I'll try to at least give a rundown each quarter for what I accomplished.

I have a few other personal goals, such as getting back to more walking and yoga. Blogging more on my green blog. Updating my twin blog because, you know, babies grow. Doing my Bible reading BEFORE studying midwifery!

Have a blessed 2009 everyone!

I'm going to Indonesia !!!!

2008-12-14T22:04:00.007+07:00

I applied to a birth clinic in Indonesia. We found out yesterday that I've been accepted for a short-term apprenticeship next June and July! The whole family will go!

From what I understand right now, we will rent a house within walking distance. My husband can bring the twins over whenever they need to nurse or I can run home quick when I get a minute here or there. Flights from Bangkok are cheap. I pay a monthly student fee to the birth center for training. Because I'm a beginner it will be just beginning clinical skills and most likely not catching babies, which is fine with me. I'm excited to get to learn anything in such a wonderful setting. The head midwife is a CPM from the USA. I can't wait to meet her and learn as much as I can from her as well.

Not much else to tell for now but I'll be getting more information over the next few months.

I'm the big 30

2008-11-26T20:21:00.003+07:00

Last week was my 30th birthday. I am amazed at how much my life has changed since I turned 20. At 20 I was dating and met my future in-laws. Now that was an adventure and I have pics to prove it. And then I got married. And then we moved to Thailand. And then came baby #1, and then #2. And then #3 and #4 came together. And now I'm this crazy lady following a dream that is slowly coming into reality. If you'd have told me all of this 10 years ago I would have never believed it.

One of my favorite Bible stories is of Joseph. He would have never thought he would be the one to save Egypt from famine. He went through trial after trial. Left in a pit to die. Sold into slavery. Accused of adultry. Put in prison. Dream interpreter. Advisor to the pharoah. Ultimately 2nd in command of one of the richest countries in the world. God was with him every step of the way preparing him for his next adventure/struggle.

I wonder if Joseph looked back at his life and saw God's hand in it leading him along, seeing that he was to turn this way or that. The story of Joseph helps me now. I can see where I've been. I can see God's hand as it led me, closed or opened doors, inspired me. I have hope for the future that He will continue to prepare my path. I cannot question what He will do for me in the future because I can see what he has already done.

When I see the task that God has put before me, midwifery school and serving women, at times I'm overwhelmed with just how much work it is and how much responsibility it will be. How I finish school, find an apprenticeship, found a homebirth practice, and more is already preplanned for me. God is guiding me in the way I should go and I know it will be the right way. Whenever I have a moment of doubt is when He seems to put me in a situation that confirms His plans for me.

So I'm 30 now. Where will I be in another 10 or 30?

Becoming a Lactation Counselor

2008-10-28T18:41:00.004+07:00

I decided that since I already had so many roles (pun intended) on my plate that another couldn't hurt.

I first got interested in birth work after the difficult time I had breastfeeding my first baby. I realized that there was no one available to come at my call to help me. There is only one fully trained lacation consultant (LC) in the whole country, Meena. (I didn't know about her at the time). She is so busy working at the only baby-friendly hospital and doing lactation work with other hospitals while also helping to enforce the WHO standards of forumla marketing.

Meena really encouraged me to consider going into lactation work as there was a great need for it and I had come to love working with breastfeeding women while working as a doula and childbirth educator. I enjoyed my training with Childbirth Int'l and was so excited to hear they were about to begin a certified lactation counselor course in October. I enrolled quickly to get an "early bird" discount on top of a graduate discount. I knew that my doula/CBE training was good for breastfeeding education and wanted something way more in depth. While the training will not be as in depth as a LC that is IBCLE trained, this is a close second I believe. This will focus some on education and a lot more on solving breastfeeding problems.

I began the course two weeks ago and I am so impressed. Right now I'm working through anatomy and physiology of breastfeeding. The breastfeeding COUNSELOR part is fascinating, and just by browsing what I will be studying, I know that the counseling skills will be a huge asset to my midwifery and doula services. A lot of what I do with women now is counseling. Sometimes it's just listening to birth stories. Other times it's helping to build a birth plan, explain information to a worried father, debunk baby-sleep myths, and more. What I also already like about the course is that all of the books I need to read and about 75% of the assignments can also be used for my midwifery education so I'm not having to do double the work!

Of course I can't know everything about every topic, though I wish I did. I now have a growing list of people that I can refer to when I know it's a situation that I can't handle. Breastfeeding problems that I can't solve go to Meena. If it's someone in need of major psychological help, depression, marital, etc problems, I have a Christian counseling group that I can refer to. (They're actually the parents of two of my former students!) The BAMBI group here also has support groups for everything from PPD to breast cancer to SIDS.

One of the requirements for certification is to support a minimum of eight women for a minimum of 3 hours each. Since enrolling, I got my first phonecall needing help with breastfeeding just this week. The baby was born 5 weeks early and I had JUST read the section on breastfeeding preemies which was so helpful! Breastfeeding counseling is going to be great for my family because it will be hours that I can schedule more easily than births that just happen when they happen. Will I earn money from this? Not very much, but I just love the satisfaction of helping a mother work through her breastfeeding problems or to establish breastfeeding with a newborn.

So how did I work through my problems of breastfeeding my firstborn? Well I suffered horribly for seven weeks. I suspected it was a latch problem as I heard "clicking" when she nursed. The nurse at the hospital had said she was doing fine before we were discharged. At the 4 week checkup, our pediatrician (supposedly trained in lactation) said, "oh she's just a noisy eater." Never mind that the baby was puking up her whole entire meal three times a day, my nipples were raw, and every second of nursing hurt. I went to a BAMBI meeting (similar to La Leche League) and that day, a woman from Canada was visiting. She just happend to be a LLL leader and said that maybe she could help. She took the time that no one else had bothered to do for me. She watched me breastfeed for over an hour, checked the positioning, the baby's mouth, and the latch. What I could not see over my engorged breasts was a baby that was sucking in her bottom lip! After correcting the latch and training the baby to open her mouth to latch and keep the lip down, breastfeeding was painless within 24 hours. No more puking because she wasn't swallowing in so much air.

I don't know the name of the woman who helped me, but she forever changed my views on breastfeeding. I learned that babies need to learn how to breastfeed as much as the mother does. I learned that women need the support immediately and not weeks later, as that's when most women give up. I was ready to quit a week later if breastfeeding was still not working. 6 to 8 weeks had been my goal anyway at the time. Wow so much has changed in my breastfeeding goals! My daughter was breastfed to 19 months. My son was breastfed to 19 months, weaned during the rest of my twin pregnancy, and unweaned shortly after their birth. He is still breastfed at over 3 years old. My twins are 15 months old and have never had a drop of formula or even a bottle! Nursing them has been a huge challenge and reward.

On to Orientation

2008-10-13T00:12:00.003+07:00

I finished all of the prerequisite work before my October 1st deadline. On to Orientation, which for someone working on it full-time, is supposed to be finished in 3 to 4 months. So my goal is 4 months, due Feb. 1st. Thankfully a lot of those assignments were already completed when I did the Intro to Midwifery course last year.

This month I'm working on Gentle Birth, Gentle Mothering by Sarah J. Buckley, an Australian GP who researches on unhindered birth and such. Very interesting and a must-read for all moms, and especially for my readers in New Zealand and Australia!

I'm also working on getting my bedroom more "office ready" as I have more women coming through needing checks, counseling, etc. Working with one mother due in two weeks and having fun palpating on her ever-growing tummy and baby. That baby stayed in one position for weeks and weeks and decided that was just too easy for me. Decided to go in a very awkward position that really made me wonder if the baby was breech posterior (RSA) or vertex posterior (ROP)... either position puts hands and feets poking out with bum and head hiding. Listening with fetoscope was difficult because with the back so far away and moving limbs I couldn't catch fetal heart tones (FHT for those learning my abbreviations) for more than 5 to 10 sec at a time. And the location of the FHT lended itself to again being one of those two postions. But this week, back to its favorite spot!

Phase 2 is done

2008-10-03T19:13:00.003+07:00

I just finished Phase 2 and requested the rest of the curriculum! The huge step only took 2 months to complete. Orientation is next and I'm giving myself a goal of 4 months to complete.

So what have I done in the last month?
Completed my inventory and documentation codes. Made a ton of charts. Set up my filing system. Started filing my piles of notes, clips, articles, handouts, etc. Read 3 books. Critiqued 9 articles on a variety of subjects. Wrote a few philosophy and formula papers.

This month I'm working on reading another book, commenting on 20 articles, creating client handouts, finishing some quizzes.

I did prenatal care for friend again yesterday. She's now 36 weeks. The baby had been in the same position the last few checks but yesterday decided that was too easy for me so switched it around some! Took me about 5 minutes (and with a very patient friend) to work around the wiggly parts to figure out the position. And when I went to check the heart rate couldn't count for long enough before the baby wiggled on away. I am just secretly wishing her labor goes so fast that she can't get across town and come to my house instead. In 15 minutes I'd have that bed pushed over to the side of the room, birth pool out and filling, supplies set up. I can dream can't I???

Birth as an American Rite of Passage

2008-09-08T11:29:00.006+07:00

I finally finished this book yesterday (along with a few other assignments). Very interesting on the rites and rituals performed in the medical model of birth and why women choose to birth this way. Really helped me understand why I feel called toward midwifery. And I didn't even have bad births. Which makes me want to respond to Letisha's blog:

LABOR MEME

Since it is labor day and what woman does not love to hear about other labor stories? So here we go!

How long were your labors?
#1: 4.5 hours
#2: 3.5 hours - today is his birthday!
#3 & #4: 5.5 hours

How did you know you were in labor?
#1: I went in for a 5-day late checkup and the monitor showed me having contractions. I could't feel them so I went home. After my water broke, it was labor.
#2: I was grocery shopping and having to stop every few minutes to catch my breath. Got home and after an hour of contractions while watching TV realized that maybe it was real contractions.
#3 & #4: Contractions woke me up.

Where did you deliver?
#1 - a natural birth suite at a hospital
#2 - at home with Certified Nurse Midwife
#3 & #4 - unassisted birth of twins at home, and YES IT WAS PLANNED

Drugs?
#1 - I opted for Demerol after it was heavily pushed on me; if only I'd known that I was so close to the end I would've refused

C-Section?
No way no how was I going to opt for a "Planned Cesarean" of twins as my "only" choice, so we stayed home.

Who Delivered?
I "birthed" my babies. Delivery is for pizzas.

We're back from the USA

2008-08-28T16:07:00.007+07:00

This post has been a long time coming. We visited the USA for all of June and July and have finally gotten back into our normal/regular routines for school.

Some midwifery-related news:

I was able to meet my sister-in-law's midwife this summer and got to tour her birth center. She was able to answer some questions for me and was happy to hear that I was enrolled in such a good midwifery program. That's now two SC midwives that I have met and can consider asking to apprentice with. I got to hear the baby's heartbeat at that appointment.

I brought back books from the USA. 200 POUNDS of books to be exact. Good thing we had a large luggage allowance! We just got a new bookcase for the bedroom and I need to put up a picture of all of my beautiful midwifery/birthing books collection. I have a library for midwifery students to drool over. I have saved and shopped and waited for the right prices for over a year. Over the 3 years that I've collected books, I've spent maybe $2500. That may seem like a lot, but the center shelf of my collection is mostly big textbooks and if I'd paid for just that shelf new, it would've cost $3000. I've paid probably 1/3 the price.

I am doing prenatal care for a mom here. This is her 4th pregnancy and she will be doing another hospital waterbirth. She figured I can give good if not better care than her OB and I see her every week for playgroup anyway. She said that if the baby is coming too fast as have some of her other births, she'll just come to my place and use the new birth pool I bought.

I started schooling full time August 1st. I have completed some work already but have not even finished orientation yet. I hope to be done with all of that by January 1st. My plan is to update on this blog once a week (somewhat for accountability, and also to appease other's curiosities). I'll do a weekend update of what I accomplished for that week. I've tried to get in 16hr a week but have been managing 10 to 12 which isn't too bad considering I have 3 little ones at home and one in school.

If all goes as planned, my family and I will be living in Indonesia next summer for 6 or so weeks. I have discovered a birth center there that is run by an American midwife. She trains student midwives and I am in much need of learning some clinical skills. My goal is to finish up my resume and attach that to an official application by Monday. I am so so excited. I've thought about it almost every day since I found out about it almost a year ago. The best part is that my family can come with me, it's a cheap place to live, and I can bring my twins who will most likely still be breastfed at almost 2yr old by then.

I just can't wait to see what this next school year has in store for me!

Yes, Twins & Triplets can be born naturally

2008-05-07T15:28:00.005+07:00

Natural Childbirth of Twins and Triplets!
(featuring me and babies, I think birth #3)

This video was created to educate women about their options for multiples birth. It was done in response to ICAN's video done about women's options for VBACs (Vaginal Birth After Cesarean). Since that's such a good video, I'll include it as well.

Question CPD (CPD is where the baby is too big to be birthed vaginally... very rare but one of the main reasons for C-sections today)

When it rains, it pours

2008-04-18T08:58:00.003+07:00

Hot season here... wish we'd get some rain... it's been 100+F for days now. Anyway....

When it rains, it pours. I can go for weeks and weeks with no one interesting in needing a doula or even wanting to talk about birth. I often pray and ask myself, is this really what I should be doing? I live in a country where C-sections are the norm for birth and there is rare evidence-based care. What can I do? And then there was this week:

Monday - I pray and ask, how can I know?

Tuesday - I go shopping and find some really nice skirts to fit my post-twin body. While poking around, I happen upon a store selling all the stuff for hot season. Including kiddie pools. I have looked high and low for a kiddie pool that would actually work for water births. I have found THE pool. Even Dayton helps me inspect it to see if we think it could work. I don't buy it, but now I knew where in this huge city that I can get one.

Wednesday - I get a call from "C". She is referred to me by another doula here. She wants a homebirth with a midwife or unassisted and wants me either as a doula or an untrained midwife. She's not sure yet, and neither am I. We have time and about until the Aug. 15th due date to figure it out. Someone wants to hire me.

Thursday morning - I go to our regular playgroup where I'm the oddball of the bunch. Should have seen the moms go bug-eyed when I nursed my 2.5yr old! A mom there "C" is pregnant with #4. The first 3 were waterbirths (2 here). With her last, she barely got to the hospital in time, and her husband caught the baby in the birth tub because her OB didn't make it in time. She said that she very well might not make it out of the house this time though she prefers the hospital. (Because she likes the postpartum vacation ?!?!? Okay, whatever.) But just in case it ends up being a precipitious birth, could I be prepared to come and help her with a homebirth?

Thursday evening- I get an official email from "S" and "W". They attended my crash course and had a birth plan for me to critique. And they want to hire me to attend their birth. Not sure if that will work. She's due June 7th and we leave for the USA June 11th. Also, with breastfeeding twins full time, I'm not sure how I can make that work just yet. They live about a 5 minute walk away so what I can do is help her stay at home for as long as possible and get her to the hospital with little time left for unnecessary interventions.

I'm just a doula. Not a trained midwife. I'm already being asked to do midwifery things. I can't wait until I'm fully trained and can do all of this skillfully. Even though I don't have the training (other than self-study and little hands-on) it's hard to say "no" to anyone because I think all women should have what they want for their birth. Women deserve a trained midwife at their birth. I'm on my way to provide that.

I'm certified!!! (and other info)

2008-04-01T11:39:00.004+07:00

As of this week, I am officially:

Erin Kannon, Doula (CD CBI) and Childbirth Educator (CBE CBI)

I finished all of the births and requirements needed! The two required births were fulfilled in a non-conventional way. The first was a friend who wanted me to doula at her unassisted birth (Hi "M"!) which ended up at my house... maybe she'll OK it for me to post about it here??? The second birth ended up being for a mom that I did all of the prenatal meetings with. Did not attend her C-section, but still gave many hours in a Postpartum Doula role helping with breastfeeding, etc..

Midwifery studies: Though I'm not supposed to start officially with AAMI until Aug. 1st, I'm going ahead and doing the pre-orientation paperwork. I'm also ordering tons (probably 100lb worth!) of books to bring back from our summer visit.

Recently I have been asked how I as a midwife would support a woman in unassisted birth. Many midwives do not support women wanting this option. I am obviously a big fan of unassisted birth: I did a UC with my twins! Let me paste in one of my assignments on the topic.

Unassisted Birth

Unassisted birth is a great option for most women, if they choose to go that route. Women choose to go unassisted for many reasons, such as the need for privacy, previous sexual abuse, lack of money, lack of insurance, no caregiver with the same birth philosophy, previous birth history, or no desire for assistance. I believe that planned unassisted birth is one of the safest options for childbirth. Yes, most women choose a midwife for homebirth, but that isn’t necessarily always safe depending on the midwife’s ways of practice. It is unfortunate that little to no research has been done on this aspect of childbirth.
Living in a country with no options for childbirth other than high-intervention hospitals, I do know of some women who have chosen unassisted birth. I did labor support for one woman on one of the remote islands … over the phone! I am currently pregnant with twins and am planning an unassisted birth for my babies. I refuse the risky testing, “high risk” label, or the “necessary planned” C-section.
As a future midwife, I would be willing to offer support to pregnant women wanting unassisted births. That could be in any prenatal facet, for phone support during labor, coming over to assist when asked, to do postpartum checks, or to help with a birth certificate. The legal situation for a midwife doing this maybe be questionable, but I believe that women have the right to choose what they want for their own medical care and birth.

"crash course"

2008-03-03T13:38:00.003+07:00

I had so much fun on Saturday that I had to share! I was approached a few months ago by a mother pregnant for the second time. She was looking for childbirth classes locally for her and a friend. I invited them to my house to just meet and answer some questions. She called me again about a month ago and asked if I could do a one-day class. She arranged lunch and childcare, and I taught. I normally teach 18hour classes, so to narrow it down to about 6 hours took some work. We covered stages of labor, how to communicate with the doctor before and during labor, breastfeeding, and a variety of other topics. Three couples attended and it was a great learning experience for them.

Now that I'm done teaching that class, I can get on to other pressing matters. In April I will be teaching the pregnancy and birth section for the highschool anatomy class. I did the same last year and have been invited back!

At some point I do need to finish those articles.

We will be traveling to the USA for June and July so of course lots of preparations to do.

And sadly... I fired our housekeeper (leaving the iron on for 2 days was the final offense) and our part-time turning full-time nanny decided to quit the next day and go back to school instead. So, for the first time in years I'm cleaning my own house. Which means no time for study. We will probably wait to hire someone new until we come back after the summer. Praise God I only have a small 800 sq. ft. apartment to take care of!

Scholarship!!!!

2008-01-16T14:41:00.001+07:00

I know this blog has been quiet, but I've been working! Every 3 months AAMI (my midwifery school) does a drawing and one of the prizes is 1/2 off tuition scholarship. To be a part of the drawing, you're given about 20 questions over a 3 month period. These questions have to be well researched with citations given. Not easy. I could only do about 7 of them. BUT, I won a scholarship! So, I called Carla, the head of the school and we talked for about half an hour. She totally thinks I can do the whole program from here and was also so excited to have a Christian missionary enrolling. She said she'd do anything she could to help me out with finding books and such.

So, I enrolled! And the neat thing is that I can postpone my start date for up to a year. I decided that August 1st would be a good starting time because a) I have time to get my house ready and study area set up b) twins will be over a year old and more routined with afternoon naps, c) regular school will be starting soon after that d) I'll have had the summer to collect textbooks. I'm so so excited!!!

On a different topic, I'm writing 3 articles for the pregnancy/parenting magazine that is a part of BAMBI (Babies & Mothers of Bangkok Int'l). It's a 3-part series: Breastfeeding Toddlers, Breastfeeding during Pregnancy, Tandem Breastfeeding. I've really enjoyed doing the research since it's relevant to me as well. I'm not only nursing 6mo old twins... I'm also still nursing my over 2-yr old as well. It's got it's own set of challenges! I'll post the articles as they are done. Also I still need to post the adventure of my friend having an unassisted birth at my house.

Having twins is busy busy, but I am so thankful to live in a country where I can hire someone to help me, which also gives me a little bit of free time to study and do what I love!

New Goals for 2007 and on

2007-09-17T13:43:00.001+07:00

Dec 2007 - finish certificates in Natural Living and Natural Health with HAcres

Jan 2008 - do full-time enrollment with AAMI's midwifery program

Dec 2008 - complete CBI doula certification births

between these dates, I'd like to find some lactation education/consultant courses as well

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

Aug 2013 - return to Thailand and begin legal process to practice midwifery while teaching CBE and labor assisting

Wow, this is all so daunting, but seeing how many goals I met in the previous post make this seem a little more possible!

My Goals Revisited

2007-08-25T16:17:00.001+07:00

Hi Everyone!! Been a long time since posting, but after a twin pregnancy and now 5 week old twins, posting wasn't so important for a while. Now in the process of updating all blogs.

In my Feb. 4, 2006 post, I listed my goals for the next few years. I figure now that the babies are here and I have a few minutes during the day, I need to know where I was to know where to pick back up. Next post, I'll update my goals.

Here's what I put in Feb. 2006 and what I did with that goal.

2 more children fit somewhere into the scheme of this...And I'm sure the dates will change (well, who would've thought this would come true so fast. twins definitely fit the "2 more children" bit!)
Feb 2006 - enroll with CBI (Childbirth International) Doula and
Childbirth Educator program (DONE)
June 2006 - finish certificates in Natural Living and Natural Health with HAcres (not done, started up again this week, should finish in about 3 months)
June 2007 - finish CBI training unless certification births not available (July 2007, finished my Childbirth Educator portions, just waiting for feedback and certification in the mail. Doula portion, I need two more births... not easy with nursing two babies... maybe a long time before this happens)
June 2007 - enroll with AAMI (Ancient Art Midwifery Institute), beginning with their ITM (Intro to Midwifery) course (enrolled Dec. 2006)
Dec 2007 - finish ITM (finished July 2007 barely meeting the due date, exactly one week before the babies arrived!... a different post coming up about the course)
the next 3 goals are still in the plans
Jan 2008 - enroll with AAMI's midwifery program or NMI (National Midwifery Institute)
June 2012 - finish AAMI course, apprentice, take NARM exam
during our 1 year sabbatical in the US
August 2013 - return to Thailand and begin legal process to practice midwifery while teaching CBE and labor assisting

so close!

2007-07-06T10:24:00.001+07:00

I am so close to being finished with my assignments! Everything is coming together. I've really had to push through even though I'm tired because the whole packet of work has to be printed out, copied, put in a binder and postmarked by the 11th of July, which is in 5 days!!! I still have 2 small assignments and 2 research papers to finish. If I can keep these babies in long enough to finish I'll be happy. No signs of labor by the way so I'm plugging along.

One of my assignments was to answer the question:
Can there ever be too many midwives in one area?
Here's what I wrote:

There can never be too many midwives in one area for a variety of reasons, such as client preference, skill level, consultation, alternative health options, midwifery training, and political aspects of midwifery.

When there are many midwives to choose from, the client can interview more than one midwife instead of being “stuck” with the only one available. Since midwives have a variety of personalities and many backgrounds (religious, political, etc.) the client can decide which midwife would support her best in
her decisions. If the client later finds that the midwife is not as
expected there are others to choose from. If the midwife decides that she is not comfortable with her client, open communication and referring to another midwife is also possible.

Skill levels will vary from one midwife to another. Some women feel more comfortable being served by a midwife with years of experience. Others find that they much prefer someone younger or with “newer” training. Most midwives continue their education long past midwifery school or apprenticeship, but many women don’t know that. And of course there are midwives that do not continue their education. Some midwives have a lot of experience in certain types of pregnancies, such as breech or multiple births. Women would have an option of transferring care to someone with more experience in these instances.

Some midwives get tired of being “on call” all the time or have small children for a while. Working as a consultant with set hours can be a solution for the midwife, an asset to other midwives, and help many women in the meantime. Areas of consultation could cover childbirth education, limited labor support, or breastfeeding assistance.

As midwives continue their studies, they may find other areas of interest and branch off from midwifery into fields that support midwifery. These areas could include herbology, nutrition, and homeopathy. Other midwives would be able to consult with them or transfer portions of care to these midwives and work in partnership to support women holistically.

In an area with many midwives with a variety of expertise, midwifery education can be more readily available. Apprentices will have many options for training, while busy midwives would have apprentices available to help with their client base. A local midwifery school could be opened with local midwives (who like to teach) covering all facets of midwifery.

Finally, some midwives are great at writing proposals,requesting grants, and getting politically involved. It takes great organization and passion to petition medical and state boards to legalize midwifery. If midwifery is legal, then to keep birthing options available to women who would want a VBAC, for example. With more midwives in one area, there will be more awareness of midwifery and birth options in that area, making it more accepted.

Too many midwives in one area? Never.

Dragging my heels

2007-04-26T22:54:00.001+07:00

I have gotten very little work done. I'm probably going to have to get an extention for deadlines. Between being sick, pregnant x 2, and no childcare help, it's not going well. I've gotten maybe 20% done and I should be almost 75% done by my goal sheet.

I've been re-reading Henci Goer's Thinking Woman's Guide to a Better Birth for one of my assignments. Just worked through the C-section chapter and it really reinforced my decision for my own upcoming twin birth. If I do have a C-section it will be for a very good reason.

I still need 2 births for my certification. Even though I'm getting a little big to do great doula support, I've said tentatively that I can support through end of May. I'm on call next week as backup doula and think I may be asked by one or 2 others. We'll see!

Midwifery school

2007-03-13T22:28:00.002+07:00

In December I decided that I would apply for the school I was interested in before the tuition went up. So I applied to Ancient Art Midwifery Institute aka AAMI. I decided to apply just to their Intro to Midwifery course to see if I would really like the program before committing to the whole thing.

Two days AFTER finding out we were expecting twins, I get my first study packet in the mail. Oh my goodness, there is sooooo much work to do. (that would explain my lack of attention to my blogs!) So now I have book reviews, papers, critiques, interviews, practice tests, etc. to do. All due before July 11th. I've written out my goals for each week just to get it done in time. My goal is to have it all done by June 15.

The administrator of the school is a Christian and said that when I apply for the whole program she'll give me a discount for being a missionary!

What I like about the school is that you get all of the assignments at once. Then you can decide what you're most interested in to start with. It's not an accredited school because they don't require apprenticeship during the studies (though it's encouraged). They don't offer a degree but expect that all their students do an apprenticeship and then work towards being licensed or towards the CPM (Certified Professional Midwife). Supposedly this is the most difficult midwifery school out there. Many midwives use it for continuing education or because their school wasn't in depth enough. After looking at the materials, it's more like getting 2 whole extra degrees!

I'm so excited! At first I thought that having twins would just put me so much more behind schedule, but then I realized... Hey! I'm two years ahead of schedule, because we're probably done having kids after this!

Now, back to work for me!

CBE class birth outcomes

2007-02-08T00:23:00.002+07:00

All of the mamas in my first childbirth ed classes have had their babies. We had a fabulous class reunion where everyone shared their birth stories, showed off their babies, and discussed what it was like being new parents.

First birth: They were using a gov't hospital and the doctor had been talking about C-sections from day one. Guess what she got? First he tried the "your pelvis is too small" excuse. Then the "you're too fat for vaginal birth" excuse. Then the "you have PIH (pregnancy induced hypertension" excuse. Well, they fell for the PIH one. Her blood pressure was slightly elevated but in the safe range. AND the doctor recommended c-section when inducing would have been the safer, evidence-based alternative. The baby was born on its due date by C-section. The hospital kept the baby for "observation" for 2 days and breast-feeding was a nightmare. As I said in my classes, you get what you sign up for. If you know your doctor has a high C-section or intervention rate, you're playing the odds that you'll get the same. They are happy overall. Breastfeeding lasted less than 6 weeks after she went back to work =(

Second birth: Mama was at a great natural-birth hospital, totally set on natural birth. Went 8 days overdue. Decided she wanted the baby out "because it's more days I can spend with him before I go back to work." So she traded 1 or 2 more days inside for an unnecessary C-section. What happened? EXACTLY as the "mock scenario" we played out in class. She asks for her water to be broken. Never mind she'd been slowly in labor the last couple days. We had discussed the risks of the water being broken. But that's what happened, and the result? A posterior baby. The early "prodromal" labor that happens for a few days is usually the uterus rotating the baby into a better birthing position. So the baby is posterior, she has major back labor, not dilated enough to get in the birth tub, so asks for... an epidural. The epidural eventually wears out, so it gets topped off. A typical side affect happens to her... too low blood pressure. So they give her a drug to keep it up. The result? The baby's heart rate goes way up. So all of a sudden... ding ding ding. Emergency, must get out baby NOW. Aaaarrrggghhh. See the cascade of interventions here? Well, at least breastfeeding is going fabulous for them.

Third birth: Aaahh, finally a vaginal birth. I was supposed to doula for them, but she went into labor 3 weeks before her due date, didn't have my contact info with them (since they'd gone in for an appointment and they realized she was in labor), and so I missed a birth =( She was in labor, but the doctor wanted to using EFM (electric fetal monitoring) to see what was going on. It was showing the baby's heart rate reacting slowly to contractions. Her doctor said, you need a C-section now. She said, "no way." The doctor said, your baby is going to die then. She says, "no, I do not consent to a C-section." They waited a little while and she prayed and prayed and had more EFM done. Which showed the heart rate doing better, so the doctor said, yes you can "try" for a vaginal birth, but you have to have EFM during your whole labor. What that means is you are stuck on the bed during all of labor and can really do nothing for pain management. My hero stuck to her plans. Yes, her water was broken, yes, she was stuck on her bed, but 4 hours later and NO PAIN DRUGS, birthed a beautiful 5 lb 5oz baby!! She said she wanted me there so bad, but I told her when visiting her at the hospital... "What did you need me for? You did just fine." Breastfeeding went really well, until she went back to work 8 weeks later.

I have advertisements out for a new series starting up, but no responses yet. In a way, I'm hoping no one wants classes right now as I'm too tired, but I really love the teaching and want more of it!

Two new blogs

2007-02-06T14:12:00.000+07:00

After feeling pulled in various directions and wanting to keep this blog focused on my midwifery studies and birth work, I decided I just needed to keep it separate. So, with no posts on either, I have set up two new blogs. The green living one is what I had actually wanted to begin before doing this midwifery one. It is vital to how we live and how our future will be. THe other one will be more personal. I've titled it "Twins, Two" but it will have more personal, family, updates, what's going on etc.

I have very little time to blog right now between trying to finish up some studies, fit in a Beth Moore study, train a new maid, gestate, etc.! I'll try to do at least 1 entry per blog per week... though I have a feeling the twin one will go faster since I have so much that needs catching up!

Links to the blogs are in the sidebar! I'd put it here but that takes more effort =)

I have a new computer!

2007-01-29T15:15:00.001+07:00

Hello to all of my faithful blog readers! After 2 months with sporadic email on my husband's computer, I now have my own new computer to go crazy on! And a wonderful wide/flat screen to go with it, which is nice since I have to share with my daughter. She does her ABCs program on one side while I read and browse on the other. Now if only there was a way to hook up two mouses to the computer!!!

I have so so much to blog about, so these will be the topics for the next little while. Birth outcomes from my first childbirth class series. Rants on C-sections. My application to midwifery school. Unassisted birth. And much much more. I am considering doing two new separate blogs... one about our new twins on the way... one about green living.

I've really enjoyed reading all of your blogs. In fact, one of my blog readers (Hi Merri!) found me by looking up midwifery and Thailand. She has since moved to Thailand with her husband and two children (close to same ages as mine), attends my church, and is quickly becoming a fabulous friend. You just never know what blogging will bring to you or teach you!

Not a birth to attend

2006-11-24T19:49:00.000+07:00

Some of you wanted to know if I'll attend my friend's birth. Nope. Unfortunately, she thinks her highly interventive, epidural giving OB is her almighty savior from labor pain. Aaaarrggghhh. I haven't pushed anything on her. She just thinks that women shouldn't have to "suffer" in this day and age of medicine. Nevermind that God's creation was designed to give birth, and for some women, a painless birth.

Isaiah's birth I consider painless. Lot's of pressure, but a wonderful and easy birth.

Let's pray that our upcoming August baby's birth will be just as wonderful.

Yes, you just read that right. =)

practiced clinical skills

2006-11-18T17:47:00.001+07:00

One of my pregnant friends is due next week. She called me up and asked if she could come over for a while since she's stopped working for a while. So she came over and asked if I wanted to practice on her!

She had gone to see her OB the day before so already knew what the results should be. Kindof good to have as the "answer key" for my findings. Especially since I'm quite the beginner!

I've been practicing taking blood pressure on Dayton a lot, so I sure wanted to get it right the first time, especially on a pregnant lady! Well, got it right the first time, and it was very close to what her BP had been the day before. Score: A+

Next came palpation. Ever tried to find all the parts of a baby through quite a squishy pregnant belly? Not easy. I figured it out after about 3 minutes. I at first second guessed myself because the baby was in a different from normal position. I told her that I thought I knew all the parts and I was right! Unfortunate for her though, the baby is not in a great position. Let's hope it moves a little more in the next week or so. I also enjoyed actually being able to feel the baby's neck and chin so well. I'm predicting a small baby, around 7lb. Did not feel big. Score: A+.

Finally, finding fetal heart tones. First time I've ever used a fetoscope (non-doppler/ultrasound) on a mom before. I knew where it was supposed to go in relation to the baby, and I found it on the first try. I handed the earpieces to her and she got to hear the baby's heart also. Score: A+

Well, that was the highlight of the week!

Birds & Bees - Grace version

2006-11-14T20:44:00.001+07:00

Dayton and I were discussing the other day how we're going to start trying for baby #3. Grace overhears this and here goes the conversation:

Grace: Is there a baby in your tummy mommy?
Me: No, not yet.
Grace: Why?
Me: Because Mommy and Daddy haven't put one there yet.
Grace: Daddy?
Dayton: Yes, Daddy helps.
Grace: No he doesn't, silly daddy.
Me: He does help.
Grace: Why?
Dayton: Because Daddy likes to help! (winks at me)

Grace then goes on to say she doesn't get it. So here's the birds and the bees explanation for a 3yr old.

Me: Mommy has eggs in her tummy.
Grace: 2 eggs?
Me: Lots of eggs. And then daddy waters the eggs. Then a baby grows and gets born after a long time.
Grace: Oooh. And when it gets born, mommy gets a big tummy ache. And she pushes and pushes. And it hurts. And the baby comes out of the 'gina.
Me: Yes that's right! You're a smart little girl.

The next morning, the minute Grace wakes up:
Mommy, did daddy water your eggs last night
Me: No, not yet.

She totally gets pregnancy and birth from all of the birth clips we watch together. There's the 3yr old version for you.

Almost done!

2006-11-10T15:58:00.001+07:00

I finished teaching my childbirth classes a couple weeks ago. Got really good feedback/evaluations.

Only downside? I "worked myself out of a job." I was going to attend J & R's birth but they said they no longer needed me since attending my class. Happy that they got so much out of the class but sad that I'm not needed. =( It is so hard to find births to attend! Now what am I going to do?

To complete my childbirth educator certification, all I have to do is submit my work (proof) of teaching my classes. Also have to audit a 12 hour childbirth class. I'm doing that right now at a local hospital where two local doulas are teaching. Interesting to see it from a different and non-Christian viewpoint. 6 couples from all over the world makes it interesting! To complete my doula certification, all I have to do is attend 2 more births. That's it!

Police Arrest 150 More Christians

2006-11-01T11:36:00.001+07:00

Thought some of you might find this interesting. Christians are continuously persecuted in Eritrea (NE Africa).

Compass Direct News reports that in a large-scale roundup the past week, Eritrean authorities have detained 150 Christians from at least five of the country’s outlawed churches. Starting Wednesday (October 25), security officers in the town of Mendefera began going from house to house, arresting local Christians from a list they compiled of known members of Pentecostal churches and the Orthodox renewal movement. During the first day’s raids, a total of 38 men and 17 women were incarcerated at the military fort in Mendefera, 30 miles south of Asmara. Local sources confirmed to Compass that police authorities were subjecting the detained Christians to beatings and other physical mistreatment. According to eyewitnesses, at least 10 nursing mothers were among the new prisoners, all of them forced to leave their infants behind.

Having Fun Teaching!

2006-10-17T21:55:00.001+07:00

Sorry I haven't been posting much. All of my spare computer time (in addition to sharing the computer with my daughter!) goes to preparations for my childbirth class. Once this series is finished I'll have all handouts and materials made. For future classes, I can just make copies and alter the course as I get feedback.

So how have these classes gone?

Class One: One of the moms came to me earlier that morning (we meet Sundays after the morning service and lunch). Her husband did NOT want to come. Near the beginning of the class, I had the moms explain to their husbands why it was important for them both to be there. By the end of the class, I overheard the reluctant husband enthusiastically saying, "see you next week" to the other dads! 5 out of 6 parents are Filipino but the English level seems pretty good, so no major problems there. So funny watching them try to figure out how the fetus doll fits through the pelvis. Moms were slightly embarrassed when we talked about perineal massage and kegels. Good thing the men weren't present for that part!

Class Two: Understanding Labor. They were shocked at the sounds women make during labor. Really liked the birth video clips. Answered lots of questions.

Class Three: They were all really involved, especially trying out different labor and pushing positions. I videotaped that class. A little un-nerving to do that but I'm already a teacher anyway so not too nervous. All of the couples at this point seem to really enjoy each other's company and aren't embarrassed talking about things in front of each other.

Took 2 weeks off. Dayton was out of town for one weekend, and 2 out of 3 couples were sick for the next. Can't miss anymore though because 2 of the 3 moms are due 2 weeks after the last class!!!

Class Four: Teaching about interventions seemed to scare them a little bit. Especially because most of them are using assembly-line like Thai gov't hospitals. We talked about evidence-based information and how to make it work for them. I'm a little scared for them... In this culture, you never question a doctor about anything. I've taught them how to ask open-ended questions so that they'll know what their doctor will probably try to do. We had a mock induction. They were amazed at the cascade of interventions.

Class Five: Next week we'll be talking about Cesareans, post-partum depression, dealing with the unexpected, sex & birth control after the birth, and much more. We're starting to work our way towards the parenting topics in class six. I've had a lot of work to do on this class because most of it I've created since it's mostly topics by request from the parents.

Class Six: Breastfeeding and parenting. This one is going to be easy with the breastfeeding, but difficult with the parenting. It will be very hard for me to not be biased, especially about vaccinations and circumsizing (both I'm against). I think it's best for me to give an evidence-based handout on them and not talk on those topics. And a few handouts specific to Filipinos so that they don't think it's an American agenda. Have to tread carefully there!

So that's basically what I've been up to. I have all of these great things I'd like to blog about. But just no time right now. Am making mental notes on them.

my resources

2006-09-15T22:49:00.001+07:00

I've had a few people ask about what resources I use in my childbirth classes. I use a combination of:

the Bible!

Childbirth International resources
some of Transition to Parenthood's pages

and many books, such as:
Henci Goer's The Thinking Woman's Guide to a Better Birth
Penny Simkins "Pregnancy, Childbirth, and the Newborn" and "The Birth Partner"
Ina May Gaskins "Ina May's Guide to Childbirth"
Myles "Textbook for Midwives"
Elizabeth Davis' "Heart and Hands"
Dr. Sears "The Pregnancy Book" and "The Birth Book" and "The Breastfeeding Book"
Mary Renfrews "Bestfeeding"
Nilsson's "A Child is Born"
and many many more I can't think of right now.

Some of my other resources come from direct conversations or online forums with other midwives, doulas, and childbirth educators.

I thought Isaiah would NEVER...

2006-09-09T23:23:00.001+07:00

... exclusively breastfeed for a year! But we did it!

Isaiah turned 1 years old yesterday!!! My how the time has flown.

For the entire year, his only source of nourishment was breastmilk. That is a huge feat to accomplish in society today. "But he's 6mo old and NEEDS solids." Nope. Look at those chunky thighs. "But he's 9mo old and is ANEMIC." Nope. Did that blood test just to prove the pediatrician wrong. "But he won't like solids because he missed that developmental window." Nope. Look at him chow down on that cucumber today.

Why is there such a rush to add solids, when breastmilk alone gives all of the nutrients and calories a baby needs for at least the 1st year of life? I have 2 theories. The first: there is no education and support for new mothers. The second: awful, money-hungry, infant formula poisoning companies, such as Mead Johnson and Nestle to name a couple.

So what can we nursing moms do? Nurse in public and show breastfeeding as something normal and natural and easy to do. Kindly educate those pregnant mothers we see. Destroy all copies of Babywise (and similar schedule feeding books) that we can find. Petition formula companies to put a label (similar to cigarettes) that says formula feeding can be hazardous to babies health. Teach a breastfeeding class.

I think at this time last year I thought that I would NEVER feel as strongly about breastfeeding as I do now. Thank you to my little son for all of the wonderful hours we've spent together.

It's official!

2006-09-01T22:35:00.001+07:00

Introducing:

Pregnancy, Childbirth, and a New Life

A childbirth and parenting preparation class

Location: Calvary Baptist Church
Time: Sundays, from 1pm to 4pm
Dates: 6 weeks of classes, from September 10th – October 15th
Cost: 500 B donation to cover expenses for handouts and materials

What you will learn:

Week One (Sep. 10th): Pregnancy & the Pelvis
Week Two (Sep. 17th): Understanding Labor
Week Three (Sep. 24th): Labor Toolkit
Week Four (Oct. 1st): Interventions & Making Decisions
Week Five (Oct. 8th): Birthing in Bangkok & After the Birth
Week Six (Oct. 15th): Breastfeeding & Parenting

Other information: Please come to these classes prepared to learn, participate, and have fun! You will learn information and skills to assist you at this very important time in your lives. If you cannot afford 500 B, please let me know.

Questions? Call or e-mail.

(edited out a few things since this is public)

Update on Isaiah

2006-08-30T22:16:00.000+07:00

Yesterday Isaiah developed quite a cough, so I rescheduled his (and Grace's) well-baby visit for today to go see their regular pediatrician.

I love his pediatrician! She is so supportive of all of our decisions, especially when it comes to us not vaccinating, extended breastfeeding, and vegetarian eating! She immediately said she wanted him off of antibiotics, which was great news to me. After listening to his lungs for quite a while, she decided another chest x-ray would be good since she could hear something "off." He still has some fluid, but that will slowly go away, no pneumonia, but just watch the cough and if it gets worse, we'll do something more aggressive with it.

Grace's visit wasn't so nice. She's off the growth chart underweight again. It's been a longterm battle to get her to eat anything of substance. If only I hadn't gotten her weaned by 19mo. (My goal with Isaiah is at LEAST to go to 2 years old) In addition to that news, it was almost impossible to check anything. At 3 yr old, she knows that doctors can hurt! But she's healthy.

So, Praise the Lord we are not dealing with any serious side affects from last week's accident!

Isaiah is ALIVE!

2006-08-25T20:54:00.000+07:00

We had a near drowning accident yesterday. Spent the night in the hospital and are now home.

Grace and Isaiah were in the bathtub together. DH was watching them but fell asleep! I didn't know he was sleeping but heard an odd sound from the bathroom and yelled at DH to get up as I ran to the bathroom. Grace had put Isaiah on his stomach with his head in the water (about 2 in.) and was sitting on him. DH pulled him out of the water and handed him directly to me. He was totally blue, floppy, and not breathing at all. I have no idea how long he was actually under water.

I held him face down, almost upside down and pounded his back. Sat him up and kindof heimliched his stomach. Tipped up back over and still nothing. 3 minutes had passed. I pounded on his back, then felt a slight twitch. He was still alive! I pounded more and finally water started coming out of his lungs. DH took over and held him upside down as I stimulated him to get more water out. He finally took a tiny wheeze of breath. I didn't have to do CPR. There was still too much water in him, so we turned him on his side and got him to spit out more water. His eyes were rolling in his head.

I grabbed my birth supplies bag that has some supplies in it and pulled out a bulb syringe. I suction huge gobs of flem from his nose. Stuck it down his throat and suctioned more. It hit his gag reflex and he threw up a lot of water. Finally started breathing better. He opened his eyes. I threw a sposie on him, DH pulled a dress over DD's head, and we ran out to the car. We drove to the emergency room. There is no 911 here.

I was too freaked out to remember the words I needed in Thai. I kept saying "he needs oxygen NOW!" They wanted to check his temperature and blood pressure. It had been 25 minutes since we first found him. They check his BP and then realize he needs oxygen NOW. Within 2 minutes, he was breathing much better, better color. Once he was stable, they took a chest X-ray which showed some fluid on the lungs. Blood work showed elevated white blood cells.

The pediatrician (who thankfully spoke much better English) said he may get pneumonia or an infection. After 16hr on IV with antibiotics, no fever, they sent us home. He is acting his normal self. Grace has no idea that she almost killed her brother. We are still in shock. We now wait and watch for fever or coughing and possible pneumonia, but he seems to be doing well.

We praise God that he spared our son's life.
Erin

Which path to midwifery?

2006-08-21T15:17:00.001+07:00

I've been reading through Paths to Becoming a Midwife: Getting an Education. I really really want to go the direct-entry/CPM route. But, to even have the slightest chance of working here legally, I almost have to go the CNM (nurse) route. I do not like the active management of most nurse-midwives, or that most have to work in hospitals being told what to do by doctors who do not understand true natural birth. Even if not in a hospital, they have so many obstacles to overcome. If I were living in the USA, it'd not be the way for me to go.

The CPM will work in the USA but most likely not be recognized here. CPM is expectant management and the approach that I will take. So what to do??? Too soon to make the big decision. I know what I want in my heart.

I once was a nerd...

2006-08-16T00:26:00.000+07:00

Why am I online at 12:30am? I was trying to work on some childbirth class handouts but I got sidetracked ... thanks Leticia ...

Wow! I'm nowhere near as nerdy as I used to be! Of course they didn't ask me what OFP, or ROA, or HELLP, or AROM mean. Though I'm sure the more nerdy Leticia would know ...

Back to Blogging

2006-08-07T15:45:00.001+07:00

Hello readers! After a nice long visit to the USA for the summer, I'm back in Bangkok and "back to work"

I've been busy planning my first childbirth ed. class scheduled for September, making contacts with local breastfeeding consultants or teachers, studying midwifery on my own, helping my husband get ready for this school year, etc..

Began cloth diapering a week ago, and it's going well... the hard part isn't the diaper, it's getting the kid to lay still long enough to get it on!

I got a printer finally! Now I can be getting my handouts and visuals ready for classes.

I'll post some pictures in a few days.

AND a lactation specialist too?

2006-06-07T00:29:00.001+07:00

Should I pursue this too? There is only one certified lactation counselor in all of Thailand and she mainly helps moms at the hospital where she works. Not good! I'm filling in as best as I can, with no formal training, unless you can count having read 3 breastfeeding books as formal!

My most recent experience. We have many missionaries visit our church from surrounding countries. Whenever I see a pregnant mama, I pretty much know she's flown into Bangkok to have her baby because China, Vietnam, Cambodia, and Laos don't have good medical care. So they come here for high-tech, highly-unnatural childbirth instead! But at least they won't be sterilized (like in China) or exposed to AIDS (like in Vietnam and China) or have complications that can't be treated (like in Cambodia).

4 weeks ago, I met C and M, missionaries from a local communist country. She was 37 weeks pregnant, due with their first. They were using Bumrungrad hospital, the "best" hospital in Bangkok. It has an 80% C-section rate!!!!! Your odds are not good for a natural delivery there. Most labor and delivery nurses there have NEVER seen an unmedicated vaginal delivery. So we all talked a little bit, and later, I gave her my contact info saying I could help with labor assistance, childbirth ed (which they hadn't done), and breastfeeding basics.

I saw her at 40weeks (on her due date!) and she still had not dropped, which is really strange for a first baby. Felt her tummy and could tell it wasn't quite right. I didn't tell her that, but I knew that either the baby was too big to drop (not very likely) or that she had a malposition. They called me Thursday morning to say that she'd had a C-section. Her water had broken, no contractions after 6 hours, and the baby had not dropped. I think if she'd waited for contractions (up to 24 hr) and given her baby time, the baby should have rotated and corrected itself.

Bigger baby too. 4.4kg (9lb 12oz). But not too big. The nurses and pediatrician said the baby was too big and that formula supplementation was needed. Crazy!!! They wouldn't bring her the baby to breastfeed or would sneak bottles and then the baby wouldn't want to nurse. How did they teach her to nurse? Showed her a video!! So in desparation and having NO ONE else to ask for help, they called me. After 1.5 hours, the baby nursed 2 times, having some trouble latching, but it was better than before. I taught them the basics of breastfeeding, gave moral support, and one order. Keep the baby in the room at all times and NO MORE BOTTLES.

I am so happy to announce that the baby is now 100% breastfed! I apologized to them at the time that I couldn't help them as much as they needed since I'm not really trained in it. Just some experience. I felt so inadequate. I learned some basics with my doula/CBE training but I was still overwhelmed. Guess I'll either get that with midwifery training or try to get some training somewhere else. Unfortunately, I'd have to work with another lactation specialist, but none of those are willing or here! Hmm, one more thing to add to my studies!

New Life Childbirth!

2006-05-18T15:15:00.001+07:00

I have been just too busy to blog! We are leaving for a visit to the States in less than 4 weeks. Things to order online, packing lists, to buy lists, collecting things to keep Grace busy on the plane, finding places to stay. If our families only knew just how much is involved for a 7 week trip!

New Life Childbirth. That's the offical chosen name for the business. It'll work for what I'm doing now and will still work for midwifery as well. It is not overtly Christian, but obviously has the double meaning. I'm still working on coming up with a logo. Not a good artist. I'll have to try to get Dayton to make something for me... though he tends to be better at drawing armor, tanks, airplanes, and guns...

And, it's official! I've been asked to teach a childbirth education class in September. Now I'm trying to finish up the requirements I need so I can count it towards my certification with CBI. I need to find a place to teach it that has the facilities I need. I'd teach it at my house, but it feels too crowded with just 4 adults in it! I'm now hunting for the supplies and videos I need. I wasn't planning on bringing the laptop with us for our trip, but I'm going to have to if I plan on getting all of my handouts, lessonplans, and visuals done in time.

Have I mentioned I have my first official doula client as well? She is so excited and has plenty of questions. Her mom is happy that someone who's had a baby before will be there to support her. There are 2 other expecting couples at my church so I'm hoping they'll be interested in either doula support or a childbirth class.

My neighbor is about ready to have her baby. I told her that if the baby comes to fast, send someone to get me and I can help. I just say that I'm studying to be a midwife, not fully trained, but I can try to help. Now I'm just hoping for a precipitious labor LOL I can only dream, but it would be fun!

Had a nice mother's day. Or "Monster's Day" as Grace called it. Here's a pic from Sunday.

Church Camp to Rayong

2006-04-18T23:36:00.000+07:00

Last Wednesday we drove down a day early for our church camp. Rayong is a 3hr drive SE of Bangkok and located on the Gulf of Thailand. Beautiful, clean beaches!

We were set up in a nice cabin with a huge front porch. Grace is scared of the ocean so ended up swimming in her little pool that we put on the porch. I actually got in there with her a few times because it was so hot! April is the middle of hot season where it easily reaches 110F! We saw monkeys, butterflys, all kinds of bugs, geckos on our bed, and a baby elephant in the back of a pickup truck... Grace was thrilled!

The camp was fabulous. About 40 people from 7mo (Isaiah) to 84 years old! Everyone was split into 4 teams. Even families and cultures were split up. We've learned that if you have all of the Koreans/Filipinos/Africans in one group they only socialize with each other, so by splitting everyone up, it was way more competitive. The sandcastle competition was amazing! Dayton's team one the whole thing thanks to his "army" skills for commanding his "Green Vipers" team in the capture the flag water fight game. The singing and worship times were wonderful. One of the families could not afford the camp so they bartered! We ended up with great childcare. When Isaiah was napping, one of them would sit in the room and watch him sleep... for once I got to go what I wanted to do! And what did I do? Hah. Ended up helping in the 100F kitchen making coleslaw. But at least I had adult conversation. Another person from that family helped keep Grace entertained during the worship times so I could play the keyboard or participate.

I drove part of the way back. (Navigated our way there). So nice to finally have our own car! On the way back, a huge windstorm whipped up while we were on the elevated expressway. We could see a large fire with flames 5 stories high in one housing area. This vacation time is the Thai holiday called "Songkran". Lots of drinking and driving and deaths. That was one reason we left early and got back Saturday to beat the Sunday traffic jams. God protected us!

It really was a restful trip. My favorite part? All of the beds were pushed together to make one big bed. (That's how a lot of places do it here). I enjoyed waking up Saturday morning with Dayton asleep on one side with Isaiah between us and Grace on my other side. All of them sleeping soundly. A thunderstorm came through about 6am, and it was so nice to hear rain hitting the roof. (Well, and the monkeys on our porch hooting along!)

Now THIS is a Birthstory!

2006-04-18T23:13:00.001+07:00

My midwife (now I consider her my mentor, idol, and friend) just emailed me a pretty amazing story that I just have to pass along. I'm editing portions to protect the innocent... well not innocent... just working where it happens to be illegal to catch babies as a foreigner.

Here's the story:

Two weeks ago I had a pretty amazing experience!

Three days before, I had received an email from "H", a Japanese man with a Thai wife, "B". He wrote

"Hello,

I am a Japanese living in Bangkok, and my Thai wife is expecting childbirth around Apr. 15 (now in 38th week). We have been interested in homebirth since the start of the conception and have been preparing for it. But we have not been able to find anybody giving us the professional technical assistance so far and are at a loss what to do. I am wondering if somebody has any information or local acquaintances that could help us. We take the regular check-ups at "X" Hospital, but mother and baby both being healthy, and we want to have the delivery either at 1) our Bangkok apartment (18sqm small concrete room), 2) my wife’s grandmother’s house in Petchaburi Province (big wooden house), or 3) any wooden house suitable for the image of natural birth.

Thanks in advance"

I emailed back and told him that I was a midwife, but legally not able to work in Bangkok, and that I doubted that he would find anyone who would be willing to help with a home birth (bearing in mind that I hear from them for the first time two weeks before the due date....) but that I would be happy to help them to prepare for (unassisted) home birth if that was what they wanted. Yes, they did - so I arranged to meet him at On Nut BTS on Thursday, and that I would teach them a crash prenatal course.

On Tuesday night at 11.30 pm "H" called to say that there had been "some blood, and contractions 15 - 20 minutes apart". I told him that she had a long way to go, and that it could be false labour. I also told him that I had heard that "X" Hospital, where they had been having prenatal care, had a good nurse in the labour ward. I didn't sleep much wondering about them, and felt vaguely guilty for not being more helpful - but I had never seen them, I did not know her pregnancy history - the baby could have been breech for all I knew...... (And you know that I only accept clients I consider to be 'low risk' for home birth.)

At 6.30am the phone rang again, and a very distraught "H" was saying "What do I do? What do I do? There is something coming out". Then I heard "B" scream and the phone went dead. I waited. And I got dressed and got my Goodie bag. 10 minutes later he called back, sounding pretty hassled. "H., would you like me to come?", I couldn't help myself from asking, with the response "Yes! Yes! Yes!"

Their place was hard to find. A long way from the main road down lots of little sois. [sois are Thai sidestreets] My lovely husband drove me, muttering on the way about his insane (but caring) wife. After taking a wrong turn and then reversing 50 metres down a narrow lane with no place to turn, we finally stumbled upon a Thai-style very basic apartment building.

I walked up three flights of stairs with my clobber, and entered an intense situation of a very frightened young girl about to give birth, and a husband who bowed about a dozen times with relief when he saw me. "B" was tiny and tight, but about an hour later, I caught her baby girl who cried lustily as she greeted the World. Her mother did not tear, did not bleed excessively, and was the perfect patient. We all cried.

After the placenta was delivered and the tiny baby (just 2.4kg - 5lbs 5oz) was suckling, we all introduced our selves, shook hands, bowed and wai-ed. [Wai is a Thai bow]

It was such a strange experience. As it turned out, they had prepared nothing. Not even a diaper or blanket for the baby, and no pads for the new mom. They live in an 18 square metre apartment, and you really couldn't swing a cat in it, (even if you wanted to...) - just a 3/4 mattress on the floor, a chair, a desk, a toilet and shower and basin, and, of course, a TV and computer! No kitchen, no sink, no stove.

But it really was a beautiful birth. I don't know why we have to make birth so complicated and difficult.

I called back to see them in the afternoon, weighed the baby and donated a couple of blankets and little shirts. "H" was effusive with his bows, and paid me more than I wanted. I gave him half back and told him to go shopping for his baby!

I love my life.

My favorite sentence of this whole story is: "I don't know why we have to make birth so complicated and difficult." This is so true. The body was designed to birth a baby. Why does society have to mess with it and make it scary, full of fear, and technical? Birth is such an amazing, spiritual event!

Went to the "Teeth Doctor"

2006-04-11T15:25:00.000+07:00

My dentist just had a baby 3.5 mo ago and is breastfeeding!!!! For a Thai that's a huge thing. And not just that, but she's pumping full time so he can have only breastmilk. I was shocked. When I walked in to see her, I could tell she was breastfeeding because her normal tiny frame had big breasts! LOL I mentioned that to Dayton (who'd had his teeth cleaned before me) and he hadn't noticed.

She did have a C-section because was told the baby would be too big. 3.75kg is only 8.5lb and not big! To me big is 10 or 11 pounds. And why do a C-section when an induction is less risky? Doctors make way more with C/S than inductions. Another rant.

I have 2 fillings that need replacing... glad to be getting more toxic metal out of my mouth. And one tiny cavity, thanks to those pregnancy hormones. I'll have to go back in a few weeks to get it done. Grace sat on the stool and watched us each get our teeth cleaned. For a kid who normally loves showing us her teeth, she would not even give a smile or glimpse of a tooth for the "Teeth Doctor." No worries. She's only 2 and a half. We just took turns watching Isaiah crawl around the waiting room. An easy trip.

Friends' Pregnancies - Different Directions

2006-04-09T22:27:00.000+07:00

2 friends (A. and L.) were due with babies this coming November.

A. miscarried last week. Seems like she's doing okay considering this is the 4th time it's happened. Really wanted me to teach her childbirth class and help her do a waterbirth at the hospital. Her doctor refused to do any tests on the embryo sac that she saved. She wanted to know if it was her body or genenics that has caused this to happen over the past 6 years.

L. is very sick with morning sickness. I went over tonight for about an hour and gave her some home remedy ideas. Brought her some apple cider vinegar because 1 tsp per 8 oz of water should help. Talked a lot about what she believes and wants. And learned that she totally wants me at her birth because her husband (he admitted it) is not good with this sort of thing. And she may want me to teach her class. I told her to let me know before the summer so I can work on my curriculum during the summer. The pregnancy books here are awful, so I'm buying some online tonight to add to my collection/lending library, and she can borrow some. Oh, and did I mention... they just got married in December! And as she says, "Can you say 'broken condom'?" They are so excited, just totally surprised.

So here I am, after that previously depressing post, helping a woman through a miscarriage, AND with a potential/probably client!

Back to work

2006-04-08T21:43:00.001+07:00

After a week of various sicknesses, I am back on track doing my CBI work.

I guess I got a little "realist" over what I'm deciding to do. I keep telling myself, that it's pointless to pursue midwifery when I just can NOT see a way to do it legally here. Why pursue it at all? Sigh. I just have this mental battle going on all day with it. It's so consuming that I don't study much else and shirk my chores at home.

So. I'm back to doing my doula and childbirth educator studies as a foundation. Taking my time doing it. Back to cleaning my house. Back to Bible reading. Remembering that every thing will fall into place how God wants it in HIS timing.

2 more friends are pregnant, due in mid-November. One may want me to teach their childbirth class. If so, I have lots of work to do. Lesson plans to write, handouts to make and collect. Supplies to buy. It's a lot of work, too, but I think if I pace myself instead of working in spurts it's doable.

Check the safety of your products

2006-04-07T22:15:00.001+07:00

I found a great website that you can use to check the safety of your beauty/body products. I decided to check what was in the deoderant we're using. The program will tell you what in it and what chemicals are not safe. The Sauve deoderant I was using was VERY bad. The Arm & Hammer that Dayton was using was safe. If it doesn't have your exact product, you can check each individual chemical listed on the bottle.

Check it out: Skin Deep

Thank you CNN

2006-04-01T15:14:00.001+07:00

Today I was watching CNN International and they had an excerpt about the Kareni villages on the Burmese/Thai borders. Right on TV, they were interviewing a woman as she was breastfeeding! Wow, they didn't edit it out... not that she showing a lot of skin, but you know how boobaphobic the news can be. =)

J & S had their baby

2006-04-01T15:07:00.000+07:00

Well I ended up not attending J & S's birth. The baby was breech, so the day after her due date, she had a C-section. He was 8.5lb, not a big baby. They had thought that since he was big (and she secretly really wanted a C/S anyway) that he wouldn't turn and couldn't have been born vaginally anyway since J is American and S is Thai and the size difference wouldn't work. Well, he could've been born vaginally, but since they weren't interested in trying to turn him, she got what she wanted.

Sounds like she's trying to breastfeed and I'll check on her to see how it's going.

Vacation pictures

2006-03-22T01:04:00.000+07:00

Sai Yok trip

2006-03-14T00:17:00.000+07:00

Saturday morning we left for a quick vacation! Dayton used up his last personal day and we came back Monday afternoon. It took us forever to get there because we had to navigate through the Bangkok traffic and then go through the mountains to about 15km from the Thai-Burmese border. Good thing we speak Thai, because most people we spoke definitely spoke no English!

We drove to Kanchanaburi province, then to the town Sai Yok, and then to our hotel River Kwae Village. It was right on the River Kwae, and looking out our window, we could see the cliffs, the river, barges, boats, etc. Grace loved looking at the boats going by. Definitely not child-friendly though. The walkways had dropoffs and waterfalls under them because it was built right on the side of the mountain! We used their swimming pools quite a bit because no one else was using them. Most of the other hotel guests were with tours gone during the day. No other little kids, so our kids were quite entertaining, especially to the Thai staff!

On Sunday, we drove to the Hellfire Pass museum. It was the site of the Australian POW camp run by the Japanese during WWII. Amazing pictures. We didn't hike down to the pass because of little kids and short legs. If you get a chance, look it up and read about it. We then drove on down to the Sai Yok Noi national park, looked at the river and waterfalls, tried to explain that to Grace that her hat "went swimming" when it blew off and into the river, and then tried to find a place to eat lunch. We got lucky when choosing one of the many food stall/mini-restaurants. The food was great (Thai of course), they played with our kids, helped Grace dig in the dirt, helped her wash her hands, etc.. Grace got to use their squatty potty. For a first timer, she did well not peeing in her shoe! We really enjoyed the lunch, just talking with the people (all in Thai), explaining we weren't really tourists, etc. In fact, instead of the $5 per adult entrance fee to the park as foreigners, we pain only 50 cents each because we could show our Thai driver's licenses and spoke Thai.

We were worried that Grace, who'd never slept in the same room as us and had never slept in a big bed, would not sleep well or bother us. But she did really well and liked her roll-away bed with the bright pink comforter. She got no nap Sunday, so that night decided to put herself to bed at 9pm. Isaiah was easy as usual.

The worst part of the trip was Monday morning. Just as we were ready to finish packing up, Grace decided that she didn't want anymore pancake. She'd brought it with her from breakfast. I was busy packing up stuff in the bathroom, and Dayton was putting away the playpen. Isaiah (who had just eaten) was laying on his back on the bed playing with a toy. I heard a gagging sound and saw Grace stuffing pancake in his mouth!!! I fished out what I could but it was too late, he gagged on it and then threw up EVERYTHING he'd just eaten. Well, since we weren't going to use the bed anymore, the sheets were used to clean him up, and we spanked Grace and then changed Isaiah's clothes. What a mess!! Isaiah is still completely breastfed... what a shock to him!

So that was our trip. We most enjoyed the driving actually. The beautiful mountains. The huge trucks we had to navigate around... full of sugar cane, or taro (rolling off and almost hitting our car!), or pineapples. And Grace enjoyed the cows we passed every 5 minutes. They were grazing along the road and she'd try to count them. It was a much needed vacation!

Baby Catchers of the Amazon

2006-03-09T18:15:00.001+07:00

Or a similar title. Can't remember exactly. But it was on the Nat'l Geographic channel. It followed a midwife in the Amazon jungles. A traditional midwife who has learned from doing things on her own. But I did notice that she's had some training because she was using gloves, had a scale, a birth bag. Showed her doing prenatal checkups, delivering babies, postnatal checkups, breastfeeding help. Fascinating! Also showed her as a local healer, gathering plants from the jungle, making medicines, compresses, baths, etc. for the village.

One of the births would have had major interventions in a normal/hospital setting. The cord was wrapped around the baby's body and 3x around the neck. Was not breathing for at least 2 minutes. The midwife did all kinds of things to get it to breathe well, and even used a clean cloth over the baby's face as a barrier for infant CPR. She did not cut the cord immediately so the baby still was receiving support from the mother until it was breathing on it's own. This should be normal procedure in any setting.

Watching this show just made me want to come right back to the computer and keep on studying!

Chat with my midwife

2006-03-03T14:05:00.001+07:00

My midwife returned from her 2 month visit home in Australia. She bought a house... waaaaaah, she's moving away in July!! But she did say that if I want to have more babies at home, she'd come back and catch them. Her husband has a business here that he'll have to visit 2x a year, so they can arrange their visit schedule around a due date if they have to. I guess the bad news was kindof good news.

We also discussed the local childbirth educators. They are awful. She was a fabulous one and I would love to follow in her footsteps. She was so encouraging and positive about me wanting to be a CBE and is even willing to mentor me while she's here. Dayton had even said to me a few weeks ago that when she leaves, who is going to fill her shoes... maybe I could. BAMBI (look at my links) will need CBE's and more doulas as guest speakers and to offer services, so that's a place I can start.

We also discussed me becoming a midwife. Her opinion is that if I want to that's fine but don't ever even think about practicing here legally. The only midwives here are Thai nurse-midwives who are not allowed to catch babies. In fact, if a baby is born before the doctor arrives, they get in trouble. She has spoken with midwives who have NEVER caught a baby with years of working in hospitals. So basically, just because I'd have the education, and if I were gifted enough to learn the language to pass the exams here to be licensed, what Thai doctor would ever approve of me, let alone be a backup. Just because I was licensed does not mean that I could work in a hospital in a real midwife capacity. She was not legally licensed here but worked as a doula/CBE/labor assistant.

Her opinion is good in her experience, but I do know of nurse-midwives here who have caught plenty of babies. Outside of Bangkok, homebirths are no big deal. My Thai teacher's aunt just had a homebirth with a local midwife, so I know there are paths that I can explore. And maybe in 10 years, it will be possible. I've read so many papers published by Thai nursing associations about how they need to be more open to foreign educated practitioners. They need to follow through and start the work to make it happen. But it's a big cultural issue as much as it is a legal one.

Overall, a VERY exciting conversation. A few months ago when I first spoke with her about my plans, she was like, yeah whatever, you just had a baby, this will pass. But now she can see the passion, the education I've begun, and the need for someone like-minded to follow behind her.

Dead Babies

2006-02-25T18:18:00.001+07:00

One of the not so fun parts of studying has been going through the grief and loss sections of reading. The things I've had to read, pictures, etc. have not been easy. But I'm glad I'm reading it because I'd not go there otherwise, and I know someday, I'll have to deal with it in one way or another.

I've finished the communications module. Just a 10 page reflection paper, which should take me a week or so to do, get it graded, and then I should pass the whole module. I started with this module in particular because it has to be completed before I attend any certification births.

Still no word on if I'll be attending the birth in March. I have passed on some info they've requested, so at least I know they're reading!

First Client Interview

2006-02-18T22:20:00.000+07:00

Tuesday's meeting went great! Dayton said I'm a pro already, at least with the teaching part =) The potential clients, "J" and "S", have been attending a childbirth class at their hospital but were very disappointed from the lack of substantial information and also very uneasy after only being shown scary birth videos. They had so many questions that were not answered unti our meeting. They do not agree on much when it comes to childbirth. He believes God created women's bodies to do as He designed. She is focused only on the pain and how to not have any. I encouraged them to build a birth plan that both would be happy with.

I have sent them a sample birth plan and other things they requested. They are also reading a couple books I've recommended. I hope to have an answer soon! I'm still trying not to get my hopes up too much because they could still say no. "J" really wants me there because he trusts in my readings, experiences, etc.. "S" is not sure because she just doesn't know what to think yet and hasn't read much.

I'll keep you posted.

Today's the Big Day

2006-02-14T11:17:00.001+07:00

I've done all the cramming and studying I can do to prep for my first client/doula interview. Hopefully what I've learned will help and not hinder the conversations.

The house is almost clean - though just noticed Grace drew on the sofa cover with a pen... and after picking up the playmat on the rug noticed it was in great need of a vaccuum. Dinner will be easy. Reheat the spaghetti sauce, boil noodles, make salad and garlic bread. Dessert will be vanilla icecream with a choice of rootbeer (Dayton's request) or strawberries. Dinners usually aren't done at interviews, but it's Valentine's Day!

I was trying to figure out the best set up for the talking time and realized it'll be nighttime, and the main overhead light is not working! Dayton's going to have to run home during his planning period to fix it because if he waits until after school, they'll be here already, and that would be... just embarrassing!

On another note, our maid (Puk) called and said her mother is dying (this has been going on for some time) and had to leave immediately. She'll be gone for at least 2 weeks. I usually save company cleanup for her on Wednesday, but I'll just have to do all the cleanup, and the laundry, ironing, mopping, and bathrooms she usually does. Puk does not seem sad, just stressed. She's the main caretaker for her parents and I think is just ready for this to be over. She has 3 daughters.

Baby Catcher

2006-02-12T22:25:00.001+07:00

"Birth is normal until proven otherwise." Peggy Vincent's book, Baby Catcher is amazing! I just finished reading it and was moved. It shows the joys of catching babies, the heartache, the stress, the affect on a midwife's family, and more. Definitely not for the squeamish though!

Hmmm, now which book to read next... Food for Thought by Susan Jen. I have to finish my health certification too.

Communications Module

2006-02-11T22:30:00.001+07:00

This post was supposed to be part 2 of Isaiah's birth, but I haven't had the time. I have a client interview on Tuesday and am prepping for that. I've been working full speed through the communications module (2 out of 7 units done) to at least be partially prepared. I have learned so much! This course is teaching me stuff that I can apply to any situation... not just childbirth! I like that the program is from an international viewpoint because it the units on Birth and Culture will help with working here.

Aaargh. Broke one of my toes tonight while turning quickly from the bathroom into the living room to pop a pacifier back in the baby's mouth. Went to the freezer to find something cold to put on it. Found an icepack that was supposed to be used for Isaiah's birth but never got used. Well at least it didn't go to waste!

Oh, and Isaiah's crawling now!

He's such a silly, happy baby... with a lot of hair! Got that from me!

It has begun!!!

2006-02-08T23:33:00.001+07:00

As of today, I am officially signed up and studying with CBI!! I'll find out next week if I have my first client. Please pray that she'll say yes =)

Homebirth Preparations

2006-02-08T22:58:00.000+07:00

When I found out I was pregnant (due Sept. 1st... again), I resigned myself to the knowledge that this birth would probably be no different from the first. I had no options other than to use the same hospital, same conservative doctor, but hopefully renovated birthing suite. I called Jan, the midwife who taught our childbirth classes, to tell her the good news. We talked about Grace's birth and what I wanted out of this one. I jokingly told her the only way I could do better would be to do a homebirth, but it wasn't possible here. In a very elusive way, she mentioned that she'd be willing to help me out in that area.

To be a foreigner who is a doctor, nurse, midwife, etc., it is almost impossible to practice legally. They have to not only be trained and certified in their own country but also pass (in Thai!) the same exams here. Impossible. So Jan was working as a childbirth educator, doula, etc.. and when the occasion came along, catching a baby, too. She's an Australian nurse-midwife with years of experience there and in Korea.

I told her I wasn't sure homebirth was really for me. At 20 weeks along, I called her and said maybe I did want a homebirth because I was unhappy with all of the unnecessary ultrasounds and tests I had to do. She said that if I was still interested to give her a call at 32 weeks. My parents came for a visit, bringing an emergency homebirth kit with them. This was important to me because Grace's birth came so fast once I was in true labor. The difference was that we now live 1hr from the hospital on a good day, plus I was due during rainy season when our streets go completely under water. I would much rather give birth at home than in a filthy taxi if I didn't make it to the hospital!

At 34 weeks, I went to a BAMBI (Babies and Mothers of Bangkok International) meeting and heard Jan teaching new moms about labor pain management. I found myself nodding along, agreeing with everything she said, and realizing that truly, I could do this at home. I told her afterwards that Dayton wasn't convinced so it was a no-go at this point. One week later, after Dayton read a lot and realized it was a better choice, he agreed. I called Jan who wanted to meet with both of us to make sure Dayton wasn't being dragged into it all!

So at 36 weeks, I scheduled an appointment with her, followed by a regular prenatal appointment with my doctor. Dayton and I went, we talked about risks vs. benefits, she listened to the baby's heartbeat, checked for proteins in the urine, and we were done. We did not sign a contract because she was not legally providing services. We just supplied an indemnity agreement later on so she wouldn't be held liable if anything bad happened. And we agreed to not say anything about our homebirth to anyone that could get her in trouble and deported. What a sad thing that a country cannot recognize the need for improvements in their medical standards by allowing foreigners to practice... but that's a whole other post!

Next stop of that day, we went to see my doctor. Dayton was amazed that I could pee in a cup less than 30 minutes after I'd already peed in a cup for Jan. Hey, a pregnant woman can pee on demand!! After getting yet another ultrasound just to check heartbeat, I asked him if the baby was head down. He said he didn't want to make a mistake so used the U/S again! If Jan, a midwife of 30years can tell just by palpitation, yet a doctor of 30years cannot, that was it for us. We knew for sure then that a homebirth was what we definitely wanted. We never did tell the doctor our plans for a homebirth. He just assumed after the fact that it was an accident. We went home and started collecting our homebirth supplies. 2 rubbermaid tubs full of towels, sheets, chux pads, blankets, etc. I had fun!

The next post... Isaiah's birth

Grace's Birthstory

2006-02-06T16:09:00.002+07:00

Grace was due Sept. 1, 2003. I went in on the due date for the NST (non-stress test) and only had one or 2 contractions, but not strong.

I went in again on Sept. 4th for another checkup. I was 3cm dilated because of the strong regular BH contractions I'd been having for 2 weeks. I don't remember losing my mucus plug, so I think it came out slowly. The nurses hooked me up to the NST again, came in and checked after 20 minutes, looked at the printout sheet and had the doctor come in. He said, you're having real contractions, you're in labor. When you're done here (I was in the L&D unit for the NST), come back down to my office. (My doc's office is at the hospital... that's how it's done here).

So I go back down to his office, and it's 1pm. I tell him I feel absolutely nothing and I feel fine. He said that I was in labor and I'd be having the baby that day. I'm thinking "yeah right". So I said to him, "I'm going home to get my husband, my suitcase, and my best friend, and I'll be back before rush hour traffic starts."

I'd been told not to go to the hospital anyway until the contractions were about 5min. apart. Not good to go too early or you get too many interventions. So I go home. I call my husband "D" and best friend Amy and say, "The doctor says I'm in labor, I feel nothing, but I guess we should go in." So we meet at my house at 3pm. I call my parents to say pray for us since we're going in. I still feel NOTHING. To me it's just BH contractions.

Get back to the hospital around 5pm. They hook me up to the NST, contractions are 10min. apart. I feel NOTHING. I eat dinner, walk around the hospital with best friend ("D" went out to grocery store across the street). I still feel NOTHING. By this time, I'm like... "What am I doing here! I'm not in labor, it's a false alarm, I wanna go home!" How embarrassing to be there for NO REASON!

The nurses tell me that when the contractions get to be 5min. apart that they'll check me again. Around 8pm, the "BH contraxs" to me were 5 min. They check me... I'm 3cm dilated... and I feel NOTHING. They suggest to me that I go lay down and try to sleep. I decide to take a shower first. I throw up in the shower because I'm so nervous!! Maybe nervous because I really didn't think I needed to be there? But the shower was relaxing and I got to sleep around 9pm. "D" is napping on the sofa in the room. Amy is watching a movie on her laptop.

11:07pm, I feel SOMETHING! My first painful contraction. NOTE: This is when I consider my labor to begin. 11:15, a HUGE contraction, and my water breaks all over the bed. So glad not at home. I yell "My water broke!!" The lights go on, I jump off the bed and run to the toilet so I wouldn't be so wet. Well, I got to the toilet and realized the contractions were so strong that I couldn't walk. Talk about going 0 to 60 in 5 minutes! So they wheel me down to the labor suite. I lean on the bed during contractions, I kneel, I try everything but no relief. I ask for the birthing pool around 1am. All of my pain is centered on my tailbone at that point. I get into the pool, moaning LOUDLY (I'm sure the whole hospital heard me), and after 5 contractions realize that this isn't going to work. I can't seem to find a comfortable position without floating. If they'd checked my dilation first, they could've told me I was entering transition and that the pain relief would be less effective. At least getting in and out of the water got me distracted.

So I go lay on the big bed (nice birthing suite... only natural birthing suite in all of SE Asia... lucky me!). Amy reminds me that I'm going to lose my voice if I keep moaning so loud. She helped me get in control by breathing in through my nose and out by my mouth. My OB hears me from down the hall and comes in to push me into agreeing to Demerol. ( My mom had to take a valium with me!!) It calms me down enough to actually relax between contractions and focus on breathing during. It gave no pain relief. I'd been taught that laboring in bed was bad, but my tailbone was so bad that laying on my right side and the nurse midwife manipulating my tailbone during contractions helped more. Around 3am I muttered that it felt better to push during the contraction. Amy asked me to repeat it and then she announced to the nurses that I felt like pushing. They check me and I'm ready to push.

3:15am. So, they try to get me to push while laying on my side. That was stupid. I insist on getting out of the bed. The demerol had worn off and I was actually relaxed and excited to be pushing. I tried the birthing stool but I couldn't get low enough. It's also at this time that I see a roach on the floor... hey it's SE Asia, the hospital is clean, but they still can get in. I even thought it was funny at the moment... especially the doc taking off his slipper and chasing it!! I decide that the best position for pushing is squatting on the floor. "D" sits on the bed behind me while I'm leaning against him on the floor. Contractions slowed down to 3 to 5 minutes apart. Pushing felt great.... like I was getting something accomplished. Looking back, pushing was 100x better than the contractions.

I remember feeling that "ring of fire" as she was crowning... Amy said isn't this where you're not supposed to push to not tear? The doctor was like nah, just push, so instead of helping me out, I tore (another pissed off story I'll write at another time!). He had the nerve to tell her, "If you're gonna tear, you're gonna tear." What a load of crap. Anyway...

3:42am, there she/he is! Less than half an hour of pushing! They ask me if I want to hold it and I say no way... I'm too shaky from being in the squatting position for so long. I ask if it's a boy or girl. Doctor says, You tell me. And I see it's a girl! Welcome Grace Elizabeth!

I layed down on the bed and then held her and tried to nurse her. She was more interested in looking around. "D" stuck out his tongue and she even copied! I birthed the placenta, got 3 stitches, and was so tired! "D" fell asleep on the floor, I fell asleep on the bed. Amy ended up holding Grace for the next hour!! Around 7am I transferred back to my room.

And that's the story of Grace's birth. I'm still amazed that I felt NOTHING when I was supposedly in labor until my water broke. Turned out to be 4.5 hours of labor with half an hour of that pushing. Overall I'm very happy with the experience of her birth.

Fast foward 2.5 years, with hours of reading and education later, and now with a totally different view point. At the time I thought it was a great birth, and it was compared to how most women birth, but I can still see so many things that went wrong. #1 - I should've waited at home and gone to the hospital after my water broke. #2 - I should've walked to the L&D room and all over the place. #3 - I should've tried more positions in the birthing pool. #4 - I should have NEVER layed back down on that bed! #5 - I shouldn't have gotten Demerol because it made me in such a haze, Grace wouldn't nurse well, and I didn't seem to care what was going on other than I wanted a nap. #6 - I shouldn't have pushed through the pain to ge the baby out... should've not pushed and let her slip out so I wouldn't tear.

I really think that as a first time mom, I did well, but if I'd had a trained doula (labor assistant), not just a friend who'd never had a baby there, I would've been encouraged to try different things to manage the pain. I also would've known the risks involved with a narcotic (Demerol) and known to ask dilation to see how much longer it would've taken.

I also wish we'd declined the Vitamin K shot. I wish she'd roomed in with me instead of sending her off to the nursery so much. I really feel like there wasn't much bonding. I didn't even have a chance to change a diaper until we brought her home. The first few weeks were not good. I couldn't sit well due to the stitches, Grace wouldn't breastfeed correctly (until I get help), and I got mono. After she started eating well, it got better.

All of her birth was a learning experience, and I took a completely different route the next time...

Here's a current picture of Grace:

My Goals

2006-02-04T15:44:00.002+07:00

2 more children fit somewhere into the scheme of this...
And I'm sure the dates will change

Feb 2006 - enroll with CBI (Childbirth International) Doula and Childbirth Educator program

June 2006 - finish certificates in Natural Living and Natural Health with HAcres

June 2007 - finish CBI training unless certification births not available

June 2007 - enroll with AAMI (Ancient Art Midwifery Institute), beginning with their ITM (Intro to Midwifery) course

Dec 2007 - finish ITM

Jan 2008 - enroll with AAMI's midwifery program or NMI (National Midwifery Institute)

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

August 2013 - return to SE Asia and begin legal process to practice midwifery while teaching CBE and labor assisting

Receiving Books

2006-02-03T15:09:00.001+07:00

Amazon is amazing! I ordered 4 books, and it took only a week for the first 2 to arrive and then another 3 days for the next 2 to come! They're all books I've been wanting for a while to help me with my midwifery quest.

The Doula Advantage It'll help me with doula skills while working towards the MW goal.

Baby Catcher Story of a midwife.

Spiritual Midwifery It's an Ina May Gaskins book with great info. And I love the birth pictures in it... hippies. I swear one of the pages they look my parents!

Hearts and Hands It's a midwife textbook with all the basics. I figure if I learn it really well, then I'll maybe be able to shadow someone working here. Then I can learn more from them.

At some point, I need to post how I've come to want to be a midwife. I'll post my own birth stories, too. Also will post my general timeframe for meeting my goals.

Welcome!

2006-02-01T16:00:00.000+07:00

Welcome to my first blog! Give me a few days to get all the settings right, and then I'll get to posting.