Placenta. Enigma. Namaste.

The placenta is a confounding element of labor and delivery. Giving birth to a brand new entire person is largely hailed as the single most challenging and unifying event humans undertake (along with death, but more on that later). This monumental feat comes after growing this would-be human INSIDE of you, which – let’s be honest – is pretty bananas. So after 40ish weeks of gestation and who-really-knows how many hours of labor, you have a baby!

But, it’s not over yet.

Now comes what we refer to as the 3rd stage of labor, a part so important it had its own category: delivery of the placenta. This new organ is something you grew before the belly fruit began to resemble anything other than a seahorse (yes, offense). The placenta makes good use of all the extra blood you’ve been pumping around (up to 50% more in fact) as it transmits nutrients and oxygen to the fetus and acts as filter for bacteria and other unsavory characters you’d prefer your child waited until daycare to meet. Its delivery has to be carefully attended to because any retained pieces can cause serious problems for you and ain’t nobody got time for that – you’ve got a baby now! So once this blood filled, brain looking, much-bigger-than-you-thought-it-would-be thing is delivered and examined, what do you do with it?

I’m glad you asked.

The placenta is a mystifying entity that different cultures hold in various high regard. Some groups believe it has a spirit of its own and must be buried near the family house as a guide of sorts. This doesn’t seem so strange to me – it has to be gestated and born along with the baby, and without it, baby would have never made it this far. Other cultures use it more practically as fertilizer – all hail the pragmatist. Companies have been built around their ability to encapsulate it so that you can eat it; preesh you, capitalism. And, of course my favorite, carrying it around with the baby until the umbilical cord (along with the placenta) dries up and detaches on its own: the lotus birth. A majority of westerners do nothing with it and it is incinerated (BOR-ING).

As with most things in birth, to all of these options I say yes. Women need to support other women as we navigate the veritable cornucopia of options available to us.

And now, a picture. Because in 2017, infographics and nihilism will be the only truth.

Source: National Institute of Health

 

Lotus birth, even though we both know you already Googled it.

Source: MJY 

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Midwifery FAQ

1. What the hell does 6cm look like?

Sure, I could pull out a tape measure and treat you like an adult, but instead please direct your attention to this gross chart so I can fulfill a childhood dream of mine by comparing your cervix to a bagel (which, by the way, vary in size greatly).

Source: Sweet Leigh Mama

2. Why is the midwife always squeezing my tummy? And who is this Leopold?

Christian Gerhard Leopold (24 February 1846 – 12 September 1911) was a German gynecologist who developed these four maneuvers for determining the position of the fetus in the uterus. They are used by midwives to assess for a breech presentation (feet or butt first) and to estimate the size of the growing fetus.

Source: Wikipedia

3. Oh, you’re going to be a midwife? Is that better than a doula?

Well, that’s like asking if a pilot is better than a flight attendant. It’s not wrong, it just means our profession needs a better PR department.

But yes, I’m also a doula — many of us are.

Source: Ancestral Wellness Temple

4. Why is my baby covered in cheese? No, I don’t want to touch it. You touch it!

Vernix is an expected finding on a newborn and its benefits (along with thermoregulation) are part of the reason the WHO recommends that baby’s first bath be delayed at least 6 hours (and ideally 24h).

Sidebar: Has anyone checked out The Alternative Mom, from whom I stole this photo via the Pinterest? She sounds feisty.

Source: The Alternative Mom

5. What exactly is the difference between a vagina, a cervix and a uterus?

More than you’d think! If a female person is standing up, the vagina is closest to the ground and is accessible through the middle of the three openings that persons with two X chromosomes typically have.

The cervix is the (normally closed) canal that leads to the uterus and becomes thinner and more open during labor. Ask to take a look the next time you have a pelvic exam or check back here soon for a series I’m working on called Guess Whose Cervix?*

For more info on the cervix, check out this great post on Across The Speculum.

The uterus is the uppermost cavity where tissue builds up every month to either support a fertilized egg, be shed during a woman’s period or be safely reabsorbed if she is on progesterone-only contraception (more on that later).

For now, this:

Source (and on sale now): Blue Barn House Store

*currently accepting photos for this series at leacraftspencer@gmail.com

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Long Distance Relationships

Sometimes they work. Especially when you’re both busy taking busy to the next level. It has now been 18 months since my person and I lived in the same state and we have 12 more to go. We’re super codependent at night so sleeping apart is just the worst. Seriously, I hate it. But during the day we’re obnoxiously independent, as evidenced by our shared refusal to compromise our goals. We’re not jerks; we each happened to be given opportunities we couldn’t turn down at the exact same time. One of us could have set their goals aside for the good of the relationship, but instead we decided to have it all.

Best decision ever.

This accelerated nursing curriculum is intense, and the only thing I can imagine being harder than doing it alone might be doing with a partner’s needs to consider. Jared works for Amazon; I’m sure you’ve heard of them, they sell books online. And praise be to whatever-deity-you-choose that he is the type of person who hears 16-hour days and thinks bring it on. Don’t get me wrong; being apart is tough for all obvious reasons: hugs make everything better, traveling is stressful, texts don’t convey tone, watching NFL together on FaceTime is hard because his feed is always ahead of mine because everything gets to The South later. You know, basic relationship stuff.

But it’s easier for a whole bunch of other reasons: When one of us has to spend all day in class or working and then come home and continue working, there’s no one to disappoint. Our reliance on verbal communication has sharpened a set of skills I think are crucial to sustaining relationship happiness. We have found joy in new activities that the other isn’t at all interested in; for him it’s learning how to box, for me it’s watching network TV in bed while eating a cheese plate.

Point is, we’ve both got goals. And we’re in this together.

We liken our current arrangement to two members of the same tribe having embarked on separate expeditions to learn skills and gather resources so we can bring them back to the village and build a stronger hut. We’ve been together since we were tiny baby 19-year-olds. This is probably the only time we’ll ever live apart so we’re embracing is as a short part of the long journey we’re on together. We have become better apart and that will make us better together.

As for right now, I know it’s easier for me to be supportive of him working all night from afar and he doesn’t have a panic attack every time I eat in bed.

It’s a win-win.

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Certified Nurse Midwife: Huh?

I wait tables in Nashville from time to time and am often caught explaining to people what I really do. Servers love this question because it manages to be invasive and critical at the same time. On one such occasion I was explaining to the stranger who had inquired that, in addition to supporting myself by waiting on people like her, I was a nurse and studying to be a midwife. She became very excited and said, “Oh, wow! My niece is doing the same thing. Oh, no… wait.. No, I’m sorry, my niece is going to be a nanny.” Now, I’ve answered an impressive range of questions about what a midwife is, how it is similar to a doctor and how it differs from a witch. But this genuine mistaking of a midwife for a nanny has been by far the most amusing.

Nursing school is a bubble land and it can be very difficult to remember how little the public really knows about advanced practice nursing. This is partly because the profession is evolving and has been for the past several decades, but it’s also because the general public doesn’t really care where their healthcare comes from — which is fine. It’s my job to know how to be a midwife, but it’s also important to offer digest-able knowledge to people when they want it (if only for the survival of our trade). To that end, I went digging for some straightforward definitions of what a midwife is and came across this infographic from 2010.* Some of the information might be a little dated, but I think it breaks it down pretty well. What do you think?

 

Infographics: making complicated concepts simple enough for you, me and everyone we know.

(Source: Scrubs Magazine)

*That’s a lie — I was looking for giggle-worthy memes and found this by accident. Whew, felt good to get that off my chest.

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Real Talk:

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Peer Pressure, I’m very sensitive.

It has been a minute since I’ve used this space but two of my best friends have recently taken to the social media and now I’m gonna, too! Their excellent writing has impressed in me the importance of using the online to spread information about women’s health. Please check out this great blog: https://acrossthespeculum.tumblr.com/ and follow this twitter feed: @southern_stdtNM. These are two brilliant women who inspire me to be more but make me feel like I’m enough. It’s possible that I will write some about women’s health, but no promises.

A lot has happened since I’ve been away. We lived in Carolina while Jared did the MBA thing and then we backpacked around South America for a few months (cause when else are we going to have the time?) and now I live in Nashville where I’m studying to be a midwife (what?) and Jared lived in Seattle, where he works for Amazon. We also exchanged sarcastic nuptials in a bar last March. Mazel to us.

But back to being a student midwife and all the amazing women I get to grow into this role with. After spending a year becoming an RN, which included spending time with a lot of 22-year-old blonde women, I am proud to call one or two of them my friends. My other comrades in this program are older, wiser and more brunette (although the true geniuses among us remain defiantly blonde). We are a motley crew of individuals from all over the country with different goals and opinions about women’s health. How great is that?

Our group runs the gamut. We have die-hard liberals eager to take issue with the status quo as well as southern conservatives whose norms are being challenged. I believe the breadth of experiences each of us bring makes all of us better. Our differences are representative of the wide range of women we will be serving, all of whom deserve health care providers who will advocate for their wants and needs.

A brilliant friend once said, “If I’m ignorant about something don’t belittle me, educate me.” This knife cuts both ways because I know firsthand that liberal New Yorkers are just as capable of being closed-minded as conservative Texans. Being truly able to embrace newness without judgment is a skill I have yet to master, but it’s one I aspire to. We have only to gain from being open to learning from people who are different from us. It’s when we think we’ve figured it all out that we’re really missing opportunities to grow.

This program has shown me both that I know nothing, Jon Snow, and that I’m capable of literally anything. We all are. In 18 months Vanderbilt has turned 140 students, some fresh of out undergrad, into nurses on their way to becoming NPs. What’s an NP do again? They help the doctor, right? And midwives – are they really still a thing?

In a nutshell, a nurse-midwife is an advanced practice nurse just like a nurse practitioner. A nurse practitioner is an independent health care provider who can work with or without doctors in a variety of settings. Other types of nurse practitioners include those who work in primary care, those who work in acute care (the hospital), those who just see kids, those who just see older folks and those who specialize in mental health. 95% of CNMs (certified nurse midwives) work in hospitals attending vaginal births and our scope of practice includes primary care for women from puberty through menopause.

Pelvic exams, STI testing, contraception prescribing, IUD insertions, prenatal care, labor and birth support, sexual health needs, menopause symptom management — midwives do it all.

The more you know.

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Last Cigarette Ever

I can remember my first cigarette ever, stolen from my mother’s pack of Virginia Slims 100s and enjoyed on the roof outside my teenaged window. It would mark the beginning of an era for me, one that would characterize both my adolescence and young adulthood. I can appreciate that only a handful of these cigarettes had a metaphysical impact on me rivaling the damage all of them were obviously doing to my body. But I was willing to gamble then and still believe now that the impact those important ones had on my being was stronger and more lasting than the physical harm they did to my lungs.

I’ve always been told that lungs regenerate and am learning now in school just how that occurs and it’s really quite remarkable. The skin lining the lungs has to go through four stages before the damage becomes irreversible, so as long as you don’t smoke long enough to get to that fourth stage, eventually your lungs will return to normal. It’s amazing to me that the trauma my lungs have been through can be righted with time, through no effort on my part other than simply no longer smoking. This is certainly something that physical damage has over emotional.

Emotional trauma has long been a reason to start or keep smoking. With that said, emotional trauma is often one of the things that shapes us the most. I can remember more than a few extra cigarettes smoked on nights of tears or too much drinking, but I also remember the ones that started friendships that would become life-long bonds. Smokers bond faster than non-smokers because we have this wonderfully terrible habit in common that leaves us with nothing else to do but chat. The friends I made smoking on the stoop my freshman year of college are still some of the best people I know. They are the people who know me, inside and out, the ones from whom I could hide little because we’ve shared so much.

It was a cigarette that introduced me to the love of my life and one that marked the moment when my mother passed. Both of these events impacted me in irreversible ways and I’m not sorry to have them marked in my memory with a cigarette. The first gave him and me what seemed to us infinite time to get to know one another and, for that, he remains my best friend seven years later. The latter gave me a moment of pure existence to truly appreciate the gravity of my mother’s passing and the numerous amazing, hilarious and heartbreaking moments that preceded it. Had it not been my instinct to reach for an American Spirit at that moment, I would have been robbed of something that has probably shaped me more than any life experience thus far.

That was the hardest thing I’ve ever done. Quitting smoking comes in second.

It has now been more than a year since my last cigarette and that era in my life has come to a close. My body is on its way to repairing itself, but thankfully the impact the cigarettes had on my existence will be mine forever. The truth is, as hard as it all was, I wouldn’t trade my smoking days for anything. They made me who I am and they were fabulous.

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