Fear

      While receiving my training I have seen many..many..many situations where a woman's mind will not allow her to release her baby nor her placenta.  However, the minute you tell her she needs to think about letting the baby or placenta come down and out....hello..the baby is born or the placenta is released.  Truly this is just one example.  As to why women tend to hold on to these things....its FEAR.  There has been a lot of research about the effects of fear, you don't need me to tell you what they are, because most likely you have experienced FEAR in one form or another that has stopped you in your tracks.Or for some, it has pissed you off enough to push you forward rather than backwards.  I think that one step in the forward direction where you are surpassing that fear is an important one and a vital one for personal growth.
     It seems women these days no longer want to experience this personal growth they can gain from getting through this Fear they have over childbirth.  I'm not saying women are any less for choosing an epidural for painless childbirth over the ones who chose to do it without.  What I am saying is each individual woman has her own personal reasons for her choice.  I think the media has done a pretty good job of striking the fear in women that childbirth is scary and they should be afraid.  I also think that other women sharing their experiences have also scared women into not letting their minds believe in there bodies.  Let me say that again...."not letting their minds believe in there bodies."  This concept that I am talking about can actually be applied to varies difficult events in our lives.  I mean you could probably look back at your life and remember specific situations where you did push yourself to overcome the emotional pain or physical pain you were feeling at that moment. For some this achievement is a goal and for others it is not.  It's at that moment where you realize..hey..I can do this..or I am doing this...or...I didn't realize I had it in me to push myself.  Its almost like a whole new world opens up for you.  When I see the media giving you another reason to be afraid.  You know what I hear..."You are not strong enough."  and the scary thing for me is..we believe it......Well until there is that one moment where we find out that we are strong enough.  I firmly believe that certain events in our lives happen for a reason and are opportunities for personal growth.  Whether or not we chose to use that event as an opportunity for growth is entirely an individual choice. 

Heart Burn

          I have to say, I've had one of the most interesting weeks.  Yet, again I am amazed at the magnitude of how social circumstances can manifest as "heart burn."  It seems that women today continue to be afflicted by their circumstances while maintaining some sort of balance in their lives.  While looking at the bigger issue, it is no wonder one of the major causes of death for women is cardiac related.  Do we really take our emotional issues to heart?  Or is it socially acceptable to place an outward appearance of strength and stability, when really you are doing your best to just get out of bed every morning? At which, emotional instability begins to manifest itself in other physical forms. It seems that women's health issues need to be addressed from a feminist perspective, which would explore and incorporate a woman's health from within the context of how women live their lives, collectively and individually within a patriarchal society.  This perspective incorporates social, environmental, and economic aspects of women's health, which is vital to understanding how women are able to achieve health and well-being (Womens Gynecological Health, 2006).

          With that said, I wanted to shed some light on some of the issues that women are facing today.  I think for those of us who are health care providers or working within health care, these women are usually the ones that continue to come in to be seen for varies health issues during pregnancy or for other gynecological crises.  When taking a closer look at their background you may find that they have an extensive social history ranging anywhere from depression, anxiety, abuse, homelessness, and the list goes on and on....Some of these women may have partners that are in and out of their lives, but they continue to bare the burden of raising their families alone and with little resources.  So again, are we really treating "heart burn" or is it a physical manifestation of their circumstances?  Apparently, 60% of patients coming into primary care have clinically significant mental health issues. Furthermore, while researching barriers to prenatal care among the Native American population in New Mexico I was somewhat surprised to find that among the top five reasons Native American women may not seek out prenatal care or there is a lack of prenatal care, are belief systems, family dysfunction and low socioeconomic status.  Findings that supported these reasons were that there was association with lack of transportation and childcare, traditional belief systems and family dynamics. 
          Obviously these issues are so complex that a 15 minute visit with your physician, midwife, or nurse-practitioner will most likely not fix the problem.  So what will?  Unfortunately, I do not have that answer for you.  I think it is important to keep a running dialogue among health care providers so that there is an awareness of the issues that our Native American communities are facing.  I realize seeing at least 20 patients on a daily bases with varies complex health issues can numb your senses as to what is going on in the home setting for these women, but some level of understanding and sensitivity needs to be maintained.  Because, when you see these women, you are not just treating heart burn.

Outreach

          One of the purposes of my blog was to give first hand knowledge of what it is like to go through a midwifery program from a Navajo perspective.  Upon entering the graduate program I was amazed to find that even though 75% of all Native American women in the U.S. received women's health care from midwives, there is only a limited amount of Native American Nurse Midwives that practice in the United States at this time.  Currently in our state of New Mexico there is only one Native American Nurse Midwife practicing.  Why does this matter?   Long before Indian Health Services became part of the "normal" childbirth rituals for our Native women, a majority of our childbirth practices was provided in the home and usually by a family member who was knowledgeable about traditional childbirth practices.  Over time these traditional childbirth practices have been abandoned and a "Blessing Way Ceremony" was replaced by a doctors visit. I realize that historically Indian Health Services was necessary to help correct the increasing loss of mothers and babies to illness prenatally, postnatally, and in labor.  However in the process it seems there has been very little meshing of our traditional philosophies and way's of life with the Indian Health Services model of care.  As a good mentor of mine has said.." there is no INDIAN in Indian Health Services."   
          I believe that most Native American providers will find themselves in a unique position to walk between the two worlds of our traditional healers philosophies and the western medicinal philosophies.  We have something to offer with a unique perspective that only we can understand and provide to the communities we are helping. So for those few individuals who find themselves walking this path, I wanted to help nurture that drive with my experiences and knowledge.  This is why I find it vital to encourage Native American women to consider Nurse-Midwifery as a path for them. I realize up to this point I have talked about things from an emotional perspective rather than specific experiences, but really it has been the emotions that have been most memorable.  Unexpectedly I have found a deeper connection with my own culture and a deeper respect for our traditional philosophies as it applies to pregnancy and childbirth.  I am amazed at how vital our traditional teachings are and how immersed in the care of our bodies and minds they are.  It is our traditional philosophies that carry us and that shape our minds to view the world in a different way.  It is with this perspective I want to share in the care of women.
          For me, part of the journey is to help educate young students about Midwifery.  As a young student in high school I never realized ones ability to impact others.  I looked up to those who were known leaders, but I never considered myself as one.  I have to say, I don't think I would have been ready for this role if it wasn't for my children and husband who have helped mold me into a woman who speaks up.  Even the very challenging events in my life have taught me to speak up and not get stepped on.  My point is, know matter your circumstances, you have many opportunities to grow from them.  You can't let your circumstances keep you from reaching your potential.  We all know that Native Americans have been marginalized for years, but that shouldn't be an excuse to marginalize ourselves and never see beyond our own circumstances.  I think for a Native American high school student to connect with someone who grew up under similar circumstances who now is in a position to lead in any field of education or profession can be very empowering.  It is kinda like..I am here now, but I want to be there later.  Now how do I get there?  Planting the seed is just the first step.  Personally, I am not surprised to see and hear that more and more Native Americans are entering health fields.  Based on my personal observation most of us excel with hands on learning.  We tend to do more listening then talking. Perhaps we have our ancestors to thank for that.  Lets just say our instincts have been rooted in our understanding of nature and natural life cycles. 
          It may be that what I'm talking about is already known by many, its just no one is talking about it.  Which I consider another Native American trait, we know what is going on, but don't expect us to always be talking about it.  All I know is...this indian is talking about it.

Mentorship

         As much as it was my drive that has gotten me this far, it has been certain individuals in my life that have helped me along.  I can't really say I did this all by myself, because I haven't.  Growing up in a traditional blended family I have to say I took direction from varies individuals in my life.  My grandmothers for one have always been a stable memory in my life.  Both women had qualities that just living day to day life has instilled in them.  My grandmother Mary was sweet and soft, but she had a certain level of strength in her spirit.  She spoke only Navajo and as a young girl I only understood a few words when she spoke to me. The amazing thing is as much of a life force as she was for me as a child, her spirit and memory are more of a life force for me now.  My grandmother Virgina was also a soft memory for me, she had a certain warmth in her smile.  Both women passed before I was old enough to really comprehend how much influence they had over me.  During the time they were in my life, there presence was the security was I seeking, the security that I was wanted and loved.  I think even though their time with me was short, what they hoped to pass on to their granddaughter has taken hold..love, strength, security.

        My teenage years were turbulent ones.  I think there is something to be said about surviving teen years.  I was at the point in my young adult life where I was letting my insecurities eat me alive and at the same time dealing with past hurts.  I felt as small and insignificant as a rock on the ground.  It was during this time that I really considered ending my life.  I had actually considered it on several occasions, but it was on one of these occasions I met Margie.  I remember going to school that day and walking to the counselors office and admitting that I was considering ending my life.  I thought counselor meant mental help, but actually this lady could only help with college placement...So she directed me to Margie who was a childrens counselor.  She happened to be visiting our school that day to meet with other students.  It wasn't so much what she said to me that changed things for me.  Of course she listened to me, but she took me under her wing.  I went to her home on occasion for just visits, she took me to meet her parents and brothers in Southern New Mexico. We talked about all her degrees and just life in general.  I remember being in awe, here was a grown independent woman who took care of herself.  This lady had it together.  I remember thinking, this is who I want to be.  This one woman has no idea what she saved me from.

       Throughout my young life I have been fortunate enough to have many more influential people come into my life.  Some of them have only been in my life for a short time, but others will continue to be influential as long as I breath.  I am comforted in knowing that with each person that comes into my life, there is always a lesson to be learned.  Even as I talk and connect with my preceptors while deciding on our plan of action for each women in our care.  What is it that they want me to know?  What skills are they trying to help me sharpen so that I may be ready to deal with similar issues in the future?  As hard as it may be to be the student it is equally hard to be the teacher.  I'd like to say I take direction well, but on some sensitive issues, I don't take direction very well at all.  I think when you have a good relationship with your mentor you are willing to share your insecurities with them and hopefully they will help you see your way out of them.  I'd like to think that the spirit world sends these special people your way so that they help you in your journey through life. All I know is...I am here.

The First Push

            I'm finding it hard to put the words together to describe all the emotions I've had since this part of my journey has taken on a life of its own.  Most of the time I'm calm and collected, but sometimes that little piece of insecurity likes to show itself.  I can imagine it is similar for a woman who has an initial plan to have a natural unmedicated birth and then once the waves of contractions start to get more intense she may doubt her ability to cope with whats ahead.  Its that one brief moment where you loose control and let the flood of insecurities take hold.  Thankfully, that moment for me has come and gone, but most importantly my "sisters" where there to rope me in and provide the support I needed to push forward.  That single moment where they held my hand and looked me in the eye and said "You got this" was all it took.  Its moments like these where one person or several people can change a life and help bring a new one into it.
           My first week of clinical intrapartum has been filled with many varied experiences and opportunities for me to provide the support my sisters gave me at my time of need to women in their time of need.  When first introducing myself to a family I find it necessary to "feel" the room.  The best way for me to describe this is to feel the energy everyone is giving off.  Some people give off warm energy where as others may put up a wall.  I find that taping into this energy and finding my place in it all is the most important piece of information.  Some like to call it trust and I agree that trust is part of it, but really it is much more.  I have found that there is different energy surrounding each birth, some are calm and full of intimacy, where as others are chaotic.
            Finding my place in their space is how I decide on what kind of support I'm going to provide.  This is where it starts...the training, putting the pieces together, working towards the common goal of any birth, safe delivery of their baby.  I feel I rely heavily on my raw intuition and weigh the pros and cons of any intervention at this early stage.  I know that the diagnostic knowledge and management will come in time and that I need to be patient with myself.  Aside from being completely present at each of these births, my time away from the hospital is spent replenishing my energy and spirit so that I may return ready for the next birth.  Unfortunately this clinical rotation has taken me away from the one thing that does replenish my spirit and energy.....my family. I know this time away will not last forever, but I am comforted that they are still well cared for in my absence.
               For now I make the most of my time being home with my family.  I take small pleasures in making school lunches, talking to my children about their day at school and making sure my husband knows he is a rock star in my eyes...because without them I could not do this.

Traditional Health and Spiritual Mentorship

               Aside from clinical skills and didactic learning what I least expected was my deep and profound interest in traditional medicine and healing practices.  Even though I grew up on the boarder edge of my reservation our Navajo traditional healing practices have always been apart of my life.  However, while growing up specific prayers and taboos were never clearly explained to me and  it is only recently that I have taken an interest in the meanings behind what the elders having been telling me for years.  I am happy to say that while at the tender age of 12 my mother made it a priority for me to have my Kinaaldá or Navajo puberty ceremony.  This ceremony is a representation of Changing Women and signifies a young girls transformation from childhood into womenhood. Changing Women, the most honored of all Navajo Holy people, was the first women to undergo this ceremony. I didn't know it then, but this ceremony was a milestone for me and I still have memories of that night.  The memories from that night I hold dear to my heart and I hope to one day have a Kinaaldá for my daughter.  Each prayer and song in this ceremony have proven to provide strength in my ability to be a mother and to give justice to the essence of womanhood.  I feel to deny my daughter the same opportunity for a life long foundation would mean that I am not carrying on my duty as a woman.

       On my way to becoming a mother I experienced a very personal loss of three babies.  My losses occurred early in pregnancy, but never the less they were a loss.  After the third loss, I decided that I needed healing from a medicine man.  He was able to restore balance and harmony within my womb by a ceremony called "Blessingway."  This ceremony combines positive, beauty and goodness concepts within a person.  Traditional health has a belief and understanding that any specific health problem doesn't only have outward physical manifestations, it can take form in other ways.  We have an understanding that one must have proper conduct to have a relationship with all in ones environment.  Our thoughts, prayers, and mannerisms effect more than just ourselves, it can affect an unborn child and our family relations.

        It is hard for me to say when my interest was sparked and a deeper realization of what my future would entail was revealed.  I find comfort in that I am being guided by a force bigger than myself and that certain individuals have been placed in my life to mentor me on my journey.  I find it even more interesting that those special women are related to me by my clan and have been my auntie and grandmother long before I new them.  Perhaps a predestined relationship that only could be reveled to me now that I am in a place to receive knowledge.

      With each step I take towards my future my desire and interest grows stronger in returning to my traditional ways so that I may have it within myself to help convey this way of life to families I care for.  This realization is a big surprise to me and yet it feels like this was my path all along.  Who knew I had it in me to be this person?      
      

It Is My Culture I take With Me

I am always in need of a humbling experience. Sometimes these moments are a breath of fresh air, other times they are a slap in the face, metaphorically speaking. I mean what does it really take for someone to take the first steps toward change. I know we are all experiencing some level of change within ourselves or within our families, but when does it become bigger then ourselves? I find these humbling experiences keep me grounded and help me reflect on why I’m even on this journey to begin with. Aside from bringing my bicultural view to the table, I feel the need to bridge the cultural gap between the western society and those that are more traditional in their beliefs. I realize it would be rather arrogant of me to think that I alone can do this, because I can’t, but with the help of my ancestors it is always a possibility.


I know thus far I haven’t talked much about my cultural heritage, but never the less I find it in bedded in everything I do. From walking in the hall and not making eye contact with those in passing, to feeling embarrassed when I feel myself thinking of “self” and not “others.” You see no matter how far off my reservation I may be living or how assimilated I may seem, deep down I still have Navajo roots. When I go home to visit my family it is still very much a humbling experience for me. Many families depend on the annual fair to sell their summer crops and it is not uncommon to find the best mutton sandwich at a roadside shack selling food. It is a humbling experience for me because, I speak very little Navajo and I chose to move away from home to learn the western cultural ways instead of living at home to learn my own culture. Even though this is what my parents wanted for me, I find it a difficult task even now.

I feel many of the issues that young Native Americans face today are centered in the loss of identity. It is a well known fact that alcoholism has plagued our reservations, but so has sexually transmitted infections, suicide, sexual and physical abuse…..and the list goes on and on. Honestly, I can count myself as one of the lost individuals at one point in time. It is only within the last couple of years that I’ve fully identified myself as being Navajo and have fully learned my clan. I find myself wanting to wake up every morning before the sun comes up to say my prayer of thanks with my corn pollen. Even though I do my best to identify with my ancestors and their teachings I still feel a sense of loss. I feel the loss of my culture and its many traditional teachings, some of those important teachings that I missed out on and now have to gather and piece together for myself.

All this I carry with me on my journey. I don't think I'm alone here, because I know there are many students getting a higher education who are having similar experiences and it may be something they talk about or have decided to keep to themselves.  However, I don't think there can be any cultural awareness in the western society if we don't talk about what is happening.  I also realize what I'm feeling and experiencing are "my" experiences, but at least you are getting a perspective instead of making up one.

My Blessing Way To Midwifery: Comfort Measures

My Blessing Way To Midwifery: Comfort Measures: " I am always amazed at how we as individuals cope with stress, pain, or any influential changes in our lives. Even as I go through this..."

Comfort Measures

     I am always amazed at how we as individuals cope with stress, pain, or any influential changes in our lives.  Even as I go through this program I feel my self changing, my mind being shaped to think a certain way and address situations with a certain tactfulness.  It would seem that this "transition" occurs for everyone and if we are lucky we have support from our families and friends to get us through this time of transition.  What I find most challenging is dealing with the personal struggles outside of the classroom while needing to maintain focus in the classroom. I didn't realize it, but this too is part of the lesson.
     For some this balancing act is not an issue, but if we are really being truthful, it is every ones issue.  We just have different ways of coping with the underlying stress. Up to this point I've felt pretty confident in my ability to cope with just about anything.  So far, I've been doing pretty well...but I can start to feel the heat rising around me. Now, I realize that it was rather silly of me to assume that my unpredictable life would suddenly become predictable while I was transitioning into this new role.  Life continues all around me, it only seems to slow down when I'm sitting in the classroom learning about labor support and the triple descent gradient.  Its during these times I think to myself..now..really..now....this had to happen now when I'm the most vulnerable and full of stress because I have all this information to remember.  Then I begin to tell myself okay Nicolle you can handle this, no need to go into crises mode.  Let me tell ya..there has been many tears shed thus far and I'm not the only one crying.  I'd like to think that my tears have been part of the release valve for all the pressure that has been slowly building inside of me.  The pressure that wakes me up at night worrying about who is going to watch my kids the next day while I'm in class or when my husband is away on travel.  That same pressure that is also building from seeing my extended family go through hard times and I can't be there to hold their hand.  That same pressure that I feel when all I can do is study while I feel silent guilt for my husband taking on all my duties because I no longer have the time to perform them. At the same time I new this was coming, but I just didn't know when. 
       How do I cope with all of this pressure?...well aside from crying.  I talk.  I talk to the Creator, I talk to my husband, I talk to myself, I talk to my grandmothers who passed away when I was a little girl, I talk to my mother....the important thing is I let it out and I move on.  I may not have control of some of these situations, but I do have some control over how I will handle them.  I have to give myself some slack...you are not perfect. I have to remind myself that it's my imperfections that make me unique and special in my own way.  See, it may seem like I pride myself on my perfections, but really I pride myself on my imperfections.  It is in my imperfections that I've been able to connect with people.  Some might think that showing weakness is well...weak.  But I disagree, is it not when you are down that you find out who your real support is? They are usually the ones handing you the tissue, eating the extra large piece of cake for comfort with you, or holding your hand when you get some terrible news.  I know this is only the beginning....but I am beginning to get the picture.

Meeting My Sisters

     The first real encounter meeting my classmates, second year midwives, faculty and other New Mexico midwives was at the San Ramon Tea.   Just for your information, Saint San Ramon is the patron saint of midwives, pregnant women and the unborn.  Honestly I had no idea what to expect.  The invitation said something to the likes of coming as my favorite female musical idol....mm.mmm..musical idol?  Even though I had time to think of a costume of sorts, I decided to just dress in my "best" and go as myself.  Truly I was very excited to see the names and faces of the discussion postings I'd read everyday, but once I arrived at my destination I was struck with a sense of  "What the hell am I doing here!"  I seriously contemplated turning around and driving home.  I really felt out of place, I mean here are these women I don't know having a grand old time dressed up in costumes drinking tea. I think at that moment I saw myself as the Navajo girl looking through the window at my future and realizing that I'm breaking some ground here.  Truly these were the inner workings of my fears at work, because these women were very welcoming.
     It took me a few seconds to collect myself and walk through the door, but I did.  Meeting my classmates was a little awkward at first, considering I lived an hour and a half out of Albuquerque and I had few opportunities to connect with them.  Some had become friends already and others had worked together before starting the program.  It was a little like being the new kid in school, except.....we were all the new kids in school.  This was to by my first lesson in midwifery. 
     The Midwifery community is a small and tight one.  There is this tradition in midwifery, that once you become a midwife, you are sisters.  So basically at the distinguished San Ramon tea I was actually meeting my "sister" midwives.  This was very different from any graduate or medical program I had ever heard of. I couldn't believe these women were going to be part of my support system in my path to midwifery and there after.  I don't know about you, but growing up I had only had a few select friends I considered "family."  Being a mother these days and I'm sure even before that, maintaining friendships after marriage and kids is hard to do.  You are busy raising your kids and trying to spend time with your husband, not to mention nurturing your spirit so you don't loose yourself in the mix if it all. That takes all your time! So here I was in a setting with some extraordinary women who all shared the same passion for women and children as I did.  You can bet that after this first encounter I felt like I really fit in somewhere.  These were my kinda ladies, smart, motivated, hardworking, compassionate, and ready to take on the world.
     If there was a recipe on how to grow a midwife, my professors had the recipe down to a science. In order to go out and care for women, we had to have a good support system and the knowledge to achieve our goals.  So like they say, behind a good husband is a good wife, well behind a good midwife is her sisters..... 

Getting in the Door

          My fascination with childbirth started long before understanding what it meant to be a midwife.  I would say midwifery is more than just helping women empower themselves, It is a philosophy and way of thinking.  The obvious view that separates it from the traditional medical model is that midwives think pregnancy is a natural and normal process.  The midwifery model of care supports a woman during pregnancy as an active partner in her care and encourages her to be the decision-maker.  Myself being a women, I am all for individual decision making especially when it comes to my body.  However, this is not the only factor I considered while making the BIG decision to return to school.  Like all women, once you become a wife and a mother your decisions are not your own.  You have a family to consider and your decisions impact everyone.  It obviously wasn't the potential all nighters catching babies or long work days of seeing 20 plus women on a daily bases that got me filling out my application to graduate school.  It was this idea that as a Navajo women, wife, mother, daughter, sister, and nurse I had something to offer. 
          I wont go into my childhood, but I will say this.  Life is not easy, people let you down, but its during those times that life is taking a turn for the worst you might find yourself.  What I found in my darkest times was hope and strength.  Now I'm not going to lie to you and say each time I was in the dumps I saw the silver lining, but after a few years when I stopped feeling sorry for myself and I really saw what was going on I started to get a sense of what I was made of.  I don't consider myself the smartest lady in the world,   I just don't give up very easly. 
          Growing up I seemed to get the sense that women have not always been treated fairly.  I mean even in my own home I saw the differences. My brother got to tell me to clean up his messes.  My father got the biggest portions of food at the dinner table.  These are small childhood memories, but once I got married and had children there was more.  The amazing part was it was coming from other women and not necessarily the male species.  I was being judged on how I mothered my children, what kind of wife I was, how well behaved my kids were or weren't.  Then I got to thinking about all the issues women face in this world, depression, suicide, sexual abuse, drug abuse, and the list goes on and on and on.  I mean no wonder we have these issues we get judged all the time about what we are doing or not doing.  We are not valued enough as a person.  Now some might say depression and suicide could be brought on by unstable family structures and personal choices, but the bigger picture is these women who suffer from these problems have been beat down enough to think they are not worthy of love, respect, and trust. 
          Midwifery is more than about birthing babies, its about helping women find their worth in many shapes and forms.  Midwives have a long history of supporting women and families when no one wanted the job.  Midwives provide information and options to empower women to be the authority of her own body so that she may make her own choices.   If women are the heart of a family and the cornerstone to healthy families, why not nurture them and support them in their choices.  This is why I decided to return to school.  You will find that many midwives have a strong commitment to women and their families.  The work is hard and at times thankless, but women who choose to take on this journey do have a greater purpose. 
That greater purpose has brought me here.....