The Plain Truth

THE PLAIN TRUTH

            I have thought many times about what I would say in this last blog.  As that my journey as a midwifery student has ended, but my journey as a new Certified Nurse Midwife has just begun.  The job search has not been an easy task.  As that, our national certification exam, NM license, and other professional necessities to practice as a CNM has taken time and money to attain. With that said... up to this point I've avoided talking about the specifics of my daily life while in school, only because I wanted you my invisible readers to get a sense of my personal thoughts on each life altering event I encountered.  What I hoped to capture in my blog was how each interaction effects us all on a personal level and that the person we see on the surface is not all that they are.  Each woman has her own story. We all have an undercurrent of emotions and thoughts that we let few people see and I felt privileged to have been allowed into the sacred circle of trust of each woman I cared for while in school.  This is what I value and find most fulfilling about being a midwife.

            With that said, I now find it necessary to discuss my life as a midwifery student.  Like many women who have families and who have decided to take the plunge to follow their dreams, I to took this plunge....and lived to tell about it.... For me to go on this journey, I said many prayers and had many silent moments of reverence while on the 1 hr and 30 min drive to Albuquerque for class.  Yes, that is right, I did not live in the city where my classes took place.  Some programs can get away with mostly on-line classes for students who live a distance like myself, but this was not one of those programs.  Granted some classes were on-line, but I'd advise those of you considering programs of the on-line nature...Student interaction in a classroom settings is vital and necessary for this kind of work.  The way our classes were set up at UNM, we had block schedules, meaning 3 weeks of class from 8 am to 5pm..then 6 weeks of clinical at a site..then class again. So basically I would drive down daily for classes and back again the same day.  My mornings started at 4:30am and ended around 11pm.  Upon returning home, I had some time with my family, but most of my evenings were spent at our dinner table reading or writing up papers for class.  Because I was determined to make things less stressful for my husband, I continued to work as a labor and delivery nurse on the weekends and during school breaks.  Even at work, when things were slow, I would use the time to study.  Still the extra money I was making as a nurse was not enough to support our family.  I took it upon myself to apply to as many scholarships as I could.  I called this my part-time job.  When I had my exit interview with Julie, my wonderful and amazing professor, she said out of all her students I had received the most scholarships she has ever seen...still this was not enough...  I also received graduate school loans and my husband had a full-time job. Because I was very enthusiastic about the work I was going to be doing, I took time out of my busy schedule to do out reach to talk to young Native American students at a local school in Albuquerque about traditional Navajo birth practices and to students coming to UNM for a visit.  For my friends who didn't hear from me during this time..this is why.  I was not avoiding you, I was just crazy busy.  Most of the time after a busy day at the clinic, hospital or class, I was a senseless blob on the couch..or wanted to be.         

Chinle, Arizona

         You are probably wondering with all the financial support I got..where did it all go?  Well, as that I was not home all the time I had to set up dependable after school care for my kids, at which I spent 9 thousand dollars on this for one year.   I also had to have my appendicts surgically removed and I spent a lot of money on gas traveling to and from school.  I am thankful that I had wonderful and amazing friends who let me crash at their homes in Albuquerque during clinical and block classes, because I don't know how I would have done it without them.  UNM is one of the best midwifery schools in the nation and one of the reasons why is that it focuses on training midwifery students to provide care in rural settings.  Which means, 2 out of the 3 clinical sites had to be out of the city.  As a student in this program, that means we had to find places to live at each clinical site and pay out of our own pockets for housing, food and gas. Just to give you an idea where we could be sent for this on site training, here is a list of some of the places...Los Alamos, Las Cruces, Belen, Socorro, Shiprock, Gallup..NM.  Texas, Arizona (Fort Defiance, Chinle, Tuba City)....and out east at a birth center.

         Before applying to this program, I had to also make sure my support system (my husband and kids) had a support system.  I sat down and visited with my husbands parents.  I told them about my plan to become a midwife and how much we were going to need their support while I was in school.  Parents being parents, they were cautious and asked repeatedly if this was the right time for me to return to school.  At the time, I don't think they understood my deep desire and need to do this, but thankfully in the end, they where there for us in every way possible.  From cooking dinner, to picking up our kids from school when my husband had to stay and work.  I will forever be thankful for all the sacrifices everyone made so that I could become a midwife.

Blessing of the Hands and Pinning Ceremony

          I am telling you this because in order for me become a midwife, I needed to have a good support system in place and the financial means to pay for childcare, gas, food, and travel while in school.  These things are vital to the success of anyone considering becoming a midwife.  When I first applied to this program, the four things they asked me during my interview were 1) how do you coup with stress, 2) do you have a good support system, 3) are you planning to work during school (if so..STRONGLY advised not to)...yeah I didn't listen to this advice... 4)..lastly are you willing to travel.  Thinking back to that first interview with my future faculty, I can honestly say..... I didn't know what I was in for.  I just knew I was going to do what ever it takes to make it work.  

        I now understand why more women have not chosen this type of work for themselves and also why there are so few Native American midwives.  It is grueling work with sometimes impossible expectations...and that was just my training.  I hope you know, while reading about my travels and experiences and my sacrifices..that those of us who have chosen to take on this impossible task of being the hands to help bring life into this world, we do it because we were called to it...

        As that support is vital to all midwives health and well-being, I wanted this blog to be a sounding block and hopefully my way of telling midwifery students and especially native american women considering midwifery, that you are not alone.  Whether you are in the throws of block or clinical, or wondering how you are going to get childcare for your kids while having to live miles away from them for training...you will get through this, if you believe in the spiritual world (as I do) our ancestors are always looking out for you...and if you find yourself on this path and wondering if you belong on it, you wouldn't be here if you weren't mean't to be here.  Lastly..trust yourself and your instincts, they never steer you wrong.

        Many blessings to everyone!  Remembering the beautiful Navajo journey song Ursula sang for us at our blessing of the hands after she blessed us with cedar and corn pollen to send us on our way.  I may start another blog...but we will see what the future has in store.

          

                      Happy..Happy..Happy!!!  

Little House of Miracles

     Thanks to my friend Miss Whitny Doyle, who happens to write for the New Mexico Alibi, for keeping us all informed of the changes being made in our state due to the financial cuts to medicaid and medicare.  She recently reported that the "state's only residential substance abuse treatment clinic for pregnant women, Casita de Milagros, will be closing on July 1, 2011. This clinic provides prenatal care and treatment to pregnant women who use drugs and alcohol."  Well, I don't know about you, but this is a serious disservice to the women of New Mexico.  Not only did this clinic treat women with substance abuse during pregnancy, but they partnered with Reflejos Familiares and Vision to help them get basic living necessities and taught them how to create a safe living environment for their new family.  Thankfully, these additional services will still be offered as an outpatient service, but Casita de Milagros will no longer be used for inpatient treatment. 
      While the topic of drug and alcohol dependence during pregnancy draws out major moral judgement by others, it is still area in women's health that needs to be addressed.  While some may say they don't believe in "Addiction" and that people can quite if they really "feel" like it, may not know the real meaning of addiction.  So let me define it for you...Addiction is defined as physical and psychological dependence on psychoactive substances (for example alcohol, tobacco, heroin and other drugs) which crosses the blood-brain barrier once ingested, temporarily altering the chemical milieu of the brain. So basically, drug and alcohol addiction isn't just a bad habit one can stop on their own.
       My guess is who ever voted on removing medicaid funding for this service did not do their homework. I consider myself a novice researcher, but I was able to look at several different websites for information about pregnancy and substance abuse.  According to the National Survey on Drug use, 4.5% of pregnant women aged between 15 and 44 years old, used illicit drugs in the past month between 2008-2009.  While this might not seem like a large number for some, but I think because of the moral stigma associated with drug and alcohol use during pregnancy, it is under reported by mothers in fear of back lashing from the health care community.  The interesting thing I found while reviewing websites like CDC, IHS, New Mexico Department of Health, and 2009 National Survey on Drug Use & Health, was that alcohol and tobacco use was highly reported and illicit drug use was not reported enough.  Furthermore, the website by HRSA, Women's Health USA 2010, alcohol and illicit drug use were not identified on the maternal health status report. Which means to me that, by it not being identified as a women's health indicator, a goal can not be set to address it.
        My point being after reading and reviewing all this information is, perhaps if we as women and representatives of our community make issues like this worthy of notice rather then having members of the "research" community report on low-birth weight babies, preterm births, and all the issues that can also result from drug use make headlines, only then will places like Casita de Milagros be standing to meet our needs.  I think it is important to address preterm births and low-birth weight babies, but these are outcomes of 9 months of prenatal care where we could have made an impact on these health indicators in our state.  So while "they" meaning those in charge of making cuts like this to health care programs, who think they may be saving money, really they only increasing the cost it will take to care for the outcomes of their decisions.  I'd be interested to see how this will have an impact on New Mexico in the next 5 years...

Here is the link to the article: http://alibi.com/news/37375/The-Miracle-of-Treatment.html

Vision

      It still feels unreal to me that I am finished with school and now have exponential free time to ponder where this path will lead me next.  Let me tell you, I've given serious thought to returning to school for my Family Nurse Practitioner degree, but I've sense fallen into a state of relaxation and stillness that the thought of returning to a stressful state is not something I want to dive into right now.  I'm not saying I will never return to school, because getting my Family Nurse Practitioner degree is very appealing and will be very helpful in the future.  However, it seems right now I am regaining a sense of equilibrium with my family.  I actually have time to reflect on the past two years and how I've grown as an individual.  I feel, for once in my life I know what kind of mother I want to be and what direction I want our family to grow in.  I finally feel like I've found my voice.  This for me is something I've struggled with, because I've been the woman who has accepted other peoples opinions of me and taken them to heart.  I've allowed my fear of other people's ideas of me to keep me from achieving my goals and being the woman I know I am.  I've basically not been true to myself and have allowed people to put my inner light in a box.  

        I truly feel like anything is possible if you trust in your own abilities to achieve them.  I can say that my reasons for becoming a Midwife remain and if anything my desire to serve women in my community has strengthened.  I feel like this poem really reflects how I felt when I decided to return to school.   

and the time came

when the risk it took to remain

in a tightly closed bud
became infinitely more painful

than the risk it took to blossom.”

- Anais Nin

      It is very easy to rationalize with yourself as to why you should not grow in a certain direction and you will probably have people in your life who will agree with you that to take a certain path would be risky and detrimental to all who love you, but are they really looking out for you?  Everyones personal goals are different and most of the time those people who are warning you not to take this major step in your life have themselves chosen not to take their own path of growth.  

       The path that I now find myself on is navigating the varies employment options.  Because of the location of our home and the type of environment we want our children to grow up in, I am faced with the creating a place for me to work.  Surprisingly, this actually is exciting.  Being a midwife comes with many obstacles, but it also comes with many opportunities to be creative.  This just happens to be an area I flourish in.  Like many artists,   I am imagining my work of art on my canvas before I've even started to paint, but my ideas will soon take shape.  This is only the beginning......

Blessing of the Hands

  

   "On this day, I dedicate both my heart and my hands to service..."

     What a way to end this journey and to begin our life's work as Certified Nurse Midwives.  Some of us will be traveling to our new destinations and others will be enjoying a few days of rest with our families.  It has been a tough two years of countless papers, exams, and training for our new professions.  Thankfully, we've had each other to lean on while balancing our many roles.  Thus far, we've been blessed to have had this time to learn from each other and to have our paths cross.

      I know the significants of this ceremony will resonate in all of us when we are faced with a difficult situation.  I hope that we can all look back on this day and remember all the blessings and words of encouragement by our mentors, professors, husbands, mothers, children and fellow classmates.  I look forward to fulfilling my pledge as a midwife and serving the women of my community.  I was especially touched to have had my wonderful and inspirational mentor Ursula Knoki-Wilson pray over us and send us off with a traditional navajo journey song.   To hear those words sung for us held all the meaning for me as to why we were brought together to pledge our hearts and hands to the service of women.   Each and everyone of us brings with her a piece of themselves to the art of midwifery and I know we will help cultivate peace in all of our associations.

  
      I can truly say this experience has forever changed me and has made me stronger as an individual.  It has also strengthened my family and my relationship with my husband.  It has brought about an inner peace that my spirit has been seeking all of these years.  A peace that I am a woman who fought hard for what she believes in and brought anyone willing to be apart of it with me.  I feel like a woman who has "walked through my past and has healed into the present."  I've learned that being with women during birth is truly a gift.  I am truly honored to be with them and to bare witness to their transformation into womanhood.  I am thankful to have had my amazing sisters be apart of my transformation through the turbulent waters of midwifery school and to have been able to be apart of their transformations as well.

      I believe this poem says it best about my amazing classmates who I have had the privilege of knowing and will continue to build a life long relationship with.  Written by Patricia Lynn Reilly...

Imagine a Woman in Love with Herself  

     Imagine a woman who believes it is right and good she is a woman.

A woman who honors her experience and tells her stories.

Who refuses to carry the sins of others within her body and life.

    Imagine a woman who trusts and respects herself.

A woman who listens to her needs and desires.

Who meets them with tenderness and grace.

   Imagine a woman who has acknowledged the past's influence on the present.

A woman who has walked through her past.

A woman who has healed into the present.

   Imagine a woman who authors her own life.

A woman who exerts, imitates, and moves on her own behalf.

Who refuses to surrender except to her truest self and wisest voice.

  Imagine a woman who names her own gods.

A woman who believes her body is enough, just as it is.

Who celebrates her body's rhythms and cycles as an exquisite resource.

   Imagine a woman who values the women in her life.

A woman who sits in circles of women.

Who is reminded of the truth about herself when she forgets.

  Imagine, we are all this woman.....

      Many blessings to my lifetime friends who have now become my family. 

 ....And to my amazing husband who remained my true friend and partner in life while I traveled this path to my truest form...

  

      

          I know our work has only begun, but I look forward to what lies ahead...............My we all walk in beauty on our own paths in life.

International Day of the Midwife 5K Walk: Why We are Walking

International Day of the Midwife 5K Walk: Why We are Walking: "We are walking because...It is International Day of the Midwife and one of the most appropriate days to highlight that over 340,000 women an..."

A Woman's Heart

     There is a constant pull on my heart between the life I lead as a woman, mother, and wife.  My duties stretched between husband and grandparents.  As I work with women in this rural setting I see that I'm not alone in this trivial divide between finding a healthy balance in the choices I make.  I realize that even though their choices may be different, we are all one in the same.  Still making our way with or without the support of those who we call family.  I don't ever remember having a conversation with my mother about the hard choices she has had to make on our behalf, nor did she ever tell me how hard it would be to make those choices for my family.  It seems as caretakers of our families and of our own minds and hearts there is a point where our future is decided for us by our circumstances or we are able to make those decisions for ourselves.  Either way, there is a pull to do what is right for our families and the decision is never easy.
     Is this what it means to be a mother? A woman?..... To always be torn between what is right for us or our families?  It seems we are not brought up to take our own voices seriously.  Do I count?  Do you hear me?  Why I am I selfish to want this?  Your more important then I am.....This is what I hear in my conversations with women.  They don't say it out loud, but it if you really listen its in her posture, her tone, her eyes, and how she asks a question or the questions she does not ask.  What a gift it is to find trust in a stranger who actually listens.  I'm not saying they aren't strong, because by all means I believe ALL women are strong, they would have to be.  To put her dreams aside to care for a dying mother,   to stay with a man who beats her so her kids will have a roof over their heads, to chose a career of helping other women even though it will take her away from her own family.   All the while being judged by other women making similar choices and perhaps their choice was different, to leave the man who beat her, choosing her family over a career, not putting her dreams aside to care for her dying mother.   I wonder why we as women must make it harder for each other by making comments full of judgement rather then understanding each decision we make is a difficult one.  Whether we show it or not.
   Each woman walks her own path making many decisions along the way. All the while wondering if it is the right one or knowing with all her being that it is the right one.  Some like the sound of their own voices and are not afraid to be heard, while others are still getting used to hearing the sounds of their own voices............I just know that my voice is all I've got to tell my truths... that is if anyone is listening.......
  

Exploration Ambivalence

             Week 5 of my clinical rotation and I'm finally more confident in my clinical abilities.  So far I've scaled the computer charting wall, collected many passwords and am spending more time talking to my patients rather then trying to figure out the computer.  I am amazed at how much of what I've learned in school is coming together for me.  Suddenly, I can make sense of the labs, order appropriate testing, and consult with my physician colleges without the feeling of dread that they will scowl at me for asking so many questions.  I guess that is what "integration" is for?..Graduation is quickly approaching and I still can't seem to bring myself to think that far ahead.  Invitations?...reception dinner?...Thankfully, I have a couple weeks after I return home to worry about those details.

             Aside from my random thoughts and wishful thinking, I am in awe of the women I care for.  Some of them traveling 6 hrs for 1 prenatal visit, some may or may not have transportation, others dealing with family members with multiple issues, trying to get a college education and trying to maintain some sense of "healthy" for themselves.  These women are doing the best they can for themselves and their families all the time!  I find myself to be not only a healthcare provider, but a counselor, advocate, friend, and many other things.  My only limiting factor is TIME!  I'm having a hard time limiting my visit to just 10-30minutes a visit.  I've heard this complaint again and again, how do they "preverbal bean counters" expect to me to see 20 women daily with varies issues?  As my wonderful preceptor has told me recently, she has had to leave pieces of her heart behind to accommodate the increasing number of clients she "has" to see daily.  Visiting with women is one of the things I love about becoming a midwife.  I will have to think outside the box to give women the kind of care I think they should have and do it in 30 min or less.

            On a separate note, I am still working on solving the pharmacy issue.  That is..why does it take so long for medications to get filled at this particular Indian Health Services unit?  Let me remind you, apparently it takes an average of 2-3 hrs for 1 prescription to be filled. I'm not saying the service units pharmacy is lazy or taking long lunch breaks, but I would really like to know the big secret as to how many prescriptions they fill daily vs. a Wall-greens and why Wall-Greens is faster?  I know I'm not the only one who would like to know this answer.

           One of my goals for being here was to educate women in their options for care and so far I've had the luxury of time to do that.  Some women have been very forth coming in their questions about "all things female" while others have taking a quieter approach, but I fear with the lack of time we as providers have to discuss all matters of heart and health, we may be missing the meat of each visit.  I know I've learned more about a woman in 1 good visit then I would have in 10 short visits!  Each woman I encounter I learn a little more about her unique needs and I pray that I do not loose that closeness with them by trying to meet the needs of the practice I am with.