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.

          
              

Reflections of Time

     Its hard to believe I am already heading into my third week of clinical's here.  I met a wonderful Navajo medicine woman who shared some traditional knowledge with me and also wrote a prayer for me to say each morning in Navajo.  Per my request of course.  This was actually one of the high lights of my week.  As well as, attending a birth at which I got to see her provide labor support and prayers for a patient.  I am still at the stage in my clinical training where I am gaining the trust of my preceptors and the nurses.  This is always an uncomfortable stage for me, as that I have to share my past experiences with them and prove to them I am competent. It is even more worrisome when they know the program I am with is well known for "good" and "competent" students.  Because, then they expect no less of me.   I know it is how it has to be, but I am the type of person who likes to feel comfortable from the get go and feel like old friends, rather then to stumble around.  However, I know the stumbling around part is in important step in my develop as well.  Gotta stumble before I can stand...right?
     Aside from some of the clinical and management skills I want to develop while I am here, I am trying to get a sense of what it means to be a Navajo woman.  I mean, I know what kind of Navajo woman I am, but what does it mean to other Navajo women?....I am asking this question because it is interesting to see the role women play in each family and compare it to the role the elder women play in each family.  There seems to be a shift in what the roles used to be to what they are now and also whether they are a "traditional" Navajo family or " non-traditional" Navajo family.  I take this to be an interesting study of my own culture and what women's roles are in it.  I have my own life to compare it to, but my up bringing was a mix of tradition and non-tradition.  Further more, my experience with Navajo women in labor is limited.  And let me tell you, the experiences I've had so far with them, is very different from the experiences I've had with other cultures.  I find this interesting, because for one I am a Navajo woman, but yet I have little knowledge of how other Navajo women cope with the pains of labor, motherhood, and their overall new roles in their family. Again....this is stuff my mother never discussed with me.  She went to the hospital one day and came home with her baby the next.  She never talked about the pain of labor or how she coped with it, nor did she tell me about how her mother birthed her.  Could this be the same experience other women have in my culture as well?
      Obviously, I am seeking a deeper meaning to what it means to be a Navajo woman today and what it meant to be a Navajo women 20 or 30 years ago.  I don't think I will get this answered in the short time I will be here, but I do look forward to spending some time with some of the elders to learn more about my cultural history.  Its during this time I wish my grandmothers were still alive to share this knowledge with me.  It is only through bits and pieces of other peoples stories am I able to put it together for myself.
    

Rural Health

     I am definitely getting a taste of rural health on my Navajo reservation.  First I would like to make it clear that each community is unique in itself and the issues that one community faces might not be the same issues the next community is facing.  However, it was very interesting to see that the research I was reading, with regards to my Native American population, does reflect what is actually going on in the clinical setting. It seems that the barriers to health care continue to be related to MUD, rural living conditions, and limited emergency services.  While I've had the pleasure of spending two whole days at the Pinon clinic in Arizona.  I was able to see what kind of services were offered to the greater community and beyond.  Mind you this is a clinic that offers multiple services like pharmacy services, public health, access to a traditional healer, pediatric care, nutrition, dental services, mental health, and women's health care services.  They have one ambulance that is also available if necessary.  The nearest tertiary center is 8 hours away in Phoenix, AZ and the nearest official emergency services is in Chinle, which is located 45 minutes east.  The road between Chinle and Pinon still is partially dirt road.  I was advised that when it rains or snows that road is not safe to drive on and you have a good chance of getting stuck in the mud.  Thankfully, my trip down this road was uneventful and safe.

       Like most Indian Health Services clinics, they try to offer all of these services in one location because they are located miles from a city.  I'm not saying Indian Health is perfect, but from what I saw here at this clinic, they are making an effort to bring health care to rural communities like Pinon.
                                        
                                             So what does this mean for pregnant women?

     For women who are high risk OB patients requiring the watchful eye of perinatal services, they will still receive some of their prenatal care here, but they will be referred to a perinatal group that is in Phoenix.  For anyone who has cared for women requiring perinatal care, you know what this means.  Usually these women will be seen by a perinatal provider twice a week and once by their primary OB doctor or midwife.  What this means for women in this community and surrounding communities is that twice a week they will most likely have to go to Phoenix, an 8 hour drive, to receive this care.  This clinic does have someone drive these women to Phoenix, but still this is hard on her and her family.
If a woman is in labor or has ruptured membranes she is checked and is encouraged to  have someone drive her to Chinle's labor & delivery unit.  Because they only have 1 ambulance they use it for more serious situations.  I am starting to see why one of the most common causes of maternal and fetal death is car accidents.
     Some of more prevalent infections these women face in this area are H. Pylori, Chlamydia and Gonorrhea.  For young children, pertussis, RSV, Flu, and upper respiratory infections seem to be causing the hospital rooms to fill up. However, I think it is also a problem in other areas outside of the Navajo reservation.
      I really was not trying to paint a gloom and doom picture, because really these issues that our reservation is facing are "Real Issues."  Indian health is complex and has many issues that are still being sorted out and addressed on a community level and a national one.  I feel strongly that government funding for Indian Health Services should be increased to more than the 50% they are getting right now.    I wonder who is advocating for the health and wellbeing of my tribe on a national level.  I wonder yet..if these issues can be fixed...and how do I fit into all of this?

Chinle

     I said my fare wells to my family yesterday afternoon.  My kids all gave me individual hugs and of course I told them each to help their dad while I was gone.  I hope that I can skype here so that I can at least see their little faces on a daily bases.  My husband promises to have them all well behaved by the time I return, but I think my kids have there own ideas.  Besides, I thought they were well behaved already?  Last night I spent most of my evening putting away all my stuff and getting groceries for the next couple of weeks.  

     Today was my first official day and so far it is going well. I spent the morning filling out all the government issue paperwork.  For anyone who has worked at an Indian Health Service Unit, know what I'm talking about.  My neighbor was nice enough to let me use his wi-fi access and his washer and dryer.  Which is a major bonus!  Internet is a resource people here don't all get to use.  So I'm thankful.  The neighbor I mentioned is a pharmacist and after chatting a little with him has told me it takes about 3 hours for medications to get filled..3 hours!  I guess that is rural health for you!  

      If I could describe Chinle,  I would say it is different shades of brown with tumble weeds all curled up at some of the western fences.  Mountains to the west and Canyon De Chelly National Monument to the East.  The main road coming into Chinle, goes to the heart of the town then T's off in two different directions. The Navajo term "Chinle" translates into "A Place Where Water Emerges from Canyon's Mouth"  While driving over here I was able to take in the beautiful sites and see farm animals grazing on the side of the road.  This also means I had to be careful not to run into one.  These photos don't do this place justice, because in the evening while the sun is setting, the mountains to the East turn bright red.

     I have to say it was nice hearing my native language spoken so freely in the hallways of the hospital.  Tomorrow is a new day and I get to meet more people.  Which I am thankful for, because I am already missing my family and all the sounds of my busy house.  

Parallels

     While reading research for my Masters exam, I have found some interesting parallels between how to care for older couples in their home setting and caring for women in a clinical setting.  The study was qualitative exploration of the home care experience.  Obviously this is perhaps an odd correlation of themes, but yet should be applied to the care of all.  Those of us living in the context of" meaning well" when we help others when at times this idea of "meaning well" can have detrimental effects on the one you are trying to help. I think as human beings we have a need to feel "independent" and perfectly capable of taking care of "self."  At which the act of giving and receiving help is tricky.  Case in point: I am a terrible speller, I may joke about it, but seriously it is something that is a soft spot for me.  My wonderful and amazing professor took it upon herself to help me correct my spelling draw backs, but I was completely put out by it.  I mean it really bothered me.  I finally told her, "No thank-you, I will ask for help when I need it."  She very kindly accepted my need for independence on this one, but I also realized my need for independence affected my sense of self.  Yes, she is my professor and very knowledgeable in her right, but I didn't trust her yet to accept her help.
     I think this can be expanded to the women and families we care for in a clinical setting.  What may be going on with them medically or naturally can be something out of their control.  They first have to process and accept their situation for what ever loss of independence they may be experiencing.  This is a big deal!  For some this adjustment takes time and the bond we are seeking to make with them is highly dependent on the kind of relationship we want to have with them. The clients themselves have expectations of us, as we have of them, but how are we going to build the trusting relationship with them?  I think this article had it right when stating that first impressions are vital, but so is developing mutually acceptable relationships by really being invested in their ideas of what they value as safe and trustworthy.
     Another parallel I found interesting and important is that both spouses should be viewed as clients participating in their own overall well being.  In the end, we as providers and caretakers of our communities promote this idea, but more importantly its the relationships we gain from these interactions that is the promoter.  One of the major themes that came out of this article that struck a cord with me is this...."Women are viewed as the gatekeepers of the household and its inhabitants." I know most women would agree with this, because it is something that this article found to be vital in gaining the trust of its participants for the study.
     I am sure that the concepts I have brought to your attention are not new ones, but it is a nice reminder for me when I am working with women in the clinic, hospital, or even with friends and family.  I know trust is a big deal to me, I also know that it also has a different meaning for each and everyone of us.  I think that is why I find comfort in exploring these topics from my experiences as a student.  Our paths, our experiences are all varied and individual.  What we gain from them is also very individual.  I think the more I explore our many complex relationships with each other and ourselves the harder it is for me to define "self." Because "self" is ever evolving with each experience.    

Self-Preservation

     In my quietness and time of reflection I find many things floating through my mind.  Really, I am just thankful to have the time to reflect at all.  The semester has been a crazy busy one, some of the craziness inflicted upon self and other craziness inflicted by others.  I have made it a point to rise at dawn so that I may throw my corn mill after saying my morning prayers.  This is all part of me trying regain the inner peace and balance that has been misplaced during this past semester.  I find myself wanting to be in a state of meditation and complete peacefulness so that I may have the energy to take on what lye's ahead.  As comforting spending time with my family was, the holidays are anything but relaxing.  I have to remind myself that what is important during these crazy times is "time and memories."  Aside from the crazy holiday shopping, what will my kids remember most?  Surely, not the number of gifts they got, but that we were together trying to keep the spirit of Santa alive, because as they have grown older, they have become more suspicious.
      While on my holiday travels I found myself revisiting old hurts, which was not part of my relaxation plan, but still it was there.  Its like in its own time capsule that seems to want to open itself up for me every time I visit. How is it possible that I have grown from these events and yet for others they continue to be a cause for future burden at which they then try and rob me of my peace.  As much as I want to bring a greater peace to all that it has hurt, I know I can't.  I am greatly disappointed by this revelation.  Yes, yes those who really want change and healing will find it in their best interest to make those changes.  They can not be forced.  However, it is very hard for me to leave those who still like to stew in their own pity to move forward in my life.  Perhaps it is also why midwifery chose me and I chose it.  To have hope that change is possible is a gift in itself.  I always hold out hope that those that I love with find their way and see beyond their own pain.  It is the same hope that I hold out for all women.  Change is possible.  Perhaps some would say that this idea of doing the same thing again and again hoping for a different outcome is "insanity." And in some ways it is, but some people need that and for some the outcome is different. 
       Aside from dealing with old hurts, I am getting closer to reaching my goal...graduation, for now I am looking forward to the next leg of my journey.  I will be in Chinle, AZ working with my tribe.  I am very excited about this.  To finally be in a place where our traditional healing practices go hand in hand with western medicine.  I know something bigger than me awaits me there, but I'm trying not to get myself worked up over it.  I am doing my best to take whatever happens as it comes my way with patience. The down side to this is that I will be away from my family for two months.  I know I will miss them terrible and I hope that while we are creating memories, this one will not be a sad one for them.  I know my husband will do a bang up job of being their for all of us, I just can't let the guilt eat me alive that I will be away from my babies for that length of time.  My choices of my reality are not easy ones to make nor to live with, but I know there is a reason for them. 

    My prayer to self " to maintain and restore peace, love, kindness, humbleness, and harmony within my self and with my family"
     

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..."