Sorry it's been so long -- two whole months now!!  -- since I've posted.  Yes, my life really has been that busy as a new CNM.

While I'm fully ensconced into year two as a CNM, I am still learning so many things.  I've learned so much GYN care over the past year, it's just amazing!  I learn new things still on a daily basis.

I am hoping to do a compilation of my birth statistics for the past year, however, my birth log is locked up in my office and will stay there until I return later this week.  So, expect a statistical analysis of my births as a CNM to be forthcoming!

I have been gradually reaching out more and more into the homebirth community.  I'm working on building better working relationships between the homebirth community midwives and their clients, and us midwives and physician colleagues in the hospital setting.  What I have found is that every single provider wants good outcomes for all women and babies.  Sometimes it necessitates care be transferred from one setting to another (that works in both directions: home --> hospital and hospital --> home).  My goal is to let the homebirth midwives (and mothers) in the community know that they do have a safe and respectful place to go for hospital care, if it's needed.  This is a relationship that I have noticed is sorely lacking in the community where I practice hospital midwifery.

That's about it for now -- I am off tonight, and will be celebrating the new year by sleeping ;-)

I passed my one year mark of my midwifery career a few weeks ago.  Now on to year #2!

I still have much to learn.  I still have to look up things that I do not know, or am unsure about.  I still ask many questions about different topics and management options with my CNM co-workers and MD partners.

I started off year two with a BANG!  I was recently an inpatient after an unexpected surgery, and have now officially had my first colonoscopy.  No, I'm not 50 or older (for routine screening colonoscopies it is recommended to start at age 50 and have one every 10 years -- see the tidbits of info I have learned over the past year?).  I had my first colonoscopy for ongoing GI issues.  The prep for it was pretty wicked (4 tabs of dulcolax, 14 doses of miralax, clear liquids only - no red color dye in any liquid).  I ended up having to do that prep for two days in a row due to my colon issues.  Oh yeah, what fun.  Liquids for 2 days, plus pooping every 10 minutes!  I've actually heard that some people feel better after having their colon cleansed like this.  I don't.  I just feel tired and thirsty.  And nauseous (so I'm not back up to my usual eating habits), as well as GI cramping.

I will tell you, I don't recall a darn thing from my colonoscopy!  I remember going into the room, commenting that (they) were going to see my "best side", and telling the CRNA "please forgive me if I say anything funny while under...I apparently get flirty."  He laughed, and said he would never tell if I said anything funny.  I'm pretty sure I was out though -- I received versed then propofol (they don't call it milk of amnesia for nothing!).  The last thing I remember is feeling like I was wayyyy drunk and was slurring my words and getting giggly.  Then.......waking up slowly in PACU.

I was very crampy in my GI tract afterwards, and the nurses highly encouraged passing gas frequently.  So I did.  Couldn't bring myself to do it in the room/on the stretcher, so I went to the bathroom and passed gas like never before!!  I still feel some gas trapped in there today (day after the procedure), and I have some nausea as well as a lack of an appetite.  Other than that. doing a-ok.

I received a very complimentary comment from a former prenatal patient recently.  Even though I wasn't there at her birth (one of my partner CNMs was at her birth) she raved about her entire experience - prenatal care, labor, birth.  It warms my heart when patients give feedback like that.  Love it, hate it, or even if it was just so-so......I like to hear how each woman feels about her pregnancy and birth.

I remember this lovely young woman in particular.  She is tall and looks like this beautiful goddess.  I told her that, several times when I saw her in the office.  I also told her -- her baby should surely slide out easily like butter because of how tall she is. Sure enough, her birth went fast and easy!  I love being able to see moms again afterwards -- several months down the road --- to see how they're doing in their transition to parenthood.  In this particular woman's case, I would say she is doing very, very well!  Her baby is just as beautiful as she is too.  I happen to see this client frequently, due to the nature of her work, and absolutely LOVE how well she has blossomed into a new mother.

As midwives in our group, we all send out nice hand written congratulations note cards to each mom/baby that we helped come into this world (when we are present at their birth).  I love that we do this, because this helps tell moms that we really DO care about her, her baby, and her new family.

I've also received a very nice compliment in the form of a hand written card from a GYN client who had a bad diagnosis, but we (she, mostly!) was able to catch it in time quickly.  That is something that will stick with me forever!

I'm spreading the word about Evidence Based Birth!  Lots of info, well written and backed up with evidence and research, about pregnancy, labor and birth.

If you're interested in entering to win an EBB waterbirth t-shirt, you can enter here.

No, we don't have waterbirth at my hospital -- it was "taken away" several years before I started there, due to a poor outcome with one baby.  It sounds like it was not the waterbirth itself that led to the problems with the baby, but more of the management of the labor/birth.  I won't go into details, because I value and respect (and honor) the pain that that particular family went through.

However, if you look at the evidence....water immersion in labor, in a low risk pregnancy is SAFE.  Waterbirth --- with lots of references listed to many different studies.  Some studies were good (appropriate power and number of women), while others were not good (small population samples).

I haven't been around due to business in the birthing arena, and more recently, me being the patient.  It feels incredibly helpless being on the patient end of the care provider/patient relationship.

I have been having ongoing issues with abdominal pain over the past several months, and they have gotten worse as time goes by.  I finally sought care when the pain became too unbearable, visiting the ER twice in one week.  Then I had an EGD (upper GI scope) which revealed nothing.  That was followed by exploratory surgery, which did find some abnormalities.

Here's where it gets frustrating -- the surgeon didn't tell me the findings face to face.  He took the easy way out and told me over the phone.  His recommendations were to undergo more surgery, where my entire large intestine is to be removed.  Let me back up.....it was not a recommendation, it was more of a "you need more surgery", and no other options given.  Does that sound like informed consent for a major surgical procedure?  No.  Does that even sound kosher that he did this over the PHONE?  Hell NO!!

As I struggled through the tears of an unanticipated open exploratory laparotomy (with a big ass incision from just under my breast bone, down to my pelvis), the pain of said surgery, and then the devastating news that I need to have my entire large intestine removed, I cried.  I cried tears of sadness (Loss of bodily integrity, How was I going to eat???  What could I eat?  What about malnutrition, which I already have post gastric bypass surgery??).  I cried tears of loss....a major portion of my GI tract is going to be removed, and I will never get it back again!  I cried tears then of anger --- how could he give this info on the phone?  Why not face to face?  Major abdominal surgery?!  I don't want to undergo that again!

I channeled my anger, after hashing it out with a very empathetic RN who was caring for me in the hospital.  She reminded me of my rights as a patient.  A right to self determination, a right to bodily integrity, a right for a second opinion!!!!  The lack of control was now turned back into self empowerment.  Thanks very much to a wonderful and caring nurse!  (PS - she received a huge, hand written thank you card from me.  She deserves so much more than just a thank you card!)

So a second opinion was obtained while I was post op in the hospital.  The GI doctor was such a pleasant, caring, sensitive provider.  He took the time and listened to me.  He asked more questions about not only my medical history, but also my family history.  He didn't brush off my concerns or suggestions.  Thank God I found (or perhaps it was fate?) a caring physician versus a cut-happy surgeon.  This physician agrees that we need to figure out why the surgical finding were what they were, and the etiology, as well as more conservative and bowel-sparing treatments.

I'm only one week post op, and we still don't have a medical etiology for what is going on, but at least we're moving in the right direction.

I lodged a letter of complaint with the hospital CEO (who I happen to also know from outside of the hospital), and voiced my dire concern about a surgeon who is cut-happy, and yet at the same time, doesn't have the guts to talk to his patient face to face to deliver bad news.  In fact, this surgeon didn't even visit me ONCE while I was post op at the hospital for 3 days.  Instead, one of his partners came on post op day 1, and wouldn't even talk to me about what was found and what the plan of care would be.  He deferred back to the surgeon who operated on me......who said he would round on me on day 2 post op, but sent yet another colleague instead. Who was a complete and utter jackass.

What has being a patient taught me?  Be sensitive to your patient's concerns.  Take the time to listen.  Answer questions as thoroughly as possible.  Talk about alternatives for treatment plans.  Encourage a second opinion if the patient doesn't like the options.  Refer patients to appropriate specialists.  Involve the patient in their care plan!  Be nice, always be considerate, and listen to the nurse's concerns regarding a patient's care.

Don't be a patient who is: powerless, defenseless, without an advocate on their side.