Fortunate as I am, my work allows me this pleasure, as does beekeeping.  In these two arenas, I must stay grounded as I approach my work with respect and an awe of creation.  I feel one with the universe, with God, and with my bees or my client.  The entire rest of the world is silent-abstract and distant as I approach my birthing mom or my queen bee and her colony.  In silent reverence, or with a gentle voice, I connect, offering reassurance and love; offering my skills only when needed and hands-off support for the natural processes to unfold.  I am lucid, observant and engaged.  This is a beautiful place to hold space-connected to the oneness of all in the natural cycles of life.  

The workshop was led by one of the founders of InterPlay, Cynthia Winton-Henry, a therapist and dancer.  She provided guidance and a safe play space.  We partook in silly activities, like babbling, and storytelling, movement and games.  We learned some of the most basic applications of InterPlay principles to our health care practices.  As what they term “recovering serious people”, it’s important for us to remember to bring levity and fun into our interactions with our clients.

Don’t expect rubber noses or face paint, but I think you will see the changes that this practice is having on me as a midwife.  It’s certainly affecting my interactions with family and friends.  It is my hope to create safe play space in my client activities to enrich my client’s experiences of motherhood and community in their childbearing years and beyond.

So after you read this blog post, I ask you to do something fun, something non-productive-just because.  Go draw a picture or turn on some ’80s music and dance;  build a sand castle or make playdough.  Do something just for the sake of fun, and see what happens.  I’ll keep you updated as to the changes I see that come from this practice.  For more information about InterPlay, go to their home page:  http://www.interplay.org/index.cfm/go/home:home/

If a mom wasn’t exercising before pregnancy, it may be challenging to incorporate movement into her daily life.  However, moms who exercised prior to conception may continue their current exercise routine if:  there are no contraindications specific to their pregnancy (discuss this with your care provider), and the routine exercise does not include prolonged periods of increased body heat (such as hot yoga, sauna, or hot tub).  While you may be able to continue your exercise routine in pregnancy, it is essential that you consume ample amounts of water to avoid dehydration, which can cause complications with your pregnancy.

If you haven’t been active, then starting a moderate exercise program in pregnancy is appropriate unless your care provider has informed you otherwise.  Walking, yoga and swimming can begin at any point in pregnancy, and are beneficial additions to any exercise routine during pregnancy.

Walking increases oxygen flow throughout the body, including the placenta, which transports oxygen to the baby.  When we walk, we loosen up tight areas in our musculature that may cause discomfort otherwise.  Walking provides an excellent mental health boost, especially when walking in nature or with a companion.  Our practice incorporates weekly 3-mile walks around Lady Bird Lake.  Moms enjoy the social support that the walks provide, and they enjoy the improvement to their overall sense of well-being.

In the summer months, we meet clients at a local public swimming pool for weekly swims.  When we swim, our bodies are buoyant, allowing us to relax and surrender areas of tension to flotation.  Swimming increases oxygen flow to the body, and it promotes rhythmic breathing that is helpful in childbirth.  When we swim breast-stroke or free-style, our babies rotate into an optimal position for birth, so swimming is especially helpful for birth preparation.

Whether you choose to walk, swim, or continue a spin class, yoga will offer unique benefits to your pregnancy.   Contrary to popular belief, yoga can be done at anytime and anywhere.  If you are a beginner, you may choose to attend a class or rent a video to learn basic yoga breathing, movement and postures that are appropriate for pregnancy.  If you have been a yogi for years, take time to learn about pregnancy yoga, for there are some important restrictions  that you need to take into consideration.  A good pregnancy yoga class will include ample time to sit, breathe and connect with your baby.  Yogic breathing is useful during all stages of labor, and it also assists new parents to remain calm when comforting a fussy baby.  At Sisters Midwifery, we usually have a yoga class scheduled, but these are not always available.  Many local yoga studios offer prenatal classes, so you will likely be able to find a class that is convenient for your needs.

Get out and move your body, connect with your breath and your baby.  Spring is coming, so indulge in long walks with your dog or partner; breathe the clean fragrant air and improve oxygen flow to your body.  If there is a pool or a yoga class offered nearby, give these physical activities a try, as well.  Dance classes, martial arts and other options may be available in your area.  Prioritize your exercise time so that you can enjoy a healthy active pregnancy.

We are fortunate to serve so many wonderful families and witness their journeys in becoming new parents.  The addition of gifted midwife Christy Tashjian to the practice has been a wonderful expansion of our services.  Christy and I attended an inspiring primigravida (first time mom) twin birth  in August.  That experience, along with a few years of assisting each other at births, helped us to see our compatibility as partners.  Developing the practice to accommodate a new partner has been a lot of work for both of us, and it has created new challenges.  I’ve never collaborated in care as closely as I do now.  This endeavor is proving to be worth the work in many ways, especially in terms of the expanding services that we can offer, individually and collaboratively.

While big changes have been taking place, some of our best working practices have remained constant.  Individualized care, holistic expertise, active listening, childbirth education and client social support activities are among those.  The success of the client activities, in particular, has had delightful outcomes over these years.  Several of my clients have developed lasting friendships, and playdates, moms-day-out and other sweet social networks have spiraled out of the clients walks, childbirth classes, yoga classes and cooking classes.  These support activities have necessitated additional time outside of normal business hours for planning and attending these events, but the work has been joyful and productive in giving moms opportunities to make connections to others who are building and raising families.

When a mom smiles with confidence after learning a successful breastfeeding technique or an expectant dad expresses his vulnerabilities around taking on the role of father, I feel like I’m doing a good job at giving my clients opportunities to grow.  Each endeavor we take as human beings, whether we are starting a family or a midwifery practice, is a chance to grow and learn.  I find that the more work I put into supporting my clients and my new midwifery partner, the richer the experience is for all.  That’s what life is about anyway-growing and loving and witnessing these things.  Midwifery is hard work, but it’s results are worth it!

In my family, Haiti is a lesson of appreciation.  I’m grateful that I know where my children are right now, that they are safe and well-nourished.  I know I am loved by my husband, and that he is a happy person free of worry about how to provide for his family.  From Haiti, I am re-learning how to appreciate my role as a mother and a partner, and enjoy the simple preparation of a meal for my loved ones.  I hope this will enrich my family life.

In my work, I’m learning to put women’s work into perspective.  The work of pregnancy, birth and becoming a mother are huge life-changing events.  In midwifery, we hold space for women to do their work while maintaining safe standards of care that are respectful of their autonomy.  My experiences volunteering in Haiti help me to see the problems of the women whom I serve here with more clarity, with empathy but detachment, as I can see their paths are theirs alone, and that I am simply a witness for their great work.  To take on more is not possible if one is to find the strength to work with women and their families daily.  Honoring the diverse paths of the women I serve is still my goal, but I feel that Haiti has made me stronger in my resolve to do so without attachment.  I hope this will serve my clients.

In my community, I found that true friendship and meaningful service are keys to happy engagement with others.  I’m spending more time with a select few friends, rather than spreading myself too thin or cutting moments in their presence too short.  I’ve become more discriminating, too, in my community service-searching for projects where I can invest my time while enjoying others and learning about myself.

In short, I’m learning from my teacher, Haiti, how to live a happier life, free of needless worry that originates from fear.  Seeing hardship close-up, alongside resilience, has given me this gift of insight that I hope will continue to grow.  I nurture it with careful reflection and thoughtful action.  Thank you, Haiti, for showing me my limits, teaching me to honor them and carefully choose when to push on to new ground.

In Haiti, the vast majority of homes are without electricity and running water.  Clean drinking water does not magically flow to their sinks-they must hike for it to the nearest pure water source.  On my trip through the Central Plateau I found that public drinking stations were interspersed along the main road.  I was delighted to see it flowing abundantly at these spots where folks gathered to visit and braid hair, among other daily activities.  The river is the preferred spot for bathing, and many a lathered-up body can be spotted along the bank dotted with locals washing clothes and children.  The lights go out at night-for the most part.  Remember when the cities and towns in the US went to sleep at night, the latest hour convenience stores were open was 11pm (i.e. 7/11, kids)?  Haiti is kind of like that-with ample barbed wire and police dogs running amok.  They bark, growl and kill innocent wildlife at night, too.  That’s why an essential item for a volunteer trip to Haiti is a pair of earplugs.  Security lights around compounds, such as ours at the orphanage in Hinche, are the sole competition for moon and stars-sleep masks are similarly not a bad idea if you’re staying at a compound.  One must have a generator in Hinche to have electricity-we were one of the few households to enjoy this luxury.  We were locked in at night, for our own safely, but that didn’t keep out the mosquitos.

Tropical people grow up with these critters.  Whether poor or rich, one has to deal with the little beasties.  They have an insatiable hunger for human blood regardless of the hour (although many prefer the nocturnal feast).  Even sleeping under a mosquito net, body slathered with toxic repellant that I wouldn’t even store in my house in Texas, one is not immune to their bites.  Who needs sleep anyway-a plain cot with clean sheets is inviting enough in the sweltering heat of summer in Haiti, but add mosquitos and insanely barking dogs to the mix, and one becomes immune to the humanly habit of shut-eye.  Instead, a good Amy Tan novel can get you through the night.

Spoiled American that I am, I can’t help but mention these inconvenient details of my travels. There were others, such as bathing daily out of a bucket of cold water gathered when the cistern was full.  It was actually a delight to do so right before bedtime, as it helped one to cool down and kept the sheets clean.  We had the luxury suite, as far as the standard living situation in Haiti goes.  I’m grateful to the brethren at the orphanage for providing such safe and comfortable dwelling for the pampered American volunteers.  Without the simple creature comforts they offered, such as homemade native cuisine prepared daily with love by a young cook with a wonderful smile and bottled water that we consumed without a thought or worry for its purity, we would likely have suffered great inconvenience, discomfort and , perhaps, illness.  The flushing indoor toilets we shared are perhaps the plushest of our indulgences at the orphanage, as most folks still use outhouses and chamber pots.

I share these details of my recollections with you as a backdrop for the work I did in Haiti-it wasn’t in a vacuum, but in an impoverished country, so when I walked out of the hospital, I saw people riding donkeys and carrying their burdens, chickens running through the streets, women breastfeeding babies and toddlers on their front stoops (hooray!), and farmers selling mangoes and bananas on blankets along the traffic-side of bikes, pedestrians, trucks and livestock.  It wasn’t an everyday sight or experience.  It was a beautiful and tragic setting with many lessons for its visitors, I among them.

I had few concepts of and attachments to what the trip would entail.  Service in Haiti simply meant giving my best to people in need.  Considering the long history of deprivation coupled with the recent earthquake in Port-au-Prince, I expected to witness suffering and loss.  My own experiences of grief and loss were motivating factors for me to assist others experiencing the same.  I hoped to have the strength to persevere in my service.

Maternal and neonatal death rates are unacceptably high in many parts of the world.  This is true in Haiti, where the vast majority of births occur without prenatal care or a trained attendant.  Haitians have become accustomed to this kind of loss.  A mother whose baby was dying used prayer as a means to surrender her child.  Her loss was as deep as any mother’s, but her strength in face of such personal tragedy was, in part  a cultural trait.  One who grows up with death and dying as a part of life and living must cultivate resiliency.

In my brief stay in Haiti, I encountered death four times.  Since I attended only two births, there being numerous midwives serving in that capacity, my experiences varied.  A baby born prematurely died due to lack of access to standard medical equipment.  A child in a hospital died of malnutrition.  An infant at a feeding clinic died the day I went there to volunteer.  A man died after being run over in the street.  Each time I encountered death in Haiti, I experienced culture-shock.  Death had become such a normal part of life that Haitians continue about their daily lives in the wake of tragedy.  It made me wonder if, perhaps, it was always so, before the advent of modern medicine and improved sanitation.

This was my awakening in Haiti-that death is accepted.  This is nothing grand or surprising, but it clashed with my own experiences growing up at the end of the twentieth century in the United States of America.  I hadn’t accepted it, and other midwives with whom I worked (similarly) had not.  We went the extra mile to save life while others seemed resigned to the inevitability of death.  Nobody was right or wrong.  Each person had to do as he or she was instructed by a higher power, or by convenience, resources, or luck.

We came from different points-of-view.  Providing formula to a baby whose mother was too ill to nurse, a baby close to dying of dehydration and starvation, was seen as controversial.  Formula is expensive in Haiti, and clean water does not flow to one’s home sink.  Yet, waiting for a baby to die-or-not while a mother may-or-may-not recover was unacceptable to us.  We did what we had to do while we were there, each in our own way.  It was not easy to find one’s place in such a system.

The best one can do is to try to reach out to others in need:   to offer services without dehumanizing those on the receiving end,  to honor differences and see people as individuals.  I found that I could help in small ways.  I tutored an orphan and helped him apply to college.  I assisted student midwives with skills and critical thinking.  I offered what I had to give without expectation.  I didn’t think it was enough, but it was all I could do.  I had a tough time understanding my role there because there are no roles for “blancs.”  We were just visitors there, hoping to make a small difference.  Yet the biggest difference occurred within.

To be continued…

The main principles of bioethics are applicable to midwifery.  Beneficence, to benefit others; and nonmaleficence, do no harm, are relevant to all helping-professions.  Yet, to practice these, along with justice, diversity, dignity and autonomy, midwives’ use an ethics of caring.

Caring is a feminine value, and it is how women often approach ethics.  While landmark research in moral development demonstrates that boys use the concept of justice to make moral decisions, Carol Gilligan found that girls do so by use of caring.  It makes sense that midwives would approach ethics similarly.   In fact, through an ethics of care, midwives maintain a client’s dignity in ways that contrast dramatically with the field of medicine.

To apply bioethical principles, midwives consider their relationships with others.  For example, when a midwife is faced with an ethical dilemma, she considers not only principles of bioethics, but also the effects that ethical decisions have on her client, the client’s family, the midwife’s practice, and her co-workers, workplace and community.  The same kind of relational and caring ethics should be applied when working with others, or non-clients, such as other midwives, physicians, apprentices, supervisors, and complementary and alternative care providers.

In considering ethics for midwives, it is important to recognize the caring and relational aspects of the Midwives Model of Care that affect how midwives make ethical decisions.  The Midwives Ecological Model of Ethical Thinking (MEMET) illustrates midwives’ unique approach to ethics.  With the midwife and client relationship at it’s center, and the support network, practice setting, and other historical and cultural considerations, the MEMET demonstrates the complex and relational influences on midwives’ ethical thinking.  This model is introduced in Professional Ethics in Midwifery Practice (Jones & Bartlett, 2010).

Choosing fresh produce that is seasonal and local, whenever possible, will increase the nutritional value in your food. Be aware of the temptation to overload the cart with too many good choices, which can often rot in the fridge if you don’t eat them quickly.  Smaller and more frequent purchases can ensure that your food is fresh when you prepare a meal.  Most big cities around the globe have farmers markets and fruit and vegetable stands along major routes, but in the U.S., we often have to drive to a supermarket to find our produce.  This inconvenience can be a barrier to getting fresh fruits and vegetables regularly, but this can be overcome by growing your own food, even just one or two plants, and locating a farmers market nearby.  Autumn is a bountiful season in most locales, so it is a good time to visit a farmer and learn about seasonal foods.

Pregnant women must be sure to eat foods containing plenty of  protein, calcium and iron.  All of these nutrients are available through plants.  Soybeans are a complete protein and dried apricots contain high amounts of iron.  Calcium can be found in leafy greens and legumes.  Vegan mothers must find a supplemental source of B vitamins, especially B12.  Vegetarian mothers can add farm eggs to their menu three days a week to boost protein and omegas.  Yogurt is another whole protein source.  Choosing grass fed beef and antibiotic and hormone free chicken are safe alternatives to eating meat from concentrated feed lots, where the meat may be tainted, high in genetically modified corn products, and full of chemicals.

Making nutritional changes in pregnancy can benefit your entire family for life.

Take a daily walk, if you can.  That is a good beginning.  Don’t take your cell phone with you unless you need it for emergencies.  This is quiet time for your brain and body to exhale.  Extend the walk a little bit each day until you feel that you’ve reached the right amount of time and distance for your mind/body.

Write down your thoughts each day-in whatever form you wish.  This simple practice allows you to purge your thoughts and ideas, and think with more clarity.  You may have some welcomed creative outbursts, as well.  A daily journal entry of 1 page is a good place to start.

Give yourself something beautiful.  You will decide what it is.  For some moms, a massage is the perfect gift.  For others, a new skein of yarn or a cup of tea in the garden will suffice.  Some times require different measures than others.  After a particularly difficult day, perhaps mom needs time to cuddle up with a good book and some dark chocolate.

Pay attention to your own needs.  Whatever the need may be, notice it.  Try not to judge, change, or dismiss it.  Allow it to show itself.  Try to give it a name, such as “rest” or “a night out” or “a distraction.” Think about how you can address that need, including a time that it will be addressed.  Try to meet your needs where they are-based on your own resources.  A trip to Hawaii may be within the reach of some in the immediate future, but most of us need to save and plan for such an extravagance.  A dip in the local swim hole with a girlfriend may satisfy the need for natural beauty and nature in the near future.

Self-care is an ongoing process, a skill like any other work we value.  Taking the time for self-care may be difficult if you allow yourself to feel unworthy or try to play the part of the martyr who needs little and serves all.  As tempting as this role can be, it is not advisable.  Martyrdom is not a behavior we want to see manifesting with our own children, so we should do away with it in our own lives.  Self-care is an ingredient for a happy life and happy family.