Cooooookies!

"They" (I'm not sure who, but a lot of people, so "they") say that baking is more like a science than an art. Like it's chemistry.

Bah, I've always thought, as any of my friends can tell you. On those somewhat rare occasions when I find enough time to bother cooking, I certainly don't have the energy to worry about things like where the tablespoon is. If baking is like chemistry, than I'm more an experimental chemist than a lab tech; maybe not so bad as the truly nutso 60's-70s "what will this do to the brain, better try it on myself!" sort, since I have yet to do anything truly ridiculous (like try to put bacon in chocolate chip cookies...yes folks, it HAS been done).

And then I made PERFECT chocolate chip cookies. Seriously completely totally perfect. A little bitty batch, just enough for the family to eat while they watch a movie. And, of course, no recipe.

BAH! I didn't even have a base recipe this time! No chance of recapturing this magic, ever!

Ah well, forward. The next time I have the inclination to bake, I think we'll be mucking about with brownie batter. Maybe I'll pay a little more attention to what I'm putting in the bowl, but somehow I doubt it. What's life without a little peril, after all?

Endings

This past weekend I attended my last birth as a student. The birth itself went gorgeously, nevermind the mind-bogglingly frustrating ordeal with the lab afterwards.

Leaving my site isn't so cut and dry. It is an agonizingly slow ending, seeing people postpartum that I like well enough and all, but at 20 dollars per round trip (usually to see just one family per trip because there are so few left) and with no compensation, it's getting old, particularly since I'm having to do some pretty financially stupid shit to keep the bills paid.

It is weird not to be pushing myself constantly. To arrive at that place I've been "almost" at for months now. Where I'm off call and life doesn't take quite as much planning.

Time to start up my own business, kind of. I'm not licensed yet, and can't accept insurance yet, not until I've got all my papers pushed and credentialing done. It never ends, truly; I'm sure it will hardly feel like I'm licensed when I'll have to start renew my credentials for the next year.

Website design, business cards, practicalities of sole proprietorship, here we come.

And she knows how to make people

BittyPrincess had a fever yesterday; it was pretty dramatic overnight but by midmorning she was running around only slightly crankier and more tired than usual. Getting 13 hours of sleep two nights running, when she averages a measly 8 (for a child her age this is a downright anemic sleep schedule) should perhaps have been a tip-off that she was getting sick. Either way, I skipped my clinic rounds for the day based on how hot she'd been burning in the night/morning, and settled in for a day of complete crankass bickering from my children. Sure makes me want to stay home with them...

Anyway, by evening I thought she was basically better. As I finished up our bookreading (Twelve Days of Christmas, but whatever, I let them do the picking) and everyone started getting settled in, BittyPrincess sat up in bed, leaned forward, and in high dramatic wide-eyed take-over-the-world fashion, said "I know how to make PEOPLE." She then settled happily into her bed, apparently prepared to dream about miniature-bitty-princess army creation.

Well, what a downright spooky thing for a 4 year old to say.

Not that I haven't occasionally been accused of plotting to take over the world, just that I never considered shooting people out my vagina to populate those plots. Or, that's not the intended purpose of my children, anyway.

And of all the million little unexpected consequences of this whole midwifery gig on my children, I didn't really think evil-army-creation was going to be on the table. Overly detailed information about all things baby-making (and all consequences involved), yes. Inability to make iron-clad plans for days with the kids, yes. A little too much talk about vaginas and birth in public places...ability to say words like "nipple" and "vagina" without blushing...disconnect/lack of understanding about how 99% of the population does this whole family-making thing...all expected consequences.

Luckily, this morning, the evil army is made of paper cutouts.

Exam complete

That was a long day. But it's done. And now just the waiting part...4-6 weeks before we know whether we passed or not...

I got some questions after my exams about whether it felt good to be done. It doesn't. I'll be done when I have my license in my hands. Maybe then we'll have enough money to celebrate with something other than air-popper popcorn and a movie we already own.

Breech Birth Video

I came across this video today and I have to share it. In it, a baby is born in footling breech position. It is not a particularly quick birth. What makes it amazing is how well you can see how baby is active in the birth process.

http://www.youtube.com/watch?v=jD5939e5PZ8&NR=1

I'm not sure that I will be doing breech births at home, well, ever. Not that I might not be singing an entirely different tune at some point in the future, but my intention in the meantime is not to plan breech births at home. They are riskier, it's true, which doesn't mean that they should never be done, just that new-minted-midwife me isn't going to be the one doing them. How difficult this choice is may make these births more triumphant when they're successful (which I'm totally happy about, I'm just not sure I'm the practitioner that can help with that). In the meantime, living semi-vicariously through the videos and others' accounts, knowing full well that I don't yet have the knowledge or the patience to be as hands-off as the midwife in this video is. I want this kind of birth to be an option for women. Right now, the standard is c-section for those women whose babies are in heads-up position at term, and it is darned hard to get any other kind of birth without splitting entirely with the medical community. Thank goodness for trained practitioners (of any sort) who know their stuff and are willing to attend vaginal breech births. I just wish there were more of them out there. Maybe someday I'll be one of them.

Zits, Hormones, Tanner Stages, Oh My!

Yesterday Girliness packed her own bags to head off to camp, with only minimal guidance from me. She reads by herself at night, up in her bed, increasingly complex little novelettes.

And yes, she now stands solidly in the preteen hormone storm.

Complete with one heck of a zit on her chin. And yes, she is suitably horrified. Horrified, and willing to wash her face thrice daily with acetone nail polish remover (yuck) if that is what it would take...luckily, we're starting with a simple soap and some witch hazel toner.

Not a TON of body changes yet, but she's definitely getting a slightly scarier grown-up-ier look about her.

Hormonal highs and lows r us, lately. Not in any kind of pathological way. In that way that makes all great parents sigh "my baby is growing UP!" when they throw a huge hour-long temper tantrum because *gasp* they are asked to put away their clean shirts.

Boyness is picking up the slack by acting perfect. I don't know what possessed him but he can keep doing it. He even mastered the art of *knocking* on my door when it is closed, a task that just a week ago seemed beyond his 7-year-old comprehension. His mental development may finally have caught up with his bulk! Oh happy day! How long do we have in this reprieve before the preteen hormones claim another victim in my household, turning my boy into a raving lunatic?

Graduate!

Or so I'm told ;). I haven't seen the document yet. But I had a pretty uneventful (aside from a few dirty looks) exit interview today, and turned in the last little bits and pieces of my paperwork. I had to leave a birth to do it, which is something I've never done before, and that sucked. I may or may not have been really standoffish at that birth with the knowledge that I might wind up waving goodbye before the birth was done. If that was my intention, it was my subconscious that made it so.

Also this morning, I missed dropping girliness off to camp.

Tomorrow, a little clinic, and time in the afternoon to visit friends.

THERE'S the Calm

This week I did only a little clinic. People I've been following are trickling slowly out past their once-weekly prenatal visits and into the lengthy span between 2 and 6 weeks, and then beyond. So I had a full-length day on Monday (after a birth on Sunday morning and another on Monday morning, both wonderful), left early on Tuesday and Thursday, and didn't go at all on Wednesday. This remains, as I happily catch my breath, the most demanding practice I've worked at. And I can see the light at the end of the tunnel, that time when everyone I'm following has given birth and is happily holding a healthy baby, and the four-times-a-week drive to and from Olympia is a distant and fuzzy memory; when the $500 per month I'm spending on gas and bridge tolls is happily tucked away into credit card bills, school loan payments, and non-essentials like rent and electric bills.

Here it comes...*sigh* oh happy distant day not behind the wheel!

I decided, since I had to do all that darned paperwork anyway, I was going to count my hours, contacts, and births in July even though I'd finished all my numbers. In going through those things, I discovered that although I took a long weekend off at the beginning of the month for health reasons and incidentally missed about 30 hours of work in one shot (not covered in the blog, don't wanna rehash it, thanks, I'm fine), I still averaged over 50 hours of clinic and intrapartum time per week. This not including the approximately 14 hours per week I spend on the road. Ouch. No wonder I'm feeling a little done. I've got some world class working-mama burnout that I've managed to only narrowly avoid all through my time with this practice. The numbers are illuminating, here in a month without a particularly heavy client load, where my only excuse is NOT spending several days of the month in or around Seattle for school-related things.

Speaking of which, I faxed off a veritable mountain of paperwork yesterday, and got a nice little "she's clear for her exit interview" kind of email from my clinical coordinator.

Until I stand over someone faxing my transcripts and certificates of graduation to the Department of Health, I am not going to be at ease about this. Even then, I'm not going to be *happy* about it. I'm not taking it personally, as so many students seem to have. What I do know is that there is one person at that school that is screwing over a lot of students, and it is NOT OK. She is not following the rules in letter OR in spirit, and is treating students like recalcitrant children instead of full-grown adults who hold lives in their hands on a near-daily basis, and have jumped through some SERIOUS hoops to get where they are. Deciding suddenly that we've done ANYTHING on a whim or are trying to get away with ANYTHING, with the amount of work we've done, is not just insulting but wrongs us as people.

Complaining on the eve of a merger with another institution, when things will change dramatically, is to a certain extent pointless. Nevertheless, there will be at least a little bit of (wordy) bitching coming off my desk headed towards Bastyr, the school board, MEAC, and NARM.

As good a student as I am, I never thought this was how my last interactions with the school would shape up.

Oh, and...

The school, of course, couldn't just let me graduate without some drama. A scant few weeks before the licensing exam, already having paid the fees, and with a "you need to repay in full if you can't be there" notice on my fridge, I get:

"We can't officially graduate you and release your transcripts until..."

Well fuck me, you don't say? I am pretty sure that I, in fact, have to do next to NOTHING on that list. I read my handbook and can quote it. And I did, with only moderate amounts of snark, which got me out of some but not all of the things on their list.

The easiest thing is to roll over, do as I'm being asked, and watch the red tape dissolve. My preceptors think I'm ready for practice (are referring a few people to me, actually) and are interested in making sure I can take exams and get licensed on time; they've humored the school in providing a second set of evals just two weeks after their last set (what do they expect to have changed?), and working with me to be able to sign a few things that if the system worked as it should, my program coordinator would be signing for me.

There are several reasons this pisses me off:

- We had a check in last quarter that made it sound like I was about done, and said NOTHING about several of the items on that list.
- Some of those requirements aren't in the handbook, meaning that they AREN'T requirements and the school has no right to hold my transcripts while they wait.
- In fact, the school has no right to hold my transcripts AT ALL. The state needs transcripts to show that I've done the coursework, they don't need my graduation papers for me to sit the exam, just before the license. The school is effectively holding my papers hostage. The transcripts are mine. That can't be legal.
- The NARM skills checklist - a 22 page long list of things our preceptors are supposed to sign off as we master - has a "safety" where if you don't manage to do some of the skills, the program director should be able to see that you've covered them in your coursework and sign you off. Which the program director is REFUSING to do. This is not OK, it really isn't. Why say you have that safety there if you don't? There are skills on that list that I'm not going to get to do. My preceptors can sign off after we review and drill; but this is something that the program director is supposed to be able to do, since we reviewed and drilled in our courses. So why not fucking sign? I passed those parts of the curriculum. I thought that was the stated reason for the hefty curriculum at this school; so that we have knowledge that we need when we encounter those things that aren't so common, that we'll not see in our practicum. Why are they being such ASSES about signing it off? I have all of 3 things left. My preceptors haven't seen me do them any more than the program director has...but my program director, unlike my preceptors, has access to my exams and course work and could verify that I know what to do. I don't get it. It feels like making life hard just for the sake of making life hard. It feels, again, like holding my papers and transcripts hostage.
- I have to do a fucking EXIT INTERVIEW before you'll release my transcripts? Again, not in the handbook. Those documents need to be at the state office...and you're telling me that I need to do this, oh yeah, and you're going on fucking vacation next week? I think fucking not! I need more notice than "do this or else, oh yeah, and it will be extraordinarily hard to do this and you don't have enough time."

Until this point, I haven't had issues with the school largely because however much asshattery I encounter, it's been forewarned in handbooks or at some point in our education. BUT NOT THIS. This is NOT OK. Setting us up for failure, much?

Yes, I'll get it done. Yes, I'll be OK. That isn't the point. The point is that I could very easily NOT have been able to, and I wouldn't have had the warning I needed to ameliorate that. The school has told me over and over again that I'd be able to take the exams in August. THIS IS THE KIND IF SHIT I WAS TRUSTING THEM TO TELL ME ABOUT, and they don't even have the "it was in the handbook" excuse, because it FUCKING WASN'T.

Mad, mad, mad.

Car Dramaz!

I thought, yesterday as I went in to clinic, that I'd just do a quick couple of visits and leave in time to see my Fran off to work (starts at 1pm). I sweated my way through clinic; in Washington the temp was over 100 yesterday, which is truly exceptional here, and the clinic building (typical for Washington) has no A/C and was, effectively, a solar oven. I walked out to the car thankful to be gone during the hottest portions of the day.

And it didn't start.

Crap, crap, crapcrapcrap.

As I sweatingly encouraged the car to start *with the force of my will and strong words* I got several offers of "I don't know what I'm doing but can I help?" which were of course not helpful, and which caused in me an irrational hatred (I said it was irrational) of those not-terribly-helpful people and their terribly-functional car A/Cs.

What else could I do? I called my man to help. That's what we get married for, right ladies? Kinda?

He got to the clinic at about the time he was supposed to get to work, all three kids in tow. He succeeded in starting the car, which ran limpingly (and stinkingly) in the parking lot, and as we were about to caravan our way to the mechanic, the office manager ran out "[client] is pushing! [midwife] is coming, be ready to jump in her car!"

Of COURSE after a week without a birth *this* would be the moment!

I left my husband with the car problem, the kid problem (erm, they're in a parking lot at 105 degrees, and I can't even say it was a dry heat), and the not-at-work problem, and ran off...we figured there would be a baby, I'd be gone 3 hours total (how long it takes to catch a baby, monitor everyone for complications, clean up, and leave), so maybe they could just wait for me?

Our mama/client/patient was not pushing when we arrived. She is a wonderful, wonderful person, and I don't hold that the least bit against her. It was just inconvenient.

She birthed in a home in the shade, which was about 20 degrees cooler than the clinic building for most of the day. That bit was at least a little convenient.

In the meantime, my family went to several air conditioned establishments in the Olympia area, spent too much money on purpose (which my husband tells me was a twisted act of passive-aggressiveness) - too much money being $50 all day, at this point.

To make a painfully long story short, they spent 10 hours in Olympia, a baby was born healthy if a wee bit early, Fran got the car running AGAIN as I came back to the clinic, and we dropped the car off at the mechanic's shop at the bright and early hour of 11:15 pm.

---

So, a few words of not-explanation?

I don't know what to do with this blog anymore. I wrote a lot when I was staying at home and writing kid-foibles. I wrote a lot when I was in Vanuatu, and had no need to worry about anonymity.

Last week I went to three births in 24 hours. Which is something to write about, except that it isn't. They aren't my stories to tell. They are significant in my life, yes, but in many ways it has transitioned into being what I do. It feels odd to say it, but birth is my work, and you wouldn't write about the minutiae of your work day either. The interesting bits aren't mine to tell, and (darn those federal privacy laws - kidding, really, it's an ethics thing) this isn't a protected space to talk about anything that could identify anyone, which in my community is pretty much anything at all.

I am tired of being broke, and ready to stop being a student. That much hasn't changed.

Approaching licensing, I feel anxiety. My preceptors believe I am ready for independent practice. I know that I can handle independent practice, and yet, I'm scared of that responsibility. In that way, being a student is a sweet deal; there are some people that are more my clients than my midwives', but if I did something wrong they'd be there to either catch it or take the blame. Not that I do wrong things, just that there's a safety net there that I'll be going without shortly.

I also feel anxiety about starting up my practice and money. I've been whining about money a lot, I know. We are at a place we've never been before, without enough money to pay our monthly expenses and at the end of our credit limits on our credit cards, scrambling to figure out how much we can charge on which cards to pay whatever car repair expense we need to pay. And starting up a business costs money. A medical business more than most; I have equipment to buy, yes, but I also have malpractice insurance to buy and in this state, you pay for a year in advance...and I don't have that money. I'm taking this thing one step at a time, because I can't just make money appear so I can't do anything differently. At the end of my student time, I'll probably need to find paying work that isn't my profession, so that I can make enough money to start up. Which is galling, because once I start up I'll have money. Business loans are next to impossible to get when you make what we do and have as much debt as we do. Funny how your school loans count against you for that.

I didn't mean to start whining about money again, but there it was. I know a few people who are students are reading this. Hopefully in a year my song will be different. Right now things are difficult. I'm not burnt out on midwifery, I'm not soul-dead from my student-hood...but things are difficult in this transition time.

Where's the Calm?

I think I just have to face it...I'm not done with practicum yet. Technically I am, but there's this pesky contract, so last month I still averaged 40 hours of clinic and birth work per week, without counting drive time (and the occasional day stuck in Olympia just because it costs $15 to make a round trip home, and I'm not doing that even if it means I'm stuck without anything I really *want* to be doing for 4 hours...I have escaped, from time to time, into a fiction book at a park). And then there's fact that I don't really WANT to pull out of practicum early (on time? before my contract ends, either way), not when every new thing I see there is one more new thing I don't have to do solo later.

I honestly don't know what I'm going to do with myself once my clinic obligations are over. Imagine whole weeks stretching in front of me without the structuring influence of clinic time, or even *gasp* being on call. Any way I start up, I get at least a month with absolutely nothing structured for me. THAT is a crazy concept.

This week, I have reaffirmed that I detest prelabor rupture of the membranes. Stop sending that scenario my way, please. Enough hospital transfers with nonexistant labors. Enough prodding women who really, if they weren't ruptured, we'd tuck into bed and see a week later in actual labor. This phenomenon is seriously getting on my nerves, and I harbor no illusions about it disappearing when I've set up my own practice. I just dislike it. A lot.

Despite all of this, I have rediscovered fiction books. Or the fact that my library has them and can order more of them. And the fact that I read quickly, after all, something I'd forgotten in the haze of TRYING to read hundreds of pages of very dry text every week.

Also discovered that the weather still dislikes me, at least a little. Yard sale day dawned with lots of thunder. Not a lot of rain, but effectively chased off the (not so big) masses. And off to Goodwill we go, 'cause I'm not into hanging on to this stuff.

Three

Three births this week. Some drama at one of them, but it all worked out in the end. It would have been four, but I put myself off call to do some babysitting and missed one.

So much for slowing down after graduation, eh?

Yesterday I mailed out very-slightly-belated thank you cards, put checks in at the credit union, and promptly withdrew a largish cashiers check to pay NARM for the privilege of taking their licensing exam.

We are, this month even more than in the recent past, finding rent at the bottom of our pockets. I am looking forward to getting paid for this work at some point, and wondering if I'll have enough money to continue paying for gas to get to and from clinic in the meantime. I'm tired of it all, and at the same time, aware that I'd miss it terribly if I stopped. I think that it is more that I am tired of the pace than that I'm tired of what I've been doing, if that makes any sense.