Book Update

Just an update for longsuffering readers. I have taken this hiatus to complete my book proposal slated to go out in early January. As my book nears completion, I am busy securing an agent and publishing house. Thanks for your support.

MANA Musings

I am so glad I was able to attend MANA this year. It's always a privilege and I learn so much and meet old and new friends. Highlights include:

• Meeting Jenny Joseph and getting an introduction to her model for prenatal care. I would love to bring this model to KC- have some ideas in the works for my FIMR board. I've got to get her here.
• Participating in a white privilege game. Its where everyone stands in a line and takes steps forward or backward depending on their socio-economic and racial factors. I was at the tail end, by a mile. I can't wait to do this exercise with my nursing students. I found it quite powerful.
• Being near sea and mountains- as a child of the midwest I hardly ever get to do both at once. Taking my little rental car on a coastal tour was a wonderful experience.
• Vegetarian meals served at the Asilomar Resort were fabulous.
• Getting to room with Morningstar and Alison, a midwife from San Miguel de Allende, Mexico.
• Seeing Diane Paul of Sage Femme and witnessing more of her birth videos.
• Bird watching- saw some new ones I haven't seen before.
• Seeing so many midwives of color- there are more and more every year- good to see the next generation answering the call.
• Conference bookstore: purchased two new books, a purse, a pair of earrings, gestational wheels for my students and a host of souvenirs for my kids
• Favorite session: At your cervix: the ethics of how we teach pelvic exams
• Most transcendent session: Morningstars session on using storytelling to teach instinctual birth
• Most practical session: Using social media to promote better birth care
• Goal for next year's MANA: do a presentation from my newly published book

MANA Faces

Photos from Monterey Bay

MANA Update

MANA has been wonderful, as usual, and has gone quickly, as usual. I've attended sessions on, teaching cervical exams in a humane way, using social media (like this one) to expand business or advocate for a cause (like I'm doing now), cultivating cultural sensitivity, and using storytelling to teach instinctual birth. I will use all of this new knowledge in teaching my nursing students, and in furthering my work at home with lactation, infant mortality, and humane maternity care. I'm off to have breakfast, stroll the beach (dip my toes in the ocean/bay one more time) and visit the Red Tent which is always a treat. I will also listen to Ina Mae give her keynote address this morning- which starts right about now...

Rebel with a Cause

I'm here in Monterey California at MANA 2009 sitting on white sand beaches, in temporate weather, contemplating my role in materal infant health in the United States. What mark will I leave on future generations of mothers and babies? I came here to see and hear my heroes in the cause, only to hear how overwhelmed they sound and defeated they sometimes feel. Still I must take up the charge. Morningstar's book, "The Power of Women" is making it's debut here at the conference. I make a solemn vow to myself, that next year, I'll be sitting at the author's table. People have begun to approach me about 'my work'. So far my work has been verbal and written, now I feel the universe telling me its time to get some skin in the game. I have an idea for a pilot program, to increase utilization of prenatal care for high risk women. I have to secure funding from somewhere, and I have to coax the powers that be to partner with me. Now that I sit on the FIMR board, I can use it as a jumping off place. I've been offered a leadership role on the Health Commission. There are lighthouses here- beacons of light and hope to ships lost in dark and dangerous waters. How do I shine a light on the darkness of infant mortality?

Doctor Dick

Okay, Even though I would run screaming from the facility if a physician handed me the following document, I still find something refreshing about his or her honesty. Most docs just say, "sure okay, we can try that" and then when labor hits they do whatever the hell they want.

A healthcare consumer posted this on another blog. She stated her plan to find another physician. Good for her.



DR. ________ "BIRTH PLAN"

Dear Patient:
As your obstetrician, it is my goal and responsibility to ensure your safety and your baby's safety during your pregnancy, delivery, and the postpartum period. My practice approach is to use the latest advances in modern obstetrics. There is no doubt that modern obstetrical advances have significantly decreased the incidence of maternal and fetal complications. The following information should clarify my position and is meant to address some commonly asked questions. Please review this information carefully and let me know if you feel uncomfortable in any way with my approach as outlined below.* Home delivery, underwater delivery, and delivery in a dark room is not allowed.* I do not accept birth plans. Many birth plans conflict with approved modern obstetrical techniques and guidelines. I follow the I follow the guidelines of the American College of Obstetrics and Gynecology which is the organization responsible for setting the standard of care in the United States. Certain organizations, under the guise of "Natural Birth" promote practices that are outdated and unsafe. You should notify me immediately, if you are enrolled in courses that encourage a specific birth plan. Conflicts should be resolved long before we approach your due date. Please note that I do not accept the Bradley Birth Plan. You may ask my office staff for our list of recommended childbirth classes.* Doulas and labor coaches are allowed and will be treated like other visitors. However, like other visitors, they may be asked to leave if their presence or recommendations hinder my ability to monitor your labor or your baby's well-being.* IV access during labor is mandatory. Even though labor usually progresses well, not too infrequently, emergencies arise suddenly, necessitating an emergency c-section. The precious few minutes wasted trying to start an IV in an emergency may be crucial to your and your baby's well being.* Continuous monitoring of your baby's heart rate during the active phase (usually when your cervix is dilated 4cm) is mandatory. This may be done using external belts or if not adequate, by using internal monitors at my discretion. This is the only way I can be sure that your baby is tolerating every contraction. Labor positions that hinder my ability to continuously monitor your baby's heart rate are not allowed.* Rupture of membranes may become helpful or necessary during your labor. The decision as whether and when to perform this procedure is made at my discretion.* Epidural anesthesia is optional and available at all times. The most recent scientific data suggest that epidurals are safe and do not interfere with labor in anyway even if administered very early in labor.* I perform all vaginal deliveries on a standard labor and delivery bed. Your legs will be positioned in the standard delivery stirrups. This is the most comfortable position for you. It also provides maximum space in your pelvis, minimizing the risk of trauma to you and your baby during delivery.* Episiotomy is a surgical incision made at the vaginal opening just before the baby's head is delivered. I routinely perform other standard techniques such as massage and stretching to decrease the need for episiotomies. However, depending on the size of the baby's head and the degree of flexibility of the vaginal tissue, an episiotomy may become necessary at my discretion to minimize the risk of trauma to you and your baby.* I will clamp the umbilical cord shortly after I deliver your baby. Delaying this procedure is not beneficial and can potentially be harmful to your baby. * If your pregnancy is normal, it should not extend much beyond your due date. The rate of maternal and fetal complications increases rapidly after 39 weeks. For this reason, I recommend delivering your baby at around 39-40 weeks of pregnancy. This may happen through spontaneous onset of labor or by inducing labor. Contrary to many outdated beliefs, inducing labor, when done appropriately and at the right time, is safe, and does not increase the amount of pain or the risk of complications or the need for a c-section. * Compared to the national average, I have a very low c-section rate. However, a c-section may become necessary at any time during labor due to maternal or fetal concerns. The decision as to whether and when to perform this procedure is made at my discretion and it is not negotiable, especially when done for fetal concerns.

Spawn of the Devil or Angel of Destruction?

Josiah turned 3 last week. While he is cute and adorable, inquisitive and intelligent, we seem to be experiencing a greater volume than normal of broken electronic major appliances in our home, lately. It seems in the last couple of months he has broken our TV (poured water over it to 'wash' it), our computer (kicked it over in a fit a rage, hasn't worked since), lost an IPOD (last seen in his pudgy little hands), broke the IPOD port on our CD player, and has been implicated in the malfunction of several cell phones. We went to look at computers yesterday, and will budget for a replacement TV next month. Has he been sent to us as a plot by Satan to break all our stuff? Well even if that turns out to be the case, he's still a lot of fun to have around. His vocabulary increases every day, he's spoiled rotten, and still insists on sleeping in bed with us or one of his siblings. Potty training is optional, right? He's still in the throes of a Batman fetish, and insists on being Batman for Halloween. Later today we head to a local pumpkin patch so he can pick out some pumpkins. Despite how expensive having him around is turning out to be- we couldn't be more thrilled. Thankfully, he hasn't broken anything today.... wait... what was that crash???

Obituary

Our 17 year old cat, Indigo passed away quietly at home yesterday. We found her late in the afternoon on our bed where she had snuggled up to nap. She never woke up. When our son Greg was 14 (now 31), his friend found Indigo as a kitten abandoned in a box in an alley en route to our house. He heard her meowing and picked her up and brought her to us. She's been ours ever since.
She was a very wild kitten, earning herself the nickname "Crazyhead" She had 2 litters of kittens early in life, and then settled down to become the mellow stranger-shy cat we grew to love. Her secret to longevity? She was an indoor cat, who didn't like to over exert herself. Many years ago, she had to have surgery that cost us $1,000 and I told her she had to live at least until we paid off the bill. She happily complied. She was always good for a snuggle, loved a good head scratch and enjoyed a high quality of life up until the end. The day she died, I saw her last in the kitchen eating her morning meal of catfood and water, while the dog and our other cat, Carl, patiently waited their turns until she was finished. She was very arthritic and slow moving, but the other animals aways gave way for her. She was always the matriarch of our animal family and beloved by our human family. She will be missed.

Indigo "Crazyhead" Payne
date of birth: unknown
deceased: October 9, 2009

PS: People have asked where we got the name Indigo. At the time she came to us, I was reading Ntzoke Shange's novel, "Sassafras, Cypress, and Indigo" a story of 3 sisters. Indigo was a midwife. It seemed to fit. I think the name Crazyhead came from the baby of the family at that time, Evan.

The Spirit Catches You and You Fall Down

I've started reading one of the two books I purchased at the conference on cultural competency called, "The Spirit Catches You and You Fall Down: A Hmong child , her American doctors and the collision of two cultures." The other book was about medical missions. Spirit catches you is the well written assessment of what happens when a non-English speaking refugee family intercepts with the American healthcare system. It is a riveting story, though the author at times becomes bogged down in clinical analysis. I remember the Hmong refugees. I was a young teen in the 1980s when they seemingly 'invaded' the housing project where one of my aunts lived. They were quiet solitary people who kept to themselves. I could only imagine how foreign our world must have seemed to them. Could anyone have possibly chosen two more unalike populations to put together- Hmong refugees fresh from the mountains placed in the urban core housing projects with low income Americans, mostly African-American? Each group kept to themselves and there were few clashes, but only because there was no interaction. Each eyed the other suspiciously as I recall. In the book, the Hmong parents of the story present to the emergency room with a child afflicted by seizures. Since they don't speak English and this is prior to the time of having interpreters on staff- the doctors don't know what the problem is. It takes several visits, until the child is brought in still in the throes of a seizure, for them to figure it out. The book goes on to catalog the highs and lows of treatment for this child with all miscommunication and misunderstanding that accompanies their interactions. It is a fascinating read- amusing in some places, heartbreaking in others. It makes me want to work harder to impress upon my students the importance of taking the time to understand the health beliefs of the person for whom you are caring. It's also changed my mind about another thing. It is not enough to seek patient compliance as the highest goal for the nurse's efforts, but rather client collaboration. The healthcare consumer has to have buy-in. Clinicians and consumers must work together to create and individualized plan of care- this is the only way, in fact, that it can be individualized- the individual has to help create it. We in our authoritative cloak cannot arbitrarily decide what is best for someone else. For true healing, rather than merely curing, to take place, we need to involve the body, mind, and spirit of the client. All of these aspects of the person are embraced by culture. In the book, progress begins to be made, when a few astute clinicians, inadverdantly begin to ask some of Kleinman's Questions, such as what the child's illness means to the parents. I can't wait to finish this book.

What is Cultural Competency?

I attended a conference yesterday (what a shock right! Everyone must think I have a hidden trust fund to attend all these conferences, when really I'm just resourceful and I live in a metropolitan area that has lots of conferences to choose from). The topic was cultural competency. I attended because, 1. I think cultural incompetence feeds greatly into health disparities which greatly impacts the health of African-Americans and Latinos, and 2. I guest lecture on the topic and felt the need for more info, and 3. it was free to nursing students of the school I attend where I'm working on my masters.

What a lovely conference! It was hosted by INMED whose focus is international medical missions, so the focus was more on healthcare professionals dealing with clientele from other countries of origin, but as we all know there are plenty of American subcultures that are misunderstood by the majority of healthcare providers, whether those subcultures are characterized by race, class, religion, region, language linguistics, language dialect, health literacy levels or any other number of factors. The conference did an fairly nice job of pointing to the fact that healthcare is a 'foreign culture' unto itself.
(I have long been an ardent supporter of this philosophy. Healthcare has its own language, its own mode of dress, its own customs, power systems, etc. Since it is populated mostly by educated caucasians, their norms have become the norms of the this 'foreign culture' we call healthcare. So even caucasians entering the healthcare system to some extent have to step into this culture in the 'patient' role. Everyone else has that to contend with putting on the patient role plus whatever cultural divides exist, known and unknown.)

The sessions were on such topics as, 'Health thru the lens of culture,' Health beliefs and traditional health practices,' 'Health disparities in relation to cultural identity,' Defining culture and cultural competency,' and much more. Fabulous topics all. The most practical information was Kleinman's Questions which are 8 questions this researcher came up with for pulling out the health beliefs (or illness narrative as one speaker so eloquently put it) of the healthcare consumer- so if you learn to incorporate these questions into your history taking, it doesn't matter if the patient is from the same or a different culture than your own. Almost every speaker quoted Kleinman's Questions so google it for yourself to find out what they are. I'm incorporating them into my history taking lab for my students.

At lunch I approached a table of older caucasian gentlemen. (This is how I challenge myself now, to sit at a table of folks I don't know and suspect that I don't have much in common with.) After polite introductions we launched into an animated discussion on what cultural competency looks like in our individual practices. There was a surgeon (I think he was a cardiologist, but he never said), a homehealth case manager/manager who was a nurse, a home health physical therapist, and me, a nurse educator. The surgeon made the (for me) shocking but typical statement that it was enough that he was kind and polite to everyone he saw, that was his idea of cultural competence. I reminded him that he could very politely offend the hell out of someone by not understanding the customs or health beliefs of their given culture. As we talked more the nurse manager gave many excellent examples of how he ammended his care to the cultural needs of the client, but the surgeon really didn't get it. I told him I could 'blow his mind' with some examples of things he didn't know about his African-American client's health beliefs that he probably wasn't taking into account when he treated them. "Name me three," he challenged me. Only three? Sure.

1. Your African-American clients don't trust the healthcare system, and by extension don't fully trust you.
   
2. You are not the final authority for your African-American clients, you are at best a second tier authority on health and wellbeing.
3. Most if not all your African-American clients indulge in folk medicine practices that you are unaware of.

I don't know if nurse manager and I convinced surgeon of anything, but we gave him some food for thought. This is why I always try to sit with strangers over a meal. Good rousing conversation always is a possibility. There's nothing I love more than thrashing around ideas with good conversationalists. I also remind myself that as an African-American woman, my voice and my story is seldom heard, and others need the benefit of my healthcare narrative and perspective.

All in all a fabulous conference and time well spent.

Have you looked up Kleinman's Questions yet?

Hand Expression and Breast Massage

Thanks to everyone for your comments. I'm glad to get some dialog on this issue. Here is a video recommended by Dr. Smillie for the proper technique of hand expression and breast massage for building milk supply.

The thing that I liked best about Dr. Smillie's approach to lactation assistance, was that the whole thing was mother and baby-led. Of course the name of the conference was, "Baby-Led Breastfeeding." But I always felt uncomfortable being overly dictatorial when helping moms in the hospital. Like so many other things that went on there, it left the patients feeling like we were the experts and they couldn't be successful without us. That's great for making nurses feel good, but not so great for empowering women as mothers. Dr. Smillie (a pediatrician) was all about allowing mom and baby discover one another without the interference of 'professionals.' I loved her videos of babies discovering the breast for themselves, crawling up the belly towards the smell of milk, or making jerking movements down toward the nipple. Babies are so smart- we give them so little credit. I remember (with horror) the time I stood by and witnessed a nurse 'help' a mom and baby by grabbing the mom's breast, and the baby's head, and 'milking' them both for 15 minutes to 'facilitate' a feeding. I stood there somewhat in shock that this very invasive procedure would pass as assisting with breastfeeding (I always had a no touch policy about lactation assistance- but I would still verbally direct and frustrate the mothers). The mother of course learned nothing from this except that she would need the nurse the next time she wanted to feed her baby to hold her breast and her baby's head to 'make' them nurse. Dr. Smillie's approach centered more on asking questions, to help the mother discover for her self was should be done. She also advocated for time for the infant skin to skin with mother to discover the breast on their own. It's been a week now since the conference, and the more I think about the information, the more excited I get. I'm adding significant information to my lactation seminar for my students on practical nursing care, with more emphasis on patient-led dialog and less on nursing interventions. I can see very clearly that there are times when being the 'expert' can interfere with a new mother embracing her own power and autonomy. We don't want to create a patient who is dependent on our expertise, we want to support a mom who can go home and care for her infant with confidence.

Hand Expression? Who Knew?

At the breastfeeding conference I attended nearly a week ago, the speaker said something intriguing. In fact, it's taken me a week to process it- Hand expression as a means of boosting milk supply? It seems too simple to be true- and just about the one thing I didn't try. Could it really be so simple? I both want and don't want it to be true. After all the teas, galactogagues, and tinctures I poured down my gullet, it was never suggested that manual expression might be something to try. I also recently watched a friend suffer this same dreaded fate, and had very little to offer her in the way of practical support or suggestions. I only half-heartedly mentioned the usual offerings since none of them had worked for me. Has anyone out there used manual expression to boost milk supply? I'd love to hear some empirical evidence or personal narratives.

Breastfeeding, midwives, homebirth

Greatly enjoyed the conference yesterday by Dr. Christine Smilie on baby led breastfeeding. I purchased her CD to show to my classes, and the books, "Pushed" by Jennifer Block, and "Mother's Milk: Breastfeeding controversies in American culture" by Bernice Hausman. I look forward to reading them both. As is the case with most conferences, the best parts can be what happens between sessions.

I got to meet some of the local hospital-based CNMs. I was chewing the fat (as we Midwesterners say) with one of the local homebirth midwives when a CNM stopped by her booth to chat with us. It's always nice for me to see CNMs and CPMs getting along and being nice to one another. Sometimes I feel like a child of divorce since I consider CNMs and CPMs to be equal parents to my dream of being a birth advocate. I hate to see the two camps go at one another. Especially when I know they have more in common than they have differences. Anyway we all made introductions and had a nice chat. It made me realize there are just too few venues for midwives of all types to meet and greet in our city. That is why I love MANA so much. MANA (Midwives Alliance of North America) is having their conference next month and I can't wait to go. It will be in Monterey CA this year so the surroundings should be exquisite. MANA is one American organization that warmly welcomes midwives and birth advocates of all kinds and varieties (and trust me you see some of everything at their annual conference). Its an experience like no other. A lot of midwife organizations segregate by midwife type, but not MANA. Midwives have enough outside opposition without fighting against one another in my opinion, but that's what it's come to- unfortunately. I spent my morning viewing this video that aired a couple of days ago on the Today Show. It's an attack on homebirth (for which I am a staunch supporter) but in all fairness, it shows a bit of the other side as well. All in all it wasn't as bad as I thought it would be. But with ACOG nipping at our heels, we really should be kinder and gentler to one another.

Thanks to the Doulas of Greater Kansas City who put on a wonderful conference yesterday, with a really informative speaker. Lots of food for thought on how we approach lactation education with parents, and learned lots of new stuff. It gave me a new perspective that just as with birth we may be too interventive instead of allowing nature to work as it was intended.

How not to bathe a baby

http://www.youtube.com/watch?v=WATnDPSs3iI

If you click on the link and watch to accompanying video, it shows a baby being bathed in a hospital setting, right after birth. It is completely inhumane. The infant in brutalized without regard to its fears or pain. I used it in class yesterday to demonstrate two things.
One, how not to bathe a baby. The students were learning infant bathing techniques, and after showing the video I demonstrated a proper infant bath. The students had to return demonstrate later in the learning lab.
Two, how we do not as a matter of course treat infants as aware and sensitive beings. We treat them less than the rest of us, because they are small and lack language. I talked about how we 'casually abuse the neonate at every turn' and gave some examples. The bath video illustrated what I meant beautifully. I also took the opportunity to discuss birth from the neonates perspective and how we give no credence to the neonates experience of birth and difficult transition to extrauterine life.

I'm sure my students all thought that a lecture on caring for normal newborns would be "Cuddles and Hugs 101." Now they know different.

Unnatural Causes

I've been previewing "Unnatural Causes" http://www.unnaturalcauses.org. This is a video series on the social determinants of health. I'm previewing it for my October class. Most of my students think of health in very simple terms. They tend to think of health as being mainly self-determined, whether or not one exercises, or smokes, or consumes a healthy diet, etc. I want to give them a broader picture of the role of education, economics, housing, social policy, municipal prioritization, market forces, federal state and local political will, societal violence, family structure, culture and so many other factors that impact health that are outside of individual control. This series does an excellent job of presenting a realistic if bleak picture. I can't wait to dialog with my students about these issues and of course how they trickle down to impact maternal, infant, and child health.
I acquired my copy of the video when I attended my monthly Health Commission meeting. I am a Health Commissioner for the city of Kansas City MO, where we discuss issues related citizen health and the city policies that impact it. Good work is done by the commission, and while it has no money to throw at problems, it does have the force of political will in it's recommendations to the city council (that does hold the purse strings). The Health Commission has had a key role in changing the status of the city to virtually smoke free. I spread my time between the women, infant, health committee and the minority health committee, depending on which projects and priorities appeal to me.
All of this is shaping my ideas about my own role in public health in my community. I once thought being a front line clinician was the key to effecting change. Once I was doing it, I saw the gross limitations of delivering care one patient at a time. Then I thought, setting policy was the great savior of humanity until I encountered bureaucracies. Now I try my hand at education with a look to the future of broadening my role in activism. This video series is an excellent tool for creating dialog around vital issues.

Hannibal Regional Hospital is Baby Friendly!

Yesterday I made the four hour drive to and from Hannibal MO to participate in the celebration for the their Baby Friendly designation. It was easily worth 8 hours on the road. What a victory to relish! I traveled with Charlene and Mary Grace, two veteran lactation consultants here in the KC area. Charlene and I are both on the Missouri Breastfeeding Committee and Greater KC Breastfeeding Committee. I also serve on the Kansas Breastfeeding Committee. As a crowd gathered in the lobby of the hospital I couldn't help but think, that most of those gathered probably didn't understand the long term consequences of what was happening here. Baby Friendly sounds so warm and fuzzy, that most folks don't realize the long term implications of making such cultural changes in a facility. There was a brief ceremony presenting the plague with the media and all the administrative bigwigs present. Afterwards, us traveling dignitaries were given a tour of the maternity care unit. (It was actually a large, attractive fairly new facility). My favorite part of the day came next. We were treated to a powerpoint presentation from the lactation consultant about the facility's 5 year journey to Baby Friendly. It was a long and tumultuous journey to say the least. Afterwards we attended a reception. This was my second favorite part. I put on my advocate hat, and sat at a table with the hospital administrators and talked with them about how this small designation is going to impact the health of their community for years to come. I wanted them to know what a big deal this was, and not just 'another certificate'. I talked about my thesis topic: the impact of lactation on infant mortality rates in the African American community. They asked lots of questions about breastfeeeding, birth practices, and cultural competency. I actually had a great time. On the car ride home Charlene said it was the best day she's had in a long time- and I would have to agree!
Thanks Hannibal Regional Hospital for showing the SHOW ME state how it's done!

Hey Kansas- Got Milk?

It's official. Missouri has it's first 'Baby-Friendly Hospital' a designation assigned by the World Health Organization for hospitals that meet it's 10 criteria for supporting lactation. The hospital is in Hannibal MO (yes, that town of Tom Sawyer and Huckleberry Finn fame). I will be traveling there tomorrow for the day (about 3 hours from KC) to be a part of the celebration planned to recognize this momentous occasion. I'm so excited. A barrier has been broken. Neither state of Kansas or Missouri had a baby friendly hospital (or a mother friendly one either- a designation from CIMS (Coalition to Improve Maternity Services) for natural birth support). It was often a topic of discussion when attending my Kansas or Missouri breastfeeding committee meetings, and Kansas City breastfeeding committee meetings. It will be nice to be surrounded by my bi- state-wide breastfeeding advocates to celebrate this occasion, and to brainstorm ways to make it happen closer to home.

The hospital in Hannibal has successfully completed these 10 steps:

The Ten Steps To Successful BreastfeedingThe BFHI promotes, protects, and supports breastfeeding through The Ten Steps to Successful Breastfeeding for Hospitals, as outlined by UNICEF/WHO. The steps for the United States are:
1 - Maintain a written breastfeeding policy that is routinely communicated to all health care staff.
2 - Train all health care staff in skills necessary to implement this policy.
3 - Inform all pregnant women about the benefits and management of breastfeeding.
4 - Help mothers initiate breastfeeding within one hour of birth.
5 - Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6 - Give infants no food or drink other than breastmilk, unless medically indicated.
7 - Practice “rooming in”-- allow mothers and infants to remain together 24 hours a day.
8 - Encourage unrestricted breastfeeding.
9 - Give no pacifiers or artificial nipples to breastfeeding infants.
10 - Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

PS: For American hospitals number 6 is the bug-a-boo. Most hospitals are absolutely dependent on the free formula they recieve from formula companies, and the free diaper bags full of free formula given to patients. Most hospitals can't see giving this up to qualify for the designation. Of course, the short-sightedness of this view of things is, if you truly support and maintain lactation, you won't need the free formula.

Baby Friendly Missouri

Yippee! Missouri has it's first Baby Friendly Hospital in Hannibal Missouri. This is a designation from the World Health Organization for hospitals that comply with the 10 objectives for becoming Baby Friendly (or breastfeeding supportive). (Find more info at http://www.babyfriendlyusa.org ) My breastfeeding advocate cronies and I will be traveling to Hannibal next Thursday for the festivities, and the satisfaction of knowing the a barrier has been broken. Since I worked labor and delivery at several local hospitals over the years, I know that our local facilities do a poor job of supporting lactation. I saw most of the things on this list often ignored and downright counteracted. It's exciting to know that there's a hospital somewhere in the state getting it right.


The Ten Steps To Successful BreastfeedingThe BFHI promotes, protects, and supports breastfeeding through The Ten Steps to Successful Breastfeeding for Hospitals, as outlined by UNICEF/WHO. The steps for the United States are:
1 - Maintain a written breastfeeding policy that is routinely communicated to all health care staff.
2 - Train all health care staff in skills necessary to implement this policy.
3 - Inform all pregnant women about the benefits and management of breastfeeding.
4 - Help mothers initiate breastfeeding within one hour of birth.
5 - Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6 - Give infants no food or drink other than breastmilk, unless medically indicated.
7 - Practice “rooming in”-- allow mothers and infants to remain together 24 hours a day.
8 - Encourage unrestricted breastfeeding.
9 - Give no pacifiers or artificial nipples to breastfeeding infants.
10 - Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

FIMR Visit

I attended a FIMR meeting last week, and it was terrific. This is a federally funded program designed to decrease infant mortality. The case review team (which I attended) is made up of various maternal child health professionals that review actual cases of infant deaths in areas (by zip code) that have the highest number of infant deaths. The FIMR coordinator conducts an interview with the mother, and gathers medical data from hospitals and doctor's offices. She brings her reports to the meetings and we discuss them case by case. The goal of the group is to provide recommendations to close any gaps in services that may have impact on decreasing future deaths. These recommendations go to the community action team to enact. Most of the cases we heard at last week had a lot of the same sad factors, young moms delivering prematurely. What I found heartening about the whole thing was that someone somewhere was addressing the problems, analyzing the issues, seeking potential solutions. I'd like to continue attending just to keep an ear to the ground.

FIMR

I've been getting these invitations to attend a FIMR meeting. I've known about them since they started several years ago, but I've not attended one. FIMR stands for Fetal Infant Mortality Review. This group of neonatal and maternal health professionals is charged with critically examining all the fetal deaths within certain high risk zip codes in our city to determine why these babies are dying, and what can be done preventitively to decrease the number of deaths. How cool is that? There is a case review team (whose meeting I will be attending) and a community action team that work to enact the recommendations of the case review team. Their work is overseen by the city Health Commission, the women and infant's health committee- my newest membership. Can't wait to check things out to see how it all works.

News

Louisa aka Mama Midwife came to visit my class of OB nursing students. She was wonderful. The students loved her storytelling, and her video of her waterbirth, and her sweet little baby boy. She was fab.

World Breastfeeding Week (Aug. 1-7) has come and gone. I usually write a letter to the editor of the local paper, but I was busy and forgot. What I did do was attend a very nice educational event that the Breastfeeding Committee I sit on, planned for our annual event. We had a local midwife speak on breastfeeding during a disaster. It was a superb presentation about the role of lactation during disaster planning. I was downright inspired! I've been toying with writing a curriculum ever since! I've spent enough time with disaster planners now (when I did speaking for pay last year) to know they don't know squat about maternal/child health as it relates to disaster planning.

Attended a local meeting a of new group forming here in KC. It's called the Kansas City Birth Network. It's a unique idea by some of my birth community cronies (I really am fortunate to live in a city with such an active birth and lactation community). The group of birth professionals meets monthly to hold a forum for the public and answer questions and present little mini seminars about birth and lactation related issues. The first meeting drew a nice little crowd of pregs and new mamas. The best part of attending meetings like that is the networking that happens afterward, and just being around 'my kind.'

Mama Midwife Comes to Town

Yes, it has been a while my Beloveds. My month has been eaten up with teaching a class and taking a class. All has been compromised this month, my eating, my exercise, even my sleeping and my blogging. But I'm so excited that tomorrow fellow blogger Mama Midwife (Morag) is coming to my classroom. She is in town for her family vacation and we met up a few days ago. She agreed to come speak to my students about her recent graduation from midwifery school and her recent homebirth (and she's bringing the baby!). The students got wind of it already (I can't keep anything a secret from them) and are excited about hearing a woman speak about being a midwife and hearing a homebirth story. Louisa is such a gem. She is so excited about midwifery and has so many good ideas. She is a tremendous asset to the midwifery community. I love meeting my blogosphere family in person- always a treat.
PS: One of my students has already decided to have her baby at the local birth center that we tour as a part of our course clinical. I'm so excited. I warn all the students that I have a strong pregnancy mojo and someone gets pregnant in every class (it's true) that I teach.

Best Blog Listing

While not quite the New York Times Best Seller List, for now it's close enough. The Laborpayne Epistles made the 100 Best Health Blogs for Soon to be Mothers.

Journey to the Holy Land

I spent a hot, muggy, but glorious weekend with Morningstar on the Holy Land in the company of about 20 other amazing women at the Summer Solstice Celebration. We had long discussions around the fire circle about when and how to say no, mothering young children, and taking ourselves out of our comfort zone. We had drumming and visioning sessions in the newly raised tipi. We pitched tents, gathered clay from the creek, fashioned talking sticks, and feasted on vegan foods as the children ran naked through a chigger infested meadow. It was as close to heaven as life gets. I received some great insights about honesty and knowing my own desires. I got to spend quality time with other women on a similar journey to my own, something I relish.

So now I'm back here in my daily life, preparing to be honest, and say no to some previous requests that before I would have just done- resentfully. I also hauled my ass out of bed and went to the gym this morning, knowing if there is going to be change in my life, I have to put in the work to make it happen. As for taking myself out of my comfort zone- I've done that too. I signed up for a 10 week figure drawing class. All the while remaining mindful of the things that block my productivity like fear, anxiety, and anger.

(I sure as hell better turn out to be one terrific person after all this.)

Preview

Coming Out of the Closet

No, not that closet! I feel it is time to 'come out' about my other blog. I have been hesitant to do so because it is rather personal. (I know you're thinking what could be more personal than birth, breastfeeding, and buying panties?) I started "Big Girl, Big Life" about six months ago, and have been writing on it sporadically, but now that I'm comfortable with it, I'm ready to let others know about it, in case some might find it helpful. It's all about my lifestyle modification/vegetarian/weight loss journey. I guess I thought once I talked about it- I'd actually have to lose some weight! If you want to check it out, find it at www.biggirlbiglife.blogspot.com

Rituals and Rites of Passage

Still a little weirded out: my past week consisted of a vacation shortened by the death of a much beloved cousin. We returned home early for the funeral, followed the next day by the wedding of yet another cousin. Both events have made me want to spend more time with my extended family (80% of whom live in the same city as I do). Next week I have to deliver lectures on male and female sexuality, spiritual care and cultural care in nursing- hefty topics all. All these events have got me thinking about the significance of birth and death rituals (and those in between, like marriage). Since I teach on the subject, I've observed that all cultures have their own unique birth, marriage, and death rituals. (Black funerals are so very different than white funerals!) I've long been a proponent of celebrations and rituals (I throw myself a birthday party every year) and this coming weekend I head off to the Holy Land for a summer solstice celebration with Sister Morningstar. She is the queen of ritual creation (she actually creates rituals as part of her services at her retreat center.) Attending a funeral and wedding consecutively made me think about the impact of rituals, how they solidify memory, ease the pain of loss, encourage hope for the future, lighten the mood, and comfort the soul. Morningstar created a cleansing ritual for me at my request when I was pregnant in preparation for my 6th homebirth. I routinely encourage women I know to create rituals to acknowledge miscarriages, to celebrate friendships, to encourage fertility, to celebrate new love, to mourn love lost, to honor one's own self- rituals are appropriate for any occasion we think is worth marking. Rituals can be private or public. I have a small private ritual during my daily quiet time. I sit in Cielo Pequeno (small heaven- as I call my backyard garden) and read my inspirational text, sip a cup of hibiscus tea (my current favorite), light a scented candle, listen to the songbirds of early morning (I'm usually in the garden by 5:30 am) and do a little meditation of gratitude for what the day will bring. I encourage you Dear Readers, to create your own rituals, be they celebratory, commemorative, or rememorative, or restorative. Our lives and the people we share them with are worth celebrating. Sometimes we have a private ritual that we don't even know we are creating like my friend Rebecca did shopping for her 'power panties' (see Bye Bye Birdie). She may have unwittingly established a new divorce ritual! At the end of every OB course I teach, I give my students a luncheon and a Blessing of Hands ritual, a service happily provided by a local holy woman. She prays for the sick and dying in hospitals routinely as a part of her ministry and knows the importance of having nurses who understand that they are a part of something bigger than themselves. Even my boss and other instructors rush down after the luncheon to get their hands blessed again at the end of every quarter! The last time, I watched as the only guy in the class, who had sternly resisted 'all things girly' during the OB rotation, waited nervously for the blessing of hands to begin. (I wasn't sure why he was so jittery- I always emphasize that the blessing is completely voluntary- many students do abstain, and it is only done once grades are posted- I don't want them to participate just to please me.) As the holy woman took his hands in her, rubbing them with the 'blessed oil' she keeps tucked in her purse, I watched in amazement as tears rolled down his cheeks and she pronounced her blessing and her 'inspired word of prophesy' upon the freshly anointed nurse. I can only imagine what that moment meant to him. I mark the occasion this way because I want them to remember it- and what it means in their own lives. So now Beloved, share with us all what rituals mark the passage of your days.

Bye Bye Birdie

This excerpt has been reprinted with permission from my friend Rebecca. She sent it as an email and I begged her to let me post it because I knew others would enjoy and relate to this sweet little essay on the nature of change and female empowerment.



Yesterday I went to Birdies, a low-key, unusually small, upscale lingerie store. I had never been before. I had been saving up for 3 months at $10 per week. I entered the store and was so nervous I was trembling. I had to shake my head at myself. Grown-ass woman of nearly 50 years should be able to buy herself some panties without being nervous.

It was the sight of all that lace, bows and see through stuff. It made me want to run. I can't wear that stuff- I am "Fruit of the Loom"- basic, clean easy lines, cotton, cheap! I had e-mailed the gals of Birdies ahead of time and said I wanted some POWER panties, not to please a guy but to please me. Something to tell me... I am worth a nice pair of panties- maybe with a bow or something that will force me a bit out of my comfort zone. After the slow death of my 21 year relationship to a really good guy, I was finally in the last phase of the mourning process - acceptance. I was ready to begin the next phase and going to Birdies was a big step.

They found the perfect pair of basic “Elle Macpherson” panties with just the right amount of girli-ness to balance the strength of its basic-ness. They had me try them on over my own undies. I really liked them but seriously... trying on panties and looking in the three-way mirror seems a bit extreme!

Of course, the sales gals went gahgah and asked me to try on a gazillion items, each just a little more girlie or sensual but never in my perceived “nasty” range. They were working hard to find me a comfort zone. They were full of compliments as they must make those sales but also because some were truly deserved! I looked like a voluptuously curvy 50s pin-up in some of those apparel! Panties, bras, swimming suits, a soft little dress that I adored but couldn’t afford. It was really fun! A fun hour just for me.

Behind the closed door of the dressing room, I looked at the prices and everything was out of my price range so I stuck to my original plan and budget. I was happy but wanted to think overnight on the bra at $70. I had a fun hour extending myself to become someone I wasn't but reality awaited. Reality, reality, reality... and then bam. I started crying right there in that stupid dressing room surrounded by all these pretty little panties and bras and soft clothes. I was crying because I felt pretty and lovely and sensual and like a woman.

I lingered in there so the cheerful gals outside would not notice and I gave way to a reflection of my past and anticipation of my future, a new phase in my life. This was the first step, a big step, right there in Birdies looking at myself, flaws and all, and loving what I saw in that three-way mirror. I felt like a real woman and not that "tom-boy" kind of gal that I really am or thought I was.

And there wasn't one man around and I knew I didn’t need a man to make me feel that way... it was the panties... I had found my POWER panties and they pleased me. Mission accomplished Birdies!

I am going tomorrow for that bra after another visit to the ATM and I am not crying!

Charmed Living

Just finished reading Victoria Moran's book, "Living a Charmed Life". Loved this book, just as I loved it's predecessor "Creating a Charmed Life." It's all about becoming who we are through conscious being and doing. It's chock full of juicy little tidbits and practical application for living a life of excellence and relevance. I highly recommend it. It's written in a series of little 1 1/2 page essays so you can easily read an essay a day. I read mine with a cup of hot tea in my garden every morning. With the sun rising in the sky, and a cat on my lap, and the tinkle of chimes in my ear, and my orange spice candle perfuming the fresh air, I find it is the perfect start to every day. (Notice I like to involve all my senses in my daily quiet time). Over the next few weeks, I'll be writing about lessons learned and experiments tried from the book. Come along for the ride, or get the book and create your own adventures!

End of an Era

Yesterday I attended my final board meeting for the healthcare foundation to which I had belonged. It was bittersweet. I look forward to moving on to other board work, like the Health Commission, but I also will miss the terrific folks I worked with at the foundation. I was a great 3 years. I learned so much. Sadly I feel like I gained more than I actually gave. I am proud of the way the foundation is leaving its legacy in the health and wellbeing of citizens on both sides of the state line. I was visiting a school a few weeks ago to find potential clinical sites for my nursing students, and the administrator mentioned the dental screenings all the kids would be getting from this new program... I had to smile inwardly because I knew that program was funded by the foundation. It's good work abounds and reverberates throughout the bi-state area and the impact of it will be felt for (hopefully) generations to come.

Batman Update

Josiah Thomas... that is. He's now a strapping 2 1/2 years old and goes by the name Batman. Yes, that's right- he's smack dab in the middle of a Batman obsession (cape and all). He's completely fixated on a cartoon series called, "Teen Titans." Keeping up my facade of good parenting won't allow me to tell you how many hours a day he watches it. He has a toy Batman that he carries around, and owns 3 shirts with the image of Batman on them. We can only remove one from his body to wash, if we have another to replace it. However, lately he's taken to wearing two at a time... Batman....er... Josiah is adding new words to his vocabulary everday. He happily eats whatever is in front of him, isn't even thinking about potty training, and is a happy healthy child. He's not to shabby with water gun and plastic sword either. Ahh the sweet simplicities of toddler life...

I Support Perineums

I have been talking with a colleague about birth position. She has recently become very irritated about women being forced to give birth on their backs. I'm afraid her irritation was precipitated by a discussion we had about my homebirth, a couple of years ago. I told her why I choose not to give birth in a bed, and prefer instead a standing supported squat. (I also gave birth on all fours once and another side-lying.) Since my friend is planning a second pregnancy in the near future, she has been examining these issues closely. "Why do we submit to that?" she demanded to know. I suspect its mostly because we don't know any better. We assume that all the things we are asked to do is for our safety or our baby's safety (and a lot of the time that is true). However, this one is purely for the careprovider. I haven't seen any research on it, but my hypothesis is that we put our perineums in jeapordy with the lithotomy position. It gives physicians and nurses lots of nice access, but mainly for the purpose of casually abusing the tissue. It is my ethical stand that healthy muscle or tissue integrity should not be compromised (ie. cut or severed) without medical provocation. The muscles and tissue of the perineum are made to stretch to accomodate the birth of a baby. Yes, there are times when tissue manipulation is warranted, but mostly lying down to give birth makes as much sense as lying down to have a bowel movement.

Circ Alert

I read this on Sarah the Doulas blog:

"Although I skip it as often as I watch it (because sometimes the cesareans and procedures are just too maddening), on "A Baby Story" yesterday, these exact words came out of the mouth of a man about to do a circumcision on a newborn:"Up to six months he didn't develop any nerve endings. He has no pain. So I don't want you to really think "Why, he's crying because he's in pain."My jaw dropped. And not in a good way."

Wow! I can't believe somebody out there is still pulling the old 'babies don't feel pain' crap. In my last class of RN students- we went round and round on the circumcision issue. The students actually had some very dynamic dialog on the issue. I always show a video of an actual circ before we get into our discussion on it-but some students saw some in clincals at the hospital first. Boy were they shocked! Here are some exerpts from their online discussion about it:

"Today I was on the labor and delivery floor. There wasn't much action so I hung out and waited for any procedure or experience. I did get to see a circumcision. I always believed that circumcision was important for every boy. I thought he might embarassed or made fun of if he was different than other boys. I knew there was no mandatory medical reason for a circumcision but never questioned the practice. After seeing the procedure done today I am torn about the practice. How is this any different than the genital mutilation we hear about in other countries? I know in other countries it is done to woman and to prevent pleasure but both are done for cultural reasons. I couldn't help but think that in the future the instruments used in this procedure would be in a museum and people would be horrified by the practice that we see as normal and "mandatory"."

Followed by:

"Actually my friends, I believe they have proven the circumcision helps to prevent infections...including STI's and UTI's. As most of us have worked in LTC, we have come across an uncircumcised male and have seen how staff do not pull back that foreskin to wash...YUCK! I know it looks barbaric when you watch it done on an infant, but I always thought, well, better now then when he is older! Still....you are right. It is, and probably will always be a controversial issue."

Another student weighed in with:

"On the American Academy of Peds website a recent survey showed that only 34% of dr in the survey thought the benefits outweighed the risks. I think circumcision is different than mutilation in other countries because in the other countries this is done to women to remove sexual plessure. The procedure has no medical indication"

Another countered with:

"I understand that it can reduce the incidence of infection however, this does not make it mandatory. If we could reduce the amounts of yeast infections in women by removing some of their genitalia would we all agree to that practice?"

Our only male student in the class concluded this:

"Being the only guy in class, I decided it would be most appropriate to comment on a circumcision. Lol. Actually, I witnessed this disgusting act of brutality on the baby boy as well. I could only stand to the side and watch in horror. I thought I knew what they did for a circumcision, but I didn't know to the full extent of what actually takes place.With that being said, I'm absolutely glad my mother/father signed that consent form. I wouldn't want it any other way. When/If I ever have kids, more specifically a boy, I would want him to be circumcised, even knowing what he will have to go through."

The conversation went on over several weeks actually. I was so proud of the students for really grappling with this issue and having an honest discussion about it. In the end some students maintained that they would still circumcize their male children while others were adamant that they would not. My proudest moment came in knowing whatever they concluded, from this point on they would all have a better understanding of the hows and whys of the procedure and not just a knee-jerk socio-culturally-based position.

Come, Grasshopper...

Life has whisked me away, but writing once again draws me back. I just completed another class of OB students and am planning for the summer class. It is my challenge to present OB nursing in a wholistic, humane way, since the reality of my chosen profession seems anything but. How do I teach the rigors of nursing care for the childbearing family and at the same time not approach this as 'business as usual'. Having a baby is not the same as having your gallbladder removed. It should be a spiritual, family-centered event designed to welcome the newborn in a respectuful, humane way. The things I teach are a direct contradiction to what they see in the hospital when they go for clinicals. The students are smart. They are quick to pick up on the inconsistances and I watch as they struggle with questions it all provokes. The best learning is in this struggling. It is in these struggles that they find that cognition and psychomotor skills come easily- but values, attitutes and beliefs- these are harder won. Yet these nontangibles will shape them more as nurses than knowing how to hang and IV bag or read a monitor strip. It is my constant challenge as an instructor to impart nursing as a noble profession, and yet constantly examine the devil that is in the details.

Maternal-Child Health Panel.

It's that time again. I'm putting together my panel of nurses/doulas to speak to my students about various careers in maternal-child health. If you'd like to be on the panel, please email me. The students really love this, and we always have a nice variety of speakers. The panel is in 3 weeks, the first Monday in April.

Breastfeeding Support

Check out this article exposing this pharmaceutical company as it attempts to mimic the federally funded "Business Case for Breastfeeding" that supports lactation in the workplace. Why would a formula producing pharmaceutical company want to support extended lactation?
(Hint: they don't)

http://www.huffingtonpost.com/melissa-bartick/ipeaceful-revolutioni-let_b_171570.html

Breastfeeding and SIDs

Here's an article from the journal 'Pediatrics' that links a dramatic decrease in SIDs to breastfeeding.

http://pediatrics.aappublications.org/cgi/content/full/123/3/e406

Midwives Deliver

A nice article by Jennifer Block, "Midwives Deliver"

http://www.latimes.com/news/opinion/commentary/la-oe-block24-2008dec24,0,102434.story

Letter to the Govenor

As my first official act as a Health Commissioner for my city, I sent this letter to my govenor, Kathleen Sebelius, who is the newly appointed Secretary of Health and Human Services. I' m hoping many of you will take the time to read this document as well.

Subject: Maternal-Infant Health
Comment:
Dear Govenor Sebelius,
As newly appointed Health Commissioner for Greater Kansas City by Mayor Funkhouser, and as you have recently been appointed as Secretary for Health and Human Services by President Obama, I would like to make you aware of a document that I had input on recently that was prepared for the former nominee, Tom Daschle. The document is titled, "Maternity Care: Community meeting in the Heartland" This documented meeting which occurred in Dec. of 2008 assembled an impressive array of maternity care advocate from various fields (including nurses, physicians, midwives, consumers, and media and communications specialists) from Kansas and Missouri to discuss problems and offer solutions regarding maternal-infant care. The result is this document. I hope you and your staff will take the time to read it- I am including a link to the pdf.:

http://www.birthpolicy.org/pdf-bin/PushReport200812.pdf

We represent a stalwart community of devoted professionals and consumers committed to improving maternal-infant health. Please know that we are here as a resource for you and your staff. Together, we can make the world a safer and healthier place for mothers and babies.

Health Commission

Tomorrow morning I will head to the local health department to attend a meeting. The mayor will introduce me as a nominee for his health commission. The focus will be health disparities. I don't know anymore until after the meeting, except that I relish this opportunity to work on behalf of mothers and babies in this way.

The Clash

Dear Reader,
I knew this day would come. I had an opportunity to write a protest letter (my specialty) to a local hospital for quietly removing a physician and midwife from their practice there. The hospital has been successful in keeping the details from coming to light, so no one really knows what happened. As I was about to don my 'birth activist' hat and pen my letter, it occurred to me, that someday, I might want to petition for my nursing students to have clinical hours there, and and that such a petition might be impeded by the presence of a ' protest letter' with my name on it.

I knew that choosing to represent an organization (i.e. getting a job) would interfere with my, shall we say, more 'covert activities' and I have the feeling this is just the beginning. Can revolutionaries really be on the payroll?

The Ranch

These are a few images from the lovely Rancho Los Palmas http://www.rcholaspalmas.com/ where I would like to stay when I return next January. It is a breathtaking place with horses, and other farm animals and an organic vegetable garden, hiking and riding trails and a swimming pool fed by underground hot springs. The staff includes a cook to prepare the meals. The ranch sleeps about 15. I'm hoping to recruit 10-15 folks to go with me. Any takers?

Parade

These grainy photos are of the start of the walk. The Pilgrams parade out of town with Native Indian dancers leading the way. The Pilgrams march by village, each led by banner bearers and singers. The marchers number into the thousands.

Hospital Maternidad

These are two photos I took of the maternity hospital where I did my service project. You are looking over the second floor railing down into the little courtyard where laboring mothers can sit and walk, and the second photo is the rooftop where gatherings and meetings are held.

Guest Home

Finally got some photos back! These are two photos of the lovely home of my gracious hostess, Michele. It was ranch/villa about 15 minutes outside the town of San Miguel. It was so beautiful and peaceful and surrounded by mountains on all sides with horse pastures surrounding the house (my hostess is a competitive rider). I loved my time of silence and solitude in such beautiful surroundings.

First Step Towards the Pulitzer Prize

Hey Readers,

Check this out. I got this email, just before leaving for Mexico and didn't have time to digest it. Now that I've had time to really look at it, it's quite a compliment. This is really cool and I wanted to share it with you. Many thanks to Kelly Sonora and all you devoted Dear Readers who support the LaborPayne Epistles. I love writing this blog!

Hi,

We just posted an article, "Top 100 Blogs for Expecting Mothers" (http://www.ultrasoundtechnicianschools.org/top-100-blogs-for-expecting-mothers/). I thought I'd bring it to your attention in case you think your readers would find it interesting.

I am happy to let you know that your site has been included in this list.

Either way, thanks for your time!

Kelly Sonora

Final Day

Today is the final day of class for my current crop of students. (Our program is condensed, so students do 1 class per month- all day, everyday. Now you know why its so hard to write during a teaching month.) As this fresh group of students move on to their next course, I have the same anxieties. Did I focus on the most important maternal-infant health issues? Did I say enough about the importance of breastfeeding? Did I stimulate new ways of thinking about maternal healthcare? Did I cause alarm about cesarean rates and the inherent risk it causes? Did I plant the seeds of love in someone's heart for this area of nursing? Was I kind and gentle in my approach? Was I creative enough, tough enough, lenient enough? This teaching thing is such a dance of opposites. I'm so proud of my students, but more importantly, I want them to be proud of themselves for what they have accomplished this month. Today, after the final exam, we will have lunch together, catered by my mother, the 'evangelist', followed by her doing a 'blessing of hands'. She brings her blessed oil, and if they wish (totally voluntary) she will pray over them and annoint their hands. This is a small ritual I offer my students that they seem to enjoy. It means a lot to my mother to come do it. My peers and I are serious about sending good nurses out into the community, and I want them to have a sense that they are on a 'holy mission'. I want to send them out (or onto the next course) with prayers and blessings and a sense that they are a part of something larger than themselves. You could say, helping them find their mission, is my mission...

San Miguel Walk

I did it, I did it! Sure I finished the walk... but I'm talking about trying huitlacoche! After I read Jill's comment on yesterday's post, I spotted this item on a menu when I went to my favorite restaurant for dinner. It was served as an appetizer, three quesadillas, one with mushrooms, one with cheese, and one with huitlacoche. It looked liked a slimy black fungus nestled in with cheese inside a corn tortilla. It tasted mushroomy only more 'earthy'. It actually didn't taste too bad (if I didn't look at it) and I ate the whole thing! Thanks Reader Jill for opening my mind and palate to new gustatory experiences!
Now back to the walk. Previously it was three days and I trained for it as if I were training for the Olympics. A couple of years ago it was shortened to half a day to get more people (and more donations). It's not nearly as big a production, and the walk was still challenging for me. The walk itself is more than 100 years old. The Mexicans walk over a nine day period from San Miguel de Allende, Guanujuato to San Juan de los Lagos in the neighboring state of Jalisco. It is a spiritual pilgrimage from one holy shrine to another. The part of the walk that I participate in, the 3 day or 1 day version is a bunch a gringos who get in at the end of the line and walk for a much shorter period of time to raise money for the organization, CASA. So the walk is actually 8-10,000 Mexican Pilgrims, and then about 50 gringos walking as a fund raiser.
This morning at 6:30 am we gathered at the Parrochia (cathedral) in the town square. There is a special Mass to bless the Pilgrims. It is very festive as the townspeople gather to see the Pilgrims off on their journey as they parade out of town. There are native Indian dancers in colorful full costume including head dresses, who lead the parade, then a municipal brass band, and then the Pilgrims. They march by village, each carrying their town banner and hoisting on shoulders, their own statues of La Virgin (you know, Mary), and giant crucifixes of Jesus. The villagers sing as they march, and one group after another heads through the town streets with well-wishers looking on. Since we are guests to the march, we gringos go last, just ahead of the 'medicos' the ambulance corp. The crowds press food into our hands (its considered a blessing to give something to the Pilgrims as they pass through) such as oranges (great for low blood sugar during a long walk), and atole, my much beloved corn-based beverage that reminds one of hot chocolate, bottled water, and small loaves of bread. I say muchos gracious even if I don't accept their offerings to show that I recognize their hospitality and generosity. We walked through the town and into the country-side and into the next small village, just a few kilometers, before we were bused backed to CASA for a tour and lunch. A group of six of us including two midwives who live here part-time from Massachusetts, are offered a ride from a Mexican in a pickup while we wait for our van. We cheerfully accept and pile into the back of his pickup (don't tell my kids!) So there we are 6 or 7 old gringos merrily riding in the back of a pickup. He drops us at the edge of town and we tip him a few pesos. He tells us its the most money he's had all week. We soon hitch another ride to CASA from a professional driver who hands us all his business card as we exit his shiny spacious red sport utility vehicle. The gringos I walk with have made their home in San Miguel, mostly retired expatriates and come from all over the globe, US, Canada, and various places in Europe. They are a delight to get to know and make the walk most pleasant. I'm a mild star, since I have traveled the furthest to participate. The view in the countryside is spectacular as the arid mountain pastureland stretch as far as the eye can see in all directions.
I can't wait to return next January with family and friends. Hopefully we will repeat my agenda of a time of shopping, a time of service, a time of rest and reflection, and of course a time walking. Pictures to post when I return!