The Breast Roadtrip Ever

I spent the day today, trailing a local lactation consultant (one of only about 50 African-American LCs countrywide!). I spent the day watching her do what they keep telling me can't be done- increasing breastfeeding rates in the African-American community. Next week I hope to observe a caucasian LC doing the same thing in an urban hospital. Both visits will be documented and added to my literature review for my thesis. The topic: The impact of lactation on infant mortality rates in the African-American population. I slipped away at noon to lunch with the midwife who worked across the hall in the OB clinic. She took me to a great new vegan restaurant called Seed. I had the best veggie burger ever, and got to listen to the midwife tell me all about her plans to start a birth center. I want a piece of that dream. Tomorrow I hit the road at 6am to travel across the state to attend the Missouri Breastfeeding Taskforce meeting in St. Louis. I'm excited to meet up with my fellow 'breast enthusiasts' from across the state. I also attend the meetings for the Kansas Breastfeeding Taskforce since Kansas City staddles both states. My 'breast buddy' Charlene and I hope to get both groups to do a joint conference here. Not looking forward to the drive, but excited to be with my statewide peeps.

Welcome to my World

I've just come off a 24 hour weekend doing clinicals at a local hospital. I really enjoy this part of the work. I had 5 students on both Saturday and Sunday for 12 hours each. I placed them in NICU, mother/baby, newborn nursery, and of course the much coveted labor and delivery. One student went to the cafeteria for a break and missed her patient giving birth! (bummer) Her patient dilated from 5-10 and pushed baby out in about 15 minutes. Oh well, that's what you get with a Gravida 5. There was a forceps delivery which opened a discussion during noon conference about forceps, vacuums, and cesareans. It's such a delicate balance to try to open the students eyes about birth in an environment that is very one-sided in it's approach. Our de-briefing at the end of the day during post-conference is the best part of the day. I encourage the students to have lively debates with me and with one another about what they see and experience on the unit. It can challenge their beliefs to the core and the resulting conversations are quite stimulating. While the use of forceps dominated on day two, the other day saw two moms on the unit test positive for cocaine. For those students the hot topic was social issues in pregnancy. One student could simply NOT imagine why any woman would forgo prenatal care. We had a very spirited discussion about delayed or no prenatal care, and why some healthcare clients make such a choice or how their choices might be limited. We discussed the role of the nurse as a part of an interdisciplinary team. There is the birthing client in the center and her family, then comes nurses, physicians, pediatricians, anethesiologists, clerks and admistrators, social workers (sometimes), dietary services, nurse practitioners, lactation consultants, all manner of specialists (if problems arise) clergy, and technologists and in a teaching institution, lots and lots of students of every kind. Speaking of which, we discussed the role of the student and trials and tribulations of walking the tightrope that is the student role. This is a fascinating opportunity for me to view the world (of birth) through the eyes of students, some whom bring only their own experiences of birth, and others that don't even have that. I love the challenge of drawing them into my world and seeing them become excited about it, or angry about it, or curious about it, or even dismayed about it. And somewhere in the middle of all that emoting, and digesting, and experiencing, and debating, and perceiving... learning somehow occurs.

Mind Over Mentor

I have a 'slow' month this month- no lectures to teach, only about 4 12 hour shifts to supervise at the hospital with LPN students (they only observe- they don't actually do patient care in OB, except on mother/baby). Only now have I had time to 'digest' the two conferences I attended last month on SIDs and birth trauma. I could do a post on each of them, they were so informative and fascinating. I probably will do a synopsis on the SIDs conference in a day or two. In the meantime, I've decided to break my birth fast (I have not attended a birth since Josiah's) and hang out with a local homebirth midwife this month. She says she has the perfect mom for me to meet and attend (with the mom's permission of course). I have had inklings of becoming re-involved with birth on some level. I could be on-call for L&D shifts at the local birth center. I could inquire about a full blown apprenticeship with one of several midwives here in town. None of these options seem quite right for me now, but I'm glad to know options are available. For now, I'm content with my observation. I will also spend a few days with a couple of lactation consultants (one in a hospital and one in a community based clinic) to interview them for my thesis. Both these LCs are phenomenal. They have each nearly single-handedly turned around breastfeeding rates for the AA moms they care for. I want to observe how they do it first hand. I want to write and speak about the methods they use to influence AA moms to breastfeed, so I can share their successful strategies with everyone else. I've learned a lot devoting my semester to literature review, but I'm eager to see some strategies in action. I'm looking forward to spending my month with women I consider models of success and mentors in my chosen areas of interest.

The Noble Savage

I didn't mean to let the month of October pass without an acknowledgement of Josiah's 2nd birthday. He is afterall, the inspiration for this blog. Here he is pictured with his big sister, coveting her soda. He's a typical two year old, into everything not nailed down or locked up. His favorite word is 'no' his favorite food, oatmeal (and any candy he can get his hands on), his favorite toy, a wooden lawnmower (it has wooden beads in it that pop when he pushes it), and his favorite passtime is reading with Daddy. We are currently tackling the task of potty training which he finds quite a novelty (he'd just as soon be naked from the waist down, thank you very much). He's constantly covered in cat scratches since he thinks its worth the price of pulling the cat's tail. No object we deem sacred is safe from his wayward grasp. He's an excellent climber, especially with a footstool nearby. He leaves no faucet unturned, no drawer unmolested. He growls better than he speaks, and occassionally snacks from the kitty dish. The distinctions between him and the pets are few at this point- save one. Have I already mentioned, he's the delight of our lives?

Rebirth of a Nation

There is an historic moment that now confronts us. Though the focus of this blog is birth, I'd be amiss not to recognize the momentus birth of a new presidency that now confronts us. Though two worthy individuals began this race, one has triumphed. May his presidency usher in a new era of peace, compassion, and prosperity.

Will Blog for Food

I didn't attend MANA this past weekend. I wanted to. I was scheduled to speak. But it was a nonpaying gig and I couldn't afford the airfare to upstate Michigan. I really wanted to go, but ironically I gave the same presentation (slighty tweeked) here in my town at another conference. After I notified MANA that I wouldn't be speaking, I got an invitation from another conference that had before rejected my application. They had a slot open up and asked if I wanted it. It was right here in town, so I jumped at the chance. I spoke on Sunday morning at the Professional Nursing Education conference. I spoke on using blogs for teaching nursing students. (I slightly tweeked it from the MANA presentation on the impact of blogs on healthcare). I ran into several nurses I knew, including one of my professors from nursing school. I even picked up a few tips on improving hospital clinical experiences. It was very nice. Yes it is ironic that I spoke at a conference for nursing educators when I've only been doing it for 5 minutes. Even more ironic is the fact that when I sent in my original request for proposal- I wasn't teaching at all- and had never thought about teaching. As much as I wanted to go to MANA, I never had time to miss it. My weekend was a blur of posting midterm grades, checking care plans, and writing powerpoints, and shopping for baby dolls to be used for neonatal assessments and infant baths. Later this week, the hordes will descend on 'kid's day' as my students do head to toe examinations on real children (mostly homeschoolers- they're available during the day, and there are usually 5-8 kids in every family- so I don't have to ask as many people!). As for the two classes I'm taking towards my masters, I turned in my first draft of my research literature review. My research topic is, the impact of lactation on infant mortality in the African-American community (the news is all bleak, folks). For my health assessment class, last week we practiced vaginal exams on teaching patients. (Teaching patients are folks who get paid to let you examine them, and they instruct you as you go.) I think I did terrible- you'd think I'd know my way around a vagina after all those years in L&D! It's an interesting contrast being both the student and the teacher simultaneously. I came across an article on being compassionate to nursing students and that nurse educators can be abusive instead of nuturing. I took it as a warning- to check my motives, and attitude when dealing with my students- and everyone who comes into my sphere of being.

Clinical Nirvana

My long hiatus has been filled with clinicals, didactics, a new classroom full of nursing students, as well as work on the two classes I'm taking. This past weekend, I spent two 12 hour shifts at the county hospital with my students in labor and delivery (L&D), mother/baby (M/B), antepartum (AP), neonatal intensive care unit (NICU), triage, and well-baby nursery (NSY). I must admit, it was a blast. I felt right at home in my old hospital. It's been four years since I worked there, but much of it was the same. I liked being there in a new context. I arrived early each day (around 6am) to find assignments for my students between the various areas (the guy with the special needs child eager to be a NICU nurse got the single spot for the NICU, the earnest eager pediatric LPN got the only open prized L&D slot, the birth phobic guy will go to the well baby nursery, and so on.) Once all the students were assigned and with their nurses, I spend the morning running from unit to unit checking on them, making sure they are taking full advantage of learning opportunities. I encourage one to start and IV in triage, another to bathe a baby in the nursery. During a lull in the activity, I pull several students into the nursery to do an exam on a day old newborn. We take his vitals, listen to his bowel sounds, test his reflexes. We peruse the nursery looking at the other babies for dermatologic alterations like milia, petechia, skin tags, and port wine stains. At lunch time, I gathered my students for noon conference. We have a twelve hour day, so I try to break up the time a little. At noon I bring them into a birthing room for a scavenger hunt. They pull a slip of paper out of a bowl and see if they can locate items like trendelenburg bars, personal protective gear, graduated cylinders, and and delee suction traps. Then we grab lunch from the cafeteria and meet in a conference room. The students take turns sharing their case studies. After lunch, they head back to their various units to continue following their preceptors. I run to and fro, checking on various ones. I watch as one give a shot of demerol, another hangs an IV bag, yet another draws admit labs. They all do beautifully and I'm so proud of them. During a lull in the activity I work on powerpoints for my lectures on my laptop at the nurses station, catching up with former co-workers I haven't seen in four years. Around 5pm I gather them all up for postconference. I have them get out their workbooks and we do test prep for an upcoming exam. They talk excitedly about their experiences on the floor. Over the two shifts, 5 students got to see babies born, the NICU guy is clearly walking on air over his experience. As he leaves the unit for the day he grabs his preceptor Aurora, a tiny but mighty Filipino nurse who has been in this NICU for over 20 years, and gives her a heartfelt hug. I love watching their faces in post conference as they talk excitedly about their day. I watch as nursing 'takes', as they begin to own it. I love the way that makes me feel. My boss keeps asking me to come on board full time. I'm considering it...