Blunt Trauma

I ran into another mother this weekend that I hadn’t seen in a long time. She remembered that I had been in school to become a lactation consultant and inquired how that was going. I told her where I was working now and that I was very happy with my job. She responded that it must be such a nice, relaxing job; that she didn’t “imagine it was very stressful.” I blurted out “Well we had two infants with catastrophic brain injuries this week and one near maternal death, but other than that…,” I trailed off. Based on the stricken look on her face, my response might have been a bit harsh but she hit a nerve.  

This job is endlessly emotional. I am working with people during the with the most dramatic moments of their lives. There is a great deal of joy. There is also immense frustration, exhaustion, and sometimes despair. The sad truth is that with over 200 births a month we see stillbirths and other tragic outcomes on a regular basis. Last week was rough. My boss quit without any notice shaking up the entire staff and leaving the entire labor, delivery, postpartum, and neonatal intensive care unit “motherless”. We had two infants with severe brain injuries transferred to another hospital. We had one mother nearly bleed to death after childbirth. I spent my days ping-ponging between rooms with pink robust infants and two rooms where a mother sat alone, her door shut tight so she could not hear other infants cry, hooked up to a breast pump, hoping that her baby might someday be well enough to take some of her milk.The worst part of my job is that I have no way to follow up on any of these mothers and their infants after they leave the hospital. I remember their faces, their bleeding nipples, their magical new babies, and their empty bassinets and I wonder what happens to them. In my old career I used to sometimes bring work home; papers to read, emails to catch up on. I don’t need to do that any more. But I do bring my job home. I think about the mothers and babies when I am home in bed. I worry about them, stress over them, and wonder if I did enough to help them. 

Natural High

My freshman year of college I was in Air Force ROTC. It was all part of my grand plan to become a pilot and then eventually an astronaut. The university I attended was far too small and nerdy to have an ROTC program so I had to travel to a nearby large university once or twice a week to play Air Force officer in training. I thought that plan would be completely manageable along with being on the volleyball team, majoring in physics, and adjusting to life on my own. I failed in spectacular fashion, literally; earning the first “F”s of my life in math, chemistry, and physics. I also realized that I wasn’t particularly good at following orders. About the only thing I enjoyed about ROTC was the memorization that was required as part of our drills (I have a nearly “photographic” memory for anything I hear) and singing the Air Force song. The item I most dreaded about ROTC was PT, or physical fitness training. PT was heavy on the running and, my god, did I HATE running. I was always the slowest in the group, my legs itched terribly (years later I found out I have exercise induced allergies), and I was just plain bored. When I quit ROTC at the end of my first semester of college I thought “And now I will never have to run again.”
Fast forward 19 years and I am a regular runner now. I don’t usually post on facebook or talk overly much about how much I love to workout now as I feel like I sound a bit like religious zealot. “Join the church of running and ye too shall be saved!” So I will preach to you, all half dozen of my blog readers! Working out is awesome. Regular exercise is, quite honestly, my antidepressant. Nearly daily workouts have made me a more patient mother and better person. Running is still hard, but it’s a good challenge that leaves me feeling like a I conquered something. Occasionally though something magical happens when I’m running and it doesn’t feel difficult but joyful. Today was a rough day at work; the worst kind of day with bad outcomes for a couple of infants. I was so down that after work I thought about just going for an easy walk. After I arrived home, I put on my running clothes and started down our block. I was hit by a blast of cold wind – it was in the upper 40s – very cold for daytime weather here. I thought about turning back but then I was struck by the intense sense of gratefulness for my healthy body and I knew that walking would never keep me warming enough in the chill. So I took off running and oh what a run it was. I ran the fastest I have in over a year. I literally lept over curbs and obstacles. At the end of 5 kilometers I didn’t feel tired but euphoric. I don’t think I have felt this “high” on life since the moments after Baby’s birth (nothing beats the oxytocin rush following natural childbirth for a high). By the end of the run I was actually smiling, probably somewhat goofily, but much like being in labor I didn’t care how I looked. I felt like I could have run forever and only stopped because I had to pick up Baby from school. I wish I knew what exactly made this run so amazing. I think the hard day and the cool weather were both factors but it felt more magical, almost spiritual. Who knows exactly. What I do know I am going to be chasing that feeling again and again. Come and join my cult!

Big Girl

The night before last I was awoken by the presence of a little person next to my bed. I feel like every night since the evening Older drew his first breath I have slept with one eye open (figuratively speaking); my radar constantly sweeping for a sign of an awake child. After nine years of this I don’t wake in a start anymore when I feel a tiny human staring at me, but with a resigned sigh. Baby stood next to my bed and stated the obvious “I can’t sleep”. “Climb on in”, I said as Husband gave a slight moan of protest. You see, we sleep in an antique double bed; it feels more than cozy with Husband and I in it. Add in Baby and the bed is downright crowded. But 4:30 am math looks something like this for me:
Crowded in warm double bed >> Sitting on cold hard stool next to Baby’s bed

About half the time Baby ends up in our room she snuggles into me; seeming to almost want to crawl back in the womb with how close she tries to be. The other half of the time Baby tells me her thoughts. There are so many thoughts. The night before last was the other half of the time. Did I know that she is old enough to use the “big knife” (my 9 inch chef’s knife) now? Baby felt that she was and this was apparently what was on her mind before the sun rose. And what shall she use the big knife for? Why to slice oranges for fresh squeezed juice, of course. Which she wanted me to know that we should make for breakfast. And did I know that it was getting very close to Valentine’s day? And that we hadn’t made any cookies yet? It was a cookie crisis. So she helpfully suggested that, after we enjoyed our juice, we should make some heart shaped cut out cookies. Naturally, no cookie is complete without sprinkles so we should be sure to get out all the sprinkles so we can make good sprinkle decisions. She informed me that she could do all of these things because she is a big girl now! (Of course, not so big that she can’t fit in Mama and Daddy’s bed.) My half of the conversation went something like this “Mmmm hmmm”. Around 6:30 am Baby finally fell back into a deep sleep. Just in time for Husband’s alarm to sound and the noises of his getting ready to keep me awake. I stared at the clock and thought about how damn tired I was going to be all day.

I’ve been working on slowing down and saying more “yes” in my life. I wasn’t fully conscious when I apparently agreed to letting Baby use the big knife, squeeze oranges, and make cookies. I don’t think anyone would hold my 4:30 am mumbles of agreement to be binding. So when, first thing in the morning, Baby headed for the knife block to implement her plans I have to admit that my first instinct was to say “no”. She’s four years old. The knife is nearly as long as her arm. And sugar cookies. Ugh. I love to eat them, but making them is time consuming. And sprinkles. The mess! Then I looked at Baby’s excited face and I thought that somewhere between six months and eighteen months from now (we’re not sure when Baby will be going to kindergarten) we won’t have any more of these moments. I won’t have the option of saying yes or no because we won’t be here together. So I get out the cutting board, the oranges, and the big knife. I place my hands over hers and gently guide her as she cuts her first orange. Triumphant she pushes half of it down on the juicer squeezing out the juice. I do the rest of the slicing but she does half of the juicing. And unlike times past, she doesn’t need me to go back and re juice all of her oranges. She inspects each orange half as she goes along, extracting every last bit of juice from every one. We drink our juice. I make myself a rather fabulous egg sandwich to go with it (when in Rome…). I preheat the oven and get our mise en place for the cookies as Baby plays. She doesn’t see me getting the ingredients ready and is thrilled when she turns to see them laid out upon the kitchen table. I wonder if I say no so often that she is surprised that I am sticking to my middle of the night “yes”. We make the dough. We make pumpkin muffins as the dough chills. We roll out the dough and Baby tells me that she can cut out the cookies without help. She’s right. She makes two dozen precise hearts exclaiming “Perfecto!” after each one. I break out the selection of sprinkles. She applies them methodically to her sheet of cookies. I work on another sheet. While it takes her longer to complete her sheet than mine, I think there is actually less mess and wasted sprinkles around her cookies. While the cookies bake we go outside and she builds a “house” out of gymnastics mats and patio chairs. When the walls collapse I step in with a tablecloth and clothes pins and we build a fabulous palace. Baby wants a sign for her house and brings me scraps of wood for the house. “Yes”, I say again and I hammer random shapes of wood together. A proper sign needs color, “Can she color the wood with makers?”. “Yes.” She gleefully writes all of the girls names in our family (mine, her sister’s, hers, and the cat) on the sign explaining that this is a girls only clubhouse. We feast on cookies for lunch; her sitting in her humble abode, me sitting outside peering in through a “window”. We’re both clearly tired, but we’re both happy. I watch her chattering to herself in her house; she’s so completely carefree and happy. I marvel at how well she did cooking this morning. She is so capable now; she really is a big girl. But not so big that I don’t have her all to myself for a little while longer.

Fresh

Most of us will only rarely, if ever, have the opportunity of being around a truly newborn baby. /Fresh from their mother’s body their skin is a pinkish purple color, still plump from being in a water world for the past 9 months of their life. They are, perhaps surprisingly, very warm. If kept with their mothers, they rarely cry and are quite alert; gazing curiously and seriously into the eyes of those who have the privilege of holding them. I happen to think the first few minutes or hours of life are perhaps the closest thing to magic here on this Earth. At only a few hours of age a newborn is already noticeably different; their skin becomes more easily chilled and mottled. They seem to almost deflate a bit. A few hours old baby is often quite sleepy and you will not see much, if any, of their eyes open until they are more than 24 hours old. The first few moments of life are fleetingly beautiful and unique time in life.

Afew days ago I was called to assist with a brand new baby; only minutes old. I usually see mothers a few hours to a couple of days postpartum; my skills are generally more valuable after mothers have had a chance to recover a bit. We were crazy busy that day; full to the point of transferring patients to other hospitals. One of the nurse managers had been called to assist with a difficult birth and asked me to come down and help afterwards as the mother was very upset during the birth and really needed, from an emotional perspective, for breastfeeding to go well. I walked in the room to find the mother raised up high in the bed, flat on her back, legs spread eagled, blood smears everywhere. Her (completely healthy) baby was off in another corner of the room being weighed. A nurse, the baby’s father, and the baby’s grandmother were cooing over the baby. The mother lay alone, shaking, trying to lift her head to catch a glimpse of her new baby. The labor nurse was cleaning up the room. I had a visceral and immediate reaction to the scene. I remember how after a challenging 44 hour labor with Older I longed only to hold him. Being apart from him, even just to have him checked over after a difficult birth made me feel an utterly empty despair. At least my midwife stayed by my side, holding my hand, advocating for my baby to be brought back to me (which, after a few long minutes, he was). I also remember how I shook after Baby’s homebirth. I could not get warm for hours, but rather than being left alone I was helped to my own bed where Baby lay on my chest, Husband sat next to me, and I was covered with warm blankets.  I’m still new at this job – fresh here – and finding my place. I realize that someday my tendency speak my mind and take charge is probably going to get me in trouble (again – it already has in the past) but within thirty seconds of walking into the room I began to work – and it wasn’t to deal with breastfeeding. “Why is baby not with the mother?” I asked. I moved some equipment so that mom could see the baby better. The mother had been planning a homebirth and after the birth had not gone well she had transferred to the hospital to eventually require a forceps assisted birth from an obstetrician. The mother’s midwife had come with her from home but within a minute of my entering the room, she left, stammering that “she thought she was coming down with something and didn’t want to pass it on the baby.” I was flabbergasted that the midwife would leave the mother at probably THE most vulnerable moment of her life. I was also perplexed; the midwife didn’t feel well enough to handle the baby, but she didn’t seem to have an issue with being potentially contagious and being in very close contact with the mother. I doubt she was sick at all, but instead wanted to leave the hospital to avoid questions. Midwives like this woman give the homebirth and the field of midwifery a bad name. I stepped to the mother’s side and in between asking the baby’s nurse to get baby back to mom I asked the labor nurse for warm blankets for the mother. I held the mother hand until the baby’s nurse gave me a curt nod and I told the father (who seemed oblivious to his wife) “Pick him [the baby] up and bring him to mom. I tucked the baby in under his mother’s gown. The baby was crying and both he and his new mother looked lost. I told that her that baby knew her voice and to speak to him softly while patting or rubbing his back. I turned the lights down low and the baby opened his eyes. The warm blankets arrived and were tossed on the foot of the bed. I covered the mother up and she gave any audible happy sigh.

The obstetrician then walked in the room. He spoke to the mother “congratulating” her on “letting him” use forceps. “If you hadn’t said yes to the forceps, I would have had to section [Cesarean Section] you,” he said with a little chuckle. He then went to on expound upon his skills with forceps and difficult births, how long and illustrious his career had been, and how lucky she was to have had him as her OB; anyone else “would have just sectioned you” he said. I looked on aghast . Here was this new family meeting their baby for the first time; moments they will NEVER get back and the OB is taking precious minutes blowing into the balloon that is his ego. He then turned his attention to me. Although we had met before he didn’t remember who I was and mistook me for a pediatrician. He was surprised when I told him I was a lactation consultant. He said I sure acted like a doctor. I think he meant it as a compliment. He then said “Well I’m done with this one!” and scurried off (presumably to “save” some other mother), muttering under his breast that “this sure was a tricky one”. Obstetricians like this one give the field of obstetrics a bad name. 
While the mother was distracted by the OB, the baby had begun to root and the mother instinctively guided him into a better position. “See you don’t need me,” I said. “You both know what to do.” The mother was still shaking and unsure so I explained how the baby’s behavior would lead to successful breastfeeding. I told her why she was shaking, how long it might last, and what her husband could do to make her feel better. I congratulated her on a fantastic job giving birth. We enjoyed a few quiet minutes together, me reassuring her, and occasionally helping reposition baby. With her more comfortable and distractions minimized she and her beautiful new son really did know what to do and the baby began to suckle. And although I could have happily stayed in that room for a while longer soaking up all that marvelous new baby energy I left them alone; things were going well now and it was not my place to intrude upon their nascent family.  
I’m happy here at my new job. I’m helping mothers and babies every day and I am being included in management decisions. I’ve even got my own office and coworkers that bring me chocolate. I’m definitely needed. But everyday I am fighting an uphill battle. There are so many things to change. Breastfeeding doesn’t exist in the absence of birth and birth sure is rough on mothers in this country. I started keeping track of everything I want to do – just directly related to breastfeeding – by writing it down on a post-it note and sticking it to my wall. There are 15 yellow squares on the wall so far. I am fighting against decades of ingrained cultural and medical practice and I feel like they’ve got nuclear weapons and I’m fighting back with a squirt gun (full of breast milk, of course). I didn’t get to dealing with any of the yellow sticky notes last week. But I hope I hope that mother can look back on her birth experience and remember the warm blanket and the baby content on her chest. 

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