A Blessing for the Coming Fruit

I’m going back through old blog posts, and as I reread one from the day before I started midwifery school, I was struck by a dream that I had:

“I had another dream, as I was waking from a brief but deep nap, that I was sitting in the middle of a circle, surrounded by all of the dozens and hundreds of people who have supported me and loved me and helped me to get to this place of beginning this journey. Everyone was wishing me well and sending me their love and prayers and blessings for a safe and wonderful traveling experience. It shifted from being in the center of a circle to being alone, in a garden. I held a single seed in the palm of my cupped hands and placed it into a hole in the rich soil. As I planted the seed, I suddenly turned into the seed myself, and was planting myself in the ground. I felt the anticipation of being inside my seed covering but also longing to sprout, to push down roots and send up stalks and leaves, to soak in the rain and sun and energy of life, and to grow into what I was intended to become.”

My eyes flooded with tears remembering who I was as I set out to become even more myself, and how I could still today say that the combination of feeling myself held and loved in community, plus the importance of being alone and doing the work of planting myself in a place I can put down roots, of tending to my own needs, is what sustains me as a person and allows me to continue the intense work of being a midwife. So much love to each of you who has stood in my circle, and richest blessings to the seed, and the soil, and the sun, and the rain, and the coming fruit.

Here’s to all that will begin anew and all that will come to an end this year. Here’s to moving beyond beginnings and endings and to finding what lies underneath. Here’s to belonging to the whole, and to remembering the vitality I find in being alone with myself. Here’s to the wild courage of planting ourselves in the fertile soil of the present moment.

Live Everything

The crisp fall air bit my face as I made my way to my car this morning at the end of a very full call shift. As I drove down the hill from the hospital towards home, the morning sunlight danced with red and gold leaves and I burst into grateful tears. I got to meet five tiny (or not so tiny!) new humans in the past 24 hours. I had the honor of standing with people at the edge of a series of moments that would change their lives forever, and of safely guarding their baby’s passage into the world. The way the light mingled with the leaves took my breath away, and with the full harvest moon sitting on the horizon as a round, silent witness, I felt myself fall in love with my life again.

This year has been one of major transitions for me, and words have been hard to come by. I keep reflecting on what this blog means to me now, nearly six and a half years after I started writing it. I am no longer the eager young prospective midwife who moved alone to a big city on a grand adventure.

I live here now, both in the city I call home, as well as in the career I have chosen and the calling that has chosen me. I am an experienced midwife. I’ve caught hundreds of babies, spent untold thousands of hours in clinic and at the bedside in labor, screened countless cervixes for cancer, helped thousands of families with breastfeeding, and supported lot (LOTS!) of people in whatever their sexual and reproductive health needs might be. I teach students now, take baby midwives by the hand and guide them as they catch their first babies and insert their first IUDs.

For most of my twenties, I had this burning goal at the forefront of my mind: become a midwife. All of my effort moved me in that direction. It worked. I did it. Then I got my first job, and then my second. I’ve settled into my role. I feel comfortable and confident in my work more often than not, which takes much of the first few years of being in practice to cultivate. (Hang in there, new grads. You will not always look over your shoulder wondering where your preceptor is!)

Now I’m finding myself in a liminal place where I don’t exactly know what’s next. My work is internal: cultivate a life (and a home, and a body, and a community) I am in love with, a world I can stay alive in. It means finding my voice in new ways, and claiming my wholeness when much exists that tries to deny me that. It means taking my word for the year, belonging, and following it wherever it has taken me.

I will admit, it is disorienting not having a major life goal to move towards. Being in-between is a rich, fertile space, not unlike how it feels to sit in my garden at night and feel the plants growing by the light of the moon. Sometimes I find myself longing for certainty and an ease in being defined and definable. But who I am called to be in the world is bigger than any boxes could readily contain. Often I distract myself to avoid the discomfort of not having answers. But then sometimes, like this morning, slivers of magic will break through the noise and offer me a split second of utter certainty that I belong precisely here, doing precisely this, precisely now.

I feel this way when I’m out in nature. I camped and hiked a lot this summer, and something about standing at the top of something so much bigger than me made me feel exceptionally small and insignificant and also deeply needed as part of the bigger whole. The summer sun shining on my face welcomes me to inhabit each day as fully as I can.

But the seasons are turning now; the chill in the air and the darkness coming earlier is inviting me inward. There are inner landscapes to explore, and dreams to dream, and new projects to undertake and goals to set, eventually. As we move towards the darkest part of the year, the shadows in me are asking once again for my attention. I don’t know where these explorations will lead me, but I’ve learned to trust that when my inner voice is calling, something vital will offer itself to me when I show up and do the work of being alive in the world as my whole self.

I don’t know what that means for this blog. For now, it will continue to be a space I return to, a touchpoint. It allows me to look back over the miles I’ve already covered. My work, now as always, is to show up and, in the words of Mary Oliver, “Pay attention. Be astonished. Tell about it.”

I wanted to write a letter to myself, but I am finding that in this moment, suspended between two call shifts at the end of a very busy week, and running on insufficient sleep, I don’t have the bandwidth to drop that deeply into connection with myself. So I will borrow from Rainer Maria Rilke’s Letter to a Young Poet:

I beg you, to have patience with everything unresolved in your heart and to try to love the questions themselves as if they were locked rooms or books written in a very foreign language. Don’t search for the answers, which could not be given to you now, because you would not be able to live them. And the point is to live everything. Live the questions now. Perhaps then, someday far in the future, you will gradually, without even noticing it, live your way into the answer.

The contrast of the two photos of myself I posted bring up a lot of feelings. There is a lot I would say to the eager student kneeling beside their nursing school’s sign.

I would tell them to go for it, knowing how hard it would be.

I would tell them the sleepless nights are tough and worth it.

I would tell them they would make it. And they would make it. And they would make it again.

I would tell them that their heart breaking wouldn’t break them.

I would tell them that a brand-new baby screaming will always be one of the best sounds in the world.

I would tell them that the weight of stillborn babies in their hands would be far more than they could imagine. Then again, maybe I would hold that detail back. Maybe the heaviness of death mixed into this work is something they have to discover on their own.

I would tell them that bad news doesn’t get easier to tell, but they’ll get better at delivering it.

I would tell them that so much love is waiting for them. So, so much.

I would tell them that they will be lost and found and unlost and unfound over and over again.

I would tell them that they are better at surviving than they realize. Which is saying something, because they already realize that quite a bit.

I would tell them that home and family and belonging and wholeness are things they will get to experience in this lifetime.

I would tell them, again, that it’s worth it. Darkness and light, pain and joy, grief and celebration, laughter and tears, and all of the supposed binaries mixed up together.

I would tell them to live everything. Answers may come. But for now, love the questions.

Born of Dust and Silence

Several months of silence have elapsed since I last showed up to pour my thoughts into this space. Much has been unfolding that is more personal than I am able to explore in this format at this time, and I trust that as stories arise that want to be shared, words will accompany them. For now, know that much is shifting beneath the surface, and perhaps the surface itself is shifting, the landscape of my life changing shape a little, taking on new elements of beauty and fascination and curiosity to marvel at.

I have wondered on and off if it is time to retire from blogging for now. It seems I have less to say here than when I was a student, and it is at least as much personal as it is about midwifery. And then, at the ACNM Annual Convention last week, I spoke with no less than a dozen people (many current midwifery students, or new midwives) who told me that my blog was instrumental to them choosing this profession, or helped them through the rough waters of school, or reminded them that they were not alone. And I realized that I could still do that, even though I am in a very different place now than six years ago when I first sat down to write about my excitement about becoming a midwife and explore my journey towards this career, this calling of mine. Six-years-ago me could not have imagined that I would be sitting down during a lull on a call shift (I didn’t say the “q-word…” I learned never to say the “q-word!”) after a busy day in clinic to blog about being a midwife and becoming myself. Or, perhaps, could have imagined it, but not what it would be like from here.

But six-years-ago me isn’t the part of myself I’ve recently been most strongly connecting with. Ten years ago this summer, I was ill to the point of bordering on death. I look back at the photos of my emaciated body, hollow eyes staring at me through a decade of time, and I have so much I want to tell the person I was then. Last week, I went back to my childhood home (one of them) to visit my parents and my sister, and I spent some time connecting with myself. It felt like a deep healing sort of magic, to be able to send love back through time to myself when I desperately needed it.

Brene Brown put it this way:

A deep sense of love and belonging is an irreducible need of all people. We are biologically, cognitively, physically, and spiritually wired to love, to be loved, and to belong. When those needs are not met, we don’t function as we were meant to. We break. We fall apart. We numb. We ache. We hurt others. We get sick.

A number of those things happened to me a decade ago. I was newly out as queer, and newly in love with the person who would become my wife. I was living in a place where I did not get to express my queerness with a sense of safety or acceptance of who I was, and I managed to internalize the unspoken message that I needed to be small and take up less space. Combined with some undiagnosed physical health issues that spiraled together with anxiety and systemic oppression and not feeling a sense of belonging or knowing where home was, I made myself small. I lost 70 pounds in a year, dropping from an average weight to one that I still cannot believe I could survive at. I broke. I fell apart. I got sick.

I didn’t know if I would get better, or if I could, or even if I wanted to. I could not conceive of a life where I got to be my whole self and was loved exactly as I was and where delight was a theme woven through my days alongside the complexities of sadness and beauty and loss and heartbreaking joy.

I remember a singular moment that felt like a tipping point, where I sat alone in my room, my stomach raging in pain and nausea, gnawingly empty. I watched the pulsations of my aorta through my gaunt belly as I sat staring at a banana and trying to decide if I could eat it. I sat with that banana for hours, feeling like choosing to eat it despite how ill I knew I would feel was an affirmation of my intent to stay alive in the world, and uncertain if I had it in me to say yes. I journaled about this inner chaos. On July 1, 2007, I wrote of how “frighteningly low” my weight was (below 100 pounds), and described all the medical interventions that were on the horizon if I couldn’t force myself to eat, and what my choices were there. And then three small words at the very bottom of the page: “I choose life.”

I ate the banana. I somehow pushed through walls of pain and mountains of fear and kept eating. I left home and built a little family and fell in love with my life again. I didn’t die. I dreamed big dreams and from the depths of myself found the courage to follow them. I moved again, by myself, went to school, got divorced, became a nurse, became a midwife. And here I am on my couch at 11 p.m., pager clipped to the waistband of my shorts, hundreds of babies later, blogging about it.

In my grand tradition of writing letters to my past selves, here’s one specifically to me in that moment when I was sitting there with that banana:

Dear Rob (yep, that’s your name now; hang on),

I see you. Where you are at right now SUCKS. You feel sick constantly. Your body is wracked with pain and your mind with terror. You can’t imagine ever feeling alive again. You are eating your own flesh to stave off death for a bit longer, uncertain how much more you have to give. You are possibly the loneliest you’ve ever been, there in the solitude of your descent into illness.

I know, trust me I know, how much you don’t want to do this. You know how sick you will feel if you eat. You know what it will cost you. But just for a minute, I want to plant the seed of the idea that you not eating will cost me everything I now have. I need you to survive. I need you to do whatever it takes to keep your body alive. I can go back and repair anything else, can return with new perspectives and skills and coping strategies and will happily clean up any messes left behind. I just need you to feed yourself.

If I could, I would give you a glimpse into what lies in store for you on the other side of not dying. In the way that time is not as linear as we think it is and magic is weird and knowing that I went back last week with the intention of reconnecting with you, I’ll give it a shot. If you eat that banana, and keep eating, and keep doing whatever you need to do to stay in the land of the living, I promise you on everything you know to be holy and good that you will come alive again. This is not where your story ends. Far from it. You will keep writing.

In a couple of months, you will move to California, and you will meet people who won’t bat an eye at your queerness. A year from now, you will be married. You will put on a dress (sorry, next time it can be pants) on International Women’s Day and say “for today, and for the days to come” to a woman you love, and you will mean every word of it. You will explore together to the end of your exploring, and your paths will diverge, and you will be sad, and you will feel broken, and you will crochet and write and cry and study your way to feeling whole again.

During this time you will have moved again, to Seattle, on to one of the biggest challenges you’ve ever given yourself. You will dream a seemingly impossible dream, and you will have no idea until you’ve actually done it whether you can. From where your emaciated body sits, banana in hand, you can’t fathom being able to take on the role of caring for anyone but yourself, but you will do it. You will kick ass at one of the most accelerated intensive nurse-midwifery programs in the country. You will rise to the challenge of the dream your grandmother offered you. You will sit in a session at a midwifery conference ten years from now and hear her whisper, from somewhere, that you are her wildest dream, and you’ll realize that she gave you yours as well.

You will get a job that will stretch you and teach you a lot about how to be and how not to be a midwife. You will stay there until you need to leave it, and then you will go to a new place. You will bring your whole self to your work. You will receive babies into your hands and stories into your heart. Your presence with your patients is being cultivated by the quality of the ways in which you are showing up for yourself right now. So keep showing up. Keep doing the hard work of staying alive in the world.

Know that you are not alone. I promise that I will come back for you. Ten years from now, I will return. I will sit in the bedroom you spent your adolescence in, and I will bring all of my accumulated love and wisdom and magic with me. I will sit in the living room eating an apple (because I can’t stand bananas anymore), and I will feel the weight of your frail body sitting there with me, and I will reach out a hand to you from across the decade and lend you all of the strength I have built in the 80 extra pounds of muscle and fat and blood and bone and life I hold in this body you now occupy, and through our collective tears I will call you home again. I must leave home to stay alive, and I promise I will come back for you and through some time-warp magic I will reach back through the past and whisper courage to your palpitating heart, the courage you need to stay alive so you can grow into me and I can go back for you.

Your (my? our?) pager will go off while you write this, and you will go catch a baby and not come back to finish blogging for another week. What will remind you is a sunset that is so astonishing in its simple brilliance that it will move you to tears. You will stand in a spot a block away from where you now live, the fading light of day dropping down over the Olympics before you, and the way the sky makes a perfect silhouette of a sprig of Queen Anne’s Lace will flood your cheeks with saltwater because you are alive to see it.

You will be listening to “Turning Wake” by Ayla Nereo right then, and you will stand still with the cool evening breeze caressing your face as she croons,

I’ll be dancing’ with the ones who remind me
we are born of dust and silence
we are made of ancient songs
and there are ones who’ll keep us sleeping
and there are ones who bring the dawn
put your back to the birch and your mind to the matter of a
listening kind of way
we are born of dust and silence
we are made of ancient songs…

I will stare into the lens of my camera in that moment as if I could look through ten years of history and catch your eye.

I will gaze unblinkingly at the memory of your dying body as tears pour down my cheeks, and I will smile because (spoiler alert!) I know you made it out alive. You can’t know that now, and that is terrifying. Your body will indeed die one day, love, and you will return to the dust and silence you were born of. But not yet. This is not where your story ends.

 

I will stare back across a decade and hold you with limitless compassion, borne out of all of the precious life I’ve lived in the 3644 days between these two photographs. I will grieve with the embodied memory of what happens when I try to take up as little space as possible. You have no idea what you are capable of, how you will proceed to gleefully and unapologetically refuse to fit into anyone’s boxes, how in claiming your authentic wholeness and all the space that is yours to occupy you will create for yourself a life that you can thrive in.

I imagine myself with you in my lap. I would kiss the top of your head and stroke your bony cheek and tell you stories of the life you will live if you eat that banana. I would whisper in your ear the names of every single baby your hands will catch. I would sing you songs you have yet to learn and recite to you some of the poems you will write. You have to stay alive, love, because the world’s best cat has yet to be born, and yours are going to be his favorite shoulders to sit on.

Oh, my love, the tales I have to tell you of who you are becoming! You have so much life left to live. I wish I could tuck you in at night with stories of how brave you are, how resilient, how you will create a home and a life and a chosen family for yourself. It will be a long, tough rode; I won’t lie and tell you otherwise. Dozens of healthcare providers, well over a hundred appointments, several surgeries, and countless medications and treatments of a variety of kinds will be required to keep your body alive. You will do so much inner work, filling journal after journal with your thoughts and reflections. You will come face to face with your own shadow and welcome it. The journey of a lifetime is to integrate all that you have seen and done and experienced and been in the world, and I promise you that you have within you a seemingly endless well of courage that you will draw from again and again to show up and do the work.

Your beautiful queer self belongs in this world, Rob. Despite what you grew up hearing and what you still hear: there is a place for you at this table. You will discover, as you do the work of staying alive, just how much the world is in love with you. Oh, I wish you could take just a tiny glimpse into my bank of memories from the past decade! You have no idea what a ridiculous life I’ve built for you to come home to. I need you not to give up on living just yet, because there are full moons to admire and queer humans to kiss and mountains to hike up and songs to dance to and heart-shaped rocks to discover in all of the places you go. There are books to read and baths to take and poems to take your breath away. There is love to give and receive and make and fall into and fall out of and do it all over again. There is so much delicious food to eat (I promise that nourishing yourself won’t always be as hard and painful and scary as it is now). There is this incredible body that you get to inhabit, and as you put in one of your poems, “to live in this skin and come alive here.”

And so you will, dear one. You were born of dust and silence, and one day you will return to the same. But not yet. I came back for you. I came to bring you home with me, to carry you to a life you’ve made for yourself to thrive in. I left a heart-shaped stone behind so that you can find your way back to me. I’ll take care of you; I’ve learned how.

Come home with me.

All my love and magic,

Rob (roughly 5,247,360 minutes later)

Packing It All In

Yesterday (Monday) was Teresa’s and my first day to go out on the mobile clinic. We went to an area called Ceramon and set up our clinic in a building established on a concrete slab with corrugated metal roofing. It was quite an adventure to get there and back in the Land Rover! Due to several days of recent heavy rainfall, the roads were even less accessible than usual. Getting out of the town of Hinche was also an issue, as police were diverting traffic due to some sort of parade of schoolchildren through the streets. We ended up going down a back road that was barely wide enough for our “machine” (Creole for vehicle) and the crowds of people and their animals and motorcycles that were arriving for market. Driving is an art form in Haiti, and the horn is a well-utilized form of communication. Drivers use it to express anger or frustration at other drivers, as we do in the States, but it is also used whenever going around a corner or over a hill when the people/animals/vehicles that might be ahead would not be able to see you coming. People often drive in the middle of the road, including right down the middle of the “do not cross” line (when it happens to be painted on the road). Our driver quipped that if he didn’t have a horn, he would kill people every day! The horn is also used to claim the right of way (which seems to follow the same rules as I saw in Colombia, where the largest of the vehicles arriving gets the right of way, regardless of who arrived first; a Jeep will always claim the right to go before a motorcycle, for example).

So the roads were sloppy with mud, and the rains had carved deep channels and ruts in parts of the road out to our remote destination. It was a very bumpy drive, and I found myself turning a little green by the end. We had to snuggle up really close to some nearby trees to avoid the most treacherous spots on the road, and our driver would quickly warn us to close our windows so the tree branches wouldn’t reach inside and slap us in the face! (I still ended up with bits of leaves all over my backpack and clothing!) But we made it without getting stuck in a rut or a deep mud puddle.

It took a bit to set up the clinic from the suitcases of supplies we brought along. First was a song and a prayer in Creole, followed by an educational session led by one of the midwives. She asked everyone who had been there before to name the warning signs of pregnancy problems, and they remembered everything except decreased fetal movement. She then used a poster to teach them about nutrition. After that, charts were handed out to the 20 women who had been there before, and the 5 people who were there for their OB intake and physical exam got new charts established.

Teresa and I helped with vital signs at first, all of which took place on the outside porch, with the women sitting on benches. Vitals included temperature, respirations, BP, pulse, weight (which happened on an analog scale which we had a bit of trouble finding a level part of the concrete porch to place it on so we could get accurate readings), and one that is not part of my vitals in the States but is important here: upper arm circumference in centimeters, which is a good approximation of nutritional status. I helped mostly with taking weights, climbing down on the ground in front of the woman on the scale to read the number upside down and translate the reading from the red needle into a French number which I called out to my translator who wrote it in the patient’s chart. Our translators were a lot more involved in the clinic than they would be in the States–I even saw one of them (a young mom herself, with a 6-month-old son at home) helping a mother of a newborn position her baby to breastfeed.

After vitals, it was time for the prenatal exams, which happened inside the building. The exam table for speculum exams was a massage table covered in a sheet and a piece of plastic shower curtain (more for the muddy feet that would be planted on the corners of the table, because there were no stirrups, and less for an impermeable barrier underneath the women, because they all had their skirts underneath them; the sheet was not changed between exams). The midwife performing pelvic exams had a wonderful system of not contaminating the specula: She brought them in a plastic tub, all wrapped in a clean towel. She had a pair of ring forceps that she kept on the lid of the tub, and whenever she needed a speculum, she used the ring forceps to push back the towel and grab a clean speculum and cover up the others still in the bin. She collected the used specs (most of which were the pediatric size today, as we had a lot of teenage primips) on the lid of a bucket to be transferred later into a container to be taken home and sterilized.

The exams happened behind a curtain that separated the exam table from the outside, but there was no other curtain dividing the exam table from the side room where two other Haitian midwives plus Teresa took histories, gave out medications (folic acid, a prenatal vitamin, and iron tablets to every woman; anemia is endemic here), and Teresa did belly checks (Leopold’s for fetal position, fundal height, and fetal heart tones). So, the women getting speculum exams (covered with a lavender sheet as a drape) were having conversations with the women waiting in line to hear their baby’s heartbeat and to get their medications for the next month. Nobody seemed fazed by this, and indeed, for several of the girls this was their first pelvic exam and the others in the room helped to talk them through it, encouraging them to relax their legs, or laughing with them at what a strange feeling it was.

Somehow, squatting on my haunches in this small, dark cement building for over an hour, lit only by a headlamp and whatever sun streamed in through the windows, helping a midwife perform gonorrhea and chlamydia tests (with only a massage table and a rickety chair as exam furniture) was a better leg workout than I’ve had in recent memory. (My quads are speaking their mind this morning.) Far more rewarding, too! I learned how to perform the rapid GC/CT tests, which required separate swabs, tubes, test media, number of drops, number of times of swirling the swab in the test media, number of minutes to wait (if any) prior to adding the media to the cassette (which looked like the pregnancy tests we use at my office), and number of minutes to wait to read the results. I counted out the drops of test media and swirls of the swab in Creole (thank goodness I paid attention in French class over a decade ago–I still remember how to count!). It was interesting that the packets said “not for use in the United States”–I’m not sure why that is, except that we have a system of labs that can perform the tests for us, and that infrastructure does not exist in Haiti.

After all of the pregnant women and the three postpartum clients and their babies had been evaluated, we packed up our supplies back into their suitcases, tied them back onto the top of the Land Cruiser along with the benches the clients sat on while waiting, and started the bumpy journey back to our home base.

Today, bright and early, we got up to prepare for our separate morning and early afternoon projects. I was in the classroom with the 30 new midwifery students, and Teresa went to the hospital with a translator where she worked with a few people in labor, including people who were being induced preterm with pre-eclampsia.

My role in the class was to teach GTPAL, which is a system of categorizing pregnancy numbers and outcomes. The acronym in Creole is a little different, GPTPAV, standing for gravida (total number of pregnancies), para (number of births after 20 weeks), term (births at or after 37 weeks), preterm (births from 20-37 weeks), abortions/miscarriages (prior to 20 weeks), and number of living children (enfants vivants in French). The students, for the most part, listened carefully and one asked 95% of the questions in class. She tried to stump me with a great hypothetical question: if a woman was pregnant with twins, and she delivered the first twin at 11:59 p.m. on week 36+6, and then had the second twin 10 minutes later, at 37 weeks exactly, and a twin birth only counts as one in the “para” category (because it is one single pregnancy that is ending, and we are not counting the number of babies until the last category), then which slot do you put it into? Term or preterm? I heard this question explained to me through my fabulous interpreter, and I loved the question and its asker dearly. (The long answer I gave her is, it depends, and you get to use your clinical judgment, and thankfully situations like this don’t happen super often, and when you are interviewing a woman about her pregnancy and birth history, she might not know the exact number of weeks she was when she gave birth, and logically we know that ten minutes’ difference doesn’t make much of a difference in terms of whether a baby is term or preterm, so use your clinical judgment in whether the babies seem term or preterm if you have to decide.)

I also taught how to determine due date based on factors other than last menstrual period. I told them the story of my own birth, where my mom was breastfeeding my 6-month-old sister when she got pregnant with me, and had not had a period yet so had no LMP to go off of. Ultrasound dating was similarly not available, especially in rural Colombia. She had a scheduled repeat c-section (I told the students how I was born via surgery during a power outage in Bogota, and the surgeon continued by flashlight–blackouts are quite common here, and they all looked at each other in surprise that this white midwife would have a birth story that they could relate to!), and when the doctor pulled me out, he noted in my birth record that I looked to be about 36 weeks’ gestation. I weighed just a little over 2.5 kilos at birth (I was a tiny little peanut!). They loved this story and I think it helped to underscore how you need to use all of the available data to make the best estimate of due date possible, because otherwise you might cause problems further down the line.

Teresa has her own stories from her time in the hospital today (her close Doppler monitoring of a mom who was being induced for pre-eclampsia at 35+ weeks, and noticing that the baby was having late decels down to the 60s-80s after every contraction, and her insistence that the baby was not doing well, likely encouraged the staff to move towards a cesarean birth sooner than they otherwise would have, and may well have saved this baby’s life, if indeed the baby survived its birth–I will check on them tomorrow), and I will let her tell those in as much details as she desires to share.

After returning from the hospital, and after my class was over, we ate a quick lunch of rice and beans and vegetables, and then hopped onto a moto-taxi to spend a few hours at Azil, a feeding center for starving children and a hospice center run by the Sisters of Charity (Mother Teresa’s order). The nuns there wear the traditional white robe and head cover with blue stripes. Teresa and I found our way upstairs to a series of connected rooms on the second floor of the compound. About thirty or forty toddlers and young children sat in small plastic chairs against the walls in the hallway, having just eaten their 3:00 meal (likely protein porridge). There was a mixture of emaciated-appearing children and those who were extremely bloated with huge, round, firm bellies (indications of kwashiorkor, or protein calorie malnutrition). Some were so edematous that their eyes were almost swollen shut. The children were all sitting quietly and patiently in their chairs in the hallway, which is atypical behavior for children this age but common in institutionalized children. Most of these kids had families who had brought them here for care and feeding for a temporary period of time, and once they were well again, they would return home. The families are allowed to visit once per week on Mondays, and the children who are well enough return home on those days. This being Tuesday, new children were being brought in, and they were all lined up in chairs waiting for an examination by the doctor. Some of them had wild looks of confusion in their huge eyes.

We moved on into the room with the youngest babies and sickest children. About twenty old wire cribs filled the room in rows. Each crib was lined with a plastic square covered in a cloth the size of a pillowcase, for easy changing throughout the day when the babies wet through the cloth diapers most of them wore without plastic covers (though a few tiny babies were in huge disposable diapers many sizes too big), or when they had diarrhea and got their clothes and sheets dirty. Several of the babies had thick, chesty coughs. The nuns invited us to sit down in short chairs they pulled aside for us, and pointed towards the cribs encouraging us to pick up a baby to cuddle. We each scooped up a little one and sat down. The first baby Teresa held was somewhere between nine and 18 months old (difficult to guess because of the malnutrition), and she kept trying to nurse at Teresa’s breasts. She appeared blind with some cognitive and motor delays, and she was covered in burn scars. It was heartbreaking. I held several babies, and when one fell asleep, I would put her down and pick up another. I held a four-year-old girl named Marielil the longest. She was the size of a young toddler, and she reached up her rail-thin arms to me from her chair and begged to be held. When I cuddled her, she kept calling me “Mama, Papa,” and when it came time to put her down, she would not stop crying. Walking away from her in her crib, reaching out for me with tears running down her cheeks, nearly ripped my heart out of my chest. Teresa and I also both held a young infant who seemed to be less than a month old.

There was minimal stimulation in the room, and some serious attachment issues. A lot of the babies didn’t want to be touched or picked up when I offered, though one enjoyed playing games with me (copying facial expressions, and giggling hysterically when I told her my name in Creole–I guess she didn’t expect the blan to speak her language!) but refused to let me pick her up, and I didn’t push it.

There were no toys in the cribs, but there were a random assortment of toys and religious artifacts on the walls, including a shelf with a statue of the Virgin Mary beside one of those giant plastic baby bottles used to give baby shower favors in. Curious.

I am not sure how I will go to sleep tonight thinking of that little girl in her crib begging me to come back for her. I have so many feelings about the experience. Those babies are there because of poverty, malnutrition, disease, because of political corruption and historical occupation of their country, because of war and greed, because of everything that is at the root of all of the problems in the country. I know there are such babies in Seattle, as well. This is not an isolated problem. But to see about 80 babies and young children separated from their families for weeks to months at a time during critical periods in their development is just heartbreaking. And the problem is so much bigger than anything I could possibly to do fix it. So I go, and I bear witness, and I get dirty, and I snuggle the hell out of those babies, and I leave when I must, but I leave changed at a molecular level. I cannot unsee what I saw there. Some of those babies will die, and some will survive and return home to families who cannot feed them food that helps their minds and bodies grow, and the cycle may repeat itself.

I had such a strong sense of being in a place when Teresa and I were on the motorcycle on our way to Azil. I saw the beautiful landscape in front of me, felt the breeze on my face, held tightly to the waist of the moto driver and felt Teresa holding tightly to me, saw the people and the goats and pigs and chickens wandering the streets, felt every bump as we drove over it, and noticed the warmth of the sun causing hot beads of sweat to trickle down my back. I was so very present, so very HERE. It is a moment captured in my memory that I plan to return to again and again.

So much of what is here is not up to me to change. I had another profound moment in the classroom this morning, sweating bullets in front of the class. I realized in a deep way that I was here for them, for the students who will become midwives and will scatter throughout their country and do more good here than I could ever hope to do. I am here to support this program, whose mission is to make more midwives for Haiti. I will go back home in 12 days, and I will continue this mission long after I return to my own practice with my own patients in my own hospital where I do not have to bring whatever equipment I need for that day.

Tomorrow, though, I will spend my first day at the hospital. Anything I plan to want to use, I need to bring. I packed a backpack and a fanny pack full of supplies. I am impressed with how much I could fit into a medium-sized fanny pack! From memory, I know I had the following in there:

  • A doppler
  • Doppler gel
  • Several pairs of sterile gloves
  • Sterile lube in packets
  • A blood pressure cuff
  • A stethoscope
  • A full-sized bottle of Purell (as water for handwashing is unpredictable)
  • Misoprostol tablets in a ziplock baggie in case of hemorrhage
  • A bottle of lidocaine
  • Suture packets
  • Gauze
  • A couple of needles and syringes
  • Tubes of erythromycin eye ointment
  • A cord clamp
  • A watch
  • Alcohol swabs
  • Three drapes to go under women for deliveries (cut from unused delivery gowns)
  • A gestational wheel
  • A tape measure
  • Some cash (a $5 and a few $1s)

All of this fit into my fanny pack! In addition, in my backpack, I have some blankets, a breast pump I assembled yesterday from random pieces of donated pump parts (to take to the woman who delivered preterm by cesarean section today), a box of gloves, and a number of other supplies.

I am nervous, because I don’t know what I will face or if I will know what to do. But I believe in myself, in my skills, in my knowledge, in my ability to stay present in intense situations. I know that much of what I will encounter will be outside of my control. But what I can offer, I will give wholeheartedly.

I feel like that list of items in a small bag is a metaphor for how this trip is “packing it all in.” I am cramming so many different experiences into such a short period of time, wedging them down, to be lived now and accessed later as memories that will serve me for a lifetime.

I have no photos to share today; it seemed most respectful to the children and the nuns not to document our presence there, and photos are not allowed in the hospital compound. But my heart is full of images that it will never forget, and hopefully I have transmitted some of them to you. They say a picture is worth a thousand words, so hopefully these 3500 or so words will give you a few pictures’ worth. 

If not, you might just have to come here and see it for yourself.

She Said Yes

I am leaving for Haiti in a week.

Holy moly, it’s happening. I’m going, along with my love, to a new place. We will be serving the cause of promoting maternal and child health in whatever ways they need us. We will undoubtedly come back different people.

I wish the Robin that I was five years ago could know that this would happen. That person, who had yet to begin midwifery school, had no idea what she was capable of. She was filled with fear, yet her courage was potent and fierce. She wanted to see if it was possible, this journey out of herself and into the world. She had, for such a long time, been containing her life inside the boundaries of what felt safe, because safety had been an elusive concept. She built firm walls around everything, and as long as each facet of her existence was controlled, the panic remained at bay.

But there was, deep inside of her, an undeniable voice that called her to bigger things. She began dreaming of catching babies, as her grandmother had done when she was alive. She had a huge road ahead of her to tackle both physical and mental roadblocks that easily could have kept her from pursuing the intensive program of study that her dream required to become a reality.

And she said yes.

She carved that “yes” onto her wrist in black ink and dove headfirst into the work of finding herself. She left the only home she knew. She took the risk of claiming her authentic selfhood, even though it cost her relationships with friends and family. She married her first love, and ultimately allowed space for her heart to be broken so they could both be more whole. One by one, she stared down her debilitating anxieties, reclaiming ownership over her life a single deep breath at a time. She left home again, moving to a city where she knew no one, to live alone and become what she dreamed of being.

She felt the sharp terror of utter groundlessness and made her way through it. She survived cold, lonely nights in a too-big bed. She learned how to be alone with herself, and little by little, she fell in love with her life. She realized that she was strong and she was capable of taking good care of herself as well as caring for the people she served.

She learned how to stay present when everything inside of her wanted to run away. She realized that she was capable of having challenging conversations and holding space for people who are in the most intense moments of their lives. She learned how to stare into the abyss and not back away.

She opened her heart and found herself falling in love with everything. Delight swept through her days, even in moments that were overshadowed by tragedy.

Her open heart one day found another person to love, and she continued in the work and the joy of sharing her life with a partner. She found herself living in a home full of animals and books and half-completed craft projects and gluten-free snacks. She remembered, little by little, that wholeness is always worth pursuing, even if the cost is high.

She and her partner talked about traveling. They both had wanted to volunteer as midwives in an international setting. Everything came together, in time, and they found themselves packing for a trip that would take them 3,419 miles from the home they were building together. Neither knew what to expect, exactly, and both were simultaneously excited and nervous. They felt the support of countless friends and loved ones, and they listened to the undeniable calling that brought them to the work that lay before them. They waded through the piles of supplies in their living room for weeks, packing and attempting to prepare for the unknown.

They are ready, and not ready. They are ready enough.

 

I haven’t written much for the past few months. I have been doing a lot more internal work and a lot less writing, and to be honest, I have been exhausted from the long hours I have been putting in at my clinic and on call. Internal shifts are happening, and I am excited and grateful to be back here in my virtual writing space.

 

To the Robin who always wanted to do what I am about to do but never thought it would be possible because there was so much she was afraid of, I say this:

You’re going to do it. All of it.

You’re going to find your way through the anxiety that currently paralyzes you. You will do things that sound impossible to you right now. One day, you will wake up and realize that you are no longer living in fear. The work you invest in healing yourself will come back to help you be healing to the wounds that exist in the world around you.

You will take on the risk of facing the things that most terrified you, because the thought of not doing what your life asks of you is scarier than your other fears coming true.

You will realize that being authentically yourself in a world that wants you to fit into a not-you-shaped-box is worth risking everything. You will risk everything, and you will lose some of it. But what you will gain is worth it. I promise.

Thank you for being willing to do that hard work that brought me here. Thank you for the hours you spent writing in your journal, processing your history, breathing through tough emotions, dealing with the intensity that held you captive. Thank you for doing that work so I can be here doing this work that I love so much.

I write a lot less now, but I live a lot more.

Your hands that once spent so many hours holding your pen and journal now spend their days welcoming new souls into the world. They put on gloves and insert IUDs and hold the hands of tiny babies and wipe the sweaty brows of people in labor. They help newborns latch on to breastfeed. They do what you always dreamed they would do.

You will feel sad about the limited time and energy you have for writing, but know this: You are still a writer. And you will write. You are currently collecting the stories that will fill the pages of your books in the future. Live the hell out of your life as it is in this moment. Be here now. Soak it all up. Write when you can.

Know that you are making a difference in the world. Know that your claiming your inherent wholeness gives permission for others to do the same. Dream your big dreams, and chase them down. Make them come true. Know that you are deeply, truly loved.

So go to Haiti. Go with an open heart and hands willing to work. Learn from everyone. Let this journey open you, break you if need be, and rekindle in you a passion to leave the world better than you found it.

Then take that passion and run with it. See where else your journey takes you.

All my love,

Robin

Enough (A Year in Review)

It is hard for me to believe, but I have finished (survived!) my first year of practice as a nurse-midwife. In school, everyone told me that the first year is intense, and I expected that, but I had no idea just how much I would learn and grow and more fully become the midwife that I am.

I have caught 80+ babies born vaginally in the past 12 months, and assisted on 40+ c-sections (some scheduled, some urgent, some emergent), and managed dozens of other labors, and seen goodness-knows-how many patients in triage (for everything from UTI and pyelonephritis, to appendicitis/abdominal pain/gallstones/nausea/vomiting/dehydration, to pre-eclampsia, to threatened preterm labor and actual preterm labor, to vaginal bleeding in pregnancy [from abruption or previa or having had sex the night before], to possible ruptured membranes, to vaginal discharge [pick your favorite reason for it, and I’ve seen it in triage!]).

I’ve had 1500+ individual patient encounters in the past year. Each time, that involves me reading through a patient’s chart, coming up with an idea what’s going on, making a plan in my head of what I might do, knocking on the door to the clinic room the patient is in, introducing myself (if we don’t already know each other) and my role as a midwife, asking about their health and any concerns they have, going through their medical history, allergies, current problems, medications, smoking status, sexual history, screening for warning signs, performing a physical exam, prescribing medications, discussing the plan with the patient, washing my hands, and going back to my desk to chart on everything I just did. Often I do all of this in 15-30 minutes or less, 15-25+ times per day. Holy moly, is that exhausting!

I have all of these incredible stories that I have collected inside my head over the past year. An aggregate of the specific issues I managed or helped to manage does not begin to delve into the full intensity of connecting with each individual and their loved ones during each of these events, but sometimes it is the best I can do here on my blog when I am so done after telling a patient’s story in their chart that I don’t have the creative energy left over to extract its essence in a form in which I can share it publicly without compromising my patient’s privacy.

Also, it’s been quite a year for me personally. I moved to a new city for a job, not terribly far away from my friends in Seattle but far enough that commuting back after work just never happened. I started that job, and fell in love with my work. I met an amazing person who became my partner, and we just recently moved in together, in an epic process of combining all of our stuff and our excessive quantity of animals into a single living space. Which necessitated another move, back to Seattle. Less than a month in our new home, and we had a break-in, in which a lot was stolen and my sense of safety was shaken. I developed a fistula and had surgery for it, and I was in the most pain I’ve ever felt in my life (which is saying something!). I am working on healing from that, still, and am reconnecting with myself and my body in very profound and important ways.

As a midwife, in the past year, I have gotten a rich variety of exposure to almost every condition I could imagine. (I say that now, and just watch–next week, something entirely new will show up on my schedule!) I have had the immense privilege of being present with people during incredible transition periods in their lives, as well as caring for them during the normal times.

I have sat with dozens of women as they labored to bring their babies into the world. I’ve held their hands, wiped their brows, held their puke bags, supported their perineums, welcomed their babies, delivered their placentas, sutured their lacerations, congratulated their families, and went to bed a tired and happy midwife.

I have slow-danced through contractions with tired mamas eager to meet their little ones, their babies in utero kicking me as we swayed.

I have caught babies coming at me from all sort of pushing positions: squatting, supine, side-lying, and hands and knees.

I’ve supported the use of hydrotherapy, birth balls, peanut balls, and birth stools in a hospital system, not to mention skin-to-skin, intermittent fetal monitoring, and early initiation of breastfeeding.

I have assisted surgeons in dozens of cesarean births and a few other surgical cases. I feel it is my job to make the OR feel a little less cold, more comforting. These hands of mine have touched skin, subcutaneous tissue, fascia, muscle, peritoneum, and organs. I have suctioned blood to keep the surgical field clear. My strength, from the outside, has pushed these babies out of their mothers’ bodies. I have gripped their now-empty uteruses, massaging them firm to minimize blood loss, then holding them in their outside-the-body position so they can be sutured closed. I have helped suture and staple bodies shut after surgery. I have assisted in tying Fallopian tubes when the time for baby-having is over. My feet feel grounded in the OR, and I consciously breathe in the antiseptic air, grateful that I can play this role, though surgery is not at all why I went into midwifery. (I really like the low risk, normal patients!)

I have seen hundreds of people in clinic for routine annual exams, and I feel the weight of holding their health in my hands. I have assessed their health risks, asked about their sexual well-being, screened for domestic violence, examined their breasts for masses, Papped their cervixes, and palpated their pelvic organs. I listened to their fears about their health and helped promote their well-being in as holistic a way as I can, recognizing that wellness neither begins nor ends exclusively in the body but involves the entire person (mind/body/spirit) embedded in their sociocultural framework. Individual wellness cannot be separated from social justice.

I have performed hundreds of vaginal exams, and I have gotten consent every.single.time. No exceptions.

Three sets of twins gave me the honor of helping to welcome them.

I caught two babies born in the caul. Lucky little kiddos, those ones.

Fetal heart tones in the twenties is without a doubt one of the worst sounds I can recall.

I have seen what happens to fetal heart tones when the placenta halfway detaches from the uterine wall during labor and blood flow to the baby drops drastically. Can I just say…YUCK!

Numerous women with scars on their uteruses victoriously pushed their babies out into my hands.

I know what a true crash c-section looks like, and what it means when every second counts. I have shed happy tears when a baby we were very worried about came out screaming and peed all over me.

I have witnessed a severely hypertensive woman’s mental status change just before she began seizing from eclampsia, and I rushed to help the team save her life and that of her baby.

I have seen many women before, during, and after their miscarriages. I have held a tiny pregnancy sac in my hands, and have gently extracted retained placental tissue that was causing bleeding after an incomplete miscarriage. I have sat with devastated clients who lost much-desired pregnancies, as well as with confused or relieved clients, or people feeling many things at once. Loss is complex, and heart-wrenching, and it evolves on its own timeline. Early pregnancy loss is very common, and despite the fact that I know my clients will very likely be able to have a healthy pregnancy in the future, I can sit with them in the intensity of losing this unique and irreplaceable pregnancy and hold space around that with them. And I do, usually at least once or twice per week.

I’ve worked with folks who wanted to be pregnant and were not. I’ve worked with folks who were pregnant and did not want to be. I worked with folks who were not pregnant and wanted to stay that way. And I worked with folks who were pregnant and were delighted about it. My job was to support all of them, and provide them the highest quality reproductive health care possible, regardless of which category they fell into. I’ve helped folks prevent pregnancy as well as plan for it as well as navigate the ins and outs of it once they had a positive test. And I feel honored every time.

I have seen placentas do all kinds of normal and funky things, from velamentous insertions to true knots in umbilical cords, to retained placentas requiring surgery or manual removal, to bits of membrane left behind causing too much bleeding, to cords avulsing (snapping off). I have a profound respect for this phenomenal creature, the only organ in our bodies that was intended to be truly temporary!

I’ve felt the presence of my midwife grandmother standing in the corner when a baby came out with terrible APGAR scores and I found myself running my first neonatal code blue.

I have inserted dozens of long-acting reversible contraceptives for people who want a highly-effective form of birth control for now and still to reserve the option of future fertility. The flip side of that is that I have counseled numerous women on contraception and have had quite a few come in to me for prenatal care a few months after I gave them birth control pills, but none of my patients (so far) have gotten pregnant with IUDs or Nexplanon. I am passionate about educating everyone that comes to me about effective contraception!

A young woman came in laboring only to discover that her baby was no longer alive. She still had to do the arduous work of giving birth, compounded by the enormity of grief. She pushed her stillborn baby into my hands, hands which had never touched a dead body until that moment. I came to visit her the next morning and she asked me to hold her baby, who had been in the room with her all night. I cradled the infant in my arms, marveling at the tremendous beauty of this child and at the utter wrongness of babies and death coexisting.

I have worked with numerous sexual abuse survivors in the clinic and in labor, and I do my best to ground myself first (knowing that with my own rather extensive sexual trauma history, I could get triggered and need to focus on good self-care) and then to be as aware of the special needs of this population as I can. I am able to show up and hold space for someone who comes to me in clinic for STI testing shortly after an assault, or to help give control back to someone in labor who feels out of control of her body. I feel very proud of this work that I do.

I have helped folks in abusive domestic relationships find resources to help them with whichever stage of the process they are at, whether they need a safe place to stay immediately, or a listening ear to talk about previous abuse.

I have learned that cancer is a hard thing to tell someone that they have. It doesn’t matter whether it is in their breast, their cervix, their uterus, their ovaries, or their vulva–saying, “The tests came back positive for cancer” never gets easier.

I have seen what an entire blood volume looks like on the outside of someone’s body. I would like to never see that again, but I know that my career will (hopefully!) span another few decades, and any number of things can happen in this time. Including postpartum hemorrhages.

I have seen almost every STI that exists, most within my first month of practice. I have encountered people with syphilis, gonorrhea, chlamydia (so much chlamydia!), herpes, trichomonas (so squirmy under the microscope!), hepatitis B and C, HIV, HPV, scabies, and molluscum contagiosum. I have treated pelvic inflammatory disease, cervicitis, vulvar abscesses, and more.

Oh, and BV and yeast–pretty much every day.

I have watched a strong young woman push out a gorgeous baby into my hands and then placed in the hands of the adoptive mother, who had dreamed of this moment for years. I have cried with both of them and sat in the midst of such intensity.

I have had to step aside from work for weeks, focusing my attention on my own body and my own healing. I have endured the most excruciating pain I have ever known, and have marveled at my body and its ability to heal. I have had to put on hospital gowns and identification bracelets and be a patient in my own hospital system. I’ve been wheeled down the hall into an operating room and given permission to someone else to cut me open so that I could work on putting myself back together. Healing is still a work in progress, always in progress, with ups and downs, but I am so grateful to be precisely where I am.

I am coming to understand in a deeper way that I need to clearly define where I end and where my patients begin. I am so empathetic that I can too easily take on someone else’s experience, especially when it resonates with mine, but this is exhausting for me. I am learning how to draw invisible lines around myself and say, “This is my body. This is her body. This experience is happening to her and not to me,” and this saves me a tremendous amount of emotional and physical energy.

These hands of mine routinely are the first contact a new person makes with the outside world. I have the privilege of, in the words of my friend Simon (who wrote an amazing poem on his becoming a midwife), “touching people inside people and calling them out.”

I have been a little hard on myself for not blogging more often like I did when I was in school. Then, last week, during a call with my amazing life coach, I had a moment of realizing that maybe being exactly where I am is just fine. Maybe just going to work, doing a great job caring for my patients, and coming home to my partner is enough. Maybe I don’t have to have extra creative energy right now. Maybe it is okay for it to feel different as a provider than it did as a student. Maybe I can be flexible and compassionate with myself in this time of transition, just as I was before I became a midwife. Maybe all that I’ve done over the past year, collecting these stories in my mind and body (if not very often on my blog), is sufficient for now. Maybe I am enough, exactly as I am now.

Another Day of Loving

“Wake at dawn with a winged heart and give thanks for another day of loving.”

–Kahlil Gibran

This blog has been an incredible outlet for me over the past three years. I have turned to this virtual space time and again to chronicle my personal and professional journey towards becoming more and more myself. I have written my way through a cross-country move, an intense immersion program for nursing and nurse-midwifery school, a broken/mending heart, a drawn-out job search, a local move, and the beginnings of a new career as a midwife.

As my life is changing, so to is the way in which I approach this space. I continue to be vigilant, as always, of protecting the privacy of the stories entrusted to me by my clients by compiling them into stories that are true to the spirit of what I have experienced while still maintaining my patients’ anonymity. My goal has been to document my life and reflect on the process of becoming a midwife in a mindful and compassionate way. I believe I have achieved this goal, and I am proud of the insights that have poured forth into these posts.

I have never been shy about documenting my adventures, and as I begin a new chapter in my personal life, I have the desire to explore that experience here as well. So, on that note, I am excited to share that the Mindful Midwife is in love. With another mindful midwife, no less!

The experience of mindfully falling in love has been unlike anything I’ve ever done before, and at the same time it is the natural progression of all of the work I have been doing over the past few years. It is simultaneously intense and gentle, and the depth of connection I feel with this amazing person in a relatively short period of time has caught me by surprise. We keep showing up for each other on a soul level and doing the hard and beautiful work of being our authentic selves in the presence of another.

I feel so overwhelmingly grateful and blessed to be here now. I love that I have a job that calls me out of bed at 3 in the morning to hear an owl’s haunting call from the top of a towering pine as I walk through the fog towards my car so that I can welcome a new life into the world. I love that I get to spend my days doing work that feeds my soul as well as my belly. I love that my work helps improve the lives and wellness of people in my community. I love knowing that my life is making a difference to others. I love my community. And now, I love having a person to share that love with.

My heart is full and brimming over. My life is magical, even on the long days after long nights of little sleep and many babies and pregnancy complications. Even after helping someone through urgent/emergent surgery for fill-in-the-blank reason (hemorrhage from placenta previa, non-reassuring fetal heart tones, fetal malpresentation in labor, arrest of dilation or descent in labor…). Even when the babies don’t do well after birth and my heart breaks open over and over again. Even when much-desired pregnancies end without a baby to hold onto and it is my job to hold the space around the lack of answers. Even when partners cheat and unsuspecting lovers contract sexually transmitted infections as a result and come to me with their grief as well as their need for treatment. Even when Pap smears or mammograms or blood tests are abnormal in potentially life-changing or life-ending ways. Much of my work is joyful, but even in the parts that can threaten to sink me in intensity for a while, I still end my days crawling under my covers flooded with gratitude that I get to be here, living this one wild and precious life. I love my work as a midwife, and learning to love it mindfully has been a tremendous journey.

Exploring mindful love in a romantic relationship has been similarly wonderful. We are both showing up as two whole people, vulnerable and honest and willing to be raw and authentic and unpretentious. We are here, doing the work, breathing into the emotions that arise, the intensity, the challenge of being real when much of what we see modeled are relationships that are founded on pretense and hiding our gorgeous true selves behind masks of propriety in order to make ourselves appear more acceptable. I feel seen and heard and understood and deeply cared for in my raw, imperfect wholeness.

I am aware that opening myself up to love also puts me at risk for loss, for disappointment, for sorrow. But I am willing to take the chance that my heart might be broken in order to experience a life lived as wide awake and full of joy as possible. Let my heart break open. Let my love bleed out all over this world in need of compassion and healing.

I’ve got more where that came from.

The End of the Light You Know

Tomorrow is my first day of orientation in my new job as a midwife. I can hardly believe that this thing that I have dreamed about and worked towards for so long is actually happening. Part of me is confident in my ability to do what needs to be done, is feeling ready to start. Another (small but definitely present) part keeps popping thoughts into my head like, “Nope, not ready!” and “Maybe I just won’t show up tomorrow.” and “Is it too late to change my mind?” (The answer to that last question is yes, unless I find some other way to fulfill my calling in the world–and pay back my student loans from nurse-midwifery school!)

I feel a bit like a person in labor, when they reach the place where it is time to really dig in and push that baby out, and they want to go back, to get out of it somehow. I’ve heard people state all kinds of things, from “I don’t want to have this baby anymore,” to “Can I take a week off and come back to it?” to “I’m going home!” to “I’m done! Make it stop!” to “I’m not ready!” A huge, irreversible change is happening, and it is hard to ever feel fully prepared for it.

But there is no going back, only forward.

I wonder what my grandmother was feeling the night before she left for Colombia for the first time. She was on her way to an unknown place to do work as a nurse and midwife that she was new at and probably wasn’t sure how it would play out, but one thing was sure: her calling. She and my grandpa felt in their hearts that this was their lives’ work, and they followed that certainty to all of the places it led them.

I have known for years that I wanted to spend my life doing this work. I have been fascinated by women’s bodies and birth and breastfeeding and reproductive health for as long as I can remember. Ever since my eldest nephew was born (his was the first birth I attended), I have been sure that I needed to be involved in birth. My path took me from doula work to childbirth education to lactation consulting to nursing school to midwifery school, with several important detours along the way, but the endpoint was always here.

I am here.

Now that I’m here, I don’t quite know what is next. Settling into my role as a midwife will take a while, for sure. I don’t need to go looking for more things to do just yet! It just feels unsettling to have reached the end of what I was planning for. This was it. I didn’t do too much thinking beyond becoming a midwife and getting a job… that was enough to focus on! But now, as I live my way into this new aspect of my identity, I need to figure out where my passion is calling me.

I am nervous, and excited, and relieved to be starting. I am a bit sad that my time as a student is truly over. I am worried that I won’t be good enough. I am trying to tease out my feelings from my recent ravenous hunger for chocolate and address each one separately rather than eating them both.

The truth is, I know what I am doing. I am so ready! I was at the top of my class all through school. I graduated with excellent grades. I passed my boards. I have so much relevant experience. I’ve been reading about birth and learning everything I can for a long time before I started school. I’ve got this. I just need to be patient with myself, and gentle with the voices that worry I’m inadequate. Those worries have been there, as a subtle theme in the background, since I was a child. The specific content of their anxiety has varied over time, but it always revolves around feeling a little bit like an imposter: If people really knew me, they would change their mind about me. I don’t deserve this. I’m not good enough.

But now I’m pulling back the curtain and letting some sunlight into that dark little corner of my psyche. Better yet, I’m opening a window and letting some fresh air in, too. I see the scared little person in that corner who doesn’t feel good enough, and with patience and compassion for that part of myself, I invite her out into the light. I sit down on the floor next to her and gently scoop her up into my lap. She is skittish, like a cat that has been spooked, but as I tell her the truth about herself over and over, she settles in.

I grew up hearing repeated messages about my unworthiness. As a closeted queer person in a very religious environment, I felt like an outsider, and was terrified that people would find out who I was and reject me. Throughout my coming out process, I have experienced a fair bit of rejection from close friends, family members, new acquaintances, and random other people. It is painful still, though not nearly as suffocating as living in the closet. I learned to believe in my own worthiness, to see my goodness and treat myself with kindness and love rather than internalizing the oppressive sentiments I heard about myself and other queer folks.

But part of that sense of unworthiness still lingers. I still occasionally question my place at the table. And when I do, if I can’t manage to talk myself into believing in my own goodness, I have dozens of friends who will tell me. This evening, as I was working on the continual process of unpacking all of my stuff and settling into my new apartment, I came across a card that a doula friend from LA wrote to me as I was leaving there to move to Seattle for midwifery school. In it, she emphasized her belief in me and brought up the quote by Edward Teller that says:

“When you come to the end of all the light you know, and it’s time to step into the darkness of the unknown, faith is knowing that one of two things shall happen: Either you will be given something solid to stand on or you will be taught to fly.”

I think I’m at the end of my visible light. I don’t know whether to expect solid ground beneath my feet, or if I will stretch out my Robin-bird wings and learn what they’re good for. But I’m ready. I have been preparing for this day for over a decade. Midwifery is in my DNA. I will get some rest, and then I will show up tomorrow and start getting oriented to my new role. I know that a lot is changing in my life at the moment (moving, starting a new job), and I choose to be gentle with myself during this time of transition.

I know what I’m doing. When I am not stressed about it, the knowledge and skills are there. I was recently at a friend’s house for dinner, and a couple or people were there who were considering having a baby. They had all kinds of questions for me, and the answers came naturally. I may not have every single lab value committed to memory or know (yet!) how everything functions in this particular practice and what its particular norms and standards are, but when it comes down to showing up for the people who are trusting me to provide them with healthcare services, I know exactly what I’m doing.

And in 8 days, I will start catching babies again! It has been nine months since I last caught a baby (aside from my friend’s birth in January), and I am so excited!

The Risk It Took to Blossom

There came a time when the risk to remain tight in the bud was more painful than the risk it took to blossom.

–Anaïs Nin

Everywhere around me, I see trees and bushes and flowers taking risks. They have lain dormant throughout a long winter season, and now they are waking up, stretching against the bounds of possibility in order to come back to life and put on a glorious show doing so.

Many times over the course of my life so far, I have felt like these flowers. I have wrestled with buds that were too small to contain me, finally bursting out into life.

The first time I remember not fitting into my skin was when the boundary of my body was trespassed when I was nine. I wondered at the time if I would ever be able to live there again. I kept the story locked away inside the shell of my psyche, telling no one, and not even permitting myself to return to it. This kind of a disembodied existence is not sustainable long-term. Eventually, something will crack, and broken shards of the story will crop up in every area of a life until the commitment is made to go on a journey and gather up all of the broken pieces.

Mayda del Valle, a spoken word artist, gave a breathtaking presentation called “A Faith Like Yours” at the White House a few years ago. In it, she wrote about her grandmother:

some say faith is for the weak or small minded
but I search for your faith everywhere
need it to reassemble myself whole from these shards
of Chicago ice and island breezes
so I can rewrite the songs of your silence and pain

wish you could have shown me its shape
but I know it’s in every sacred breath
in the shadow of trees that you visit me in
and the flicker of flames I stare into, searching for what’s divine
and I know my body is the instrument my maker uses
to rearrange the broken chords of your history
into a new symphony for my unborn children’s feet to dance to
and I see you, Grandmother, gathering with your sisters
to chant the names of the living and the dead

we have always raised our hands to the sky
to touch the invisible force that holds these cells together
into a fragile mass
children of different nations but the same vibration
we be sound, to beat, to bass, to bone, to flesh
we are all truly miraculous

I resonate with so much of Mayda’s poem. Ever since beginning my pursuit of a career as a midwife, I have searched for my grandmother everywhere, needing her story to “reassemble myself whole” from a childhood spent barefoot in Colombian jungles and a rather tortured adolescence in an environment that systematically devalued me as a queer person. Unhealed trauma was superimposed on unhealthy family dynamics and extreme guilt and shame about my entire essence.

I tried to change myself. I tried so hard. I prayed over and over and over again that God would make me straight so I could live the life that was expected of me. I wanted more than anything to fit in. I stuffed my feelings down with food and drastically gained and lost hundreds of pounds in short periods of time. I sought out conversion therapy to help me change my sexual orientation. This was ineffective at best and harmful to me at worst. I underwent multiple exorcisms in an attempt to help rid me of the “gay demons” that were obviously at the root of the evil that resided in my soul. Except that nothing changed afterwards, which left me with the deep sense that I was evil down to my core.

Coming out was an enormous, painful breaking open. I was terrified that I would no longer be welcome in my family’s home (which turned out not to be the case, but I had no way of knowing this ahead of time, and I had known several people who had been kicked out of their parents’ houses because of their sexual orientation or gender identity, so this felt like a very real concern). I finally told my parents halfway through my senior year of college.

While exceedingly painful, this has been one of the most liberating journeys of my life. I went from being told by a pastor of the church I was attending at the time that I was banned from taking communion because “there is no place at the table for people like you” to, ten years later, taking communion at the ceremony welcoming the first out lesbian bishop into the Episcopal church. Hearing Reverend Mary Glasspool standing there at the altar with a loaf of bread in her hands saying, “This is my body, broken for you,” was a lightning bolt of healing that I will never forget. I felt like she was speaking directly to me and my broken body. She was extending an invitation for me not to isolate myself from my own soul any longer. She, in essence, pulled out a chair and offered me a place at the same table from which I had been unfairly denied spiritual food a decade earlier.

Again, in college, sexual violence broke my world open. I felt like I was a walking crime scene, and every time I connected with my body I remembered how exquisitely vulnerable a thing it is to be alive in such a breakable vessel. Living my way back from that experience was challenging but life-affirming as well. I had no idea if I would ever feel safe again, but I clung tenaciously to this belief that I could make it better, that with courage and willingness to go to the places that scared me, feeling all the fear and doing it anyway, I could drain the emotional charge from my traumas and find a new way of living that embraced the whole of my story.

Rilke said, “Let everything happen to you, beauty and terror. Just keep going. No feeling is final.” I have taken these words to heart in my life. I repeated them to myself several times today when I had a bit of a meltdown about all of the changes happening in my world. The panicked voice in my head insisted, “I’m not ready!” I wanted to curl up tightly inside the bud of my life as it is in this moment. I know I can do this. I am used to everything as it is now. I know my job and love my colleagues and am familiar with my current apartment and my neighborhood. I know how to do this. I don’t want everything to change!

But I do. What is normal and comfortable for me now was, not too long ago, terrifying and new and its own bud bursting open. I had no idea how I was going to get through midwifery school and live my way through my divorce with as much wholeness and dignity and grace as I could muster. It felt impossible at times. But I did it, and I made a life for myself that I love living.

I did it then, and I will do it again in a new place. Starting this week, I will turn the key of my new apartment for the first time and walk away from this place that has been home to me. First, I will be attending the Ending Violence Against Women International conference this Monday through Thursday here in Seattle. After taking my two-week training recently to become a sexual assault nurse examiner in addition to my main job as a nurse-midwife, I am excited to network with other professionals from various fields and make connections and learn more about how I can support trauma survivors in my work. A decade ago, I was the survivor in need of support. I am so grateful that I listened to the call of my life, that I allowed my buds to burst open, that such glorious beauty awaited me on the other side of the pain and and anxiety and hard work. Not dissimilar to labor, that. So very worth it all in the end.

Moving

I haven’t been writing much lately, for a multitude of reasons. My days have been filled with preparing to leave one home and establish another, as well as with work as a lactation consultant and with a two-week online training to become a sexual assault nurse examiner. I have been taking a lot in, and have had little energy at the end of the day to reflect on the content of my life as it is at the moment and put those thoughts into words.

The SANE training (taken from this program) both put a lot of information into my head and took a fair bit out of me emotionally. For the most part, I found myself very well able to cope with the content. There was only one really hard day in which we spent 8 hours looking at graphic images of anogenital injuries in adults, adolescents, and children (all the way down to infants). This is the worst of the worst of the worst (seriously, what level of awfulness has a person experienced in their own past that would cause them to rape a baby?!?), including some postmortem images. It was heart-wrenching, not because it re-triggered my own trauma history (surprisingly, it didn’t too much) but because I know how much work it takes to come back from something like that. It isn’t just that that is one of the worst days of a person’s life; violence fundamentally changes the way that you see the world and people in it. It alienates you from your own body. It leaves you with broken pieces of your life that need time and space and support and healing to reassemble.

Going into this new line of work, I don’t have any illusions of saving my patients from the horrors they are experiencing. I cannot rescue them. But I can go to the places they are and provide them with dignity, care, compassion, safety, and hope. I am flooded with awe and gratitude that my journey has turned me into the person I needed to have there with me when I was assaulted. I have become, in many ways, my own sexual assault nurse examiner. I know how much of a difference your care providers can make (for better or for much worse) during this awful time. To have someone believe you, listen to as much of your story as you care to tell, treat your medical and emotional concerns as well as collect evidence that could help if the case goes to trial, and empower you to make decisions all along the way about what you do or do not want done to your body: this is important.

One of the things I learned in this training that most resonated with me was the concept of “disastrous response.” The idea (and research supports this) is that the way the first people who you interact with after an assault respond to you can have huge long-term impacts on how your trauma unfolds, for positive and for negative. The severity of the assault is not as strong a predictor for long-term problems afterwards as the quality of the response you get when you tell. Having people blame you, judge you, treat you in an undignified manner, threaten or frighten you, and/or not take you seriously can cause huge problems later on.

I want to be one of the people who believes my patients, who gives them control back, who reconnects people with the land of the living. I cannot save them from what they are going through, but I can sit there with them in it for the time we are together and I can offer them hope in the midst of it all that it will not always feel like this. It is unspeakably awful, but not forever.

There are some things I wish I could tell myself 10 years ago about the aftermath, the early healing period:

  • You need support people. Collect as many as you can find. Talk to them. Get your story out of you. You’ll be surprised who will listen.
  • Get out of bed. Every day. Put on clothes. Go through the motions. Do what needs to be done, even if you don’t feel like it right now, even if that is the last thing you want to do. Inertia only makes it worse. Push through it.
  • Reconnect with yourself and your dreams. Set a big goal, and take baby steps towards it, even if it seems impossible now. You will amaze yourself with your own courage.
  • Get a dog. Or a cat. Or several of each. Let the creatures heal you.
  • Drink tea. Take hot baths. Walk around in nature. Breathe.
  • Create something every day, no matter what it is. Color with crayons. Make crafts. Paint. Write. Design your life and make it beautiful.
  • Let yourself fall in love again, with a person or a song or a beautiful sunset. Life has broken you open, and this raw state can be one where deep beauty knocks your socks off.
  • It won’t hurt like this forever. Seriously. There will come days where you don’t think about it at all, as impossible as that sounds right now.
  • Don’t ever ever ever ever give up. There are people you can call and ask for help. Don’t be too proud to ask. Let them help you through it. Then you, in turn, can help others.

Mary Lambert, one of my new favorite artists, has a beautiful song called “I Know Girls” about loving your body. The concept of sexual violence and subsequent self-harm is part of the song. Some excerpts:

I know I am because I said, “I am.”
My body is home…

Lay your hands flat and feel the surface of scarred skin
I once touched a tree with charred limbs
The stump was still breathing
But the tops were just ashy remains
I wonder what it’s like to come back from that because
Because sometimes I feel forest fires erupting from my wrists
And the smoke signals sent out are the most beautiful things I’ve ever seen…

Your sexiness is defined by concentric circles within your wood
It is wisdom
You are a goddamn tree stump with leaves sprouting out
Reborn

To help me process the intensity of my training (and to avoid eating every cookie in the world to stuff my feelings down), I have been spending time in nature. On my lunch break at work last week, despite prohibitively chilly temperatures, I walked around outside barefoot and delighted in the sensation of the cold mossy earth beneath my feet. They were screaming with the cold and the sharp rocks and pine needles, but I felt so very alive. I wandered through the trees, breathing them and being breathed. I greeted the robin birds and felt so gloriously present. I took a picture of my bare feet and my tattoos (note the purple scrubs!), claiming my existence in this place, in this moment.

There is something about moving that triggers my deep thoughts. So much has happened while I lived in this little studio. The Robin that moved in here is not the same person I am today. I have grown up a lot, faced some of my biggest fears head-on with compassion and courage, and found strength I wasn’t sure I possessed. I was married when I first turned the key to this apartment door; I will walk away independently. I was neither a nurse nor a midwife; now I am both. I wrote my thesis in this place, following my grandmother’s story back through time and bringing her legacy alive. I had so many wonderful study sessions with my friends in my little living room, practicing skills on each other (everything from IV starts to clinical pelvimetry) and on my wide variety of low-tech simulation equipment. As happy as I will be to have twice as much space and my own laundry and a designated place to park my car so I don’t have to park four blocks away when I get home from catching a baby at 2:00 a.m., it will be bittersweet to walk away for the last time.

I walked home from work through the Seattle University campus this afternoon. I said goodbye to one of my favorite trees in the world, knowing I can return whenever I want. I took one of its pine cones home with me and will bring it to my next place as a reminder of the shelter my tree-friend gave me during my time here. I noticed in several places where branches had recently been trimmed that the tree was bleeding red, and I touched the wounds gently. I sat under this tree and finished up a journal I had started writing shortly after catching my first baby last year.

I hugged one of the low-lying branches and felt how solid the tree was, how firmly planted in the ground. I asked the tree if everything was going to be okay, and I got a simple, one-word reply: “Grow.” This is what trees almost always tell me when I ask them a question. They answer not audibly (obviously), but with their entire being. Growing is what trees do. Beginning with their tiny seed-selves, trees have in their DNA to sprout and plant down roots and reach eager buds towards the sky. Buds sprout leaves and stretch outward, becoming branches and stalks. Bark forms a protective coat around tender insides, shielding the channels that bring nutrients from the soil to every part of the plant. Photosynthesis happens (science!), and trees create food for themselves. Eventually, as the tree matures, it puts forth more seeds and sends them out into the world to make more trees, wrapped safely in fruit or pine cones or some other clever mechanism.

The tree grows according to its own inner code. My favorite redwoods could never turn into apple trees, and similarly, apple trees were never intended to live for millennia, towering over all the other creatures on earth.

When I stood under this mighty creature and rested against its branches, a beautiful pine cone in my hand, I felt the life energy coursing through it, and this, in turn, connected me with my own vital force. I have imprinted on my DNA what I am to grow into, as well. I am a Robin, and a damn good one. I am not any other person who has ever existed, nor should I be. I have a big calling, and big work to do. When I spend time in nature, I am reminded that I don’t need to try to make myself into anything. I just need to allow myself to grow into who I already am and be as wholly myself as I can in any moment.

As I walked away, I heard the refrain of a song playing in my head:

Oooh, follow my tracks
See all the times I should have turned back
Oooh, I wept alone
I know what it means to be on my own
Oooh, the things I have known
Looks like I’m taking the hard way home
Oooh, the seeds I’ve sown
Taking the hard way home
–Brandi Carlile, “Hard Way Home”

I’m not sure if there is an easy way home, to be honest. My journey has been circuitous, not linear. Every stop along the way has opened new doors and closed old ones. This will be true for the next few months, as well. I will begin working as a sexual assault nurse examiner and a midwife, from a new home base in a new city (not too far from where I currently live, but it will be an adjustment nevertheless). I am glad to have friends, furry and otherwise, to keep me company throughout the transition. (This particular friend is more than happy to help me fill my moving boxes!)

So there. I did it. I got some thoughts out. Now it is time to close my eyes for a while and let dreams teach me new things. Much love to all. I couldn’t do this work without you.