Books.......

I got sent this, and thought, well, okay then. So, if you are reading this too, have a go at your own blog!

Instructions:

Look at the list of books below. Bold the ones you’ve read. Itilacize the ones you want to read. Leave blank the ones you aren’t interested in.

Movies don’t count!!!!! (K. - Damn.)



The DaVinci Code (Dan Brown)
Angels and Demons (Dan Brown)
Pride and Prejudice (Jane Austen)
To Kill a Mockingbird (Harper Lee)
Gone With the Wind (Margaret Mitchell)
The Lord of the Rings: Return of the King (Tolkien)
The Lord of the Rings: Fellowship of the Ring (Tolkien)
The Lord of the Rings: Two Towers (Tolkien)
Anne of Green Gables (L.M. Montgomery)
Outlander (Diana Gabaldon)
A Fine Balance (Rohinton Mistry)
Harry Potter and the Goblet of Fire (Rowling)
Harry Potter and the Order of the Phoenix (Rowling)
A Prayer for Owen Meany (John Irving)
Memoirs of a Geisha (Arthur Golden)
Harry Potter and the Philosopher’s Stone (Rowling) Fall on Your Knees (Ann-Marie MacDonald)
The Stand (Stephen King)
Harry Potter and the Prisoner of Azkaban (Rowling)
Jane Eyre (Charlotte Bronte)
The Hobbit (Tolkien)
The Catcher in the Rye (J.D. Salinger)
Little Women (Louisa May Alcott)
The Lovely Bones (Alice Sebold)
Life of Pi (Yann Martel)
The Hitchhikers Guide to the Galaxy (Douglas Adams)
Wuthering Heights (Emily Bronte)
The Lion, the Witch and the Wardrobe (C.S. Lewis)
East of Eden (John Steinbeck)
Tuesdays with Morrie (Mitch Albom)
Dune (Frank Herbert)
The Notebook (Nicholas Sparks)
Atlas Shrugged (Ayn Rand)
1984 (George Orwell)
The Mists of Avalon (Marion Zimmer Bradley)
The Pillars of the Earth (Ken Follett)
The Power of One (Bryce Courtenay)
I Know This Much is True (Wally Lamb)
The Red Tent (Anita Diamant)
The Alchemist (Paulo Coelho)
The Clan of the Cave Bear (Jean M. Auel)
The Kite Runner (Kaled Hosseini)
Confessions of a Shopaholic (Sophie Kinsella)
The Five People You Meet in Heaven (Mitch Albom)
The Bible -- Yes i used to do regular bible studies... what ever happened to me!
Anna Karenina (Tolstoy)
The Count of Monte Cristo (Alexandre Dumas)
Angela’s Ashes (Frank McCourt)
The Grapes of Wrath (John Steinbeck)
She’s Come Undone (Wally Lamb)
The Poisonwood Bible (Barbara Kingsolver)
A Tale of Two Cities (Dickens)
Ender’s Game (Orson Scott Card)
Great Expectations (Dickens)
The Great Gatsby (Fitzgerald)
The Stone Angel (Margaret Laurence)
Harry Potter and the Chamber of Secrets (Rowling)
The Thorn Birds (Colleen McCullough)
The Handmaid’s Tale (Margaret Atwood)
The Time Traveller’s Wife (Audrey Niffenegger)
Crime and Punishment (Fyodor Dostoyevsky)
The Fountainhead (Ayn Rand)
War and Peace (Tolstoy)
Interview with the Vampire (Anne Rice)
Fifth Business (Robertson Davis)
One Hundred Years of Solitude (Gabriel Garcia Marquez)
The Sisterhood of the Traveling Pants (Ann Brashares)
Catch-22 (Joseph Heller)
Les Miserables (Hugo)
The Little Prince (Antoine de Saint-Exupery)
Bridget Jones’ Diary (Fielding)
Love in the Time of Cholera (Marquez)
Shogun (James Clavell)
The English Patient (Michael Ondaatje)
The Secret Garden (Frances Hodgson Burnett)
The Summer Tree (Guy Gravriel Kay)
A Tree Grows in Brooklyn (Betty Smith)
The World According to Garp (John Irving)
The Diviners (Margaret Laurence)
Charlotte’s Web (E.B. White)
Not Wanted on the Voyage (Timothy Finley)
Of Mice and Men (Steinbeck)
Rebecca (Daphne DuMaurier)
Wizard’s First Rule (Terry Goodkind)
Emma (Jane Austen)
Watership Down (Richard Adams)
Brave New World (Aldous Huxley)
The Stone Diaries (Carol Shields)
Blindness (Jose Saramago)
Kane and Able (Jeffrey Archer)
In the Skin of a Lion (Ondaatje)
Lord of the Flies (Golding)
The Good Earth (Pearl S. Buck)
The Secret Life of Bees (Sue Monk Kidd)
The Bourne Identity (Robert Ludlum)
The Outsiders (S.E. Hinton)
White Oleander (Janet Fitch)
A Woman of Substance (Barbara Taylor Bradford)
The Celestine Prophecy (James Redfield)
Ulysses (James Joyce)

seeking self

Are you in there?
I used to be so in touch with you
Used to hear your voice everywhere I went
Used to believe everything you said to me

Where did you go?
I know I am busier these days,
And not listening as hard….
But I find myself sitting in the silence, wishing I could hear you

Is it that you think I don’t need you?
Cause, I really do.
I am not the way people think I am
Not so sure of myself as I seem

How can I reconnect with you?
I really want to catch up.
I want to hear what you think of me now…
Want to see where you think I am headed

Can you tell that I am scared of you?
You are my truest reflection
Of what I truly am, and what you say
Could shatter my world if it is not what I expect

You force me to take notice,
Show me what is really there.
I know you are really just a part of me
But, goddess, I need your truth.

Post graduate study?

So, I am heading back to uni. I have enrolled to do my honours and will be studying parttime for the next two years to achieve this. I must be mental! But I love the learning almost as much as I love the work. So back to it I go. But the process of applying, and deciding on course structure has raised some stuff for me. I was not a good student in high school. I dropped out, pregnant, at sixteen. I then worked in a series of completely shite jobs, getting nowhere fast.

I never imagined a time when I would be a university student, let alone a graduate with a degree. Post graduate study wasn't even on my radar! And, now that I am doing it, I have this wierd am I getting above myself and pushing to high feeling in the pit of my stomach. Who the hell am I to think that research I might do could be of interest let alone benefit to others? I was the woman I now want to study!

I am constantly surprised by the realisation that I am an educated and intellient person. This is quickly followed by the question "how the hell did they not realise how shit I am?" I really honestly expected to fail out of my degree at every stage. And now, going into post grad studies, I feel the same way, like I am asking to fail spectacularly at something that really matters to me. Friends tell me constantly that I am "uber smart" and other such bollocks, and to me, it is like when ssomeone tells me I have lost weight or look good... the auto denial is right there.

Goddess, this is rambling... my point. In my heart and in my honest moments, I know I am good at this job. I know the stuff I need to know to practice safely and smartly. I am not scared to integrate others knowledge and other ways of knowing into my practice. I am fully and wholly committed to what I do, and if I didn't believe I could do it, I wouldn't do it. But, still I have these masses of self doubt and feelings of being a fraud... Is that just what women do to ourselves? Is that why we birth in the hospital but want a natural birth? Cause we know we can do it, but doubt it anyway?

I am confused. I am scared. And yet, I am excited.

Births, being an LMC and American doctors.

So far this week, I have attended two births, one a VBAC with slow progress but a good outcome in the end, and the other a lovely physiological birth with a primip who was perhaps the most relaxed woman I have ever come across in labour. She laboured while sitting with legs crossed gently on a chair, eventually getting on to her side when she wanted to push. She did the whole thing in just over four hours, with only 20 minutes of pushing. Truly a lovely birth. the VBAC delivery was a bit more difficult. A long latent phase, followed by very slow progress, eventual syntocinon augmentation, and then a long second stage. I had to hand over care to the hospital eventually, due to sheer exhaustion and was appropriately villivfied as being a lazy uncommitted independent midwife. They argued that the woman was needing "primary midwifery care" I argued that syntocinon augmentation with a VBAC is very much secondary care!

But, what am I talking about, ask my non kiwi readers. Well, here is a quick run down of how being an LMC midwife works in kiwi land.

Section 88 is the legislation that governs maternity care in NZ. Under this legislation, Midwives gain the ability to practice at home or in hospitals, by gaining "access agreements" which allow them to use a facility, and receive support from that facility. We provide antenatal care under our own supervision throughout the pregnancy. when labour begins we must attend a woman within twenty minutes of her arrival in a hospital/ birth unit, or by negotiation with the woman in a home birth. We are not bound to follow the protocols or policies of a particular hospital, although there is an expectation that you will be able to well defend any variation. We are able to prescribe medications applicable to common pregnancy problems, and IV fluids, etc. We are responsible to provide all primary midwifery care, either by ourselves or by arranging another midwife to cover from the arrival of the woman at the hospital, until at least two hours post partum.

The referral guidelines list the criteria for consulting/referring or handing over to obstetric care. therefore, if something is a "level two referral" such as syntocinon augmentation, then we are required to inform the woman that we recommend that she allow doctors to coordinate her care. We can stay and provide the midwifery care for these women, or we can "hand over" to secondary care. In most instances, we stay with our women, for as long as we can. But when you have been awake for 27 hours, you are perhaps not the safest practitioner, especially in a complicated labour.

We are then required to provide at least five to seven home visits during the four to six weeks following birth. Most of us do more than this. for this, the government pays us as per the schedule in the above link. As you can see, it is not a huge reward for 24/7 on call! However, I don't think anyone becomes a midwife for the money. That is a really basic rundown!

So, having explained that... my issue the other day was that i had been caring for a woman who was secondary care from the outset by dint of being a VBAC attempt, who then had slow progress, ARM, Meconium, syntocinon, etc etc. At the 27 hour point, i knew I could not safely continue. And I was basically attacked, for being lazy and uncommitted. What do you want? Blood? Right, that is that rant over. Onto the next....


My dearest friend in the world, who I will call Blond Ambition, is a beautiful and vivacious 22 year old midwife, working for a different busy hospital. Once a week we move heaven and earth (and shift rotations and labouring women) to get together and spend time catching up on our lives. This week, we went for a lovely walk on the beach, where there was sunshine, small children, and lots of dogs. There was also ice cream (goody gum drops and marshmallow coconut ice for BA, and rum raisin, cappuccino and butternut pecan for me!) and lots of chatting.

During the chat, BA told me about an American doctor, doing an obstetric rotation at her unit. She had a conversation with him, where they discussed the difference between NZ and American obstetric care. She asked him what was the most different, and he replied "you". It really was a challenge to him to work in an environment where most of the labour care happens independently of the doctors, with midwives doing the ordering, and doctors doing the "fixing". It highlighted for me just how different our systems are. Here, a midwife is the primary carer for the vast majority of women. Therefore, obstetricians really do provide "secondary care", just as they should. But maybe, that is why they are so anti midwives... because would you want to give up all your normal births, and only have the complicated and problematic cases?

BA asked the doctor what he thought of homebirth and he responded "I wouldn't touch it with a bargepole". when asked why, he said "well, for a start I would lose my licence to practice". Surely that is not true? If a doctor backs a home birth, he is delicenced? Or is he just concerned that if something went wrong he could lose it? Or so convinced that homebirth is inherently unsafe that he KNOWs he would have something bad happen, leading to the loss of his licence?

Blonde Ambition ended their chat their on the grounds that he was not open to the chat, and she had way more important things to do... but it saddens me that doctors can't see the difference between a normal woman birthing at home, and say a really dangerous situation like a placenta praevia delivering at home. Hmmmm.

Maybe, this then draws back to our language difference. Maybe this basic difference between doctors and midwives is more than a misunderstanding... As pointed out by both Peggy Vincent and Penny Armstrong in their memoirs, doctors view birth as normal only in retrospect, and midwives see it as normal unless it deviates away. If you do not believe that birth is inherently natural and safe, then how could you, ethically, deny women the right to avail themselves of medical care. Think about how you would feel if a woman with twins, placenta praevia and preterm labour with both twins breech requested you to attend her at a home birth... Now what if doctors feel that ALL deliveries are that dangerous?

I don't know how we save the women from this attitude, but I begin to understand why none of our evidence is enough to change the minds of doctors so heavily indoctrinated into a model of birth as pathology.

Wow. BA will read that and laugh her head off, cause it is not where I planned to go AT ALL.

Never mind.

Runs of three

Is it just me or does anyone else have runs of three? Since I entered independent practice, every birth I have attended has been one of three! I swear, it's true, not a single stand alone birth! Last month, I had two runs of three, a week apart. The month before two runs of three, two weeks apart. This month i had a run of three last week, and now already, I have a woman in labour and another in early labour... which could of course all stop, but.... if they keep getting closer like this, will I end up with runs of six? I couldn't cope with that!

One of the deliveries last week was a wonderful primip, so strong and grceful and bave, that I wanted to cry for her! She laboured beautifully to full dilatation with no pain relief except the pool, and began pushing soon after. Eventually, after two hours we got out of the pool. Baby was fine. Slow but steady progress forr the next half hour, but mum's contractions started to go off. The head was "right there" but the contractions just weren't bringing it any closer. Nipple stimulation failed to increase them, and the position was all wrong. Finally, I asked her permission to do an episiotomy. I hate doing them, and never do them, but I did this one, and it was immediately followed by the birth of a good sized pink screaming baby. But my call was a good one. That uterus had had enough, and despite active management of third stage, next thing I knew there was blood, and lots of it, everywhere. Basically, she lost about 1100 mls. So, after her beautiful strength in labour, and completely unmedicated birth, she ended up with suppositories for her stitches, and an IV for her bleeding.... Why does it happen that way?

Domestic violence....

This post was a while ago, but I now have a follow up on the story, that raises more questions than it answers.
I was at the hospital the other day, and ran into the social worker involved in that case. She asked me if I had heard from CYPFS. "Errrm, no?" I replied, slightly confuzzled.

She then told me that my client has been admitted to hospital twice after beatings, and the child is now at the centre of a massive custody battle. The partner is wanted by the police for assault and battery and CYPF's are asking why "something wasn't DONE". WTF? we BEGGED them to do something! Everyone who was involved in the case had nightmares about the potential headlines, and now, although it is not the baby being beaten (to our knowledge) they are coming true, and WE are in the wrong!???

Sorry, got a bit carried away there. I guess my point is, that this woman had the right and the responsibility to avail herself of help all those months ago. While I agree it is sad that she may now lose her child, this was her decision. Her plan to "change him" didn't pan out, and now, the shit has (predictably) hit the fan. but, my question to you, my intelligent and opionated readers, is what could I have done to hellp her make a different, better decision? Anything? Suggestions, please!

Self fullfilling prophecies.

In my everyday life, I believe in self fulfilling prophecies. If you think it, you may make it so. I often use this method to try and get my vacuuming done... but although that doesn't often work, I still believe that what we think might happen often comes to be so. And the more energy we give to that thought, the more likely it is to occur. For example, I believed I would be happier when I started my independent practice. I thought I would have more time for my family, and be more energetic. I believed it had to be better than working in the hospital. And it has so very definitely come to pass.

But, like every good thing, it has it's reverse aspect. negative beliefs seem to be given more mind space, and so often, we believe in a negative. So we believe that we CANNOT. Cannot achieve, cannot succeed, cannot birth. And that is what sparks this post. A woman, who honestly has said to me at every one of her (22!!) Antenatal visits, "I will need a cesarean" in some variation, finally began labour at 41+3. She then contracted for twelve hours at three minutes apart, lasting a minute to ninety seconds, and managed to get to ........ 2 cm dilated. The head was high, the contractions were "unbearable" and slowly, but surely, things went Tit's up. FH was high, and a CTG was commenced. Baseline: 160 bpm. Long story short, after about 16 hours of labour, a cesarean section was performed, with a FH baseline of 200 bpm. At 2 cm's. A normal size baby in OA position was born, with heavy mec staining and apgars of 6&9.

Why did this happen? Did she believe this would happen because intuitively she knew there was going to be a problem? Or did her belief create the reality? Could I have saved her alot of heartache by pushing for an elective CS at term for maternal request? Would she have even been happy if she wasn't "saved" by the doctors who operated to deliver her of her burden? I struggle with this aspect: How do you help the woman who wants to be saved, not empowered? Is it right to try and empower someone who sees herself as inadequate, and doesn't mind?

Agatha raises interesting points about language here and a similar vein of discussion occurs on One Hot Mama's site. Both of these post's struck a chord with me, originally sparked by Barbara. I don't know quite how my ramblings are going to end up linked to their thoughts on language and empowerment, but it is brewing. Just so you all know.