CNM 189

Two days ago I received this email from Frontier letting me know that I was accepted into their CNM program. It doesn’t really feel real yet. And while I can’t wait to get started, I’m looking forward to enjoying the rest of my summer off.

I was able to log into the portal and get started on all of the “pre-bound activities” that are required of us before attending bound. I’ve been able to complete:

  • Frontier bound fee of $675.
  • Castlebranch (the company they use to track immunizations, verify your nursing license, do your background check, and verify your physical exam) fee of $61.
  • Sign up for bound.

I still have so many questions about how this program is going to go. I guess they will be answered at bound.

I’m planning on driving to bound. I hate flying so much, so I’m taking the ten hour drive from Philly by myself. I’m actually looking forward to the alone time. 🙂

The wait.

I applied to a midwifery program through Frontier last month. There’s talk on the facebook group about admissions decisions going out next week. Today, I feel so anxious at the thought of receiving that email. I pray it works out for me this time. It has been more than ten years leading up to this. Frontier is the only school I am interested in, so I threw all of my eggs into that basket. I do that a lot.

I haven’t told my family. I told a select few friends who are midwives and the ones who wrote references for me. I just can’t handle the constant “have you heard yet”s? It does nothing for my anxiety. The waiting is the hardest part.

Here goes nothing.

She wanna be a midwife or whatever.

I moved to England when I was 19. I had £80 cash and a credit card with a balance of $300. I didn’t know why I wanted to go abroad. I just knew that there was a great, big world outside of NW Philadelphia, and I had to explore it.

I knew a girl who lived in London. She told me that if I ever made it across the pond, I could stay with her until I figured things out. She gave me the permission I needed to book a flight, which I did, later that day. I found a roundtrip flight on Air India for about $500 (which was my bank account balance), and I bought it.

A few weeks later, I was in the air.

London was cool. Dreary and busy. People walked too fast and drank their tea with milk instead of sugar. It was fun to be an outsider. Bush Jr. was president, and I got to ignore American political drama and just float along in a bubble. I met people from all over the world. I drank alcohol and stayed out late. I made a lot of friends. And I completely ran out of money two weeks later.

Money. I didn’t have any. I refused to go home. So I decided to move in with a wealthy family in the English countryside town of Standsted Mountfitchet, and become their au pair. This family had three children. They lived in a huge farm house, which I lived in with them. They paid me £120 a week to look after their kids. They fed me. I had no bills. So I was able to save some money to explore the rest of the country.

An opportunity for me to visit Ireland came about, and I took it. In Ireland, I rode on a bus with other foreigners for three days all over the country. We explored the Cliffs of Moher, Killarney, Dingle Peninsula, and some other places that escape me. On this trip, I met a man who I would date for almost three years, and who I credit for introducing me to midwifery.

After a few boring months in the farmhouse, I decided to move to Manchester where I had another friend, so I could meet more people my age. I moved in with a 40-something year old physical education teacher who was a diehard Manchester City fan, and once came home from a football game, forehead bloodied from head butting another guy rooting for the opposing team. He was kind of crazy. He drank heavily, and initially lied to me about his age. After living with him for a few months, and not being able to find a job in Manchester, he kicked me out. I’d run out of money again. I was sort of homeless that night, until his girlfriend picked me up and took me to her house.

The next day I packed up all of my shit and took the bus and ferry back to Ireland to move in with the guy I’d met on the trip a few months before. We were gloriously broke and drunk in love. He was a bicycle courier in Dublin. A shy virgo who devoured any opportunity to talk about the meaning of life. He loved Nick Cave and Jack Kerouac, and had big plans to ride his bike from London to India one day.

We lived in a dank basement flat on the north side of Dublin. It was dark and damp. The stove was five feet from the mattress we slept on. There was one window that faced a stone wall. But it was only a 10 minute walk to the city centre, and we paid €400/month to have a place to ourselves. Dublin is a very expensive city. Most people paid that much to live in a crowded house with loads of roommates. Two introverts in love – we were happy to have privacy.

But we hated the city. You couldn’t walk a straight line in Dublin without bumping into 10 people. Luckily, his parents lived in a tiny cottage 90 minutes from the city in county Meath, and we frequently escaped there to enjoy the fresh air and stillness.

His mom had been a nurse for many years, and eventually became a home birth midwife. I didn’t know what a midwife was before I’d met her. She was the sweetest, most gentle person I’d ever met. Now in her 60s, she went back to school to study homeopathy. When we talked about midwifery, I knew this was what I was meant to do. Even though I’d never been to a birth, I started devising a plan to enroll in nursing school as soon as I moved back to the US, not knowing then that CPMs existed, and that not all midwives were nurse’s first.

My visa eventually expired, and I had to come back home. I crammed in all of my prerequisites for nursing school into summer courses and was accepted into a second degree BSN program that fall.

I had no real interest in any of my clinicals, except OB. During my entire nursing school career, I was only able to witness one vaginal birth. But that birth reaffirmed for me why I wanted to do this work. It was a beautiful experience. There’s so much mystery surrounding childbirth. All of us are born, and yet not all of us get to experience a birth. The mystery and magic of it keeps me motivated and excited.

More experienced nurses advised me to get at least a year of med-surg experience before going into a specialty. One year turned into four. I was burnt out and angry, but finding a labor and delivery job felt impossible without experience. After nearly two years of applying for labor and delivery jobs, I was offered what I thought was my dream job – a full time labor and delivery RN position. However, that position did not align with how I wanted to practice, and after five months, I left.

I write all of this to say that more than ten years ago, I was called to midwifery without really knowing why. Today, with the stark black maternal mortality rate in America, I am even more motivated to become a midwife. The cultivation of more black midwives in this country is mandatory in addressing this crisis. I knew there would become a time where practicing within a large health system would infringe on my ability to practice within a reproductive justice framework. And now it’s time to build my own system, because my people need me now, more than ever.

My birth story.

As I sit here writing my birth story, almost three years later, I’m amazed at what my body has gone through, and still continues to go through.

My daughter was born hours before a snow storm hit Philadelphia in 2016. I remember driving to the hospital with my partner. Excited and nervous. Telling myself not to think about it too much. To just go with the flow. That, no matter how, my daughter would be born soon, and the lower back pain and awful reflux I’d experienced my entire third trimester would soon be over.

We arrived at the hospital around 1am. The front doors were locked, and we had to use an intercom to get a security guard to let us in. I waddled to the labor and delivery unit with clear fluid dripping from my body. A woman checked us in and told us where our delivery room was.

The delivery room was large. My bed was uncomfortable. Someone who I cannot remember now hooked my baby up to the monitor. Eventually, a man, who I assume was a resident, did a cervical check. My cervix was still closed, but he’d tested the leaking fluid. It was amniotic fluid, and, for that reason, I had to stay. The medical team decided to induce me by inserting misoprostol into my cervix. I was checked four hours later, and still not dilated. I recall the second cervical check being one of the most painful things I’d ever experienced. My examiner was an older white woman – a doctor or a nurse practitioner –  I don’t recall. I just remember her forceful shoving her hand into my vagina and not stopping when I screamed out in pain. She had no remorse for my obvious discomfort, told me my cervix was still closed and that she wanted to try another dose of misoprostol, this time in my check, and she left. I wept into my pillow. Not even being a nurse had prepared me for being treated like a diagnosis and list of symptoms, and I wanted to go home.

After the second dose of misoprostol, I started to feel intense discomfort in my lower back. My primary nurse had gone to lunch, and I rang the call bell for the nurse covering her. Another older white woman walked into my room, and I asked her if I could get an epidural. She asked me to rate my contractions on a scale of 1-10. I told her nine. She looked at the screen which was monitoring my daughter’s heart rate and my contraction pattern, and scoffed, “Oh, you’re not a nine!” I didn’t know what to say. At this time, I was a pretty new Registered Nurse myself, with less than one year of experience working with adults with acute and chronic illness. I did not work in the OB setting, so I told myself, “listen to them. They know what they’re talking about.” Still, I felt vulnerable. I felt like a patient who wasn’t being listened to, and even though I spend 36 hours each week advocating for complete strangers, I was completely unable to advocate for myself in that moment. It wasn’t until after my daughter was born that I’d learn about a study that was done which confirms white practitioners perceive black people as being able to experience more pain than white people.

The nurse told me to wait a little longer before requesting an epidural, so I did. Awhile later, a black woman walked into my room and introduced herself as the nurse practitioner. She asked what my plans for pain management were. I reiterated to her that I wanted an epidural, but I was waiting, at the advice of the nurse. The nurse practitioner looked me straight in the eye and said, “I don’t see why you have to wait. If you want an epidural, I will call anesthesia right now.” Possibly ten minutes later, I was in position to receive an epidural.

I was afraid to get the epidural. Stories I’d heard about possible paralyzation from the needle going into my back played in my head. But after a few minutes and hardly any pain, the epidural was in and I was fine. Or so I’d thought.

Shortly after the epidural placement, several staff members came running into my room. They put oxygen on my face and made me get on all fours and rock my hips from side to side. A young white women pushed something in my IV, which I can now speculate was ephedrine. No one told me what was going on. No one said anything to my partner who was standing near my bed watching all of this happen. Again, I did not ask questions. I just did what they said. In retrospect, I can assume my daughter’s heart decelerated and my blood pressure dropped as a result of me receiving the epidural.

Once we were stabilized, my attending OB finally came to see me. She explained that I wasn’t making cervical change with the misoprostol, and she didn’t think my baby would tolerate pitocin. She recommended a cesarean section. I started bawling. I was a young health woman. I’d never had surgery before, and the thought of being cut was terrifying. My OB tried to empathize with me, “If you wanted a c-section, I’d think you were crazy.” I looked over at my mom who had snuck in somewhere during the madness, and my partner, and asked them what I should do.

I ultimately decided to get the c-section because it felt like my only option. When your doctor says your unborn child may not tolerate labor, your hands feel tied. I knew I had to birth my baby as safely as possible, and somehow that meant via c-section.

I left my mom and my partner in the delivery room, and as the nurse and anesthesiologist wheeled me back to the operating room, so many terrifying thoughts swirled around my head. Would I feel the incision? Would I die? Would my baby be ok? I began to have a panic attack. This was absolutely not how I’d envisioned my birth story unfolding.

In the OR, I remember Justin Bieber playing on the radio. They started the surgery, and I laid there trying to hold it together. The only person who acknowledged my fear was the nurse anesthetist standing at the head of the OR table. Her offer was, “I’ll give you something for anxiety once they baby is out.”

Suddenly, I felt intense pressure. I started shouting, “I can feel that! I can feel that!” My doctor didn’t explain to me the tremendous amount of pressure I would feel as she and her resident stretched my skin to make room for the baby to come out. I thought something was going terribly wrong, and I panicked even more.

At 8:43pm my daughter was born. She was 6 lbs 14 oz. A nurse took her over to a radiant warmer before I got a chance to see her. I could hear the nurse’s saying how wide awake my baby was, and that she was rooting. I didn’t hear her crying. I felt numb, physically and emotionally, as they sutured me back together. My partner was called over to the warmer to cut the remaining part of the umbilical cord and to take pictures with our baby. I laid on the OR table with the blue drape blocking my view of the doctors and my family.

Finally, a woman brought my daughter over for me to see. She was wrapped up and had a little pink hat on. Months later, I’d remembered that I wanted to do skin to skin and delayed cord clamping. We weren’t offered those options. They took my partner and our daughter back to the delivery room, where my mom was waiting. I stayed in the OR. No one offered to let me keep my baby next to me and transfer back to the delivery room together with her. Days later, I would see pictures of my mom holding her first grandchild in the delivery room during the time that I was still in the OR. During this crucial first hour of her life where skin to skin and early breastfeeding would’ve helped her transition to life outside of my womb.

I still weep at all of the missed opportunities to advocate for myself or my daughter. If I could do it again, I would have had a doula with me for support.