Showing posts with label midwifery. Show all posts
Showing posts with label midwifery. Show all posts

Monday, April 2, 2012

Should have put this up in September...

*This is a "process so far" entry that I wrote in September, WAY before our home study, dossier, match with our beautiful girl, etc.  It's more detailed than my overwhelmed memory is right now, and I had happy reminiscences while reading it. Enjoy.*

 
Our adoption process really began in earnest shortly after I started my midwifery training.  I am currently doing the academic portion of my midwifery training through Midwife to Be, an online/correspondence program headed by Lisa Aman, CPM.  Midwife to Be, or MTB, participates in mission trips to the Dominican Republic several times a year to both get more hands-on experience with births and to provide needed equipment to the Dominican nurses and midwives.  

After Lisa’s church returned from a mission trip to Uganda, she started working on setting up a midwifery-mission trip there.  The minister’s wife whom they worked with is a midwife at a hospital that delivers 20-30 babies every day.  It is also located near an orphanage run by the couple that serves over 600 orphans.  She said if people were interested in adopting one of the orphans from Uganda, there would be opportunity to pursue that.  

*PERK*  

Adoption?  We’ve always wanted to do that.  There was one problem, however: I could be interested all I want, but I’m only HALF of the parents in this family.  What would Lashi say?  I figured he’d say what he usually says about my great new ideas: no.  Usually, he’s right.  If left unchecked, I’d not only bring home half of the Ugandan orphan population, but I’d also start 3 new businesses, buy a farm and a herd of milk cows and run for office all at the same time, while learning to speak Arabic.  
 Can we say burnout?  

So, I took a deep breath and told him about the trip and the hospital, the birth opportunities, the orphanage and all the little kids – probably very fast and all in one breath, but I can’t remember – and then I waited for his response.  He took his own deep breath, looked me in the eyes very seriously and said, using his finger for emphasis, “You are allowed to bring home ONE child.  Do not even look at twins, sibling groups, anything.  I know they’re cute, but I don’t care how cute they are.  ONE CHILD!”  

I couldn’t believe what I was hearing!  He was ready to take the step and go for it without a big to-do.  I couldn’t even get him to do things he really wanted to without at least some hemming and hawing.

I got to work searching out Ugandan adoption requirements.  Turns out, there were several major problems.  One was the residency requirement.  Though they “sometimes make exceptions”, the Ugandan government requires a 3-6 month residency for foreign couples wishing to adopt a Ugandan child.  We couldn’t move the whole family to Africa for that long.  Lashi has work, the kids have school.  If we left them here, who would take care of them for that long?  Would I be travelling alone?  No, that looked like a problem.  Bigger yet, though, was that I found that many of the children in the orphanages are not true orphans, but children from poor families who cannot care for them, but visit frequently.  I don’t think it would be right under those circumstances to remove them from their family and culture.  There were many other “variables”, such as the time a visa might take, if the child we’re working to adopt becomes “qualified” at the right times, if the US would allow them in, etc.  Too many “ifs”.  

I looked at intercountry adoption in general, using the State Department website and calling all of the adoption agencies in town to get as much information as possible.  I filled quite a few pages in a notebook and printed numerous charts and lists of requirements.  

Many countries had residency requirements that we just could not comply with.

Many others had limits on the number of children allowed in the family.

Even more had wait times that were 3-5 years or longer!

In the end, the countries that “fit”, meaning they were willing to deal with us and we were willing to deal with them were: Russia, China and Ethiopia.  

Both Russia and Ethiopia were fairly stable, but had had some diplomatic issues in the past.  Both required two trips to the country.  Ethiopia has rampant AIDS, and although the children have to test negative before leaving the country, not all cases are caught.  Russia has a higher rate of children with RAD (reactive attachment disorder) after placement.

China looked like a long shot.  The income requirements looked very high: $10,000 per year per family member, including the child to be adopted.  That’s quite a bit if you’re a large family.  Second, the family has to have a net worth of $80,000 or more to qualify.  I was just counting up our liquid assets, and it doesn’t come close.  That worried me.  Third, they disqualify anyone who has had a history of depression.  I was on medication at the time for postpartum depression.  I thought that would disqualify us.   

Turns out I was worried for nothing.  Income includes the benefits package (health insurance, vacation time, etc.) which more than took care of that qualification.  Net worth includes a lot more than I thought: our home’s appraised value, our contents value (based on the insured amount), and more!  Finally, postpartum depression is not a mental illness - which is what China frowns on – it is a situational stress from a temporary hormonal state.  I was also ready to wean off of my medication (as the youngest had weaned from breastfeeding a couple months before), so that was not an issue.  

 Hooray!

Another issue with China is that because we have more than four children, we are allowed to adopt only a special needs child.  Uh-oh! Two of my siblings are “special needs”, did NOT want to deal with that!
Lashi, wanting to make sure we had checked all of our options off of the list, asked me to check out a couple other options first.

What about domestic adoption?  There are tons of children in the foster system that need adoptive homes.  What about them?  I called Denver county, because my mother said they had been so good to work with during my sister’s adoption.  They were very kind and friendly, but the story was clear: all of the children available through the county systems have serious issues from abuse, neglect, drug exposure, severe medical needs, or a combination of those.  At this point in our lives, we cannot risk the well-being of our other children on such a risky situation.  I know lots of kids that were adopted through the system, and their stories are not pretty, their adjustments are not pretty, and many of them never are able to recover from their past.  We just can’t go there.  

What about domestic infant adoption?  We actually had one agency that thought we could get an infant within a couple years: A Act of Love.  (Terrible, un-grammatical name, but I digress…)  They were also very kind, optimistic, and good to work with.  However, they said that about 7-10% of their birth mothers back out of the adoption AFTER the birth of the baby.  That’s a pretty high risk.  Also, quite a few babies are still special needs or drug exposed.

So, the choice really came down to China or A Act of Love.  Act of Love was a sure shot – eventually.  We would someday have an infant through that agency even if there was a lot of heartache and false-starts in the process.  China adoption meant special needs for sure, but we could pick which special needs we are open to!  We discovered that “special needs” in China means anything from serious medical problems to deafness or even a red birthmark or prematurity.  Almost anything can get you put on the “special needs” list.  Even some of the little ones on their “special focus” list, which is for harder-to-place and higher-needs children are all but perfect in my opinion!  The cost between Act of Love and China was about the same.  We decided to give China a shot, and if we did not meet the Chinese government didn’t accept our family’s qualifications, we would still have Act of Love to fall back on, and that was an option we could be happy with.  

During this debate, I looked at the only two China-focused agencies I could find: Great Wall China Adoptions and Chinese Children Adoption International (CCAI).  Both of them seem like very good agencies, but every family I knew that had adopted from China had worked with CCAI and had only the best, glowing reports about working with them.  There was a huge support network here.  Best of all: they were located IN Colorado, just one hour drive from our home.  They also run the only Chinese Cultural center in the country, and were the first Chinese Adoption agency in the US.  After talking to Joshua Zhong, director and founder of CCAI, and having all of our worried alleviated, it was settled:

We decided to adopt a special needs little girl from China through CCAI.
I called Hillary, the applications manager at CCAI, and she sent us the information packet right away.
Our packet arrived within days by mail with a packet about CCAI’s traditional China adoption program (healthy infant), another about the Waiting Child Program (special needs), forms for getting started, an application, schedule of orientation meetings, a DVD highlighting both the agency and their charitable arm that funds orphanages and cleft palate surgeries.  I poured over all of it until I had it nearly memorized.

I spent several days going over the Medical Conditions Checklist.  Because of my midwifery training, I was familiar with many of the defects and conditions that were listed on it, but I still had to look up some of them, like gastroschisis (rather shocking to see the first time), and strabismus.  After that, Lashi and I had to discuss each condition and whether it was something we thought we could (or should) deal with.  We had the options “Yes”, “No”, and “Maybe”.  We discovered that I was much more willing to say “yes” to conditions than Lashi was, but that came as no surprise.  We indicated on our sheet that we are particularly interested in a little girl 0-18 months with hearing loss of any degree.  

I spent so long on the process of filling out the sheet that we didn’t send it in for over a month.  Finally, I submitted both the Medical Conditions Checklist (MCC) and our Family Information Sheet online, which put us in the waiting pool for a child match.  

The very next day a little girl’s profile was posted to the Special Focus list on the website, meaning that she has languished in their waiting files for months with no MCCs that match their conditions.  Had I submitted our sheet earlier, she would have been matched to us.  She was a perfect little 9 month old with [I remove the specifics of her condition here just to be on the safe side of CCAI policy.  Needless to say, very minor conditions as far as we were concerned]– an absolute angel, gorgeous child.  I called Lashi, who was still very concerned about the amount of money that is due early in the process that we would not have saved up for several months yet.  I called my grandparents, Jim and Vera Spain, who very sweetly gave us a loan of $4,000 to get us started on the process.  I called Pam Rodriguez at CCAI, and requested the file for the little angel.  I was told that 20 other families had requested her before us, but we were put in the queue.  Pam said that sometimes the first family ends up adopting the child, and sometimes they go through dozens who all turn the match down.  I could hope, but it was slim. 
One week later, Little Angel was matched to her family.  It was bittersweet.  I was happy for her – the whole point is for the little ones to find their forever families.  But I mourned for the lost opportunity.  She would have been perfect for our family.  I can only trust that there is another little one out there who is the right match at the right time and is meant to be ours.  The other little girl I had been considering was also matched to her family.  [Again, removed her specifics.  She did require more therapy and medical attention, though.] 
Even though CCAI said that hearing loss is very seldom seen, we have seen two children just on the Special Focus list with hearing loss.  Maybe

 I never finished that thought back in September and I don't remember what I was going to say.  I was so focused on the possibility of having a deaf or hard-of-hearing child that I didn't give much thought to the other conditions we had indicated on our MCC.  Just goes to show - God often has different plans than we do and His turn out quite well.  

Thursday, December 22, 2011

(Almost) One down, 29 to go...



I am so close I can taste it!!!
All I need is to demonstrate a couple skills (sterile technique, proper hand-washing, gloving/degloving, and sterilizing instruments) and read and review one more book, then I'm finished with my first Midwife-to-Be unit.

I've been inspired lately by several graduates of the program.  Their success tells me "Yes, you CAN eventually get through this!"  One graduate posted on the forum about a month ago with her advice.  I've started implementing some of it, including:
  • Record EVERYTHING! You need 60 study hours per unit and 6 clinical hours.  When I really started writing things down, that was CAKE to achieve!
  • Take heart - the first unit takes the longest.  NO KIDDING!!!  I've been working on this since March.  At least, that's when I signed up.  Raising five children and being an active, breathing person takes time, so it's not like I've been spending 8hrs/day.  There is also a learning curve.  I have had to figure out a new system and find my rhythm, as well as find the books! 
My most recent hangup: I spent a month studying and preparing to test on a book that, when I looked more closely at my list, was the WRONG BOOK!  Poo...  So, I get to pick one more carefully from the list this time, and start over.  Sigh... well, it'll be okay.  I would rather study and read than play.  *geek*

I had one of those I-will-never-finish-this moments a couple weeks ago.  My skills book requires demonstrating instrument sterilization techniques, and several methods are listed.
  • boiling
  • cold chemical
  • autoclave
  • pressure cooker
  • oven
I looked at this list and thought, "Okay, I know how to boil things to sterilize, I have an oven and can figure that one out... I have a pressure cooker that doesn't work... what chemicals? I don't even KNOW anyone who has an autoclave!!!"  Panic ensued.  Of course, some day I will realize that prior to panic, I should just go to the source and ask questions.  It would save tons of time, stress, and migraines.  Lisa said that I only have to be able to demonstrate one or two - as long as I HAVE a method of instrument sterilization.

OKAY! I CAN DO THAT!!!

Hope restored, moving forward.  :)

Birthing a Midwife: Introductions



ME
I suppose I should start by introducing myself and explaining why I would want to become a Certified Professional Midwife (CPM).
My name is Erin.  I am a stay-at-home mother of (currently) five children.  Four were born in hospitals, one at home.  Two of my babies were born attended by OB/GYNs, two with Certified Nurse-Midwives (CNM), one with a CPM.  Three were born with the epidural-and-pitocin treatment, one "accidentally" natural, one natural by choice.  I feel that short of a cesarean section, I have largely run the gamut of normal birth experiences. 
Like many people, I assumed that babies were born in hospitals, that doctors know best, and that if you can get yourself labeled "high-risk", you are likely to get the safest care available.  I thought that home birth was for crunchy-organic-granola people and I wanted nothing to do with that kind of irresponsible extremism.

MY SHORT OBSTETRIC HISTORY
My first child was born in 2001, attended by a OB/GYN who not only had the bedside manner of a drunken sailor, but who told me during my labor that he had a camping trip that weekend (it was a Friday) and that I was to have that baby by 5pm.  After a violent-but-effective experience with pitocin, and a too-little-too-late epidural, low blood sugar, exhaustion, forceps delivery (which bruised my sweet baby's face) a HUGE episiotomy and further tearing, I was delivered of a 7#3 baby boy.  During the stitching-up process, my doctor left several gauze packs inside my body, which caused a terrifying scene almost a week later. 

The following year, 2002, my second child was born in a different hospital attended by a CNM.  I LOVED this woman.  She was a calming, wonderful influence in the delivery room.  Although I still had pitocin augmentation and an epidural, I was this time calm and lucid enough to participate in my daughter's birth.

In 2004, even after giving birth twice, I had not at this point ever experienced a true active labor contraction - only pitocin-augmented contractions.  When my labor began with my third child, I assumed it was pre-labor because it was not wrenchingly painful.  I went about my business, even sleeping through a long stretch of active labor.  I awoke during transition, and only began to realize that I MIGHT be in labor.  I tried to go do laundry, but found the task impractical.  My husband and I arrived at the hospital with only enough time to change clothes, have every vein in both arms ruptured in an attempt to start an IV, and have a fight with the CNM-on-call (same practice as the previous birth, but not my favorite person in the practice) before our son was born less than an hour after our arrival.  No drugs.  I had no idea what to expect because I had never experienced natural labor before.  I was terrified.  I was equally shocked by the sudden relief, calm, and buoyancy I felt immediately after the birth.  The recovery was phenomenal.

My fourth (another son) was born in 2007, in a new hospital in a new city, with a new OB/GYN.  The experience of being thrust back into the pitocin-and-epidural routine contrasted sharply with my previous birth experience and confirmed to me that something needed to change. 

When I became pregnant with my fifth child, I searched for local CNMs, finding very few options, and none I was comfortable with.  I did, however, find many CPMs/RMs (Registered Midwife) who did home births.  It was an option I never had considered before.  My preliminary searches yielded very comforting statistics about the safety of home birth, and I was shocked to discover that our insurance company would actually COVER a home birth with a CPM!  My husband slowly became convinced that this was a doable option, and we hired our wonderful midwife, Merrie.  I studied and read everything I could during the pregnancy, becoming ever more convinced that this was the right course, and discovering the likely reasons I endured so many interventions with my previous births.  I gained confidence in my own ability to birth, discarded my fear of the process, and just enjoyed the beauty, power and majesty of the miracle of new life.  Our son was born in November of 2009 in our own room, next to our bed, in an unprecedented atmosphere of peace, joy, support and comfort.  Less than an hour later, I was showered, dressed in my own comfortable clothes, and in my bed with my son at my breast and my husband lying beside me.  It was a remarkable and life-changing moment.

A NEW JOURNEY
I knew after this experience that I wanted to change our society's birth culture - and in so doing indeed change the world - one family, one woman at a time.  So began the journey I am currently on.  I decided within a year after my little son's birth that I wanted to become a home birth midwife.

I now am studying and doing the academic portion of my training through an online program called Midwife-To-Be, which is run by Lisa Aman, a midwife in South Carolina.  I also do clinical hours at prenatal/postnatal visits with my preceptor, Merrie, the midwife who caught my last baby.  I am taking my time with the program.  I want to be thorough, and I do not intend on having regular office hours or my own practice until my youngest child (who is not yet born) is old enough to be at home alone or with his/her siblings.  In the mean time, I participate in the birthing process wherever I can, including giving support (and foot massages) to expecting mothers, volunteering as a doula at friends' births, and helping wherever I am wanted.

AN INVITATION
Join me on my journey.  I welcome your insights, comments and experiences.  I hope that my experiences and knowledge will help you.