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More reflections from semi-rural Alberta

It’s been quiet here. Eerily quiet. We’re talking browsing strip-malls/getting up-to-date on Jon & Kate/trusting that there’s something I’m learning in exchange for being in Northern Alberta far from my family with no births/ quiet.

Quiet enough that I watched The Proposal at the West Edmonton Mall. A famous (infamous?) mall which has a pirate ship, submarines, sea lions, an amusement park, a casino, and a hotel. 

Did I mention the submarines?

The Proposal was entertaining in a pre-feminist-movement kind of way, especially since it gave me insight into the life of my book editor.

(“We’re dying to know–what does a book editor do?” two fawning guests ask at the mock-engagement party. Hmmm. Wouldn’t it be relatively obvious what a book editor does?)

It has got me thinking, however, about career. Every job has its lines, the things we say over and over. Like “Please take a number” or “We take visa or mastercard” or “Use APA formatting next time.”

This is what I say, over and over:

“Okay, now bring your ankles together and let your knees fall to the side. That’s right. Now you’re going to feel my touch, and some coolness from the gel, and then a bit of downward pressure–”

It’s an odd job.

In my first year at UBC I read I knew a Woman , an account of the caregiver-patient relationship by Courtney Davis, a nurse practitioner in a women’s health clinic in Connecticut. At one point in the book Davis’s friend is marveling that she performs pelvic exams routinely, “touching women like it’s nothing.”

“Not like it’s nothing,” Davis replies.

In my 2nd year at UBC, we attended a pelvic-exam workshop where a group of incredible women taught us how to perform pelvic exams and paps.

On them.

The women knew their bodies, told us where we’d find their cervixes. They handed us mirrors and pointed out features of their anatomy. They breathed a sigh of relief we were midwifery students –“the medical students, they shake so much the speculums hum”–but were fast to reprimand us if our touch was anything less than gentle.

At the time, I compared it to Halloween as a kid at school: the mystery bags you were made to plunge your hand into while blindfolded, told it was filled with eyeballs. Without vision you had to rely on touch, using your fingers to see, processing through touch until you thought: peeled grapes.

It’s the same with a vaginal exam. Using two fingertips we feel and try to interpret: Where is the cervix and how open and how thin? How low is the baby, and in what position? Do we feel the amntiotic sac? The fetal head? The posterior or the anterior fontanelle?

I try to remember what Davis wrote, and so while pelvic examinations have become routine for me (though I’m no expert on navigating a baby’s exact GIS location from a suture line), I try to remind myself they’re not routine for the woman.

And more than that: given the stats on sexual assualt in our society, it’s very possible that the woman lying before me has been touched in terrible ways in the past.  I can’t control that, but I can ensure that my touch is thoughtful, deliberate, gentle. Like our teachers say: sensitive & skilled.

Some days I feel like I’m there.

Other days…

Midwifery is a profession where one grows & learns over a lifetime. Those are the lucky professions. But as an adult learner, it can be tough to feel that distance between theoretical knowledge & actual practice skill.

Yesterday I palpated my first breech. I called an experienced midwife over, not yet confident enough to declare the baby breech on my own. She felt the mother’s belly and couldn’t be sure, so we used ultrasound (the midwives here have ultrasound) to confirm the presentation.

Yup, breech.

“That’s my first breech palpation!” I exclaimed. And then remembered the mother on the examining table, the anxiety on her face as she worried over whether her operating room date was about to be booked.

(I’m not a total lout–she was only 33 weeks and a 3rd time mom, which, I quickly assured her, means plenty of time & space for the baby to turn. And: The SOGC [Canada’s ACOG] has recently called for a return to vaginal breech birth.)

Of course, touch isn’t only about assessment. As midwives we also wipe foreheads & rub backs, bend to help a woman slip on her socks, stand tall to wrap a warm blanket around wet shoulders.  

A friend in Edmonton referred to herself as a “doomer.” As in: doomsdayer. I’d never heard the term before, but told her that, since we’d been on the subject, the approaching apocolypse was a reason to like midwifery. While in our current practices we depend on all sorts of technological bells & whistles –from ultrasound to functional ORs–midwifery at its heart is about respecting –even guarding–a natural process and assisting it with touch, words, support.

The Doomer is a Nephrologist.  “Take away my machines,” she said, “and I couldn’t do anything. Anything.”

But sometimes, touch is one of the most important things we can offer.

When I worked at a women’s clinic I followed the nurse’s lead by taking a woman’s hand in my own as an abortion began.

“Squeeze as hard as you want,” I’d tell them, “it won’t hurt me.”

There was one woman whose hand I was reluctant to take–she was so gathered into herself, I didn’t want to violate her privacy. At the same time, I had found that asking only made it difficult for women to say, yes. Better to take her hand, I decided, and judge from her hold whether she needed someone to hang on to or not.

She gripped my hand back. And said to me afterwards: “I was so hoping someone would hold my hand.”

What did this have to do with The Proposal? I can’t remember. I’m just biding my time here, learning from some very wise midwives, hanging around pregnant mothers, occassionally practice-suturing placentas (okay, once, but that’s one date I plan to repeat) and trying to remember as I wait for births to forget about the numbers (we students need to count them, and it can be hard to silence that count) and remember instead that 4 births = 4 wonderful babies.

And it’s the stories behind those numbers that make the caregiver.

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