Saturday, December 1, 2012

Birth Center to Open In Youngstown, Ohio

I haven't blogged much lately because I've been working on a ton of new projects, the most exciting of which is a freestanding birth center in Youngstown, Ohio (What is a birth center?).  Our goal is to provide an additional option besides hospital or home birth to women in the Mahoning Valley.  We are starting the build-out now, and hope to be open very early in 2013.  Please follow the birth center progress on our website!

Tuesday, September 28, 2010

Pieces of Life

When I logged into my blog today, after many weeks of neglecting to post, I was surprised to find how little is actually posted about my first loves: my family and midwifery. Why is so easy to write about laundry detergent (when I loathe doing laundry), and difficult to post about my births (which I love!)?

I guess the reasons are time and privacy. When I'm busy, I don't tend to write as much since I'd much rather catch up on my sleep. I'm pretty involved in my births, which leaves me exhausted! And I can't exactly blab the details of a patient's birth on my personal blog, although I do write about many of them. Most posts never make it past "draft" because I worry that my patients will come across their story while they are recovering at home. To be honest, I think the woman giving birth views her experience very differently than I do, and I think many women would be shocked to hear their birth story from the midwife's point of view: how she did so well, or how that family member was such a distraction in the room. Reading my point of view might only serve to undermine their sense of accomplishment.

Case in point: when I had my last daughter, I gave birth in the standing position. I was thrilled to have this option, and it was the easiest of all my deliveries (despite the fact that I was a Cytotec induction, on Pitocin, almost 42 weeks pregnant.....yeah, we did that back then). Years later, when I was apprenticing with the midwife who delivered her, she told me she thought I didn't get into the bed because I was "freaked out". This was soooo far from what I was actually feeling! I felt a tremendous sense of accomplishment for being able to birth in the position I was most comfortable, and extremely grateful to her for not insisting I do things her way.

I am always surprised at the comments women make a few weeks after their births, when they have processed everything. One patient I delivered in the squatting position seemed to be having some kind of personal crisis as she pushed. I didn't quite get it at the time, but afterward she told me that all she could think about was that her legs weren't as strong as she'd thought, and she was having a hard time maintaining her position! Another woman who wouldn't push AT ALL later told me that her mother told her while she was in labor that she'd had a stroke eight months after one of her births, so the patient was worried that if she pushed something like that would happen to her.

Being in labor is such an emotional time, and it's sometimes hard to judge just why someone is feeling the way they are. I try to keep that in mind as I write about my births, and to be objective. The girl who beat up her boyfriend while pushing must have had something on her mind, but all I can talk about is what I saw!

I'm saving all my drafts in hopes that someday I'll get the nerve to post them. There are some really amazing portraits of some really strong women. I know you'll be inspired by them!

Thursday, August 19, 2010

How To Remove Ink From Clothing

At long last, I've found an easy and cheap way to remove all traces of ink from clothing! This came about because I'm forever putting pens into my lab coat pocket where they either write on the inside of my pocket or pop open and leak all over the place. I've known from my floor nursing days that alcohol will remove ink, but the really big stains that tend to spread need a little more attention.

Today I brought home two of my lab coats to spot clean (we have a service at the office, but sometimes they just need TLC). I poured alcohol over the inky areas, but some of the areas spread and I was afraid to put them straight into the washer. So I poured a little of my homemade detergent on the area and rubbed, and ALL TRACES of the ink were gone!

Now, how to market this.....

Wednesday, July 7, 2010

One Year

I just got home from delivering a baby and was going to change my clothes and head to a swim-meet-in-progress. But my computer called to me, so I sat down and started to write.

Now, I NEVER miss swim meets, but I see that it was almost exactly one year ago today that I was avoiding one to start this blog. The difference is, I'm not feeling any guilt today, because I've been up since 4:30am. Still, I've got to run......

Saturday, June 26, 2010

Homemade Laundry Detergent

I've been using the homemade laundry detergent for a few weeks now, and the results are fantastic! It is especially good at removing "organic" stains: blood, milk.....well, you know. I chose not to put a scent in mine, but I'm still using Bounce in the dryer, and the clothes smell fantastic. Today I decided to break down what I'm saving, and I was pleasantly surprised at the results. The homemade stuff costs about 10% as much. In other words, I'm saving 90% on my laundry detergent! The best part is, I don't have to run to Sam's Club every 3 weeks or so to buy the huge container of Tide.

To get started, I needed to invest in the supplies and the bucket to mix and store the detergent. I bought the smallest quantities I could, but I'm sure I have enough Borax and washing soda to last for years!

Here's a breakdown of what I spent to get started:

  • 5 gallon bucket with lid from Home Depot, $3
  • 5 gallon size paint stirrer from Lowe's (I already had mine, but they're free)
  • 1 bar of Fels Naptha Soap from Giant Eagle, $1.49
  • 1 box of 20 Mule Team Borax from Giant Eagle, $4.39. I'm sure I could have gotten this cheaper if I'd have shopped around.
  • Washing Soda, $9.99. I couldn't find regular Arm and Hammer Washing Soda, so I bought pure sodium carbonate in the pool section of Home Depot.
  • An old, empty detergent bottle, about 2 quart size
    TOTAL: $18.87

Next, I mixed up a batch of detergent, which took about 30 minutes or less. The kids helped, since I'm sure they thought I was crazy. I got the recipe from the book "The Duggars: 20 and Counting".
  • 1 bar Gels Naptha soap, grated (on your kitchen grater) ($1.49)
  • 1 cup washing soda (83 cents)
  • 1/2 cup Borax (24 cents)

Grate the soap bar into a small saucepan. Cover with hot water. Cook over medium-low heat, stirring continually, until the soap completely dissolves.

Put washing soda and borax in a 5-gallon bucket. Pour in the hot, melted soap mixture. Stir well, until all the powder is dissolved. Fill the bucket to the top with more hot tap water. Stir, cover securely, and let set overnight. The next morning, stir the mixture. Mix equal amounts of soap concentrate and water in a smaller laundry-detergent dispenser or container. Shake before using.

Top loading machines: use 1 cup of mixture per load
Front loaders: use 1/3 cup per load *this watery gel is very low-sudsing

One fun thing I found is that this is an excellent stain remover when used full-strength. Just pour a little on the stain and rub it in, as you would with Shout. I also used a little to soak some badly stained items and it worked like a charm. I read online that Fels Naptha is kind of the original fabric stain remover. It used to be made with Benzene (which causes cancer and is harmful to unborn babies), but that ingredient is no longer included.

COST PER BATCH: $2.56 (makes 10 gallons). If you use 1/3 cup per load, cost is about 1.4 cents per load.

Compare to Tide HE: the big jug at Sam's Club is around $18, and does 120 loads. That's a cost of 14 cents per load.

So, I'm saving here, and making one less trip to Sam's Club (hooray!).

Sunday, June 20, 2010

What Does a Midwife Do?

It seems that no matter how much progress we nurse-midwives have made over the past half-century, there are still those who have no idea what we really do. The very word midwife conjures up ideas of old, uneducated women who attend births in the dark corners of society. Despite the fact that I have a professional place of practice and privileges at two hospitals, I am still asked all the time whether I deliver babies at home, and am dismissed by those women who who assume they can't have an epidural if they want one while in labor.

So what does a nurse-midwife do?

First of all, we care for pregnant women, and deliver babies. We provide complete prenatal care from the time of conception through the postpartum period. The prenatal care I provide is very much like what is provided by a regular obstetrician: vitamins, regular prenatal visits, ultrasounds, lab work, and so on. However, we believe that pregnancy and birth are natural processes that usually don't need intervention. Read more about the midwifery model of care. I usually spend a very long time with my patients, offering emotional support and making sure they know the best way to care for themselves during pregnancy. I explain all the tests and procedures that have become standard during pregnancy, so that my patients can make truly informed decisions about what is done to them. When it comes time for delivery, they have a lot of choices in how they birth. I help them to understand what those choices are, and the implications of those choices. If they don't want pain medicines, I will be there with them and support them throughout their labor, encouraging them and letting them know what a good job they are doing! And if they choose to have an epidural, there's no judgement from me. After all, it's not my birth, it's theirs.

We manage obstetric complications. This is actually why we go to school. While in most cases pregnancy and birth go pretty smoothly, the reason you have someone attend your birth is to manage any complications that arise. I tend to be very low intervention, so if nothing goes wrong, I'm likely there just to monitor the baby's heartbeat and encourage you, rub your back, help you change positions. If a complication develops, I'm trained and experienced to handle most things: hemorrhage, stalled labor, dips in the baby's heartbeat. If there is an emergency, I have a relationship with a physician, and I will consult and refer as necessary. The State of Ohio requires this written agreement, and it helps provide a smooth transition of care.

We care for women throughout the lifespan. This means that from adolescence through menopause, we offer regular gynecologic care including PAP tests, contraception, and treatment of gynecologic problems.

We have superior outcomes. Really! When compared to physicians with low risk patients, midwives with the same types of patients had better outcomes Cochrane review. Patients who use a midwife are more likely to feel in control during labor, and to have a spontaneous vaginal birth. Midwives have fewer C-sections, fewer epidurals, fewer episiotomies, fewer medicated births, and even in high risk populations, fewer low-birthweight babies (Obstetrics & Gynecology 1990;75:341-345).

We provide primary care, which means that we diagnose and treat common health problems. To accomplish this, we order lab work and other diagnostic tests, and prescribe medications. We are advanced practice nurses who can treat a wide range of problems, from strep throat to bladder infections to asthma. We consult and refer to other physicians and specialists as necessary.

Our practice is evidence-based. This means we are continually reviewing the best research and learning from it.

So now you know what I do, too! But please feel free to ask if you've got more questions. I'll talk your ear off about it!

Tuesday, June 15, 2010

Quilting Tuesday

Today I am letting the housework wait for me (as it always does). I have a day off from the office, and I'm dying to get in touch with my creative side. Daughter#2 has been wanting to start a quilt for her bed, so I dug out my old tools, and in the process found the quilt for which said tools were purchased.

This is actually the first quilt I ever pieced, and never got around to properly finishing. I started it in the summer of 2001, when Baltimore Sister was pregnant with Boy#2. I thought the quilt top came out pretty well! I even started to machine quilt it, but I either got bored or busy, or ran into something I couldn't conquer at the time, and it's been packed away ever since. Sheesh, that was another house and another lifetime ago, it seems.

At any rate, I've really never been taught to quilt, so I went to the Great American Teacher (youtube) and watched a bunch of how-to videos. Then I purchased a $30 darning foot for my sewing maching, plopped the machine down on a table in the (waiting-for-me-to-clean-it) basement and voila! Quilting!

OK, ok, it's not great. That stippling thing looks much easier on screen than it actually is. My "meandering" looks a little hesitant, and you can tell every point at which someone started talking to me, because that's where my curvy lines take a sharp turn. It's too bad there aren't any videos that tell you how to make your stitches uniform, because mine range from microscopic to gigantic.

I'm sick of stitching for today, but I do plan to practice some more on this quilt while we finish piecing Daughter#2's quilt. Maybe I'll be pretty good at it by the time we're ready to quilt hers. After all, the housework will wait as long as I'll let it!

Thursday, June 10, 2010

Don't try this at home

Well, I'm trying to be frugal and earth friendly. So I've made my own laundery detergent and make-up remover wipes, and I was trying to make my own dishwasher detergent. I found quite a few recipes online, most of which called for either washing soda or baking soda mixed with equal parts salt and borax. Easy enough, but most of the blogs said that this may cause a film on your dishes, which could be corrected with citric acid. No problem! I already use citric acid in the dishwasher for exactly that reason!

So, apparently ignorant of the most basic laws of chemistry, I mixed equal parts of washing soda, salt, and boric acid with half as much citric acid. It clumped up in the container, so I added some warm water, put on the lid, and shook it up. As I started to shake it up, the container started to expand, so I shut my eyes and started to loosen the lid. Before I could get the lid off, KABOOM!! The container exploded all over me and all over the kitchen. The ceiling fan was drenched! My kids were crying and asking if I was alive and if I could see. I hadn't even considered blindness until they brought it up, then I was afraid to open my eyes!

I can still see, and I guess this is a lesson learned. Don't try this one at home!

Monday, May 31, 2010

Memorial Day

Happy Memorial Day! Today we are remembering those who gave their lives in service to our country. I am especially blessed to have my own son home from West Point today.

I thought I wasn't going to be able to celebrate with my family, since I have three patients who are over-due. They are all first-time moms, and I can't believe they aren't begging me to induce them. In fact, I scheduled one to be induced this evening and she doesn't want to!! She prefers to wait, which I support, since the average gestation for a white primapara is 41 weeks and 1 day. However, I did have to review the risks of post-term pregnancy with her, and we have to do fetal surveillance in the form of non-stress tests and biophysical profiles (ultrasound to measure amniotic fluid, fetal tone, etc.).

To make a long story short, I am home with my family today, and we had the chance to bake some cupcakes and see a family movie. Here's some pictures of the cupcakes we made. We even made the flags, which were printed from this website, cut, and glued to toothpicks.

I used my famous chocolate cake recipe, which uses only ingredients everyone has on hand; no eggs.

Double Dare Chocolate Cake

3 cups flour
2 cups sugar
1/2 cup Hershey's cocoa
1 tsp. salt
2 tsp. baking soda

Stir these dry ingredients together with a whisk.


2 tsp. vanilla
2 tsp. cider vinegar
1 cup vegetable oil
2 cups cold water

Mix with electric mixer.
Pour into greased and floured 9 x 13 insulated pan. Bake at 350 degrees for aboput 50 minutes. Check with toothpick. 24 Cupcakes: bake for 22 minutes.

I modified my white icing recipe and the results were fantastic! Here is the modified recipe:

White Icing

3/4 c. Crisco shortening (I don't have good results with generic)
2 TBSP. margarine
Salt: very generous dash(es), probably about 1/8 teaspoon. Don't omit this!
6 cups powdered sugar
1 tsp. vanilla

Mix together with electric mixer until very well mixed.

4 TBSP. milk

Continue mixing until very light and fluffy. Mmmmmmmmm!!

Friday, January 29, 2010

I'm a Not-So-Faithful Blogger

One of my new patients this week mentioned that she'd seen my blog.

My what????!!!!!

OK, so it's been awhile since I've blogged. (Is six months really that long?) I guess my life has been so crazy for the past few months, I forgot I had a blog! It would have really come in handy a few times when I needed to vent, or at Christmas when I wanted to share my theory of why I think the Virgin Mary had a midwife present at Christ's birth.

Those of you who know me personally are aware that the past few months my life has literally been on fast forward. I've had some major life changes, and am just beginning to catch my breath! Where do I start?

First of all, I have a new employer. Dr. McClusky decided to close his practice on October first, and he took a job at the clinic at St. E's. He wanted me to join him there, and St. E's made me an offer, but I would have been seeing patients in the clinic full-time, and not doing deliveries. Before he made the announcement, I had a feeling something might be on the horizon for him, so I had already been interviewing out-of-town since spring. I had a few nice offers, all of which included uprooting my family and abandoning my pregnant patients, and I had become pretty discouraged by the time Dr. M. made his official announcement. I just prayed and prayed, and one Sunday I had a delivery at North Side Hospital. My labor nurse was Pam, who is a nurse practitioner in Dr. Canby's office during the week and works in labor and delivery one day on the weekend. I kept thinking of her and Dr. Canby all that evening, and wondered aloud to Rich if I should ask her if she was interested in hiring a nurse-midwife. He pretty much commanded me to call her the next day, and the rest is history! She hired me that week and I started the day after Dr. McClusky's practice closed. It is a match made in heaven, I think! I became very busy very quickly, and I am sooooo happy there.

The rest of my business has been all about the kids. We visited some east coast colleges at the end of summer, and I spent nearly every day in the fall begging son#2 to finish his college applications. He's been accepted at three places he applied; we won't hear about the others until April. We also took a trip to Philadelphia in early December for the Army-Navy game (you may recall my emotional blog last year when I was forced to miss it?). The game was exciting until Army fell behind, and I was a little emotional watching all those cadets march on at the beginning of the game. Of course, winter swim season has also begun, so I've been doing my best to get to practices and meets. This year I have two high school swimmers as well as one on the Y team.

Altogether, these have been positive changes, and I'm starting to relax a little and settle into a routine now. Yesterday was the first time in months I touched my scrapbooking stuff. I got the swimming pages done for this year, so now perhaps I will find some time to blog!

Thursday, July 16, 2009

Just in time? Maybe...

On Leap Day 2008, I had the privilege of delivering the seventh child of a local couple. The woman chose me to provide her prenatal care and attend her birth because her previous ob-gyn had missed the delivery of the last two of her children. It wasn't that her labors were too fast: She labored for hours under the careful supervision of the nurses, but they didn't call for the doctor until she was almost fully dilated.This situation is actually very typical in modern labor wards, and it brings up an interesting difference between obstetricians and nurse-midwives. Generally speaking, nurse-midwives make it their business to be present during a woman's entire labor and birth. Obstetricians, by contrast, are called when the woman is ready to push. While it is true that in a hospital situation there are nurses who are watching the monitor, and will offer support if they are able, they usually have other patients to attend to besides you. So why doesn't everyone choose a midwife? Many women fear that by choosing a nurse-midwife, they will not be able to get pain medication during labor. This simply isn't the case! Patients of nurse-midwives can have IV narcotics and epidurals just as patients of ob-gyn's. However, many women who choose a midwife do so because they feel that the extra support during labor will be enough to get them through the experience without pain medication.

Thursday, July 9, 2009

On time delivery

My friend Shannon shared this with me last night:

A nurse in labor and delivery was checking a young expectant mother. "Is this your first baby?" the nurse asked.
"Yes," the mother-to-be answered calmly.
"Are you having any contractions or pressure?"
"Are you having any discomfort?"
The nurse was perplexed. "If you don't mind me asking," she said, "why are you here?"
"Because today is my due date!"

Making a Choice

Every decision you make - every decision - is not a decision about what to do. It's a decision about Who You Are. When you see this, when you understand it, everything changes. You begin to see life in a new way. All events, occurrences, and situations turn into opportunities to do what you came here to do. ~Neale Donald Walsch

A friend of mine sent me this quote a few weeks ago, as encouragement about a business decision I am making. Simultaneously, I am preparing for my child to receive a new treatment for a chronic illness. As I've reflected on my decision over the past few days, I realize it begs the question: What are the circumstances and decisions that shape my ability to choose healthcare for my child?

First and foremost, I am a mother. I love my children, and I want the best for them. When I found out my child had a potentially life-threatening disease, I was absolutely devastated. While I'd watched his health deteriorate for months, I did what mothers do best: kept him in the best possible state for nature to help him heal. I dressed his wounds and dosed his medicines, all the while praying and hoping that his situation was temporary. After four long months, he was finally diagnosed with severe Crohn's disease, and although I'd already pretty much assumed that is what was wrong with him, I was devastated. I did everything I could to learn about the disease and the possible treatments for it. I made myself crazy reading not only everything posted on the web, but also peer-reviewed academic journals.

I am grateful that as a nurse, I'm a part of the health care system, as I am able to understand complex information about the disease and I'm connected to people with expertise. But as a midwife, and a person who is passionately believes in non-intervention, I have also sought out alternative medicine gurus and read every crackpot cure out there. We put him on an elemental diet, made sure he had nothing artificial, eliminated everything from his diet that we thought would aggrevate his symptoms. We gave him probiotics, put him in the sun, force-fed him vitamins. Still he lost weight. His wounds didn't heal. His hemoglobin dropped to 7.

As a human being, I couldn't avoid hearing advice or opinions from literally every person I know. I've been asked prying questions about our heritage, our family medical history. Did I breastfeed? For how long? Did we vaccinate him? Did we use antibacterial soap? A friend insisted that he had celiac disease (her mother had it: same symptoms!!). Another suggested it was his nerves. Everybody knows somebody who was healed of Crohn's by taking vitamins, or visiting the Dead Sea, or stopping white flour, or getting accupuncture. A Shaklee salesperson kept me on the phone for an hour, insisting that she was cured of Crohn's by taking $300 worth of vitamins a month. My sister bought them for me.

Yet, none of those things made my child better. For four years we tried everything, and began adding medication after medication as he had exacerbations. At one point, he was on over 20 pills a day. When he finally developed a small bowel obstruction (while on steroids and Imuran), our doctor had a talk with me. " I know you don't want to do this, but I think it's time to consider Remicade."

More journals, more research. More advice. A friend who had a reaction. "You know, it causes cancer." My head spinning.

I've reviewed the options, and come to the only conclusion that makes sense to me. Those other things aren't working. I've done my due diligence. I've tried everything natural, I've allowed the doctor to step up the meds only when necessary, I've done everything in my power to help him heal. And he isn't. So it's time to try something else, something that's got the evidence to back it up, but something that's outside my comfort level.

The midwife in me says it's time to intervene. The nurse in me says it's time to try an evidence-based approach. The Christian in me is grateful that God has allowed a treatment that looks promising. The mother in me says I love him too much to watch him suffer.

It's time.

Wednesday, July 8, 2009

The worst. mom. ever.

If you have never had a kid on the swim team, stop reading. You will never be able to sympathize with the early morning practices, the endless meets, the drama! You won't be able to comprehend the bone chilling cold that occurs during the Ohio summer, when the sun goes down and your wet 10-year-old hops onto your lap in an attempt to thaw. You won't understand the drain on your wallet, one dollar at a time, as your child attempts to recover calories at the snack bar that he/she has lost during a race.

I, however, cannot miss a moment of the excitement. I rise every morning at the crack of dawn to cajole my children out of their warm beds and into their damp suits. I pad their palms with dollar bills and fill their gas tanks, so they can spend their summer mornings in the swimming pool. I dutifully go to work each day so that I can buy pool passes, and swim suits, and caps and goggles. And more goggles. And then more goggles.

I arrive at the swim meets at 4:45pm every Wednesday (well, 4:55pm), and I weave my way through the sea of chairs and blankets, picnic coolers and wet bodies, until I find a space on the (always damp) grass where I can place my chair. I sit close to other parents we chat mindlessly until a child, who has long since passed the age where they can comfortably fit on a lap, plops their wet frame on top of me and asks for money. I oblige, knowing they will disappear only until they are hungry, or cold enough that they need to find the lap once again. I do this each and every week, all summer long, no matter the weather. When it rains, we stand at the side of the pool and cheer, hoping silently that we will see a flash of lightning.....the absolute only thing that will stop a swim meet.

Despite this level of committment, I made a major faux pas tonight. **gasp** I missed 30 minutes of the swim meet. I will make no excuses: I wanted some time to myself. The meet was very close to my house, and I dropped the kids off for warm-ups while I went home to do nothing at all. I surfed the internet, answered some e-mails, and blogged a little while waiting for my husband to come home from work and go to the meet with me. Although the meet was slated to start at 6pm, I didn't even leave the house until 6:20pm.

By 6:30pm, all three of the kids had called me from their cell phones, and I came to the most amazing realization: They need me! They do know when I'm not there! They do care if I'm present! They need my money!! And I am the worst. mom. ever.

Blogging: Why do we love it?

I've decided to try my hand at blogging again, just as I've started a diary a few hundred times in my life. And while I love reading the blogs of others, I have to ask myself just why people want to share their private lives with the world? Why do people think anyone would enjoy anonomously creeping about, soaking up the frustrating details of someone else's mundane life? Why do they think anyone would spend hours secretly reveling in the fact that the life they read about is more screwed up than their own?

I've blogged briefly in the past (perhaps you saw those??), and when I read over them, I realized my life is decidedly mediocre, considering I have so many kids and a rockin' profession! I've blogged about my practice, and I would love to share the juicy tidbits and heartfelt stories I hear from patients every day. What limits me there (besides HIPPA) is the fact that whenever there is a really interesting detail, there will be a mother, a sister, a friend who will recognize the story. I've written about my children, but do you really want to keep hearing that I have the best kids in the world? I guess my favorite use for my blog is to sound off about the kinds of problems everyone has---a crappy schedule, spouses or colleagues who don't appreciate me, teenagers who think I'm an ATM, and the insane busy-ness that all moms feel at one time or another. By publicly ruminating on these details, I've come dangerously close to offending friends, family and co-workers alike. But when I seriously contemplate this, I realize that perhaps blogs can be a delightfully passive-aggressive way to bring them back in line (with my point of view) once again.

Of course, that's not the purpose of my blog, but then again, does it need a purpose? I think I'd just like to just entertain you with yet another imprudent opportunity to gaze into my life.