Archive by Author | anne_sokol

four births in 16 days

One of the requirements of training/experience that we’re to fulfill is that of having “continuity of care” clients. These are clients where we do most of their prenatal care, attend their births, do the newborn exam, the postpartum follow-up, etc. It’s quite a bit of work to plan around.

Back in Sept-Oct, I carefully choose 3 women to approach for this, and I was offered a fourth. They were all due in February, each due in each of the weeks of February. So for months, I’ve been meeting with them and anticipating the month of February. So, with their due dates, I was on call from the last week of January through the middle of March.

That’s a long time for me to listen to the rings and dings of my phone, which I usually have on vibrate.

So for months, I’ve been anticipating this month, a long, marathon month of being on call, attending births at any time of the day/night, and doing then all the scheduled follow-up.

And now, February 22, it’s all over. All four births happened in a 16-day time period! Only the follow-up visits are left, and those are already starting to space out nicely. No one was transferred which was a minor miracle. I’ve been praying for these births for all these months, each woman by name.

I want to remember one set of a 3-day marathon–day one, labor, day 2 a birth around 1am, then working prenatals in the morning, then class in the afternoon, then another birth just before midnight. Wow. Midwife life!

It’s been a special month! <3 I’m thankful for God’s timing and help! I’ve not gotten much school work done with all the distraction, but I’ve sure gotten a lot of other special things done 🙂

Thank you, Lord.

2023 and midwifery

This was a great year for midwifery. Looking back over it gives me a lot of fulfillment, even though it was emotionally probably the worst year of my life.

So in 2023, I worked 42 prenatal shifts and 125 birth room shifts (that’s just over 1000 hours in the birth room)–this involves many things: labor care, births, newborn exams, giving injections, and baby meds, charting, filling out birth certificates, doing the newborn screening, postpartum checks galore, and a few other details I’m forgetting.

I also worked in the well-woman area 4 times learning to do Pap smears and gram stains on my own.

I certified in CPR in July and was later moved, along with my class, into primary roles. It feels wonderful to have gone from such incompetence to feeling more comfortable with the myriad of skills we need to learn.

Advent Scripture readings

ТИЖДЕНЬ 1: НАДІЯ

Рим. 15:12-13 “І ще каже Ісая: Буде корінь Єссеїв, що постане, щоб панувати над поганами, погани на Нього надіятись будуть! Бог же надії нехай вас наповнить усякою радістю й миром у вірі, щоб ви збагатились надією, силою Духа Святого!”

Іс. 11:1-5 “І вийде Пагінчик із пня Єссеєвого, і Галузка дасть плід із коріння його. І спочине на Нім Дух Господній, дух мудрости й розуму, дух поради й лицарства, дух пізнання та страху Господнього. Його уподобання в страху Господньому, і Він не на погляд очей своїх буде судити, і не на послух ушей Своїх буде рішати, але буде судити убогих за правдою, і правосуддя чинитиме слушно сумирним землі. І вдарить Він землю жезлом Своїх уст, а віддихом губ Своїх смерть заподіє безбожному. І станеться поясом клубів Його справедливість, вірність же поясом стегон Його!”

Іс. 7:10-14 “І Господь далі говорив до Ахаза й казав: Зажадай собі знака від Господа, Бога твого, і зійди глибоко до шеолу, або зійди високо догори! А Ахаз відказав: Не пожадаю я, і не буду спокушувати Господа. І він сказав: Послухайте, доме Давидів, чи мало вам трудити людей, що трудите також Бога мого? Видадуть пах мандрагори, при наших же входах всілякі коштовні плоди, нові та старі, що я їх заховала для тебе, коханий ти мій! Тому Господь Сам дасть вам знака: Ось Діва в утробі зачне, і Сина породить, і назвеш ім’я Йому: Еммануїл.” 

Іс. 9:2, 5-6 “Бо Дитя народилося нам, даний нам Син, і влада на раменах Його, і кликнуть ім’я Йому: Дивний Порадник, Бог сильний, Отець вічности, Князь миру. 6 Без кінця буде множитися панування та мир на троні Давида й у царстві його, щоб поставити міцно його й щоб підперти його правосуддям та правдою відтепер й аж навіки, ревність Господа Саваота це зробить!” 

Єр. 3:14-16 “Верніться, діти невірні, говорить Господь, бо Я вам Господар, та візьму вас по одному з міста, а з роду по два, і вас поведу до Сіону! І дам пастирів вам згідно з серцем Своїм, і вони будуть пасти вас умінням та розумом. І буде, коли ви розмножитеся та розплодитеся на землі за цих днів, говорить Господь, не скажуть уже: ковчег заповіту Господнього, і він вже не прийде на серце, і його пам’ятати не будуть, і більше не буде він зроблений…”

week 2: Preparation: Лк. 3:4-6, Михей 5:2; Мт. 2:1-12
Week 3: JOY: Лк. 2: 7-15, Рим. 15:4-13, Мт. 1:18-25, Лк. 1:26-38
Week 4: LOVE: Иоанна 3:16-17. Иоання 1:1-3, 14, Лк 21:25-36, Еф. 2:12-22
Christmas Day: Псалом 100, Лк 2:8-20, Отк. 3:20-21.

тиждень 2 підготовка

“як написано в книзі пророцтва пророка Ісаї: Голос того, хто кличе: У пустині готуйте дорогу для Господа, рівняйте стежки Йому! Нехай кожна долина наповниться, гора ж кожна та пригорок знизиться, що нерівне, нехай випростовується, а дороги вибоїсті стануть гладенькі, і кожна людина побачить Боже спасіння!” Лк 3:4-6

Михей 5:1 (5:2) “А ти, Віфлеєме-Єфрате, хоч малий ти у тисячах Юди, із тебе Мені вийде Той, що буде Владика в Ізраїлі, і віддавна постання Його, від днів віковічних.”

Мт 2:1-12 “Коли ж народився Ісус у Віфлеємі Юдейськім, за днів царя Ірода, то ось мудреці прибули до Єрусалиму зо сходу, і питали: Де народжений Цар Юдейський? Бо на сході ми бачили зорю Його, і прибули поклонитись Йому. І, як зачув це цар Ірод, занепокоївся, і з ним увесь Єрусалим. І, зібравши всіх первосвящеників і книжників людських, він випитував у них, де має Христос народитись? Вони ж відказали йому: У Віфлеємі Юдейськім, бо в пророка написано так: І ти, Віфлеєме, земле Юдина, не менший нічим між осадами Юдиними, бо з тебе з’явиться Вождь, що буде Він пасти народ Мій ізраїльський. Тоді Ірод покликав таємно отих мудреців, і докладно випитував їх про час, коли з’явилась зоря. І він відіслав їх до Віфлеєму, говорячи: Ідіть, і пильно розвідайтеся про Дитятко; а як знайдете, сповістіть мене, щоб і я міг піти й поклонитись Йому. Вони ж царя вислухали й відійшли. І ось зоря, що на сході вони її бачили, ішла перед ними, аж прийшла й стала зверху, де Дитятко було. А бачивши зорю, вони надзвичайно зраділи. І, ввійшовши до дому, знайшли там Дитятко з Марією, Його матір’ю. І вони впали ницьма, і вклонились Йому. І, відчинивши скарбниці свої, піднесли Йому свої дари: золото, ладан та смирну. А вві сні остережені, щоб не вертатись до Ірода, відійшли вони іншим шляхом до своєї землі.”

Exercise in pregnancy

Exercise during pregnancy 

Regular exercise is important at all stages of life. When you’re pregnant, regular, moderate exercise can help you feel better and enhance your social life; it can possibly help your labor go faster; regular moderate exercise can also lessen your chances of labor interventions, of needing a C-section, or of experiencing preterm delivery.   

 Here are a few guidelines I’ve gleaned that you can add to your own common sense. And during our prenatal visits, let’s talk about what kinds of activities your already doing or might want to try.   

 Guidelines:  

  • Be sure you’re adding calories, water, and nutrition to your diet if you’re exercising.   
  • Warm up and cool down; include gentle, careful stretching when you cool down.   
  • When rising from the floor, go slowly.   
  • Walking and swimming are good forms of exercise.   
  • During pregnancy, avoid scuba diving and exercising at very high altitudes.   
  • Don’t exercise to exhaustion, stop if you get tired. While exercising, your own sense of how you feel is the best judge what is enough or too much. During pregnancy, don’t push yourself to achieve higher goals, rather, use exercise as a form of supporting yourself.   
  • Don’t lie on your back to exercise. Don’t pull yourself up using your abdominal muscles.   
  • Go gently. Avoid exercises that require jumping, jerky motions, speed, etc. The pregnant body has a different load balance because of the heavy uterus, so move carefully. Be careful of your muscles, tendons and ligaments—pregnancy is a special time when hormones loosen the joints, and having a heavy uterus can strain the body and alter the posture in specific ways.   
  • No exercises that might cause abdominal trauma or can cause you to fall.   
  • No exercises that require you to hold your breath and bear down.  
  • Stop immediately if you feel unusual sensations or pain.   
  • 30 minutes of moderate exercise (like walking or swimming) a day is a good amount. Don’t overdo.   
  • Stop exercising and re-evaluate your situation with your midwife or doctor if you are spotting, if your cervix is opening preterm, or if your baby is not growing normally.   
  • Don’t exercise if you have a fever.   

Sources:  

Frye, A. (1998). In Holistic Midwifery: Care during pregnancy (2nd ed., Vol. 1, pp. 262–264). essay, Labrys Press.  

Sinclair, C. (2004). In A midwife’s handbook (pp. 47–48). essay, Saunders. 

newborn bath

Bathing your baby

You can think through when and how you want to bathe your baby. Some parents like to wait days or weeks, so the vernix remains on the baby’s skin as that is also considered healthy and protective. Others like to put the baby in the herbal bath that the mom takes in the first few hours/day after birth. You can think through beforehand what you’d like to do, or just decide in the moment, it’s up to you. I’ll explain here basic information about giving the newborn a bath.

I’d like to start by saying that I personally think it’s important to have a peaceful bathing experience, for the whole family. This is not something worth arguing over or forcing. If you or the baby enjoys bathing, that’s great. If not, you might want to try calming elements, like bathing the baby with you, or using a different tub setting. Or not bathing that frequently if it’s distressing. Babies are very different from each other and they grow quickly—what they dislike one month might be what they love the next.

Basic bathing instructions:

Items you need or might want to have on hand: warm water, baby bath or regular tub, washcloth (optional), soap (optional), herbal “tea” to use in the water (optional), clean towel or two, diaper and clean clothes ready.  Free up your time so you’re not rushed; your constant presence with the baby in the water is essential. Don’t leave babies in the bath by themselves or with a sibling who’s not ready for that responsibility.

Simple baby baths just need some kind of tub and warm water. But sometimes it’s fun to add in natural skin care (like an herbal soap) or herbal teas to add to the water (that are already prepared and cooled down).

If you buy a baby bath, the ones with the backs tilted up are really comfortable so the baby can sit up and it’s easy to run water over the baby. If your tub is a flat baby tub or an adult tub, you can consider putting in about 2 inches of water and letting the baby lay in it flat and you keep a hand near their face, not allowing to turn to the side all the way and get their mouth/nose in the water. Babies often love relaxing in the water.

Also, you can consider making a bath for yourself and just having someone hand you the baby. You can spend time letting the baby float around while you support him, and also have the baby lie on your breast with you. All the while, you gently wash him. There are lots of ways to bathe a baby.

It’s important that the baby not get overcooled during the bath. So make the room warm, if possible. (If the room air is cold and you need to bath the baby, consider a washcloth bath, not uncovering the baby all the time and drying off the body part right after as you clean it.)

The water needs to be a good temperature, not too hot nor too cold. If the bath takes a while, add more warm water to keep the temperature warm enough.

Herbs to consider using are chamomile and calendula. There are many other options, so if this interests you, look online! I’m sure you can buy premade mixes also. Follow their instructions, or just make it up as a tea, let it cool off, and add it to the bath water.

If you need a systematic way to start off with baths, here’s a step-by-step method that made a lot of sense to me. When you first put the baby in, the water is cleanest, so use some of the water to rinse the baby’s face. Using soap on the face might get into the eyes, so just water is fine. If you have a washcloth, you can just wipe the face: over the eyes, the nose, forehead down the cheeks, under the nose and over the mouth.

 For the rest of the body, you can use soap if you want to use soap. I usually go from the neck down, making sure to get into the creases—neck, arms, legs. Gently wash the genitals and the bottom crease, not being invasive. The legs are usually easy to wipe downwards. I usually soap one part, then rinse that part off. Then, I turn the baby over on one hand and soap/rinse the back.

I pay more attention to the hair, as this usually has a lot of dried fluids and particles from the birth. I wet it, then soap it. I try to be very gentle so the baby likes it, and I spend time massaging out all the things in the hair. I may rinse-soap, massage, rinse-soap-massage-rinse a few times. I make sure to get around the ears and then the back of the head, too.

If you want to have a heating pad on low setting under the towels, that is a nice touch. Get the baby out, covered in a towel, and dry quickly. I dry from the hair down, and sometimes I use two towels, the first to get the bulk of the wetness off and the second for the baby to lay on while I finish drying and putting on the clothes. Drying the hair well can be important, as babies lose heat through their heads.

Putting some kind of healthy natural oil (olive, coconut, etc.) on the bottom helps while the baby is passing meconium, as the mec tends to stick a lot. Putting it under and on the male scrotum, too, helps to make it easy to wipe off.

When not to bathe the baby: if the baby is sick or cold or there is some other common-sense reason that it’s better not to bathe him, there’s no harm in waiting. You can always use a damp washcloth to deal with something troublesome. If you don’t have access to clean water, consider using store bought wipes.

Grace, A. (2022, May 18). I’m not washing my baby for a month because it’s healthier – if gross. New York Post. https://nypost.com/2022/05/18/im-not-washing-my-baby-for-a-month-because-its-healthier-if-gross/

Heidi. (2021, September 27). DIY herbal bath for babies. Mountain Rose Herbs. https://blog.mountainroseherbs.com/baby-bath-herbs

Lund C. Bathing and Beyond: Current Bathing Controversies for Newborn Infants. Advances in Neonatal Care : Official Journal of the National Association of Neonatal Nurses. 2016 Oct;16 Suppl 5S:S13-S20. DOI: 10.1097/anc.0000000000000336. PMID: 27676109.

Хто я як акушерка?

Існують різні види акушерок, і це добре, якщо ми чесні перед собою та нашими клієнтами щодо того, ким ми є та своїх можливостей.

Частиною навчання є вивчення того, ким я є як акушерка, примірка та/або спостереження за різними типами акушерок і акушерства. Це передбачає постійну оцінку мого стосунку з медикалізацією багатьох життєвих процесів.

Сьогодні я змогла висловити частину своїх особистих цінностей як акушерки.

Я хочу бути акушеркою, яка розвиває наш зв’язок із Богом і Його творінням, а також шанує медичні методи лікування, розроблені завдяки Божій укріплення для людства.

Who am I as a midwife?

There are all kinds of midwives, and that’s a good thing as long as we’re honest with ourselves and our clients about who we are and our capabilities. Part of schooling is exploring who I am as a midwife, trying on and/or observing different types of midwives and midwifery.

This involves a constant evaluating my relationship with the medicalization of so many life processes.

So today I was able to express a part of my personal values as a budding midwife.

A midwifery that cultivates and preserves our connection to God and His creation yet honors the treatments of medicine that God has enabled men to develop.

Newborn crying and colic

This post is based off of a midwifery school assignment.

Crying is a communication tool, one of the few that babies have. It is vital to understand that newborns and babies do not have the rational capacity to perform manipulative behavior; train your mind and heart to accept their crying for what it is, a cry.

For most infants, crying is normal and is fairly easy to soothe. Not so long ago, your baby was warm, hugged and held (by the womb), hearing the soothing sounds of his mother’s heart beat and whooshing water around his ears, muted voices. He never experienced hunger or uncomfortable diapers or clothing, injections, loud noises, feeling cold, alone, or even something as simple as an itch somewhere on the skin.

They are also developing awareness and brain development at a stunningly rapid pace. This causes its own good and bad stresses for the baby.

Let’s think of some common reasons a baby might cry. He feels hunger (breastmilk digests quickly), his diaper is dirty, he’s tired and can’t control his limb movement; he instinctively understands that he should not be alone and needs to be held, a loud noise or a jostle scares him, he has an earache or other sickness that causes pain.

With observation, parents learn to differentiate why their baby is crying—one type of cry is for hunger, another for sickness, another for fear. It’s helpful to learn the pre-crying cues that baby is hungry—turning head to the side, sucking on fist, and mouthing sucking motions are common hunger signals. Responding quickly to babies’ cries can minimize crying and facilitate good communication skills between the parent and their child that can last a lifetime.

Holding your baby actually induces a state of calm in the baby. His heartbeat automatically slows down and it physically relaxes his muscles and nervous system.

We’ll discuss colic below, but first, here are cries and conditions that should be immediately evaluated by a doctor:  

  • A high-pitched, catlike wail (especially when the baby is also jaundiced)
  • Any strangely high-pitched or low-pitched crying
  • Persistently weak crying
  • Crying that doesn’t stop for 2 hours no matter how you try to soothe, feed, or comfort
  • Crying when you hold, touch or move the baby
  • If your baby looks or acts in a way that is abnormal
  • If your baby has a temperature over 38.0
  • If your baby won’t feed (or only very little) for 8 hours or more
  • If you baby vomits in a way that is unusual, persistent, or projectile
  • If the baby has a bulging or swollen soft spot or a swollen groin area

These can be emergency situations. When there are crying questions that are non-emergency, check the baby’s weight gain, that it is normal. Observe if the baby is spending long periods of the day content and alert (rather than lethargic, overly sleepy, weak, and fussy). Observe any inconsolable crying if it occurs more than 3 times a day, or if you can comfort the baby but it’s unclear why the baby is crying. It’s best to write down the date, time, describe the crying, how long it lasts, and any activities or “symptoms” that accompany the crying, so you and the pediatrician can look for patterns or possible causes.  

Colic

Colic is hard to define, and its cause is still unknown, though we are still guessing and trying to find ways to soothe these babies and provide parents with relief. Advice for treating colic is contradictory, so open yourself up to learning possible relief methods and trying them safely to see if they work or don’t work for you and your baby. Colic is a frustrating topic for parents and caregivers alike, so let’s take a deep breath and calm ourselves, especially if we have a colicky baby or if we’re around someone who does.  Even if our own baby is not colicky, let’s give understanding and support to parents who experience this.

How colic is defined:

  • The infant is less than five months old;
  • The infant has prolonged (3 or more hours consecutively or in a 24-hour period) repeated (at least 3 times in a 7-day period) times of crying/fussiness that is not soothe-able nor preventable and has no other symptoms or obvious cause;
  • The infant has no other symptoms like fever, illness, failure to thrive, etc.  

The pediatrician needs to rule out underlying illnesses or conditions that could be causing the crying (gastroesophageal reflux, allergies, etc). If the crying is due to an underlying problem, there will be other signs other than just crying.

Colic is common in the first 6 weeks of life, typically decreases around 3 months, and is resolved by 4-6 months. It’s still unknown as to what causes colic. The current theory that holds some promise is that it is due to discomfort caused by the infant’s gastrointestinal microbiome and in breastfed infants, probiotic supplementation (Lactobacillus reuteri DSM 17938) might be helpful (in formula-fed babies, the same results were not noted). Another current theory is that colic is due to gut permeability and dead or tyndallized bacteria might help this. Older theories are things like gas/air in the gastrointestinal tract, the mother’s diet/allergies, and too much stimulation.

REMEMBER: The most important part of colic treatment is reassuring and supporting the parents. Like babies, parents are different; some handle crying easier than others, and colicky baby needs large amounts of patience and love. It’s key for the provider to rule out other possible causes or complications causing the crying and help the parents be confident of this, too, then to support the parents in coping with the crying and developing a healthy relationship with each other and their child.

Any intervention done to soothe the crying needs to have no adverse effects; doing something that utilizes the placebo effect is fine. Soothing skills are valuable for all parents to know: swaddling, shushing, sucking, stomach position, swinging (see Dr. Harvey Karp’s site in the resource section to learn these skills—he’s probably on YouTube, too; I especially recommend this for fathers, as they do not have a breast to soothe the baby and needs other ways of interacting with and soothing their small kids).

Things that have been tried but are of questionable effectiveness for colic: maternal dietary changes (no dairy, for example), simethicone, formulas (for formula-fed babies) that break down the allergens in cow’s milk (extensive hydrolysate formulae). These have been tries. Medical studies seem to show that they are not effective, but there are parents for whom they are effective. DON’T USE THESE PRODUCTS  due to their side effects: Dicycloverine or cimetropium bromide.

Trying 2 weeks of oral lactase is recommended in the UK along with prebiotics; this does show some promise. Trying a maternal diet of no dairy for 2 weeks can be tried.  Sears has an elimination diet (see recommended reading).  

Long term, it’s possible that babies with colic have more gastrointestinal pains and disorders as adults, but the immediate emotional effects on the family are even more pronounced—parents are frustrated, depressed, anxious, visit the pediatrician more often, and even child abuse is more likely.

Here’s a Recommended Reading List for colic and baby soothing:

NOTE: Lots of ideas and products to try for colic. However, these are not all categorized as medical recommendations. PLEASE USE YOUR COMMON SENSE; remember, any treatment tried for colic should have no bad effects on the baby.

Ask Dr Sears: “Colic Relief: 10 Tips for Comforting Colicky Babies”

Dr. Harvey Karp The 5 s’s for soothing babies.

Gentle Birth archives

Resources I used to write this paper:

AskDrSears.com. (n.d.). 5 possible hidden medical causes of colic. Ask Dr Sears: A trusted resource for parents. https://www.askdrsears.com/topics/health-concerns/fussy-baby/coping-with-colic/5-possible-hidden-medical-causes-colic/

Daelemans, S., Peeters, L., Hauser, B., & Vandenplas, Y. (2018). Recent advances in understanding and managing infantile colic. F1000Research7, F1000 Faculty Rev-1426. https://doi.org/10.12688/f1000research.14940.1

Davis, E. (2004). Heart & hands: A midwife’s guide to pregnancy and birth (4th ed.). Ten Speed Press.

Gianluca Esposito*, Sachine Yoshida*, Ryuko Ohnishi, Yousuke Tsuneoka, Maria del Carmen Rostagno, Susumu Yokota, Shota Okabe, Kazusaku Kamiya, Mikio Hoshino, Masaki Shimizu, Paola Venuti, Takefumi Kikusui, Tadafumi Kato and Kumi O. Kuroda. “Infant calming responses during maternal carrying in humans and mice”. Current Biology, 2013.doi:10.1016/j.cub.2013.03.041  

trichomonas vaginalis

These are just midwifery study notes, not medical advice 🙂 I am exploring ways to conveniently store information as I study.

“Trich” is a sexually transmitted disease, usually symptomless. It is a parasite. It is curable.

symptoms of infection in women: discharge (thin or foamy; white, greenish, yellowish); pain/discomfort during s’x or peeing; irritation/itching around vag’na.

for diagnosis, a sample of discharge is taken from the cervix/vag’na and looked at microscopically. It can also be noted in urine sample if it is very developed.

treatment is antibiotic pills (metronidazole)–safe in pregnancy, but under question during breastfeeding as it passes through the breastmilk.

concerns of trich infection during pregnancy: low birth weight, prelabor rupture of membranes, preterm delivery.

resources:

Cleveland Clinic about trich

WebMD about treatment

Centers for Disease Control

Midwifery student, reflections on Yr One

It’s not been a year yet, but close, so I’m going to start reflections on this process.

I don’t like being a new midwifery student. It’s constantly being incompetent. It’s uncomfortable relationships sometimes.

However, I am very glad that I persevered during this year. It’s nice to see that I have grown and become so much more competent than I was at the beginning. And I’m in the process of getting into harder skills now.

So the early skills were vital signs—learning to count blood pressure–and realizing that there are several different qualities of sounds to be heard, and which ones to count. . . And hearing the baby’s breathing. And being able to count a fast newborn heartbeat for a full minute.

I’ve learned tricks that help me along. Like when I count the newborn heartbeats, I count to 60, then start over. So I usually have 3 numbers at the end of one minute– 60 + 60 + the third number. 60+60 gets me to 120 easily, then I add on what’s over that. As I watch my second-hand on the clock, I know that if in the first 30 seconds I’ve counted less than 60 or more than 80, then my end count will be outside of the norm. And I adjust accordingly. Is the baby in a deep sleep and that’s why the number is too low? Is the baby crying and upset and that’s why the number is too high? Or is the baby truly sick and is that confirmed by other signs? (We’ve transported several for infections.)

Things like that. Palpation, using a Doppler, sometimes a fetoscope. reading lab results, prenatal education, discomforts of pregnancy, monitoring labor, charting (aaaalllll the charting they do here!), filling out birth certificates, recognizing signs of needing to transport, and the transport process. It’s nice being a in a setting where midwives are an integral part of the medical community.

Skills that are higher level, that I’m working on now are vaginal exams (still struggling with this) and the movements to help the baby out (that they do particularly in this clinic and in supine birth in the hospital) and Active Management steps. The Expanded Newborn Screening is also a challenge.

I took CPR and soon we’ll be getting our NRP (neonatal resuscitation) certification. We’ve learned to insert IV, and I’ve successfully inserted IVs on 2 patients with assistance. I’m also looking forward to starting suturing in a few months. Seen things like hemorrhage and shoulder dystocia.

During this time period, I’ve been the assistant under supervision at 33 births, 11 of those where I was the one catching.

42 postpartum exams as an assistant under supervision, 126 prenatal appointments, 11 initial prenatal appointments.

I will be honest, that I’ve realized how committed I am to homebirth through working at a clinic. This clinic is good in that it fits exactly what women want and need in this cultural context and they are kind and helpful and have a good transport situation. We also regularly pray with our patients if they desire that.

It’s been quite a year.

Coming out of this war in Ukraine has been a double struggle. I’ve found the midwifery and birth work to be a good distraction from that heartbreak. Emotionally, mentally and physically I’ve not been myself, and I’ve been trying to be kind and patient with myself and others. I’ve never been through such a devastating situation and those around me haven’t either, so none of us really know what to expect or what this is like.

It’s been a horrible year, a year I’ve disliked intensely, been intensely homesick and heartbroken. But with God’s help, I’m enduring the suffering, and I am gradually re-emerging out of the darkness. I’m learning to integrate the devastation of my past and present life and the future expectations that I had into this current life. God gradually gives small hopes for the future and I trust him when it is a future that only God sees. I feel like we will not be fully healed until we can return to Ukraine and the war is won in a good way. But God also gave me the promise that he restores my soul. When I feel it is smashed and mutilated beyond help, he is the only one capable of restoring my soul, and he will do it, is doing it.