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.

Brief overview of midwifery in early America through today

(I would like to state that I wrestled for some time with writing this “blog post,” as I am a writer and I have a great interest in midwifery history. This time around with this topic, I became dissatisfied about how much midwifery is usually presented and defined by its opposition to doctors, the medical system, etc. Midwifery has its own glorious, stand-alone history, our own errors and mistakes that we rarely own up to, and I eventually decided to leave out almost entirely the history of medicine, doctor’ persecution, childbirth under early doctors’ (purpureal fever, etc.), and instead just make it a simple, brief actual overview only of midwifery. It is intentionally very brief, and doesn’t go into much detail about the arguments for nurse- or direct-entry midwifery, for example. I was thinking mainly of clients who would only like an overview, not a selective piece of swaying writing highly critical of the medical model nor a deep overload of information about direct-entry midwifery.)

A very brief overview of midwifery in early America through today:

America has a rich history of midwifery care, though much of it is not recorded. The colonists brought midwives among themselves, and later, midwives were also brought among the slaves and immigrants. Knowledge and skills surrounding helping women in childbirth were passed on orally and in hands-on apprenticeship training. Few women were taught to read and write.  Some midwives we know about (because of extant writings) are Bridget Lee Fuller, Anne Hutchison, and Martha Ballard.

In the 1800s, male involvement in medicine and formal training for doctors rose, licensing for doctors became formalized, and along with this, doctors openly promoted the view that childbirth is an inherently dangerous process that requires routine interventions. Midwives, being female, were often illiterate and not trained to write, or they were immigrants and didn’t know English very well, so they could not compete with the growing social and legal power of doctors.  

Wealth and social status are also large factors in childbirth. Wealthy and middle-class women still birthed at home but using a doctor became more accepted. Doctors organized into what became long-standing, powerful, legal organizations like the American Medical Association. Gradually, childbirth moved into hospitals where drug pain medications and many medical interventions could be practiced.

In many countries, midwifery developed as an integrated part of the medical system. However, in the U.S. and Canada, in the first half of the 1900s, midwives were more and more sidelined, put out of practice, or allowed to serve only poor communities. The “granny midwives” of the South are remembered during this time and several well-known biographies are written about their unwavering service to women. Midwives often skillfully and sacrificially served poor communities that were unable to pay for doctors’ services.  Some famous midwives of this time are Mary Breckinridge, Mary Coley, Etta “Granny” Nichols, and Onnie Lee Logan.

Particularly in the mid- to late-1900s, there was a resurgence of middle-class women wanting home birth and midwifery care. Midwives organized as both nurse-midwives and as direct-entry midwives. Each developed their own standards for education and licensing. Some well-known midwives of this era (who also authored popular textbooks and books) are Elizabeth Davis, Ina May Gaskin, Helen Varney, and Anne Frye.

Resources

Connerton, W. C. (2012, May 25). midwifery. Encyclopedia Britannica. https://www.britannica.com/science/midwiferyhttps://www.ohsu.edu/womens-health/brief-history-midwifery-america

Feldhusen, A. E. (2000). The history of midwifery and childbirth in America: A time line. Midwifery Today. Retrieved April 19, 2023, from https://www.midwiferytoday.com/web-article/history-midwifery-childbirth-america-time-line/

Hanna, C. (n.d.). A brief herstory of midwifery and childbirth in America . Happy Mama Healthy Baby Alliance . Retrieved April 19, 2023, from https://motherbabysupport.net/professional-education/history-of-midwifery/

Hill, H. (n.d.). Five black American midwives you should know: The history and impact of black midwives in the U.S. . Hanna Hill Photography. Retrieved April 19, 2023, from https://www.hannahillphotography.com/hanna-hill-photography-blog/5-black-american-midwives

Rooks, J. P. (2012, May 30). The history of midwifery. Our Bodies Ourselves Today. Retrieved April 19, 2023, from https://www.ourbodiesourselves.org/health-info/history-of-midwifery/

The story of the granny midwives, who birthed untold numbers of babies in the rural South. (n.d.). Vimeo. Retrieved April 19, 2023, from https://vimeo.com/211012543.

Varney, H., & Thompson, J. B. (2015). Chapter one: The early voices of midwives. In The midwife said fear not: A history of midwifery in the United States: (pp. 4–19). essay, Springer Publishing Company. (accessed: https://connect.springerpub.com/content/book/978-0-8261-2538-5/part/part01/chapter/ch01)

Update on my studies

I’ve been in school for almost 7 months now.

For academic studies, I’m enrolled in the National College of Midwifery’s program, and I completed several Antepartum classes (Basic Skills, Provision of Care, Risk Screening, Diagnostic Lab Tests and Procedures, Observation & Charting).

I’ve completed several other classes (Family Planning), just waiting for grading.

I’m currently working through History of Midwifery and we’re finishing up Lactation and Perinatal Education.

For my clinical studies, I’ve assisted the midwife at about 80 prenatals, 17 births, 4 newborn exams, almost 20 postpartum exams. I’ve learned venipuncture and soon we start our IV class. Checking vital signs, palpation to determine fetal position, listening to FHTs, evaluating labs, charting–these are all things I regularly practice.

My three philosophical thoughts from this time: 1) I hope the world tires soon of all. the. research. and realizes the limits of what is actually measurable. Reducing these experiences to numbers is a major weakness of the allopathic system.

2) How on earth did the legal system become such a chokehold to good care?!?!

3) I continually remind myself that clinic midwifery has it’s pros and cons. Pros: amount of experience, multiple teachers and input, ability to leave it until the next shift. Cons: lack of the emotional synergy, freedom, and physiology of home birth.

When missiles struck our hearts

My name is Anne Sokol. My last name is Ukrainian; sokol means “falcon” when translated into English. Twenty years ago, I moved to Ukraine, and less than two years later, I married a Ukrainian man, the air to my lungs. We have four children, currently ages 17 to 8.

2022. Rumors of war filled the air, and the evening of January 25, 2022, the US embassy in Kyiv hosted an online meeting for Americans living in Ukraine. “Significant invasion” was mentioned, and we were given instructions on various ways to leave the country, hasten document processing, etc. Emails from the embassy every 2-3 days followed, repeating and updating these warnings and instructions.

We left our apartment January 30. It is now early September, and I’ve never returned to that apartment. We’ve been to Albania, Romania, Moldova, Poland, and in/out of Western Ukraine. Once the war started, three kids and I stayed in Albania while my husband and oldest daughter went to work on the Ukraine/Poland border then into de-occupied areas in Ukraine. We’ve lived in so many places—camps, churches, apartments. We’ve packed and unpacked so many times. Washed clothes in so many different machines. Learned Thank You in various languages. Our wallets bulged with coins of different currencies, and we had to keep track of tiny SIM cards with each new country.

When we left Ukraine ‘just in case,” I had no idea of the emotional terrain ahead of me. We’ve driven through the Carpathian Mountains in the dead of winter, the enormity of the winding Balkan Mountains, the tiny highways of Albania, the lovely roads of Poland, and crossed countless borders. But by far, the emotional terrain of war is the most difficult to traverse. It’s taken me into territories of the heart I never asked to enter and finding my way back across the border is perhaps impossible. My heart must painfully expand to include this land, too, without becoming lost in it.

My husband is a pastor, and my world is shaped by intimacy with God. When the war started, I agreed with God that I would not hide, run away from nor ignore the horrific pain of whatever lay ahead, that we would go through it together. The following are my attempts, in journal form, to express what it was and is like. It includes my intimate thoughts, prayers, events, and, as time passes, my observations about being a refugee and war displaced.

_____________________________

January 25, 2022

The embassy has recommended that Americans leave. So now I’m packing in earnest. Vitaliy left for classes today. I’m taking the van for an oil change today.

January 28

Awakened early with evacuation thoughts. The sadness of leaving our cat, our known home and soft bed. Lord, whatever lies ahead, I thank you. I thank You that You are leading us by the hand in a way suited to us. Fill our hearts with such love for all those we meet. Use us. Use others to love us, too. Help us be sad, be glad, be mad– all in Your way and with and unto You.

22 February

In Albania, waiting. Olympics in China are over so we should know soon if something will happen. Watched Putin on TV, listened to his whole speech… crazy.

Feb 23

Well, we’re feeling better today about returning to Ukraine

25 Feb

Second day of war, full war, in Ukraine. Situation quickly deteriorating.

26 Feb

Oh, such fighting.

28 Feb

Victoria’s birthday. I cried on the guy who arranged a party for her. It’s all so horrible what is happening. And I feel like I can’t cry with Vitaliy because he is also sad. His family is under occupation! I don’t want to burden him with my sadness but to help him bear his. Now I’m crying at a café in Tirana while the kids are at the birthday party.

1 March

Oh God, my life is stuck in this war. Time has stopped for us. We can’t go on. Will it be like this forever?

7 Mar

Day 12 of this terrible war. War. World War. Sanctions. Cyber attacks. And so many words I’d rather not think about.

8 Mar

It’s an all-out holocaust on Ukraine. Very bad in Irpin right now.

9 Mar

Oh God, some days I just feel like throwing up. It’s hell. So here we all are—a pandemic and terrible war during our lifetimes. God, give us maturity, patience to endure hardship and discomfort; love, to shower around us all. Love, for this is your presence.

11 Mar

God, save Ukraine. I can’t take pictures of our “war sigh.” The “war sigh” is a sigh that Vitaliy and I both developed simultaneously—it’s a particular sigh we make when reading and absorbing certain war news. We’re glued to war news.

March 14: Vitaliy is ready to leave with Skyla for helping at the border. Lord, I bless him. Am I angry, always feeling left behind? It’s an old friend [this anger]. Why am I so mad? “Keep me . . . from all evil thoughts which may assault and hurt the soul.” (a prayer from The Divine Hours).

Days are a terrible cycle: I am terrified to fall asleep—that while I sleep, I am not praying. But then I think, my friends in America are waking up and they are praying while I sleep. Then I wake up, horrified, roll over and grab my phone to check the news. Is Ukraine still there? Praying.

I finished my latest diary. When I started it on November 17, 2021, I had no idea it would be a “war diary.” Flipping through those days of November, December, January– such a banal, sweet life: home school, sick kids, Hercule Poirot reruns… Such different life it was. It becomes a dream, a life hit by a missile and exploded into a million pieces. Gone.

We were walking to church today and Victoria suddenly said, “I’m tired of this.” And we all agreed. We are tired. We are tired of never having a home, never having a home the way we like it. Never able to relax. And there is no *homecoming* in sight. What to do with this tiredness?

This church in Albania is so full of love for us. They have activities for the kids, which I never anticipated how important that would be, because what else are displaced, homeschooled kids going to do? And the people here have fresh memories of the Serbia/Kosovo war, so they are full of compassion.

One Sunday not long ago, I picked up the church information letter, and it was talking about how they needed children’s workers. So I was reading the letter, imagining myself volunteering with the children during church, ready to sign up. Then the final line said that those interested in serving should contact so-and-so for an information packet.

I’m not sure I can explain in words this experience. I read the words “information packet” and suddenly I wanted to heave into major crying. I just wanted to wail, hard and deep. An overwhelmed cry of how it’s all too much and adding an Information Packet to it all just tipped the scales of emotional control.

It was one of the most bizarre experiences of my life. I, Anne, who love information packets! Who have dealt with more paperwork and documents than the average bear can even imagine. Here I am, reduced to an incapacitated mess by the idea of a volunteer information packet.

Volunteering for the children’s ministry is probably not what I should do at this point.

I haven’t had the heart to post any family photos on FaceBook while this horrible genocide is going on in our beloved country. I have a deep sense that I must respect the horror of what people in Ukraine are experiencing. I feel it with them, and I have no desire to post my usual photos of what the kids do during the day while, in real time, people are being tortured, raped, and destroyed in the most unthinkable ways.

Normal life hurts. It hurts to exist in normalcy because, while I drink a coffee or do a math lesson, people are living in this hell.  

I’ve decided to let people here love me in an uncomplicated way.  I desperately need their love and comfort. I’ve noticed this trend of criticizing things people say when trying to comfort those in tragedy. Like those lists of phrases one should and shouldn’t say to those grieving.

It’s helpful to some extent, but poor people! I’ve never been in a war before; I have no idea what people should or shouldn’t say to me. So how will they know what is correct to say to me? I’m committing myself to accept people’s love to me no matter what words came out of their mouths. I’ve been surrounded by compassionate people, and I’m not going to close my heart off by criticizing their love. I need their love, I need their compassion. It’s how God made us in His image, to be comforters. And to need comfort.

Poor people. They also hear and read about this war and are slightly traumatized, they are also inconvenienced by the gas prices and other issues, and this war has been politicized by their own media and government, so who knows what they are hearing and believing.

Last Sunday, a lady at church asked me how I was doing, and then she looked embarrassed for asking me that. But she was trying so hard to reach out to me and be friendly! She wanted to show love to me and welcome me. So I smiled and said I was fine. Another lady acknowledged that my life is just about survival right now and survival is exhausting, and I was surprised by the truth of her comment. Even though I’m “safe” and thousands of kilometers away, she is right.

In a rare outing with kids, we were sitting in a group, and one lady asked the perfect question that opened the way for me to share my feelings about this war. I can’t remember what she asked, but it was spontaneous and kind, expressing her own horror about it. They didn’t ignore my pain or feel uncomfortable about it.

There is one time I struggled with this principle. There was one moment when a person publicly prayed a general sentence for Ukraine, then paused and prayed the same general sentence for Russia. And I felt like I had physically been struck–praying identical prayers for the abuser and the abused!

But if I think compassionately about this, it was just a person who had too much distance from the situation to feel the nuances. She wanted to show love, and she was doing it as she knew how. [And later that person cried buckets when we moved on from that place.]

Doing a small thing alters lives, March, Albania still.

I’ve never met G—, I’d only written him about homeschooling in Ukraine. He’s from Canada. Canada has been quick about starting their refugee program for Ukrainians, and G wrote me saying they had some Canadian families organized, ready to sponsor refugees. Here I am alone in Albania. But I know Ukrainian refugees in Romania, Poland, Germany, France, Hungary, Spain, Czech. And Ukrainians are excellent networkers.

Just feeling obligated, I took a few minutes to write a brief message in Ukrainian about this Christian man G, who was willing to help Ukrainians who wanted to move to Canada. I put his contact email in there and said to mention that Anne Sokol told you to write. I posted this message in 3 social media groups (I was pretty sure that by the end of the day, it would be all over the place).

Jump forward to July. I must confess that when I sent that message out in March, I hardly thought about it. But G thinks I know everyone in Ukraine from all the people writing him that Anne Sokol told them to write. At least 10 refugee families have moved already, and more are in the process. I had no idea the scope of G’s plans, and I want to cry about how amazing they are. These thoughtful people have organized themselves and their whole community to integrate Ukrainian families into their space. They even give them option of flying the family back to Ukraine in six months, if they so decide, which is what every refugee needs to hear who is making these life-altering decisions unwillingly.

M and B (a married couple from our church in Ukraine) were the first to immigrate to Canada. Months later, thanks to G and all the Canadians helping them, she wrote: “Exactly three months ago we flew to Canada. Five months ago, we lost everything that was dear to us in life, we didn’t know how to live further, what to dream about or strive for. Now we have new dreams and hope, and we again want to continue living. Thank God for G…”

April, still in Tirana, Albania, still without my husband

We moved away from Ukraine to be safe. I didn’t expect feeling myself in danger. I feel pursued and in danger. I am very glad we live in the second-floor apartment of this house, with a family downstairs, and a high fence around us. It helps me a lot with feelings of safety. Even the glass shards along the top of the fence comfort me. I am alone looking after our kids, and I feel like, even here, because of propaganda, people are coming to find and kill my half-Ukrainian children. How will this war go? What will the world believe? What will the European leaders decide long-term? Will everyone believe the terrible Russian propaganda? I don’t post any photos or place-identifying information. Call it paranoia.

The longer this war goes on and the more bizarre and unrealistic the propaganda, the more I feel myself in danger.  Plus, it becomes obvious that Putin wants to wipe all things Ukrainian out of existence, so all the more I feel that my children are in danger.

April 7:

God, my heart! They are extinguishing our people! Our culture!

I did not anticipate the emotions of this experience at all. Also, I didn’t anticipate the hateful politics. This war is Russia’s delusions of grandeur and its ideology about Ukraine.  But each country takes it and makes it about their own politics–to them, their own politics is the cause/prevention/meaning of the war. I no longer feel safe because a lot of people who’ve never been to, much less lived in, and have hardly even heard about Ukraine, are suddenly more knowledgeable about who we are than we ourselves are. This actually causes me much pain, and I never expected this. At all.

May 2022, Romania

Tonight, as I was getting ready for bed, I realized that I was looking forward to waking up. For many weeks when the war started, I dreaded waking up; it was painful to be conscious, to be awake, aware of what was happening. So I tried to stay asleep as long as possible.

I assumed that “recovering” from these war emotions would be like going down a mountain– I would logically move downwards and out of all these feelings.

It is not logical nor downwards. It is waking up every day to the emotional carousel ride. Round and round on the same emotions, sometimes going up a little, or down a little. Round and round.

I’d “recover” from an emotion, think, phew, glad I’m done with that horrible experience. Then bam, there it was again.

I’m glad we have photos of us smiling. At some point, I’ve stopped smiling so much. It’s not worth the effort right now. Not many people ask me how I’m doing, but when someone does, sometimes I tell them I’m OK, sometimes I tell them I’m terrible. Both are true. Because it is the most terrible thing that has ever happened to me, but I’m still OK.

It’s still February 24, 2022, in so many ways. The date that destroyed the lives we all had. We remain frozen but in motion. I’m trying to somehow integrate the devastation and somehow build a life out of this experience. It’s an untimely rebirth of sorts, a rebirth from destruction, not from life.

Years ago, in Kyiv I got acquainted with a lady who was a religious refugee because of persecution. She said to me one sentence I’ve never forgotten. “I don’t live a life here. I’m just watching other people live their lives.”

I’m in these places, and when I can look up from the pain, I am watching others live their lives while mine is frozen, back in Ukraine, in the war. I’m waiting for the end of the war, forced to figure out an “in-between life” somehow, somewhere.

Our stresses used to be so simple. Education of our children. Money questions. Ministry issues.

We’re doing pretty well. But in my angry weeks, early on, when Vitaliy was gone, and I was periodically hemorrhaging my repressed anger (and Vitaliy is my safe person to do that with, poor man), we had some tense conversations, along with all those lovely internet problems that complicate heartfelt, long-distance communication.

It was nice to be reunited, to hold hands and eat ice cream and drink coffee together, to chat about the animals in the fields. To soften the hard things.  So many couples are forced to make life-altering decisions that came upon them in this unnatural, destructive, grief-wailing situation. Working through decisions they never wanted to make.

June 2022, Poland

It’s time to step over some line, from focusing on the horrible present in Ukraine, to focusing on the future that is before our family.

I’ve been trying to get rid of these feelings of sadness and anti-anticipation about our future. I’ve been having a lot of anxiety that is unfamiliar to my own life experience. I’m feeling a lot of stress about moving between my “sad life” here and my “happy life” that I so desperately want to have in our next permanent location. All my imaginings of moving are colored by feeling sad all the time. But I don’t want to feel sad there. I wanted to feel happy and excited.

How strange! I usually love “adventure,” but during this war, I realized that “adventure” takes on a horrible new meaning. I remember sitting in Romania and thinking, “I don’t like this adventure, not at all.”

In a way it’s comfortable to stay here, in a life in contact with other Ukrainians who are displaced, who are living in cramped and uncomfortable places, trying to fashion a life they never wanted to live, carrying around this invisible pain and trauma. We can sigh about the latest bomb destruction together. Moving on is scary.

But like other refugees who’ve gone to Canada, England, the US, etc., we’re taking the risk of a new place, of a life not really touched by this sadness. I talked to God about this, about how I can’t feel very much all the ways He’s blessed and protected us during this time. I can just feel and anticipate pain and sadness.

So I started to think specifically about things He’s given us … especially all the friends who can see a bright future for us when I cannot feel it.

July 2022, Poland

I’ve never read about a condition called “Refugee Brain”, but I’ve now had it, and so many others have, too. The decisions we make must look hasty or crazy to outsiders. But with all the unseen factors that are constantly shuffling around in our heads, a particular decision makes perfect sense to us. It does not make sense at all to someone living a stable life, sincerely wanting to help in the best way. I’m amazed by those who remain able to help refugees in the long term without becoming cynical about this.

I’ve been walking around feeling like someone poured Jell-o into my head, then used their fingers to mash it up.  But this morning I had a moment of feeling like my former brain was back in my head, the brain that could make decisions, handle lots of details, and go through complex processes like international flights. It was there for a brief moment. I was standing at the bathroom sink, feeling it in there, so strong and capable.  

Imagine, all these refugees with “Refugee Brain,” having to make life-altering decisions and do more documents and paperwork than they ever have in their entire lives.

I’m glad now that I’ve photographed some memories of this strange, sad time in our lives. We smile, do happy things, while our hearts are bombed into a million pieces. The first 3-4 months of this war, I wouldn’t let myself cry; I was alone with the kids, holding it together.

Now I can’t hold it back. I just leak tears all day. The TP roll is my undignified friend. The losses stemming from this event don’t get easier, they get harder and sharper. I’m sure that at some point this will turn around, but it’s not yet. “Yet I am confident I will see the Lord’s goodness while I am here in the land of the living. Wait patiently for the Lord. Be brave and courageous. Yes, wait patiently for the Lord.” Psalm 27:13-14

I want to record again a bright gift God gave us–Skyla’s new dog. He’s a “refugee” puppy from Ukraine, so we love him all the more. The grief of losing all her relationships she’s had since birth is somehow soothed by this new doggie she can befriend and attach to.

It was hard to lose our cat due to this war, and I was surprised by the sadness I felt about that later. The sad memories are made smaller by new memories, and the sharpness of the loss is less. But there is something terrible about giving up a creature you’ve cared for, and in such violent circumstances. Una keeps remembering the cat and praying for her.

I still feel like big pouches of tears are stored behind my eyeballs. Vitaliy asks if I’m still leaking. But I also experience more moments of feeling like the person I used to be, so the Anne that loved her life and had energy and interest for many things must still be down in here somewhere.

August, 2022—we’ve moved to a permanent location

For months, there is this hope or expectation that suddenly I will wake up or suddenly the war will stop, and in a snap, the sadness will be gone; life will instantly return to the emotional flow it once was.

I was imagining that this will be like a light switch: On. Off. I’ve been waiting and waiting for that click Off. For my emotional landscape to go back to what it used to be.

It slowly dawns on me that the sadness will never go away entirely. It will never turn Off. I will have to live with this Sadness. It must become a part of me; I have to integrate it into my future life: That I will choke up unexpectedly when holding new babies or thinking about Christmas. That swallowing back tears around people untouched by this tragedy will be a new part of life.

I recently read about an extreme case of this in a book about the Hmong refugees who ended up in America. A quote from an American psychologist describing his Hmong patient: “It turned out he was an agoraphobic. He was afraid to leave his house because he thought if he walked more than a couple of blocks he’d get lost and never find his way home again. What a metaphor! He’d seen his entire immediate family die in Laos, he’d seen his country collapse, and he never WAS going to find his way home again. All I could do was prescribe antidepressants.” (The Spirit Catches You and You Fall Down by Anne Fadiman, p. 204)

Another way I often feel these days is … numb. Not happy, not sad, not excited, not dreading. There is something soothing about this particular stage after all that’s been before. But it would be nice to feel some kind of pleasant emotions.

Just before we flew here, I remember having about 30 seconds every morning of feeling anticipation and excitement. That has left me. When I was first here, I had a few first meetings that involved certain urges to cry.

I don’t like being emotionally flat. I worry that I’m depressing to be around. But I don’t think I’m technically depressed. I’m just riding all this out. Who can control it? I’m controlling what I CAN control– like reminding myself of loving God, waiting to feel emotions towards Him again. Reading the Bible. Praying. Doing the work I ought and want to do every day. Also resting.

My worst fear is that I will be stuck in this flatness-bordering-on-sadness forever. But I think that’s a ridiculous idea, as humans are so changeful.

I was thinking recently about the one-year anniversary of the US military leaving Afghanistan and comparing it to Ukraine. The people of Afghanistan are in a seeming place of such setbacks a year after their president suddenly fled the country.

I remember, when Russia invaded Ukraine, the US immediately offered a refuge/government-in-exile option to President Zelensky. And he refused with his famous words: “I need ammo, not a ride.”

And, in the providence of God, that made all the difference. Russia immediately spread rumors that Zelensky had fled Ukraine, but I remember watching, with Vitaliy, Zelensky and all the major leaders of Ukraine–on live video–recording themselves and reassuring the people of Ukraine that they were right there, in the capitol city.

And, in the providence of God, it’s made all the difference. This leader chose to stay and suffer with his people. He has chosen to live with the overwhelming stress and trauma of leading Ukraine through a disgusting, relentless, brutal war. He’s not let the defamation of character stop him. He has, with great dignity and with relentlessly reminding the free world of the price of freedom, asked, asked, and asked for weapons to fight with. He’s not given up after incredible physical, psychological, and moral blows have struck us over and over.

There is something emotionally healthy about his staying and fighting—the loyalty, the striving for justice.

I’m thankful today for God’s providence in leaders for Ukraine, who are willing to risk their lives, health, and futures in the face of such incredible darkness. And we all keep praying, which feels like grasping God’s muscular arm in the darkness, for the future still hangs in the balance.

About the end, whatever that end will be, I also feel nervous. Once it ends, especially if Ukraine wins, we’ll be free to feel and acknowledge the horror of what we experienced, and I think all the grief and shock will be experienced a second time, in even more awfulness because it will be opened up for all to see and know. And the unhappiness of destroyed lives still having to be lived.

But what if Ukraine is forced into a compromising end? To somehow make peace with the evil? That type of end will darken these continually-beaten-down people, and we’ll face a new level of cynicism and hardening. I don’t like to think it, but maybe fighting (as it now is) will be better than the end. Now at least, we’re fighting the evil.

People ask me what they can do about the war and to help refugees. I don’t hurry to answer this question.

Years back I read a book, Visions for Vocation by Steve Garber. I remember one pivotal thought from that book that really affected me. The author recounts stories of young people moving to Washington, DC, with lots of passion and visions of changing such-and-such an issue. Then they get disillusioned realizing they can’t “fix it.”

And the author makes the point that we have to be OK with doing *something* good, with doing something in the good direction. And that thought has stuck with me for many years because the savior complex wants to save everyone and fix everything. To make it all completely right.

But only Jesus will do that. So can I be fulfilled and satisfied with doing the good works He made me to do, living in the tension of not being able to fix it all? It’s an important moment. Because if I don’t accept the grace of my limitation, then I tend to give up. All or nothing? then nothing. Like, if I can’t give the entire million dollars, why send one? If I can’t stop the war, why do anything at all?

Singlehandedly, no one can’t stop the war. But each can use his ‘hand’ to do *something,* and it’s important that we use our agency to do that something. I’m thankful for those who ask, What can I do?

I am so touched by many things these days that would never have touched me if I had not been forced to cross into the emotional territory of war. Today’s tears were brought on by the beautiful first line of Rachael Bunger’s poem “I Am.” (She is, incidentally, also a half-Ukrainian teenager, like my own teenagers.)

“I am a star, small but crucial in this night.”

Start of my 6th week

Last night I worked on night shift, and for the first time ever, I was taught how to check the fundus after birth, and I checked it myself once, too. I was thrilled that it’s actually there and palpable. I’ve always thought it’s crazy to try and feel for an organ inside the abdomen, and I didn’t believe I’d actually be able to feel anything. But I did!

I also learned in my reading that the #1 way to prevent tears during birth is a slow pushing stage. (And it’s actually better when the head emerges between contractions.) Last night I saw a physiologically “slow” (ie, absolutely normal) second stage. And no tearing 🙂 Which also helps there to be decreased blood loss.

My clinical experience

I’ve been in school for 5 weeks–today is Saturday; it’s the completion of the 5th week. Week one was Orientation Week.

I’ve worked 5 shifts in the birth room (one shift I worked in August, because I arrived early). I’ve observed 5 births here. While working birth room shifts, I also observe immediate postpartum care, the newborn exams, 24-hour postpartum observation, newborn screening and discharge. I also observe return mother-baby checks (each client is under the clinic care through 6 weeks postpartum).

I’ve worked 4 days in the regular prenatal care room, taking vitals and observing a midwife doing prenatal visits. One of those days was a day of initial prenatals (the mother’s first visit to the clinic during her current pregnancy).

I’ve stared learning to measure fundal height, palpation of the fetus and finding and timing heart tones using a doppler.

First day of clinicals

This Monday was my first day to work clinical prenatal shifts (I’ve already worked several birth shifts); our job was to take initial vital signs on the moms coming into their initial prenatal visit.

I do confess, I was very clumsy! The first woman who sat down, I needed to count her pulse, and my own heart was pounding so LOUDLY it was all I could hear!

I also was trying to take her blood pressure with my stethoscope head turned to the infant side, so no wonder I heard nothing, and a teacher pointed out that this was why.

I have so many emoticon faces going through my brain while writing this post!!!

To get through it, I learned to go slowly, and fortunately, there was no hurry as the initial interviews take a lot longer for each woman to complete. I calmed myself down, positioned my chair so it was easy for me to hold her hand/arm to take her pulse and count respirations. There were a few other gaffes.

But! I made steps of learning! I’m so thrilled. I asked a teaching midwife for help with one blood pressure– it takes a lot of coordination to count backwards with the dial while watching the dial and listening for her heart sounds to start. And the midwife said something that made it *click* in my head–what I was supposed to be expecting to hear.

So I have practiced again on some family members, and it’s getting easier to hear that first knock of the heart and remember the number and ignore extraneous crackles.

Also, another teaching midwife let me sit with her for the initial exams, taught me about their computer program for entering data, and let me practice measuring fundal height and palpating the baby and using a doppler to hear heart tones. I have since practiced on myself feeling my pubic bone for FH (fundal height) measurements).

Overall, it was an amazing 4-5 hours. I learned a lot in a friendly, safe environment.

I’m also working through a required reading list. I’ve finished 14 of 25 books, and I’m reading #15 and #16 currently. It’s a range of reading–biographies of midwives, different cultures of birth, various birth models, missions books, midwifery books, women’s physiology and cycles books.

I’m specifically trying to choose books I’ve not read before, and this gives me a lot of choices.

In this photo is one page of the required reading lists to choose from, and the bottom page is my own list so I can track how many I’ve read from each section, when I finished, the date I wrote then submitted the review. The purple highlighting marks what I have read; the yellow marks what I’m planning to read.

Being a midwifery student and Spiritual opposition

I have often wished that someone would have a blog or site devoted to midwife-wanna-be’s and midwifery students. Not about education, but about the condition of being a midwifery student or being *called* to midwifery but unable to pursue it currently. In my own path, I’ve come across very little to read or encourage myself while waiting indefinitely. Also, there isn’t a lot for American home birth midwifery students about actually being a student and the issues relevant to actually being a student (there is literature and videos for those in England, for example). There is a growing body of texts about the student-preceptor relationship, which is a part of being a student in home birth midwifery, but it’s not really the same question.

Midwifery and being a midwife is a mixture of science, knowledge, developing intuition, and spirituality and spiritual warfare. So all this bears when one is a student.

I want to talk about the last because I don’t think many talk about this, but I think that actively being involved in childbirth puts a Christian inside a particular sphere where opposing spiritual forces are acting (I think this is true in other professions, too).

(Why is this such a spiritual sphere: I haven’t been able to think very deeply in this topic, honestly, though my life experiences put me in contact with the fuzzy edges of it. Historically, pregnant women (pregnancy itself), the act of childbirth, and small babies seem to be repeatedly attacked. I’m not sure why that is spiritually—but as God is the Creator, and pregnancy is how he creates eternal souls, and possibly going back to the curse of satan about “seed of the woman”– it is something opposed on a foundational level spiritually.)

Here are some examples of what I’m talking about, from the book Mamatoto: A Celebration of Birth by Carroll Dunham and The Body Shop Team, published in 1991, page 81:

“… there are parts of the world today where women’s reproductive rights are controlled by the state. In Romania under Ceausescu’s regime, every woman, married or not, was forced to breed, and produce five children. … scars of frequent illegal abortions (many without proper anesthetics) have left only 5 per cent of Bucharest women of childbearing age with healthy uteruses.

“Tibetans today suffer a chilling form of genocide by the Chinese, who have forcibly occupied their country since 1950. Tibetan women are checked each month for pregnancies. On each neighborhood block in the capital, Lhasa, a female government official monitors menstrual cycles. Any Tibetan female discovered to be pregnanct is taken to the hospital for an abortion. By the end of 1989, 87,000 women had been sterilized in Qinghai province in central Asia. The Chinese government’s terrifying justification of these genocidal practices may be found in its official report on family planning policy: ‘It is much more common to find in their population persons who are mentally retarded, short of statue, dwarfs and insane.’”

Actually wanting to go into this sphere of work is opposed spiritually, and so is the student becoming the midwife God has created her to be. There are a lot of ways to be derailed, deformed, or distracted.

But I don’t think it’s all negative. There are powerful forces of God guiding and protecting women (and consequently their families) who are in this work. I consider how many times I’ve “had a funeral” for this midwifery life calling, how many times I’ve even actively tried to beat this interest and desire out of myself, and I see how God has protected this somehow, even from myself. It gives me hope, a glimpse of God’s power in guiding this process.

In another way of looking at this role and the spiritual elements one encounters:

Midwifery is the skills and actual personality of the midwife actively defending/protecting pregnant women, their births, their young. The essence and skills of midwifery protect those in these natural states; that is also to say, the natural vulnerability of these states needs protection. The physical process needs protection, as does the untouchable parts of pregnancy and birth– the souls and psyches.

But becoming and growing in that protective role is challenging, to say the least.

Somehow, in choosing this profession, one is choosing to try an become capable to face the ideologies, systems, politics, and people that do harm, and, as this deals directly with the creation of new life and eternal souls, it is a spiritual realm with spiritual opposition that one has to directly act in.

This verse below describes part of what a student midwife is becoming–the *heart* and actions– it sounds so sweet and nurturing, and it is. But there’s so much acting and being (the power of skill and philosophy) of the shepherd underneath these small clues:

Midwifery-missions required reading

I received a list of required reading books while we were in Romania, probably in May. So I slowly started reading through it. So far, I’ve read 7 of the 25 books, and reading through my 8th book currently.

I like these books. They are interesting, and they play off of one another–one book gives principles, another has an illustration of that in another context; they mention each other and how they were influenced by ideas. I find them personally and professionally interesting.

After each book, I write a review to submit.

Birth in extreme conditions

This is a brief article written for a Russian-/Ukrainian-speaking audience during the War in 2022.

In the classic movie, “Gone with the Wind,” the beautiful heroine, Scarlett O’Hara, has gone in search of Dr. Meade. Scarlett’s friend is in labor, and Scarlett wants him to come attend the labor, as he usually would. She finds him working in an enormous field of wounded soldiers.

He refuses to come help with the birth, saying that he is more needed to help with the hundreds of dying soldiers, and he says a line I love: “Don’t worry, child. There’s nothing to bringing a baby.”

“Don’t worry, child. There’s nothing to bringing a baby.”

I don’t want to make light of having a baby, but what the doctor (and perhaps culture in general) understood is that childbirth is a self-starting and self-completing process that usually needs very little intervention.

If you find yourself a pregnant refugee, or possibly pregnant and hiding, I want to remind you of important practices that will keep your pregnancy and birth as normal as possible.

Before childbirth:

  1. If you can evacuate to a safer place, do so immediately. Do not “wait and see.”
  2. Ask God for His personal protection over your pregnancy and birth, over your body and your baby. Ask Him for miracles on your behalf. He deeply loves and cares for you and your baby.
  3. Create playlists of music that honors God and encourages you. Find verses in the Bible that comfort you and record your voice reading them in one long recording that you can turn on and listen to during pregnancy and labor.
  4. Healthy eating is the number one way you can physically influence your pregnancy and birth to remain uncomplicated. You need to be eating, daily, approximately 2200-2500 healthy calories. You need a mix of carbohydrates (grains, potatoes, macaroni, etc.) with protein (meat, eggs, tvorog). At least 80grams/day of protein is a basic estimate. Eat small portions throughout the day.
  5. Find help, if at all possible. Contact a midwife or doula or someone who can answer your questions, even “attend” the birth with you by phone, hopefully by video.
  6.  Gather birth supplies—if you only have minimal supplies, you need some newspapers or clean rags for the water and blood that accompanies birth. Also have towels and blankets for the newborn—one to initially wipe away the wetness, then clean and dry ones to cover the baby.
  7. Spend time relaxing your belling while on your hands and knees. This can help facilitate good positioning for the baby.

During childbirth:

  1. Light eating and drinking during labor helps your muscles maintain energy. Remember to use the toilet because you don’t want a full bladder when pushing the baby out.
  2. Move during labor and change positions. Your baby has reflexes that he uses to navigate his way through the birth canal. Changing positions, rocking, standing, hands and knees—these movements of your body allow the baby freedom to get himself out.
  3. When you start feeling like you want to poop, that means the baby’s head is close, and your body will start pushing. Don’t lay on your back to push! Stand, be on hands and knees, or lay on your left side if you must lie down.
  4. Don’t force pushing. During labor, the uterus muscles have been drawing upward, gathering at the top, exactly to push the baby out. Just follow the sensations that your body gives you. Pushing with force can cause tearing. (Vertical positions allow the baby to exit naturally without forceful pushing.)
  5. Whoever is with you will need to be able to catch the baby. Once the head is out, that person might want to check if there is the cord around the neck. This is perfectly normal, and if it is, it can be slipped off over the head. The body will slide out pretty fast and be very wet, so be ready 😊
  6. Put the baby on your stomach/breast. Rest. Talk to your baby. Feel all the relief and love God designed you to feel at this moment.
  7. Caregiver can check the baby’s breathing. He might sneeze out mucus. If you have a bulb syringe you can carefully suction the mouth then nose if needed. Rub his back to help stimulate breathing if needed. At this time the baby has to push all the fluid out of his lung sacs (alveoli) to start breathing, so some crying can help with that, but it’s not essential. The baby should be pink in color.

Placenta:

  1. There is no reason to cut the cord. You can wait almost indefinitely, and the blood in the placenta is the baby’s blood and will flow to him, helping him survive and adapt.
  2. The placenta should come out any time from 7 to 30 minutes after the birth (this is a general rule, not an aggressive standard). Don’t pull on the cord or aggressively try to remove the placenta! This is very dangerous because it can cause excessive bleeding. After birth, the uterus continues contracting and will expel the placenta itself. This phase might be confusing to some parents, so please have someone to call who can help.
  3. It’s important that the caregiver monitor how mom is doing. About too much blood loss: hemorrhage might happen suddenly, but usually it is too much bleeding over a period of hours in the immediate postpartum. When the body loses too much blood, it goes into shock to preserve itself, and intervention is needed. The signs of shock: pulse of over 90 bpm (the heart is pumping faster to compensate for less blood in the veins), pale skin and cold sweat; lowered body temperature; low blood pressure: systolic (upper number) is less than 100). This most likely will not be an issue. but it’s better have someone you can call on the phone for help if needed or even if you just need reassurance.

“You created my inmost being; you knit me together in my mother’s womb.” We often think of this verse when we think about the child we are carrying. But let’s pause and meditate on how this verse describes you, mother; it describes your body, created with the ability to carry, birth, and breastfeed this child. God is with you.