Merry Christmas!

Merry Christmas everybody!

I really want to apologize for having fallen off the blogosphere this past month or so. I've been crazy out of my mind and so the blogging has suffered. I just quickly want to post so people know we're alive and well. There is much to share from the past weeks including lots of parties and events, numerous clinic shifts, and cramming in 2 modules-worth of midwifery assignments that must be completed by mid Jan along with tests on all of them and paper work of my clinical experience. That's a big part of the being overwhelmed lately.

I regret that this has happened around Christmas (which contributes to the busyness, of course) as it takes away from being really present during this special holiday. I regret that I haven't taken time to think and be silent, to reflect on the year, to be thankful for God's gracious gift of Jesus. Of course, these thoughts and quick prayers happen but I've not made it the priority and given it the attention it deserves. There may be some belated Christmas thoughts forthcoming in future posts.

For now, the thing at hand is to pack for a weekend trip that we are taking with Lou & Marilyn (A's parents) tomorrow. They have been here for 2 weeks already and will stay with us until early February. It is a rich blessing to have them here with us in Cebu these days. We'll be staying on Camotes island for two nights, then back to Cebu for 2 nights, then we'll go to another island nearby, Negros, for 5 nights. It's our big vacation time together as a family during their visit. They have been such troopers so far, remaining very flexible and laid-back, cooking, cleaning and shopping for us, encouraging us and coming along to all of the various event and social involvements that demand our time lately (including a Christmas event today that our church put on for 900 people!, yes, 900!). Quite impressive actually how they just dive in and experience what there is to experience here.

So once I get these assignments done and tests taken and holidays done with, and I get caught up on some much-needed sleep, I'll be much more present. I'm looking forward to a break. Much love and blessings!!

Here are a few photos from our church's Christmas event today in a gym at a local elementary school. All 900 people were fed lunch and juice, received gifts, heard about God's gift and were given the opportunity to receive it freely. They also got family photos taken and the kids got their faces painted, balloons, and ice cream. It was wild!

Andrey's Birthday

Thursday was Andrey's 33rd birthday. We went out for Italian food. We enjoyed a relaxing dinner and good conversation. I love Andrey's birthday. Mainly because it means we are the same age for the next six months and he can no longer tell people that he married an older woman. Happy Birthday, Andrey!

Turkey Day 2008

Sorry I've been MIA lately. It's been busy. We had a wonderful Thanksgiving day. It was a ton of work and I was exhausted by the end but it was worth every hour in the kitchen. I didn't have to cook for a whole week after, that's how many left-overs we had. I was in turkey heaven! Here a few shots of my favorite holiday...

Sunday Night Dichotomy

Sunday night was the busiest night shift I've worked so far. In addition to our 5 inpatients and their babies (a couple of them needed to be watched closely), we had two women in labor.

The first woman came in at 5 centimeters dilated. She progressed beautifully from 5-10 cm in just a few hours. It was her 2nd baby and I was hoping and praying for just one normal delivery. What a refreshing idea! She did not disappoint. This woman was one of those women that I am in awe of as I watch them labor. She was calm and confident (what a difference confidence makes!).

As I said, she progressed well and quickly. Her husband did a fantastic job providing labor support. It also helps when the partner is confident and not afraid of the whole process like most of our guys. Although, just as his son was born he rushed out to the hallway to vomit. He had to leave until after the placenta was born and out of site. Hee hee. I'm getting ahead of myself though...

So my patient did great. She stayed relaxed and calm and before long she felt the urge to push. It's also nice to get to be hands off for a change. We checked her to see if she was indeed ready and she was fully dilated with the bag of waters still intact. She pushed for about five minutes. And as soon as her water broke her baby was out in the next push. Amazing. All I did was simply catch her six and a half pound baby boy. She didn't bleed abnormally. The amniotic fluid wasn't stained with meconium. There were no abnormal heart tones. The baby didn't need deep suctioning. What a happy and beautiful and refreshingly normal birth! I really needed that. (Never mind the mother, it's all about me right? ha ha) But seriously, it is just so nice to see and experience a normal birth. Most births are in fact normal but I just haven't seen one in a while.
She did tear, however. Which meant I got to suture for 1.5 hours. This month has been great for suturing practice!

Just before this first patient delivered, another woman in labor arrived. A primie at 5cm and having a very difficult time remaining calm. She was the polar opposite of the first patient. Not to begrudge her it's just that most of our primies are very young and immature and not well-prepared. The father of the baby was not in the picture and so she was all alone except for her father who was all she had, I guess and he kept his distance.

To make a long story short, we had to transport her to the public hospital at 5 a.m. We couldn't get her to stop pushing prematurely. Her cervix was almost fully dilated (about 9cm) but was getting swollen. We tried absolutely everything to get her to relax and breathe through contractions until she was "fully" but she just couldn't do it. So our only option was to manage her cervix while she pushed in addition to continuing to do what we could to get her to relax and breathe and she did become fully dilated pretty soon after that. But she couldn't push effectively no matter how much advice and support we gave her. And she refused to try other positions. She was exhausted. She just kept gripping the table, my arms, her legs. She put all her energy into every other part of her body besides where her energy really needed to be focused. The poor girl was in agony. She pushed like this for over an hour and during that time, the baby's head became in view but failed to move beyond a certain point. And her water broke. And it was stained with thick meconium (fetal poop) which is a sign of fetal distress and is very dangerous because the longer the baby is inside, the more likely it is to aspirate the meconium. The fluid was such a color as to indicate that the baby had pooped a long time before.

So even though she was close to delivering we felt it best that she deliver in the hospital where the baby could have better emergency care. So there go the hazard lights on my car again as I drive us to hospital.

We heard later the baby was delivered using fundal pressure and episiotomy (routine at the hospital). Her 5-pound baby needed resuscitation and oxygen and will be held for observation.

Tiring? Yes. I got home and was in bed by 8:30 and slept till almost noon. I've never been so tired after a night shift. Last night I slept for 10 hours. I dreamt I delivered a baby on a bed in someone's home. The shoulder was stuck and I pulled on the baby too hard and hurt it's neck. The baby's body was twisted in a freakish way and I knew I had just damaged it's spine. It was a traumatic experience. When I awoke I sighed with relief that it was only a dream.

Rolyn Update

I went to visit Lin Lin's daughter in the hospital yesterday. It turns out I got her name slightly wrong on my last post. Her name is Rolyn. Anyway, it appears that she has typhoid fever. She is still having fever and diarrhea. I was able to help Lin Lin get some needed lab work done on Rolyn yesterday - a blood culture and a typhoid test. She is receiving IV antibiotics and fluids. Poor girl, she did not look like a happy camper yesterday.

I explained to Lin Lin how typhoid is spread and how she could prevent it in the future. I read yesterday online that children who are treated while dealing with typhoid rarely die and I was happy to see that Rolyn was receiving all the necessary care at the local public hospital. With that information I was able to encourage Lin Lin. We prayed together over her daughters sick body and I feel confident that she will be okay.

Thank you to all of you who are praying. I told Lin Lin yesterday that my friends and family were praying for her daughter. She was very thankful for that.

Please pray

My helper's 2-year-old daughter is in the hospital with persistent diarrhea and dangerously high fever (38 degrees) since Wednesday night. She's was admitted on Thursday morning. It is now Sunday evening and the diarrhea and fever haven't yet abated. Her mother is very worried and distraught. I'm going to visit her in a few hours. Please pray with me as you feel led. The toddler's name is Ronlyn. Our helper's name is Lin Lin. She's also 3 months pregnant.

I really wonder if this is some kind of spiritual attack as Lin Lin's family has had illness after illness since she came to work for us in August - her husband twice and both her kids at least twice each. She is the only one with a stable job and carries the burden of providing for her family and is learning to entrust that burden to Jesus. She is a relatively new christian and has been making strides in her faith so I wouldn't be surprised if the enemy is trying to get in the way of God's plan for her and her family's life so please pray.

I'll let you know what happens. Thanks.

The Long-Awaited Home Study Report

I am so happy! Our home study report is now officially done! Not only is it done but it is pleasing in every way. All of the revisions we've painstakingly tried to get accomplished have been made to our liking. We've been working on getting this home study report done since March. March! So I can't tell you how satisfying it is to have this document in front of me, that I can now say represents us in a truthful and accurate way. What a great feeling!

I spoke to our social worker this morning to tell her that we are very pleased and to thank her for her work. She apologized for it taking so long. She said she was going to submit our report TODAY. (Insert my big smile here)

What I found out was that she had pulled out the original report (the one with all the mistakes submitted in August) when she learned we weren't happy with it but left our dossier with the adoption board. According to her, the adoption board has been requesting the home study report. I asked her how long she thought the approval would take and she said maybe two weeks to a month. So it's possible that they have already looked over our dossier and now with the completed report it may not be that much longer before we are on their list of approved adoptive parents! Did you hear that? Approved adoptive parents! :-)

A Rough Night. A Sad Story.

Night shift last night was busy. We had two women in labor and four staff members. A midwife and a nurse attended a 21-year-old, first-time mother. Hilary and me took care of a 39-year-old mother of four. I'll try and write this quickly as I'm very tired and need a nap.

The first-time mom arrived yesterday morning at 3 centimeters dilated and labored in the clinic all day. Sometime after 8 pm she was reaching transition and was transferred upstairs to the labor room. Around 9 pm our other mom arrived. Smiling. Moderately strong contractions. Clearly a pro after doing this four times before. Seven centimeters dilated. Amniotic sac intact. Wanted her husband nearby. It was clear they both were a little excited about meeting their new baby soon. The mood was light and happy. We've seen many women like this deliver their babies quickly and (seemingly) easily as their bodies are quite familiar with the process. This mom was remarkable. After I did her internal exam she said softly and kindly, "thank you." We laughed and said, "We cause you pain and you say thanks?" What a sweet woman!

Due to her age and high parity (many pregnancies) we inserted a heplock so we could give her IV fluids or meds more readily during or after birth if needed. On our initial assessment we noticed the baby's heart rate slowed slightly during contractions so we took her upstairs to the labor room and hooked her to our electronic fetal monitor. With it we can track the baby's heart rate in relation to contractions, fetal movement and the position of the mother. We can also assess the strength of contractions. The baby's heart rate decelerated during contractions but only slightly, which could have several possible causes.

Some decelerations are normal due to head compression as the baby descends through the pelvis. The baby can handle these generally as long as labor is progressing and delivery is not far away. Sometimes decels can happen if the cord is wrapped around the baby's neck so we considered this as a possibility as well. Again, not necessarily a huge problem if the cord isn't tight, which is the case most of the time and as long as delivery is not delayed and the heart tones don't stay low.

Another possible cause is cord compression, which many times can be remedied by a change in position. So we asked the mother to lie on her side, then her other side, then squatting, then standing. While in the squatting position, the heart tones seemed to improve. Great, we thought. She stayed in that position for about 20 minutes. The baby's heart was fine but mom's legs were getting tired. We asked her if she wanted to stand for a few minutes to give her legs a break. She did.

Hilary and I didn't like what was happening to the baby's heart rate after she stood up. With contractions the baby's heart rate dipped to a very dangerous level. We started to become concerned and knew we needed to do what we could to help get this baby delivered ASAP. We immediately had her return to the bed. Hilary checked her cervix again to see how close she was to delivery and suddenly felt a piece of cord that was pinched between the baby's head and the mother's pelvis on her left side.

This uncommon, ominous discovery alerted an emergency - occult cord prolapse as it's called is extremely dangerous. Hilary said, "We gotta go to the hospital now!" One of the Filipino midwives explained to the mother and father what was happening and what we needed to do. Hilary kept her hand inside putting pressure on the baby's head to keep it off of the cord. Surprisingly, the mother's amniotic sac still had not ruptured, which was good as that usually causes the baby's head to descend further into the pelvis.

Also at this time, our younger mom was starting to push her baby out. Thank God one of the nurse-midwives who is also a supervisor lives just next door so we called her to stay with the other two staff members and the patient that was pushing. Meanwhile I ran to get the car. The security guard and our patient's husband carried our patient down the stairs and placed her in the back of our car with Hilary still putting pressure on the baby's head.

The hazard lights went on and I drove as fast and as safely as I could to the city hospital about 10 minutes away from the clinic, honking the horn all along so people would get out of our way.

It took several minutes to find a stretcher. An old woman was shooed off of a stretcher so it could be wheeled outside where I was parked. Our patient was transferred to the stretcher by the guard and the patient's husband and she was wheeled into the ER.

I've written about this hospital many times already. It's dirty, chaotic and awful. And it's the only option for the poor. There is no triage system. There is an abundance of clueless nursing students and usually no OB doctor to be found until we continuously ask to have him or her called. Hilary continued applying pressure. I listened to the baby's heart beat with our handheld doppler, a basic tool the hospital doesn't own.

Hilary and I asked for the doctor. Ten minutes later she showed up and moved to see a patient next to us in labor with high blood pressure that arrived after us. She eventually makes her way over and after appraising the patient and confirming what we report is true, she tells us that the patient needs a C-section but they have no anesthesiologist. We think of what the other hospital options are but the family has only a little money. No other hospital in the city will take them without a large deposit in cash. But even if that were an option, we didn't have time to take her anywhere else. She needed an emergency C-section!

The next moments were filled with the doctor asking us for lab work information and then asking the patient her entire past obstetrical history including whether she's had boys or girls and how much her babies weighed in the past.

The mother's amniotic sac ruptured spontaneously and the baby's head began exerting more pressure on the cord. The heart rate slowed even more. She suddenly had a very strong urge to push. They replaced Hilary with an intern who then provided the pressure on the baby's head. For the next hour, our patient desperately hung onto my arm while Hilary and I coached her to breath through each contractions and ordered her to look in our eyes and NOT push. We told her she was doing a great job and she was. It must have been very hard for her not to push. She did her best at breathing. You could see the panic in her eyes. Tons of activity going on around her and so much of it confusing. As I heard the baby's heart beat get disturbingly slow with each contraction, I felt helpless. thump.......thump..........thump.........thump........all I could do was pray.

They told us that the OR was busy (which contradicted what was said earlier) and that our patient would be next in line. They began to prep her for surgery by taking her clothes off, cleaning her abdomen with betadine and shaving her. They hooked her to IV fluids and checked her vital signs.

We felt there was nothing else we could do. We needed to get back to the clinic to our other patient. We explained what was happening to our brave patient and we layed our hands on her and prayed aloud. She looked at us with sincere eyes and said, "Thank you. Thank you."

We made it back to the clinic soon after and focused on the first patient who's baby delivered within minutes of our arrival. She had a healthy baby boy with a few breathing difficulties at first but after some suction and oxygen he was fine. Mom needed a few stitches but overall was fine. Grandma was ecstatic. We rejoiced with the young mom. "You did it! Look how cute your baby is!"

It was 3:00 a.m. when we got our new mom & baby settled and the labor room all cleaned up. Hilary called the city hospital for a report on our patient. They never did a C-section. Apparently, two hours after we left she delivered a baby girl with no heart beat. Her cord was wrapped around her head three times - twice around her neck and once around the top of her head, which was the portion that was pinched. We found out later they named her Angel. The hospital didn't even let them see her before they took her to the morgue.

Given what we learned, it is unclear whether there was anything that we could have done differently or whether an emergency C-section would have avoided this from happening. But that's no excuse for how this family's situation was handled at the hospital.

That's about all I can share for now. There is a whole other post about the atrocities that happen here everyday in this country to those who are not considered to be worth the time or money to be given basic care by their government. It's an injustice that angers me. Such an unnecessary tragedy. Please pray for the grieving parents of baby Angel.

Waiting

I know the Lord has his timing and I know He is working in and through the circumstances of our fertility and adoption and I know that I'm trying to finish a midwifery degree that will most certainly not be completed before Spring next year but I just keep getting these surges of impatience! I want my children and I want them NOW! I'm reading books about motherhood and parenting. I'm praying. I'm identifying areas that I will likely struggle with when I'm a mom and I'm forming plans to deal with them in a healthy way. I'm preparing myself to lay down my claim on my time and my rights. How much more ready can I be??? When Lord, when?? How much longer!? I don't want to look at another cute Filipino toddler. I don't want to look at another cute Filipino baby. I don't want to look at other families and their happy family times. Have mercy Lord! I don't want to hold another baby until I'm holding mine! I've waited so long and I've been so patient...

Forgive me for that emotional outburst. It's just been building up for a little while and I just needed to get that out.

On that note, I read something encouraging in the book, A Mother's Heart: A look at values, vision, and character for the Christian mother by Jean Fleming. I've read 3/4 of it and I can already highly recommend it - especially if you already have kids. I have many other things I'd like to share about the book but today I just want to focus on one rather encouraging part. Here's an excerpt:

Waiting on God - For Children

"Before I was pregnant with Matthew, I studied the lives of biblical women who had waited for a child. These women were Sarah, the mother of Isaac; Hannah, the mother of Samual; Rebekah, the mother of Jacob; Elizabeth, the mother of John the Baptist; and Samson's mother. From my study I gained a conviction that every child comes from God and ought to live for God's purposes.

Each of these women was initially barren. They waited and waited to conceive a child. Since failure to bear a child in their culture was often considered a curse, they experienced torment and ridicule. All of them endured a painful wait. Two of them - Sarah and Elizabeth - reached old age before conceiving.

Was it really necessary for these women to experience the agony of a long wait? Yes, there was a purpose.

God had something special in mind. He wanted to give each of these mothers a special child - a child with a specific purpose - and He wanted to receive the glory. Everyone must know that God did it. The awe and wonder of conception is often lost on us, since almost anyone can conceive - rich or poor, educated or uneducated, godly or ungodly. We can easily forget the part God plays in every birth.

Unless a sense of wonder accompanies parenthood, we may either take our responsibility too lightly or else cling too tightly to our children. God knows that withholding children often produces a different mentality in a waiting mother- or father-to-be.

I wonder if Abraham could have laid his son Isaac on the altar if the long wait had not prepared his heart. Would Hannah have given her beloved young Samuel to God's service if he had come much earlier? Did the wait produce a conviction that Samuel came from God and should live for God's purposes, a conviction she otherwise might not have experienced?

Perhaps another reason God allowed these mothers to endure a long wait was to lay a groundwork of prayer. They knew that these children were children of purpose and promise, and undoubtedly each of them was much prayed for."

I feel like I can relate to the desperate cries of Hannah in 1 Samuel who poured out her soul to the Lord out of her great anguish and grief.

I was so delighted when I read this part of the book because I have never read anything like it before. It resonated with me because I believe God has told me on several different occasions that he has a purpose in the waiting. I may never know exactly what that reason is but I am encouraged to once again be reminded that what I'm experiencing and have experienced in the past 4 1/2 years has not been a random waste of time. God is building something in us. He is preparing us for something. I have already noticed that my faith is much stronger and has more depth than it would had we gotten pregnant in 2004 like we had planned. Of course God can see what we can not. So I'm hoping in his wisdom and his unfathomable, huge-scale, x-ray vision. One who is wise, all-knowing, all-seeing and loving? Ok. He's got it covered. I can chill out now.

I really believe God is going to perform a miracle for Andrey and I like he did for each of those women in the bible mentioned here. In fact, in the past month we have received two more prophetic words about us conceiving a child. My brother and sister-in-law were praying for us recently and really felt God was going to bless us with a child - and my brother felt specifically that it was going to be a girl. They told us this while we were in the US. Then, when we returned to Cebu our friend at church said he recently had a vision of us and we had a daughter. He said she was very beautiful and that she looked like me. These aren't the only words we have received from the Lord. Even years ago, as friends have prayed and encouraged us, we were told several times that as they prayed, they got the sense that it was going to happen and that we shouldn't be discouraged.

And why is that 9 out of 10 people, after we tell them we are adopting, tell us about some one they know who adopted and then not long after found out they were miraculously pregnant? I can't tell you how often I hear that story over and over again. It's bizarre.

I am almost to the point where I can say that I know it's going to happen. It's only a matter of time. Besides, what about this?

"Whatever you ask for in prayer, believe that you have received it, and it will be yours." Mark 11:24

In my adult mind, I doubt. But with the simplicity of a child's faith, I choose to believe. Why wouldn't it happen? Nothing is impossible with God. And if Sarah and Elizabeth can get pregnant when they are old women then I can have faith enough to get pregnant despite our circumstances - no matter how ridiculous it seems.

Still working on that home study report

Finally today, after emailing Holt last week, we received a copy of our new, improved, revised version of our home study report from our social worker. Although I thought we had agreed she would just need to write an addendum (since the original home study was already submitted in August), she went ahead and rewrote the entire report including the changes we requested. I'm not sure what effect this will have on our expected approval from the adoption board here but that's not something we have control over. At least they will have a version with accurate information somewhere in their files once this one is submitted.

The good thing is that most of the substantial inaccuracies were corrected. I was quite pleased with the changes she made. However there were still several minor errors and a few major ones. The other good thing is that she's giving us the chance to make more corrections. I sent her my list of remaining changes today so hopefully the final copy will get done very soon. If she agrees to change the things I suggested, I will be sufficiently happy with the home study report and I will feel like it truly represents us well.

I tried to be as gentle as possible with her and tell her how much I appreciate all the time and energy she was putting into getting this right for us. I was able to explain why we care so much about so many details. And for once I was able to articulate those reasons, even to myself.

1) Our intention is to be completely honest in our dealings with this adoption even if it means we must share a negative aspect of our history, i.e. my past experiences with drugs. Especially when I answered honestly to questions regarding my past during the home study. Why our social worker thought it best to state the exact opposite of what I said is beyond me. This was done in several areas to cover up truths SHE didn't like about us or things she thought would hurt our case.
2) We desire that the personal information (such as ages, dates, the length of our engagement, circumstances & intentions for major decisions) provided to the various agencies involved in this adoption be as consistent as possible. That way, we are not put into an awkward position at some point in the future to defend incorrect information (lie) simply because it was stated in a report.

That's fair, right?

God's Gracious Gift

I got to name a baby. I was intimated by the fact that I had been asked specifically to name someone else's baby. Too much pressure. So I made I list of Hebrew names I liked and their meanings and presented it to our home group. As a group and with Ate Inday's approval, we decided on "Johanna" which means God's gracious gift.

Ate Inday (pronounced Ah-tee In-dai) is a friend of ours from church. I've written about her in past posts. I need to share her story because many of you have impacted her life by giving me money toward the family planning fund I started. Ate means older sister and is a commonly-used affectionate term in the Philippines.

Ate Inday & Baby Johanna

Ate Inday was distraught when she found out she was pregnant again. It was her 10th pregnancy. At the age of 41 she didn't think it was still possible. In fact, when she was pregnant the last time three years ago, she was worried how she would care for yet another child - since her husband doesn't have stable work and the family struggles to survive with hardly enough food to eat, much less the ability to pay for schooling for their children or needed medical care.

Together with my midwife friend Marielyn, we provided prenatal care for Inday at Glory Reborn. We supplied her with healthy foods and vitamin supplements and encouraged her to take care of herself as best she could. As her pregnancy progressed several complications arose. She started having premature labor at five months which was able to be stopped with treatment of a urinary tract infection. She was diagnosed with gestational diabetes and had too much amniotic fluid surrounding her baby, which carries it's own risks. To top it off, she struggled with iron-deficiency anemia which combined with everything else put her at high risk of hemorrhaging after delivery (one of the top causes of maternal death in the developing world). Given her age and the number of babies she's carried, in addition to the complications she was experiencing, Inday had to be transferred to hospital care. It was too risky for her to deliver at our little clinic.

While Andrey and I were in the US, Inday delivered a healthy baby girl. After delivery, at her request we arranged for her to have her tubes tied (tubal ligation). All of her pregnancy and delivery-related costs were paid for (ultrasounds, lab work, Dr. fees, hospital fees, medicine, etc...) in addition to the cost of her ligation. Without this support she would have likely lost her baby to premature labor. Or she would have given birth at home without the aid of a skilled birth attendant and would have put herself at a much higher risk of dying in childbirth. And she certainly wouldn't have been able to have tubal ligation and very well may have gotten pregnant again. In addition to all of her other problems (and she has many), at least getting pregnant again is no longer one of them. It's one area that she no longer has to worry about. Her current children are more likely to have their mother around to take care of them.

We are so thankful for God's grace, provision and mercy for Inday and especially her baby Johanna who was delivered in the hospital without any major complications. Praise God!

She's so cute!!

So THANK YOU! Thank you to those of you who contributed to helping Inday and others like her. I look forward to sharing more stories like this in the future.

And Another!

Yesterday I got to deliver another baby. To another primie! She came in when she was in early labor so I ended up working with her ALL day. She was ready to push just as my shift ended 12 hours later so of course I stayed to deliver her baby. It was a long & difficult labor for her but she did it! And it was another boy! What's up with all the baby boys lately?? This little guy weighed 6 pounds and boy was he cute! I am so proud of his mama who did such an amazing job controlling her intense need to push so her baby's head could be delivered slowly, thereby reducing the risk of a bad tear. Great job, mommy!

Even though my day yesterday was long and tiring, I didn't feel exhausted by the end. I felt energized and happy. I guess that's what it's like to be doing what you love. I'm so thankful for this opportunity.

Another Birth!

I worked last night and got to deliver another baby. I'm so happy that babies are being born during my shifts! I have increased from two shifts a week to three, so that helps as well.

Interestingly, the birth last night was so similar to the two we had on Wednesday night - a first-time mom ("primie"), age 19 or 20, giving birth to a boy weighing around 3 kg, some tearing & suturing and some hemorrhaging. Crazy. So perhaps we can say I'm fairly comfortable now with that particular type of birth? I emphasize "fairly." I'm getting there. I will say though, that it is refreshing to deliver babies that have a healthy birth weight. I love that.

In the year and a half I've been at the clinic I've noticed that certain situations and complications happen in groups. It's very strange but it really does happen like that where for example, all the babies in a week will end up needing phototherapy for jaundice, or IV meds for infection, or we'll have many cases of hemorrhage, or transport to hospital for induction due to slow progress, or a slough of normal births (love those!), or premature rupture of membranes, or whatever. I guess this week is the week of primies who progress beautifully but tear and need suturing and some form of intervention for blood loss.

The suture job I did last night took me nearly two hours as it was definitely the most challenging case I've had so far. It was great experience - especially with Hilary talking me through and assisting me the entire time. I'm learning so much from her!

I have come to believe that catching the baby is actually the easy part (and the most fun). What is challenging is managing a birth appropriately, i.e. knowing when to intervene or transfer care; managing & treating blood loss; assessing tears and suturing them up properly; newborn assessment, etc... Those are the hard parts.

So I only got a few hours of sleep again last night but I can't complain. I'm having a great time. :-)

Where we are at with the adoption

Some have asked if there have been any developments with the adoption. This is where we are right now.

Before we left for the US on Sept 19, our social worker agreed to write an addendum to our home study, which took us many weeks before that to get her to agree to do. The agreed-upon plan was for her to email it to us before she submitted it so that we could make sure it was accurate (which is what failed to happen with the original home study, thus the numerous inaccuracies that resulted in us feeling very misrepresented).

Here we are November 1. About a week ago I called her and left a message. Then I emailed her asking about the addendum and kindly and respectfully asked her to call or email us. Nothing. It's been nearly six weeks since we've heard from her. Next week, I'll call and email her again and if I don't hear anything I'll email Holt in the US. That has caused her to act in the past.

Our original home study was submitted to the Inter-country Adoption Board of the Philippines (ICAB) on August 13th and we are told it takes 2-3 months for approval. To my knowledge, since ICAB isn't expecting an addendum, we should be expecting an approval from them any day now. Oh! It just now occured to me that perhaps our social worker knows this and perhaps once we are approved by ICAB, she will think it is pointless to write an addendum. Hmmm, interesting. I wonder about that. Or perhaps it's a better idea to submit the addendum after our approval? I'd consider dropping it if in fact they do approve us without it but there needs to be consistency between the information in our home study and the information we give to the US government. Anyway, I'm just processing this as I write. Sorry to bore you with those details.

Frankly I don't know what is best. I just pray and have to trust that the Lord is taking care of it and that if there is anything we really should be doing differently, that he is big enough to make us aware of it. I will keep doing what I can to get our social worker to come through on what she promised. The rest is out of our hands at this point.

I will say however, that once we get that approval from ICAB, we will officially be waiting for a match which means technically we could get a call at any time!

More on Adoption & Being Ready for Motherhood

In the past week or two I've found myself more comfortable with referring to our future adopted children as "our kids." I feel like I can almost imagine who they are. I can clearly imagine two. Siblings. A boy and a girl perhaps? That is less clear. I can't imagine their ages. Part of me really hopes for a baby but I'm trying not to get too excited about that for fear of disappointment.

Perhaps I'm just making all that up but when my parents were visiting my father encouraged us to be specific when praying and asking for children. So I've been thinking about what my "ideal" option would be. It sounds weird but I thought it couldn't hurt. After all, I'm not getting my heart too set on any one specific thing and I know I can not limit God's plan by dreaming and praying. It's not like I'm going out to buy a double stroller with a baby carrier attachment.

While in Alabama I had a long conversation with my parents' neighbor. She and her husband adopted a toddler from the Ukraine. She said something that struck me. She said that she just knew that God had created her son specifically for their family. At first I found I couldn't agree completely as I believe God does not intend for families to not be able to care for their children or for a mother or father to choose to abandon a child. But what I've come to embrace as my own view is the belief that our children were created with Andrey and me in mind.

That has brought me to the place where I feel free to refer to those children (whoever and wherever they are) as ours... and mine. This has helped me in praying for them. I find I am already becoming connected to them in some way. I think about more often than before.

My prayer for them is this. That they would experience God's love, somehow. That God would reveal himself to them and that they would know him, even as very young children. That they would experience his comfort and love - despite their care situation but ideally through the loving touch and attentiveness of their carers. I pray the Lord be with them in a close, personal way. That they know his peace, his joy, his comfort, his protection and security.

Even as I write this I hear the voices of doubt hovering just below the surface of my mind saying,

"That's not possible. How can that be? That's unrealistic. You're asking too much."

But that's what hope and faith look like. Believing for the impossible knowing that God desires to bless us with more than we can even ask for or imagine. (I still think I'll be pregnant one day.) For I firmly believe that he is trustworthy and faithful in all he does. And that those whose help is from God, whose hope is in the Lord, are blessed. And those who put their hope in the Lord will not be disappointed. These are the truths that have carried me through our struggle with infertility and I choose to believe them - not because it feels good to believe them but because I personally know the God behind those promises and I know from experience that he. really. is. good. So how can I go wrong?

It's not that I believe that no way are our children going to grieve or struggle with attachment or face challenges common to adopted children. Those issues just seem reasonable to me for children who experience tremendous amounts of loss and uncertainty before and through the process of adoption. So I'm doing what I can to prepare myself for these things so I'm not blind-sided and left without resources to deal with them.

And at the same time I am holding out hope for having a relatively positive adjustment period. I've read about particularly resilient children that seem to be able to deal with transition and change shockingly well. But regardless, I feel confident that whatever we are faced with, (and I do expect trials!) we are going to be able to handle - with God's help and with reasonable preparation and support from others.

So I declare these truths over our children:

Though [your] father and mother forsake [you], the Lord will receive [you]. Psalm 27:10

The Lord will keep you from all harm. He will watch over your life, the Lord will watch over your coming and going both now and forevermore. Psalm 121:7-8

At times I really feel like something is missing. In the last month or two especially I've become aware of this place in me that feels ready. I feel more than ready. I want my children. I want them with us. I want to be the one to care for them. They belong with us. At times I've tapped into this deep place within me that groans in anticipation. I am becoming a mother.

Last week there were signs that the time may have been right to try and make a baby. I mean, why not? And then it occurred to me. If I were to (miraculously) become pregnant, our adoption process would end. I was suddenly aware of my desire for those Filipino kids I've already set my heart on. I choose them.

At church on Sunday there was a baby dedication. My first thought was how I want so badly to dedicate our children to the Lord in this church. The desire was so strong I had to fight hard to keep from crying. So I prayed for that specifically. As my father encouraged me recently and as it has been said, "You have not because you ask not."

Busy Night

Last night I worked a shift at the clinic for the first time since we got back. It was a busy one. I had the privilege of catching two baby boys. How fun! And I got to suture again. Not fun for the mom but good practice for me.

When I arrived at 7:30 pm there was a woman in labor who had been admitted 2 hours prior and was found to be 7 centimeters dilated. She progressed quickly and gave birth to her first child just before 9 o'clock. Unfortunately for the mom, her son's hand was pressed against his face as he was exiting her body. That was the likely reason why she ended up with a second degree tear. Not fun for her but it did mean I got to get more suturing practice. I think I'm starting to get the swing of it.

Ten minutes after our first patient delivered, another woman in labor arrived. She was about 6 centimeters dilated. Clearly we were busy with all of our post-birth duties so it was good that the second patient didn't require a lot of attention. Our nurse on staff was able to attend to her while we focused on suturing and monitoring the health of both mom and the new baby while they got to know each other upstairs. By 11, the mom and new baby were settled in their bed and the labor room was cleaned and ready to go so we brought our newest patient upstairs. She too was a first-time mom. To be honest, she did not appear to be in active labor so we doubted whether she was actually progressing. She barely grimaced or made a sound during contractions. She whimpered a little and reached for her lower back with each set of pain. She kept saying she wanted to push so we explained to her why it's not a good idea to do that until she is at least dilated to 10 centimeters. Over the next hour she labored beautifully while we did what we could to support and encourage her. Despite her calm disposition it became clear that her contractions were indeed quite strong. I love watching a pregnant belly contract. You can see it change shape as it tightens and does its work at sending the baby on its way. It's amazing to watch.

In response to her increasing discomfort and desire to push we checked her progress. It was now midnight. I was pleased to find she had progressed to 9+ centimeters, with only a small portion of the cervix remaining. We broke her water and by the end of the next contraction she was fully dilated and ready to push. She was relieved to finally be given the green light to do so. (On a side note: we aren't trying to be mean when we don't let a woman push as soon as she says she's ready without checking her progress. An exception to this would be a woman who clearly has an unavoidable urge to push. We have numerous women who are accustomed to pushing well before it is time. Doing this can cause a lot of problems, from cervical swelling to maternal exhaustion, to malpresentation so we find it best to avoid this.)

It took our mom some time to find a way of pushing that was effective. She alternated between a semi-sitting position and a full squat. She ended up pushing for about 45 minutes, which is perfectly normal for a first time mom. The baby descended little by little until finally it was crowning. We encouraged the mom to breath and let the baby's head ease out slowly. She was a trooper at responding to our directions.

The baby's head was born, then with the next contraction the entire body was delivered. And would you believe that this baby ALSO had his hand up close to the top of his head so that his elbow was at shoulder level. This too caused quite a bad tear. Probably the worst I've seen yet. Hilary had to do the suturing as it was very close to being a 4th degree tear. Poor mommy. That's going to take some time to heal.

After another suturing job, getting another mom and baby settled, and checking vital signs on the other four mother & baby pairs we were able to sleep for a couple of hours. That was at 4 this morning. With that, I'll sign off. I'm going to try and get some more rest.

Alabama Photos

Another Haenlein family reunion. As usual, some quirky outbursts ensued. Here we are attempting the classic family shot. Many of these were taken by my father without our knowledge while he was supposedly setting up the timer on the camera. Nice one, Dad. You captured the moments well. We certainly are a bunch of nuts.

What is it about the conscripted family photo shoot that results in berserk fits of disobedience?

My brother's new boxer puppy, Purity

Here the guys are playing King of the Hill on the huge pile of sand
my Dad has accumulated near the pond on their property

Mom & Dad at their 35th Anniversary dinner

English...that funny & difficult language

I bought a bamboo cutting board today. Made in China. This is what it said on the label:

"People need bamboo for inhabitancy under the circmstance eating without meat"

Did you know that?

You know something's different when...

When Andrey and I woke up today we both noted the overcast and drizzly weather outside and it brought us joy. When we were in the kitchen preparing breakfast we noticed a coolish breeze. Put it this way, we couldn't be happier about clouds and rain! My immediate thought was that I wasn't going to sweat as much today. Maybe I'll only need one shower. Maybe I'll even make it through the day without having to change my clothes. Maybe I won't feel dehydrated today. I remember the days even last month when the idea of clouds and rain meant cold, miserable weather and how differently we'd felt when waking up to weather like that. How different life is in the tropics!

Fuzzy Day, Random Brain

I stayed up till 10:30 last night which is pretty darn good for ensuring a good first sleep after traveling to the other side of the earth. I was glad we both slept pretty well last night, with only a few short wakings throughout. I wonder how Andrey is holding up at the office now that it's late afternoon. I'm thankful I don't have to start back at the clinic for a few days. There is much to get caught up on here at home. I've learned to maximize those more alert, early hours in the day while getting over jet-lag.

So far my day has been productive but now I'm fighting the urge to lay my head down and close my eyes. I was alert early this morning but now the brain fuzziness is setting in big time. I do feel satisfied with what I accomplished today - or at least I should feel satisfied. I got our bills paid, check books balanced and our budget up-to-date and ready to report to Andrey on the status of our finances post-furlough. I made a few necessary adoption-related phone calls. One to the US Embassy in Manila regarding an approval notice we are anticipating for some forms we submitted a while back. The other to our social worker who is supposed to be working on an addendum to our home study which should have been completed well before now. She was conveniently not available. I took advantage of the time alone and did some praying and journaling. I also did some much needed emailing, planned a few dinners and educated myself on what is happening in the world via CNN international version. It takes leaving America to actually get some international news. I mean, I too am enraptured with the US election and I can't wait to find out who our next president will be but after a week and a half in Alabama trying not to get too angry or disrespectful when FOX News was dominating the TV (love you Mom & Dad!), I realized that I had no idea what else is going on in the world. The funny thing is that when I watch other news I find myself just wanting the non-US-election news segments to hurry up and get on with the election coverage! Only 12 more days. I never thought I could be so wrapped up in it. Do those "best political team on TV" people on CNN ever sleep? What is everyone going to talk about once it's over?

All that should mean that I shouldn't be feeling guilty for not accomplishing more today, right? But I still feel a little guilty. Does this mean I'm going to have a hard time when I'm home all day with kids and didn't feel like I accomplished anything? Oh boy.

Well guilt or no guilt, I am now letting myself get caught up on blogging - both reading and writing - since I got a little behind while on furlough. Frankly, my brain isn't up to much more right now.

A good aid for adjusting to a new time change is to be outside in fresh air but I just can't bring myself to go for a walk in our congested neighborhood in the heat. In fact, I haven't left our air-conditioned bedroom most of the day. I feel pent up though. And my legs hurt for some reason. Soon I'm going to have to get in the kitchen and get some dinner together. It was so nice to be in North America in the fall. Being outside in the cool, dry air. Working in the kitchen without sweating. Now I'm practically sweating in the air con! I'm gonna tell myself it will take a few days to get acclimated to the heat again.

My goals for the rest of today?

STAY AWAKE TILL NINE

FEED SELF & HUSBAND

DON'T FEEL GUILTY

It Feels Good to be Home

We made it! Bags intact and all five flights on-time. Montgomery-Memphis-Detroit-Nagoya-Manila-Cebu. Whew! Door-to-door the trip took 42 hours. That included 6 hours of sleep in a hotel in Manila. Not bad. I think Andrey and I are becoming quite the travelers as trips like these just don't seem to be that big of a deal anymore. In some ways they are even fun - a good time to decompress and think and be before delving into life as usual again. We'd better enjoy it while it lasts because traveling with 1-2 kids is going to change that!

There was some stress in the beginning when it wasn't clear if we were going to get seats together on the 12-hour flight from Detroit to Nagoya. Even though we booked months ago and checked-in online 24 hours in advance, we were assigned separate seats and weren't able to change them. Being separated on the shorter flights is no big deal but for that one long one I really like to sit with Andrey so I can prop my head on his shoulder to sleep and not have to worry that I'll lean into and drool on a stranger in my drowsiness. Thankfully, a kind young Filipino man was obliged to switch seats so that we could sit together. I was so happy. We both slept most of the flight. We both had "fat feet" by the end of it.

The title of this post mentions "home." I use this term when going "home" to North America and when we return "home" to Asia. What is "home" anyway? This is something I've pondered lately, especially as I wonder what our future kids will identify as their home. For us home is a very loose term. Now that we are well up-rooted from our life in North America there is no one place that feels like home more than any other. There are elements of home in many places we go.

Home is where family is. Home is where we currently live. Home is the ease I feel when comfortable and surrounded by familiarity. Home is a sense in my being that whispers, you are secure, you are loved. Home is where I am truly free to be myself. Home is with Jesus. And since His Spirit lives in me I can feel at home anywhere. One day I will meet my Jesus face-to-face and in His embrace I will really find out what it feels like to be home.

What will I teach my kids about home? I think that I want them to know their place in God's family first, then their place in our family, then their place in the world/on this earth. I guess if you have your identity straight then your definition of home can be very loose without it threatening your peace. I think home is wrapped up in identity. Maybe that's why I have no problem with home meaning so many different things - because underlying it all I know who I am. I am a child of God, part of God's family. I want my kids to know who they are and where their true home is. I think this will be important as I can imagine that it may be a little confusing to be from the Philippines but have a couple of Americans for parents and potentially live in a country other than either of those two places (because who knows where we will live once/if we leave the Philippines). I do hope we get to stay in the Philippines for a while though and that our kids will have the opportunity to stay in their home country during the initial adoption adjustment/bonding period. I'm not exactly sure why I think that would be great but even if that doesn't happen I believe that our kids can have a healthy concept of home. I mean, what a better way to experience life in God's family? Afterall, we are orphans. We've been adopted into God's family. Perhaps it is a privilege for our kids to have the opportunity to grasp that from the beginning. Perhaps they will have to learn about their true identity early on without being limited to an identity related to their nationality. Not that I won't expose them to and educate them about their Filipino heritage as I think that is important but I want to model and teach an expanded definition of home as I have come to understand it.

I was happy to arrive in Cebu today...even with the dense, humid air that slapped us in the face as we got off the plane. I was happy to enter our house and rediscover its unique smell. America and Canada felt pristine and shiny. In comparison Cebu City is bedraggled. Chaotic. Developing. Foreign. Driving through traffic with the windows down I felt grateful for the breeze and the white, puffy clouds that made the day just shy of unbearably hot. Ah yes, I know this feeling. Sweat immediately forming in the crevasses of my body. My bangs that were so cute and stylish suddenly a nuisance. Even though we have air-con in our car, we drove with the windows down so we could take in the sounds and smell of this place that is remarkably strange yet familiar. There are just so many people. Everywhere. Lots of them.

"Oh look! The pineapple guy!" I tell Andrey to pull over. I plan to buy two (they're small). The man says, "3 for 100 pesos." "Alright," I say. How wonderful! Three delicious pineapples that have already been shaved for about $2! Oh joy. By tomorrow I'll have a few canker sores but who cares.

Well that's all for now. My brain is fuzzy and I'm not sure if I'm making any sense at all, just rambling a bit. It's almost 7 pm here and I'm starting to fade. It's time to get up and do something. I've got to make it until 9 pm at least. That's the rule.

Another furlough is done

Early tomorrow morning we'll begin our journey back to Asia after another year's furlough. We've spent the last 9 days in Alabama with my side of the family. My parents only have dial-up at their house so we've been a little out of touch. We're at Starbucks for a couple of hours making use of the internet so I was just now able to at least get the rest of the photos up from our time in Eastern Canada. I'll post about the Alabama portion once we get back to Cebu.

It's been a wonderful furlough (our 4th since we left the US) with times of relaxation, fun, reconnecting and a few speaking engagements regarding our respective areas of involvement in Cebu. While it's been enjoyable, I have to say that I'm ready to get back. At least for me, it's time to get productive again. Andrey has been working throughout our time here so he's still been able to at least keep up with a few things at the office. I'm ready to get back to the clinic and to dig into those hovering midwifery assignments. I'm ready to see our friends and get back to our church. I feel refreshed and energized for life in Cebu. Getting away like this usually has this positive effect on me. I get perspective and appreciate things about life in Asia that I might not recognize if I didn't get out of there every once in a while. For that I am so thankful to Andrey's employer for this chance each year to step away, take a deep breath, unplug, ponder, stop sweating, reconnect with loved ones, think, breath, rest, laugh and enjoy the benefits of certain longed-for conveniences and edible treats while hanging out in North America. We are so blessed. I am thankful.

Hike at Musquodoboit Harbour Trail

The day before we left Nova Scotia we took a lovely hike with Mike, Lisa and Stella. It was drizzly and overcast but turned out to be perfect weather for working up a sweat while taking in beautiful scenery in the Nova Scotian woods. The brightly-colored autumn leaves speak for themselves...

Localicious

A day of apple-picking and a trip to an herb garden, meat shop, cheese house and a farmer's market resulted in a tasty dinner meal with beloved friends who we are privileged to call family...

Items purchased: 10 kilos of apples (hand-picked), sausage made from local pork, quark cheese, smoked gouda, whole wheat bread, broccoli, sweet potatoes, blueberries and ginger lime thyme jam

The hungry bunch

maple sausages with homemade apple sauce, roasted sweet potatoes and steamed broccoli
(this came after our appetizer of cheese and ginger lime thyme jam on fresh bread)

Apple pie for dessert, of course...