And while I'm thinking of it, I'll share the recipe of my favorite pancakes:
Oat Bran Cranberry Pancakes (from Simply in Season)
Serves 3-4
3/4 cup oat bran
1/2 cup whole wheat flour
1 tablespoon baking powder
1 teaspoon salt (I found this way too salty so I only use 1/2 teaspoon)
1/4 teaspoon ground cinnamon
1/4 teaspoon ground ginger
Stir together in a large bowl.
1 cup milk
1 egg
1 tablespoon oil
2 teaspoons honey (slightly warmed)
Combine separately. Mix into dry ingredients.
1/2 cup cranberries (chopped)
1/2 cup apple (chopped)
Fold in. Fry in a medium-hot, greased frypan. Serve with cranberry syrup (optional).
Cranberry Syrup: Boil together 1 cup cranberry juice, 2 tablespoons honey, 1 tablespoon cornstarch, and a pinch of ground ginger.
Now I know this is clearly an autumn recipe but since we don't have access to cranberries here I just replace the cranberries with raisins and serve with pure maple syrup. You Canadians in BC can make the original recipe in the late summer/early fall when you have fresh cranberries available (am I right about that?). I also don't have ground ginger so I just omit it.
Saturday, May 31, 2008
Delicous Whole Grain Muffins
Inspired by Mel's recent postings of food and recipes, I thought I'd share the recipe to the muffins we enjoyed this morning. They were excellent! We enjoyed them with scrambled eggs and fresh mango. I love Saturday morning breakfast!
Banana Oatmeal Muffins (from Recipes from the Old Mill: Baking with Whole Grains)
Yield: 12 large muffins
1 cup whole wheat flour
1/4 cup sugar
3 tsp. baking powder
1/4 tsp. salt
1 cup rolled oats (not instant)
1/2 cup raisins
3 Tbsp. oil
1 egg
1 cup skim milk
2 mashed bananas
Topping:
2 Tbsp. sugar
2 tsp. flour
1 tsp. cinnamon
1 tsp. melted butter
1/4 cup chopped pecans or sunflower seeds
Combine whole wheat flour, sugar, baking powder, and salt. Add oats and raisins.
Combine oil, egg, milk, and bananas. Mix well.
Add liquids to dry ingredients and stir only until ingredients are moist.
Spoon batter into greased muffin tins. Fill 2/3 full.
Mix topping ingredients together and sprinkle on top of each muffin.
Bake at 350 degrees F for about 15-20 minutes.
So easy and delicious! I used pecans for the topping and it was delightful.
Banana Oatmeal Muffins (from Recipes from the Old Mill: Baking with Whole Grains)
Yield: 12 large muffins
1 cup whole wheat flour
1/4 cup sugar
3 tsp. baking powder
1/4 tsp. salt
1 cup rolled oats (not instant)
1/2 cup raisins
3 Tbsp. oil
1 egg
1 cup skim milk
2 mashed bananas
Topping:
2 Tbsp. sugar
2 tsp. flour
1 tsp. cinnamon
1 tsp. melted butter
1/4 cup chopped pecans or sunflower seeds
Combine whole wheat flour, sugar, baking powder, and salt. Add oats and raisins.
Combine oil, egg, milk, and bananas. Mix well.
Add liquids to dry ingredients and stir only until ingredients are moist.
Spoon batter into greased muffin tins. Fill 2/3 full.
Mix topping ingredients together and sprinkle on top of each muffin.
Bake at 350 degrees F for about 15-20 minutes.
So easy and delicious! I used pecans for the topping and it was delightful.
Friday, May 30, 2008
Small Babies 2
So I think I may have uncovered at least 1 underlying belief that causes many pregnant Filipinas to want to inhibit the growth of their babies in utero so it's not "too" big, meaning anything approaching 7 pounds...
Yesterday, I went to visit one of the obstetricians that partners with the clinic where I work. We refer those patients of ours to her that need something beyond our scope of practice - for example: prescriptions, hospital care, consulting for a complication, etc...
A few friends and I visited her at the hospital because she gave birth to her first child 2 days ago. We dropped off some flowers and congratulated her on her new baby. We asked how much he weighed and she replied, "5 pounds 15 ounces. I'm sooooo luckyyyyyy! I just knew if he was 7 pounds I'd need a C/S (cesarean section)!"
Let me explain that this is a very educated, upper-class Filipina who is also an obstetrician! If she believes it's impossible to give birth vaginally to a 7 pound baby, then it doesn't surprise me that many ignorant, poor people believe that too! I wonder what she did, if anything to keep her baby small. Don't get me wrong, I don't think she starved her baby or anything, as the size of her baby is just on the low end of normal. I just know that she hoped, really hoped her baby would be small.
I just wish that all the women in my life (including my own mother and mother-in-law) who have given birth naturally to healthy babies weighing 7, 8 or even 9 pounds could come and share their birth stories. While I am sure it was hard work to push those babies out, let it be said that it is possible people! I know I'm preaching to the choir here...
For the record, according to the newest growth charts from the World Health Organization, a normal, healthy birth weight range (between 3rd to 97th percentiles) are 5 lb 5 oz to 9 lb 4 oz (girls) and 5 lb 8 oz to 9 lb 8 oz (boys). That means birth weight under 5 lb 5 oz and 5 lb 8 oz for girls and boys respectively is considered underweight and this indicates that the health of that baby may be compromised.
Let me just explain why the newest WHO growth charts which launched in 2006 are a much more reliable indicator of normal growth compared to the ones used in the past put out by the National Center for Health Statistics, or NCHS in the US. The following is an excerpt from WHO regarding how these growth charts are different from the ones previously used:
"For the first time they describe “how children should grow,” which is a prescriptive approach, not just descriptive. These charts show that all children across all regions can attain a similar standard of height and weight and development with correct feeding practices, good healthcare and a healthy environment. It is, then, a more proactive way of measuring and evaluating child growth, setting out normative conditions and evaluating children and populations against that standard.
As such, a key characteristic of the new standard is that it establishes breastfeeding as the biological “norm” and the breastfed infant as the standard for measuring healthy growth. Previous reference charts were based on the growth of a random mixture of breastfed and artificially-fed children.
Furthermore, the pooled sample from the six participating countries allows the development of a truly international standard, which is in contrast to the previous international reference based on children from a single country."
I used to think that it was normal for smaller people to have really small babies. But now I realize that while smaller people will likely give birth to healthy babies that happen to be on the smaller end of normal, there is still a limit to how small a healthy baby can be. The women who I've known to limit their intake of food in the 3rd trimester have had babies that are just too small! The 4 pound 13 ounce baby I delivered earlier this month was too small!
So when I ask these women why they aren't eating much and they tell me they're not hungry - I'm not going to believe them right away. I'm going try to address what they just might be afraid to tell me - their fear of a "big" baby and a complicated birth - and do my best to convince them that their choice to limit their intake may very well have long-term damaging consequences on the health of their baby and that they can, in fact give birth naturally to a baby that weighs more than 6 pounds. Most of our patients do actually give birth to babies over 6 pounds so it can be done. I now personally like to see babies born at at least 6 pounds (15th percentile). So in addition to addressing this underlying belief, I will do my best to educate them and prepare them for the hard work of labor. I will also do my best to provide labor support when these women are in the middle of it and hope that they begin to believe they can do it!
Yesterday, I went to visit one of the obstetricians that partners with the clinic where I work. We refer those patients of ours to her that need something beyond our scope of practice - for example: prescriptions, hospital care, consulting for a complication, etc...
A few friends and I visited her at the hospital because she gave birth to her first child 2 days ago. We dropped off some flowers and congratulated her on her new baby. We asked how much he weighed and she replied, "5 pounds 15 ounces. I'm sooooo luckyyyyyy! I just knew if he was 7 pounds I'd need a C/S (cesarean section)!"
Let me explain that this is a very educated, upper-class Filipina who is also an obstetrician! If she believes it's impossible to give birth vaginally to a 7 pound baby, then it doesn't surprise me that many ignorant, poor people believe that too! I wonder what she did, if anything to keep her baby small. Don't get me wrong, I don't think she starved her baby or anything, as the size of her baby is just on the low end of normal. I just know that she hoped, really hoped her baby would be small.
I just wish that all the women in my life (including my own mother and mother-in-law) who have given birth naturally to healthy babies weighing 7, 8 or even 9 pounds could come and share their birth stories. While I am sure it was hard work to push those babies out, let it be said that it is possible people! I know I'm preaching to the choir here...
For the record, according to the newest growth charts from the World Health Organization, a normal, healthy birth weight range (between 3rd to 97th percentiles) are 5 lb 5 oz to 9 lb 4 oz (girls) and 5 lb 8 oz to 9 lb 8 oz (boys). That means birth weight under 5 lb 5 oz and 5 lb 8 oz for girls and boys respectively is considered underweight and this indicates that the health of that baby may be compromised.
Let me just explain why the newest WHO growth charts which launched in 2006 are a much more reliable indicator of normal growth compared to the ones used in the past put out by the National Center for Health Statistics, or NCHS in the US. The following is an excerpt from WHO regarding how these growth charts are different from the ones previously used:
"For the first time they describe “how children should grow,” which is a prescriptive approach, not just descriptive. These charts show that all children across all regions can attain a similar standard of height and weight and development with correct feeding practices, good healthcare and a healthy environment. It is, then, a more proactive way of measuring and evaluating child growth, setting out normative conditions and evaluating children and populations against that standard.
As such, a key characteristic of the new standard is that it establishes breastfeeding as the biological “norm” and the breastfed infant as the standard for measuring healthy growth. Previous reference charts were based on the growth of a random mixture of breastfed and artificially-fed children.
Furthermore, the pooled sample from the six participating countries allows the development of a truly international standard, which is in contrast to the previous international reference based on children from a single country."
I used to think that it was normal for smaller people to have really small babies. But now I realize that while smaller people will likely give birth to healthy babies that happen to be on the smaller end of normal, there is still a limit to how small a healthy baby can be. The women who I've known to limit their intake of food in the 3rd trimester have had babies that are just too small! The 4 pound 13 ounce baby I delivered earlier this month was too small!
So when I ask these women why they aren't eating much and they tell me they're not hungry - I'm not going to believe them right away. I'm going try to address what they just might be afraid to tell me - their fear of a "big" baby and a complicated birth - and do my best to convince them that their choice to limit their intake may very well have long-term damaging consequences on the health of their baby and that they can, in fact give birth naturally to a baby that weighs more than 6 pounds. Most of our patients do actually give birth to babies over 6 pounds so it can be done. I now personally like to see babies born at at least 6 pounds (15th percentile). So in addition to addressing this underlying belief, I will do my best to educate them and prepare them for the hard work of labor. I will also do my best to provide labor support when these women are in the middle of it and hope that they begin to believe they can do it!
Tuesday, May 27, 2008
More B-day Weekend Pics
Photos from Saturday morning birthday brunch...
My girlfriends - Hilary, Marielyn, Bambi, and Florence
The guys, pitching in to help Andrey in the kitchen - what in this picture proves it was warm?
Saturday evening dinner... (some of Andrey's co-workers and their spouses)
Andrey working hard in the kitchen
My girlfriends - Hilary, Marielyn, Bambi, and Florence
The guys, pitching in to help Andrey in the kitchen - what in this picture proves it was warm?
Saturday evening dinner... (some of Andrey's co-workers and their spouses)
Monday, May 26, 2008
My 33rd Birthday
Friday was my birthday. How it began was so over-the-top unbelievable that it could have an entire post dedicated to it...
Friday Morning at 5:20 am, from a deep sleep, I was awoken by 15 Filipino singing teenagers from our church. Many of these kids have become our friends. At least half of them attend our home group. They had been planning this surprise for weeks. As is Filipino custom, the "mangenita" involves greeting the birthday celebrant before dawn (I was told they initially planned to come at 4am but was advised by their youth leader not to go so early - thank you Bambi!) so as to be the first to sing the celebrant happy birthday. There is always singing involved. For me the kids had practiced and performed a song about friendship, complete with harmonizing parts and a special part with just the male voices. After that, they sang the Filipinized version of happy birthday (a bit more upbeat) and then each of them laid small bouquets of flowers and very elaborate homemade cards in front of me on my bed.
Talk about a shocker! First of all, I was dead asleep and NOT expecting any of this so therefore I wasn't dressed for the occasion. I was in my underwear! Thankfully I was also wearing a t-shirt and was safely under the covers. And my hair was a mess (hello! sleeping bed head!). Thankfully the songs were long because it took me a little while to figure out what was going on. I didn't know what to do so at one point I put the covers over my head but then I realized that was rude so I lowered them. I must have looked very confused.
After they finished they left the room and I was able to quickly get dressed and brush my teeth and make myself semi-presentable. When I came out of the room everyone was in the kitchen preparing a breakfast of instant coffee, rice, and eggs. We had a party before 6 am!
As crazy and as unexpected as it was, I was truly blessed by this celebration. I was overwhelmed actually. Man, Filipinos are the best at special occasions! I mean, they really do it up. They made me feel very special. One of the high schoolers wrote this in one of my cards. It's my favorite so I have to share it with you... "Hi Jen, Happy Birthday and bless you to live a hundred of age, and to have a child by the blessing of God, to live happily ever and ever and have a peaceful and happy relationship together with your husband. Promise you won't forget about us, not even when you are a hundred."
Apparently, they had been planning this for weeks. Also, they apparently had a co-conspirator to help them pull this off. Andrey!...
Friday Afternoon - Andrey was at work by then and I took the day off. I treated myself to sushi for lunch, a massage, and a pedicure. During lunch and the pedicure I got to relax and do some reading.
Friday Evening - Andrey bought me 33 long-stem, red roses and took me out to dinner at a fantastic restaurant in town. We hadn't been there yet so it was a real treat. It's a fancy place (by Cebu standards) with delicious food. We enjoyed steamed mussels in white wine and cream sauce with fresh bread, wine, a lovely salad, and melt-in-your-mouth chateaubriand (center-cut beef tenderloin) served with roasted potatoes and baby carrots. I was so full and so tired by the end that we didn't even order dessert. I was so ready to go home and sleep!
Saturday Morning - We hosted a small birthday brunch for a few of our friends. Andrey did all the cooking (bless him!). I planned the menu but he did all the work. Aside from a few small mishaps (he learned there is a difference between whole oats and oat bran) Andrey successful prepared cranberry oat bran pancakes and bacon. We also enjoyed delicious coffee, juice, fresh bananas, blueberries and pure maple syrup. It was a really nice and relaxing time with our closest friends in Cebu. I'll post photos of this in the next post because I can't add more here for some reason...
Saturday Evening - Saturday did not involve any more birthday events but we did have 3 IJM employees & their spouses over for dinner. We starting hosting a dinner like this once a month so I could get to know each of the employees better since I rarely see them. Each month we'll host a different group. IJM Cebu has over 30 employees so it's going to take several months before we host everyone. I made chicken thighs in the slow cooker with an apricot ginger sauce (inspired by a recipe by Mel Vose found on her blog awhile back- thanks, Mel!), coconut rice, stir-fried bok choy and snap peas, and fresh pineapple. It was so easy and very delicious and seemed to satisfy both the Filipinos and the foreigners which was the goal.
By Sunday we were quite tired and thought we might be getting a cold. We still made it to church though and then lunch after with a few friends but after that we decided to come home and rest up for the week ahead. We're feeling better today after a good, long sleep last night.
Over the past few days I have been greeted via phone, email, and Facebook by so many friends. I want to say thank you everyone! I wasn't feeling very festive about this birthday - not depressed or anything - just like it wasn't a big deal - but then so many people poured blessings out on me and I just feel so richly blessed! I know God loves me so much and I have experienced his deep and undeserved love for me this birthday through so many of you. Thank you!
Friday Morning at 5:20 am, from a deep sleep, I was awoken by 15 Filipino singing teenagers from our church. Many of these kids have become our friends. At least half of them attend our home group. They had been planning this surprise for weeks. As is Filipino custom, the "mangenita" involves greeting the birthday celebrant before dawn (I was told they initially planned to come at 4am but was advised by their youth leader not to go so early - thank you Bambi!) so as to be the first to sing the celebrant happy birthday. There is always singing involved. For me the kids had practiced and performed a song about friendship, complete with harmonizing parts and a special part with just the male voices. After that, they sang the Filipinized version of happy birthday (a bit more upbeat) and then each of them laid small bouquets of flowers and very elaborate homemade cards in front of me on my bed.
Talk about a shocker! First of all, I was dead asleep and NOT expecting any of this so therefore I wasn't dressed for the occasion. I was in my underwear! Thankfully I was also wearing a t-shirt and was safely under the covers. And my hair was a mess (hello! sleeping bed head!). Thankfully the songs were long because it took me a little while to figure out what was going on. I didn't know what to do so at one point I put the covers over my head but then I realized that was rude so I lowered them. I must have looked very confused.
After they finished they left the room and I was able to quickly get dressed and brush my teeth and make myself semi-presentable. When I came out of the room everyone was in the kitchen preparing a breakfast of instant coffee, rice, and eggs. We had a party before 6 am!
As crazy and as unexpected as it was, I was truly blessed by this celebration. I was overwhelmed actually. Man, Filipinos are the best at special occasions! I mean, they really do it up. They made me feel very special. One of the high schoolers wrote this in one of my cards. It's my favorite so I have to share it with you... "Hi Jen, Happy Birthday and bless you to live a hundred of age, and to have a child by the blessing of God, to live happily ever and ever and have a peaceful and happy relationship together with your husband. Promise you won't forget about us, not even when you are a hundred."
Apparently, they had been planning this for weeks. Also, they apparently had a co-conspirator to help them pull this off. Andrey!...
Friday Afternoon - Andrey was at work by then and I took the day off. I treated myself to sushi for lunch, a massage, and a pedicure. During lunch and the pedicure I got to relax and do some reading.
Friday Evening - Andrey bought me 33 long-stem, red roses and took me out to dinner at a fantastic restaurant in town. We hadn't been there yet so it was a real treat. It's a fancy place (by Cebu standards) with delicious food. We enjoyed steamed mussels in white wine and cream sauce with fresh bread, wine, a lovely salad, and melt-in-your-mouth chateaubriand (center-cut beef tenderloin) served with roasted potatoes and baby carrots. I was so full and so tired by the end that we didn't even order dessert. I was so ready to go home and sleep!
Saturday Morning - We hosted a small birthday brunch for a few of our friends. Andrey did all the cooking (bless him!). I planned the menu but he did all the work. Aside from a few small mishaps (he learned there is a difference between whole oats and oat bran) Andrey successful prepared cranberry oat bran pancakes and bacon. We also enjoyed delicious coffee, juice, fresh bananas, blueberries and pure maple syrup. It was a really nice and relaxing time with our closest friends in Cebu. I'll post photos of this in the next post because I can't add more here for some reason...
Saturday Evening - Saturday did not involve any more birthday events but we did have 3 IJM employees & their spouses over for dinner. We starting hosting a dinner like this once a month so I could get to know each of the employees better since I rarely see them. Each month we'll host a different group. IJM Cebu has over 30 employees so it's going to take several months before we host everyone. I made chicken thighs in the slow cooker with an apricot ginger sauce (inspired by a recipe by Mel Vose found on her blog awhile back- thanks, Mel!), coconut rice, stir-fried bok choy and snap peas, and fresh pineapple. It was so easy and very delicious and seemed to satisfy both the Filipinos and the foreigners which was the goal.
By Sunday we were quite tired and thought we might be getting a cold. We still made it to church though and then lunch after with a few friends but after that we decided to come home and rest up for the week ahead. We're feeling better today after a good, long sleep last night.
Over the past few days I have been greeted via phone, email, and Facebook by so many friends. I want to say thank you everyone! I wasn't feeling very festive about this birthday - not depressed or anything - just like it wasn't a big deal - but then so many people poured blessings out on me and I just feel so richly blessed! I know God loves me so much and I have experienced his deep and undeserved love for me this birthday through so many of you. Thank you!
Saturday, May 17, 2008
Goodbye to Friends, Hello New Ride
Yesterday our friends, Sally & Lee left Cebu to return to England indefinitely. Although we haven't known them very long, we did get to know them quickly and it wasn't long until Andrey and I felt we could really relax and be ourselves around them. We really liked spending time with these two and are now sad to see them go. So that's the sad part of this post. But like many things in life, there are good things that come out of the bad. That's what I want to share with you now and at the same time give you a taste of what Saturday morning looks like around here...
Check out our new ride! (Formally Sally & Lee's car) Introducing our "new" Toyota Revo Sport Runner! It's been a great family car for our friends (they have 3 kids) and we expect to be lugging around some of our own at some point. It has seatbelts! I can't believe I'm thinking about these things already. It feels wild and crazy and exciting and also a little like my chest is tightening when I think of suddenly taking on a couple of kids, but that's beside the point...
So here we are Saturday morning. I slept in which was delightful. Once I got up I found Andrey outside washing our new car. What a great husband! As I type he is cleaning the inside.
It has a few problems that we'll have to take care of, mostly minor as far as we can tell but all in all we think it's going to be a good, dependable vehicle for us. My favorite part is the dark tinted windows so now I don't have to be stared at when I'm sitting in traffic. I can hide! Which on some days is so welcome. The tint on the front is way too dark and quite dangerous for night time driving so we're gonna look at having that replaced. And the air con works great (a necessity) and it's an automatic which is just luxury in a congested city! And in the back there are two benches that fold down and face each other. We can comfortably accomodate 7 big foreigners (that's us) or 11 Filipinos! Sally & Lee said their record is 17 (a lot of Filipinos, mostly kids). Don't worry people nobody drives fast around here and they were only going down the street. Anyway, we really feel this car is from the Lord, just for us. Our friends were willing to give it to us for exactly our budget (it was really a good price) and it is so nice to buy from someone you know and trust.
And did I mention there's a bench seat in the front?? Some of you remember the car Andrey and I drove when we were still dating and how the bench seat was a prized component in our falling in love. Why sit far away when you can sit right next to your man with his arm around you (also possible with an automatic)? ha! Good times ahead. We went out on a little date last night and it was so fun to just slide over to be near my ridiculously good-looking accompany for the evening.
We've been using taxis and jeepneys for about a month now which has been fine but a little inconvenient when there are several stops or errands to make.
Which one of you is coming for a visit next so you can be a passenger in our sweet family ride. It's smooth...
Check out our new ride! (Formally Sally & Lee's car) Introducing our "new" Toyota Revo Sport Runner! It's been a great family car for our friends (they have 3 kids) and we expect to be lugging around some of our own at some point. It has seatbelts! I can't believe I'm thinking about these things already. It feels wild and crazy and exciting and also a little like my chest is tightening when I think of suddenly taking on a couple of kids, but that's beside the point...
So here we are Saturday morning. I slept in which was delightful. Once I got up I found Andrey outside washing our new car. What a great husband! As I type he is cleaning the inside.
It has a few problems that we'll have to take care of, mostly minor as far as we can tell but all in all we think it's going to be a good, dependable vehicle for us. My favorite part is the dark tinted windows so now I don't have to be stared at when I'm sitting in traffic. I can hide! Which on some days is so welcome. The tint on the front is way too dark and quite dangerous for night time driving so we're gonna look at having that replaced. And the air con works great (a necessity) and it's an automatic which is just luxury in a congested city! And in the back there are two benches that fold down and face each other. We can comfortably accomodate 7 big foreigners (that's us) or 11 Filipinos! Sally & Lee said their record is 17 (a lot of Filipinos, mostly kids). Don't worry people nobody drives fast around here and they were only going down the street. Anyway, we really feel this car is from the Lord, just for us. Our friends were willing to give it to us for exactly our budget (it was really a good price) and it is so nice to buy from someone you know and trust.
And did I mention there's a bench seat in the front?? Some of you remember the car Andrey and I drove when we were still dating and how the bench seat was a prized component in our falling in love. Why sit far away when you can sit right next to your man with his arm around you (also possible with an automatic)? ha! Good times ahead. We went out on a little date last night and it was so fun to just slide over to be near my ridiculously good-looking accompany for the evening.
We've been using taxis and jeepneys for about a month now which has been fine but a little inconvenient when there are several stops or errands to make.
Which one of you is coming for a visit next so you can be a passenger in our sweet family ride. It's smooth...
Friday, May 16, 2008
Small Babies
What is up with pregnant women here not eating so they won't have to give birth to a "big" baby?? I am telling you this really gets to me.
Yesterday was Thursday and I was on day shift. Wednesday, Thursday, and Friday are the days when we do "prenatals." On these days we see anywhere from 15 to 40 patients. Yesterday, I personally did 10 prenatal check ups. I was one of four staff on duty. It was a busy day.
One of my patients was a "primi," meaning it's her first baby. She's also quite young, only 20. I noticed she had a cotton ball taped to her belly button. When I asked her about it she told me she doesn't want it to pop out. I thought to myself, Ok, it probably won't work, but it's not harmful so I won't worry with it.
During her check up I noticed that her fundal height (the size of her belly) was quite small compared to where it should be at 35 weeks. It has been small and lagging for the past several prenatal check ups, staying around 31 cm. We have a minimum of 32 cm in order for patients to give birth in our clinic.
When I asked her what she's eating. She said "nothing." I figured she didn't understand my English so I got help from a midwife to translate for me. Again, in Cebuano (I understand this word) she said, "nothing." "For how long," the midwife asked? The young woman said, "3 days."
Upon further questioning we found out that she typically eats once a day but for some unknown reason that she wasn't willing to divulge, she hadn't eaten in 3 days. When asked why, she said she's not hungry but I could tell she wasn't being honest with me. The Filipina midwives I was on duty with later explained to me that it is quite common for women to do this during their pregnancies so they won't have a "big" baby.
Apparently this is quite common in the Philippines - or at least among many of our patients. Some days I feel like I am giving the same talk over and over and over again. Eat 3 complete meals every day plus 1-2 snacks - each containing and energy food, a protein food, and fruits and vegetables... take your iron with vitamin C... eat iron-rich foods such as... you don't want to be exhausted in labor... make sure you're drinking enough fluids...you're at risk of hemorrhaging since you are still anemic... if your hemoglobin stays low, we'll have to insert IV in labor unless you can improve it...
Yesterday was tiring because I had several patients who seemingly weren't eating enough. This is common but for a lot of our women it's because they have no money to eat well, or to eat enough. But for this young woman, lack of money wasn't her problem. My impression is that she just didn't want to have a big baby.
With any patient-practitioner interaction I have learned that you're not supposed to judge or react to patients when they tell you things that aren't in line with your expectations or what you think should be so but when this woman told us she hadn't eaten for 3 days I have to admit I reacted emotionally. I was mad at her. I tried not to show it but I did try to scare her into eating by listing all the possible consequences of her choices.
I gave her very clear diet guidelines and told her to record everything she is eating and bring the record with her next week. If her belly doesn't grow, she may not be able to deliver at our clinic. I hope she chooses to eat. Clearly she doesn't understand the short-term and long-term affects this level of malnutrition could have on herself and especially her baby.
It's one thing to see women who try to do everything they can for their child but limited by support and resources. It's another thing to see a woman with resources make such an ignorant choice to starve her baby.
Yesterday was Thursday and I was on day shift. Wednesday, Thursday, and Friday are the days when we do "prenatals." On these days we see anywhere from 15 to 40 patients. Yesterday, I personally did 10 prenatal check ups. I was one of four staff on duty. It was a busy day.
One of my patients was a "primi," meaning it's her first baby. She's also quite young, only 20. I noticed she had a cotton ball taped to her belly button. When I asked her about it she told me she doesn't want it to pop out. I thought to myself, Ok, it probably won't work, but it's not harmful so I won't worry with it.
During her check up I noticed that her fundal height (the size of her belly) was quite small compared to where it should be at 35 weeks. It has been small and lagging for the past several prenatal check ups, staying around 31 cm. We have a minimum of 32 cm in order for patients to give birth in our clinic.
When I asked her what she's eating. She said "nothing." I figured she didn't understand my English so I got help from a midwife to translate for me. Again, in Cebuano (I understand this word) she said, "nothing." "For how long," the midwife asked? The young woman said, "3 days."
Upon further questioning we found out that she typically eats once a day but for some unknown reason that she wasn't willing to divulge, she hadn't eaten in 3 days. When asked why, she said she's not hungry but I could tell she wasn't being honest with me. The Filipina midwives I was on duty with later explained to me that it is quite common for women to do this during their pregnancies so they won't have a "big" baby.
Apparently this is quite common in the Philippines - or at least among many of our patients. Some days I feel like I am giving the same talk over and over and over again. Eat 3 complete meals every day plus 1-2 snacks - each containing and energy food, a protein food, and fruits and vegetables... take your iron with vitamin C... eat iron-rich foods such as... you don't want to be exhausted in labor... make sure you're drinking enough fluids...you're at risk of hemorrhaging since you are still anemic... if your hemoglobin stays low, we'll have to insert IV in labor unless you can improve it...
Yesterday was tiring because I had several patients who seemingly weren't eating enough. This is common but for a lot of our women it's because they have no money to eat well, or to eat enough. But for this young woman, lack of money wasn't her problem. My impression is that she just didn't want to have a big baby.
With any patient-practitioner interaction I have learned that you're not supposed to judge or react to patients when they tell you things that aren't in line with your expectations or what you think should be so but when this woman told us she hadn't eaten for 3 days I have to admit I reacted emotionally. I was mad at her. I tried not to show it but I did try to scare her into eating by listing all the possible consequences of her choices.
I gave her very clear diet guidelines and told her to record everything she is eating and bring the record with her next week. If her belly doesn't grow, she may not be able to deliver at our clinic. I hope she chooses to eat. Clearly she doesn't understand the short-term and long-term affects this level of malnutrition could have on herself and especially her baby.
It's one thing to see women who try to do everything they can for their child but limited by support and resources. It's another thing to see a woman with resources make such an ignorant choice to starve her baby.
The Dossier is Done!
I can not begin to tell you what a sense of relief and satisfaction I feel after I sent our completed adoption dossier on Wednesday. Each document in this photo represents many hours of effort, some headache, a few tears of frustration and eventually, success. All of that adds up to the satisfaction I feel right now. Hallelujah!Thank you to those of you who provided reference letters on our behalf as they are a very important component of our packet. We appreciate your time and effort put into those.
I expect it will take a few months before the dossier is actually submitted to the Inter-country Adoption Board of the Philippines (ICAB). Currently, our social worker in Manila is finalizing our home study report to be added to our dossier. Then she'll send to our agency in the US before it gets sent back to the Philippines and officially submitted to ICAB. At that point we are told it will take 2-3 months to become "approved applicants." And at that point, we will be able to say we are waiting for a match which could take anywhere from 12-24 months, we are told. But we are also told that anything can happen! I guess we should be ready for anything. Here we go!
Monday, May 05, 2008
Work Photo
Here 's a photo of me and the family whose baby I delivered recently. It's the one I wrote about in my last post... 
Saturday, May 03, 2008
The Most Fun Morning
I just finished the ideal night shift. I will outline what made it so good...
- I slept most of the night
- A woman came in at 6:00 am, clearly in active labor, at 8cm dilated
- At 6:55 a beautiful, but small (4 lb 13 oz) little girl was born to two very happy parents (they were really hoping for a girl. they had a moment where they thought it was a boy but then with joy pronounced "babaye! babaye!" meaning "it's a girl! a girl!")
- I got to manage the birth and deliver the above-mentioned baby (Happy Birthday cute one!)
- I got to watch the transition of a mom in extreme pain to a mom experiencing the joy of her new baby. She was all smiles!
- It was pouring rain outside (= relatively cool) so the birth did not involve the usual sweat dripping down my face
- The birth was normal with no complications (good progress, no hospital transport, no hemorrhaging, no manual removal of placenta) which was like a breath of fresh air after the last several births I assisted at or observed which were a little scary for a newbie like me
- I got to suture the small tear (from a previous episiotomy done in the hospital at the delivery of her first baby) all by myself. I'm beginning to get the hang of it!
- At this birth I found myself empowered by what I've been studying, was bold enough to put a few new things into practice, and learned that my confidence level is increasing
- I rode home in the taxi feeling high and considering the idea that maybe I was made to do this kind of work. Yippee!
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