Anniversary #7

Seven years. It feels significant. Every year is I suppose, so we do our best to celebrate well.

Andrey returned from Seattle late in the evening on Saturday after being there most of the week for work-related meetings. Sunday morning I made us a pancake breakfast and we enjoyed some delicious Stumptown coffee that Andrey brought back from Seattle. Before breakfast I prayed to bless the meal and began to thank God for giving us each other and the fulfilling relationship we enjoy. I asked for many more years together and for guidance for the future. I got a little emotional as I prayed, thinking about how good God is to have given me Andrey. What a gift! Even better than what I asked for.

God really is the best gift-giver. Since he created us he is the one who really knows us - way better than we know ourselves. Because this is true, it makes sense that the gifts he gives are much more appropriately suited and specially designed for us, who we are - who we truly are. We, not knowing ourselves the way our Creator knows us, many times lack the creativity, wisdom, and understanding to determine what it is that would really fulfill us. For this reason, in my experience, it is a much better deal to trust the Creator for his plans and his gifts, in his timing. This wouldn't work if the Creator wasn't loving and good or lacked power but since the Creator is good and loving and powerful, then it becomes exciting and entirely more fulfilling to let him take care of the details.

I realized this when I wanted so badly to be married years before Andrey and I started dating. I let go of how I wanted it to happen and with whom and waited for my Creator to set me up. I even had a list of what I wanted in a husband. But when God gave Andrey to me and after we got married, I began to realize how wonderfully perfect this guy was for me - in ways I didn't even consider before! God gave me everything on my list (except for the ability to dance well, which I had decided I didn't really care about) and much, much more.

This is what David was singing about when he said, Oh taste and see that the Lord is good! I have tasted and I have seen and I know the Lord is good. With this certainty I can relinquish and trust this good God to bring about our family the way that is best and in the right timing. I can lay down my ideas of where I want to live and what kind of work I want to do.

I am just amazed at God's gifts. It is said that every good and perfect gift comes from the Father of lights. Yesterday in church, there was a prophetic word spoken that went something like this: Through my death, you have been set free. Because I have taken care of all of your needs, you are free to receive and enjoy my gifts and free to give generously to others.

So we celebrated yesterday. We enjoyed the gifts we have been given. After church we went out for lunch at a nice Greek restaurant and had a delicious meal. Then we went home and relaxed for a few hours and in the evening I made us a simple dinner. Our appetizer was toasted whole grain bread with Danish cream and gruyere cheeses and ginger lime thyme jam from Nova Scotia. Our dinner was grilled steak and zucchini and red wine. It was great to have a whole day to spend with Andrey, just the two of us. We discussed how more than other years, this anniversary really is the most likely so far to be our last without kids. That perspective helps us enjoy and appreciate our time together even more.

I am so thankful for my husband, my best friend, who continues to make me laugh and love me well. I am excited for what the future holds.

(Thanks to Andrey's Mom for providing the attached photo)

What a week...

It has been a full week. Andrey left for Seattle Monday morning for a big meeting. He'll be back on Saturday. I worked all day Monday and we were busy. I got to attempt an external cephalic version (ECV) on a patient (with the help and guidance of a real midwife, of course). An ECV is a procedure done to manipulate a baby's position from breech to head down. It didn't work. I was disappointed, not only for our patient who really wanted it to work, but for myself as I've never done this before and it's one of the skills I'm supposed to know how to do in order to graduate.

We also saw one of our patients who is pregnant with twins. She's 36 weeks and both babies are head down and so we had been planning to deliver her at our clinic but then her last routine complete blood count revealed that she was severely anemic and would need blood transfusion. She would no longer be able to deliver at Glory. Again, disappointed for our patient, as she has delivered all of her babies at our clinic but also disappointed for me because I really want to see a twin delivery.

I texted our obstetrician who also happens to be the head OB at the city hospital and asked her if I could observe the delivery. She said she'd try to coordinate with the residents on duty and that she'd call me when the patient was in active labor.

She texted me at 4 on Tuesday morning. The patient was 5 cm and in active labor. It could go fast so she advised me to go right away but when I arrived at the city hospital she was resting and didn't seem to be in active labor. I waited until the next IE at 6 am and she was still 5 cm. I had lots to do that day so I left and asked the docs to kindly text me when she was closer.

Nobody ended up calling me when the patient delivered normally at around noon so unfortunately I missed it but that was for the best because I had appointments to see two patients at the clinic that morning that I couldn't skip out on. One was a postpartum check-up on my last continuity patient who delivered last month. The other was a prenatal check-up on an extra continuity patient I decided to take on just in case the National College of Midwifery wasn't satisfied with my first three. It's extra experience. I've been providing all of her prenatal care for the past 2 months.

Just as I was finished and getting ready to leave, the patient who's baby was in breech position returned. This time I got to attempt ECV again, with Hilary's help, and it worked! It was amazing! With lots of gooey gel and hand manipulations over this woman's belly and prayer. We'll see if baby stays in this position. If not, we are going to let her try and delivery vaginally since it's not her first baby. So that wouldn't be so bad because I'd love to see a breech delivery.

Just as I was about to leave, my last last continuity patient returned in labor - the one who had been in earlier that morning for a routine check-up. She had actually been in early labor when I saw her. When she came back a few hours later she was 5 cm and getting active very quickly. This was at noon. So I stayed and expected to be there for the rest of the day until she delivered.

Let's just say she had what is called a precipitous labor. I didn't even have to do another IE. One minute I was rubbing her back during a contraction and the next she was bearing down spontaneously (without warning!). Remember she just came in 2 hours ago and was 5 cm dilated. She was so quiet and calm that I didn't realize that her baby was quickly on it's way. I pleaded with her to quickly walk upstairs to the delivery room and to not push. Perhaps she was as shocked as I was that it was happening so fast. We got her on the bed and donned our gloves. We told her it was okay to push and in that very instant I was supporting her baby's head and shoulders as it made it's surprisingly forceful appearance. I was not expecting this because her water did not break. Right before she pushed I could feel the bag of water bulging under my hand as I lightly held an absorbent pad over the opening so I wouldn't get splashed. It never splashed or burst. I'm not sure what happened except that her baby was born with the bag practically still intact. Somehow it must of torn as it wasn't covering the head as I held him. His cord was wrapped around his body twice so I untangled him and placed him on his momma's belly as she sighed relief. Whew!

Patients with precipitous labor tend to bleed a lot after birth. Her placenta was delivered after 8 minutes and she had minimal bleeding up to this point and several minutes after. However, a few minutes after her placenta was out, it was as if her uterus sighed in relief as well and decided to stop contracting. So her uterus remained boggy and blood flowed intermittently. Nothing too scary or dangerous, but enough to warrant medication to help her uterus contract. The medication took several minutes to kick in but it did and the bleeding stopped.

These are the cases that it is scary to think about what would happen if they had delivered at home without a trained attendant and without necessary medication to stop bleeding.

Here are a few interesting statistics that I gathered while doing my community health assignment today.

• A woman's lifetime risk of maternal death is 1 in 7300 in developed countries versus 1 in 75 in developing countries.
  
• Among Filipino women, the lifetime risk of dying from maternal causes in one in 100.
• The four major killers are: severe bleeding (25%), infections (15%), hypertensive disorders (12%) and obstructed labor (8%). Complications after unsafe abortion cause 13% of maternal deaths. Globally, about 80% of maternal deaths are due to these causes. The other 20% are from indirect causes, which include diseases that are complicated or worsened by pregnancy, such as malaria, anemia and HIV. Women also die because of poor health at conception and a lack of necessary and adequate care essential for a healthy pregnancy and delivery.
• 40% of births in the Philippines do not have a trained attendant present.

The World Health Report 2005 - Make every mother and child count. Genva, World Health Organization, 2005 (www.who.int/whr/2005/en) and World Health Organization Philippines Health Situation and Trend (www.wpro.who.int/countries/2007/phl/health_situation.htm)

Back to Tuesday. I finally left the clinic around 5 pm, went home and relaxed for the rest of the evening. Wednesday I worked on the computer in the morning and ran errands in the afternoon then I worked the night shift. Our shift was busy with 2 postpartum patients, 2 prenatal patients sick with fever and a primigravida in labor. I helped a newer staff deliver the baby around 1 am with Hilary supervising us. It was fun to be teaching someone else. It made me feel like I knew a few things.

By 3 am we got to rest for a few hours. At 7 another patient arrived in labor. When Hilary checked her she was fully dilated with compound presentation. The baby's elbow was very close to making an exit. Not good. Hilary yelled to me to get the car ready. Thankfully our driver was there so I didn't have to drive. Within 5 minutes we were on our way to the hospital. Thank God our patient was from outside the city so we could take her to the provincial hospital and not have to go to the city hospital where we have seen babies die for lack of the necessary action to perform an emergency cesarean section.

At the provincial hospital they attended to the patient right away and the doctors were actually nice to us. What a welcome contrast to the city hospital! We heard later that she delivered a healthy baby by C-section.

I spent most of the day at home at Thursday getting stuff done. And today, Friday, I got two more midwifery assignments done. Yeah! Only 3 more to go and then I am DONE. Like really done. I'll be working all day on assignments again tomorrow.

I haven't cooked much this week. It's interesting how little motivation I have to cook just for myself. I get so much more joy out of cooking for the two of us.

Andrey will be back late tomorrow night and then Sunday is our 7th anniversary! We'll have the whole day to hang out and celebrate. Not sure how we'll spend the day yet but it will hopefully include champagne.