The 'Ber Months in the Philippines

With the arrival of Septem'ber' and Octo'ber' so begin the 'Ber' months (some go so far as to say the "Burrr months," I figure someone's saying "burrr" somewhere in the world as I sit here in a tank top and shorts). In the Philippines, this means Christmas season has ensued. Since I haven't been to the mall lately I could have easily forgotten this if it weren't for the Christmas music coming from the house next door in the variety of the Chipmunks' rendition of the 12 days of Christmas. Oh my.

For some, having four long months of Christmas commercialism is a joy. I know a few Americans here that love it. For others, who have a low tolerance for even a month's-worth of Christmas music, the 'ber' months are just an annoyance. I'm trying to have a good attitude. (Okay, I realize I'm not or else I wouldn't be posting this.) Classic Christmas music is one thing - Nat King Cole and contemporaries heard in the month of December - but the Chipmunks? On October 1st? You've got to be kidding. There are just a few too many annoying things about America that have made it to Filipino culture for my liking.

Glory Reborn Video

Hilary & David recently had a video made about Glory Reborn. It will be used in some local fund-raising. We are praying and hoping that wealthy business people in Cebu want to support the work of Glory Reborn by helping us build a new facility. Thought you might enjoy seeing where I work.

Click here to watch the Glory Reborn video from David Overton on Vimeo.

Details on the Adoption Timeline

In the past week, since becoming a part of an online support group for families adopting from the Philippines, I have learned some information regarding where we are at in the process. It is very helpful to know a little more about how this process works.

As I mentioned in a previous post, I learned that approved applications are made available for consideration in groups, based on the approval date. For example, applications approved in a certain time period will be made available for matching with children. Prospective parents where there is any Filipino heritage are considered first within that group. When most of these are matched, they look at the rest of the applications approved in that time period. I heard that when the majority of these are matched, but not necessarily all, the next group of applications are made available.

So what I know is this. Applications approved by the adoption board between February and June 2008 are currently being considered. Most of those with Filipino heritage have been matched and it's possible that they've already begun matching the non-Filipinos or that they will soon.

Our approval date was in December 2008, so our application has not been made available yet. It may be in the next group of applications or maybe even the one after that. So it seems we have a little ways to go. There were many families in the current group that haven't been matched yet - most have waited well over a year already.

What I don't know is how long it takes between groups. The good thing is that through the online group, I get to hear when other families get matched and when they travel to pick up their kids. Because of this I may get to keep tabs a little as to who is getting matched and when we are getting closer. I will likely be able to see when other families who were approved around the time that we were get matched. At that point, I will get really antsy. But for now, I feel like I can exhale a little and settle in for a bit more waiting.

For now, it's looking like we probably won't get matched until next year sometime but I'm okay with this. There are so many other families who have been waiting much longer than us and it is totally right and fair that we wait while they get matched. It is helpful to know this and to actually read emails from families ahead of us in this process - to know their names and how long they've been waiting. I can pray for them - that they get matched soon.

This online group seems to be a great community and I am happy to be a part of it although the volume of messages is a little overwhelming at times. I think there are more than 500 families - from those considering adoption, to those who adopted years ago. I have already met a young woman who is considering adoption who lives about a kilometer away from us here in Cebu City. I will have coffee with her on Wednesday. There are others I've met who used to live in the Philippines or whose children came from the children's shelter down the street from us. Many share about traveling to the Philippines, where they stayed, what they learned and what it was like to pick up their child, what kind of health/grieving/attachment/food/sleep issues they had to deal with and how the transition is going. I'm sure having read others' experiences will be very useful when our time comes.

Aside from the wait to be matched there is also the question as to how long we will have to wait after being matched. Most families in the US have to wait until the child gets a US visa before they can come pick up the child and bring him home. For many, this takes another 6 months or so. What we don't know is whether we'll be able to take custody before we get the child's visa, since we won't need to take him/her out of the country right away. Of course we are hoping our living here will shorten this part of the waiting time out but we certainly can not bet on that until we talk to our agency and social worker and learn more.

We will continue to pray every day for our chid(ren). I'm sure they are well worth the wait and it's going to be fantastic to finally be able to bring them home.

"In the morning, Lord, you hear my voice; in the morning I lay my requests before you and wait expectantly." Psalm 5:3

My Husband is Nesting

So cute. Yesterday, Andrey says to me, "I think I'll work on that photo organizing project because if we get kids soon..." I immediately told him, "You're nesting!"

I found this on a pregnancy website referring to the nesting instinct:

Around the fifth month of pregnancy, the "nesting" instinct can set in. This is an uncontrollable urge to clean one's house brought on by a desire to prepare a nest for the new baby, to tie up loose ends of old projects and to organize your world.

While I wouldn't call it uncontrollable, I would say that Andrey and I are in the least tending toward tying up loose ends of old projects around the house. It's not that uncommon for us to putter around the house on a Saturday and get a few things done but what is uncommon is for Andrey to suddenly feel the need to work on a project that we honestly have been ignoring for years.

The photos that need organizing are printed photos, taken before we got our first digital camera in 2004. We have stacks and stacks of photos that need to be put into albums. When we moved to Thailand in 2004, we brought the piles of photos and at least 5 or 6 empty photo albums waiting to be filled. Since then the furthest we got was getting some of the piles in chronological order. When we moved to Cebu in 2007, we again, moved these piles of photos and the empty albums. We haven't done anything with them, except pile the boxes they are in in one of our guest bedrooms. It's been years. Until yesterday. So that's why I immediately called it a nesting instinct. Well done, Andrey.

He worked on it all day yesterday and is still working on it today. It will likely take a few more days but at least we are finally addressing this project, for which I can take no credit for. I'd help, but I'm busy getting our budget up-to-date, which is another overdue project.

I just read this post to Andrey and he wanted me to add this greeting (brought on by looking at old photos full of great memories): "Thanks for the mammaries, everyone."

Midwifery Paperwork Complete!

As my mother would say, "Hallelujah! Pass the biscuits!"

This is what ran through my mind last night after I finished scanning the completed paperwork for my midwifery degree. What a happy feeling to have all assignments and tests completed and graded and every form completely filled up with all the signatures I need! The midwifery college has even received my transcripts and applied the needed transfer credits.

So with this, I am happy to report that I have completed all coursework and clinical requirements for my Associate of Science in Midwifery from the National College of Midwifery! Except... there is one thing I am missing: my newborn resuscitation certification. :-(

Hilary and I erroneously assumed that my infant, child, adult CPR certification with the Red Cross was the only necessary requirement because when Hilary was a student that was the only one she needed. Unfortunately, the college recently asked for my NRP (newborn resuscitation program) card. Shoot. After inquiring further and after I waited two weeks for a reply, I learned that I will need to take a class in line with the training of the American Academy of Pediatrics or the American Heart Association. My deadline is October 15 to complete and submit this last requirement.

Yesterday, I called Red Cross in Cebu and they do not offer the class, nor do they know who does in Cebu. So I looked online and found a class in Manila scheduled for today and tomorrow. The class is only offered three times a year through the Philippine Heart Center and this was the last training of the year. The office closed at 5pm and it was 4pm. Shoot. I scrambled to the phone and prayed that maybe they'd still have space, I could register late over the phone and somehow get to Manila by this morning. I was relieved to learn that the class had been postponed and is scheduled for October 5-7. Whew.

The man I spoke to was kind and willing to work with me given my unique situation of registering outside of Manila. So, all I have to do is find some way to send payment to Manila in the next few weeks and arrange for them to mail me the manual so I can do the required study preparation for the class, then confirm one week before the class, buy a ticket to Manila, and find a place to stay for 3 nights. If all goes well, and the class is not postponed again, I will likely accomplish this last requirement. Then I will truly be relieved.

It is so fun just to work at the clinic like everyone else, knowing that any experience I get is just bonus and is helping me gain the skills and confidence I need to be a good midwife. Although not 100% done, I still feel very satisfied having made it this far. Once I get the NRP certification and get the okay from the college, I will apply to take the NARM exam in February in Oregon. Once passed, I will receive the credential of certified professional midwife (CPM). I am looking forward to that!

Getting Closer?

Lately I have felt led to pray more specifically regarding our getting matched with our child(ren). Now that I am done with my midwifery requirements, (yes, as of a week ago all assignments are done and clinical requirements achieved! just an evaluation left and a bunch of paper work to submit!), it's as if I suddenly feel FREE to receive our child now. And with what God recently did in my heart regarding how I viewed adoption, I now feel more ready than ever. According to the average wait times, we have a long way to go but something in me just feels compelled to ask the Lord for a miracle, for something sooner, as Andrey and I and many others sense it is near!

On Monday I met an American woman introduced to me by a mutual friend. She and her husband and their three older kids were in Cebu City because they came to pick up their adopted son. I got to hear all about her experience and how long they waited and who, in her experience, tends to get matched sooner. Some of the info was a little disappointing to hear, like how the adoption board can cause some pretty heavy delays so that some families get really stuck in part of the process, but other info was very promising. I learned that our application likely hasn't even been made available yet to social workers responsible for matching children. I learned that only a chunk of applications approved in certain period of time are up for matching and the next sets of applicants don't get released until those earlier ones are matched. I learned that they like families in which the adopted child is a first child and that any tie to or family background from the Philippines is a huge bonus, meaning these families tend to get chosen by the social workers first. Apparently social workers choose 2 or 3 families as options for a particular child and then it is up to the adoption board to pick out of them.

To me, this is hopeful. Since it seems our application hasn't been released yet, it tells me that perhaps once it does, it may not be long. We might be slightly more desirable given our childless status and the fact that we live in the Philippines. She also told us that she knows of some families who got matched after 9 and 11 months of waiting. (We've been waiting over 8 months.) Although this is less common, it is possible.

In addition, she mentioned that it may be possible for us to get a child younger than I earlier thought because of the new law in the Philippines that makes the abandonment process an administrative one through the Dept. of Social Welfare, rather than a judicial process through the already overloaded court system. Under this new law the time period before a child is considered abandoned has been reduced to a maximum of 3 months from the original minimum of 6 months. Because of this this law, which in already in effect, it's possible a child could be declared legally available for adoption in less than 2 months. Before, it took as long as 3 years in court proceedings for such declaration. This is very positive since it will reduce the amount of time children will need to live in a child caring agency prior to being placed with an adoptive family. However, it is unclear how and if it will positively affect the wait time for applicants on the adoption board's wait list. I had heard about this change in the law but had not thought it could affect the age of the child we get. Although we are not counting on it, the fact that it is possible is exciting for us.

This woman's adoption story and also the adoption story I read recently from a good friend of mine, Melissa, who adopted from Thailand, have some similarities. In both stories it was very clear that God had arranged all of the details AND the timing so that the circumstances that took place in order to bring a particular child to a particular family at a specified time just could not have taken place without God orchestrating it all. I was blown away by the timing element to it all.

I just believe that we are going to get matched when it is the exact right time and not only us, but many others sense that time is near. Last week my mom had a dream that I called her saying, We got the call! We're getting our kids in 2 weeks! And my father also told me that he just has a gut sense that something is going to happen soon. Wow! Talk about building my faith to pray specifically! Andrey even said recently, why pray that we hear by the end of the year? I'm asking for the end of the month. Ok, then. Fine. It's not like we are going to limit God by praying the wrong thing. He's going to do what he's going to do. But so, so many people are praying for us and with little encouragements and indications here and there, I can't help but be expectant! I feel like I'm in my third trimester.

Sometimes I wonder if God gives us faith to pray something that he plans to do. In this, he involves us in bringing about his will and because we asked for it, it builds our faith. It also honors God for us to believe him enough to pray specifically, to ask, to seek, to knock; knowing that he is going to act. This is also a faith-building process and in it God is delighted that his children trust and believe him enough to do what he wants to do in the first place! Does this make sense?

So each day, an alarm goes off on my phone to remind me and Andrey to pray together for the following:

• That God would be with our child(ren), wherever they are. The he would protect them and keep evil far from them
  
• That they would know and experience the love of the Father and the Mother through the revelation of the Holy Spirit and ideally also through the love of the people caring for them
  
• That they would be well cared for by those responsible for them
• That God would prepare them to join our family
  
• That we would get the call informing us that we have been matched by the end of the year (or the end of the month) :-)
• That the child(ren) would come from CEBU or an island in this region

I invite you to pray with us, these specifics, or any other specifics you feel led to pray for.

Woohoo! I'm so excited to be a mommy! And I just know that Andrey is going to be a fantastic daddy.

Back to Work, A Birth Story, and the Practice of Midwifery Among the Poor

Yesterday was my first shift at the clinic since our trip to North America. I felt a little nervous about going back, as I usually do after a long break. I'm typically a little nervous that I will have forgotten how to do something or that I'll be a little rusty from being out of practice, but after a busy labor and birth-filled day, I am happy to report that I didn't forget and I didn't feel rusty. I just slipped right back in to sweaty, busy clinic life.

A 24-year-old woman in labor with her third child arrived just before 10. The rest of the staff was in our weekly meeting so I was the one to receive her. This meant I would be the one to deliver her baby and I was quite happy about that. I wondered if I would get a birth on my first shift back.

She said her contractions were coming every five minutes. She was 39 weeks and 3 days. Her blood count was uncommonly good and she didn't report any major complications in her previous pregnancies. All very reassuring things. Upon examination and monitoring her I found out that she was 3 cm dilated, her blood pressure was slightly elevated and her contractions were indeed coming every 5-6 minutes and they were moderately strong. She was very relaxed even though it was apparent that her contractions were painful.

After I hung out with her a while timing her contractions and noticing her blood pressure was borderline high between contractions, I asked her how she was feeling about giving birth, which would likely be this afternoon. Was she excited? Nervous? Worried? I tried to get an idea of what was going on inside her mind. I find it's not easy to read some of our moms. Most are very reserved with their emotions and I was trying to see if there was an emotional reason for her B/P to be on the high-side. She didn't say much at first, then as I asked her again she just shrugged her shoulders and said something to the effect of, Whatever, man, totally fine. Like what's the big deal? Okay right. No big deal. At least she wasn't worried about anything. That certainly can't hurt while in labor. (Assuming she's telling me the truth.)

As the day went on she progressed well. Four hours after she was admitted she was 6 cm dilated and her contractions were every 4-5 minutes. Within an hour after that, I knew she was reaching transition as her contractions grew stronger and were coming every 2 minutes. Her blood pressure continued to rise. I transferred her upstairs and had her lie on her left side. She continued to do an excellent job of keeping her body relaxed through the intensely strong and painful contractions but she clearly appreciated support through each contraction. Between me and her boyfriend rubbing her back and talking her through, I think we were able to give her the support she needed.

As her labor intensified, her blood pressure rose and became disconcertingly high. I called Hilary in who was busy with lots of new patients downstairs. (Each month we offer free labs in order to fill our available space for patients so there were numerous new patients waiting to have their interview and first check-up.) Usually we would transport a patient with high B/P but I knew she was getting close and at the public hospital they would likely leave her unattended without monitoring her properly. Since she was progressing well and was asymptomatic, we decided to keep her at the clinic and do what we could to help her deliver safely.

We hooked her to IV fluids just in case it became a true emergency and we either had to take her to hospital or infuse hydralazine to bring her B/P down. I did an IE and she was 9cm and the bag of waters was at +2 station. After a contraction I rupture her bag of waters. The water was a dark brownish-green color, "moderate meconium stain." She said she wanted to push but I doubted it was a physiological urge since she wasn't instinctively bearing down and also because I knew she wasn't yet fully dilated. It was best to let her uterus do its job and wait for the physiological urge to push. She would have to continue breathing until she really had the undeniably strong urge to push. And when this happens, it will be undeniable. So she stayed lying on her left side and we encouraged her to breath deeply through each contraction and try to stay relaxed. She did this well although we could tell it was very difficult.

Within 20 minutes it was clear that the baby's head had reached the pelvic floor as she couldn't do anything else but begin bearing down. Her B/P continued to rise beyond what is normal. We tried to get her to only push as much as she had to but to breath when she was able. Again, she did such a good job trying this and I knew it was extremely difficult to do, but I knew the baby's head was coming down and all we had to do was wait a couple more contractions, get her to breath and the baby's head would be visible. And soon it was.

With the next contraction and with her doing more breathing than pushing, the head was emerging. Her perineum was taut and bulged with about a 2-inch circle of the baby's head just behind it when her contraction ended. I wanted her to stay as relaxed as possible in order to keep the tissues oxygenated and give them a few moments to stretch. I have read that this can help prevent a tear by letting crowning happen slowly (when possible!). I was amazed at her ability to relax and breath! I thought, this is amazing! This will really help. We waited for the next contraction. At the beginning of the next contraction and with a small push, the head was out but I could tell that she tore. The body followed and the baby was placed on its mother's belly just as the room filled with the sound of his first cry. Another baby boy! (Their third.) He weighed 7 pounds 6 ounces. It was almost 4 pm.

I waited for the cord to stop pulsing before we clamped and cut it. The baby was placed at the breast while our nurse dried him, put a dry blanket over him and checked his vital signs. The placenta was delivered after eight minutes and pitocin was added to her IV. Hilary said in her experience that women with high B/P in labor tend to bleed.

I was surprised to discover that this mom had about seven first degree tears. Five of them would have to be sutured. I spent the next two hours suturing! Poor gal! Don't worry, we do give local anesthesia. It was a challenging suturing job for me and I was grateful that Hilary was there to guide me. I learned a lot with this one but I'm am disappointed and confused why she tore so badly. First baby, okay maybe but the third? Most of our women tear and I still wonder why it happens so often. What are we doing wrong? Hilary says a simple episiotomy would have prevented all those tears but I keep believing that it shouldn't have to be this way. But after tear after tear after difficult tear I can't help but wonder. But you never know that a woman will tear so badly until after and at each birth I am always hoping for the best! Do our moms tear more often? If so, why? Of course I don't know what is normal because at this point I don't know any different. Anyway...

What a way to come back to work! By the time we got mom and baby settled, got everything cleaned up and I finished the paperwork, my shift was over and it was time to go home. Even though there are many elements to this birth that I need to process and evaluate in my mind, I feel very satisfied to have gotten the chance to work with this young mother. I did a lot of praying for her throughout the day and so I give glory to God for helping us and helping her safely deliver a healthy baby without a trip to the hospital!

This is exactly the kind of situation that is clearly out of the scope of practice for midwives in N. America. There are many reasons for that and it's good that that's the way it is, but I am beginning to realize that working with the poor in a developing country is practically a different career than practicing midwifery in a developed country. It's just so different. I know the midwifery I am able to practice in the Philippines is not possible back home. I am starting to wrestle with this reality as I develop in my mind where and how I'd like to use my midwifery skills. Do I want to be limited to working with low-risk women, many of whom have several options available to them? Or do I want to work with women considered to be "high-risk" because of their age, their high fertility rates, their poor nutrition levels - who have little to no options for giving birth in what would be considered to be a safe place? I'd say the majority of the women we see at Glory Reborn would be considered "high-risk," but we are compelled to work with them because of their lack of options and we are able to work with them and care for them beyond the scope of midwifery in the West because we have two obstetricians who have agreed to oversee our cases. I'm glad for this. It's good for the moms we serve.

In the spectrum of developing countries, the Philippines is not as bad as many other countries like Afghanistan and Haiti, and those in West Africa. I'm not saying it's not bad here because it is, considering how much better it could be. I was recently looking at maternal and infant mortality rates in Haiti and it's so much worse than the Philippines! Although about half as bad as West African countries and Afghanistan, Haiti's maternal mortality rate is three times that of the Philippines. And the infant mortality rate is ~2.5 times that of the Phils. Haiti is clearly the worst in the Western Hemisphere, which is not a surprise since it is the poorest country in the Western Hemisphere.

We have friends who are working with orphans in Haiti and I hear stories about how bad it is there and how they need midwives! One of the babies our friends adopted was orphaned because her mother died in childbirth. I can't help but dream (am I crazy?) of working in a place like Haiti where only 26% of all births are attended by skilled health personnel (only 6% are attended among those in the lowest wealth quintile!). This figure is 60% of all births in the Philippines, with 25% attended births among the poorest, versus 92% among the wealthiest! This is outrageous! It is well documented that one of the best ways to improve maternal and infant mortality rates is to have access to and utilize a trained health care provider during pregnancy and birth. Midwifery saves lives!

I am compelled to use midwifery in the developing world but to do that is to choose to practice a different kind of midwifery. Different than the dreamy natural birth stories I hear of friends in North America attended by midwives, which are wonderful and great and well, that's why I call them dreamy. I must, I believe, in order to be a good midwife, experience natural birth in the West. Learning what those midwives know will enable me to only intervene when it is really necessary. I try to do this now but it is hard without experience on my side and those with experience telling me this is what is needed to keep our moms and babies safe. I don't want to lose my trust of birth and God's enabling of women to give birth. I get sad expecting, trusting things to go as they should and then they don't. Fine, if that is the case in the minority of cases. But the majority? I struggle with this.

I understand that our women aren't birthing under ideal conditions. Malnutrition is rampant and I think its effects are underestimated. Plus lack of access to decent health care must play a role in their health level coming into pregnancy and birth. I am learning in the health care debate in my own country that those without health insurance access less health care and are subsequently sicker and have higher mortality and morbidity rates. This has to be a factor here as all medical costs are out-of-pocket. The only social insurance is for those with full-time jobs who pay taxes and the health coverage they get is not worth much. Arg! It's just so frustrating!

Other factors that I can see include lack of basic education regarding how the body works, cultural factors that keep poor women from thinking for themselves and being empowered to affect how her pregnancy and birth is handled, and simply poverty. Not having the money to treat basic infections, buy nutritious food, get care when it is needed to even maintain a minimum level of health. We do provide education at Glory Reborn but just a few teachings here and there is simply not enough to change the way people think and approach the births of their babies.

Okay, that's it for now. Just needed to vent a little and process some of the stuff running around in my head.
p.s. I took these photos last week at the monthly Glory Reborn baby party. We had a photo shoot so Hilary could get photos for some upcoming Christmas cards she's making that will be for sale on the GRC website. They're just so cute I had to add some. I'll post more later.

Yard Work

Since we've been back, I have been motivated to try to get a garden going again. My last attempts to plant seeds were unsuccessful for various reasons. We also had a compost system set up, which worked for a while and then, because of it's accessibility to slugs and rats, it became clear that a new system would be required.

Another issue was that our landlord stopped sending a gardener over to tend to the yard each month. We had really let it go and it became extremely overgrown. It is amazing how quickly things grow here!

This post will showcase the progress we have made in one week in those three areas - the compost, the planting of vegetable seeds and the yard.

The "before" pictures are from last Saturday. The "after" pictures were taken today.

COMPOST

BEFORE - note the aluminum wire than I hand-weaved into the basket for reinforcement.

AFTER - No slugs or rats have entered yet! During the day I take the clay weight off the top and let the sun shine into it to further the decomposition. I add a little water to keep it slightly moist and add composting enzymes regularly.

............................

THE VEGETABLE GARDENING

BEFORE - This is just after I planted tomato, basil and cilantro (coriander) seeds. I was planning to put these inside the house but thought better of it when Gerald (our cat) immediately started in for a dig in the new dirt. In this spot they are under shelter and I have a plan to keep the slugs away. The young boy in the shot is our helper's 3-yr-old son, Dilbert. He's a cutie.

AFTER - 1 week after planting. We have seedlings, people! This brings me much joy. If this actually works out and I get tomatoes that I can eat, it will be my first ever successful gardening experience. The pot on the right has the tomato sprouts. I know I will have to thin them out. I just didn't think any would sprout so I put the whole packet in. The pot on the left only has 2 sprouts but I'm hoping more will pop up here in the next few days. Note the black stuff at the base of the pots. It is coffee grounds. Slugs hate it and it may even be fatal to them. We'll see if it keeps them away. This is the stage where my progress was halted last time.

...............

THE YARD

BEFORE - There's Dilbert again. This is the front of our house and I have to walk through there to get to the side of the house where the potted plants are. I seriously have had to practically crawl through there. That plant was taking over!

BEFORE - Note the height of the grass

AFTER - So much better


BEFORE - Our circular bed. Last week I sprinkled an assortment of other seeds that I had in the center just to see if anything happens. You can't tell but the center is actually empty.

AFTER - Today I noticed a few sprout but I have no idea which ones they are - could be green onions, Thai eggplant, sunflowers or lemon basil.

Gerald BEFORE - playing in the tall grass

Gerald AFTER - He is loving the out of doors these days but never leaves the yard because he's very timid when it comes to the unknown

On a side note. These are the papaya trees that were a third of the size when we left for the US in late July. The gardener who used to come would chop them down but after being left untouched for a little over a month, they have not only tripled in size but are producing fruit! This is one tree that split into two branches. We have another one like it in the yard. Note the narrow space it has to grow in between the roofs of ours and our neighbor's carport. We'll have a lot of papaya to eat soon. It's very high in potassium and is great for the stomach and intestines, I think.

And for my last exhibit. Our lemongrass plant. I had no idea what it was until one day we decided to cut it back. The fragrance was so strong that after further inspection of the base of the plant, I knew right away that it was lemongrass. Who knew?! I'm such a novice.

A Realization; A Choice

"Infertility is the greatest tragedy that I have experienced and yet in it, my heart was opened to those who would have no mother." Shelley Monaghan Clay

During a rare quiet alone time in Saskatoon earlier this month, I took a few moments to sit in the sun in our Aunt & Uncle's back yard to do some journaling. Have you ever had the experience where as soon as you take even a few moments to be quiet you sense God's Spirit intimately close? That is what happened. I sat down and I felt as if the Holy Spirit was all around me. The sky, the sun, the trees, all seemed abuzz with life. I looked up at the trees pointed to the sky and saw creation worshiping the Creator. The character Sirayu in the book The Shack came to mind. In it the Holy Spirit is portrayed as a petite Asian woman who moves around like a breeze, full of joy and creativity, working the land diligently to weed and sow and produce a brilliant, healthy, colorful garden. As soon as I brought that to mind, a breeze came upon the yard and rustled the willow tree and the other plants all around. It was if the Lord was saying, Yes, I am here. I felt God's tender love toward me and a joyful peace ensued. I LIVE for such moments. What a high!

In moments like these, when I am quiet and present enough to hear the still, small voice of God, I find that if I begin to write what comes to mind, something significant flows from my heart and onto the page of my journal. This is what came to me...

I realize now that I can choose to be thankful and that I can choose to accept, with grace, the path the Lord has set before me. Alternatively, I can choose to compare myself to those who have what I wish I had - pregnancy, fertility, a bosom full of milk made specially for a baby that I bore - and subsequently feel jealous and pity for my sad and unfortunate situation. And then I could have a good cry.

Well I have done my crying - and most of it was right and appropriate at the time, as it was necessary to grieve the loss of that which I had to let go of, more specifically, 'my plan'. It is time to move on from that place of grief to acceptance.

Now today, I am looking to the future. The future that will happen upon us at any moment. I am thinking of our child or children - those who have already been chosen for us. For me to continue to stomp my feet and tell the Lord that I don't like his plan is to look into the eyes of that child and say, You were my second choice, Plan B. This is not the way to enter into adoption. And if I did, I know that I would feel guilt and regret about it later.

So I will not. I will choose to prepare myself for that child as if I were carrying him. I will remind myself of something that I know. Once that child is mine, I know that I will be thankful that my plan did not work out; for if it did, it would mean that my son, or daughter would not have come to me and that I would not have the privilege of being called their mommy.

So I am sorry Lord, that it has taken me this long to "get" this. Somehow you knew that I needed this time. This wait. Perhaps it won't be long yet.

I'm Back

We are back in Cebu after a month break to the US and Canada. I have not blogged since before we left. Sorry for the long lapse. I find it so difficult to keep up on emailing and blogging while we are away. Probably because we aren't in any one place for very long and there is just too much fun stuff going on to be able to sit down for very long at someone else's computer. It's all good though because when I'm with my family and friends in N. America, I don't have as big a need to connect through blogging. And a break every once in a while is good. I'm happy to be back in Cebu and back to blogging. The trip accomplished it's purpose. I was really ready to come back by the end.

What a blessing to have had the privilege of spending time with so many of you. We had a fantastic nine days in Tampa with practically my entire family. Our Florida family took time away from their busy schedules to hang with us, which was so appreciated. We went to the beach, had BBQ's, celebrated my brother's 40th birthday, tubed down a crystal clear river and spent almost a whole day shopping with my mom - most of it in Target. It's a tradition.

The rest of our time was in Canada. Except for the night in Seattle we had when Matt & Colleen, Taj & Danny and their three kids collectively hosted us for a delicious dinner of smoked wild salmon, roasted veggies, salad, and key lime cheesecake. Yum! Those guys are so good to us.

In Canada we spent a week in the Okanogan Valley in BC with friends on Osoyoos Lake. It was hot and we got a ton of sun, spent many mornings at the beach on the lake, and went tubing. Then the last two weeks were spent between Calgary and Saskatoon. We got to connect with pretty much every family member in both cities. We threw a party for Andrey's parents in Saskatoon to celebrate their 40th wedding anniversary. It was a huge hit. I think that fact had something to do with the reenactment of the wedding procession with several members of the original wedding party - Lou, Marilyn, the flower girl (our cousin Cathy), and Marilyn's brother and sister. Both Marilyn and her sister wore the original wedding dress and bridesmaid dress, respectively. Those skinny ladies are amazing! The thing that made the party so fun was the karaoke machine we rented. Oh man do we have some funny videos of that. I already posted lots of photos on facebook.

Everywhere we went, family made time to spend with us, hosted us generously and showed us a very good time. We are so grateful for each one of them.

Now it's back to business. I have two midwifery assignments to finish this week and two tests to take before I'm finished. Then just a few last clinical skills to master before we submit everything to the college by mid October at the latest. Then I will have to start studying for the licensing exam I plan to take in the US in February. I will continue to work at the clinic as long as they let me so as to gain more experience.

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.