Saturday, July 25, 2009

Prenatal Conversations

Because my school does not afford its students much in the way of practical life experience, the ARIEL internship program was created in order to prove to students that one's career can indeed be enriched and augmented by a liberal arts education. The program offers stipends to students in order to facilitate summer internships and apprenticeships, and asks only that the recipients write an essay about their experience.

I received an ARIEL stipend to help me while I apprentice with a midwife. This midwife in fact assisted my mother at my own birth, and my four subsequent siblings' births. She now works primarily with Amish families, but her clientele is fairly diverse besides.

I've been living at home this summer, in the green country, and thanks to ARIEL have not needed to get a second job besides my apprenticeship. (Since the midwife hasn't needed me terribly often, I'm almost finished with War and Peace). I thought I should try to write about some of the things that I have seen and learned, since $500 of my stipend is held hostage until I turn in that essay. I'll do bits at a time.

I'll call my midwife ... hm. Phanarete was the name of Socrates' mother, who was a midwife. That doesn't roll off the tongue quite as easily as "Elizabeth." I don't want to use her real name because midwifery is currently illegal in the state of Indiana.

For most of the summer, I attended pre-natal visits with Elizabeth and sat quietly. I was introduced to each client as "our intern," and after a brief smile I disappeared from the expectant mother's awareness. I silently charted blood pressure, weight, hemoglobin, and other factors which Elizabeth tested. She doesn't have ultrasound equipment, and the only sorts of "testing" she really does are for hemoglobin levels, blood type, and various elements present in urine. Most of the information-gathering that she does is verbal. It's surprising how much someone wise can learn from the simple question "How are you feeling?" She weaves this questioning into a conversation about canning fruits, breastfeeding other children, how Amos' farrier business is doing, whether the Stoltzfuses got a good deal on the horse they bought at the auction, and the garden. Because Elizabeth lives in the same rural community as the Amish, she is aware of the country happenings that her clients care about, and they trust her. Pregnancy is not an isolated illness to the Amish, rather it is another part of life that is certainly special but doesn't mean that the green beans don't need to be cleaned.

Elizabeth can't make prescriptions for pharmaceuticals, but she does make suggestions for vitamins, minerals and herbs that will help with various aches and pains of pregnancy. Calcium for leg cramps, red raspberry leaf tea for uterine strength, and iron to get hemoglobin scores high enough to eliminate the threat of a post partum hemorrhage. Wear stockings, even in summer time, to keep varicose veins under control. Massage the perineum with olive oil to aid in stretching during birth. Most of this advice seems like a no-brainer-- many problems in the body are caused by a deficiency or excess of the various nutrients which allow the organs to function. A growing baby skews that balance, sometimes more quickly than a pregnant mother realizes, so Elizabeth reminds her that the way she's feeling is a natural reaction to those imbalances.

Elizabeth also feels the mother's bare stomach to determine the position of the baby. It isn't difficult for experienced hands to discern where the head and other parts are. If she finds that it is in a difficult breech position close to term, she advises the mother to lie upside down on an ironing board leaned against the sofa. Usually this turns the baby into a more deliverable position.

I am not well acquainted with the modern medical model of care. I spent very little time at the doctor's office as a child and my hospital experience has been limited to ER visits. I wish I were better able to compare Elizabeth's model of care to that of a typical general practitioner, or better yet an OB/GYN, but I can't. It seems completely normal to me because it is the kind of "naturopathy" that I was raised with (in fact my mother often repeated Elizabeth's words to me as a child). I'll write more later about the births I saw, statistics, the legal situation, and the difficulties and rewards of being a midwife that I observed.

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