don't take the fun out of dys/fun/ctional!

A trip down the hallway on the 5th floor of the building where I am living is an interesting experience for my nose. Upon opening the door of my apartment the first smell to hit me is that of nasty cigarette smoke. Then as I make my way towards the laundry room I catch more pleasant smells... someone is cooking bacon and someone else is frying fish. And the folks behind door number 506 are smoking something even nastier than cigarettes. I'm guessing they opened up the tin of roaches and rolled something up. In the laundry room I am assailed by the overwhelming scent of "bounce" dryer sheets or some other chemical fabric softener. I put two dollars in a washer add detergent and a load of clothing then follow my nose back down the hall. I close my eyes and walk slowly wondering if I will know when I get to my door. When I catch the scent of amber insence I reach for the doorknob and open my eyes. I'm home.

A few weeks ago now, after my first blog post I think, Gina asked me a question via email and I have been pondering it from time to time. How have our homes changed now that we no longer give birth in them? Of course there are some few people who still do give birth in their homes. But most do not. On Friday night over dinner Cynthia told a story of growing up in Scotland. She is one of the older children in a large family and enough babies followed her that she came to understand that when a box with the words "Do not open until confinement" appeared in her mom and dad's room that meant that a new baby was coming soon. She was old enough to read those words and somehow young enough to think that the new baby was in the box! Across the table from Cynthia, Bernie tells us that he was born at home in Germany, that his father had been sent to fetch the midwife. It was a long walk for him and he walked back with the old midwife, carrying her bag. He has been told that his mother was greatly comforted by the arrival of the midwife and that his birth was a good experience for his mother. His siblings, all younger, were born in hospitals after his family emmigrated to Canada and his mother remembers being afraid and being left alone with no support. Bernie's father was there when he was born, but was not allowed to attend the hospital births of the other children.

You know what else doesn't happen at home much anymore? Death. Just as most births happen in the institution we call a hospital so do most deaths. What is it that we have lost? How have our homes changed? We may have lost a sense of connection with life... a sense of the rhythmic cycles of birth and life and death and birth and life and death...

Gina also reminded me of a quote from an Inuit Elder... something I had seen before and was moved by. I am sorry that I cannot find the email from Gina to be sure that I quote her correctly and I cannot remember her name but what the Elder woman said (more or less) was this: "I can understand that some of you think that birth in remote places is dangerous, but you must understand that life without meaning is also dangerous." There is no life without birth and all that which is born will one day die.

So, those are today's meanderings...

And now, for those who are still reading, a story. A little chapter from the life of a midwife in Iqaluit. This is a story about the creation of tension and misunderstanding. In the telling of the story I hope to find a path to peaceful resolution.

On Friday morning I went to the hospital rounds... the rounds that I had been told one day that I should not attend. "This is coming from the doctors" I was told. Well after a day or two I went back to my supervisor and told her that the rounds were an important part of my orientation to the hospital. I asked for her support for my right to be there. She did support me and I learned that it was only one doctor who had emailed her with the suggestion that the midwife should not be at rounds. I do not know which doctor. It doesn't matter. This is not the first time that I (and every other midwife that I know) has been made to know that some doctors do not welcome her as a member of the team of health care providers. Anyway, as the rounds progressed I became aware that there was a woman who appeared to be in labor that morning. I have been welcomed warmly by the nursing staff and as part of my orientation I was invited to attend a delivery as a "shadow" to the nurse. So after the rounds were over I spoke to the unit manager and to the nurse caring for the woman in labor and I obtained permission to attend this delivery. I then went into the patient's room, introduced myself and asked her if she would mind. After talking with her and her husband for a while it became obvious to me that she was not in active labor. She had come in because she thought her water had broken and she had "taken blood out". I went to the nurse's station and began to look at her medical chart. I was just getting to know a bit about her history, her previous births, her general health, how far along she was etcetera. I engaged in quiet conversation with a doctor who is here in Iqaluit in a locum position and who appears to be getting involved in the care of pregnant and birthing women. We discussed the woman's birth history and the fact that this would be a "late preterm" baby at 36 weeks gestation and I wondered aloud if antibiotics would be started now because her active labor could be pretty quick or if they would wait until she was in active labor to start antibiotics. Either of those approaches would be completely acceptable, I was only wondering. I was also looking at the chart because in the near future I will be caring for patients here, writing orders, writing narrative notes, and documenting assessments and care plans. I saw this opportunity to shadow the nurse as part of my orientation.

The unit manager appeared at my left side and whispered quietly that she had been told by Dr. X that as a "shadow" I was not allowed to look at the chart! I was shocked to say the least. I was also hurt. I felt very disrespected and even a little angry. The unit manager was also surprised. She said she had never heard of anything like this happening before. At the same time as she and I were discussing this I saw Dr. X take the new locum Doctor and the Doctor who was managing the care of this patient down the hall for a chat. I did not know what to do. I was stressed and very troubled by this. I fussed a bit around the nursing station, trying to understand why Dr. X would just make up a new rule like that, just for me and trying to decide what I should do. I thought "I have to talk to her"... I need to understand what is going on. But I knew that I needed to calm down first. So I headed off to the other side of the hospital to talk with my supervisor. I guess I should not have been surprised to discover that she already knew why I was there. She had been the first one Dr. X called. She told me that as a professional hired to work in this hospital I had absolutely every right to examine the charts of people that I was involved in the care of. But Dr. X had played the "she is not lisenced in Nunavut" card. "Okay" I said to Cynthia "that is a problem that will go away because I soon will be lisenced in Nunavut, but the problem of Dr. X's resistance is not so easy."

When I returned to the inpatient unit all of the nurses were aware of what had happened and they were all angry on my behalf. I found myself calming them down and justifying Dr. X's decision but not the way that she behaved. Dr. X has been nothing but polite, even sweet, and very calm and serene in her face to face dealings with me. There have been "signs" that there was something else going on behind that lovely face, rumors and innuendos. But there was nothing subtle about that behaviour. I find myself choosing my words very carefully here, aware that as a published blog post, these words could make their way back to her. Although I have not used her name she would, of course, recognize herself. I have tried to be honest and fair. I have tried not to say anything here that I would not say to her face.

Tomorrow I will go to her and tell her that I have been thinking a lot about what happened. I will tell her that I am a person who values peaceful and respectful relationships. I will tell her that I would prefer, in the future, if she has a concern about something that I am doing, if she would please come to me directly it would likely help to reduce tension and misunderstanding. And if I am really courageous I will ask her why she does not welcome midwives to the team of health care providers.

It had an interesting effect on me, encountering that resistance. A week ago I might have cried and considered packing and heading for the airport. This week, thanks in part to the strong support of the nurses and my supervisor, I found myself feeling strenghtened. Thanks also to the many strong midwife role models that I have known and continue to admire. We continue to claim and reclaim our places on the team of people caring for pregnant and birthing women because it is the right thing to do and because it is our right.

And because it is important to keep the fun in dys/fun/ctional I raised an $8.50 glass of red wine to Dr. X at the bar on Friday night!

This midwifery project in Iqaluit really feels like an icebound ship these days. It seems like everyone that I need to help me push it forward is either away from work right now, on a leave or a vacation, or out of town for medical reasons, or else they are working and just too busy to get back to me. Yikes! Waiting around for something to happen is quite a challenge for me. Today I have my laptop and the portable modem in my office. Lots of time for blogging, but not very much to say.

Passing the time in Iqaluit... I finished my first quilt! I had tried hard to finish it before coming up here but those last days and weeks were just so busy. I loved quilting and was proud to post it to my wee grand nephew, now nearly 6 months old, in London, Ontario. I hope his Gramma Holly notices and admires it! I brought a quilt top that was already created - something Val had stored in a closet. I have finished assembling and quilting it and now I sleep under it every night.

two parts crow and one part crone...

Sunday, February 20, 2011.

A woman named Misty popped in to my office one day this week. She came with a textbook and an invitation to attend a training program all about caring for pre-term and unwell newborns. She also had a little story to tell me about how a certain doctor was rumored to have said she thought the training opportunity should have gone to another doctor, not to the midwife. She said I must be a brave woman to be here, doing this...

What can I say? one part brave and two parts crazy I think. Its my job... I have been hired to push my way in through the resistance, to begin the creation of a space for midwives in this town. I am not here because the doctors wanted me. I am not here for the nurses. I believe that I am here because the people told their government that they wanted midwives, that they wanted their own midwives. The government has heard them and I applied for this position. So here I am.

I am just the crow on the prow of this icebound ship. Behind me I have all the support that I need. All the midwives that have gone before me in this land, may I truly honour them as I go forward, all the young Inuit women who may come along now, may I teach them well, the hands-on skills of midwives. Trying to show the doctors and the nurses that this is the way that it should be. Women having babies should be cared for by the women of their own community. Empowerment of Inuit women is the best way to preserve what is left of this culture. Spring is coming, the ice will melt, the waves will soften and begin to sway.

I saw a sign today. Well more of a poster really. I really liked it. It was an image of three very strong and healthy looking young athletic men. It boldly stated: "Strong men don't hurt women. Do you?" Oh, it excites me to see this. To know that women here are standing up and saying NO, this is not okay! I will not be your punching bag!

One part crazy and two parts heart. I want to be an ally, a friend and a teacher, to these women. At least for a while. I also want to fly home and be close to the warm arms of my girlfriend and my family.

painting/drawing by Heike inspired by my dream

babies are pure creative energy, gifts from the universe

Starting a new service in an institution such as a hospital is a bit of a slow process for this gal who is rather used to keeping quite busy. I am staring at that turtle tattoo on my right foot and trying to remember her lessons. Keep still, pay attention to the vibrations, and when the time is right to move forward then poke out your head and move. Slowly. Can you even imagine how slowly a turtle must move on the frozen tundra? Maybe I need another symbol.

There is always the raven. I watched two of them from my window for a while. Amazing creatures really. They were walking around a bit but mostly just sitting there on the roof, gazing about and speaking now and again. There is no doubt in my mind that they are talking. They don't talk a lot, just the occasional word or two. That was me at work this past week. Quite mostly, lots of sitting and gazing about, watching, listening with the occasional squak! just to remind them that I am there and I have got something worth hearing to say. It is lonely here for a midwife. I sense that the doctors do not really want to let me in... don't really know how.

Last night I had an amazing dream. I was in a hospital, beside the bed of a woman who had just given birth. Her mother and her Aunty were there too. We were in a crowded hallway but there was a big empty room nearby. I asked a nurse if we could use the empty room. She hesitated but finally agreed saying that we could only have it for a little while. As I wheeled the mother's bed into the empty room I was thinking that we would not leave it until we were good and ready. That we absolutely had the right to be in that room. The baby was like a baracuda, rooting, latching, sucking as if its life depended on it. It was trying to latch on to the grandmother but she knew she couldn't feed it. The mom was moving around, restless, unable to keep still, all over the bed like a wild horse. I took the baby from the gramma and helped it to latch onto this restless wild woman. The aunty was in the room, but not fully present, dressed in "professional" clothing and busy with her hand held communication device. At one point I kind of freaked out on this mom cause she was lying on her side and right on top of the baby, it seemed as if she was oblivious to it. I thought she was crushing it but no it was still latched and sucking hard! She was unable to keep still. But nothing was going to stop this kid from getting what it needed. As the dream ended the baby was lying on the pillow beside her head and somehow still latched and sucking! Anatomically impossible even with really stretchy breasts and nipples! The mom reassured me that the baby was okay.

So here is what I have come to after thinking about this dream off and on all day. I am the slightly overwhelmed midwife, impressed by the power of this baby to get what it needs. I am the grandmother with the dry empty breasts and I am the restless woman who has given birth to this voracious baby and now must nurture it. Sometimes I will be overwhelmed by this work and sometimes I will feel completely empty and dry. Sometimes I will be restless and pacing with impatience but through it all the baby (this midwifery project) will latch and suck and grow. Maybe we won't get much help from the nurse and the aunty but still the baby will thrive. Valerie thinks that the baby ending up at my head is significant. She reminds me that heads contain the brain and have two eyes, two ears and only one mouth... do more listening and observing (and thinking) than talking. This baby needs careful thought, careful planning... it must not get crushed under the body of this restless mother. I must stay focused on the project, the goal, Inuit midwives caring for Inuit birthing women and Inuit babies...

Gina, if you are reading this, I have not forgotten your very excellent question. I am pondering it and my fingers will ramble over the keyboard again soon with some kind of answer.

Thank you to everyone who found the time to read my first post and thanks especially to all who commented either here in the blog sphere or else by personal email. Your support and encouragement mean a lot to me.

walking backwards

The Wind picked up last night. I could hear it beginning to roar outside my windows when I went to bed and at first I wondered if it would keep me awake. But no, the wind song became my lullaby, accompanied me in dreamland, and like a loving companion, she was still there in the morning. I woke to the sound of a Raven, there is no other sound like it in the world.

I don't know who (if anyone) will read my meanderings. I will do my best not to bore you. This blog will be some kind of mix of journaling about my work in Iqaluit for the Government of Nunavut and the ramblings of my mind.

I left my home in Guelph just one week ago today and following a lovely little "transition-time" with my own dear loving companion, the lovely Valerie, I flew into Iqaluit on February 1st. The last time that I flew into Iqaluit I was on the same airplane as the deceased body of a young Inuit woman that I once loved with all of my heart. One can walk backwards against the bitter wind but time appears to go in only one direction... forward. Daisy is gone and I am still here. I kind of always knew that there was work for me to do in Iqaluit. Can I be completely honest here? I probably could not have come to this town to do this work if Daisy was still alive. Our love was impossible, her addictions and her violence made it impossible. I don't understand the mysteries of life and death but my heart tells me that it was time for Daisy to go. Death had her in his grip in summer of 08 when she was involved in the crash that killed her cousin. She lived through that, I think because she had some work to do back home in Iqaluit. The next time Death came for her he did not let go.

My work here in Iqaluit is to start midwifery services at the Qikqiktani General Hospital (QGH). There is already a midwifery education program at Nunavut Arctic College (NAC) and having midwifery services in the hospital is a vital component of that education program. The volume of births in this hospital will provide the perfect training opportunity for the students. High quality prenatal and birthing services already exist in Iqaluit, delivered by doctors and nurses, most of whom, like me, come from other places. My job is to work with these other service providers and the women of Iqaluit and the rest of the region, to integrate midwifery services into the existing services. From my perspective, the most exciting thing about the work that I am here to do is the fact that NAC's midwifery program is for Inuit women. This is about capacity building. This is about Inuit women pushing their sweet little brown babies out into the hands of Inuit midwives. Walking backwards, back to a time of fierce strength, independence and resourcefulness. Blending the traditional art and science of midwifery with "modern" midwifery, reducing dependence on health care providers from away, improving the health and well-being of the people of this wild land. People walking forwards, facing the wind, smiling and laughing as they go.

I bundled up in warm clothing and went for a walk outside today. I have this excellent pullover parka with a fur trimmed hood. It is so warm and snug. I wasn't planning to be out for very long so i just wore the regular boots and put long underwear under my jeans. For longer walks I wear snow pants and "serious" boots. Its really cold out there. I don't know how cold in terms of the numbers. My friends and co-workers will know this about me. I am a "broad-stroke" person who prefers not to get bogged down in details like -32 and -50 with the wind chill. Cold is cold and very cold is very cold! Just me and the ravens out there today... everyone else in Iqaluit is using vehicles, stinking up the frozen air with exhaust fumes. The wind was at my back going down the hill and towards the library and in my face (except when I turned and walked backwards) as I made my way up the hill and home. When I came inside I ate an orange that has been sitting on the table looking gorgeous and yummy. Something about being here gives me a greater appreciation for the humble orange. I found myself thinking... how far has this orange traveled to be here in my hands on February 6th? And what was it like for the first Inuit person in this land when he or she first gathered the courage to taste an orange?