Thank you nurses and midwives

This week is a big week in my healthcare world.  It is Nurses’ Appreciation Week and tuesday was International Day of the Midwife.  In honor of both celebrations, I wanted to thank my beloved nurses and midwives.


Dear Nurses,

thank you for bringing some laughter into my triage room as we waited for the maternal fetal medicine doctor to come and give me terrible news.

Thank you for being the protector of my privacy- making sure I was ready for visitors in the midst of emotional turmoil.

Thank you for telling me about the “secret menu” the hospital offers where I can order quesadillas and pork bacon.

Thank you for sitting and chit chatting during my two week stay, keeping me sane and reminding me that things were happening beyond the fetal monitor I was trying not to watch.

Thank you for watching that fetal heart rate monitor so I could have the freedom just to be pregnant, knowing my baby was safe.

Thank you not commenting on how ridiculous i must have looked in in my sleeping outfit- it was just too hot to wear pants even though I knew you’d be coming in to readjust the monitor.

Thank you cheering me along in my in hospital exercise regimen.

Thank you agreeing to be my labor nurse, knowing my case would be emotionally hard and would likely sit in your memory for a long long time.

Thank you for taking photos of Mabel’s birth- not in your job description, but so meaningful to me.

Thank you for watching my baby in my stead, while she was whisked away to the NICU and I got my stitches.

Thank you for repeating everything the neonatologist said, right after he left because I could barely process it all.

Thank you for getting Mabel skin to skin with me for as long as humanely possible.

Thank you for the footprints, in ink and in clay, that turned out amazing, all done while she was on my chest.

Thank you for making sure she wasn’t in pain.

Thank you for taking out her breathing tube, gently, allowing me a first good glimpse of my daughter’s face free from medical equipment.

Thank you for taking photos, during her life and her death and in the after.

Thank you for feeding me, which I needed direly, but was unable to recognize myself.

Thank you for being present but unobtrusive.

Thank you taking her gently when I gave her up that very last time.

Thank you for giving me peace and solitude to sleep and to grieve in the hours after I gave her up.

Thank you for coming to her wake, taking me for walks, bringing me food in the aftermath.

Thank you for being part of it all and keeping her safe, in pregnancy, in labor and in the NICU.


Dear midwives,

Thank you for all the extra care

Thank you each for calling and checking in when we got the news about Mabel’s Down Syndrome.

Thank you for letting me make tons of extra visits to help keep me sane.

Thank you for letting me use my appointments as mini therapy sessions

Thank you listening for a heartbeat first thing, so I knew she was still alive, before doing the rest of the visit

Thank you for having the hard conversations with me- the ones that were hard for me and hard for you.

Thank you for being honest, saying “I don’t know,” when I asked how I was supposed to return to midwifery if my baby died.

Thank you for giving me the few things I had hoped for- skin to skin, Chris cutting the cord and announcing gender (if he could figure it out!).

Thank you coming to meet her in the few hours she lived- so that you are part of the proof that she actually existed.

Thank you for her dress, an outfit given with love and purpose, the only outfit she worse outside her grave.

Thank you for eating wings with me, bringing me cabbage leaves for engorgement and looking at photos in the aftermath, reminding me that you are not only my midwives, but my friends.

Thank you for the donations you made in Mabel’s memory

Thank you for the lilac bush that you gave me because you know purple is my favorite.  It’s beginning to bloom right now.

Thank you for remembering dates- due dates and anniversaries.

Thank you for saying her name, easily and freely, just like she was any old living child.

Thank you for keeping her safe in my womb and alive in memory.







Work update!

I have a new job!

I still have my old job too.

Since I returned to work I’ve been seeing patients in the office 4 days a week, the fifth day is a day of appointments- therapist, chiropractor, acupuncture and general mental well being. I took a significant pay cut to work this schedule, one that kept me out of the hospital, and I am thankful that my practice was able and willing to accommodate me. But the “(when) will I go back to births” question always hung over my head. When I first asked to be an office-only midwife, I left the door open to return to birth, but with no time line. I still like having that option, but my practice needed something a little more definite. I honestly thought I’d be back by the holidays (Thanksgiving and Christmas) so I could repay my co-midwives for unexpected holiday time they put in for me last year. But I soon realized that goal was unrealistic. It caused me a lot of stress to even hear my co-midwives even talk about holidays and schedule, knowing they had more to do because of my absence from the hospital. When the topic came up at our winter midwife meeting, I conveniently had to use the bathroom at that moment. In addition, my practice wanted to know whether they should hire another midwife to replace me or if I’d be back soon. Well I finally was able to give them an answer.

As of April first I took on a part time position as Program Director for Hope After Loss, my local non profit helping those who have experienced pregnancy and infant loss. The organization runs peer-led pregnancy and infant loss support groups in four towns, does outreach and education to hospitals, medical providers and anyone who asks, and provides burial or cremation financial assistance to those who cannot afford it for their babies.

Taking on this new position means I plan to remain in the same capacity at my other midwife job- no call. I gave them the go-ahead. Hire another midwife! Takes a huge burden of guilt off my shoulders. I know my colleagues are sad to hear I’m not doing birth in the near future and I’m sad too- there are some things I miss about it, certainly the hospital staff I almost never see anymore! But I know I’m not ready. Some may call it avoidance, but I call it self-preservation. I need to still work on enjoying midwifery in the office and finding fulfillment there before I can return to joyful birth in a place that holds so many memories for me.

This wonderful new part time position has kept me a busy bee these past few weeks, hence my absence from the blogosphere.  But my dear friends, I have missed you!  And I”m trying to be back.  I have much to tell.

That same day

“has not had a period since birth of her son on February 15, 2014”

I read the last note I had written on the patient before I went in to see her.  I rarely am so specific in the dating- usually I’d say something along the lines of  “has not had a period since childbirth 5 months ago.”  Clearly the date had struck me.  I wrote it down mindfully, deliberately in the note.  I remember that visit.  I was seeing the patient in the same room actually and thought of how that was also Mabel’s birthday.  At the time all I could think of was how she had a baby to go home to and I did not.

On this day, many months later, a new thought crossed my mind when I re-read my note.  As I stared at her, all I could think of was how she had been on the labor floor at the same time as me.  She was there, down the hall, when I was wheeled from the NICU back to my labor room so that we could call our family in private and tell them our daughter was going to die soon.  As I said “it’s a girl!” in the same breath as “her time with us is short,” picturing the five pound wonder child I had just left on a warmer, tubes criss crossing her slowly bluing face and body, this woman was holding her baby on her chest, shushing those first newborn cries and excitedly cooing over her own little wonder.  Not long later I held my dead daughter as I struggled to keep my eyes open, having been up all night in labor, but not wanting admit I needed sleep for it meant saying good bye to my baby forever.  She probably struggled with fatigue as well, wondering how on earth she would be able to take care of her needy little one when she was just so tired.  I returned to a postpartum room, crawled into the hospital bed with my husband and slept, undisturbed in a quiet room.  She went down the hall, her attempted sleep punctuated by cries telling of a needed diaper change or feeding.  I walked out of the hospital with a box and she was wheeled out with a baby.

I write these words not out of bitterness and jealousy, as I would have many months ago, but out of fascination… that here we both were, face to face, our lives forever changed by the birth of our first children on that same fateful February day, in the same place, but how very very different our lives are now.




Play Date

I was at the dog park with Muppet and she was having her usual blissful time running around with the other dogs. The snow has begun to melt creating a large muddy patch at the park, which of course tends to draw all the dogs. Muppets fur soaks its all up and she gets crazy dirty, loving every minute. This day she found a couple of puppies that she played so well with. Coco was a brown and white dog (I am terrible at remembering breeds) just a few months older than Muppet and about the same size. They romped happily giving chase and play biting.

Dog parks are friendly places. Conversation seems to flow easily between puppy parents.

“Which one is yours?”

“What’s his name?”

“How old?”

“Where do you get her groomed?”

We exchange advice on boots for the snow, where to get a cheap light up collar, where there is a do-it-yourself dog bathing station near by.

On this day, Coco’s mom and I struck up conversation. She seemed about 15 years older than me and very friendly. She spoke with an accent and I soon learned she was from Columbia. She told me how she met her husband, an American, while she was vacationing here and ended up moving here for him.

“Our puppies get along so well!” she said. “If you ever want, we have a fenced in yard and live down the street. You can come over with Muppet and they can play!”

She told me how she works, but her mother is at home with Coco during the day.

“but she doesn’t speak English,” she warned.

“Esta bien. Hablo espanol!”

Her eyes widened and she smiled! “That’s great! She would love you! Even if you speak just a little Spanish.” She wanted to know what I did and I explained I was a midwife (“una partera o comodroma” I said when she wasn’t familiar with the English word. “pero en la hospital,” explaining that here midwives practice a little differently). I joked about how my obstetrical and gyn spanish was much better than general conversational Spanish, so hopefully her mother wouldn’t mind if I talked about vaginas! She laughed.

I left the dog park with her name and number to later arrange a puppy playdate. I thought, is this what parents with living children do? Would I be making similar playdates for Mabel, had she lived? Or not because she would have been sick?


Grief exposed

It was the end of my day and I walked my last patient up to the front desk. “She needs an appointment in 4 weeks,” I told my secretary.   As she searched the schedule, the patient tapped me gently on the arm.

“And how’s your little one?” she asked, continuing some of the friendly banter we had started in the exam room. She remembered that I had been pregnant the last time I saw her.

I am so prepared for this question. I’ve answered it time and time again. I’ve come to terms with the fact that people will ask- a lot of people, because I have a lot of patients who saw me pregnant. Probably hundreds of them. Some know what happened and some don’t. I no longer get emotional or shut down when asked. I have my go-to words that fill the once awkward space the question leaves.

But this time was different. I had an audience. I am usually asked about my baby when it’s just me and the patient in the exam room. I don’t think I’ve ever been asked in front of others who know and here I was, with the patient, sweetly asking in about my daughter with my front desk staff there to witness. I felt self-conscious.

“I have sad news about the baby. She died last year,” I told the patient. She was kind- gave me a quick hug and expressed genuine condolences. And then I quickly moved on and brought the conversation back to the future appointment for the patient.

It was a little different than what I usually do in privacy with the patient. If it’s someone like this patient I usually give a little more space for them to react and leave room for conversation if it happens. I think it helps me and it helps the patient. But this time I felt almost embarrassed that my staff had to watch this awkward interaction, perhaps thinking about how awful it must be to get this question over and over. Part of me is glad they witnessed- people getting a little window into the ongoing grief I have, but another part of me is so very shy about it. I can open up about the raw grief I have more easily in the privacy of an exam room, but not while being watched.

Have you had this question asked in a group setting? How have you reacted?


World Down Syndrome Day 2015

World Down Syndrome Day.

March 21- 3/21-  a day picked to represent trisomy 21 or three of the 21st chromosomes (most of us have only 2- the third is what is responsible for what we know as Down Syndrome).  It’s a day of celebration for the Down Syndrome community- a group I tentatively belong to.  For me it’s a day of celebration, a day of sadness and anger, a day of reflection.

Last year I wrote a letter to those who were expecting a child with Down Syndrome.  I’ve written a lot throughout the year about Down Syndrome- what I see in the news, how it crosses my path on a daily basis, my memories… I recently reblogged this post by Sadie at Invincible Spring, which I wanted to share again today, of all days.

1) Prenatal screening can detect the risk of delivering a baby with Down syndrome.

2) Prenatal screening can detect the possibility of delivering a baby with Down syndrome.
They mean basically the same thing, but not. We welcome possibility, while we shy away from risk.

After reading her words, I have totally changed my practice.  In the babyloss community we are admittedly very sensitive to words and phrases, even if they are well intentioned.  “God needed another angel” is well meant, hoping to give us comfort- but those words sting us, even those in religious communities.  Those in the Down Syndrome community, can experience the same hurt.  And it starts early- before a diagnosis is even made.  We obstetrical providers are the first to address the idea of having a baby with Down Syndrome.  Sadie’s words has made me rethink how my simple words as a midwife portray Down Syndrome in our society.  I no longer use the word “risk” when discussing  genetic testing.  I now talk about the possibility of having a baby with Down Syndrome.  One little word, that connotes so much.  Especially for me.

I was open to the possibility of having a child with Down Syndrome.  I opted for testing even though based on my family history and my age, I was “low risk.”  But as I have counseled patients in the past, low risk doesn’t mean no risk.  I wanted to know my chances of having a baby with Down Syndrome, even though I didn’t think it would change my management- I thought I would continue a pregnancy with that information.  I have also learned, we don’t really know what we would do until actually faced with a certain situation.  When I was told, “it’s Down Syndrome,” I felt relief. The initial abnormal screening had me worried about all the life limiting conditions it connoted, but Down Syndrome was livable in my mind.  My baby could live!  I certainly cried my tears later over the loss of the dream child I thought I was having, but I also eventually embraced the idea- going to my state’s annual Down Syndrome conference, talking with parents of children with Down Syndrome, researching therapies and pediatricians who specialize in children with Down Syndrome.  I had a registry full of special baby wearers and toys made for children with Down Syndrome.  I accepted.  My baby began to feel extra special- yes, a wanted baby, but a wanted baby with Down Syndrome.  An estimated 92% of pregnancies diagnosed with Down Syndrome are terminated.  I was proud to be part of the minority, and also sad that I was part of the minority.  In some ways, I feel future pregnancies may never have that same specialness.  Don’t get me wrong, I hope for nothing but as healthy a baby as possible, but having a baby with the typical number of chromosomes seems almost easy.  Almost.

International Down Syndrome Day is also a little painful for me.  I see photos of smiling children on the news and flooding my facebook and blog feeds, their features of Down Syndrome evident in their faces and their stories of how happy and loved they are written underneath.  I so badly wish I could be in that club- that club I at first never wished I belonged to- the parenting a child with Down Syndrome club.  It’s a lovely community, full of support for people having both an easy and a hard time.  Raising a child with Down Syndrome is a challenge- no one can argue that.  But what child doesn’t have his/her challenges?  Learning your baby has Down Syndrome simply makes your baby’s challenges known and upfront.

At times I can be a little angry- it was the extra chromosome that stole my baby from me.  Mabel’s kidney defects are rare, but they are more common in babies with Down Syndrome.  I sometimes get angry that I was in that minority that said “yes,” that I would raise a child with Down Syndrome, while the overwhelming majority chooses not to.  But I was given a child that wouldn’t live, while others terminated a pregnancy of child that might have lived.

I still believe in a woman’s right to choose. I just simply wish that more people would choose yes, when it comes to Down Syndrome.  It is not an easy road- sometimes it can end in heartache, like with me- but I don’t regret taking the risk of loving my child with Down Syndrome.  I would carry another child with Down Syndrome, despite the risks of loss.  There are no guarantees in life, in love, in family- all we can do is hope.


In remembrance of our daughter Mabel, my husband is fundraising for Best Buddies, an organization that helps people with intellectual and developmental disabilities- including those with Down Syndrome.  On May 31 he is biking 100 miles across Cape Cod to raise money in her name for Best Buddies.  If you’re looking for a way to celebrate World Down Syndrome Day, consider donating by clicking here.




A patients grief for her dad

I was reviewing her medical history and when we went over her family history, she told me that her father had died last year.

“I’m so sorry to hear that,” I replied.

She told me how his birthday just passed and the anniversary of his death was coming up. I asked if she did anything for the birthday or was planning anything for the anniversary. She peered at me with a look of surprise- like she never thought about doing something in remembrance.

“It’s just been so hard, losing my dad…” she started. She was young- younger than me by ten years at least, which meant her dad died young. She mentioned how her live-in-boyfriend didn’t quite understand, especially now that it’s been so long. She shrugged her shoulders, brushing it off a bit.

I looked at her in the eyes, trying to drum up all the compassion I could. “There is no timeline on grief,” I spoke the words I have read over and over again on blogs and articles and have tried to convince myself are true. “You will be sad forever. He was your dad. It’ll change over time, but you can always be sad. I’ve learned a lot about grief over the last year and one thing I know is that you grieve how and for as long as you need to.”

Her eyes got a little wet and she gave a small smile.

“Thank you.”

Have you been able to comfort someone in their grief?