You know how they say, “Wear sunscreen? Well, let me be your cautionary person-writing-this-blog-post and say, up front, WEAR YOUR SUNSCREEN. On that note of “The more you know” (did you just hear the music?), let me also share that we need to watch our skin for more than just those changing moles we always hear about. Yesterday I had a Mohs procedure on a superficial basal cell
carcinoma on my face (yes, skin cancer). My only clue this was something that needed attention was the fact that, all summer, I had this spot on my nose that would scab up for a week or so, and then heal.  Scab, then heal. Scab, then heal. It was a shiny piece of flesh-colored skin that maybe looked a bit callused – no pigmentation, no mole appearance, just a regular area of skin that looked and
behaved a little differently. A visit to my dermatologist revealed it was problematic, and that leads us to the Mohs procedure.

In order to fully get the root of the tumor, a Mohs surgery can be lengthy.  The skin is numbed, the surgeon draws, and then they cut. They take that piece of tissue and essentially put a cross-hair on it,
mapped to match the area from where it was removed. This is examined to see if all the bad cells are gone (I never said I was an expert). If they see anything remaining on the sample, they know exactly where the offending tissue lies; my surgeon had to come back one more time in true, if-at-first-you-don’t-succeed fashion. There is a wait time of 30 minutes between each sample, which is why this isn’t generally an in-and-out procedure.  

After this was all taken care of, I expected my doctor would just swab some antibiotic ointment and slap a cutesy Band-Aid on and that would be it.  But I was wrong.  I actually had to go to a different part of the building. “I’ll meet you over there, “ my handsome, thirty-something, Mediterranean (Middle-Eastern? Spanish? Who knows) hunky doctor said. Then a nurse walked me through some doors, shoved some things into my arms, and said, “Go ahead and put your clothes in the bag.” Um, what? I am just getting
my nose bandaged!? What’s going on?

In the shock of suddenly realizing I needed to strip down, I couldn’t remember if the gown was to open in the front or the back. I tried it one way, spun it around, then twisted it back the first way.  Finally with it half on, fabric clenched in my hands to cover my behind, I stuck my head out to call, “Hey, what’s the story on the gown?  Open in the front or the back?”  The back, definitely the back.   

I continued with my booties and the ever-lovely surgical hair-net thing.  I was placed in a bed and my nurse brought me a warm blanket -- other accoutrements included an automatic blood pressure cuff, and a pulse ox on my right index finger.   My nurse sat and chatted with me for a bit, over such everyday topics as allergies to any drugs (none), was I supposed to take my bra off, because I did (there are so few places outside of one’s own home where I can do this, so why not?  But no, it was not required), and the fact that we both were breastfeeding mothers (can’t remember how that came up). 

I was actually wheeled, wheeled, I say! into the surgery (that sounds so Doc Martin, but unlike the European definition, this was the place in the surgery center where they do surgeries, not the office where docs do visits). When my doctor came in, I was kind enough to remind him that it had been a couple hours since last my nose was bee-stinged beyond feeling, so I would love some more drugs to numb that region. Here is the comment that started it all: “I think I have a pretty high pain tolerance, but I don’t want to feel this if I don’t have to.” His response was, “Oh, why do you think that?”  I shared I had 4 babies with no pain meds. He and the two nurses all gasped. Oh, I had one more coming, “And the last one was born at home.”  My nurse fainted to the floor.

Okay, not really. But I they were still abuzz with a lot of questions, that all sounded like “Why?” (Let me come down off my high-horse now.) “I wasn’t planning to have my first without pain meds.  In fact, I said, ‘I have seen women give birth naturally, I think it’s pretty crazy; I am totally getting an epidural.’  Well fast-forward to an unneeded induction, and I wasn’t able to get an epidural. My fear of throwing up won out over my fear of having a baby, so I somehow was able to give birth to my first baby without an epidural or narcotics. It took some time to work through mentally, but eventually, I was happy about
it.”

By this time in the surgery, my bed has been lifted up, the doctor has cleaned the left, upper quadrant of my face with iodine, my eyes stinging from the closeness of the fumes, and my face has been covered with a piece of paper with a circle cut out of it so only my nose is exposed.

I continued on…“With my second baby, I wondered what could birth be like if I actually planned to not use any medications?  I got a midwife who delivered in the hospital, and I waited to go into labor on my own. Third baby, the same.  Fourth baby, we moved here, there were no hospital-based midwives, so I found a licensed midwife who came to our home to help us have our baby there.”

“Why would someone choose to not have pain medications?  It is painful to have a baby!” he stated, with much authority (at this point, I did question how he knew this, had he ever experienced it?  To which
he conceded, no, but he had seen it a lot).  So I asked him this:  “Why would someone choose to climb Mt Everest?”

“That’s different,” came his reply, “I can understand that.  You want to see what you are able to
accomplish physically.  You are challenging your body, working toward a goal...”  My pulse-ox’d finger interrupted him, pressing, pressing on its imaginary quiz-show buzzer – or maybe it was my voice -- “DING DING DING! You got it!”

I couldn't see him because my face was covered, but his hands paused in their stitching.  “I…could see that,” he came around, slowly. The hands resumed their stitching.  “I am not sure what the big deal is about drug-free birth though.  There is so much pressure to have a natural birth, but we don’t have the
longitudal studies that show epidurals, or even c-sections, have life-long health risks.” On the spot, under the cover of plastic-y-paper, I couldn’t think of anything incredible to counter with.  I did cite that babies born via cesarean birth have higher levels of allergies, and that was about all I could think of.

I joined him, then, because I do feel it’s the truth, “There is a lot of pressure for women to go all natural, I see that. It is very similar to the pressure we put on women to breastfeed  -- ”  Okay, this is when he cut me off!  

“ – But those stats are there, we know breastfeeding is beneficial, we have that information.” Interesting! 
Super, hard-cord breastfeeding advocate, not so much on the normal birth platform! I decided, since I
couldn’t present any compelling evidence-based studies or data from Cochrane, I would just keep it simple and stick with his line of thinking. “We are humans, though, and we know as mammals, breastmilk is the optimal, species-specific diet for our newborns.” He agreed.  "Doesn’t it stand to reason, then, that
vaginal birth, as unhindered as possible, is the norm for us as well?  And even though we have the option for epidurals and cesarean births, that vaginal birth would provide the most optimal way for our babies to be born?” Honestly, I can’t remember what he said after that, only I know he wasn’t trying to refute anything.

The cover was lifted off my face and it was time for the nurses to step in and dress my wound.  As he stepped back to let them take over, he asked, “Are you a medical professional?”  I paused before my
answer, and then said, “No, I am a birth doula, a childbirth educator, and a La Leche League Leader.” He shook my hand, nodded his head to me, and then departed to fill out my discharge papers.

What fun!  It made all those 5 bee stings to the nose worth it. I can actually say, due to that conversation, I rather enjoyed my day at the dermatologist. The staff was incredible and attentive (and I am assured my scar will be minimal).  You never know where great birth conversations will happen! But the opportunity to have 20 minutes, one-on-one with a surgeon (albeit a derm surgeon), was pretty darn fun.

I had a cavity filled today.  I like my new dentist, he is a funny guy and his
staff is friendly -- they remember my name.  My dentist was chatting today about when he was a kid, he was always building things.  He decided he wanted to be an engineer, but once in school, a fellow engineering-turned-dentistry-student talked to him about becoming a dentist, and he changed his mind.  "I like being a dentist, but sometimes I think I should have stuck with engineering."  From my stand-point, or chair-point (lounge-point?), I see the fields of dentistry and engineering as pretty similar -- bridges are built in both, right?  He seems to think we should write a book together, about something important, I guess -- the topic is still undecided.  

I had a lower cavity filled, and my dentist made sure I was good and numb -- actually, my whole tongue was numb and half of my lower jaw, including the right side of my lip.  After he injected the medication, he asked me to keep my mouth open for a couple of minutes and to stretch the muscles, and also tilt my head to the right so the anesthetic could gravitate downward to provide better coverage.  Once he came back, and I could take the spit-sucker out, close my mouth, and then open it to talk, I shared with him that when a woman receives an epidural a similar anesthetic issue can occur.  After epidural placement, a woman is propped on her left side, and if everything is going well, she is left in this position indefinitely.  Gravity causes the medication to pool into that lower left side, leaving the right side less-anesthetized.  Have you ever heard from a woman, "My epidural only worked on one side"?  This could
be why.  My dentist agreed this made sense. 

There are ways to prevent this, something called "pancake-flipping," where we have the woman lie on her left side for a few contractions, and then we help her move to her right side for a few; next we facilitate a forward/hands and knees position, usually with lots of bunched-up pillows.  As mom keeps "flipping," it helps to evenly distribute the medication through her lower body.

I wanted an epidural with my first birth -- I had voiced that request loud and clear for months before I even had a hint of what labor would feel like.  In my case, I never received one.  In hindsight, I am glad for that, but at the time I was bitter.  Regardless, today I felt like my tongue had epidural anesthetic. (I realize, just as there isn't a specific "epidural" drug, it is a cocktail of different medications that can be changed according to an anesthesiologist's preference and a patient's needs, "epidural" refers to the specific spot where the medication is placed -- the epidural space is the sac of fluid that surrounds the spinal column.  Obviously this doesn't apply to my tongue.)  My dentist requested I move my tongue to the left so he could drill on my tooth a little.  I tried to move my tongue, but I was unsure if it was actually going anywhere!  "I can't tell ith I am moothing it or not!" I half-mumbled, half-dribbled.  I was instantly reminded of being with a past client who had a heavy epidural, during her pushing phase, and the doctor demanding, "Push!  You need to push!"  To which her confused reponse was, "I can't tell if I am pushing!?"

I do like my dentist, he is gregarious and puts me at ease; I think I will, however, give him six months to ponder over what we could collaborate on -- I am in no hurry to return back to the chair to get an epidural for my tongue.
 

My step-sister, Michele, had her first baby via cesarean birth.  She was set up for an induction, and after many hours she heard the label "failure-to-progress."  To the brain, induction sounds good -- let's get this show on the road. The  body doesn't always have the same plans, especially when a woman hasn't had a baby before.  Even with the medications and procedures offered, the body may not make fast enough progress for the medical establishment.  In these situations, a cesarean birth can become necessary.  

With her next baby, Michele wanted to try a VBAC.  She chose a doctor who was comfortable with vaginal-birth-after-cesarean (although it required her to travel to a bigger city an hour away), and dreamed and planned for her son's birth.  As Michele's confidence grew in her body's ability to birth her son vaginally, her fears of the pain and work of labor didn't ease.  In order to cope with these intense feelings, she made the decision to get an epidural pretty early on in labor. 

Last summer Michele learned her family would grow yet again, and this time she was determined to step it up even one more level -- try for a VBAC with no pain medications.  Although she chose her same doctor, she did make one change - she decided she wanted a doula to accompany her and her husband during this birth.  That's where I come in!

Every baby and every birth is different, and this was no exception.  Michele's labor seemed to drag on and on and on this time.  I ended up at her house at about 3 am.  It felt a lot like a slumber party, and we let her incredible husband take a nap in bed while we laughed and swapped gossip and stories.  I knew we should try to get some sleep, seeing as how any time labor could pick up and we would all be exhausted, but we were truly having too much fun.  We finally decided to try resting, but Michele wasn't really able to get any sleep.

The next day (or later that day) found us still puttering around their house, playing with the kids, watching movies (Puss in Boots, Toy Story, something else, I think, and then Baby Mama!).  We were still waiting for labor to start rolling...we really had no way to plan for the baby-sitter, or my mom to travel to the hospital -- oh, and Michele's little sister just happened to be flying in that night, of all nights!  And my mom was going to pick her up in the event we were off having a baby (Murphy's Law!). 

At one point during Baby Mama I had Michele stand through a contraction in a deep lunge position, and I asked her to switch to the other leg during the next contraction.  It seemed after that, Michele's contractions really started to pick up.  That silent energy that so often comes when the invisible switch flips on inside the mama was humming around us.  Michele was buzzing around, calling the baby-sitter, pulling together the kids' supplies, finding her shoes!  It was finally time to go!

We climbed into the car, Michele in the back seat and her hubby at the wheel (I had shotgun) and we hit the road.  After about 75 minutes we walked into the hospital.  There was a woman ahead of Michele in line, but the receptionist could tell Michele needed to be the priority!  They quickly got us a room and let Michele start doing her thing.  After an intense 90ish minutes of labor, Michele was holding her new, sweet baby girl!

And it was intense!  Michele was amazing.  She coped in many effective ways.  She moved around and changed positions.  She verbally told us what she needed.  She even prayed outloud (although she said at the time she thought she was praying in her head).  I know it is hard to prepare for the unknown urgency of how labor feels, and Michele was able to take each contraction one at a time, focusing her attention on her loving hubby or me -- sometimes both! so she could keep her head above the water of the labor-waves instead of being tossed and turned about in the surf.  

I can't say how proud I am of this mama and her decision to seek something different in our not-very-supportive VBAC society.  The fact that she challenged herself even more by deciding to work toward a birth free from pain medications is something I am also impressed by.  It is scary to do something you have never done before, and armed with support and education, she not only set the goal, she achieved it.  Michele, you are amazing!  I admire and love you tons, and I will always remember the power and beauty you shared on the day your sweet little R was born.