I think you ought to know what’s been going on.
We’ve been eating a lot of seaweed. In everything. Even granola. And it’s the best damn granola either of us has ever had and you’d never know there was seaweed in it if we didn’t tell you. Minerals have been a top priority. It has changed our bodies for the better.
We’ve been following a fairly strict schedule.
We try to fit in all of our work, school, housework and homework on Mondays, Tuesdays, and Wednesdays.
Thursday we do some kind of cardiovascular exercise–jogging around the park, shooting a game of horse, playing catch. Otherwise, Thursday is a free-day, but I usually end up going to acupuncture (if I didn’t go on my 17-hour workday, Wednesday) gardening or doing special projects around the house.
Friday is Boolar day. Recording, mixing, writing on this website, taking photos, making videos, etc. Last week that meant recording the first track off of the Beach Boys’ Love you album, Let Us Go On This Way, and doing a final four-track mix of it. We plan on doing the whole record, each song in order. Look for it here soon.
Saturday is gardening day. I usually end up doing household projects, too. Not chores. Projects. It is also estate sale day. And twice a month or so I get to close Tiga.
Sunday is food day. Farmer’s market and prepare the week’s seaweed-infested meals: a rice cooker full of whole grains, lentils, and seaweeds; a large stoneware dish of kuku (persian egg & greens frittatta-like snack. I like to add barberries in addition to the fresh greens and herbs from our gardens and sometimes morel or shitake mushrooms); salad dressing of apple cider vinegar, olive oil, fresh parsley, one bulb of green garlic fresh out of the ground, greens and all, homemade mustard, blackstrap molasses, and Portland-made miso; cultured ketchup out of some of the last year’s tomatoes paste from the freezer; and three small pieces of salmon (less than half a pound total) baked in parchment paper with nothing, not even salt, on them. They are delicious. Sunday is also family day and dinner day. Sunday is also Softball day, but I wasn’t able to get my chores done in time to go to Tiga’s game this week. We won.
Monday we go back to school and work and chores and homework. We sit on the back patio a whole lot, admiring our handiwork in the backyard. But we get stuff done. We talk all the time, while we are happily busy with our hands.
I’ve been in the process of quitting nail-and-cuticle-biting. Bradley has already quit drinking. The garden is lush, the cats are happy, the bird has stopped biting. Everybody is doing better, see?
Today, I wrote a letter to the first midwives I had, the ones who left me feeling helpless and tragic about the miscarriage while I was in the process, a letter explaining my dissatisfaction with the services they had provided.
I want to post it here. Because I want it to be a very good letter. So I want your help editing it. I mean it. Send all suggestions to boolar.org at gmail dot com or comment here below the post. Please.
Boolar
6025 NE 19th Ave
Portland, OR 97211May 19, 2009
Certified Nurse Midwife, Nurse Midwife-Nurse Practioner, Naturopathic Doctor Team
Somewhere in North
Portland, OregonTo All Concerned,
I have as yet failed to remit payment for the services you provided to me. This has not been an oversight on my part. I did not send payment because I wanted this letter to accompany the check, as it does now, but I was far too angry to communicate effectively until now.
I hope that you are wondering what I could have been so angry about. As far as you know, the story of my miscarriage ended March 26th. This is probably going to be a long letter, but I hope that you will take time out of what I know all too keenly to be very busy schedules to read it. I’d like to tell you the whole story.
Your practice was actually my second choice for prenatal care. My first choice was a Certified Professional Midwife (CPM) in Northeast Portland. Though she is incredibly well qualified and very experienced, and her rates are competitive and reasonable, my medical insurance would not cover her services. I decided to work with you for very obvious financial reasons.
At my first prenatal visit, I began to have doubts about my decision. Even though I felt I had made it clear at our first meeting that a food and herb based intuitive pregnancy was important to me and thus I did not want to take prenatal vitamins, the CNM, NMNP, ND I saw seemed to have forgotten that by my first prenatal visit. I wondered if she would remember that my mom died in a medical accident when I was two and that I was very afraid of the hospital and of doctors.
I felt that if I were to work with your practice, which seemed more locked in to the established medical system than I had previously believed, I would need strong support from somebody who, like me, believes in herbs and food-based medicine. I contacted the CPM in Northeast Portland, my first choice, and asked if I could pay her out-of-pocket for consultations. She expressed her sadness that I had chosen to work with somebody else and tried to explain the difference between the practice of a CPM and a CNM or NMNP, but assured me that she understood the economic reasons and was all too happy to help me on very reasonable terms. She did let me know that I might get advice from her that conflicted with yours.
Then came the spotting and soon after the Doppler and the ultrasound, neither of which were supposed to be a part of my original plan for a non-invasive, intuitive preganacy, but were the only recourse offered to me by your practice. If I had been pointed to very safe, nourishing and calming herbs and foods and habits, of which there are plenty highly and safely recommendable for the situtation I was in, I could have avoided much anxiety and out-of-pocket expense. But I wasn’t, and so I took the only option presented, however much it was at odds with my original plan.
I was further upset about the way the CNM, NMNP, ND broke the news to me. I wish, that she had told me that the technician wouldn’t tell me anything and let me go home after the ultrasound telling me to call her when I got there, instead of making me wait in a public waiting room to have my heart broken. I had already seen it in the forced half-smile of the technician; keeping me there while she got you on the line so that you could tell me there in the clinic only prolonged the agony of being in that place. Remember, I’m terrified in medical establishments. And I wish that she hadn’t immediately mentioned how much it was going to cost; it seemed crude in light of the blow I’d received only moments earlier.
I also always felt that she was annoyed with me when I spoke with her on the phone (as did my husband). I hesitated to call even when I desperately wanted to. For example, I talked to her on Tuesday, March 24th in the evening to report that I had started rhythmically cramping. She told me that I was “gearing up” and to call when the bleeding got heavy. She didn’t tell me that I would need the largest size menstrual pads I could find, some beverages with electrolytes on hand, or offer me any advice about pain relief. Once I needed those things, I wish she had. I cramped so badly that I was awake all night with the pain. I was afraid but I didn’t call mostly because when I asked her during my office visit when it was appropriate to call, she said, “In an emergency. Like if you are in labor or trying to decided whether to go to the emergency room or not. “ I wasn’t in labor and I wasn’t about to go to the emergency room willingly and I wasn’t bleeding heavily, but I was scared. I am not blaming her for my fear. I am explaining it so that you will understand my story.
I began to bleed heavily early the next morning. I was relieved because that was my permission to call the CNM, NMNP, ND. She gave me very simple instructions about how many pads I could soak in a certain time period and said to call if the bleeding was any heavier. She told me to call to check in with her in an hour and a half.
Exactly ninety minutes later (I know, because was I counting them.), I called. I was bleeding way more heavily than I was comfortable with, and I was extremely anxious and unable to stop pacing. I was also in the worst physical and emotional pain I had ever experienced. An apprentice answered the phone and told me that the CNM, NMNP, ND on call was in a meeting and that she would call me when she got out in about an hour. “I can’t wait that long. I need help now, “ I said, and told her with exasperation that the CNM, NMNP, ND had told me to call at that exact minute. She was sympathetic said she’d see what she could do but left me, yet again, alone with my biggest fear– the hospital. It seemed to be my only option since I felt like the CNM, NMNP, ND on call had abandoned me. I panicked. I’m sobbing now, remembering the feeling.
I did not go to the hospital. I called the CPM in Northeast Portland who had agreed to consult with me during the pregnancy. She answered immediately, but I couldn’t speak, I just cried into the phone. She spoke soothing words in a soothing tone for minutes until I was ready to tell her that I was having a miscarriage and that my midwife wasn’t able to come to the phone. She talked me through my fears, asked me if I was getting enough fluids (I wasn’t—the CNM, NMNP, ND didn’t even mention fluids until a few hours later, when I was still bleeding heavily but had passed no tissue), and recommended that I get into the bath (like I said, I was pacing). She didn’t make me feel bad for choosing your practice over hers, she didn’t mention money or even hint at any cost, she never threatened me with the hospital (not that she did, but when the CNM, NMNP, ND casually said “We’re trying to keep you out of the hospital,” she may as well have. That statement might not mean much to most women, but to me, it puts my biggest fear right in front of my eyes). She remembered my anxieties because of the circumstances surrounding my mother’s death and very sympathetically worked with them.
As I laid in the bath, as close to comfortable as I had been in almost a full day, I decided that I wanted to tell you that you and your practice were fired, that I was taking my business somewhere else, and, in fact, I wanted to use those words. But I didn’t have the strength at the time. And since I figured my insurance would be paying you anyhow, I continued to talk to you when you called me.
According to the CNM, NMNP, ND on call, I was finally done with my atypically long miscarriage (she told me 1-4 hours was average) on Wednesday and told me to come in for a checkup in four weeks. I think it was at this point that she also asked me (for the first time) how I was doing emotionally. I told her that now that the hard work was over, I was miserable, in those words. “Well, call us if you get too bogged down in that,” was her reply. To that CNM, NMNP, ND and fellow woman, I would like to say that I think you are a brilliant woman, I really do believe that. You also have so much schooling. But you are sorely lacking in what they call bedside manner. Your brilliance and training could be so much more useful to so many more people if you would work on that. I have another example. Once, when you called, I mentioned that I had talked to the CNM, NMNP, ND who was not on call. You scolded me in a rather harsh tone, telling me not to call her because she was not on call. I didn’t have the strength to tell you that she had called me. I figured she had heard that I was panicked and so she checked on me.
I’ll skip ahead. I finally passed the majority of the tissue on the following Saturday, twelve days after I started bleeding, nine days after your practice stopped calling. I was soley under the care of the CPM for the majority of my natural miscarriage. Though there were many times when I felt scared, I never panicked under the CPM’s care like I had under yours.
If it were up to me, you would not call yourselves midwives. I have experienced the kind of care that a midwife gives and have come to the conclusion that your practice does not provide the kind of care that I call midwifery. You do provide a specific variety of prenatal care and do open the option of home to birth to many women, for which fact I am glad, but I do not include you in the same group of healing women as my CPM. You are doctors and you are nurses but you are not what I call midwives. I know that this misnomer is not your fault; it is yet another problem with our broken medical system in this country and it is a pity that my insurance, for which I pay dearly out of my own pocket, will cover your services, but not those of a CPM.
But, since I know that you (and many other people) consider yourselves midwives, and the long list of letters after your names asserts this fact, I ask that you do a better job of teaching the women interested in your services exactly what kind of midwives you are. Sure, I read in your informed consent the “small print” that says that you are operating under your NMNP licenses, but I had no idea what that meant for me. In hindsight, I can tell you for certain that the care I received from you was not what I expected from what I would call a midwife. Please find a way to educate people like me, who don’t know what it means in a practical sense that you have different guidelines to follow when assisting a home birth, but who, like me, would not like it if they found out the hard way.
I would also like you to change your protocol when dealing with a client who is experiencing the almost traumatic experience of spontaneous abortion. One of my co-worker’s partner also went through a miscarriage in your care not too long before I did. In fact, it was she that made me aware of your existence. She was also left unsatisfied with the care she received, but she, unlike me, had nothing else with which to compare it. She, like me, will not be working with you again. You could learn from clients like us.
I highly recommend that you give your miscarrying client more practical advice, reminding her to drink plenty of fluids, that she can take a bath to ease her pain, that she ought not pace, but might take one of any number of positions that you can teach her about that might facilitate the process. Help her relax, tell her to take care of herself, speak to her slowly and make her feel certain that you will be there for her when she needs you. Be there when you say you will. Tell her if you are going into a meeting or will otherwise be unavailable. Don’t make her feel like she is taking up valuable time; instead, make her feel like there is even more than she is asking for. Make her feel that her body knows what it is doing and that her strengths are larger than her fears. Treat the whole patient.
I hope that you will value the information I have tried to convey in this letter. I put a lot of work into it. Thank you for your time, and any thoughtful consideration you might put towards the matter. I do not require it, but will be very happy to receive your response.
I thought you should know that I am also writing to my insurance company, the Oregon State Board of Nursing, Birthingway College of Midwifery and the National College of Naturopathic Medicine. I do not plan on mentioning your names. I just feel strongly enough about the issue that I’d like to help bring about a change that might help women like me find the care they desire. Perhaps you can help be a part of that change, too.
Wholeheartedly,
Melanie Boolar
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