why I don’t “deliver” babies

Babies caught in February: 4. Shiphrah Birthing Home was really slow in February (notorious to be our slowest month). We had a grand total of 7 births in February, and migraines plus 2 Sunday births (my day off) meant I missed 3 of them. Up to this point in March, we have already had 2 births and we had another birth take place during the time it took me to write this update today! It’s looking like all those ladies “due” in February are coming now, giving me a busy last-three-weeks for my apprenticeship here. And I’m here for it!

It’s been quite a while since I put some birth stories up here, so I  decided I couldn’t help but share these two. But first, a side-note/soapbox:

Within the birth world, you’ll hear midwives (and the women who choose to have their care with midwives) contrast themselves with obstetricians. The philosophy of care, the methods/options/emphasis of care, the context of care… the differences are vast and varied, going all the way down to the ways we talk and the words we choose. The OB’s I worked with while working as a RN in the States would talk about how many (thousand+) babies they’ve delivered during their career, a term used to reassure women and their families of their experience and expertise. I, and any midwife I know (both in person and online through midwifery school) would never say I have “delivered” a baby, regardless of my level of experience. And I’d like to present the following two birth stories as evidence. A midwife is a birth attendant at best. Certainly we have experience and the education and skills to handle most complications that may arise, but we are neither the expert nor the center focus (which, I would argue, the term “deliver” connotes). Each birth is different, and we don’t call the shots. The mom, the baby and that nebulous third variable we call “birth” calls the shots. We don’t deliver babies, we “catch” them. Maybe you’ll see through these birth stories how that difference in vocabulary really isn’t a matter of semantics. 

Story #1

Mom first arrived at 4am Saturday morning, Feb 22nd, after contracting for the past 3 hours at home. This was her 4th baby, but her first to be born here at Shiphrah (baby #1 was a hospital birth, while #2 & #3 were birthed at home). A quick exam confirmed what we saw with our eyes: mild to moderate contractions, a bit of bloody show, 5cm dilated, 70% effaced, head at -2 station = early labor. We encouraged mom to rest and kept an easy eye on her as her labor continued to slow and dwindle. 

At 9am she said she’d like to go home to shower; we encouraged her to take her time at home. “Shower, rest, eat, relax. You and baby are fine, and you’re still really early in your labor. Come back when your contractions become stronger”. At 4pm we ended up calling her cell phone, just to check in. “My contractions have all but stopped”, she reported, which isn’t unusual. A mom having her third/fourth+ baby could be dilated to 5cm for days (even weeks) leading up to her actual birth, contracting intermittently before really going into labor. Pondering possible reasons for the mini-labor during the night, my apprenticing midwife and I thought perhaps this mom was dehydrated or tired the night before and had some stronger cramping that resolved as she got some rest during the day. You can’t plan the way a birth will go. “Maybe she’ll come back tonight” we thought and went about our day (which meant going to see “Little Women” which FINALLY showed in theaters that week here in the Philippines). 

Later that night I get a call that a fourth-time-mother was in labor; shift change meant this new midwife didn’t recognize our mom, but I did,  so I ran back over to Shiphrah at 8pm. Mom was 8-9 cm now, baby -2/-1 station (if you’re not familiar with the term “station” as it’s used in labor/birth, click here), bag of water still intact. Now we’re getting somewhere!! 

As her labor progressed further, we saw lots of bloody show (a good sign we’re nearing “go time”), but baby never came down any further than -2/-1. Mom started to show signs of perineal swelling, which wouldn’t concern me if she were pushing a baby almost-born, but when baby is still too-high to really start pushing, we have to start thinking “what is causing this swelling??”. When a baby is being pushed through a swollen perineum, mom is at greater risk for tearing, bleeding and other complications. So Ate D- and I encouraged mom to try different laboring positions in an effort to encourage baby to descend. We always like a baby to be nice and low (deep in the mom’s pelvis) before a mom starts to push, or else she’ll just get tired! Why force the baby to come down with pushing when your body will move him down for you, more often than not, if you just wait?? A midwife always hopes to find few positions to help baby come down further before we really start to push. 

We were even more surprised to discover this swelling, greater on the left side, would completely disappear when mom was lying on her side, but return when she was flat on her back (yet another example of how lying on your back is rarely an easier way to give birth!). Four hours passed, swelling still position-dependant, baby still too-high-to-push. Mom was almost fully dilated (just a tiny cervical lip that would disappear if baby would finally descend!!), but Ate D- and I started talking with mom about possible transport. Something, we couldn’t figure out what, seemed to be keeping baby high up in mom’s pelvis. It could be a cord around his neck (though you often see fluctuations in baby’s heart beat that hint at a nuchal cord, which we didn’t find here), or it could be that he was sitting a bit crooked in the pelvis. We suspected the second reason, and that’s why we suggested the possibility of transport. At this point, neither mom nor baby were in distress, but you don’t want to wait until it’s an emergency before you move. We’d tried almost every position to get baby to come down, and he didn’t seem to want to/be able to budge, and now we were wondering if this birth needed some outside assistance. 

Then, like magic, her water broke! Bingo!! When you can’t see what’s going on inside, you take what you can see/hear/smell/observe as clues; none of us broke her water, so there’s a really good chance that the baby did by moving down/into an easier birth position, which is exactly what we were wanting to happen. Mom now felt an urge to push, so we encouraged her to try on her side (to reduce swelling). Left side-lying = decent amount of baby movement visible from the outside. Right side-lying = nothing. Flat-on-her back, = no movement at all. In between each re-position, mom would say “I’d like to sit up and push” or “I want to stand/squat”. Ate D- and I encouraged her to try to push baby lower while lying on her side (while we could see signs that baby was moving down as she pushed, we couldn’t see any of baby’s head, so it seemed like he was still pretty high). We talked about waiting till he was really low before getting upright, as upright pushing positions can increase swelling if baby is still really high, and we didn’t want her swelling to increase any further. Finally, after she asked for the third time “can I sit up”, we helped her to her feet. 

And that’s when everything changed. Mom felt the next contraction coming on and, with her back to the bed, squatted deep down on the floor. Feet flat, knees wide, tailbone inches from the ground. In the next contraction baby went from invisible, to “I can see his head now”, to crowning, to head fully out. The baby’s body followed as the contraction died off, spreading blood, stool and baby poop all over the floor and my feet. 

Ate D- and I laughed at ourselves as we watched this baby nurse within 10 minutes of birth. He was an excellent pink color, and despite the powerful, one-contraction-delivery, mom only had the tiniest tear (far too small to need stitches). 

Midwives have to use their judgement and experience throughout a birth, encouraging moms that their birth process is normal and giving options if she isn’t sure what she can do. But sometimes, if a mom asks to sit up, we should just let her sit up. 

This is NOT the baby from the birth story above. This baby, and his darling older sister, were from the previous day. This 4 year old girl was OVER THE MOON excited her baby was being born. She wouldn’t sleep, even though her mom labored all night, and kept saying “No, the baby’s almost here. If I go to sleep, when I wake up I’ll be big, the baby will be in school, and Daddy will be a grandpa!” After the birth, she brought everyone into the room, loudly boasting: “May baby na ako! Ako ay ate na!” (“I have my baby now! I’m an older sister now!”). Too sweet not to share.

Story #2

0630, March 3. Three-weeks-to-the-day left in the Philippines and I get a text message “We have labor. 4 to 5cm, G2P1”. Hooray! Homework can wait, I’ve got the second birth in March to catch! 

Mom was looking uncomfortable but not birth-imminent, so I run back over to the apartment to pull together a quick breakfast and return to Shiphrah to eat while I birth-watch. Mom steps out into the courtyard to labor in the early morning sun, and Ate L- and I make sure everything is ready in the birth room, when two women walk through the doors, one looking very pregnant. My first thought was “I don’t think I’ve ever seen someone show up this early for prenatal seminars before”. It was only 0749 (prenatals usually start at 9/9:30am), and this petite woman in a beautiful brown dress was smiling at me, hands resting at her sides, not looking in labor one bit. She sees Ate L- and I blinking at her and answers our silent question: “I’m in labor”. 

Ok! Her friend gathers the things they’ve brought as we show them into the other unoccupied birth room. I do a quick cervical exam, and end up asking Ate L- to confirm what I was feeling. My RN days made me a pro at internal exams; I haven’t had to have someone double check me in ages…. But I just couldn’t believe that this woman was fully dilated, with baby’s head below her pubic bone at +1 station! I was right (fingers don’t lie, no matter how mystified your brain might be!), and mom smiled, meekly saying “oh, I’m close now? Yeah, that makes sense. It was pretty hard not to push on the tricycle ride here”. #understatement. Two silent pushes later, her water breaks and we can see a tiny bit of a baby’s head peaking out. 2 minutes from SROM (“spontaneous rupture of membranes” means we didn’t break her water), baby girl is born! 

We asked this mom when her labor started at home, and she said “Oh, around 7 this morning.” Our mom had a 50-minute first-stage-of-labor (from start of contractions to fully dilated), and a whole 7 minutes in the second stage (from fully dilated to baby-born)!!! Mama was sitting up in bed, nursing her baby, within an hour of arrival at Shiphrah. 

After we got everything from the whirlwind birth settled, I went in to check on the birth I’d originally started with this morning. She had made some progress, stronger contractions and a bit more bloody show. I double checked that everything was ready and stepped out into the main room to catch my breath. Morning prenatal check-ups were about to start, so I knew it would be busy today. 

Just then, Ate L- and I see a petite woman and her husband walk through the doors. She looks at us with her hands pressed against her back and a serious look in her eyes that quickly turned to astonished confusion as Ate L- asks incredulously: “Oh, you’re in labor too????” (She was not in labor, just a 39-week pregnant mom with a sore back. But Ate L- said she woke up that morning with a firm feeling we’d have 4 births today, and we’d reached the halfway point by 11am, so I can’t fault her the natural question). 

Again, not the woman from the birth story above. This superwoman mom is pregnant with her 5th (36 weeks pregnant in this picture, if you can believe it. We have LOTS of petite moms in the Philippines). She has an 8 year old, a 7 year old, and these darling 4-year-old twins, who bring their rambunctious energy to each prenatal check-up. They are so excited to be kuyas!
When “cute” meets “makulit” (“mischevious/active”).

plans in transition

(I’m not going to write how few babies I’ve caught since my last post, because it would only make you cry like I have been for the past few weeks. I will note, however, that the entirety of the following update was written while observing a mom in labor, and I’m so hopeful that this birth will once again open the door to all the coming-labors!

In my previous update I mentioned I have solidified my exit plans. In 22 days, I will celebrate exactly 18 months in the Philippines. Incredible to think I’ve been here for that long!! Just eleven days later, I will be leaving. Once again, packing up all my worldly goods into two suitcases and traveling to distant, foreign lands. 

All of my wordly goods (except one box and piano at Lauren’s house)
when I came here in 2018

Because the internet is forever, I’m choosing to remain vague about my planned destinations on this blog. I don’t want to put any of the friends whom I’ll be visiting in any compromising situations, so suffice it to say I’ll be traveling to a few countries in South-east and South Asia. As I shared before, I’m flying out of Manila on March 24 (a mere 5 days after I finish my first year of Indie Birth Midwifery School #halfwayfinished!) I’ll hit a handful of countries in the following 5 weeks and set my feet on American soil in May. 

It’s every bit as exciting and exhausting as it sounds. Anyone who knows me will readily agree that I’m never one to turn down a chance for international adventure. Indeed, these upcoming travels were elective and planned by no one but myself. Yet, if I’m honest, as D-Day (“D” for ‘departure’ or ‘doom’, you decide) looms closer and closer, I’m already starting to feel a bit worn and weary. In my more lighthearted moments, I joke that “of course I picked the most complicated way home. I don’t ever do things in a straight line”. But when the more anxious parts of my mind grow loud enough to warrant center stage, I wonder if choosing to start my re-entry-transition (and the most acute expressions of reverse culture-shock) by repeatedly shocking my system with multiple even-newer cultures and languages was a nasty mix of naïveté and masochism. I know myself well enough to know that most of the time, all the new will be received as exciting and full of promise (#eternaloptimisttotheextreme), but I’m also making effort to hold space for the difficult, too. 

As far as my plans once I’m state-side are concerned, I have a 50/50 hold on what I know and what’s still TBD. I know I’ll be finishing up my final year of Indie Birth Midwifery School online (running from July-March 2021), and I’ll also spend that time finishing up the process I started with the Team I’ve chosen to work under long term. I’ll have a few months in Ohio over the summer largely devoted to re-settling, reconnecting with friends and trying-not-to-die-of-hypothermia (you think I’m joking, but I’ve been shivering in the no-hot-water-shower for months and I start complaining about it being cold outside whenever the temps drop below 84. #imabadalaskan). I’m planning on a month in Alaska mid-summer, and then I’ll return to Ohio which will act as my “home base” as I travel to headquarters and various churches across the country when I’m ready to raise support. To repeat my previous sentence: the prospect in front of me is every bit as exciting and exhausting as it sounds.

But I’ve been given a new perspective on what’s ahead, and I couldn’t have asked for better timing in its arrival.  A conversation with my Dad helped me see that my previous thoughts concerning the purpose of my time in the States isn’t the complete picture. I’m not just “going home because I’m done here”. In reality, “home” is even more ambiguous now than when I left. “Home” isn’t the home I left; in Ohio I’ll be living in a different house, working a different job(s), spending my time differently (between full-time school and ministry involvement), and interacting with different people in my inner circles (new people have joined my church, and some of my favorite people are following God’s call that just so happens to be leading them very far away. *insert lamenting cry here*) 

My new perspective: seeing the time in front of me less like that awkward period a young-adult might go through when he/she moves home after college and is waiting for “real life” to start, and more like a missionary going back to the States because the things she must do require her presence in the States. Yes, I could finish my online schooling anywhere, but I can’t afford to stay here in the Philippines (my living costs here have closed that door). And with the experience I’ve gleaned in my apprenticeship thus far, 18 months has given me AMPLE instruction and opportunity; I don’t need to be here. But I’m starting to see that there are things in front of me that DO require me to be in the States. Finishing up the application and completing the process for my long-term Team requires many visits to headquarters in the States. Visiting all the amazing people I know around the country to share my vision and calling with them and ask for their support requires an extended period of American living. Ironically, viewing this season in front of me as necessary and purposeful (instead of “the natural choice”) is relieving; it helps me even now as I anticipate the awkwardness and uncomfortability waiting for me at “home”. If I thought of it as “natural”, I’d be frustrated at how unnatural I felt.

I’ve been reading a book recommended by the Team I’ll be partnering with long term, a book written exclusively for cross-cultural workers in “Looming Transition”. In addition to giving really practical ideas for how to handle the real-life-necessities of an imminent transition across cultures (included in this is “reverse culture shock”, a term that may be unfamiliar), this book has helped me recognize recent symptoms and experiences I’ve been seeing for what they are: signs of stress. I won’t subject you to the entire list, but suffice it to say that the author’s list of common manifestations of emotional stress had me laughing incredulously by the end. I’ve seen every one of those stress signs these past weeks. 

A simple trip to the post office had me feeling nostalgic (I shared those feelings in my most recent Instagram post; if you don’t follow me on Instagram, I’m sorry to tell you that you’ve missed out. But it’s not too late; head over here to catch up. Between the posts themselves and the two first “highlights” sections, you’ll see my chronicles of the real-life moments this past 18 months.) 

Anyway, I’ve been surprised at how sad/panic-y I get during these bouts of nostalgia. Just thinking that next Tuesday marks only one month left here gets me going. But why? I still struggle with the same things I’ve wrestled with daily throughout my life here (loneliness, etc), and both the nature of my relationships here and the fact that I’ll have some semblance of familiarity awaiting me in Ohio make this coming goodbye so different from my last transition in 2018. So this feeling of sadness to let go, and a fear of the unknown before me, where is it coming from?

I think I understand some of the sources behind these feelings, but I’m sure as the day grows ever closer, more emotions and more experiences will add to the soup I’m sitting in. Attempting to sort it out is helpful, but I also know that it’s going to be messy, and that’s ok. There’s grace to perceive and understand, and there’s grace in the transition, even when that looks like disproportionate responses and a prolonged feeling of being “unsettled”. 

From my prayer journal a few days ago: 

“I know You’re going to go before me in Ohio, just like You went before me when I came here. And even though that “going before me” here was exceptionally hard, I came away seasoned and I grew. I’ve been getting the sense that You’ve got more layers, more revelation to show me this year. And now I’m getting the sense that all these concerns, this anxiety, this crack-of-the-door being opened that’s showing me a room that I haven’t really dealt with much but is going to be much more unavoidable so soon… I’m getting the sense now that I’ve got significantly hard in front of me. But I’m actually going get to those layers in this; it’s not a matter of “despite”, nor is it a coincidence that “New Layers” and “Incredibly Difficult” is being spoken by God at the same time. I’m gonna grow. I’m gonna become seasoned. It’s gonna strengthen me. So, God protect me. Keep watch over me, guarding against those flaming darts of my enemy that want me to be afraid. That want me to be overwhelmed. That want me to be defeated. Because none of those things are true.”

– February 9, 2020

Pray for Me :

Pray for my protection in the transition. Protection from attack (our enemy loves to strike at points of stress in times of critical importance, like transitions), but pray also protection in the midst of the unexpected that’s bound to come up. Sometimes a difficulty you didn’t see coming isn’t a cosmic masterplan, it’s just a day that feels even harder because you’re juggling more than usual.  Protection as I place even more “traveling-as-a-single-woman-in-Asia” experiences under my belt. 

Pray that I finish well. Pray for financial and emotional provision as I try to seal hard-earned relationships with love, honor and joy. 

Pray for clarity on what job to pursue. I have a few ideas, but I’m not sure what will be best suited to my needs. 

-And finally, pray against flight complications. I have many flights connecting my travels throughout Southeast Asia, and we’re pretty worried about the Corona virus over here. I’m not worried that I’ll get sick, but I am a bit concerned that these countries might place travel restrictions in April. That combined with the fact that I have a layover during my long flight home in the Arabian Peninsula… Pray that the-Powers-that-be (in ALL the places I’ll be) don’t freak out and cause problems for my many flights. Thanks. 

thoroughly twenty …

You may or may not be a New Year’s Resolutions person; I can only think of one year where I had definitive resolutions outlined (and I think I did pretty well with them!). This is the fourth year now where I have maintained a practice taught by some of the leaders of my church in Ohio, asking God to give me a Word for the coming year. Something that will challenge me and guide me further into His plan for me this coming year. 2017 was Manna. 2018: Come Wait. 2019: Pillar of Fire….

This year I was excited to repeat the tradition I’ve recently established of spending New Year’s Eve in fasting and prayer, reading through the past year’s prayer journal(s), praying over the things God has laid on my heart in that current moment, and asking for direction and anointing over the coming year. A full day spent in God’s Presence, calling out to Him to speak. I did it last year (my first full day of prayer & fasting on NYE; the previous year was just an afternoon), and it was groundbreaking. This year, because Lauren was here, I knew I’d have to be flexible with the specific day. So I recognized NYE in my own way on January 9.

I write out my prayers on a page, and when it fills up, it gets taped upon the wall. Each column is its own thought/prayer, on an overflow of the original if I ran out of wall/door (and you can see, the door handle got in my way!)
Two more prayers taped onto my closet doors (centrally, “Comparison is the Thief of Joy” lives there permanently)

It was a beautiful day. As you can clearly see in the pictures above, I take the time to write down all the things God spoke to me during the past year (they could be specific words or visions, or Bible passages that I’ve been shown), and I also write out long “thought-streams” of my prayers in areas where I’m especially burdened/needing guidance. There are few things quite so encouraging as a visible representation, ten 13-inch-pages-long, of the things God has shown and said to You over the past year. Our God is living and active!!

Last year on July 17, 2019, I had my 20th spiritual birthday. Way back in elementary school I remember a classmate telling me his family celebrated spiritual birthdays (the day you got saved) with a cake, treating it like any other kind of birthday. Since hearing that, I decided I’d keep track of my spiritual birthday (thank you, Dad, for writing down the specific day in your journal when it actually happened. I don’t think he kept journals consistently as I grew up, but if he hadn’t have written down that my life changed forever one quiet Saturday afternoon, I wouldn’t be able to celebrate like this!) 

As the new year approached and I began praying for God to give me a word for 2020, I kept getting this sense that something new, something big, something more lay ahead. Many of us have been taking this new year more seriously, since it’s also brings us into a brand new decade. I am feeling like I’m not only walking into a new year, and a new decade, but also a whole new season of life in my walk with the Lord. If you take the metaphor of “spiritual age” into the realm of real-life experience, your 20’s are the time of life when you start really flexing your legs. You’ve been an “adult” technically for a few years already, but now it’s time to really figure out what your life will look like. Who are you really? What inside you is actually you, and what is just who you thought you were/who you were raised to be? What will your life look like? How do you do relationships, responsibilities, life choices? You 20’s are a time when things get shaken up, your principles are tested and re-established. You make choices, you make mistakes, you take lots of risks… 

Praying through this vague sense of “something more”, God kept leading me to these deep, raw places in my heart and mind. Areas I didn’t know about, or maybe I’d been hoping would just go away. But His kindness and mercy sometimes looks like relentless pursuit; God wanted me to fight for faith even in those hard areas. 

And that’s where my word for 2020 comes in. Rooted in the parables found in Luke 11.5-8; Matt 15.21-28; and Luke 18.1-8; my theme for this year is Persistence.

Persistent”, a definition: 
-continuing or inclined to persist in a course.
-continuing to exist despite interference or treatment.

Persist”, a definition:
-to go on resolutely or stubbornly in spite of opposition, importunity or warning.
-to remain unchanged or fixed in a specified character, condition or position.
-to be insistent in the repetition or pressing or an utterance (such as a question or opinion).
-to continue to exist especially past a usual, expected or normal time.

Those areas where hoping, continuing to hope, hurts. Those areas where it’s just easier, safer, to change, to accommodate, to let go in resignation. Those areas where I’d be tempted to settle, to convince myself that what I’m seeing actually is what I’m longing for (when, if I really listen, I’m hungry for more). Those areas where bringing my hopes, dreams, my heart’s-desire before God feels like a really big ask. Feels like it’s not safe, like the pain of looking at this dream full-on and then letting it go would crush me. In those places, God is calling me into deeper water. I have grown so much; my faith and relationship with Jesus is not what it was decades ago. And yet, God in His loving gentleness is now showing me that there are deeper layers yet untouched. It’s time to plow new ground. It’s time to give those areas over. It’s time to come persistently and keep laying my heart down. It’s time to be real and real honest with my desires, my hopes and needs before the Lord, trusting that He is good, in both the giving and not-giving. In this new year, in this new decade, in this new season of my spiritual maturity, God is calling me to fight for faith, to persist in prayer. 

“She keeps crying out…” 
“yet because of his persistence He will rise…” 
“He told them a parable to the effect that they ought always to pray and not lose heart…” 
“And the Lord said… ‘will not God give justice to his elect, who cry to him day and night? Will he delay long over them? I tell you, he will give justice to them speedily. Nevertheless, when the Son of Man comes, will he find faith on the earth?’” 

highlights from Matt 15.21-28; Luke 11.5-8; and Luke 18.1-8

Amazingly, as I’ve been praying in specific areas of my life, asking for direction and next steps, I get the sense that God is telling me to just make a choice. And I find it so interesting that these two lessons, (remaining persistent in vulnerable prayer and walking in the freedom to make a choice) are being taught to me at the same time. Where I would so easily swing to either side, God is teaching me that He wants me to come to Him and KEEP coming to Him, but I also to know that the outcome isn’t dependent on my persistence. I can’t pray God into my will; I can walk back and forth until there’s a rut in the ground, but His way is best. The persistence He’s calling me into is to bring myself, my heart before Him. To trust Him as the safe place, really the only safe place, for my hopes, dreams and hurts. To pray big, bold, vulnerable prayers, and then leave them at His feet. Wake up, repeat. 

And yet I’m also challenged that in the midst of that persistent prayer, Christ has bought me the freedom to just take a step forward. I don’t have to wait until God has laid everything out clearly before I head in a certain direction; indeed, many times He won’t lay it out clearly on purpose. Not because He doesn’t know, and not because He wants me to discover the magic prayer recipe that will make Him tip His hand (God doesn’t play games). He wants me to see that His power is so great that it not only has a master plan, but can work that master plan even when it looks like I’m just choosing between A or B. So go ahead, pick one and run down that road. Watch what He’ll do. Pour your heart out, lay it all down, and get going. 

Here’s a song I’ve just heard. I love the poetry in verses: the sound of Jesus walking into a room full of His praises.

it’s the most wonderful time of the past 16 months…

Births since last post: 1. One. We had quite the dry spell after my last post of 2019, and then I took off-call completely during the 3 weeks my sister came to visit. I caught one babe in January and then gave call over to a current short-term intern who is tantalizingly close to finishing all her clinical requirements before she takes her midwifery licensure exam. So, let’s just say, my break was nice and I’m ready to put my midwife shoes back on (actually, we catch babies barefoot here. Yet another reason I love being a midwife! I’ve never liked shoes, just as my parents.) Shiphrah Birthing Home had a grand total of 15 births in December and we’ve had 12 thus far in January… come on babies! 

Tagalog word for today: naramdaman (nah-RAHM-dahm-MAHN) = “feeling”. No particular reason I chose this word, other than it’s a newer one to my vocab, and I think it’s fun to say. (If you want extra credit points, try saying this phrase: Ano ang nararam daman? Masakit ba kapag hinihila ko ang karayom, o masakit lang talaga kapag tinatahi? (I’m not writing out the phonetic spelling for that whole question. It’s a phonetic language, try your best). Translation: “What are you feeling? Pain or pulling?” (I got real ambitious and wanted to learn how to ask this when doing stitches… but I think I’ll save memorizing that tongue-twisting-marathon for a few more miles down the road towards language-fluency…) 

I just posted my first post for the year (decade!), and January is nearly over! It’s been an odd six weeks: no births, no school (and oh how I’d been needing that break!), but also busy with my favorite people. In case you didn’t see it all over my Facebook and Instagram, my favorite person came to see me for Christmas. Cue: “It’s the most wonderful time of the past 16 months” (that’s how that song goes, right?!). We had such an incredible time. I hadn’t seen her since July 2018, and so she boarded a plane on her 25th birthday to come see me (her first time out of the country since we returned from Indonesia when she was 8 years old, AND her first time flying internationally on her own! #superherostatus). To summarize the wonderful 22 days we had together: scuba-diving certifications and beach days on the island of Palawan; lots of walking around my hometown here in Taytay; an amazing Filipino Christmas with my closest friends and their extended family here; waterfalls in the Sierra Madre mountains up in Tanay; and the saddest movie we’ve ever seen in theaters. (Interested? here’s a trailer. Artistic creativity + based-on-real-life-events + foreign film = we knew it’d be right up our alley… we just didn’t know we’d be SOBBING the whole time. Sheesh). 

Lauren and I spend some fun time with J-, and it made my heart the most happy to see my two favorite people instantly connecting so well. I even tried Balut! Despite the reservations toward this Filipino delicacy that seem obvious to anyone from the West, I just knew I couldn’t live in this country without having tried it at least once. (Here’s a video of someone eating balut that looks closer to 21 days old. Mine wasn’t quite this developed, but it gives you a good sense of what I worked with!) So I worked up my courage (and fixed my poker face firmly in place) and sat down to eat my first balut with a new friend just before she, J-, Lauren and I spent the evening doing karaoke, which is probably the most Filipino thing you can do. (If you’re wondering, my balut was 17 days old and it really didn’t taste too bad. Quite a strong smell… but once you get over the hurdle in your mind, decide you ok with drinking the grey “broth” that occurs naturally within the egg and that those feathers you’re seeing won’t kill you, it was pretty much like any other soft-boiled egg. I’d do it again.) 

My sister and I had a quiet New Years Eve; we’d wanted to go into the city to see a big firework show, but couldn’t get transport by the time we’d come up with a plan. So instead we stayed in, watched a movie, and then ran out into the neighborhood to watch everyone shooting off fireworks around us. Shiphrah sits on a small hill, so we got to see fireworks spraying out in the valley all around us, peeking through banana leaves and palm branches to see their colorful displays. Really special memories, and I couldn’t think of a more special and unique way to welcome in a new decade!

You’re looking at two newly certified scuba divers, and we’re hooked!
Proof that our Christmas dinner was tastier than yours: lumpia!
Lauren helped me lead worship at my church the day before she flew home.

It was hard to see her go; not as hard as our previous goodbye back in 2018, but there were definitely tears. And even after she left, I was surprised to see how Lauren being here really left me feeling more excited about going home. Perhaps because I have my plans more solidified now, so I know what I’m going back to (I’ll give more details about my plans in future posts. Suffice it to say, I have a departure date now: March 24. But don’t get too excited; I won’t be back in the States until May). And, at first, I re-entered my life at Shiphrah feeling less alone. It wasn’t just me doing this here; felt much more like when we lived together: it’s us doing this.

As the rosiness of her presence has faded with her return over the more recent weeks, I will say I am once again feeling lonely. That’s been the baseline “normal” here; I knew it would be even before I came here. But I’ve been trying to be more kind to myself now; living by myself and not having the deep community I’m designed for (we’re all designed for) is not the best for me longterm. But this season isn’t long term, and I know that in order for me to glean what I need to during my time here, it’s going to have to be this way. So I’ve got the end in sight, and I’m choosing to be ok with the mixed feelings of sad-to-go/ready-to-go. 

I’ll finish this bits-and-pieces update post with a funny anecdote. Chinese New Year just passed (something I’m only really aware of because Filipinos will celebrate ANYTHING, so the moment the Christmas decorations went down all over town, out came the red paper lanterns.) 2020 is the “Year of the Mouse”, and in a massive mall close to my church you’ll see a giant silhouette of Mickey Mouse to commemorate the coming new year (probably not what the Chinese had in mind, lol). Well, I’ve been living in the Year of the Mouse already for the past few months. I noticed my little mouse way back in November; I’d naively hoped he’d just go away (why would he?), because traditional mouse traps scare me. But, after seeing him boldly running around on my kitchen counters WHILE I WAS COOKING, I figured it was time to instill some healthy fear into the little guy. I broke down and bought some glue traps, knowing I was more likely to catch every gecko and cockroach in my apartment than this little mouse. But, many innocent geckoes later, we got him! 

Naïveté springs even more eternal than hope, because I was shocked to see just days later that we had another mouse. Mickey 2.0 was of hardier stock; he defied my glue traps for WEEKS. And he was bolder than his predecessor, too; I found that out when I felt him run across my rib cage while in my bed at 4:45 am. Feeling like my single-bed-for-one-only space had been very rudely violated, I went to war. A whole month passed, but I finally got him on January 20th. (Let me tell you, picking up a glue trap with a mouse on it is a lose-lose situation. You don’t want him to be still alive and moving… but you also don’t want him to be dead.) Just when I thought I was in the clear… my roommate tells me she saw another one last night. 

I’m trying to decide if I want to pull out my ammunition once again, or just surrender the territory. My front door isn’t flush with the floor (it’s rotting away so you can see daylight in multiple places), so I know it’s only a matter of time before I get more friends. And I’m leaving in 8 weeks…. But still, I gotta get him. #jessileighmousehunter According to the Chinese Calendar, I’m a “Water Rooster” (what on earth is that?!), meaning I am a “master of the art of persuasion and people are drawn to me and my opinions”. Maybe I’ll convince him to find a new crib! We’ll see who wins #staytuned

Praises for end of December and the start of the New Year:

— December brought me many gifts from my home/sending church. The sweetest package, filled with everything from hand-written cards, books, and Lindor truffles! I am so blessed by everyone who has sent things (incredibly, that December package was the FOURTH package I’ve received during my time here!); USPS puts an indecorous sticker on the face of each package denoting the astronomical cost of shipping things to me. Once I (actively) decided to get over the horror of people spending that much on me, I am unavoidably reminded that I am so loved, by so many. Thank you. And what a phenomenal end-of-year financial gift was I given!! I am sustained not only by your generosity, but also your love and prayers. Thank you. 

— My time with my sister was exactly what we both needed. Refreshing, relaxing, restoring and so much fun. 

— I made and sent out a video update both to PGC and TBC (if you haven’t seen it, contact me and I’ll email you a link!)

— Exit plans have been made and plane tickets have been bought #costlypraises

Pray for Me:

— Exactly 7 weeks and 6 days until I fly out. After over 71 weeks in this country so far, I’m already feeling like I’m running out of time here. Pray that I finish well. Pray that I glean many new, educational and confirming experiences these final 8 weeks of my apprenticeship here at Shiphrah. Pray for the relationships I’ve been given and have worked hard to maintain here. 

— Pray for financial provision. God has been faithfully providing manna for me every month while I’ve been here. I know He’ll provide for these last few months; He’s shown Himself too faithful up to this point for me to question whether He wants me here. And yet, even knowing that, trusting his day-by-day provision is a stretch of faith. I originally made the decision to be here for 18 months because I had 18-months-worth of savings, so it’s not surprising that finances feel extra tight. God has provided through you all; I thought I had 18-months-worth of savings when I got here, but it’s obvious now that I would have had to return to the States MONTHS ago if it weren’t for so many of you faithfully giving every month. I’m humbled, and moved each time I see those gifts. 

O Come, O Come Immanuel to Rowena

Thursday night, December 5. The sun has just set. Families are gathering, spouses coming home from work, women bustling in their kitchens, preparing dinner for their loved ones. Kids running from house to house in the Rowena “squatter community” (a term used here in replacement of the more common term “slum”). 

Rowena is a community located just on the other side of the hill atop which Shiphrah Birthing Home sits, a community that has long been in relationship with our midwives. Many of our moms live in this community. The Shiphrah team has hosted multiple clinics and community education seminars there, providing more accessible opportunities for family planning and breastfeeding support. The pastor of a local church is also connected with our team, working together to improve the lives of Rowena residents as best they can. These aren’t “just” neighbors (an impossible qualifier in this community; as you’re about to see, neighbor’s are “just the people who live next to you”. In Filipino culture in general, and in squatter communities in particular, “neighbors” are the people who ensure your survival). 

Another normal day dying away, when all of the sudden, BOOM. BOOM. BOOM. Three gas tanks (propane tanks that power every kitchen stove here) explode, causing the cheap materials with which the surrounding homes were made to quickly catch fire. Despite the heavy rain that fell hours earlier, the flames grow, spreading from house to house. People flee their totally incinerated homes, even more evacuating in hopes that their homes will be spared from the destruction; young moms hold their kids in their arms, gathering in the street at the top of the hill and in the covered courtyard behind Shiphrah, while men run back down towards the fire to salvage whatever they can. Two smaller local fire trucks arrived to start fighting off the flames, but back-up support didn’t fully appear until about 8pm (two hours after the fire started). 

Hearing the sirens (I didn’t hear the explosions themselves), I ran over to Paanakan (the common name for Shiphrah), knowing the midwives would likely know what was happening. I found them standing in the street, talking with survivors. They had welcomed some of the families into the courtyard and already had dinner cooking for them in the kitchen (generously coming up with ways to feed them from whatever they had available).

The moment I learned this commotion was because of a fire, two thoughts crossed my mind:

  1. Ate H-, one of Shiphrah’s midwives, lives near this community (her squatter community goes by a different name, but is connected to Rowena). Praise God, her house and family came away untouched. She just had her roof replaced this spring; I’m so grateful Ate H-, her two daughters, her mother and her niece (and the home they share) were not harmed.
  2. Back in February I mentioned a fire that ravaged a community 30 minutes west of us in Taytay, a fire in another squatter community that destroyed 300 homes, displacing 800 families. I sincerely hoped that this fire, in my community, would not be so destructive as the San Buena fire.
Entrance into Rowena from the Shiphrah-side of the community. The river running through Rowena’s center will flood, creating a dangerous situation. During heavy rains, children can’t go to school.
Hallway-like passages woven between homes in Rowena. These close quarters made it hard to reach the fire with an adequate response quickly
The church in the heart of Rowena

That night families slept in the church at the top of the hill behind Shiphrah, the chapel next to TLC (the Philippines has TONS of churches), and the Nazarene seminary on our hill (the same seminary where I use the internet 3 days a week to do my homework). Snacks and toys were given to the kids to help them feel a bit more calm; emergency clothing given to parents who ran in whatever they were wearing as they prepared to settle down with their families for the evening before the fire started. 

The Rowena fire destroyed 13 homes, displacing the 29 families living inside them. Do let that sink in: 29 families living in 13 homes (structures that would not be called “homes” by many from a Western perspective). Whatever wasn’t destroyed by the fire was successively ruined with the water used to put it out (Ate H- told me today that she is talking with survivors about replacing birth certificates, etc.) Praise God no one was killed in the fire

All of the upstairs-portions of these homes (where wood supports attach metal roofing to the cement brick walls) completely burnt away
Homes in Rowena are built with whatever materials available. Miraculously, this home didn’t catch fire.
One week later, Rowena residents are working to rebuild with what’s available and what has been provided: bamboo and tarps
We don’t know what caused the Rowena fire, but fires are often the result of bad electrical wires (seen running through the Rowena’s center here). More destroyed homes in the upper right and left portions of this picture.
The complete outline of a fully incinerated home. Heavy rain fall hours before the Rowena fire began helped restrict the fire from spreading even more quickly between these close-packed homes.

Why do I share this with you? I’m not aiming to share a sensational story, nor am I looking to manipulate heart strings… That night, as I sat in my perfectly-fine house with its cement-brick walls and tile floors, I was struck with the raw necessity of community in life here. Neighbors provide for neighbors, giving what they have (like the Macedonians, giving out of their lack), filling in the gaps left by an unjust society, an unjust world. Without these neighbors, the suffering and destruction going on inside Rowena would be ignored by the outside, just as most events that happen within squatter communities. Even now, neighbors (the Shiphrah team, the Rowena pastor, and people from the Seminary) are figuring out first steps. Tarps have been given as temporary replacements for the incinerated roofs and walls… 

For the past seven years I have maintained my own Advent tradition of reading certain scriptures I’d assigned to each day leading up to Christmas, Old Testament prophecies foretelling the incarnation, life & death, and second-coming of Immanuel. I returned home from Paanakan that night and read December 5th’s passage, pondering the already/not-yet promises in this prophecy with all-new longing: 

The Spirit of the Lord God is upon me, because the Lord has anointed me to bring Good News to the poor [also translated “afflicted]; he has sent me to bind up the brokenhearted, to proclaim liberty to the captives, and the opening of the prison to those who are bound [the opening of the eyes to those who are blind]; to proclaim the year of the Lord’s favor, and the day of vengeance of our God; to comfort all who mourn; to grant to those who mourn in Zion – to give them a beautiful headdress instead of ashes, the oil of gladness instead of mourning: the garment of praise instead of a faint spirit; that they may be called oaks of righteousness, the planting of the Lord, that he may be glorified.

– Isaiah 61.1-3

Lord, may it be so in Rowena. 

Obviously the hope would be to help families get back into their homes before Christmas, but it’s too soon to know how feasible that is. In the words of Ate H-, we expect the government to respond with resources and finances (they did so within a week after the San Buena fire), but we don’t know when they will step in (or how much they’ll provide). There’s a chance that the smaller size of this fire might cause delay in response (less urgency), and San Buena is located in a different district (one that tends to have better governmental infrastructure). All that to say, if you want to donate to support the rebuilding and resettling of those displaced by the Rowena fire, you can do so here: donate. A fund has been started through the Nazarene seminary and all donations will be allocated towards needs determined by the Rowena survivors themselves. 

growing pains

“The future feels so hard and I want to go back. But the places that used to fit me cannot hold the things I’ve learned”.

Lately I’ve been remembering those lines from a favorite song of mine (a song I first encountered the last time I was living overseas.) I told a dear mentor the other day, “2019 has been fun”… and while there certainly have been many fun experiences this past year (traveling down to Mindanao with my best friend, visiting Singapore again after 20 years, exploring Australia for 10 days, going on a Shiphrah-staff retreat to the beach), I was referencing how difficult this year has been for me. From January to now (nearly all the way through 2019’s 11th month), that difficulty may have changed in its specifics, but it’s never waned. I’ve said in the past that I feel like all I do is share about how hard things are, and I’ve shared how this summer God taught me that hardship and difficulty aren’t signs that I’m doing something wrong. Sometimes things are just hard. And sometimes things are hard because that’s how you grow. 

I have been busy these past 2 months (hence the radio silence.) I’ve started a new trimester in school (which means 5 new classes to complete in 10 weeks); we’re still in the “-ber months” which is most often Shiphrah’s busiest birth season (just two weeks ago we had 4 births in 4 days; one mom’s active labor lasted 14 hours and another poor mom pushed for 5!); and lately it’s felt like every area of my life is requiring difficult conversations (not my favorite thing). 

As I enter into these situations I find myself feeling so inadequate for the task. “I’m not enough for this”; “I don’t have the skills to navigate this the best way”; “This is too much for me”; common phrases in my mind recently. And despite these thoughts, the difficulties just keep coming, which makes me wonder… maybe things are hard on purpose. God must be doing something here.

Way back this spring God gave me a vision while kneeling in my prayer room and a few days later I attempted to capture that vision with my negligible drawing skills. The vision was simple in its metaphor: water pouring from a pitcher into a clear, pebble-filled glass. But through that simple picture God spoke what He was doing then (and what I believe He is still doing now): pebbles don’t have to be cognizant of the water’s will or purpose as it flows past them; their ignorance (or even resistance) doesn’t prevent the water from moving. They might not even recognize that something is slipping around them, subtly causing everything inside the glass to shift. God showed me that even when I can’t feel it, even when I don’t see/know/understand what’s going on, even when I think I may be in the way, He is working. His Holy Spirit is pouring in and through my life, washing, shifting and resettling my heart, my priorities, my desires and my pursuits into the form He wants for me.

(Don’t judge my art skills. I was homeschooled by an accountant/lab tech and a mechanic).

People ask how I’ve handled “culture shock”, and at first I didn’t know how to respond. I always thought of culture shock as an ex-pat suddenly screaming in the market because some seemingly-harmless encounter tipped the internal scale provoking a meltdown. But I’ve never had a dramatic meltdown. “Maybe that’s not my temperament” I’ve thought. “Maybe I’ve grown better and better at remaining flexible and open with each new culture and language I’ve pursued in my adult life” (Tagalog is the 5th foreign language I’ve studied!). But recently I’ve begun to see that maybe that’s not the way culture shock looks most often. Rather than the occasional eruption, I now see culture shock as the constant filling of every area in your life, keeping your stress levels at a consistent 6-7/10 most days. Things that would normally be easy are suddenly difficult and draining. Conversations that would have been encouraging and natural leave you feeling confused and strained. You’re exhausted in tears at 3pm when you haven’t finished half the things you’d “normally” accomplish in a day’s work. And I keep expecting that stress level to go down as I grow more and more settled in my life here. But it remains untouched. 

And that consistency reminded me of something that was once ever-present in my life (amazing how easy it is to forget something once a few years have put distance between the experience and your day-to-day!). I’m experiencing growing pains! Google tells me that at 5’10” I’m among the 99th percentile for height among American women (I didn’t need Google to tell me where I stand among Filipina women! #jessithegiant) I was always the tallest in my class in elementary school, but from age 11-14, I needed new shoes every 3 months. Kneeling on the floor would bring tears to my eyes; my femurs were growing faster than the tendons and muscles in my legs could keep up, so I always felt pulling and pain in my kneecaps. I’ve been 5’10” since 14 years old (wanted to be 5’11” my whole life and I stopped 1 inch short?!?!) My dad tells me that the summer going into his senior year of high school he’d be woken in the middle of the night due the severity of his growing pains; he grew 6 inches that summer!!

I should have remembered that this constant, nagging, energy-draining pain isn’t new; I’ve already experienced it as a symptom of coming new growth. And just like those early teen years, I’ve felt a bit like I’m back in junior high these past few months. It’s awkward; I’m unsure of myself; skills I once had so much confidence in are suddenly uncomfortable and foreign. Usually communicating on this platform is easy, the words just flow, but I’ve been struggling to come up with anything to write for the past 2 months. 

Growing pains are bothersome because there’s just no way to know when they’ll finally go away. We are told by those around us that this won’t be forever, at some point they’ll stop. But just like a parent can’t really know how tall their teen will become, I don’t know what image God is fashioning me into here. We can have a vague guess by looking at the genetics of the mom and dad, but that only leaves us with general guessing at possibilities, and a lot of “wait and see”-ing in the mean time. 

So as I’ve been “waiting and seeing”, I’ve come to recognize how hard I push myself to grow.  Urgency is never lacking within me. I’m a passionate person and once I get it in my head that something is worthwhile or important, there’s no time like the present to get started. Throughout the past 14 months here in the Philippines I’ve faced many challenges, and with each new challenge I am reminded of just how far I have to go. “I really need to get this mastered because it will be so important in my life” has been on endless repeat. “This” could be a midwifery skill, a living-solo-in-a-foriegn-context lifeskill, another high-stakes conversation or a better understanding the social dynamics around me. But I’m now seeing that just around the corner from every “this” overcome is yet another challenge waiting. Just like the American perpetually saying “it’s just a really busy season right now, in a few months things will slow down”, I’m coming to realize that this pattern isn’t changing. So maybe my perspective should. I’ve got a WHOLE LIFE of needing to grow ahead of me; perhaps it’s time to balance that urgency with an eternal perspective: it is important to do this well, but I can trust that God is going to keep growing me even after this is behind me. Not a novel idea, but what a profound antidote to the urgency that rules within me with an iron fist.

I shared at the beginning of this year that my word for 2019 was Pillar of Fire. At the start of the year I clung to the truth that even though I didn’t know where to go or what to do, God would guide me as my Pillar of Fire. I didn’t need to know where to go; He knows and He’s leading. But now, as 2019 comes to a close, I still rest in that leading provision, this time trusting His pacing. When I’m not in charge, when I have to look to Him to lead, I’m forced to take one step at a time. One step of growth at a time. And when I’m tempted to compare myself to who I was 14 months ago, or who I think I should be wherever I end up long term, I instead must look to He who leads me. He knows the path He’s laid before me, and he knows the new creation He’ll be shaping me into along the way. 

I’ll finish this post with a Tagalog phrase. I asked the midwives if they were familiar with the phrase “growing pains” (and promptly had to explain it. That’s not a term here). The translation they gave me is “dumarami ang sakit” (“doo-mah-RAH-mee AHNG sahk-EHT”), literally “an increasing of the pain”. Close, but not quite the same.

I discovered this song months ago, and it’s come back as the perfect expression both of where I find myself and what I’m clinging to here. I hope it encourages you too. 

Praises these past 2 months

  • In late September I spent 10 days visiting an old Bible-school friend now living in Australia. This was my first time Down Under, and I came away so refreshed. My two hopes in going were to see beautiful sights and encounter some solid Gospel conversation, and I’m so grateful that I got plenty of both!
decided missionary budget didn’t cover a live show #sydneyoperahouse
Queensland just took my breath away #stradbrokeisland
Thanks to J- and his girlfriend for giving me such an amazing experience!
“ocean” is my favorite color
  • Balancing school and my apprenticeship has been difficult (largely due to irregular internet access), but it’s working. I’m 3-weeks-from-finished with my second trimester of my first year at Indie Birth Midwifery School, and I’ve now got my 123rd baby (48th Primary) under my midwife belt. Praise God for resilience, flexibility and an ever-changing system that’s working to get this midwife what she needs!
  • A big shoutout to Mercy House Philippines, where I wrote most of this blog post. I was privileged to spend Thanksgiving with these amazing people (celebrated a week early), and I’m so grateful for our friendship. Mercy House is a home for boys 9+ who had been living on the street. Spending three days with this massive family was profoundly refreshing and rejuvenating (and the surrounding countryside ain’t half bad neither!)  
view from Mercy House. wish MY neighbors were this nice

Pray for Me

  • In a previous post I asked y’all to do some serious praying for a family member in a desperate and dangerous place. Keep praying. Pray that God would speak clearly, rescue and continue to sustain in His mercy until things change. And pray for those of us close to this loved one; right now it’s looking like this hard season is only going to keep getting harder. 
  • In 2 weeks, 6 days and 22 hours the moment I’ve been dreaming of since August 2018 is finally happening: LAUREN IS COMING TO SEE ME! We’ll have three beautiful weeks together, and I can’t wait to have my favorite person at my side once again. Pray for protection for her (this is her first time flying internationally, and her first time out of the country since our family left Indonesia in 2003), and pray for extra blessing over our reunion this Christmas/New Years. We both could use some encouragement, and we know it’s just around the corner. #sistersmakethebestchristmasgifts
  • With each week that passes, I’m coming to see that the end of my time here is approaching. I really want to finish well; pray that I will be given the grace I need to approach the end of an 18-month-season-of-life with wisdom and understanding; I want to end well in relationship here; I want to give joy and peace as I go. I want renewed strength to let go of what I have known here and walk into the unknown ahead of me (more specifics to come later, but I’ve got a few cross-cultural adventures in store between the Philippines and the US that mean more resilience, grace and learning required). 

one year in, so let’s go deeper

Tagalog word for today: tapos na (“TAH-pohs  NAH”). Yes, technically this is a phrase and not a word. “Tapos na” is most often used in situations in which English speakers would say, “I already did that”, or “I’m finished”. (Reading between the lines, you can start to see what language-learning-by-immersion really looks like. Most often I don’t learn what words/phrases “mean”, as in their literal English equivalent; instead, I learn how Tagalog words/phrases are used in context. This means that I’m not only learning a language, I’m actually learning an entirely different thought process and culture.) This phrase seemed fitting for today’s post, as I’ve both FINISHED my first trimester of midwifery school as of yesterday, AND I’ve FINISHED my first year here in this Philippines as of last Friday! Three-cheers for the double-finish!  

Today is my first day of freedom! September 19 was the last day of my first 10-week trimester in Indie Birth Midwifery School (yes, we’re midwives, so we don’t do semesters, we do trimesters. #everythingpregnancy) Another huge thank you to everyone who has given to support me in this endeavor!!! I really couldn’t do this full-time-school-full-time-apprenticeship without you! IBMS students take FIVE 10-week classes each trimester, and I’m so pleased to say that I am 1/6th of the way done with my school journey! 

One of my favorite classes this trimester was titled “Speaking Your Truth: Content Creation for Birth Workers” (Indie Birth loves a long-and-specific course title!) This class was all about excellence in writing and content development, so we learned how to create our own podcasts and got tips for making approachable, interesting videos. The “why?” here is the idea that midwives have a unique perspective on the world (yes, specifically the birth and pregnancy world, but also the world at large), and one of the BEST ways to explain our perspective, not to mention possibly expand that thinking further in the world, is by creating material that connects with the people. Videos that encourage women interested in natural childbirth, podcasts that empower midwifery apprentices to continue down their road, articles and blog posts that create port-holes into a world that can be rather niche and specific so those unaware of this different perspective have a chance to look-in-and-enter a different frame of thinking. This course helped me see that my skill as a story-teller has the potential to shift the narrative from the medicalized myth to the fuller picture (That’s a direct quote out of my notes from one of this trimester’s lectures). And it helped me see that this blog is acting as a means of keeping my Family in touch with my growth spiritually and cross-culturally, certainly. But it is also creating a space where I can act as a bridge; simply by sharing birth stories and my experiences as I learn and grow as a midwife I am inviting you to walk with me. How encouraging to realize that I’ve already found a way to share my voice, and that a way that’s sustainable (32nd blog post in a 15-month period!) So thank you for journeying with me.  

So, I figured now would be the time to answer a question that I’ve encountered a few times already; I’m sure these questions will keep popping up as I continue through midwifery school, so let’s get the jump on it. This question is/can be asked a number of different ways, including the following I’ve heard from loving friends and family members: “Will the experience you’re getting at Shiphrah count?”; “Does the education you’re receiving in school count towards your midwifery license?”; “Why would you decide to not get a license?”; “How will you practice as a midwife without a license?”

 It all comes down to the same concept: licensure.

The long and short of it is this: I have decided NOT to pursue a midwifery license, otherwise known as a CPM (certified professional midwife) license. There are two sides to this decision: external (the limiting factors around me) and internal (my own perspective as a midwife), and I want to take this opportunity to explain a little on the first, and elaborate more on the second. 

Let’s start with those external factors, condensed down to the most concentrated version. During the years leading up to my apprenticeship here at Shiphrah I began to research the CPM licensure process in the States. The few schools I managed to find that are MEAC-accredited (the midwife equivalent of “board certified”) were SUPER expensive, long programs that looked exactly like nursing school: a number of midwife-specific courses sprinkled in with a bunch of “well-rounded student” classes that result in a bachelors degree. Initially put-off by the expense and time required, the final nail in the coffin was when I learned that only a tiny percentage of my international experience here at Shiphrah would be “accepted” to meet their clinical requirements (for example, only 10 of the 25 primary births I’d need could be met overseas). Looking over the fact that the US has decided that I only need to attend 25 births in the primary role before I’m a qualified independent midwife (!!), I was personally told by these schools that I could take as long as I wanted at Shiphrah, but only these small percentages would “count” towards my overall experience. The rest would have to be finished in the States, no matter how much I had learned in the Philippines. Fulfilling those requirements all over again in the States (“2-3 years” as the average time it would take per the school’s estimation) after already exceeding the license-board’s requirements overseas seemed like a frustrating waste of time to me. I’ve shared before how I specifically chose to do my apprenticeship overseas BECAUSE I wanted to learn how to be a midwife while encountering cross-cultural, cross-lingual, cross-life-situation hurdles; re-entering an apprenticeship in the states just to fulfill the US requirements would not only be a waste of my time, it would likely also mean 2-3 years of un-learning all the valuable skills I worked so hard to work into my bones as I grow up as a midwife.  

So I pretty much knew even as I approached my apprenticeship at Shiphrah that I wasn’t going to be able to be licensed in the US. But not being able to be licensed is not the same thing as choosing to not be licensed. The external factors would have my my pursuit of licensure difficult, but it’s my internal perspective that has brought me to the decision that licensure is not necessary

As I shared earlier, the US license board requires license-seeking midwife apprentices to have met certain clinical requirements (in addition to graduating from a board-approved school) before taking the license exam. If this seems exactly like the process it takes to become a nurse to you, you’d be correct. THAT is another reason to be skeptical of the midwifery-licensure process/system. I’m an RN and a midwife-in-the-making right now, so I can clearly tell you: there’s a difference. A philosophical, practical-approach difference. And I think that difference should be honored. A midwife isn’t going to be taken more seriously just because she’s jumped through the same hoops as an RN. If she’s going to be doing different things, acting from a different mindset, I would argue she needs as different process to take her there… 

I could say so much more about the unique advantages of choosing to be an unlicensed midwife; how so many people think that having a license will protect you from legal action (when in reality a license doesn’t make you immune to liability or criminal charges. In fact, having a license can even make you even more susceptible to charges as the licensee is forced to follow her license regulations to the T); how the trust relationship between client and midwife is profoundly strengthened without a license in the middle (a mom/family-unit is required to do their own research into an unlicensed midwife because she doesn’t have an outside standard saying she’s “sufficient”. If they decide this midwife has the experience and perspective that they trust, the are already more closely bonded, creating that mutual respect and trust that is essential for the midwife-client relationship); how not having a license frees the midwife to determine for herself and for each client if this situation is one she is willing to enter into (rather than giving that choice to state regulation); how an unlicensed midwife has greater personal responsibility (“Am I sufficiently prepared, both in education and experience, to care for this pregnant mom, her birth and her baby?” I am forced to answer this question with each client when I don’t have some third party stamping me as acceptable.) And to answer the question of needing license for any future VISA applications for my overseas plans: My RN license gives me a medical license if that’s required (though, I may not even go that route based on the experience of some other Workers). 

As I shared in a previous post, I am already seeing sign posts saying “you’re going the right way” in my different approach to midwifery journey. So many of the other interns who have come through Shiphrah as part of their licensure-process are so numbers-focused; they come for 4-6 weeks desperate for as many births, prenatal check-ups, postpartum checks, etc. that they can get their hands on. And I understand why; they’re in a system that’s demanding all these clinical requirements before they can fulfill their dream of becoming a midwife. But that system seems to be shaping the way these students approach midwifery (coming from the perspective that you learn how to be a midwife by being a midwife…); when I’m desperate for numbers, the women I’m interacting with are so easily reduced into the various ways they fit the system requirements and what they can give me. I would venture to say that every one of these midwifery interns would agree that midwifery is not a clinical (medical, systematic) approach to pregnancy and birth, and yet the very system that’s “qualifying” them as midwives is demanding clinical requirements, and thereby creating little clinicians in the process. My non-traditional apprenticeship (which, in light of history, is actually the more traditional approach) of learning-by-doing without the goal of approval-by-licensure as my goal frees me to interact with each birth uniquely and fully as a relational experience. It’s not about the numbers.  

Honestly, it has been pretty scary for me to work on this blog post. I know my perspective on licensure is NOT common or easily understood. I’m afraid of offending dear friends and past co-workers; I’m afraid of the possibility that my attempts to explain my thought processes (slowly developed over years and hundreds of hours in conversation and birth attendance) might have have erected walls rather than built bridges. I know my power to share and explain has limits, just as I know that my perspective here isn’t finished developing. So please hear me as I say thank you for bearing with me in reading this blog post, an attempt to challenge myself to put my soup-of-thoughts into words and courageously invite you to listen to my controversial perspective. If what I have shared here is new and confusing to you, let’s talk. These ideas are hard to condense into writing (though each time I try to articulate them I will get better and better at it; gotta start somewhere today). I’d love to share my thoughts and my heart more clearly, and the easiest way to do that is in a real conversation, in response to your questions and thoughts. 

One year down. So much learned already; what an incredible blessing.