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It’s been a few weeks since my last birth. The midwife I had built the strongest connection with went back into retirement. Fewer and fewer full-bullied women were waddling into the clinic for pre-natal checks.  It was not looking good for me and the births.

Just as I was beginning to resign to the slowness of Fridays, I walked into the midwifes office to find it empty. The nurse sent me straight upstairs to find the midwife assisting a laboring woman.

At 31 years old, this is Emily’s 6th pregnancy, and 6th child. She arrived at the hospital at 7am already dialed to 8cms. By 9am she was fully open and had received a spinal block.

I entered labor and delivery unit at 9:15am. The midwife said they’d wait to get her to push. I helped her catch up with the paper work.

Emily only came into the clinic for one pre-natal visit. She canceled the rest of her appointments; maybe she couldn’t take the time with 5 other kids to care for.

At 9:30 the midwife decided it was time to have a baby. Myself, the midwife and the nurse entered the delivery room to inform the mother. The nurse re-assembled the bed. Plastic, comfortable-looking stirrups were pulled out. Emily’s feet were placed into them. The bottom of the bed was taken out and the whole apparatus was raised so the midwife could stand between her legs and be at arms level to catch the baby.
 
The midwife suited up in a blue gown and good fitting gloves. She pulled the sterile blue tray of tools closer to her.

Emily sat following all the movements in the room with her eyes. The monitor thudded out the baby’s heartbeat. Emily’s face was empty .

The midwife watched the monitor and the vagina. She told Emily when, how and how long to push.

Under direction, Emily easily pushed out a 7lb 3oz baby girl at 9:37am.

The midwife put pressure on the woman’s belly triggering the uterus to expel the placenta. She investigated for perineum tares, found a little one and sewed it up. Within a minute of the last stitch, she had the mother push the placenta out.

Placing the placenta and some bloodied sheets on the blue tool table, the midwife left the room and I followed her out. The midwife finished up her paperwork, looked over at me and said “our work here is done” signaling it was time to go back down to the clinic. That was one fast birth!

I couldn’t help but thinking how absent the women seemed in her birth. Her face was relaxed but she never spoke.

Back downstairs the midwife stated that that was one of her easiest births she’d ever attended.

When I asked if Emily was in great pain when she checked into the hospital, the midwife said no and that she probably could have delivered without it. She hadn’t used anything with the other 5 kids.

It was quiet the rest of the day down in the clinic. Hopefully it was quiet and peaceful for the mother and new baby upstairs as well.

baby booties

With two C-sections in a row, I was beginning to wonder if I’d ever see another vaginal birth.

I arrived to shadow the midwife at 9AM yesterday. The midwife had just warned me of a slow morning , when at 9:30AM the office phone rang. The midwife said, “Ok, I’ll be right up”. I put down my writing and followed her upstairs to the maternity unit.

Michelle laid flat on the bed, her mother and partner on either side of her head, holding her hands. Her mamaw (granny), and sister sat in the corner. Michelle’s golden hair framed her quiet face, a sign the epidural was working well.

The midwife checked the mama’s cervix. Fully dilated and the baby was already well on her way down.

There was a rush to roll the new born incubator/monitor and the delivery tools into the room. The midwife put on her sterile blue gown, locking it with a bow tied on the side. She asked Michelle if she’d mind sitting up, and tilted the head of the bed up 45 degrees. The mama bent her knees up and placed her feet flat on the bed about a foot from her butt.

Epidurals take away the pain of the contractions, not the pressure of the baby. This makes it more difficult for laboring women to accurately indentify their contractions 

The midwife stood at the left side of the bed, just below the woman’s waist. She placed her un-gloved left hand on the mama’s lower abdomen, detecting contractions through hardening of the uterus.

Initially the midwife guided the mother to push with contractions. Mama bore down, naturally – a series of short pushes, followed by a break.

As the baby girl’s head became visible at the vaginal lips, everyone’s encouragement increased. The room filled with excitement. The mama’s mom wanted her to push continuously, harder and longer. The assisting nurse told her to push with contractions and pulled her leg up.

The midwife encouraged her to push when she felt like it (as long as she kept barring down). The evidence says that no pushing style is more effective than others. Therefore, as long as the mother is moving the baby down, the style is good.

Michelle pushed with all her might, breathing deeply. Her eyes stayed shut and face scrunched to her nose with each forceful motion.

The vagina and perineum slowly expanded, opening until the widest diameter of the baby’s head crossed the threshold and the head popped right out. A little hand wiggled under the baby’s chin. The midwife told the Michelle to hold off for a moment. Michelle opened her eyes. The midwife reached in and checked for elbow placement. Then asked the mom to resume. Michelle closed her eyes. With one swell push, out came the baby’s pink, squirmy body.

It wasn’t much more than 30 minutes and the baby was delivered. Dad cut the chord. Michelle held the baby at her chest. Ten minutes later, while the baby got cleaned up, when the uterus was ready, mom pushed out the placenta.

Soon as the nurses had Michelle cleaned up, the room was filled with eager family and friends waiting to catch a glimpse of mother and baby.

Before the midwife and I left to return to the clinic downstairs, we stopped by Michelle’s room. The midwife wanted to check her vaginal swelling.

The dad (who during the birth had curiously glanced in my direction a few times) called me over, “Have you seen her yet?”. The 6lb 4oz baby was bundled up in his arms. Her eyes where locked on his big ole round face. He looked down at her, glowing, then over at me and said, “meet Vanessa”.

Frontier2

Greatness can be detected by many subtle factors.

Last week I walked into a presentation at the Frontier Nursing School. I was late and didn’t know where to find the speaker. My best guess was the old barn. I entered the building with light steps. I followed traces of music. Rushing down the stairs, I walked the tightrope between speed and gentile steps. The room was a large and square. White words were projected onto a dark screen. The audience took no notice of my entrance as they caroled on behalf of midwives, women, and children.

I stood in the back of the room, in awe at a speaker of such respect and reputation to bring a room of strangers in unison through song.

Kitty Ernst first arrived in this corner of Kentucky as a nurse studying to become a midwife under Mary Breckinridge. Today, she stands in front of hundreds of nurse midwifery students every year unveiling an entangled history of herself and midwifery in America.

The song closed. There was lightness in the room as Kitty began the story of how she started the Frontier Nursing School’s distance education program for midwifery students. The tales goes, our country needed more midwives, more individuals to sit with women during their pregnancies and labors. FNS had existed for decades at this point, but only a small number of pupils could make is to the corner of Kentucky to be trained. Kitty set her eye on creating a mechanism to train nurses to be midwives across the country.

From a converted chicken coop on her Pennsylvania farm, this accomplished midwife held board meetings, planned curriculum, recruited staff, constructed a clinical setting, handled marketing, and formalized accreditation for a mater’s level nurse midwifery program that could reach men and woman throughout the fifty states.

Paired with trails and tribulations, Kitty filled her staff, enrolled the initial 35 students required and from there the program has exploded. At present the school accommodates over 500 students a year (primarily nurse midwifery, and also other graduate and doctorate level nursing programs). FNS has grand plans to build new facilities to stretch their annual class capacity to 1,000 students.

A true visionary, Kitty is a midwife to the fullest of its definition, “with woman”. No doubt, she is an icon for the women’s health and women’s empowerment movement. Kitty reminds us to trust women’s bodies, to listen to them and to believe them.

Kitty’s voice has a depth and directness that carries a well-deserved authority. Her confidence fills the room. She wraps you in her words. By the end of the story you are equipped with the fuel, the grace, and the inspiration to creatively soar past any obstacle just as she has.

The last story Kitty told that evening was of the first birth she attended.

She had just passed the FNS final exam. At the time, Mary Breckinridge sat by the fire in the big house with 6 diplomas rolled up and tied with a red ribbon in her lap. Ms. Breckinridge would ask each student one question. If you answered it correctly, you passed. Otherwise, you went through the program again.

Kitty received her diploma. That evening, Ms. Breckinridge sent her off to a post at one edge of the county with a few simple words, “Go forth on behalf of women and children”.

Within her first week at the clinic, a husband came to her door for his wife was in labor. Kitty saddled up and rode her horse to the creek. She dismounted at the water’s edge and rode across with the husband up to the bank by their home.

Kitty did what every good midwife does. She found a seat and waited. To still her hands and mind she sat on her fingers. Her shoulders were slowly creeping up to ears. She waited. The pregnant woman paced around the room in her night dress, following the instincts of her body. At one point, Kitty felt the mother’s hands rest on her shoulders. She looked up. As the laboring mother massaged her stress bent muscles, these words passed through her mouth with an Appalachian twang, “Now Ms. Kitty, don’t you worry a thang. Everything gonna be alright”.

To this day, Kitty declares this was one of the best lessons of her life.

The evening session ended where it started, in song. Kitty simply said, “circle up ladies and gentlemen. If I know one thing, there surely isn’t enough laughter and singing in this world”.

Frontier

10000687-stork-1

This turned into a busy week for births. I shadowing a midwife on Friday and another woman was admitted for labor. From the moment I saw her, I knew this would be a very different birth.

Her visit to the midwives late in pregnancy were frequent, lots of false labor. She arrived that morning, just barely in labor and already looking miserable.

I shadowed until about 4pm. When I was about to leave for the day, I went up to ask the pregnant woman if I could observe her birth. She agreed. She’d been in bed all day the baby was having “D-cells”. When the baby’s heart rate drops and then goes back to normal. She was a heavy smoker and had traces of opiates in her urine that day (she was not in the drug treatment program).

I left for dinner and came back around 7pm. When I arrived she was about 4 centimeters and getting an epidural, but she could still feel a lot of pain. I asked the midwife how well the epidurals work, she said that in the past she had seen a 90% effective rate. Here in Hyden, it was closer to 50%. And that maybe the lower rate is due to patients previous use of drugs, blocking the effectiveness of this drug. The woman cried and moaned for hours. With the epidural she is unable to move from the bed, unable to do anything physical to cope with her pain.

The midwife gave her pitocin to increase her contractions. She started making changes or progress. In an hour she was at 5 centimeters. Thirty minutes later she was close to 6, with the inclination to push. If the woman pushes before the cervix is fully open, the cervix swells and the possibility of a vaginal birth is delayed or eliminated. They turned the pitocin down. This whole time she wept and wailed. For much of the time I stayed by her side, encouraging her to breath, telling her it would be ok. Nothing really seemed to calm her down. Her mother and partner were in and out of the room. Trading off providing support and taking smoke breaks.

For hours the midwife went back and forth with the pitocin, trying to promote progress, then turning it down. From the nurses stand the woman cries were loud and clear. She continued to groan and whimper. This process lasted almost 5 hours. After her cervix had not changed from 6 centimeters for over 2 hours and they had given her all the drugs they could offer, the midwife called the OB to come in and consult. The midwife wanted the doctor to come on sight so she could turn up the pitocin again. She knew the baby was small and the mother should have no problem with a vaginal birth.

The OB did not answer his pager or phone, which is very out of character for this physician.  The hospital night manager drove to the doctor’s apartment to wake him and get him over the hospital.

At 2:30AM, the doctor arrived, consulted, and sent everyone downstairs for a Cesarean Section (C-Section). I put on scrubs and followed the crew into the Operating Room. I had been in the OR before, but nothing I have seen compared to this type of surgery.

The anasthesialogist gave her a spinal block. I watched him act with precision as he pushed multiple needs into the middle of her back. Spinal fluid light rolled out of the hole he poked into the column.

They covered her in a blue sheet with a clear plastic square over her belly. Her partner sat beside her. Neither could see the operation.

I stood at the end of the bed. The doctor worked with incredible speed and accuracy. First he made a long incision above her pubic line and proceeded to reach in with both hands and PULL her skin and muscle/tissue layers apart. Once he located the uterus, he cut the bottom of is and reached into her, and pulled out the baby. All these steps occurred in a couple minutes. The doctor used a baster to get the liquid out of the baby’s mouth, cut the chord, and briskly handed the baby to a nurse. The nurse left the room to clean and evaluate the baby. At this point the doctor pulled the uterus out of the body, ripped the placenta out, and began sewing the uterus back together. The uterus was thick and purple and the size of an extra large grapefruit. I started to feel a little queasy with all the rough movements and abrupt request for metal instruments (never has this happened to me before, I’m generally great with blood and guts). I stepped out of the room (trying to avoid the embarrassment of passing out) to take a look at the new-born girl.  I watched the doctor sew the tissue back together and staple the skin on the stomach through a window.

And people wonder why surgery resolves in such a painful recovery. Six weeks of healing while trying to care for a newborn. I recognize that C-sections save lives and often are necessary. I think that everyone who elects to have a C-Section should watch one first. On some level I feel traumatized.

Before we left early that morning, the midwife expressed her disappointment in the doctor not trying for a vaginal birth. She said, “he could have just slept in the call room, while we turned up the pitocin. I just needed him here to monitor”.

This birth was on the complete opposite end of the spectrum from the one I’d seen 2 days before. The midwife told me that once you start with medical interventions, they almost always escalate over the course of labor. That’s what happened here. It seemed the pregnant woman was not interested in taking responsibility or an active role in her labor. She wanted to come to the hospital and be treated. Labor cannot be controlled. When the person cannot fully detect what their body is telling them, I think it is even harder to react to the labor in the best way.

I left the hospital at 3:30 that morning still nauseated and a little confused. What I saw did not even seem like a birth. It was a procedure. 

(written Wednesday, June 4th. it's a well-described birth story, skip it if it's not up your ally)

Pregnant-drawing

Everyday I get a little clearer sense what the life of a nurse midwife looks like. Today I opened an entirely new door, the exhaustion of laboring. Yesterday I attended my first birth.  Today I can feel it.

On some levels I feel there was some fate in it, well fate and luck. I showed up at the wrong clinic and ended up shadowing a different midwife than I’d been scheduled with.

As I was walking into the hospital clinic I saw a woman who had agreed to allow me at her birth, sitting outside, cigarette in hand, hair recently washed and done. It didn’t take a looser looking belly to know the deed had been done. I approached her to see a new whiteness in the irises and an exhaustion laid heavy in the pupils of her eyes. The baby came out the previous night and she was doing well.

Inside the Labor and Delivery Ward another mother, Eve, who I had seen on a couple of pre-natal visits in the clinic was in the initial stages of labor. The midwife suggested I visit her and ask if I could attend her birth. First thing in the morning, I opened the door, to see this young, beautiful woman laid flat on a hospital bed breathing with great concentration. She was holding on to the bars on the sides of the bed, bracing herself. Long brown curls (which are a rarity around these parts) fell onto either side of her chest. I asked if I could be at the birth, she said “everyone else will be here I don’t see why not” and gave me a sweet, teasing smile.

As soon as the midwife told Eve it was better not to stay in the bed, she was up and around the majority of the day. When I left the building for lunch she was lapping the hospital parking lot stopping to lean on your partner during contractions. When I left for dinner, Eve, in hospital gown and bright red corduroy, velour paints, was seated on a bench in front of the hospital surrounded by what seemed to be an entire family.

The midwife told me that Eve wanted to go through labor without any drugs. Many of the pregnant women in this midwifery practice had been recreational drug users. Most pregnant drug users cannot get pre-natal care or any help getting off the pills. This clinic runs a program that puts these women on Suboxin, an opiate blocker, to help them stay clean through the pregnancy (and hopefully permanently). They also monitor the babies very closely.

Eve was one of these women. When she first came to the clinic the midwives weren’t sure she’d make it through the program. All sorts of terrible things happened to her during pregnancy – her car was broken into, she was assaulted, her car broke down, she got kicked out of her apartment. The whole time she stayed clean and followed the rules of the program. I can’t help but think that her ability to stay off drugs through all this was inspiration and motivation to go through labor without medical intervention.

The midwife was committed to helping her succeed. She said we’d stay in the room as much as possible to help Eve stay calm and on track.

After dinner Eve’s labor picked up, the contractions were stronger and closer together. Her mother, aunt, mother-in-law, and partner were all her hospital room. The first stage of “extremely” active labor lasted for 3-4 hours, in which the contractions are crampy. She mostly sat on the “birthing ball” (blow up exercise ball), rolling her hips around in a circular motion, with her head on bed next to her. She hated laying on the bed, swearing the pain was 10 times worse.  Following the midwives lead, we rubbed her back and whispered encouraging words into her ears: “You’re doing great”, “This contractions is almost over”, “You are so strong”.

Before long she was in transition, which is when the contractions are extremely close together and intense. It pushes the woman to her edge. This period is borderline intolerable. Eve stated she’d never get pregnant again, the she couldn’t do this, that she was dying. Tears rolled down her face. She clenched her partners hand with desperation, her green tipped acrylic nails shaking.

And then it was over. Eve was 10 centimeters, or fully dilated. The contractions calmed down. Eve was still frazzled and scared of what was to come next. She was especially afraid of pushing the baby out, the pain it would bring. The midwife helped her relax. She told her what it would feel like. She explain that an epidural would take away some of the pain, but that it was better for the 1st stage of contractions, which she had already made it through with brilliant courage. The midwife never told her what to do. She gave Eve options, explanations, enough information for Eve to make the decision herself. Eve chose to keep going without medication.

In Stage Two of labor the contractions shift from cramping to pressure. It was 2-3 hours of pushing before the baby came out.  Eve started on the ball and moved to a hands and knees position on the bed. We were all around her, cheering her on through massage, kind words, holding her up, giving her necks to grasp around and hands to squeeze. First she pushed the membranes out. The midwife suggested she rotate onto her back.  At this point, the midwife put her sterile gown and gloves on and rolled the table of delivery equipment into the room Her intact water sack was at the lips of her vagina. The midwife broke it with a tool similar to a plastic crochet needle. The baby’s head crowned, hints of its black hair peaking through.

Eve breathed the baby out into the world. With each exhale the head moved 2 steps forward, and with each inhale the head returned to the womb 1 step. Slowly, with great control, over the course of 4 contractions a child emerged from the vagina. Once the head was fully out, the body followed in one smooth, goop-covered, movement, like coming down a slide. It was 11:45pm, just moments before the next day. Within seconds the room was in tears. The midwife worked with calmness and precision, smiling assurance into the room. As she bulbed liquid from the babies mouth, he made his introduction to this room with strong stream of urine up into the air. The purple and white candy-canned umbilical chord reached from mom’s vagina to the baby’s belly. Still connected, the midwife handed the tiny purplish boy to his mother. Extending her arms forwarded, with a look of surprise and uncertainty, she reached for him, bringing him to her chest. For a few moments they were joined in two incredibly profound connections.

The midwife handed the father the scissors and clamped the umbilical chord in two places. Dad cut between them.

 The final step of labor is delivering the placenta. With one push, Eve urged the purple-red mass out of her body. The midwife laid it out on the table and showed the mother her healthy placenta.

The mother’s body quivered from the loads of lactic acid built up in her body.  The nurses checked the baby with the dad looking over their shoulders. A fine little boy. Before I left for in the early morning, Eve and the baby were practicing breastfeeding. A perfect culminated to long sought union.

I’ve looked forward to my first birth for some time now. It was the ideal delivery for me to participate in – all natural, vaginal. I saw the stages of labor clearly over the course of the day. I experienced the power of a birth in the company of loved ones. I observed a midwife work in her ideal conditions. I had expected to be most blown away from by the moment the baby emerges from the vagina, into the world. Although I shed a tear or two, what impressed me the most were the steps the midwife took to keep the mother clam and fully inform her of all her options. Throughout the birth, the midwife was the mother and child’s advocate.

My alarm went off this morning after 4 hours of sleep. Signs of darkness where still in the air and rain was pouring down making that sound that streams “stay in bed”. Knowing, if I was a midwife I’d have to get up, I hit the snooze button twice and jumped out of bed with no complaints. I structured my crazed curls into a semi-appropriate style and hopped in the car at 7am to head to the elementary school to assist health education lesson. Now I sit, sipping soda to keep my eyes open at the Habitat for Humanity Thrift Store in town. I was planning to start painting the walls. The weight of birth has slowed me. Rocking back in forth, old time mountain music singing over the radio, and rain ringing patterns on the sidewalk, I am grateful.

I can’t remember the last time I heard rain approach. It takes a combination of personal and environmental stillness. This morning I sat on the porch swing in the screened in area outside the Garden House reading the final pages of East of Eden. As I rocked back to the closing ties of Steinbeck’s well-woven story, I began to hear a rush in the distance. At first it was faint enough that I believed I could be imagining it. Soon that thought passed and the noise was closer and louder. With the overcast sky sealing me into the mountains, I thought of rain. I swung quietly tracking the advance, my heavy book resting in my lap. The sound of thousands of water droplets crashing into broad leaves compares to a deep, soft wind. Before I knew it, the rain reached me and I was surrounded. Small bits of moisture fell tapped on the roof above me. I re-engaged my book and sounds of weather moved into the back of my mind.

From all this talk of rain, you’re probably thinking that’s all it does here at Wendover. To be honest, it does feel that way sometimes. In my three weeks on site it’s been just a handful of days without moisture looming in the clouds above. Everyone here says it’s uncommon for this time year and that they’re thankful. As with many spots in the Southeast, drought has been vicious over the last decade or so.

It’s not like back in Mary Breckinridge’s days. Rain or shine, when a baby’s on the way out the only option was to saddle up and hit the trail. Life goes on despite inclement weather. Comparably, we’ve got it easy these days at Frontier Nursing Service (FNS). Wendover’s old buildings are well insulated, equipped with all the modern conveniences and of course there are cars and roads.

I guess I should clarify before I continue. Wendover is to the town of Hyden as a suburb would be to a city or large town. It’s an area, but it’s own entity. Wendover is about 2-5 miles of Hyden. There’s a small “corner store” (they sell bread and milk) here, but no gas station, pharmacy, parks, etc. FNS was started in Wendover back in the early 1900’s. When I refer to Wendover I’m talking about FNS’s compound up on the hill.

Wendover is primarily comprised of 3 buildings: the Big House the Garden House, and the Barn. The Big House is a two story log cabin that Mary Breckinridge and the nurse midwives originally lived in. The Garden House was for administrative purposes and courier housing. The Barn – home of the horses.

Now the Big House is a Bed & Breakfast and houses a commercial kitchen - where we take and make all our meals. The Garden House remains much the same: the bottom floor is laundry and storage, the middle floor is administrative offices, the top is dormitory style housing (pretty nice ones – individual rooms with wooden floors). The Barn accommodates extra B & B guests, the gift shop and some Breckinridge artifacts.

Scattered across the hillside are random single room enclosures that served larger purposes when this place was not only packed with people but also horses, livestock, chickens, garden produce and compost.  

Now its remains quiet and scenic, especially on the weekends and holidays when the staff doesn’t come in and there are no guests.

Memorial Day Monday at Wendover is the perfect time and place to celebrate freedom by observing weather patterns, re-reading favorite books, compiling cover letters, and roasting cauliflower.

Tomorrow will be my second day shadowing one of the midwives at the hospital.

I am slowly rapping my head around women’s health and fetal heart beats…

Tonight the fog hung low between the mountains. Going on two weeks in Southeast Kentucky I'm beginning to pick up on a pattern. If there's a break after it rains (even if the water pours again in a few minutes time) the fog falls into the valleys. The moisture hangs, held by the hills. It sits silently, peacefully, dangling until it disappears.

The landscape here is worthy of many passages. I'll try to keep it short this time; I'm sure it's bound to become a recurring theme. It's a wet, warm, moist version of the Colorado mountains that were my home for so many years. The soil is rich and dark. The ground wears a constant coat of green. Water curls around every mountainside. The sky sits high atop the peaks and out of reach of human hands. There are only mountains and valleys. You're either on top of the world or tucked right into it.

I'm here in Leslie County, KY as a "courier" with the Frontier Nursing Service (FNS). FNS was founded in 1925 by Mary Breckenridge as a commitment to the health under-served woman and children in the forgotten, out of reach corners of Appalachia. She studied nurse midwifery abroad and recruited fellow practitioners to tend to the medical needs of the community. The nurses rode out at all times of day and night on horses. With their medical equipment nessled in saddle bags, they forged rivers and raced through tight woods to deliver babies and treat illness.  At the time, Leslie County had one of the highest infant mortality rates in the country. This ratio was dramatically altered in less than 10 years. 

In the 1940's M.B. started the first Nurse Midwifery School in the U.S.

Originally couriers' primary responsibility was to care for the horses - feeding, brushing, shoveling up after them - along with other odds and ends around Wendover. The preface of the program is for young women (and now men) to come experience rural America and rural health care and instill a sense of service and community.

Here I am living at Wendover - M.B.'s original home and administrative site. It's a handful of small buildings from the 1920's on the side of a mountain across a one lane (pot-holed) road from the Middle Fork of the Kentucky River.

Today couriers split there time between community outreach (teaching in the schools, Habitat for Humanity projects, tutoring at the adult learning center, organizing the library, Hospice supporty, anything and everything that arises) and shadowing local medical professionals (Dr.s, PAs, NPs, RNs, CNM, etc.).

I came to get a taste for midwifery as a profession. After knocking the idea around for years, I decided to genuinely check it out. Not to mention, I do love to get a taste for a new community.

There's the introduction. More to come with frequency.  

The first bell rings at 4:30. Its dark. You can find me in the fetal position curled into my blanket hiding from the cold that crept into the palm-thatched dorm in the early morning hours. My eyes check the clock and return to their familiar shut position. The second bell goes at 4:45. After my minimal morning pep talk, that goes something like "Yana (my Slavic neighbor) is moving towards getting out of bed, maybe I should follow suit", in one fell swoop I straighten my legs, and slide them out from under my baby blue mosquito net. As my feet hit the floor, I sit up. The day has started and there is no turning back.

For the month of February as the western world hibernated from winter's chill with fireplaces, red wine, and down comforters; I took shelter from the intrinsic commotion and perpetual movements of the outside world with discipline, quietude, and a hammock under a mango tree. As I walked off a village street and through the yellow gate of the Meenakashi Ashram I simultaneously recognized that I wasn't quite sure how I got there and was mostly uncertain about what exactly I was doing. That being said I entered this Yoga Teacher Training Course with great comfort and surprising confidence, and when I exited through those iron gates 4 weeks later I carried the same sentiments with even greater intensity.

Ashram life is no different than life anywhere else. You wake up, you do what you've got to do - get out of bed, eat, show up on time (or, sometimes a little late), participate, try your best, learn a new trick, hear a good story, have a laugh or two, and go to bed. The big difference is that all the activities are focuses on encouraging the participant to look for the answers, to search for happiness internally. Whether it be yoga (asanas) to calm and strengthen the body, meditation (dhyana) to tame the beastly mind, chanting (bhakti yoga) to feed to the heart and the fulfill the emotions, service (karma yoga) to appeal to the active nature, or the study of scripture (jnana yoga) to satisfy the intellect and skepticism - each part of yogic life is about attaining bliss through oneself. No small goal. No easy task.

And so the days went. Wake up before the sun, rinse off the night's sweat under a frigid shower, climb into the mandatory yellow and white uniform (yellow for learning and white for purity) and step along the red dirt path, dew dripping onto the top of the head from the leaf tips of banana trees, up to the yoga hall. 

5 am Morning Satsang - 30 minutes of silent meditation, 30 minutes of chanting, 30 of minutes teachings, 1 handful of prasad (blessed food) - is a fine way to start any day.

7am. Yoga/Asana class. The first two weeks we practiced the classes we were learning to teach. The last two in more advanced classes, endearingly termed BBC (bone breaking class) by Maniji, our asana teacher.

9am - Brunch. The dining room is floor seating only. Upon entrance rows of bamboo mats with metal plates in front are laid out. I fall into line next to the person in front of me, crossed legged on the bamboo with a plate decorated in a palate of colorful vegetables and grains, cooked and raw. All meals are taken in silence for a dual purposes (1) speaking while eating tends to distracts us from focusing on the present activity (2) speaking while eating fills the stomach with air and hinders our ability to digest properly. No ashram food is the same (even throughout the Indian Sivananda Ashrams). Lucky for me, there were lots of beets, mung beans, dosas, sambars, fresh fruit, chutneys and sauces in this version of the yogic diet - a delightful rainbow of edible options.

9.45 am - Karma Yoga/Service. Yes, sometimes I was scrubbing the toilet. But let me tell you, ringing the bell all day (that includes, the initial 4.30 am morning bell) sounds much worse to me than a few minutes of whipping away daily grind.

11 am - Chanting or Bhagavad Gita Class. Time to get up close and personal with Sanskrit. A lovely American woman guided us through the songs with her sweet voice and harmonium skills and then into one the essential vedic texts, the 'Gita, with patience for the western cynical mind and a depth of (un-blind) faith that can only be demonstrated through devotion.

1pm - Vedantic Philosophy – the backbone of yoga as it is known both in the east and the west. Vedanta literally translates to "the end of knowledge". These were our precious hours with the main man, the guy in orange, our Swami. Swami Govinda runs the Ashram. He's renounced the world. So, one of his job/hobbies/duties is to explain what all this is about to the loads of folks that pass through his Ashram. Once I master all this business, surely I will be enlightened.

3pm - Yoga/Asana Class (#2) - Practice and Instruction in teaching hatha yoga classes.

5pm - Dinner. The smaller of the two daily meals.

7pm - Evening Satsang - same lineup as above with occasional movies or study nights.

9/9.30 - Light's out. We didn't need much convincing to climb back under our mosquito nets and into the horizontal position. Exhaustion from the day's pilled activities and the looming early morning bell was enough enticement for us to quickly brush our teeth, disrobe our uniforms and find our way into the bliss of sleep.

 Sixty-six of us from all over the world spent 28 days in the fashion mentioned above. At any moment you could hear at least 3 different languages at the dish washing trough. The first week our knees ached from a daily average of 6 hours spent crossed legged on the cement floor, our bodies cried at the adjustment to the intensity of the yoga schedule, and our minds became dazed and confused at the change of life's pace. Before long, the routine normalized and the weeks soared by with a blink, as we maintained a “present-based” mindset. The ups and downs of life continued to exist. One day I'd find myself running to the shelter of the mango tree to release tears who's origins and destinations I could not always uncover, and the next I'd be rocking in the nylon webbed hammock under the shade of the glossy, green leaves sure that I was on the right track towards "true happiness", humming in rhythm with my friends the tropical birds. And then, before I could count the days, I sat at the final puja to the Divine Mother, learned my final yoga pose, sang my last arati, and then Swami handed me my teaching certificate. I'd graduated, the course was over and the ashram was quickly clearing out. I stayed around for a few days, enjoying the peace and quiet of the almost empty ashram.

And then with good posture, an evolving headstand and some new mind taming tools, I strolled out the ashram gate, back into the rush and ramble of the real world, with one task at hand, one prevailing thought, my mother. In two days I’d be in Mumbai, my eyes catching the lovely lady for the first time in 6 months. Yeah!  

Last night I boarded a bus in Pondicherry and after riding through the night in a reclining chair (with foot rest), my stiff back de-boarded to explore Madurai. This South Indian city is most famous for the Sri Meenakshi Temple Complex. And a prize this 16^th century, 6 hectare maze of colorful intricately carved towers, dark tunnels and thousands of god depictions deserves. I spent my first 3 Madurai hours on temple grounds. The first wondering around with some self-pity over my exhaustion and confused about where exactly all the hoards of Hindu pilgrims were running. The last two were shared with a local begger woman by the central pond eating snacks, reading (me), and taking pictures with Indian tourists. Besides the bloody heat, this Madurai is soaring above my expectations. Locals are playful, it is easy to get around, and a relaxed energy rides in the air.

My visit to Maduria will be quick. This afternoon I move into the Sivananda Ashram (www.sivananda.org) outside of town to embark on 4 weeks of intensive yoga. The schedule is strict. The day starts at 6am and ends with lights out at 10pm. Yesterday I met a women who did a shorter program at the main ashram in Kerala. She said it’s really tough, that they “break you down to build you up” and that she really enjoyed the yogic portions of the program (opposed to the meditation and chanting). After a few months of traveling about, I’m excited to get down with Hatha yoga, chant loud, stretch hard, and find some building blocks to arrange into a yoga foundation. After years of practicing, I am ready to acquire the basic information based on the Gita (the sacred Hindu doctrine), focus on the breath, and give this ashram business a try.  Tomorrow morning, bright and early all this will start.

As for the past month or so. David left me in Goa were I soaked up the sun to work through my transition back into traveling solo.  Sun therapy, I like to call it. This ancient anti-depression process involves many hours on the beach splitting time between ocean swimming, embracing sun rays, and drinking fresh lime soda. Goa is a stream of beaches along India’s western coast. Each beach has its own vibe. (There is one beach that is purely Russian. Even the people who work in the restaurant are Russian and they’ve got their own brothels with ladies from home) I took up in Arambol, a northern beach the Lonely Planet claims to be a dream for travelers. I would rephrase to say “a homecoming for world’s lost hippies and laid back European holidayers”.  A perfect spot for escape, it is a mixed scene. European vacationers blissed out on the beach, the rhythm of the waves massaging their stresses into molecules of sand. While practicing pois (the training version of throwing fire), hippies compare dread lock upkeep tips and take advantage of the substances that clear out their minds. The spiritual searchers come by accident, thinking a few days laid out on a beach chair will aid their quest to quiet the mind. These folks, the active soul enhancers find tucks of new age solutions – the spastic, spiritual Kundalini yoga, the skull cracking Great Freedom, secretive sat songs, and release by dancing to all 5 rhythms. There is a place for everyone and for no one. Maybe it was an issue of armpit hair length – not long or short enough – but even after a week in my beach shack, it was clear this was not the place for me. Although it isn’t my personal paradise, there was much enjoy - a secluded beach a 30 minute hike to the north, morning iyengar yoga classes, fresh salads, a funny mix of people, and a look into the real world of hippies. After 7 days of walking through a burning man scene without the huge public art forms, I met a seasonal Goan hippie/paraglider and heard stories of the “real Goa” in a shared taxi to the bus station.

One bouncy bus ride - most of my time was spent in the air - and Hampi would become my home for the next week. This town is full of ruins (for sightseeing), boulder fields (for scrambling), and reservoirs (for drowning the heat). I went from a beach were I had to work real hard to enjoy myself, to a desert/canyon atmosphere were everything feel into my lap. My first few days were spent nursing the dreaded Delhi Belly on the swinging bed outside my cabana. The view of rice fields and a boulder bound river made 5 meters to the toilet at all times requirement not so bad. After I regained some strength it was all European/Isreali friends, swimming with crocodiles, boulder yoga, monkey’s crawling across my lap, motor bike riding, and temple visiting.

On an afternoon walk back to my room from the Stone Charriot, I happened upon a group of women planting rice. So the rest of the day (my best Hampi hours) were spent knee high in mud, bent over plunging young rice plants into the fertile soil. Two mothers and their 4 daughter plus me equals 6 women squishing around the square plots, filling them with little green plants and occasionally sipping on hot, sweet tea. There was one man around. He was standing in the shade, supervising I guess. 

Once I decided on the yoga course, I had to wish this rocky home of mine a farewell and start the long trip south. Twenty-four hours of straight travel – two trains, 1 bus, and 1 amazing South Indian thali doubled the worth of the trip – brought me to Pondicherry. I spent three days in this mix-matched town. Home to the famed Aurobindo Ashram, French spirits, the ever present Indian madness, generational fisherman, and a rocky sea side, Pondicherry may be the most confusing place I’ve visited yet. Luckily I found my way to an old red beater bike to navigate the half wide, clean, quiet French streets and half scattered, chaotic, classic Indian routes.  Sunrise cruises through the local village and sunsets spent peddling down the beach promenade. I made a sweet Aussie traveler friend, got the digs on Pondicherry life from the lady who waxed my legs, drank real coffee every day, and found the meanest people in India (this is a longer story). Not too bad.

And now, Maduria. I’m off to a world of rules and regulations. Hopefully I won’t turn in Humpty Dumpty, pushed off the wall only to be put back together again. But if so, I expect to be put back together with a firmer glue. For now I am settling into getting educated, relaxing into not having to make any decisions, and pleased to put my bag down for one full month.