Saturday, November 26, 2011

Women's Right to Choose

            I'm happy to say that I have completed my last day as a labor and delivery nurse...or so I hope.  As I have spent the last six months working as a labor and delivery nurse while sorting out my future work as a Nurse Midwife, I've come to view the hospital setting with new eyes.  Midwifery school has changed me and in ways I never dreamed it would.  No longer do I enjoy the many tasks nurses do on a daily bases, while getting little thanks for the hard work.  I long for the complete attention I can give to women during their time of change.  However, I feel comforted in knowing that I gave 100% to the few women under my care in the hospital.  While the word "hospital" may give you a feeling of nausea justing saying it, it really is an alternate universe.  A building filled with it's own ethics and personalities to boot.  There is a certain art and finesse about navigating these complex systems in a hospital.
             I've never really realized how much hospital policies dictate how women will be cared for, or even how physicians will practice.  I recently encountered a woman who wished to have a VBAC and because the hospital policies did not support this practice, she had to hold out to the last minute to come in to delivery her baby.  Boy..did this rough up the feathers of the nurses and physicians....Nothing pisses off a doctor or nurse more then a woman who actually has a say in her own care.  It's the illusion that you will get the birth of your dreams...that is...if you do what we tell you...really?..In this particular case, she was an excellent candidate for a VBAC (Vaginal Birth After C-section), but because of the American College of Obstetrics & Gynecology's statement about VBACs a couple years back, hospitals have also changed their policies.  As well as insurance liability coverage for those few physicians still holding out.  So the big question is are VBAC's safe?  I would encourage you to make up your own mind on this...meaning read some literature on the topic.  So what is really behind all this hoopla?  Well..I'm not surprised to learn its money.  Hospitals make more money with c-sections.
             This is where I don't want to confuse you, yes there are some situations where a woman is not a good candidate for a VBAC...please also look up those reasons too.  I'm telling you to look up the information for yourself, because its important you educate yourself on the matter.  If you don't know about your options, it is to easy to be persuaded in one direction.  I'm happy to report this gal got what she wanted, much to everyone else's dislike for her deception.  When I sat down and visited with our manager about this situation, she said she supported VBACs, but didn't like how this gal deceived everyone.  I replied with..what choice did she have?  The hospital makes it's policies and women are forced with guilt and scare tactics to abide by them...and for what?...for control and to make money. It is situations like this one that I am reminded of everyone's motives in the baby biz.  I"m not saying all hospitals are bad and are out to get you, but in certain situations, hospitals are necessary for the safe delivery of babies.  However, the words safe, money, access, and ethics have all been used interchangeable enough that confusion has set in. I say this with the experience of seeing what goes on in a hospital from a nursing perspective and with the knowledge of doing my homework on the matter, and as an advocate for a woman's right to choose where she will give birth, how she will give birth, and what is deemed safe to her.
              I think when it comes to deception, hospitals can be the biggest deceivers in this matter.  You will get what you want only if these conditions are met (A thru Z). The skill of the nurse..is she comfortable with you having no IV, is she comfortable with you walking around, is she comfortable with what she is seeing on the fetal heart monitor?  (Yes, machines are not 100% accurate).  Does the hospital have enough blood products to replace lost blood in a post-partum hemorrhage?  How skilled is your physician with forceps? Do you have a history of post-partum hemorrhage?  How busy is the labor and delivery unit?  Do the nurses have multiple duties other then to care for you?  This will all play into what kind of care you will get?  Your provider will also be thinking of these things when discussing your delivery.  Like I said....alternate universe.
               So what is my angle?...It is this..I will continue to support a woman's right to choose and educate those unknowing individuals working in this alternate universe of complex systems.

Wednesday, November 16, 2011

Passion in the Eye of Feminism

"Woman is the first Environment"  Katsi Cook, Traditional Midwife

          If we are fortunate enough, we get to experience a level of passion for the work we do and have the ability to share it with others.  It would be selfish of me not bring to light those who have worked so feverishly, so that women today could experience a level of "knowing" that has never been experienced before.  For if it wasn't for their passion where would we be today.


    

          Six Nations Aboriginal Midwives

Lesley Paulette, Midwife

Ursula Knoki Wilson, CNM




           These women here are exemplarily examples of passion at it's best.  They turned there vision into a reality and have made a path for us to make our way.  They have all made it their life's work to educate   and be an example of how to weave a beautiful tapestry of cultural practices and modern medicine.  They continue to do this in a positive way filled with integrity and the beauty of our cultural knowledge. I count myself blessed to have been in the presence of each of these women and to have been counseled in a manor that I feel they are all my grandmothers.  Grandmother, does not mean what you think it means.  These women are my grandmothers because they have walked the path I am on, they are knowledgeable and express a level of "knowing" that they are able to share, and they do it with the grace of our ancestral mothers that is hard to find today.  I can only hope to pass on this level of "knowing" to my daughter and Native American midwives who have their own path to walk.
         While attending a conference in Canada, I had the pleasure to meet women from all different parts of the world.  It was here that I realized "midwife" means different things to us all.  It is in our diversity that makes us strong and to have the ability to view life in a different perspective.  It was so empowering to see and meet more indigenous women like myself who are making strides to bring traditional birth practices back to there communities.  It is when I was able to sit and talk with these women, that I felt so honored to have been able to hear their stories. This is what I learned.....If we are able to see beyond our own pain and hurts, we have the ability to make change.  We are never alone in this.  
         

United we stand in the face of diversity to make change for the future...

From our grandmothers...to your granddaughters, we are listening....
           

Thursday, November 10, 2011

Titles And The Work At Hand

             Spent a rather long day being a part of varies conversations surrounding why I became a Certified Nurse Midwife.  I felt like I had to tread lightly in discussing my reasoning, as to not diminish the importance of the work "Midwives" do in general,  despite my educational background versus those who have chosen a different one.  If your a Certified Nurse Midwife or a Licensed Practicing Midwife, or a Direct Entry Midwife, or a Registered Midwife, or a Lay Midwife, or a Certified Professional Midwife...this means you.  So many titles, when really we all "Are With Women" and we've all contributed to the advances in our professions.  This is a very difficult subject for me to discuss with this community of midwives right now.  I've found that my interactions with those who have variations in educational training to be very hostile, when really there should be none.  Attending this conference has been an eye opener for me, because somehow I am being viewed by "others" as being overly educated and medicalized because of my CNM training, and I'm also getting quizzical looks from women of different cultural back grounds because I'm Native American   It is all very disturbing to me...as a woman and individual (minus the educational titles).  Despite the unsettling feeling I get while discussing my Native American views on women's healthcare and what their needs are, I feel like I'm constantly deflecting competency associations with educational training to those other then CNMs.  The minute I start to explain myself...and I shouldn't have to really, because automatically it becomes about why I feel my training should be held in higher regard.  When really, its not even about that nor did I ever say those words.  But some how..they automatically associate that with my CNM training.  This is what really turns me off from midwives who feel they need to "define" midwifery for "everyone" and if you don't fit into this box..your are not worthy to practice midwifery.  The interesting thing is I hear this from CNMs and CPMS, who are so used to defending their roles in women's health to physicians.  Let me tell you...I'm not going to play the game.
           I've always believed quality work will speak for itself and I've known amazing women from tribes and communities who have done amazing work for their communities without the title of MD, CNM, CPM..or PhD.  Which is why I have conflicting feelings sometimes on whether or not I should get my PhD.  Questions I ask myself..Do I need it to accomplish my goals?  What do I want to do with it?  Will it put me at the decision making tables that matter the most to my people?  Will it give me the ability to work autonomously?  Will it in hence my ability to help my tribe and the women in my community?  Education is a tool and allows for me to function in another world, the academic one.  Native Americans have already had to fight an up hill battle to maintain their "identities."  Why not use the education that is available to meet the many needs of our people.  We have the ability to make changes to the standards that have been set up without our input.  Our insight is valuable and needed, because right now the focus is on our "title" rather then focusing all our energy to providing culturally congruent care to women in our communities. Providing care that meets THEIR needs, not ours..
             In order for me to meet the needs of my people I had to get CNM training.  Native American women have many health issues, and when it comes to providing that kind of care, it has had to happen in the hospital.  Traditionally, home birth has selected out for women who are educated and healthy.  That is just the nature of the work, but I want this model of care to be available to Native American women.  I want them to be healthy and take active roles in their own health.  They deserve the option to birth in a birth center, in their home, in a hogan, in a hospital, but in a cultural way that meets THEIR needs.  I am committed to pushing this forward and I will get what ever training necessary to ensure that, that is what they get. Consulting with physicians and having positive collaborative relationships with them or them with us is vital to this process! Because right now... our women deserve more then what they are getting.


             Aside from conversations about educational training, I've also had some amazing conversations with the Six Nations Midwives...and you know what..THEY GET IT! And..they are Aboriginal Midwives..not CNM..not CPM.. They are able to access and use their traditional knowledge and birth practices to create an atmosphere that is un-like no other.  They are able to use traditional herbs for pregnancy, labor, and post-partum.  And no, these herbs can not be bought in a health food store.  They get what birth is about, they get why traditional knowledge needs to be included, and more so...they see it as a sacred ceremonial event that sets a life long foundation for the well being of the mother, baby, and the community.  They see it as a rebirth and realignment with our "Life Ways." Which historically, has been systematically dissected from tribes as a way to obliterate us as people.  I am in awe of these amazing women, as well as filled with gratitude.   They have been open and willing to share their knowledge with me, which is a great gift.  They see my dream for this birth center and I am happy to say, willing to help in anyway they can.  I've been fortunate to be invited back to learn about how they use their herbs, when they collect them, and how to prepare them.  I'm also going to make it a point to learn more about our traditional South West herbs that our healers have used in the past.  I am amazed at their ability to see my dream, but also to be willing to share their healing medicines with me.  For this...I am truly blessed...

                       Six Nations Birth Center, Ohsweken, Ontario

Translation of indigenous language for use in Birth

             All the babies born in 2011...this is one of many walls

Front desk as you enter the birth center ...person is called "House Mother"

Front desk..different view

Birth room 1 & Prenatal visit room

Family Kitchen

Hall Way
Gyn Room 

Front view of Birth Center

Midwife board room

Part of Family Room

Rest of Family Room

Private Counseling room for Couples

Services:  Just a list a few....
Post-partum doula:  who cares for the new mother & father over night, who also will make home visits to educate mom on newborn care, watch the baby so she can shower, and provide support up to 6 months. ( ALL within the traditional teaching of their tribe!)
Nutritionalist: educates new mothers on traditional foods to eat in pregnancy, in labor, and in the post partum period.  They will even go to their home and show them how to cook meals.
Full-scope midwifery care..well woman, menopause, sexual education..etc..

Programs They Offer Their Community
Traditional Medicine Work shops
Traditional Parenting education
Puberty education using traditional knowledge 
Called the Tsi Non:we Ionnakeratstha Ona: grahsta 
Or Degowadihsnye Program...translates.. (She Looks after Them)
Education, Awareness, and supportive services related to Fetal Alcohol Spectrum Disorder (FASD)
                                                         (Will be assessed for alcoholism during pregnancy)
Education on Child nutrition

     Yet, again I find myself in a unique situation, but I also feel blessed to have specific people in my life who have ALL different kinds of knowledge and come from diverse backgrounds.  Because it is from them I've learned the most from.  It is rare to find a community of colleagues and friends who share the same vision and despite what our educational training is, we are able to see our work as a collaborative effort by all of us.  One that requires all of our skills and knowledge.  CPM..MD..CNM..Midwife..Traditional Midwife..Aboriginal midwife....SISTER!....FRIEND!.....MOTHER.........DAUGHTER.......GRANDMOTHER.....no one person does this alone.

Here is to creating a foundation of trust and unity.

Friday, October 28, 2011

Trust and Research in Indian Country

      I don't know what it is about today, but the topic of research seems to keep re-emerging in discussion topics.   As a full blooded Navajo woman, this topic presses my buttons on so many levels.  Which is why I feel the need to discuss it.  Aside from the personal and historical relationship I have with "research," I also have a professional relationship with "research."......I just needed to clarify that with you before hand, because its not a straight road from here.....
       While writing a literature review about barriers to health in Native American women, I found a lot of research data to be outdated by at least 10 to 15 years.  Which made my review difficult, because what I was reading didn't really reflect what was going on today.  For college students interested in reading research about what is going on in Indian Country, you will run into this. So where is all the current research?  It's no secret that there is a "common feeling among many tribal people that research has harmed American Indians and Alaskan Native people."..This is not just a feeling too..


Historic Distrust

  • Termination of government - to - government relationships with many tribes (1950's & 1960's)
  • Relocation to urban areas (1950's-1960's)
  • Sterilization without knowledge or permission (through 1970's)
http://ruralhealth.und.edu/presentations/pdf/041610timeout_gray.pdf

Current Issues
  • Misuse of blood samples taken from tribal members by ASU (tribe told it would be used for a study on the genetics of diabetes..however blood samples were used for studies on schizophrenia, inbreeding, and possible migration patterns of the tribe's ancestors from Asia to America..(2004).
    The history of research in Indian country has not been a positive one....Now here is the kicker.....Why is research even important? With the many health disparities afflicting our tribes, how do we even begin to identify and address these issues, because many healthcare providers and community programs rely on research to justify their work.  If we stick to "all research does harm,"  how are the tribes going to justify community programs that support families and if the research is not current how are the healthcare providers going to know how to guide their practice when providing care in Native American communities?
     At the many conferences I attend, I am always hearing about how we need to shape our care to meet the needs of the population we are caring for...Research??..Anyone..The question then becomes, who does the research, how is the research used, and can we read and understand what the research means?  I can tell you now..you will not find vary many Native Americans doing research...PhD's..etc..I'm not being an educated snob here by saying that, but seriously, you want to be at the tables where decisions are being made that affect your tribe, get educated.  Use it to your advantage...consider it another language...use it so you don't get taken advantage of...
      On that point, tribes are now developing or have developed regulatory policies and institutional structures to regulate research.  Which is a positive thing, because as soverign nations, we should be able to regulate research on our reservations.  Institutional Review Boards, Community Advisory Boards are all types of research committees who decide what type of research is ethical, safe, and will benefit the tribe..and a few other things, but I will let you look those up yourself...Now before you start reading the word "U.S. government formed" and decide to "doubt" the efficacy of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research..remember this is a group of scholars and policy-makers who basically wrote the "Belmont Report" (look it up!)..a set of ethics codes that guides the responsible conduct of research.  Basically..Respect for persons, beneficence, and justice.  It was drafted in 1979.  Federal Law mandates that all research conducted or funded by federal departments and agencies must follow the Protection of Human Subjects, meaning research involving human subjects must be approved and continuously monitored by (IRB's)..yes IHS has one. The down side to the IRB's I just stated, are that it is founded by Universities and community members at large. However, thanks to the Indian Self-Determination and Education Assistance Act of 1975 and Self-Governance, American Indian and Alaskan Native communities have the legal bases for regulating research as it relates to health and social issues.
              Basically, we have the means to develop our own research communities that support how research studies should be conducted.  Enforcing these laws is up to the tribe, but the National Congress of American Indian (NCAI) Policy Research Center (PRC) http://www.nacaiprc.org/ maintains a data base of tribal complaints that allows tribes to share information about "unethical" researcher conduct with other tribes. (Sahota,  Research Regulation in American Indian/Alaska Native Communities: Policy and Practice Considerations )..link:  http://www.ncaiprc.org/files/Research%20Regulation%20in%20AI%20AN%20Communities%20-%20Policy%20and%20Practice.pdf

                My point in all of this is, as a healthcare professional I see the need for research, as a Navajo woman, we have to tread lightly in this area.  Rebuilding trust, mutual respect, and letting tribes be FULL partners in the research is vital.  Assuming that all research is untrustworthy and not taking an educated look at it, so that you can make your own decision as to whether or not it is best practice for yourself...is allowing yourself to be volunerable.  As someone who has chosen to get an education, so that I may use that information to make changes for our tribes, it is extremely frustrating to encounter those who still avoid possible healthy practices to go by the wayside because government is attatched to it, rather then learning how to read research for themselves.  It's even more frustrating to continuesly hear the overabundence of complaints of how government makes these decisions for us.  Get out of your box and do something about it...Put yourself in a place to be heard, be on the committies that make these decisions.  I'm not saying be a politician, rather be an educated advocate.  Which is why there needs to be more Natives going to college and beyond. You have something to offer!
         Yet..Again..another reason why I love midwifery!

NCAI Policy Research Center link:
http://www.ncaiprc.org/research-curriculum-guide
  

Wednesday, October 26, 2011

Our Life Ways


     Recently, I had the pleasure of giving a presentation at the University of New Mexico on integrating traditional healing practices into modern medicine.  I was even more elated to learn that I would be sitting on a panel with Dr. Lori Arviso Alvord, M.D., the first female Navajo surgeon, as well as author of  "The Scalpel and the Silver Bear."  I also had the pleasure of meeting additional panelists Dr. Eliseo "Cheo" Torres, who has written two books on Curanderismo " Mexican Folk Healing."  To say the least, we were a very interesting group of panelists.  I think it is rather an amazing thing when healers from varies cultures can come together to share their traditional knowledge, as well as discuss how it can be integrated into modern medicine.  Why is this amazing?....If you've ever met a medicine man/woman, you will quickly learn that they are very busy people.  I'm not calling myself a traditional healer by any means, for that title takes years of apprenticeships and spiritual calling.  However, to have "scholarly" individuals like ourselves interested in learning and sharing traditional knowledge, as well as integrating it, that is short of a miracle.  I honestly felt truly honored to even be considered "knowledgable" on the level of these other two panelists....and yes I did have Dr. Alvord autograph my copy of her book. I would have had Dr. Torres sign a copy of his book for me as well, but I wasn't aware of his accomplishments before hand, otherwise I would have brought his book with me too!
        Aside from being excited about presenting at this academic star studded event, it really allowed me to take an in-depth look at our Navajo teachings and what they really mean.  I named the title of my presentation "Our Life Ways, " because that is really what they are.  A set of values, teachings, stories, and basic necessities to live.  What struck me the most about these teachings were that they were very basic and made a lot of sense.  I didn't find them in a self help book that showed me how to reach enlightenment, but rather bits and pieces of oral history I had remembered throughout my life.  I also had the pleasure of spending some time in Chinle, AZ, where I got to ask two medicine women about our Life Ways and what they mean.  It has been quite an education and something that has really made me think about everything I do and what knowledge I will pass on to my children.  Most importantly, I had to ask myself ..was I following our "Life Ways?"...and how was I going to integrate this knowledge into my care?
         I think it's important to first acknowledge that Native Americans think differently and to remember that how we experience the world is through our traditional knowledge and teachings.  Part of socially supporting our needs is to first give voice to our Life Ways and accept that it is who we are.  Rather then trying to get us to fit into a medical model of care that is completely detached from our Life Ways efforts need to be made to use that knowledge to reach the positive health outcomes we are all striving for.  Also, to be mindful that our teachings and healing practices have their own timeline.  You can't necessarily take a pill and feel better tomorrow, nor can you learn all there is to know about health in a 20 minute office visit.  
       Here are a few basic Navajo values that I will share with you and I pray that they make you think a little deeper at what you are saying and who you are caring for.

Think and speak in a positive way
Our thoughts and language have the power to shape reality and control events.

Importance of relationships
Awareness & respect for interconnected systems in the universe

Life
All living beings have a natural lifespan, and the cycle of birth, growth, maturation, and decline is essential to the worlds harmony.

  Like I said, these are basic teachings, but filled with so much meaning.  Don't get lost in the science, but rather respect and live by the meaning......
    
Here is a wonderful article that expresses what I mean by speaking and thinking in a positive way..
Setting up Realistic Expectations



                               Who We Are- Dine

Tuesday, October 18, 2011

Strategic Planning

      "Change is disturbing when it is done to us, but exhilarating when it is done by us!"



           I spent most of yesterday in a planning meeting discussing how we were going to build and sustain a comprehensive communty-based midwifery care & birth center.  A place that is accessible, culturally congruent and effective in nurturing family and community health.  Let me tell you...it was an amazing experience.  Imagine 10 to 15 motivated individuals discussing a "vision" and how we are going to get there.  It was a good mix of varies cultural perspectives with past and present philosophies converging on a project that is worth the time and effort.  What I loved most about this planning meeting was everyone's ability to think "outside the box." This kind of motivation and creativity is inspiring, as well as nurturing.  It  was good to know that despite the years of "internalized colonization," that our traditional knowledge and necessity to reinforce "community" was not lost.  We spent most of the day discussing barriers to birth center visions like ours and you would be amazed at what came up in our discussions.  Here is what we came up with...

Vision Wall


Blocking Progress..

1) Inability to hold/respect multiple world views alienates healthy relationships
2) Misogyny denies the divine feminine blocking harmony and spirituality
3) Fragmentation of spirit disconnects us and blocks healing.
4) Healthcare chaos blocks effective collaboration and nurturing care.
5) Culture of violence uses intimidation to block resources, creativity, and love
6) Addiction to consumerism creates insecurity, distracting us from our authentic self, empowerment and  meeting our real needs.
7) Institutional oppression replaces and suppresses critical consciousness.



       Before you begin to think that we are radicalists, let me explain something.  Native Americans in all parts of the country have experienced hardship and organized separation from their cultural knowledge.  Does the concept "Intergenerational Trauma" ring a bell?  I'm not going to go into the history of this,  I think that it's important to read up on our history, because it will help you understand why things are the way they are on our reservations.  From my perspective..alcoholism, sexual abuse, physical abuse, child abuse, depression, suicide, and devaluing of women are all outcomes of these past traumatic events.  I bring this up now, because we see what the issues are.  We want to try to make an effort to provide a space for change and healing.  Again..I realize healing and deciding to change is an individual choice, but it is possible.
      Okay..I'm going to go all out "midwife" here, but there is substantial cultural knowledge and scientific (for those of you who need hard evidence that this does occur), that a woman's emotions during pregnancy effect the fetus.  We are all well aware that what we eat during pregnancy effects the growth in our fetus's, but so does our emotions.  In our "Navajo Way"  we are not to see or say things negative while pregnant, because this will effect our child.  Recently, while attending a conference a physician presented evidence that this does happen. I can post the article's if you like.  My point is, change happens at conception.  I've always thought that each community should have a birth center, because their presences should be a health indicator of the community.  Because, really when things went way ....left field is when birth was taken out of communities.
         Our goal is to bring birth back to communities, while encouraging harmony, healthy relationships, and reinforcing our relationship with the land (which has sustained us despite how we continue to treat it). Indigenous people used to farm this land for food, but this has also gone by the way side.  If you can pull yourself away from the TV, you might notice that more communities are starting community gardens and there are more grants supporting farming projects that encourage teaching youth traditional agricultural practices.
          I think the time for healing and for regaining some of our indigenous "life ways" are returning.  I find myself surrounded by more and more individuals who are motivated and ready to get things going.  Which is why being apart of strategic planning meetings like this one feed my spirit.  I look forward to catching my first baby in this new birth center.



Espanola Valley Women's Health
  

Thursday, October 6, 2011

In Transition

            It seems every step I've taken in this new path, I feel a strong sense of responsibility.  Not only a responsibility to my family, but a responsibility to share my knowledge and experiences with anyone who will listen.  Anyone who knows me, gets a sense of the passion I feel for the work I do and will continue to do.  This strong sense of responsibility stems from the knowledge of knowing that there is a small percentage of Native Americans who pursue an education beyond high school and an even smaller percentage of those that pursue a graduate education.  Why is this important?  Because there are so many issues that tribes all over the world are facing and it seems we are only still trying to dig our way out of the many years of turmoil.  Those who do not understand the many years of infastructual damage that have turned our tribes inside out, really have no clue of why we live the way we live.  I hear all the time.."you natives get free health care," or "you put yourselves here", or "you chose to live this way," or "where is all that money from the casinos?"  Here is a little insight from someone who has grown up in a world where alcohol and physical abuse is the norm, where our healthcare system is struggling to meet the fast growing needs of it's people, and where there is an on going battle in tribes over who is able to receive tribal resources and who is not....and many other issues that you would be surprised to know we are still struggling with.
           Getting a higher education isn't just about getting a better job or making money, or even to show our friends back home that we have become respectable "important" individuals.  Rather, it's an opportunity to educate ourselves so that we can lead our people in a direction of healing.  I realize this may not be the case for every Native pursuing a graduate degree, but in my opinion (as that this is my blog), it should be.  I am always amazed at the work of communities who come together to bring about healing and unity.  My biggest question is "How did you do that?".."How can I do that?"  My reality is knowing that "I" can't do it.  It's has to be the priority for everyone.
           With all of this on my mind, I have to say, I'm very restless.  There is so much work to be done and it has to be done on so many levels.  Part of my restlessness with this is thinking to myself, where do I need to be to make the most impact? Grassroots, returning to school to get a PhD to generate research or getting my PhD in Health Policy and addressing these issues on a legislative/policy level?  I also think to myself..that I don't necessarily have to have a PhD to make these changes, but it would help.  Right now, I'm just trying to align myself with working in a positive working environment with motivated healthcare providers who are just as motivated as I am to providing the best care possible.  Because I'm still new and have MANY things to learn, I am being careful with who I align myself with.  Getting experience is at the top of my list for the next few years, but honestly I am one of those people who has to feel confident in those I'm working with.
             The point being....I am still very much in transition.  I'm exploring many new professional relationships, learning about who can be trusted and who can't, finding a balance between my very "loud" passion for the work I am doing and my important roles as a mother and wife.  Let's just say I'm still putting all the tools in my tool box so that I can tactfully get our issues (Native American) addressed and hopefully educate more communities on these issues. Like I said, I can't tackle these myself, but I can try my best to find innovated ways to get more people involved.  The changes I hope to see, most likely will not happen overnight or even in my lifetime, but any little bit of a change in the right direction is still encouraging.  I feel blessed that midwifery has opened my world up to think about all the factors (social/ethical/spiritual/governmental) that effect us all.
         Which brings me to the reason for starting this blog.  If you've read the "why's " in my last blog, about becoming a midwife, this one is not so much about me, but about all the amazing relationships and information I've been allowed to be apart of.  I've attached all the websites I used during school and still use professionally as a CNM.  One of things I love about midwives is, we are not just about mom's and babies, you can bet we are involved in policy, legislation, business, world health, research, and many more areas I'm still learning about.  My education and training has taught me a lot about these areas and it would be a shame for me not to share it with you.  Most of us are strong willed and committed to doing best by those we care for.  I hope this blog is informative, as well as, a glimpse of what I find so thrilling about what I do.