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17 parenting wins and the stuff I wish I'd done

1/18/2020

8 Comments

 
by Augustine Colebrook
This article first appeared in the Elephant Journal on January 31, 2018. Read that version here
I am a grandmother and recent empty-nester, and it’s given me the time and space to reflect on this gigantic, twenty-year, “Life 101” course from which I just graduated. I read Kahlil Gibran’s masterpiece, “The Prophet’ when I was a teenager, and remembered the swelling feeling of recognition in my chest reading the chapter on children. When I had my children, I knew they did not belong to me.  I tried to parent them accordingly, and I think I succeeded mostly. ​
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“They come through you but not from you,
And though they are with you, yet they belong not to you.
You may give them your love but not your thoughts.
For they have their own thoughts.
You may house their bodies but not their souls,
For their souls dwell in the house of tomorrow,
which you cannot visit, not even in your dreams.
You may strive to be like them, but seek not to make them like you.
For life goes not backward nor tarries with yesterday.
You are the bows from which your children as living arrows are sent forth.
The archer sees the mark upon the path of the infinite,
and He bends you with His might that His arrows may go swift and far.”​

 Here are my #parentingwins 

1.      I was always just honest with my kids. 
Speaking the truth to anyone takes courage, but to kids it’s a gift that grounds their developing brains in reality.  Also, I always had a reason, and wasn’t just the ‘heavy’ with the rules they had to follow’.  Kids really want and need to know “why”.  I frankly told them when I didn’t have extra money for going out or buying things.  I shared my emotions with them – I believed that it was better to be sad and say so, rather than pretend I was ok (because they would know anyway).  And then maybe they would just be sad when they were sad without trying to hide their real emotions.

2.      I choose to live in community as much as possible. 
Co-housing, community dinners, room-mates, house-mates, live-in nannies, close neighbors, in-laws in the guest room and big family holidays over the years all helped me raise kids in a village and therefore life lessons came repeatedly from many sources.
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3.      I let natural and logical consequences be my secret parenting partner. 
Right from the beginning when they were very little I allowed them to learn from their own choices.  Choose not to wear a coat when it’s cold: you learn that being cold at the playground is no fun, and next time you bring your coat. Throw a fit and refuse to eat dinner: then you go to bed hungry.  Now obviously, compassion also teaches, so I was also the mama that had a blanket to share when they were cold and a bowl of soup at bedtime when they were hungry.  But I tried to always find the balance between compassion and enabling.
4.      I made forward going motion the law of the land.
Playing was more important than work.  A clean floor was good enough in the playroom, organization of toys can be a part of the playtime tomorrow.  The point was to get out the door to the park not dress to impress.  I refused to tarry with shoulda, woulda, coulda language.

​​5.       By de-emphasizing the little things, we had a lot less fights than our peers. 
That old saying, “shoveling snow while it’s still snowing, is like cleaning your house while your kids are young” is true. Day to day, the mess will continue, you can either spend a lot of time clearing sidewalks, or you can just get out and play in the snow!  We played a lot!​
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​6. I never put my babies in baby-jail and never let them ‘cry it out’.
My infants had unrestricted access to me – their first and only home. I tried to meet their needs as soon as they had them because I believed that I was teaching them to trust the world. Slowly, and at their own pace, they transitioned from sleeping on me, to sleeping near me, to in-the-next-bed, to in-the-next-room. Slowly they found their own way confidently in the world. This patient way of introducing the big bad world to my little innocents created a deep well of self-confidence and self-love. I believed that my children’s relationship with me would set the precedent for all future relationships and I wanted it to be loving, mutually respectful, and honoring of each other’s needs. In other words, I treated them how I would have wanted to be treated right from the beginning.  It was exhausting, but worth it.
​7. Horses… just horses.
My kids all suffered various stresses, challenges and bouts of depression navigating adolescence. Horses solved so many of these issues. As a single mother I didn’t have much money to spare – so this access didn’t look like the hunt club scene, but I did find ways to make it a daily part of our lives at one point or another. From volunteering at the local ‘horse therapy group’ to just getting the local show barn head groom’s permission to walk down isles and feed carrots. Where there is a will there is a way. Horse people love to share their knowledge and love of horses and pre-teens are usually willing workers. Also, once some skill has been developed, a partial lease is a real possibility. 
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This means going barn to barn until you find some unused or barely used horse and proposition his owner for you to pay ½ his expenses. This can be as little as $50 a month up to $150, in exchange your kiddo gets access to a horse to brush and clean-up after and ride and love 3 days a week! Even though only one of my daughters got totally bitten by the horse-love bug, we all benefited. Horses (and the work they create) is the ultimate in teaching accountability, patience, and a good work-ethic.

​4-H, pony clubs, and school equestrian teams exist in most parts of the country and can be a great place to start. Bottom line, if you can create regular access to any animal or any daily or weekly outside pursuit - you're #winning!
8.      I made a conscious choice not to use violence to teach my children. 
I used to hold their little hands in mine when they were being aggressive or hitting their peers or siblings and say earnestly, “these hands are for helping, NOT hurting”.   The one time that I involuntarily slapped my rude, disrespectful, screaming, teenage daughter’s face, we talked about it for a month.  It took a lot to forgive myself for hitting my child.
 
9.      I forgave myself regularly.
 I messed up, forgot, lost track of, or downright dropped the ball so many times.  I tried and tried and failed again and again.  And I learned how to be gentle with myself – I believed that I was a newborn parent and then a toddler parent and then a teenage parent and I was gentle and forgiving to me and to them.
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10.      I took breaks. 
This parenting gig is so much more full time than any other experience in life. It didn’t used to be, however; we used to parent in community with others helping with the daily chores of life.  This nuclear, secular family living in a vacuum is unnatural and it’s exhausting.  I took personal days and played hooky and I am better for it.  I also encouraged my kids to take breaks sometimes, not just sick days, but personal days to stay home and bake cookies or go riding horses on the first snow day, or stay under the covers when they were sad.
 
11.      I got divorced (twice). 
When it was clear to me that my household was growing up believing that disrespectful or abusive behavior was the norm, I took a stand.  My kids saw me modeling self-respect and radical self-care their whole lives.  I think they will be better prepared to live a whole, full, and fulfilling life because I took this stand, rather than sticking with a marriage only so they could grow up in a two-parent household.
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​12.  I fed whole foods at home. 
Sure, Halloween candy and chips and cookies crossed the threshold occationally, but almost all the time, my kids only had access to fruits and vegetables, traditional fats, organic meats, etc.  Exposure is ½ the battle with nutrition – they like what they think is normal.  Comfort food is simply the food that feels the most like home.  For some people that’s microwave TV dinners; for my kids, its homemade chicken broth or pot roast.

​13.  I took my kids on vacations that had no agendas. 
Our lives are scheduled enough – they needed to have days of un-ended time to let ideas and inventions bubble up.  They needed to taste freedom and then take a bath in it.  No rules is a good way to live sometimes!

​14.  My kids’ rooms were their private space. 
I decided early on that I didn’t want to be in a battle with house cleaning or doing it for them– so the only rule was; 'keep your stuff in your room'.  Sometimes they decorated and organized and cleaned, and sometimes you couldn’t see their beds or floors for months at a time. I’m pretty sure that this is how the hamster died – again refer to #3.  By allowing them this total sovereignty they quite literally lived with the consequences of their actions or lack of action – and developed personal responsibility and accountability all on their own.
15.  They had the same chore for 6 months at a time. 
Every family comes up with their own method for teaching participation in house maintenance. My method was to assign each kid a job that was theirs for 6 months at a time.  It allowed there to never be a shirking of responsibility or blaming it on the person before, and encouraged development of total responsibility – ownership if you will.
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16.  I kept switching schools till they found something that was both fun and challenging, inspiring and where they felt successful. 
If I hadn’t been a working mother, I probably would have homeschooled.  But instead I let them switch and switch until they found what they loved and thrived in, including letting one and then another go to live with their dad in another state.  I let them be in charge of as much of their own lives as they could handle, because this is the goal, right?  With so many parents experiencing the phenomena of ‘failure to launch’, I wanted to ensure their development was always centered around self-determination.
 
17.  I kept the focus of our lives on how we wanted to feel. 
If we can define how we want to feel, then choices become a lot easier.  Want to feel successful, then get things done.  Want to feel joyful, then hang around joyful people and do the things that bring you joy.  Want to feel responsible, then be responsible for your own life.  This simple exercise will do more to inform their life than anything else – It’s radical and simple.

Ok, some things I wish I had done differently.

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1.      I wish I had set better boundaries around money.  I never set up an allowance or a schedule for when money was available to them, so consequently, I was always being shamed, blamed, or guilted by my teenagers.  Because there was no established limit, they wanted money all the time and it was a struggle frequently

2.      I wish that I had moved overseas with my teenagers.  Teenagers will get into trouble anywhere they are and their very point of living is to experiment and push boundaries, but I really wish that they had also had a giant dose of non-America in their developing perspective. Time overseas at any time in anyone’s life is probably valuable, but for American teenagers prone to entitlement and classism, It just might be life-changing!  Plus it changes the dynamic of rebelling against parents to parents being the only ‘known’ or constant and that shift of focus would have been welcome.

 ​3.      I limited my kids screen time a lot more than the mainstream, but I still wish I had limited it more.  There was no screen time at all until my youngest was 5, but then (partly because of a new husband’s habits) TV, video games, and cell phones moved into their lives.  It is the single most destructive force in America today, if you ask me, and I wish that I had really understood the challenges it would bring.

4.      I talked about sex and birth control often (I work in women’s health care), but I didn’t encourage decisive action until after my 15 yr old daughter got pregnant.  I wish that I had taken my girls for birth control as soon as they hinted at being sexually active and I wish that little bowl of condoms in the front hall was there for all their teenage years.  My granddaughter is a blessing beyond measure and we all love her very much.  I think my daughter feels differently, but I know we would have loved her just as much were she to have arrived 5 years later.  I will always wonder what would have been different for my daughter who didn’t go to college.

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5.      When looking back I really wish I had more grace when they decided to move out.  My kids all at different times launched sooner than I was ready for them to leave.  I wish there was a workshop on how to prepare yourself for the end of daily parenting.  I knew all along that raising strong, independent people was the goal, but then in the end, I wasn’t ready to not be needed any more.

But, what's the point?

​In birth and parenting and life in general, we finally become experts right when that expertise is no longer needed; it’s said that you ‘master’ a subject after 10,000 hours immersed in study. So here I am, graduated from parenting with an unnecessary master’s degree.  I’ll never parent daily again (in this lifetime) and no, grand-parenting is NOT the same, so what exactly was the point of the last 20 years of my life?

This is the question that keeps me up at night.  What was the point of spending all that time and money and energy raising people that don’t even seem to even like me some days and certainly don’t have need of me daily anymore?  Most of my elders tell me that they really don’t appreciate you until they’re 30 years old… gee, that’s reassuring.

I have come to believe that parenting is the most extreme personal growth workshop any of us will ever experience.  It’s the most magical and diabolical collection of joy and heart-ache.  A mystical, shamanic journey into the heart of humanity.  Welcoming a tiny, helpless human into your heart and home starts a odyssey of epic proportions, weaving through a ‘candy land’ of hormones and histories, morals and ethics, physical, spiritual, mental and emotional exhaustion.  The trials in the show ‘survivor’ have nothing on the lived-experience of surviving parenting.  In fact, the challenges little people inflict on their parents, no TV producer could ethically replicate – much of parenting is downright torture. 

But we keep doing it, not just in all of humanity, but many of us have more than one child, and although the way babies are made does ensure a modicum of success; this still doesn’t explain why many of us have devoted huge portions of our lives to parenting.  I know, we don’t all do it for the personal growth.  So why?  Why do so many of us not just sign up for a 20+ year odyssey, but in fact give it all our focus and determination?
​
I believe it’s more than the biological imperative, hormonally driving us to procreate. That may be why some of us GET pregnant, but it doesn’t account for slogging through the next 20 years of painful challenge. 
​Although, Kahil Gibran’s essay on children prepared me to let them go, I failed to fully comprehend the last line of the poem.

 
“Let your bending in the archer's hand be for gladness;
For even as He loves the arrow that flies,
so He loves also the bow that is stable.”​
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To be stable, to be still, to hold space and be flexible -  this is our most precious job.  I have been bent mightily – I am a long slender bow made of willow – and I have been bent nearly in half.  I have sent my arrow children flying on their own paths of freedom, but when I read and memorized this chapter as a teenager, I didn’t have the foresight to read the chapter on giving, and even if I had, I’m not sure I would have understood its meaning.
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"And to the open-handed, the search for one who shall receive is joy greater than giving
And is there aught you would withhold?
All you have shall some day be given;
Therefore give now,
​that the season of giving may be yours and not your inheritors'.”
​Parenting is giving – giving all of ourselves until we are emptied out - carved and hallowed. Some stay here sadly lamenting their emptiness for a life-time, but I – I am glad for it.  I feel completely hollow – ready to be filled with the experiences of the second half of my life. 

Someday I will be emptied again, but right now I am happily gathering experiences like seashells on the beach.  All the sparkly and stripy ones catch my eye. 

All my years of parenting was an exhale of breath, now, I am inhaling life sharply.  The season of giving is over, and it is a celebration not a mourning.  Just as each new seasonal shift is welcomed – I feel ready for this winter spiraling into myself and then the spring that will follow. 
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In the goddess tradition there are 5 life phases – maiden, lover, mother, queen, crone.  Using this imagery, I have donned my crown this year.  I am happily reigning sovereign over my own life for the first time ever!  Were we still living in tribal culture, I would be celebrated and honored for my service. 
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​So, what’s the point of parenting?
To raise strong, confident, independent, conscious individuals – and then to take up your crown and rule as queen. 

We need more queens in this world - powerful women who have suffered and know battle, but who remember to walk with a strong back and soft open heart. Love Warriors who are experts at giving and holding space, but who have the courage to strike out on their own.
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8 Comments

Midwives and the Care of Their Instruments

1/4/2020

1 Comment

 
Disinfection and sterilization of instruments is a crucial point in any midwifery practice. It is the procedure by which health care professionals ensure that all reusable medical devices do not harbor any biological matter before the next use. Sterilization causes biological entities to be killed, removed or deactivated either by physical or chemical means, where as disinfection causes most but not bacterial spors.

DEFINITIONS

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Cleaning:
is the removal of foreign material (e.g., organic material) from objects and is normally accomplished using water with detergents or enzymatic products. If soiled materials dry or bake onto the instruments, the removal process becomes more difficult and the disinfection or sterilization process can become ineffective. Surgical instruments should be presoaked or rinsed to prevent drying of blood and to soften or remove blood from the instruments.
For instrument cleaning, a neutral or near-neutral pH detergent solution is commonly used because such solutions generally provide the best material compatibility profile in addition to good soil removal. If your instruments are not rinsed properly, low pH detergents may break down the protective surface of stainless steel instruments and cause black staining. Likewise, alkaline detergents may leave surface deposits that cause a brown stain and interfere with the smooth operation of the instrument. Rinse your instruments in cool water. Hot water can cause proteinous substances to coagulate. If desired, soak your surgical instruments in cool water with an enzymatic detergent. The detergent helps to dissolve the proteins and break down oils. Then, the instruments may be cleaned by hand or mechanically in a washer or ultrasonic bath
Disinfection:
Disinfection describes a process that eliminates many or all pathogenic microorganisms, except bacterial spores, on inanimate objects. In health-care settings, objects usually are disinfected by liquid chemicals.
Factors that affect the efficacy of both disinfection and sterilization include prior cleaning of the object; organic and inorganic load present; type and level of microbial contamination; concentration of and exposure time to the germicide; physical nature of the object (e.g., crevices, hinges, and lumens); presence of biofilms; temperature and pH of the disinfection process; and in some cases, relative humidity of the sterilization process (e.g., ethylene oxide).
Unlike sterilization, disinfection is not sporicidal. A few disinfectants will kill spores with prolonged exposure times (3–12 hours); these are called chemical sterilants. At similar concentrations but with shorter exposure periods (e.g., 20 minutes for 2% glutaraldehyde), these same disinfectants will kill all microorganisms except large numbers of bacterial spores; they are called high-level disinfectants. Low-level disinfectants can kill most vegetative bacteria, some fungi, and some viruses in a practical period of time (≤10 minutes). Intermediate-level disinfectants might kill mycobacteria, vegetative bacteria, most viruses, and most fungi but do not necessarily kill bacterial spores.
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Sterilization:
Sterilization describes a process that destroys or eliminates all forms of microbial life and is carried out in health-care facilities or home-health providers by physical or chemical methods. Steam under pressure, dry heat, EtO gas, and liquid chemicals are the principal sterilizing agents used. 
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Media of Disinfection
Alcohol
Chlorine and chlorine compounds
Formaldehyde
Glutaraldehyde
Hydrogen peroxide
Iodophors
Ortho-phthalaldehyde (OPA)
Peracetic acid
Phenolics
​Quaternary ammonium compounds

​CATEGORIES OF PATIENT CARE ITEMS AND INSTRUMENTS

1.CRITICAL ITEMS:
Critial items deal with a high risk of infections if contaminated with any biological agents. These items may come in contact with internal tissues and the vascular system, so the sterility of these items is prioritized above all. Because any microbial induction could lead to the transmission of disease, surgical instruments, implants, catheters and probes are examples of this category.

2. SEMICRITICAL ITEMS:
These items have contact with mucous membrane and nonintact skin. Items should be free from all microorganisms, but as they are less critical than the above category, a small number of bacterial spores are permissible. A laryngoscope blade is an example in this category.
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3. NONCRITICAL ITEMS:
Like semicritical items,  these items are in contact with intact skin but not with mucous membrane. As the skin is the most substantial effective barrier to most of the microorganism, so here sterility is not a big issue. Blood pressure cuffs, bedpans, and stethoscopes are some examples of this category.

STERILIZATION TECHNIQUES

DRY HEAT STERILIZATION:
​This technique is best suited for sterilization of surgical, suture and birth instruments. It uses thermal conduction for sterilization.
METHOD:
In this technique, heat is absorbed and passed through layers. First, it is incorporated in the outer layer and then transferred to the next layer. When the temperature reaches its maximum, the particular item is said to be sterilized. Dry heat destroys proteins. Proteins are the essential component of a microorganism’s cell wall, and hence their death occurs after the removal of proteins. It usually takes a longer time than steam sterilization, because moisture penetrates faster than dry heat and causes the death of microorganisms
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​PROCEEDURE:
  • Preheat oven (with internal oven thermometer to verify correct temp)
  • 320’ F for 2 hours OR 340’ F for 1 hour
  • Clean, dry and package metal instruments
  • Place instruments plastic side up, on a towel or paper bag on a cookie sheet or bake stone
  • Set timer for appropriate time based on temp
DISADVANTAGES:
  • High temperature i.e. 160-170 degree Celsius is required.
  • Items such as plastic and rubber cannot be sterilized because of increased temperature requirements.
  • Slow heat penetration- an hour or two of heat- plus cool down time is required.
  • Requires oven and a constant source of electricity.

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STEAM STERILIZATION VIA AUTOCLAVE:
For steam sterilization an autoclave is used. An autoclave is an instrument in which saturated steam is applied under pressure. Destruction of microorganisims occurs by the irreversible denaturation of enzymes and structural proteins. Like dry heat sterilization, it can also penetrate through all the surfaces of the instrument but is not time-consuming. This technique provides complete sterilization in a shorter time period.
PROCEDURE:
  • Fill autoclave with distilled water according to package instructions
  • Clean, dry and package metal instruments
  • Place instruments plastic side up on rack
  • Secure autoclave door according to package instructions
  • Set timer or turn on self-timed autoclave to the appropriate time
  • Be sure to properly vent autoclave before opening
DISADVANTAGES:
  • Moisture retention in package is possible.
  • Only stainless steel and plastic items can be used for this technique.
  • Danger exists when not following autoclave instructions.​​

STEAM STERILIZATION VIA PRESSURE COOKER:
​Pressure Cookers, or pressure canners, are often referred to as portable autoclaves. While this is not entirely true, the pressure cooker can be used to create much of the same effect. Using an immersion only method, pressure cookers are ideal for sturdier instruments and most substrates. While they cannot reach quite the level of pressure and heat that an autoclave can, pressure cookers have proven themselves time and time again as an effective means of sterilization. 
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Because it is not designed to create a vacuum as its first priority, however, it is recommended that you let it vent and build pressure for a bit before starting your timer in order to create complete sterilization.
For more in-depth explanation of the comparisons of different brands please see this thorough study.
PROCEEDURE:
  • Read your pressure cookers instructions
  • Add clean instruments to the proper amount of waterbath
  • Close lid and turn on burner
  • Process instruments  at 15 psi for at least 15 min. This means the temp will be about 121 °C within the cooker.
DISSADVANTAGES:
  • Sterilization time required can vary depending on the amount of liquid the size of the pressure cooker and the altitude 
  • It can be messy and time consumin
  • Danger exists if not following instructions
  • Moisture retention in package is possible.
  • Only stainless steel and plastic items can be used for this technique.

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CHEMICAL STERILIZATION:
If as a result of dry heat or steam heat sterilization the instruments are at risk of being damaged or if the autoclave or oven eclectic source is not available, then the best technique to sterilize the instrument is chemical sterilization. Most commonly formaldehyde and glutaraldehyde are used as disinfectants. By using high-level disinfectants, bacterial endospores can be killed if exposed for 10-24 hours. Sterilization usually takes place when you soak the item in 2-4% glutaraldehydes, for at least 24 hours and in 8% formaldehyde for at least 24 hours. Both disinfectants require special handling because the residue may leave after the complete procedure; rinsing with sterile water is essential. 
PROCEEDURE:
  • Purchase chemical items, read package insert carefully to avoid injury or exposure
  • Clean, and dry instruments
  • Place instruments and chemical liquid into container that completely covers all instruments
  • Leave for 24 hours in a safe and secure location
  • Remove just before use using sterile technique
DISADVANTAGES:
  • Skin irritation is possible.
  • Chances of leftover residues.
  • Rinsing with sterile water after soaking requires heat to create sterile water.
  • Glutaraldehyde is expensive.

GAS STERILIZATION:
Ethylene oxide or any other highly volatile substances are the active agents to this technique. Must be mixed with any other inert gas, to reduce highly toxic properties. This technique can only be used when no other method works. The efficiency of this gas depends on the concentration of gas, humidity and time exposure. Because 100% EO is required and it is extremely volatile, this procedure must take place in a vacumn. This is not a viable technique for community-based midwives
DISADVANTAGES:
  • Time-consuming (24-72 hour process).
  • Difficult to control.
  • Highly skilled staff supervision is necessary throughout.
  • Maintaining sufficient humidity during procedures is essential.
  • Expensive equipment necessary
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A NOTE ON BOILING INSTRUMENTS:
Boiling instruments in 100°C water for at least one minute kills 99% microorganisms, except for a few bacterial spores. Boiling does NOT sterilize equipment. This is a disinfection method and may be deemed to be acceptable for cord clamping and cutting implements, but is not recommended for episiotomy scissors or suturing instruments. Pathogenic organisms begin to die off between 60° C and 70°C. To fully disinfect, water must be at a full rolling boil for at least 2 minutes at sea level, 3 min at 6000 ft or above to achieve full disinfection, with instruments submerged the entire time.
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